Analysis shouldn't be criticized because of the adverse reaction of vaccination vaccine vaccines useless | | _ the World Health Organization news

(Editor's Note: the original text on June 27, 2013)

Recently "the vaccine war" a set of reports, "vaccine reactions" issue again in public. Report reveals China's vaccination status existed in areas such as technology, refrigerated transport, as well as some problems such as poor management, and even for the very low incidence of "vaccine victims" should also have appropriate assistance mechanisms. Reports of an interview with a group of such intentions, however, during the process of secondary spread, still caused a lot of people raised questions about the safety of vaccination, even when Twitter, triggered the panic of parents, a lot of people think the there is no epidemic, not vaccination safer.

It cannot be denied that vaccination does have risks, of course, a very low risk, however, when discussing immunization safety issues, because ignoring the risk of vaccination of small probability bring enormous health benefits to society as a whole, is likely to cause more serious consequences.

　　Public misunderstanding of vaccines will ultimately miss the public health

In foreign countries, there are several very famous case. In 1974, the United Kingdom reported 36 serious occurred after inoculation of DPT vaccine reactions of the nervous system. TV news report on the issue, the public loss of confidence, leading to vaccination work interruptions, the vaccination rate dropped from 81% to 31%. But with the decline in vaccination rates, the incidence increased to 100 from being closer than 1/100,000/100,000 ~200/10 million, thus forming a whooping cough epidemic.

This is because vaccination was not purely individual choice, immunization rates to reach a certain percentage, to develop population immunity, prevention of infectious disease pandemic. Different diseases, meet the coverage requirements are different, unified China on the free vaccination rate is 90%, which is the integration of the management requirements. So, if there is misunderstanding that vaccinations are not safe, have opted not to vaccinate is likely to cause large epidemics of infectious diseases and serious consequences.

Japan during the same period because of media coverage of DPT vaccine adverse reactions occurred with the United Kingdom almost exactly the same scene: DPT vaccination rates fell from 80% in 1974 to 10% in 1976; 1979 pertussis epidemic occurred over more than 13,000 cases, 41 deaths consequences.

The same event, 1998 United Kingdom authorities published a paper in the Lancet, a medical journal, said Ma Gill wind vaccines can cause autism, reported by the media, many parents refused vaccination for their children the vaccine. 6 years later, United Kingdom Ma Gill wind highest vaccination rates by 92% per cent to 81%. The paper has also spread to other European countries and the United States, triggering a worldwide "vaccine boycott" campaign.

But the United Kingdom Medical Research Council and other institutions to carry out a long-term study, ultimately did not find Gill air link between vaccines and autism. 2010 United Kingdom General Medical Council revoked the qualifications of the author, and also removed the relevant papers in the Lancet. But since its publication, affected countries have accumulated a great deal of measles in unvaccinated susceptible population, measles was imminent. In 2008, the United Kingdom of measles cases more than 1000 cases for the first time in 10 years, United Kingdom epidemic warning is issued. March 2012-February 2013, European economic area countries and Croatia 8499 measles cases were reported, of which United Kingdom report 2314. 8499 measles cases, 6655 (82%) have not been vaccinated, 1045 (13%) only received 1 dose vaccine (regular immunization 2 doses). In children aged 1, ~4, 77% of cases there is no vaccination.

　　"JE vaccination time limit" event

If Europe's example more distant, in China, there are similar things.

Detection of Japanese encephalitis (JE) is a mosquito-borne infectious diseases, high in the summer. However, China has 5 provinces/municipalities have made in summer (July to September) decision to discontinue immunization live attenuated JE vaccine. Reasons for stopping vaccination, ostensibly because the pharmacopoeia there "live attenuated JE vaccine vaccination is not recommended in the popular seasons" articles is, in fact, in order to avoid the incidence of coincidences. Pathogenesis of so-called coincidences, refers to some children vaccinated against je prior to infection, incidence after inoculation of Japanese encephalitis live attenuated vaccine, is thought to be caused by vaccines.

