DOH93-DC-1025
1997 1~2 1999 1~2 1999 1~12 ( 2003) ( 2002) acyclovir(200mg) 5 1
1. 2. 3. 4. 疱 2
(varicella) 疱 - 疱 (varicella-zoster virus, VZV) 疱 3 DNA VZV 疱 (Reye s syndrome) (Preblud 1986 1999 2000) 85-90% 5-9 50% 15 10% 95% 30 (Ipp 2003) VZV - 疱 (VZIG) VZV ( 2000) (CDC 2003) (bacterial superinfections) (central nervous system;cns) (Law 1999) 20% 疱 (iritis) (uveitis) (granulomatous angiitis) WHO(2003) - 疱 (VZV) 10-20% 疱 50 HIV 3
(1999) 3 30% ( 2000) 4
15-20 (Ipp 2003) 9300 4 100 (McKenddrick 1995 Preblud 1986 Guess 1986) 3.3 (Varughese 1988) Ipp(2003) (Law 1999) 30-50% (disseminated infection) 10% prophylaxis varicella zoster immune globulin(vzig) acyclovir Liew (1994) ( 2-2-1) 0.0015 1.4 0.8 0.09 0.035 0.118 0.88 24 0.05 0.02 2-2-1 5-9 9156 Wharton (1990) ( ) 0.0015 Wharton (1990) 0.00014 Wharton (1990) 0.00014 Wharton (1990) 0.0000082 Wharton (1990) 0.03 ( ) 0.0055 Lieu (1994b) 0.118 Lieu (1994b) 0.88 Lieu (1994b) 24 0.05 Lieu (1994b) 0.02 Acyclovir 0.2 Dunkle (1991) 5
Lieu TA, Cochi SL, Black SB, Halloran ME, Shinefield HR, Holmes SJ, Wharton M, Washington AE. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994a; 271(5):375-81. Law (1999) ( 2-2-2) ( 7 ) ( 7 ) 40% 30% 5% 5% 16.2% 5% Acyclovir 20% 32.9% 97.5% Acyclovir Law (1999) ( 2-2-3) 2-2-4) 2-2-2 IMPACT IMPACT IMPACT IMPACT 328 80 80 84 40 ( ) 3.8 (3.2) 3.8 (2.5) 5.1 (3.3) 6.6 (3.2) 6.6 (3.3) 58.2% 56.2% 53.8% 48.8% 62.5% 79.2% 90.4% 76.0% 87.8% 80.6% 疱 39.9% 41.2% 42.5% 36.9% 40.0% 疱 3.0% 1.2% 2.5% 46.4% 45.0% 13.7% 5.0% 3.8% 92.8% 50.0% 42.1% 45.0% 30.0% 1.2% 7.5% (CNS) 19.8% 23.8% 28.8% 1.2% 5.0% 4.6% 5.0% 0 1.2% 2.5% 19.8% 21.2% 37.0% 3.6% 35% / 1.8% / 0.6% 5.0% / 2.5% 16.2% / 7.5% 1.2% / 1.2% 5.0% / 2.5% Acyclovir 21.4% 20.5% 32.9% 100% 97.5% ( ) 3 (1-7) 3.5 (1-7) 11 (8-57) 6 (2-30) 7 (2-16) 6
Law B. Fitzsimon C. Ford-Jones L. McCormick J. Riviere M. Cost of chickenpox in Canada: part II. Cost of complicated cases and total economic impact. The Immunization Monitoring Program-Active (IMPACT). Pediatrics. 104(1 Pt 1):7-14, 1999 Jul. 7
8
2-2-4 (n=20) (n=20) ( ) VZIG * 7.3 (2.6) 7172.1 (2576.9) 6.1 (2.1) 6034.4 (2056.7) VZIG 9.5 (2.7) 9397.9 (2651.1) 7.3 (2) 7221.5 (1925.6) VZIG 1.5 (2.0) 55.2 (62.1) 1.2 (1.3) 56.3 (50.3) VZIG 3.1 (4.6) 110.5 (146.9) 1.0 (1.3) 44.2 (58.1) VZIG 0.6 (0.9) 3.1 (4.6) 0.6 (0.8) 3.0 (4.2) VZIG 2.1 (3.0) 31.4 (85.3) 0.4 (0.5) 7.3 (18.1) VZIG 7230.4 (2598.9) 6093.8 (2105.5) VZIG 9539.8 (2825.6) 7273.1 (1906.2) *VZIG 疱 Law B. Fitzsimon C. Ford-Jones L. McCormick J. Riviere M. Cost of chickenpox in Canada: part II. Cost of complicated cases and total economic impact. The Immunization Monitoring Program-Active (IMPACT). Pediatrics. 