1 RNA Yellow fever virus, YFV Flaviviridaegenus Flavivirus 2 Aedes Haemagogus sppaedes aegypti WHO revised International Health Regulat

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1 第9章疫苗 Required 黃熱病疫苗與流行性腦脊髓膜炎球菌疫苗 (Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine) 仁濟醫院家庭醫學科作者:洪孜幸台大醫院家庭醫學部大綱作者:詹其峰一前言二黃熱病與疫苗簡介三國際預防接種證明介紹四最新黃熱病疫情及各國黃熱病疫苗要求查詢五各國黃熱病疫情疫苗要求六流行性腦脊髓膜炎球菌疫苗簡介七結語前言目前世界衛生組織實際規定旅遊者必須接種的強制性疫苗 Required or Mandatory Vaccine 只有黃熱病疫苗一項然而沙烏地阿拉伯另規定朝聖者必須接種腦膜炎球菌疫苗本文謹將介紹上述黃熱病與流行性腦脊髓膜炎球菌疫苗以及國際預防接種證明之相關規定第9章.indd /4/2 下午 12:59:55

2 1 RNA Yellow fever virus, YFV Flaviviridaegenus Flavivirus 2 Aedes Haemagogus sppaedes aegypti WHO revised International Health Regulations infected area a risk of yellow fever transmission is present [1,2,4] CDC the Yellow Book 2 191

3 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine 50 / 100, / 100,000 5 / 100,000 1 / 100, % [1]

4 4IgM 6 Aspirin 7 DEET Type Number of doses 0.5ml Booster Contraindications 6 thymoma CD4 T <200/mm3 <15% Percautions CD4 T / mm3 15%~24% Indications for use 9 193

5 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine International Health RegulationsIHR waiver 3. 10%-30% Yellow f ever vaccine associated neurologic disease, YEL-ANDGuillain- Barré Yellow fever vaccine associated viscerotropic disease YEL-AVD 194

6 % neomycin thymoma CD4 T <200/mm3 <15% CD4 T /mm3 15% 24% waiver 1969 IHR, International Health Regulations

7 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine [4]

8 2. www. cdc.gov.tw [1,3] WHO CDC, Centers for Disease Control and Prevention Yellow Book 197

9 疫苗 Required 黃熱病疫苗與流行性腦脊髓膜炎球菌疫苗 (Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine) Step1 CDC ->Traveler s Health Step2 Traveler s Health -> Yellow Book 第9章.indd /4/2 下午 12:59:58

10 Step3 Yellow Book -> Table of Contents Step4 Yellow Book -> Table of Contents ->Chapter 3 Infectious Diseases Related to Travel 第9章.indd /4/2 下午 12:59:59

11 疫苗 Required 黃熱病疫苗與流行性腦脊髓膜炎球菌疫苗 (Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine) 針對黃熱病疫苗接種經過文獻回顧後世界衛生組織 WHO 美國疾病管制局 CDC 與專家學者們共同訂出三種建議模式黃熱病疫苗建議原因建議接種建議所有9個月以上前往該區者應接種疫苗意即該 Recommended 區持續或週期性發生黃熱病病毒流行一般該區黃熱病病毒傳染風險低意即迄今並無人類罹患通常不建議 Generally not recommended 黃熱病病例且活或黃熱病病毒傳播程度低但部分暴露風險較高的旅行者如長期旅遊大量蚊蟲接觸或未能有效防蚊者仍應考慮接種不建議接種該區不具黃熱病病毒傳染風險意即迄今並無黃熱病 Not recommended 病毒活動或環境因素不利黃熱病病毒傳播註 1.資料來源美國疾病控制中心 2012 Yellow Book Update 2013/03 2.黃熱病疫苗不建議年齡未滿9個月的嬰兒接種本表所列僅供現況參考各地區情況仍可能隨時發生變化地圖1 2012年非洲黃熱病流行地區疫苗接種建議 Yellow fever vaccine recommendation in Africa 第9章.indd /4/2 下午 01:00:00

12 資料來源美國疾病控制中心 2012 Yellow Book Update 2013/03 圖2 2012年中美洲黃熱病流行地區疫苗接種建議 Yellow fever vaccine recommendation in the America 第9章.indd /4/2 下午 01:00:00