Live attenuated JE vaccine is our independent research and development of vaccines used in other countries in the world are inactivated vaccines. Japanese encephalitis live attenuated vaccine for 24 years, produces more than 300 million doses, the actual vaccination more than 200 million doses, never happened because the vaccine causes encephalitis cases and proven to prevent Japanese encephalitis is effective. The World Health Organization, in its position paper on JE vaccine live attenuated JE vaccine safety and cost-effectiveness given the high praise.

However, due to worries about the coincidence of encephalitis after vaccination, drug approval Department unnecessarily increases in the Pharmacopoeia "vaccination is not recommended in the popular seasons" provisions, departments will make the vaccination stopped in the summer. Final outcome is that supposed season of vaccination to protect children be delayed 3 months before vaccination, and it turns out that 3 months is the highest risk of suffering from Japanese encephalitis season.

　　Would you go there is no vaccine yet?

Because the vaccine adverse reactions, people who think vaccines useless, it may be difficult to imagine before the invention of vaccine world epidemic situation. China has in the past "children had rashes and acne, only Yan Wangkou solutions" argument. "Rash" measles "pit" for smallpox, the effect that, when a child is born, after tests of measles and smallpox, is truly down. Chinese folk this, universally, as borders and race cannot stop the epidemic.

Smallpox is in addition to plague most horrific killers, their terror is: spreads through the air, a highly contagious second fatality rate as high as 30% c survivors of skin left behind a large number of scars, smallpox, hence the name.

It is estimated that in 18th century Europe as many as 150 million people dying of smallpox, 30% CFR concluded that as many as 500 million smallpox-infected. In 18th century, smallpox spread to Australia, killing 50% of the local aborigines. In earlier times, intentionally spread smallpox by European settlers to the Indians of the Americas had no immunity, almost caused the Indians to extinction.

Measles illness is relatively mild (fever, rash, and case fatality rate is less than 1%, leaving no sequelae), but highly contagious, almost everyone will suffer from measles, the highest incidence (5000/100,000) than birth rates. If there were no vaccines, most adult measles infection before.

At that time, measles and smallpox, coupled with the plague, cholera and other infectious diseases in the world, the average human life expectancy is less than 40 years. In an era of uninterrupted fashion horrors of the plague, infectious disease was the number one enemy of human health, even in very significant influences on the course of human history. Any sane people, are unlikely to reproduce the past.

Invented the first vaccine is the vaccine against smallpox. Since 1979, mankind can be divided into two groups: species had Cowpox, and have not tried cowpox. The vaccine was invented in the late 18th century, after more than 200 years of promotion and vaccination, and finally help people control smallpox. In October 1979, the World Health Organization announced smallpox was completely eradicated from the Earth's natural environment, human smallpox eradication, worldwide to stop using vaccination.

To view now, vaccine is not a safe vaccine, not to mention leave huge scars affect the appearance (almost 100% the incidence) if vaccination doses did not have a good, or vaccine liquid accidentally get in other parts of the body, can cause serious infections, some infections are fatal. But relative to the three major terrorist threat of smallpox, Cowpox vaccine these risks are acceptable.

After the measles vaccine has been developed from the 1960 's, on continuous improvement processes and promoting vaccination. Incidence of measles in China from the 50 's of last century's average 5300/100,000 below the current 10/100,000 per cent, down 99.8%, which almost all credit will go to the measles vaccine. Meanwhile, measles vaccine adverse reactions incidence or reporting rates in many types of vaccines are not high. 2010 operational monitoring of measles vaccine adverse event report rate is 15.4/1 million doses, safety in all more than 30 kinds of vaccines after the reduction of polio vaccine, vaccine adverse event reports average rate was 35.6 per 1 million doses.

Conclusion:

Children and their families experiencing adverse vaccine reactions, indeed deserve more attention and aid, but if a small probability of critical vaccines useless vaccine adverse reactions, even refused to be vaccinated, the ultimate result will be that the public is not willing to take the epidemic.

