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季節性流感疫苗

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「流感疫苗」重新導向至此。關於針對H5N1、H7N9等的疫苗，請見「流感疫苗 (消歧義)」。
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季節性流感疫苗
美國海軍人員接種疫苗
臨床資料
商品名（英語：Drug nomenclature）Fluarix、Fluzone、others
AHFS/Drugs.comMonograph
給藥途徑IM、鼻內
ATC碼
法律規範狀態
法律規範
識別資訊
CAS號1704512-59-3
流行性感冒
H1N1 virus
類型
疫苗
治療（英語：Influenza treatment）
大流行
爆發疫情
參見

季節性流感疫苗，簡稱流感疫苗（influenza vaccine，flu shot），為針對流行性感冒（季節性流感）的疫苗。因為流感病毒變化的速度很快，一年會發展新的流感疫苗兩次。大部分狀況下，疫苗有中度到高度的保護力；然而每年情況略有不同。[2][3]對65歲以上的長者，目前證據較缺乏。[4][5]平均來說，他們可以減少半日因病而上班必須請假的狀況。[6]有打疫苗的孩童，可以保護他們周遭的人。[2]

世界衛生組織和美國疾病控制與預防中心都建議幾乎任何大於六個月的人，每年應該施打流感疫苗。[2][7]尤其是孕婦、六個月大至五歲的孩童、有慢性疾病者、美洲原住民、以及醫療相關人員。[2][1]

分類

[編輯]

流感疫苗多分為：（裂解）滅活疫苗（IIV）及裂解亞單位疫苗[8]、減毒活疫苗（LAIV）、重組亞單位疫苗（RIV）[9]。滅活疫苗（含滅活全病毒、滅活裂解、裂解亞單位三個子類[8]）最為常用，又分為三價與四價劑型。

其中，對於流感的滅活疫苗是用滅活劑來處理在雞蛋或細胞培養物中製備的野生型病毒。如果季節性疫苗所包含的病毒在抗原上與最終流行的病毒非常匹配，滅活疫苗通常可以預防一半以上的嚴重流感相關的疾病[10]。然而，這些人群應禁止接種該疫苗[10]

  1. 接種流感疫苗後出現過危及生命的過敏反應
  2. 對疫苗中的任何成分（其中一些含有少量雞蛋蛋白）嚴重過敏的人
  3. 有格林-巴利綜合徵病史的人

疫苗通常每年接種一劑，但 6 個月至 8 歲的兒童在一個流感季節可能需要接種兩劑。

第二種主要流感疫苗是通過鼻腔噴霧局部注射的三價或四價減毒活疫苗。每年都會製備新的疫苗，以解決抗原漂移問題[10]。該疫苗在美國許可用於 2 至 49 歲的人群[10]。

有效性

[編輯]

過去滅活疫苗及減毒疫苗曾產生抗體依賴增強作用使2009年接種季節性甲型H1N1（針對類似A/Brisbane/59/2007的一株）疫苗的人更容易得甲型H1N1pdm09（A/California/7/2009病毒）新型流感。[11]2010年起H1N1株被改為「pandemic系」，2022年為人6B.1a.5a.2系。[12]2011年起開始推廣亞單位疫苗。

年度更新

[編輯]

在每年的季節性流行期間，編碼血凝素和神經氨酸酶蛋白的基因都會發生點突變，而這兩種蛋白是保護性抗體的主要靶標。流行性流感病毒株的這種抗原漂移導致監管官員和生產商每年都要調整流感疫苗中的病毒抗原。偶爾，人類和禽類共同感染的情況下，分割的病毒基因組會重新出現，產生一種新的病毒，也就是抗原轉變，從而導致大流行。1918 年（H1N1）、1957 年（H2N2）、1968 年（H3N2）和 2009 年（新型 H1N1）都發生過全球性的大流行。在這種情況下，必須對疫苗進行重大調整[10]。

以下為北半球每年流感疫苗針對的毒株列表。Starting in the 2012–2013 season, the recommendation shifted from a trivalent influenza vaccine (TIV) containing three strains to a quadrivalent influenza vaccine (QIV) that contains both influenza B lineages.[來源請求]