13 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine [1,3] AFGHANISTAN Requirement ALBANIA Requirement ALGERIA Requirement > AMERICAN SAMOAUS Requirement ANDORRA Requirement ANGOLA Requirement 9 202

14 ANGUILLA U.K. Requirement ANTARCTICA Requirement ANTIQUA AND BARBUDA- Requirement ARGENTINA Requirement 9 <2300Corrientes Berón de Astrada, Capital, General Alvear, General Paz, Itatí, Ituzaingó, Paso de los Libres, San Cosme, San Martín, San Miguel, Santo Tomé Misiones. Iguaçu Falls 2300 Chaco Bermejo Formosa all departments Jujuy Ledesma, San Pedro, Santa Bárbara, Valle Grande Salta Anta, General José de San Martín, Oran, Rivadavia

15 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine ARMENIA Requirement ARUBA Requirement 6 AUSTRALIA Requirement São Tomé and Príncipe, Somalia Tanzania Galápagos Islands in Ecuador Misiones Province in Argentina AUSTRIA Requirement AZERBAIJAN Requirement AZORESPORTUGAL Requirement 204

16 BAHAMAS Requirement > BAHRAIN Requirement BANGLADESH Requirement BARBADOS Requirement Guyana,Trinidad Tobago > BELARUS Requirement BELGIUM Requirement 205

17 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine BELIZE Requirement BENIN Requirement 9 BERMUDA U.K. Requirement BHUTAN Requirement BOLIVIA Requirement 9 <2300 Beni, Pando, Santa Cruz Chuquisaca, Cochabamba, La Paz, Tarija >2300 La Pazc Sucre 206

18 BOSNIA AND HERZEGOVINA Requirement BOSTWANA Requirement > BRAZIL Requirement 9 AcreAmapáAmazonas Distrito Federal Goiás Maranhão Mato GrossoMato Grosso do Sul Minas Gerais Pará RondôniaRoraima TocantinsEspirito Santo PiauiBahiaSão Paulo Paraná Santa Catarina Rio Grande do Sul Iguaçu Falls dados_acre2010_2011_18_10_2011.pdf Area com recomendação de vacina Area sem recomendação de vacina Fortaleza, Recife, Rio de Janeiro, Salvador, São Paulo 207

19 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine BRITISH IINDIAN OCEAN TERRITORY ; includes Diego Garcia U.K. Requirement BRUNEI Requirement > BULGARIA Requirement BURKINA FASO Requirement 9 BURMA see MYANMAR BURUNDI Requirement 9 208

20 COMBODIA Requirement > CAMEROON Requirement 9 CANADA Requirement CANARY ISLANDS SPAIN Requirement CAPE VERDE Requirement CAYMAN ISLAND U.K. Requirement 209

21 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine CENTRAL AFRICAN REPUBLIC Requirement9 9 CHAD Requirement 9 CHILE Requirement CHINA Requirement CHRISTMAS ISLAND AUSTRALIA Requirement São Tomé and Príncipe, Somalia, Tanzania, Galápagos Islands in Ecuador Misiones Province in Argentina 210

22 COCOS ISLANDS AUSTRALIA Requirement São Tomé and Príncipe, Somalia, Tanzania, Galápagos Islands in Ecuador Misiones Province in Argentina COLOMBIA Requirement 9 <2300Corrientes Berón de Astrada, Capital, General Alvear, General Paz, Itatí, Ituzaingó, Paso de los Libr es, San Cosme, San Martín, San Miguel, Santo Tomé Misiones Iguaçu Falls <2300 Chaco Bermejo Formosa all departments Jujuy Ledesma, San Pedro, Santa Bárbara, Valle Grande Salta Anta, General José de San Martín, Oran, Rivadavia 2300 Requirement Magdalena Cordillera OrientalChocoano Antioque Urabá Sierra Nevada de Santa Narta Orinoquia Amazonia COMOROS Requirement 211

23 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine CONGO, REPUBLIC OF THE Requirement 9 COOK ISLANDS NEW ZEALAND Requirement COSTA RICA Requirement Argentina, Panama, Trinidad and Tobago CÔTE D IVOIRE IVORY COAST Requirement 9 CROATIA Requirement CUBA Requirement 212