Responsible editor: Wang Hao

Article keywords:
Vaccines World Health Organization

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分析称不该因为有接种不良反应而批判疫苗无用|疫苗|世界卫生组织_新闻资讯

　　（编者注：原文发于2013年6月27日）　　

　　近日“疫苗之殇”一组报道，将“疫苗不良反应”的问题再次呈现在公众面前。报道揭示了中国疫苗接种现状中存在的诸如技术落后、冷藏运输以及落后的管理等一些问题，并指出即使针对发生率极低的“疫苗受害者”也应该有相应的救助机制。然而这样一组采访颇为用心的报道，在二次传播过程中，仍然引发了诸多人对预防接种安全性的怀疑，甚至微博上传播时，引发家长的一致恐慌，很多人认为目前并无疾病流行，不接种疫苗更加安全。

　　不可否认，预防接种确实存在风险，当然风险极低，不过，在讨论预防接种安全问题时，因为小概率的风险就忽视预防接种给整个社会带来的巨大健康收益，很可能会造成更加严重的后果。

　　公众误解疫苗，最终会误了公众健康

　　在国外，有几起非常著名的案例。1974年，英国有报道称接种白百破疫苗后发生36起严重神经系统反应。电视新闻持续报道此事，公众丧失信心，导致接种工作中断，接种率从81%大幅下降到31%。但随着疫苗接种率的下滑，发病率由接近之前 1/10万上升至100/10万～200/10万，从而形成了百日咳的疫情。

　　发生这样的情况，是因为疫苗接种并不是纯粹的个体选择，人群疫苗接种率要达到一定的比率，才会形成人群免疫力，预防传染病的大规模流行。不同疾病，在达到的接种率要求不同，目前我国对免费疫苗的接种率指标统一定为90%，当然这其中也融合了管理要求。所以说，如果人们因为误解认为疫苗接种不安全，都选择不接种疫苗，很可能造成传染病大规模流行的严重后果。

　　日本在同一时期也因为媒体报导白百破疫苗的不良反应而发生了与英国几乎完全相同的一幕:白百破疫苗接种率从1974年的80%下降至1976年的10%；1979年百日咳疫情流行，出现1.3万余病例，41人死亡的后果。

　　同样的事件，1998年英国权威医学杂志《柳叶刀》发表一篇论文，称麻腮风疫苗可能引发自闭症，经媒体报道后，不少家长拒绝为孩子接种该疫苗。6年后，英国麻腮风疫苗接种率由最高时期的92%降至81%。该论文观点还波及欧洲其他一些国家和美国，引发了全球范围的“疫苗抵制”运动。

　　但是英国医学研究委员会等机构开展了长期研究后，最终并未发现麻腮风疫苗与自闭症存在关联。2010年，英国医学总会吊销了该论文作者的行医资格，《柳叶刀》也撤下了相关论文。但自论文发表以来，被波及国家中已经积累了大量未接种疫苗的的麻疹易感人群，麻疹疫情一触即发。2008年，英国麻疹病例10年来首次超过1000例，英国为此发出流行病警告。2012年3月－2013年2月，欧洲经济区国家和克罗地亚共报告8499例麻疹病例，其中英国报告2314例。8499例麻疹病例中，6655例（82%）未接种疫苗、1045例（13%）只接种了1剂次疫苗（常规应该接种2剂次）。1岁～4岁儿童中，77%的病例没有进行疫苗接种。

　　我国“乙脑疫苗接种时间限制”事件

　　如果说欧洲的例子比较遥远，在我国，也有类似的事情。

　　乙型脑炎（乙脑）是一种蚊子传播的传染病，夏季高发。然而，我国有5个省/直辖市做出了在夏季（7月～9月）停止接种乙脑减活疫苗的决定。停止接种的理由，表面上是因为药典里有“乙脑减活疫苗不推荐在流行季节接种”的条款，实质是为了避免巧合发病。所谓巧合发病，是指有些儿童在接种前已经感染乙脑，接种乙脑减活疫苗后发病，被认为是疫苗所致。

　　乙脑减活疫苗是我国独立研发的疫苗，世界上其他国家使用的均是灭活疫苗。乙脑减活疫苗上市24年，产量超过3亿剂次，实际接种超过2亿剂次，从未发生过因为疫苗导致脑炎的案例，且被证明预防乙脑效果显著。世界卫生组织在其乙脑疫苗立场文件中对乙脑减活疫苗的安全性和成本效益给予了极高的评价。

