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冬季流感加上疫症夾擊,「疫苗」一詞成了熱門關鍵字。不少人對新型病毒疫苗持觀望態度。那麼,除了常見的流感疫苗外,還有哪些疫苗是小朋友需要或建議接種,好更全面保障健康的呢?下文聽聽兒科專科朱蔚波醫生一一講解。

為何要接種疫苗?

疫苗主要是將病原體或其代謝物,經過人工處理而製成的自動免疫劑,能激活人體免疫系統並產生抗體,防禦一些由病毒、細菌或其他致病原所引起的傳染病,故接種疫苗到目前為止被認為是最有效預防傳染病的方法。以流感疫苗為例,衞生防護中心指出,流感疫苗對65歲以下人士提供的保護效用可達70%至90%(註1),是預防季節性流感及其併發症的有效方法。

有哪些兒童相關疫苗?

根據政府制訂的「香港兒童免疫接種計劃」,已為本地合資格初生至小學六年級兒童提供多項疫苗免費接種,預防多種常見於嬰兒和兒童的傳染病,包括:結核病、乙型肝炎、破傷風、百日咳、小兒麻痺症、肺炎球菌感染、水痘、麻疹、德國麻疹等(註2)。由2019/20學年起,政府已將HPV子宮頸癌疫苗接種納入此計劃,為就讀小五及小六的女童接種疫苗,以預防子宮頸癌(註3)。家長只要按照母嬰健康院以及子女就讀小學的疫苗接種安排,就能按時接種所需疫苗。

按此下載小冊子了解詳情

除此之外,為更全面保障兒童健康,家長亦可按需要考慮為子女接種其他不在上述接種計劃內的疫苗,包括:

流感疫苗流行性感冒可由多種類型的流感病毒引起。本港的流感高峰期一般是每年一至三月及七至八月,若受感染一般可在2-7天內痊癒,但也有可能出現支氣管炎及肺炎等併發症,嚴重可導致腦炎及死亡。現時政府對6個月至未滿12歲的兒童有資助計劃,每年一次(9歲以下兒童,首次需接受兩劑)(註4)。

輪狀病毒疫苗輪狀病毒是香港常見導致兒童腸胃炎的病毒,亦是全球引致兒童腹瀉的最常見病因之一。3個月至3歲的幼兒是高危患者,若受感染一般可在3-7天內痊癒,但幼童偶然會出現嚴重脫水的情況,病癒後並非終生免疫。供嬰兒使用的口服輪狀病毒疫苗能有效預防此感染。

乙型流感嗜血桿菌疫苗乙型流感嗜血桿菌感染多見於5歲以下兒童,對6至11個月嬰兒的入侵及破壞性特別強。若受感染可導致肺炎、腦膜炎、中耳炎及會厭炎等併發症,甚至出現呼吸困難等病徵。現時已有能有效預防乙型流感嗜血桿菌的疫苗。

甲型肝炎疫苗甲型肝炎主要經腸道傳染,病毒可透過被污染的食水、食物(尤其是貝殼類海產)或與患者接觸而傳染。若受感染可引致發燒、腹瀉、黃疸及急性肝炎,嚴重的更會肝臟衰竭。目前沒有特定藥物醫治甲型肝炎,小童接種甲型肝炎疫苗,能有效產生抗體增加免疫力。

6合1疫苗–採用無細胞混合疫苗把多種疫苗結合在一起(包括白喉、破傷風、百日咳、小兒麻痺、乙型流感嗜血桿菌、乙型肝炎疫苗),能大大減低疫苗注射的次數(一般可減6針),以及減低寶寶注射後出現副作用及不適的機會。一般建議寶寶於6-8星期大時開始注射第一針6合1疫苗。

接種疫苗會有副作用嗎?

不少人都關注接種疫苗後會否產生副作用,其實這視乎個別人士身體狀況而定。一般來說,疫苗的副作用都是輕微和短暫的,並且會在數天內消退。常見的疫苗副作用症狀包括:注射部位發紅、頭痛、肌肉疼痛、發燒等。每種疫苗的副作用都有所不同。但若有持續發燒、不適或出現嚴重過敏反應,就要盡快求醫。此外,若是對疫苗中的蛋白質,或是疫苗製造過程中使用的抗生素過敏的人士,接種任何疫苗前須讓醫療人員知道過敏情況,醫療人員會為疫苗接種再作評估及安排。

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註1:https://www.chp.gov.hk/tc/features/100764.html#FAQ17(常見問題29)
註2:https://www.fhs.gov.hk/tc_chi/main_ser/child_health/ child_health_recommend.html
註3:https://www.chp.gov.hk/tc/features/102146.html
註4:https://www.chp.gov.hk/tc/features/46199.html#10002


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26/Aug/2020

新手父母對BB安排打防疫針最傷腦筋,現時母嬰健康院提供嘅免費疫苗,並冇包括一D高危致命傳染病,例如腦膜炎雙球菌、水痘等。

想以最少嘅疫苗針數為BB提供最全面嘅保護,不如等兒科專科羅婉琪醫生為關心BB健康嘅你逐一解答BB打針嘅迷思啦️:

 


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06/Apr/2020

What is it?