24 Requirement Requirement CYPRUS CZECH REPUBLIC DEMOCRATIC PEOPLE S REPUBLIC OF KOREA see KOREA, DEMOCRATIC PEOPLE S REPUBLIC OF DEMOCRATIC REPUBLIC OF THE CONGO Requirement 9 Katanga Requirement DENMARK DJIBOUTI Requirement DOMINICA Requirement

25 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine DOMINICAN REPUBLIC Requirement ECUADOR Requirement Andes MountainsMorona-Santiago, Napo, Orellana, Pastaza, Sucumbios, and Zamora-Chinchipe 2300 Andes MountainsEsmeraldas, Guayas, Los Rios, Manabi, and designated areas of Azuay, Bolivar, Canar, Carchi, Chimborazo, Cotopaxi, El Oro, Imbabura, Loja, Pichincha, and Tungurahua 2300 Quito Guayaquil Galapagos Islands EAST TIMOR CHILE Requirement EGYPT Requirement

26 EL SALVADOR Requirement EQUATORIAL GUINEA Requirement 9 ERITREA Requirement Anseba, Debub, Gash Barka, Mae Kel, and Semenawi Keih Bahri. Dahlak Archipelago ETHIOPIA Requirement 9 Afar Somali FALKLAND ISLANDS MALVINAS Requirement 215

27 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine FAROE ISLANDS DENMARK Requirement FIJI Requirement FINLAND Requirement FRENCE Requirement FRENCH GUIANA Requirement FRENCH POLYNESIA Requirement GABON Requirement 9 216

28 GAMBIA, The Requirement 9 GEORGIA Requirement GERMANY Requirement GHANA Requirement9 9 GIBRALTAR U.K. Requirement GREECE Requirement GREENLAND DENMARK Requirement 217

29 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine GRENADA Requirement GUADELOUPEFRANCE Requirement GUAMU.S. Requirement GUATEMALA Requirement GUINEA Requirement 9 GUINEA BISSAU Requirement 9 218

30 GUYANA Requirement Argentina, Paraguay, Suriname, Trinidad and Tobago 9 HAITI Requirement HONDURAS Requirement Panama > HONG KONG SAR CHINA Requirement HUNGARY Requirement ICELAND Requirement 219

31 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine INDIA Requirement WHO 4 WHO 6 Angola, Benin, Burkina Faso, Burundi, Cameroon, Central African Republic, Chad, Congo,Côte d Ivoire, Democratic Republic of the Congo, Equatorial Guinea, Ethiopia, Gabon, Gambia, Ghana, Guinea, Guinea-Bissau, Kenya, Liberia, Mali, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Sudan, Togo, Uganda Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Panama, Peru, Suriname, Trinidad and Tobago, Venezuela. INDONESIA Requirement 9 IRAN, ISLAMIC REPUBLIC OF Requirement 220

32 IRAQ Requirement IRELAND Requirement ISRAEL Requirement ITALY Requirement JAMAICA Requirement JAPAN Requirement JORDAN Requirement 221

33 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine KAZAKHSTAN Requirement KENYA Requirement 9 Kilifi, Kwale, Lamu, Malindi Tanariver Nairobi Mombassa KIRIBATI Requirement KOREA, DEMOCRATIC PEOPLE S REPUBLIC OF, Requirement KOREA, REPUBLIC OF Requirement KUWAIT Requirement 222

34 KYRGYZSTAN Requirement LAO PEOPLE S DEMOCRATIC REPUBLIC Requirement LATVIA Requirement LEBANON Requirement 6 LESOTHO Requirement LIBERIA Requirement 9 223

35 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine LIBYAN Requirement LIECHTENSTEIN Requirement LITHUANIA Requirement LUXEMBOURG Requirement MACAO SAR CHINA Requirement MACEDONIA, THE FORMER YUGOSLAY REPUBLIC OF, Requirement MADAGASCAR Requirement 224

36 MADEIRA ISLANDS PORTUGAL Requirement MALAWI Requirement > MALAYSIA Requirement > MALDIVES Requirement MALI Requirement 9 MALTA Requirement