104(1 Pt 1):7-14, 1999 Jul. 1972 1983 48 (Preblud 1986) 388 96 aspirin 1985 14 ( 2-2-5) 20 15 ( 2-2-6) 20 10 30.9 ( 2-2-7)(Guess 1986)20 ( 127) 15-19 ( 42) 14 12 ( 2-2-8) ( 2.6) ( 1.3) 20 ( 26.7) ( 3.3) (Nach 2002) Miller (1993) 1967-1990 14 1/4000 1967-70 0.021 1986-90 9
0.043 (Brisson 2002) 1996 2000 32 18 Rawson (2001) 1995-1997 25 10 9.22 81% 19% (12% 4%) 2-2-5 1972-1983 1972-1979* 1980-1983 % ( ) No. % No. % < 1 2 2.7 1 0.9-86.6 1-4 12 22.0 7 25.0-44.3 5-9 26 46.6 9 35.2-63.5 10-14 8 14.3 3 13.0-56.2 15-19 2 3.4 1 2.8-57.9 20 6 11.0 6 23.1 +1.6 58* 100.0 28 100.0-53.1 * 464 ( 18 ) 109 ( 1 ) Preblud SR: Complications and costs. Pediatrics 1986;78:728-35. 10
2-2-6 1972-1983 1970-1974* 1975-1979 1980-1982 % ( ) No. % No. % No. % < 1 12 10.8 6 5.9 5 7.1-55.8 1-4 24 21.2 15 16.1 9 12.5-60.6 5-9 44 39.1 28 29.4 14 18.4-68.6 10-14 9 8.3 9 9.3 8 10.4-16.3 15-19 1 0.7 3 3.4 3 4.0 +275.0 20 22 19.9 34 35.8 35 47.5 +59.0 Total 112 100.0 95 99.9 74 99.9-33.3 * 557 472. 223 Preblud SR: Complications and costs. Pediatrics 1986;78:728-35. ( ) 2-2-7 % < 1 333 9 10 1-4 1,129 29 9 < 5 1,462 38 12 5-9 1,096 29 8 10-14 370 10 12 15-19 248 6 42 20+ 661 17 127 Guess HA, Broughton DD, Melton LJ, Kurland LT. Population-based studies of varicella complications. Pediatrics. 1986;78(suppl):723-727. 11
2-2-8 ( ) <5 Bacterial skin infections 320 2.6 Pneumonia 160 1.3 5-9 Varicella encephalitis 124 0.9 Reye syndrome 92 0.6 10-14 Reye syndrome 47 1.5 Varicella encephalitis 28 0.9 15-19 Varicella encephalitis 17 2.9 Varicella pneumonia 14 2.4 20+ Varicella pneumonia 139 26.7 Varicella encephalitis 17 3.3 Guess HA, Broughton DD, Melton LJ, Kurland LT. Population-based studies of varicella complications. Pediatrics. 1986;78(suppl):723-727. Fornaro (1999) 1997 39 (sentinel network) 30,168 0-14 0-14 1599 51.01% 8 0-14 1-5 56(3.5%) 12
(Anonymous 1988) 1966 10 8.0 1983 2.3 1983 3 1984 4 571 54% 10 27.5 Bovill(1998) 1989 1993 144 25% 78 10.3% 1972 1983 48 (Preblud 1986) 388 96 aspirin 1985 14 20 Choo(1995) (Harvard Community Health Plan, HCHP) (automated record) <5 8 2 Meyer(2000) 5-9 20 5-9 13 5-9 6 Galil (2002) 65.4% 1-4 35.3% 20 60.9% 1-4 1-4 20 13
Galil (2002) (1988-1995) (1995-1998 ) 0.42 0.32 25% 1-4 (32.17%) 20 (31.9%) 0.42 <1 20 5-9 12.8 <1 5-9 5.7 Bovill(1998) 1968-1972 1979-1983 1989-1993 >15 2.23 26.2 34.3 23% 6 2 1.2 Guess(1986) (Olmsted County Minnesota) 20 ( 127) 15-19 ( 42) 14 12 5 5-14 20 Law (1999) ( 7 ) ( 7 ) 40% 30% 5% 16.2% 5% Acyclovir 20% 32.9% 97.5% Acyclovir 14