Japanese encephalitis (JE) is a vector-borne zoonotic viral disease. JE virus (JEV) is the leading cause of viral encephalitis in Asia. JE occurs in nearly all Asian countries, whether temperate, subtropical, or tropical, and has intruded into new areas through importation of infected vectors. Currently, an estimated 3 billion people live in the 24 countries, mainly in the WHO South-East Asia and Western Pacific Regions, considered at risk of JE.1

In temperate locations, the period of transmission of JEV typically starts in April or May, and lasts until September or October. In tropical and subtropical areas, transmission exhibits less seasonal variation, or intensifies with the rainy season.20

As JE surveillance is not well established in many countries, and laboratory confirmation is challenging, the true extent and prevalence of the virus and burden of disease are not well understood. It is estimated that 67 900 clinical cases of JE occur annually despite widespread availability of vaccine, with approximately 13 600 to 20 400 deaths, and an overall incidence rate of 1.8/100 000 in the 24 countries with JE risk.1

Mode of transmission

JEV is transmitted through a zoonotic cycle between mosquitoes, pigs and water birds. Humans get accidentally infected when bitten by an infected mosquito and are a dead end host. Humans do not participate in the spread of JE because of low level and short-lived viremia.2

Signs and symptoms3

Symptoms usually start at around 4-14 days after being infected. Mild infections may occur without apparent symptoms other than fever with headache. More severe infection is marked by quick onset of headache, high fever, neck stiffness, impaired mental state, coma, tremors, occasional convulsions (especially in children) and paralysis.

Treatment and complications3

There is no specific treatment for this disease. Supportive therapy is indicated. Death rates may range from 5% to 35%. Patients who survive may have neurological consequences.

Prevention

WHO recommendations: JE vaccination should be integrated into national immunization schedules in all areas where JE is recognized as a public health priority. Even if the number of JE-confirmed cases is low, vaccination should be considered where there is a suitable environment for JEV transmission, i.e. presence of animal reservoirs, ecological conditions supportive of virus transmission, and proximity to other countries or regions with known JEV transmission.1

Besides, to prevent contracting the disease, one should take general measures to prevent mosquito bites, apply effective insect repellents (containing DEET) to exposed parts of the body and avoid going to rural areas from dusk till dawn when the mosquitoes spreading this virus are most active.22

General Measures on Preventing Mosquito-borne Diseases:3

  • Wear loose, light-coloured, long-sleeved tops and trousers, and apply effective insect repellents containing DEET to exposed parts of the body & clothing.
  • Use mosquito screens or bed nets when the room is not air-conditioned.
  • Apply household pesticide to kill adult mosquito with a dosage according to the label instructions. Do not spray the pesticides directly against functioning electrical appliances or flame to avoid explosion.
  • Place mosquito coil or electric mosquito mat / liquid near possible entrance, such as window, to prevent mosquito bites.
  • Prevent the accumulation of stagnant water
  • Put all used cans and bottles into covered dustbins.
  • Change water for plants at least once a week, leaving no water in the saucers underneath flower pots.
  • Cover tightly all water containers, wells and water storage tanks.
  • Ensure air-conditioner drip trays are free of stagnant water.
  • Keep all drains free from blockage.
  • Top up all defective ground surfaces to prevent the accumulation of stagnant water.

 

Reference:

  1. World Health Organization. Japanese encephalitis: WHO position paper. 2015.
  2. Misra UK, Kalita J. Overview: Japanese encephalitis. Prog Neurobiol 2010; 91: 108–120.
  3. Centre for Health Protection. Communicable diseases – Japanese Encephalitis. 2016. doi:http://www.chp.gov.hk/en/content/9/24/28.html.

06/Apr/2020

What is it?

In most countries, meningococcus is recognized as a leading cause of meningitis and fulminant septicaemia. It is classified into 12 serogroups based on the structure of the polysaccharide capsule. The majority of invasive meningococcal infections are caused by organisms expressing one of the serogroup A, B, C, X, W135 or Y capsular polysaccharides.