37 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine MARSHALL ISLANDS Requirement MARTINIQUE FRANCE Requirement MAURITANIA Requirement 9 MAURITIUS Requirement > MAYOTTE FRENCH TERRITORIAL COLLECTIVITY Requirement MEXICO Requirement 226

38 MICRONESIA, FEDERATED STATES OF Requirement MOLDOVA, REPUBLIC OF Requirement MONACO Requirement MONGOLIA Requirement MONTENEGRO Requirement MONTSERRAT U.K. Requirement MOROCCO Requirement 227

39 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine MOZAMBIQUE Requirement MYANMAR FORMERLY BURMA Requirement > NAMIBIA Requirement NAURU Requirement NEPAL Requirement 228

40 NETHERLANDS Requirement MONTSERRAT Requirement NEW CALEDONIA FRANCE Requirement NEW ZEALAND Requirement NICARAQUA Requirement NIGER Requirement 9 229

41 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine NIGERIA Requirement 9 NIUE NEW ZEALAND Requirement 9 NORFOLK ISLAND AUSTRALIA Requirement São Tomé and Príncipe, Somalia, Tanzania, Galápagos Islands in Ecuador Misiones Province in Argentina NORTH KOREA Requirement NORTHERN MARIANA ISLANDS U.S. Requirement NORWAY Requirement 230

42 OMAN Requirement PAKISTAN Requirement 9 > PALAU Requirement PANAMA Requirement 9 Emberá Kuna YalaDarié Colón Panamá San Blas, Balboa PAPUA NEW GUINEA Requirement 231

43 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine PARAQUAY Requirement 9 Asunción PERU Requirement Amazonas, Loreto, Madre de Dios, San Martin, Ucayali Ancash ApurimacAyacucho CajamarcaCusco HuancavelicaHuanuco Junin La LibertadPascoPiura Puno Lambayeque Tumbes Cajamarca Piura 2300Cuzco Lima Machu Picchu Inca Trail PHILIPPINES Requirement PITCAIRN ISLANDS U.K. Requirement 232

44 POLAND Requirement PORTUGAL Requirement PUERTO RICO Requirement QATAR Requirement REUNION France Requirement ROMANIA Requirement RUSSIAN FEDERATION Requirement 233

45 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine RWANDA Requirement 9 SAINT HELENA U.K. Requirement SAINT KITTS AND NEVISU.K. Requirement > SAINT LUCIA Requirement SAINT PIERRE AND MIQUELON France Requirement SAINT VINCENT AND GRENADINES Requirement 234

46 SAMOA Requirement SAN MARINO Requirement SAO TOME AND PRINCIPE Requirement SAUDI ARABIA Requirement SENEGAL Requirement 9 9 SERBIA Requirement 235

47 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine SEYCHELLES Requirement SIERRA LEONE Requirement 9 SINGAPORE Requirement 6 SLOVAKIA Requirement SLOVENIA Requirement SOLOMON ISLANDS Requirement 236

48 SOMALIA Requirement Bakool, Banaadir, Bay, Galguduud, Gedo, Hiiraan, Lower Jubabada, Lower Shabelle, Middle Jubabada, Middle Shabelle SOUTH AFRICA Requirement Eritrea, São Tomé and Príncipe, Somalia, the United Republic of Tanzania, Zambia SOUTH KOREA Requirement SPAIN Requirement SRI LANKA Requirement 237

49 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine SUDAN Requirement 9 SURINAME Requirement 9 SWAZILAND Requirement SWEDEN Requirement SWITZERLAND Requirement SYRIAN ARAB REPUBLIC Requirement 238

50 TAJIKISTAN Requirement TANZANIA, UNITED REPUBLIC OF Requirement Tanzania THAILAND Requirement TIMOR-LESTE Requirement TOGO Requirement 9 TOKELAUNEW ZEALAND Requirement 239

51 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine TONGA Requirement TRINIDAD AND TOBAGO Requirement Trinidad9 Spain Tobago TUNISIA Requirement TURKEY Requirement TURKMENISTAN Requirement TUVALU Requirement 240