　　然而，由于对接种后巧合脑炎的担心，药品审批部门在药典中毫无必要地增加了“不推荐在流行季节接种”的条款，使用部门亦顺水推舟地对夏季接种疫苗喊停。最终的结局是，本应在流行季节接种乙脑疫苗获得保护的幼儿要推迟3个月才能接种疫苗，而这3个月正好是罹患乙脑的最高危季节。

　　你愿意回到没有疫苗的年代吗？

　　因为疫苗不良反应，就认为疫苗无用的人，可能很难想象在疫苗发明之前世界流行病的情况。中国民间过去有 “孩子出过疹和痘，才算解了阎王扣”的说法。“疹”即麻疹，“痘”为天花，大意是说，孩子出生后，经过麻疹和天花的考验，才算真正成活下来。而中国民间的这个说法，放之四海皆准，因为国界和人种完全无法阻挡当时的传染病。

　　天花是除鼠疫之外最恐怖的人类杀手，其恐怖之处在于：①通过空气传播，传染性极强；②高达30%的病死率；③幸存者的皮肤会遗留大量疤痕，天花也由此得名。

　　据估计，18世纪欧洲死于天花的人多达1.5亿，按30%病死率推断，感染过天花的人数高达5亿。18世纪，天花传到澳大利亚，杀死50%的当地原住民。在更早的时候，天花由欧洲殖民者故意传播给美洲毫无免疫力的印第安人，几乎造成印第安人灭绝。

　　麻疹的病情相对轻微（发热、出疹为主，病死率不超过1%，一般不留后遗症），但传染性极强，几乎每个人都会罹患麻疹，发病率最高（5000/10万）可超过出生率。如果没有疫苗，多数人在成年前就会感染麻疹。

　　当时，麻疹和天花，再加上鼠疫、霍乱等传染病在全球肆虐，人类的平均寿命不到40岁。在那样一个瘟疫不间断流行的恐怖时代，传染病是当时人类健康的头号敌人，甚至说在很大程度上影响着人类历史进程。任何一个精神正常的现代人，都不太可能想重现这样的过去。

　　人类发明的第一个疫苗就是针对天花的牛痘疫苗。从1979年起，人类可以被分成两个群体：种过牛痘者和没种过牛痘者。发明于18世纪末的牛痘疫苗，经过200多年的推广和接种，终于帮助人类成功控制天花。1979年10月，世界卫生组织宣布：天花病毒已从地球的自然环境中被彻底铲除，人类消灭了天花，全球范围内停止普种牛痘。

　　以现在的眼光来看，牛痘疫苗绝非一种安全的疫苗，且不说其留下巨大的疤痕影响美观（几乎100%的发生率）；如果接种时的剂量没掌握好，或是疫苗液不小心弄到身体的其他部位，都可能引发严重的感染，有些感染是致命的。可是相对于天花的三大恐怖威胁，牛痘疫苗的这些风险还是能够接受的。

　　我国从1960年代研制出麻疹疫苗后，就不断改良工艺和推广接种。我国的麻疹发病率也从上世纪50年代的平均5300/10万降至目前的10/10万以下，下降了99.8%，这几乎全部是麻疹疫苗的功劳。同时，麻疹疫苗的不良反应发生率或报告率在众多疫苗种类中并不算高。我国2010年实际监测到的麻疹疫苗不良事件报告率为15.4/100万剂，在所有30多种疫苗中安全性仅次于脊灰减活疫苗，所有疫苗平均的不良事件报告率为35.6/100万剂。

　　结论：

　　发生疫苗接种不良反应的患儿及其家庭，的确应该得到更多关注与救助，但如果因为小概率的疫苗接种不良反应而批判疫苗无用，甚至拒绝接种疫苗，最终的结果很可能是公众更不愿意承受的疫病流行。

责任编辑：王浩成

文章关键词：
疫苗 世界卫生组织

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