Meyer(2000) 1973-1985 86 ( 0.21) ( 0.12) 60 20%(Anonymous 1988) Rawson(2001) 1995-1997 25 9.22 1967-1977 64% 1986-1997 81% 19% 0-4 15-44 15
(Lieu 1994 Preblud 1986) Law (1999) 11 1991 1 1996 3 (Immunization Monitoring Program Active IMPAC) 160 40 26 ( ) $7,060 ( ) $8,398 ( ) $7,228 ( ) 89% 346,527 ( ) 0.54% $12,240 $2400 1970 (Magano 1992) 95% (Kuter 1991 Asano 1986) ( 2003) Lieu (1994) 97% 94% 35 1.62 1 5 2 2,500 1990 7,482 16
90 7-12 91 ( ) 91 ( ) (ICD9-CM 052 ) 疱 (ICD9-CM 053 ) 2,666,348 19,803 138,151 14,937 138,952 33 2002 1 1,149 91 137,770 ( ) Meyer(2000) ( 3-2-2) ( ) ( ) 91 ( ) 91 338,256 10,818 3,406 ( ) 30 91 1-11 ( ) ( 12 ) 91 17
119,532 ( ) Acyclovir ( 3-1-1) 603,991 268,071 歩 91 2,495 91 3-1-1 Acyclovir 03010E 03011F 03012G 03013H 57001B 57002B Acyclovir A032684321 A032684343 A032684399 A032785321 A032785329 A032785365 A032785355 A032785377 A032785399 A033063321 A033063365 A033063372 A033063399 A033590319 A033590329 A033590399 A033738321 A034015321 A034015365 A034015372 A034015399 A034224312 A034224321 A034224372 A034355321 A034355377 A034583100 A035035317 A035035372 A035354321 A035354329 A035391321 A035391363 A035391399 A035544321 A035544329 A035544372 A035544399 A035977321 A035977329 A035977372 A035977399 A036408326 A036481312 A036481317 A036481321 A036481325 A036481343 A036481365 A036481372 A036481399 A036739321 A036825316 A037139316 A037139321 A037286321 A037286329 A037286372 A037286399 A037832323 A038288316 A038288321 A038288329 A038288361 A038323321 A038323329 A038604329 A038604363 A038604399 A038927323 A039005321 A039005329 A039036100 A039315100 A039368100 A039616329 A039616372 A039616399 A039620321 A039620372 A039620399 A0396203AH A039628100 A039629100 A039854100 A040090100 A040808321 A040808329 A040808335 A040808338 A040808355 A040808372 A040808399 A040910321 A040910372 A040910399 A041492209 A041492265 A041492277 A042280100 A042755100 A042877317 A042877326 A042877343 A042877363 A042877372 A042877399 A044122100 A044971329 A044971372 A044971399 A046143100 B011325420 B011326265 B012736100 B013476309 B013476312 B013476321 B017035100 B017161109 B017161158 B017161159 B021385316 B021385329 B022077312 B022120312 B022251229 B022251238 B022550277 B022927100 B023300100 18
( ) Meyer(2000) Lin(2000) ( ) 20 <20 ( ) Law(1999) ( 7 ) ( 7 ) ( ) Meyer(2000) ( ) Lin(2000) 疱 19