52 UGANDA Requirement 9 Requirement Requirement UKRAINE UNITED ARAB EMIRATES UNITED KINDOM WITH CHANNEL ISLANDS AND ISLE OF MAN Requirement UNITEND REPUBLIC OF TANZANIA see TANZANIA, UNITED PREPUBLIC OF Requirement Requirement UNITED STATES OF AMERICA URUGUAY Requirement 241

53 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine UZBEKISTAN Requirement VANUATU Requirement VENEZUELA BOLIVARIAN REPUBLIC OF Requirement 9 Aragua, Carabobo, Miranda, Vargas, Yaracuy Falcón Lara,Zulia Paez Municipality Margarita Caracas Valancia VIET NAM Requirement VIRGIN ISLANDS USA Requirement WAKE ISLAND Requirement 242

54 YEMEN Requirement ZAMBIA Requirement 9 > ZIMBABWE Requirement 243

55 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine Type MPSV4 Number of doses >2 3 ~2 : 3 Booster 3 Contraindications Indications for use the meningitis belt Meningococcal disease Neisseria meningitides A B C Y W %-15% 2. Meningococcal vaccine meningococcal polysaccharide vaccine-mpsvmeningococcal conjugate vaccine-mcv 90% 244

56 2012 Yellow Book Update 2013/ Yellow fever vaccine recommendation in Brazil

57 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine bivalent-a&c tetravalent- A, C, Y&W- 135 MPSV4 4 A, C, Y, W-13590% 2 4 C monovalent serogroup C tetravalent- A, C, Y&W sub-saharan Meningitis Belt MPSV Menomune MPSV4 Menactra Menveo MCV

58 % Yellow fever vaccine associated viscerotropic disease YEL-AVD Yellow fever vaccine associated neurologic disease,yel- AND [1,5] 1. World Health Organization ITH 2012 Country list.international Travel and Health. Available at Accessed December 1, Arya, S. C Travel and Yellow Fever Vaccine. J Travel Med, 9 6, Centers for Disease Control and Prevention Chapter 3:Infectious diseases related to travel. Health Information for International Travel Available at Accessed March 15, Centers for Disease Control, R.O.C Taiwan 2013 Available at: Accessed March 15, Monath, T.P., Dengue and Yellow Fever Challenges for the Development and Use of Vaccines. N Engl J Med Centers for Disease Control and Prevention Yellow Fever Vaccine recommendations of the Advisory Committee on Immunization Practices ACIP. MMWR 59 RR07 ;

59 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine Yellow Book Update 2013/ Afghanistan Albania Algeria Angola Anguilla Antigua and Barbuda Argentina Australia * 248

60 Bahamas Bangladesh Barbados Belize Benin Bhutan Bolivia Botswana Brazil Brunei Darussalam * Burkina Faso Burundi Cambodia Cameroon Cape Verde Central African Republic Chad China Christmas Island Colombia Congo, Democratic Republic Congo, Republic of the Côte d Ivoire Djibouti * * * * 249

61 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine Dominica Ecuador Egypt El Salvador Equatorial Guinea Eritrea Ethiopia Fiji * * French Guiana French Polynesia Gabon Gambia Ghana Grenada Guadeloupe Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras India Indonesia Iran Iraq Jamaica 250

62 Jordan Kazakhstan Kenya Kiribati Lao People s Democratic Republic Lebanon Lesotho * Liberia Libyan Arab Jamahiriya Madagascar Malawi Malaysia Maldives Mali * Malta Mauritania Mauritius Montserrat Mozambique Myanmar Namibia Nauru Nepal Netherlands Antilles New Caledonia Nicaragua * 251

63 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine Niger * Nigeria Niue Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Portugal Reunion Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia S a i n t V i n c e n t a n d t h e Grenadines Samoa Sao Tome and Principe Saudi Arabia Senegal Seychelles * * 252

64 Sierra Leone Singapore Solomon Islands Somalia South Africa Sri Lanka Sudan Suriname Swaziland Syrian Arab Republic Tanzania, United Republic of Thailand Timor Leste Togo Tonga Trinidad and Tobago Tunisia Uganda Uruguay Venezuela Vietnam Yemen Zimbabwe * WHO International Travel and Health publication Annex 1 * * 253

65 Required Required Vaccines: Yellow Fever Vaccine and Meningococcal Vaccine /3/ B

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