年度 H1N1甲流 演化支 類似豬H1支[note 1] H3N2甲流 演化支 乙流Victoria株 演化支 乙流山形株
November 1998–April 1999[13] A/Beijing/262/95 (H1N1)-like virus 未譜系 A/Sydney/5/97 (H3N2)-like virus N/A B/Beijing/184/93-like virus
November 1999–April 2000[14] B/Shangdong/7/97-like virus[note 2] B/Beijing/184/93-like virus[note 2]
2000–2001[15] A/New Caledonia/20/99 (H1N1)-like virus A/Moscow/10/99 (H3N2)-like virus N/A B/Beijing/184/93-like virus
2001–2002[16] N/A B/Sichuan/379/99-like virus
2002–2003[17] B/Hong Kong/330/2001-like virus N/A
2003–2004[18] B/Hong Kong/330/2001-like virus N/A
2004–2005[19] A/Fujian/411/2002 (H3N2)-like virus N/A B/Shanghai/361/2002-like virus
2005–2006[20] A/California/7/2004 (H3N2)-like virus N/A B/Shanghai/361/2002-like virus
2006–2007[21] A/Wisconsin/67/2005 (H3N2)-like virus B/Malaysia/2506/2004-like virus N/A
2007–2008[22] A/Solomon Islands/3/2006 (H1N1)-like virus B/Malaysia/2506/2004-like virus N/A
2008–2009[23] A/Brisbane/59/2007 (H1N1)-like virus 1B.2.1[12] A/Brisbane/10/2007 (H3N2)-like virus N/A B/Florida/4/2006-like virus
2009–2010[24] B/Brisbane/60/2008-like virus N/A
2010–2011[25] A/California/7/2009 (H1N1)-like virus (0)[26] 1A.3.3.2[12] A/Perth/16/2009 (H3N2)-like virus N/A
2011–2012[27] A/California/7/2009 (H1N1)-like virus N/A
2012–2013[28] A/California/7/2009 (H1N1)pdm09[note 3]-like virus[29] A/Victoria/361/2011 (H3N2)-like virus B/Wisconsin/1/2010-like virus
2013–2014[30] A/California/7/2009 (H1N1)pdm09[note 3]-like virus A(H3N2) virus antigenically like the cell-propagated prototype virus A/Victoria/361/2011[note 4] B/Massachusetts/2/2012-like virus
2014–2015[31] A/California/7/2009 (H1N1)pdm09[note 3]-like virus A/Texas/50/2012 (H3N2)-like virus[note 5]
2015–2016[32] A/California/7/2009 (H1N1)pdm09[note 3]-like virus A/Switzerland/9715293/2013 (H3N2)-like virus B/Phuket/3073/2013-like virus
2016–2017[33][34] A/California/7/2009 (H1N1)pdm09[note 3]-like virus A/Hong Kong/4801/2014 (H3N2)-like virus 3C.2a
2017–2018[35][36] A/Michigan/45/2015 (H1N1)pdm09[note 3]-like virus[37] 6B.1 不再使用
2018–2019[38][39] A/Michigan/45/2015 (H1N1)pdm09[note 3]-like virus A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus 3C.2a1 B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage)
2019–2020[40][41][42] A/Brisbane/02/2018 (H1N1)pdm09[note 3]-like virus 6B.1A.1 A/Kansas/14/2017 (H3N2)-like virus 3C.3a
2020–2021 egg-based vaccines[43] A/Guangdong-Maonan/SWL1536/2019 (H1N1)pdm09-like virus[note 3] 6B.1A.5a.1 A/Hong Kong/2671/2019 (H3N2)-like virus 3C.2a1b.1b B/Washington/02/2019 (B/Victoria lineage)-like virus V1A.3
2020–2021 cell- or recombinant-based vaccines[43] A/Hawaii/70/2019 (H1N1)pdm09-like virus[note 3] A/Hong Kong/45/2019 (H3N2)-like virus
2021–2022 egg-based vaccines[44] A/Victoria/2570/2019 (H1N1)pdm09-like virus[note 3] 6B.1A.5a.2 A/Cambodia/e0826360/2020 (H3N2)-like virus 3C.2a1b.2a.1
2021–2022 cell- or recombinant-based vaccines[44] A/Wisconsin/588/2019 (H1N1)pdm09-like virus[note 3]
2022–2023 egg-based vaccines[45] A/Victoria/2570/2019 (H1N1)pdm09-like virus A/Darwin/9/2021 (H3N2)-like virus 3C.2a1b.2a.2a B/Austria/1359417/2021 (B/Victoria lineage)-like virus V1A.3a.2
2022–2023 cell- or recombinant-based vaccines[45] A/Wisconsin/588/2019 (H1N1)pdm09-like virus A/Darwin/6/2021 (H3N2)-like virus
2023–2024 egg-based vaccines[46] A/Victoria/4897/2022 (H1N1)pdm09-like virus 6B.1A.5a.2a.1 A/Darwin/9/2021 (H3N2)-like virus
2023–2024 cell- or recombinant-based vaccines[46] A/Wisconsin/67/2022 (H1N1)pdm09-like virus A/Darwin/6/2021 (H3N2)-like virus
  1. ^ 早期針對人類流感病毒進行詳細譜系，僅存在最接近的豬H1流感病毒的HA蛋白譜系，一些最接近人H1N1流感病毒的豬H1流感病毒甚至屬於H1N2型。
  2. ^ 2.0 2.1 The recommendation was for either the B Victoria or the B Yamagata strain.
  3. ^ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 (H1N1)pdm09 is newer nomenclature for the 2009 pandemic H1N1 virus, not a different strain.
  4. ^ It is recommended that A/Texas/50/2012 is used as the A(H3N2) vaccine component because of antigenic changes in earlier A/Victoria/361/2011-like vaccine viruses (such as IVR-165) resulting from adaptation to propagation in eggs.
  5. ^ A/Texas/50/2012 is an A(H3N2) virus that following adaptation to growth in eggs has maintained antigenic properties similar to the majority of recently circulating cell-propagated A(H3N2) viruses including A/Victoria/361/2011

副作用

[編輯]

疫苗大致上是安全的。在兒童，有5-10%會有發燒的反應，也有可能有肌肉痛、疲倦等症狀。在某些年份，疫苗可能在年長者引起格林－巴利綜合徵，機率約百萬分之一。疫苗不應該施打於對蛋嚴重過敏者、或有流感疫苗過敏史者。疫苗有不活化疫苗及減毒疫苗兩種。孕婦應該使用不活化疫苗。在施打類型方面，有肌肉內注射、鼻噴劑、皮內注射等形式。[2]

歷史

[編輯]

對抗流感的疫苗在1930年代開始，一直到1945年開始在美國廣為使用。[47][48]它被列在世界衛生組織基本藥物標準清單，即其建議之對基礎健康照護系統最重要的藥物。[49]在2014年，其批發價約5.25美元。[50]在美國，則是少於25美元。[51]

參考

[編輯]
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