菏泽和巨野预防接种异常反应诊断处理小组对.doc

一例联合接种两种疫苗偶合不明病原体颅内感染的调查 马敬仓，贺旭英 菏泽市疾病预防控制中心，274010 摘要 目的 调查某一例联合接种两种疫苗发生不明病原体颅内感染的病例是否属于属于预防接种异常反应病例。方法 对病例开展个案调查，收集资料、汇总分析等，并提出相关诊断结论等。结果 该病例在腮腺炎减毒活疫苗、水痘减毒活疫苗1天后,无明显诱因发病， 主要症状有发热、抽风。先后在市级医院和省级医院住院治疗，主要诊断为重症脑炎，脓毒症，颅内感染和支气管炎；病例血清、脑脊液均未培养、分离出病毒、细菌，相关病毒抗体IgM检测阴性。市级预防接种异常反应调查诊断意见认为，该病例的临床表现与其接种的2种疫苗不存在完整的临床证据链条，现有资料不能证实该病例发生的颅内感染与疫苗有关。结论 病例不属于预防接种异常反应，应判断为偶合症。 关健词 疫苗；病毒；感染；腮腺炎；水痘 A Case Investigation of Two Kinds of vaccination Coupled with Unknown Pathogen Intracranial Infection MA Jing-cang， HE Xuying Heze Center for Disease Control and Prevention,ShanDong,274010 [Abstract] Objective To investigate whether a case of intracranial infection was a case of adverse events following immunization. Methods investigating the case, collecting and analyzing the data ,and issuing the diagnostic reports. Results The case, with live attenuated mumps vaccine vaccination and live attenuated varicella vaccine vaccination history 1 day later, had main symptoms of fever, convulsions, with no obvious inducement. The case had treatment successively in a municipal hospital and a provincial hospital, and the main diagnosis were severe encephalitis, sepsis, intracranial infection and bronchitis; NO virus or bacteria was cultivated and detected in the case抯 specimens and acerebrospinal fluid; No related positive IgM antibody of virus was detected. The opinions of municipal Immunization Survey diagnosis expert group for the diagnosis were that there were no chain evidences between the clinical manifestation and the two kinds of vaccination ,and the clinical data available could not support the relevance between the occurrence of intracranial infection and the Vaccination. Conclusion The case of intracranial infection was not an AEFI case, which could be judged as a coupling case. [KEY WORDS] Vaccine; Virus; infection; Mumps; Varicella 随着我国经济和社会的发展，我国的免疫规划工作深入开展，适龄儿童各类疫苗接种率不断提高。与此同时，预防接种异常反应时有发生，偶合其它疾病的可能性也相应增加。2015年3月-2015年10月间某乡镇预防接种门诊观察到1名女童在接种腮腺炎减毒活疫苗、冻干水痘减毒活疫苗后第二天发生了出现发热、抽风症状，先后在市级和