Neisseria species, which usually reside asymptomatically in the human nasopharynx, are easily transmitted to close contacts by respiratory droplets. Nasopharyngeal carriage of potentially pathogenic N. meningitidis has been reported in 4%–35% of healthy adults.1

Clinical features

Symptoms of invasive meningococcal disease (IMD) usually occur 1–4 days after infection. Signs and symptoms of IMD in infants and young children include fever, poor feeding, irritability, lethargy, nausea, vomiting, diarrhoea, photophobia and convulsions. The characteristic feature of meningococcal septicaemia is a hemorrhagic (petechial or purpuric) rash that does not blanch under pressure. Signs of meningitis in older children and adults include neck rigidity, photophobia and altered mental status, whereas in infants non-specific presentation with fever, poor feeding and lethargy is common. Besides meningitis and septicaemia, meningococci occasionally cause arthritis, myocarditis, pericarditis and endophthalmitis.

Most untreated cases of meningococcal meningitis and or septicaemia are fatal. Even with appropriate care up to 10% of patients die, typically within 24–48 hours of the onset of symptoms. Approximately 10% to 20% of survivors of meningococcal meningitis are left with permanent sequelae such as mental retardation, deafness, epilepsy, or other neurological disorders.

Mode of transmission

The disease is mainly transmitted by direct contact through respiratory secretions from infected persons.

Management

Meningococcal infection is a serious illness. Patients should be treated promptly with antibiotics. Close contacts would need to be placed under medical surveillance for early signs of disease and may be given preventive medications.

Prevention

Maintain good personal and environmental hygiene.

WHO recommendations: In countries where the disease occurs less frequently, meningococcal vaccination is recommended for defined risk groups, such as children and young adults residing in closed communities, e.g. boarding schools. Travellers or overseas students to high-endemic areas should be vaccinated against the prevalent serogroup(s). In addition, meningococcal vaccination should be offered to all individuals suffering from immunodeficiency, including asplenia, terminal complement deficiencies, or advanced HIV infection. Meningococcal vaccines against A, C, W, Y serogroup and vaccine against B serogroup  are now registered in Hong Kong.

 


06/Apr/2020

Hepatitis A is a viral hepatitis caused by the Hepatitis A virus. It is transmitted via intake of contaminated food (e.g. undercooked shellfish) or drinking water. Symptoms include diarrhoea, vomiting, fever and jaundice. Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it causes debilitating symptoms and fulminant hepatitis, which is associated with high fatality rates.

There is no specific treatment for hepatitis A. Therapy is aimed at maintaining comfort and adequate nutritional and fluid balance. Immunization is effective in preventing Hepatitis A infection and is recommended to residents and travelers to endemic regions (e.g. Mainland China, south-east Asia).


06/Apr/2020

Rotavirus damages the cells on the hair-like projections of the small intestine, reducing their ability of absorption, causing diarrhoea. It is the leading cause of severe, dehydrating diarrhoea in children under the age of 5 years globally. Features of the disease include fever, vomiting and watery diarrhoea. The disease lasts for 3-7 days and young children are at particular risk of dehydration.

Rotavirus is highly contagious. It is transmitted via fecal-oral route, through consumption of contaminated food or water, or by contact with contaminated surface. To date there is no drug available as specific treatment to Rotavirus. Supportive treatment, such as intravenous fluids administration to prevent dehydration and antipyretics, are mainstay of treatment. Disease can be prevented by oral vaccines available to infants.

Vaccines are available in 2-dose or 3-dose from. Infants can be vaccinated from 6 weeks of age. Depend on the brand chosen, the schedule need to be completed by 24 weeks or 32 weeks.


06/Apr/2020

Haemophilus influenzae is a bacterium that causes severe invasive infections such as pneumonia, otitis media, acute epiglottitis and meningitis. It may be present in nasopharynx or healthy adults and transmitted to vulnerable persons via respiratory droplet or contact of contaminated surfaces. 90% of invasive Hib disease affect children under the age of 5 years. Getting vaccinated is an effective way to prevent Hib disease.

Hib vaccine is incorporated into national vaccination scheme in various countries/ regions. To date, it is however not yet included in “Hong Kong Childhood Immunization Programme” by Department of Health. Hib vaccine is included in 5-in-1 or 6-in-1 combined vaccines. It is also available as standalone vaccine. Children can get vaccinated in private clinics.


06/Apr/2020

What are the differences between 4-in-1, 5-in-1 and 6-in-1 combined vaccines?

Disease covered

4-in-1 combined
5-in-1 combined
6-in-1 combined

Diphtheria

O

O

O

Tetanus

O

O

O

Pertussis

O

O

O

Polio

O

O

O

Hib

X

O

O

Hepatitis B

X

X

O

10 injections are required to cover all 6 diseases as above in conventional vaccination schedule. Number of injections can be reduced to 4 if 6-in-1 followed by 5-in-1 combined vaccines are used. (Number of injections may differ slightly depending on schedule chosen. Please liaise with medical staff for exact schedule for your child)


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