( ) ( ) ( ) ( ) Meyer(2000) Lin(2000) 30 ( ) 3-2-1 ( ) 7 14 30 3 4 7 3-2-1 ICD-9-CM Lin(2000) 038.0-038.9 681.0-682.9 (Impetigo) 684.0 Meyer(2000) Choo(1995) 334.3 334.9 781.3 049.9 323.8 323.9 348.3 047.8 047.9 322.0-322.9 321.7 348.1-348.5 348.9 331.8 286.6 286.9 287.0-287.5 287.9 034.1 035 040.0-040.9 041.0-041.9 729.4 420.0-420.9 421.0-421.9 429.0 320.1-320.3 320.8-320.9 680.0-684.0 686.0 686.8-686.9 038.0-038.9 790.7 324.0 324.1 324.9 326 481.0 480.8 480.9 486.0 483.0 485.0 681.0 681.00 681.1 681.10 681.9 682 480.8 480.9 483 485 486 321.2 321.8 322 323.9 357.0 038.0-038.4 052.7-052.8 070.4-070.6 070.9 570 573.1-573.3 573.9 785.59 20
( ) Coplan(2001) 0-4 5-9 10-14 15-19 20-24 25-29 60 7 ( ) ( ) ( ) Meyer(2000) Lin(2000) ICD-9 ( 3-2-2) Meyer(2000) Lin(2000) (183 ) ( ) 3-2-2 ( ) 3-2-2 ( ) ICD-9-CM Meyer(2000) 140.0-165.9 170.0-175.0 179.0-208.9 279.0-279.9 /AIDS 042.0-044.9 795.8 Lin(2000) 042.0-044.9 795.8 200.0-208.9 140.0-199.9 284.0-284.9 288.0-288.2 179.0-179.9 634.0-634.9 647.6 647.9 650.0-656.9 / / V58.0 V58.1 V07.2 21
SAS 8.2 7 Acyclovir 22
疱 4-1-1 0-4 5-9 3.26% 3.95% 0-4 5-9 5-9 14.08% 4-1-2 91 11 12 1 12 13.26% 9 5.5% (>=20 ) ( <20 ) 13.8% 86.2% 11 12 1 9 4-1-3 0.2% 12 0-4 5-9 0-4 5-9 25-59 60 60 0.3% 60 10.18% 91 23
( 4-1-4) 55.8% 2.3 (0.558/(1-0.558) + 1) Beutels et al. 12 (Preblud 1986) (Meyer 2000) 12 2.3 91 285,900 ( 4-1-5) 24
25
26
27
28
29
4-2-1 30 6-8 (7.95%-8.94%) (10 11 1 3 4 ) 4-2-2 30 (7.08%) 0.09% 0.06% 1.66% 14 25-59 9 60 4-2-3 91 1-11 2,495 (13.83%) (11.42%) 17.03 9 (5.52 ) 7 ( 13.62% 10.88%) ( 10.34% 8.07%) (5.15%) (4.68%) 27.27~33.80 (6.25 ) (4.40 7 (20%) 1.82% 6% 1.82% 4% ( 10% 6.67%) (20.32%) (16.47%) 4.18-6.07 (5.75 ) (4.71 ) 7 ( 13.45 10.21%) 30
(4.17%) (20.83%) (21.43%) (12.5%) 31
32
33
34
4-3-1 91 96.94% 4.63% 2.34% 30 80.43% 13.59% 28.26% 30 90.48% 7.14% 11.9% 30 80% 4% 16% ( 4-3-2) 30 847 433 44 370 930 756 42,262 35,833 5,714 4-3-3 30 1.37 446 4-3-4 1.05 950 歩 3,562 6,511 4-3-5 1.02 15,793 5.15 145,453 294,818 31,975 17.46 17.80 6.50 35
36
37
38
4-3-6 4-3-9 30 107 12,801 1,631 254 10,916 136,748 2.23 2,178 1.27 3,286 1.07 38,467 6.02 4-3-10 4-3-13 30 71 23,222 1,018 776 21,428 60 93,677 2.36 1,225 1.20 2,204 1.12 36,224 8.55 4-3-14 4-3-17 30 8,459 2,473 718 129 1,625 100,037 318,907 2.08 735 1.08 1,340 1.06 20,098 5.77 39
40
41
42
43
44
45
46
47
48
4-3-18 4-3-21 30 1,982 7,265 975 364 5,926 105,551 2.36 1,037 1.11 1,830 1.05 18,352 5.52 4-3-22 91 1 11 119,532 847 10,124 107 136 71 164 8,459 2,091 1,982 1,439 130,399 10,562 49
50
51
52
疱 53
4-4-1 92 1 12 疱 疱 疱 0-4 5-9 3.26% 3.95% 疱 60 4-4-2 0-4 5-9 57.96 36.20 20-24 19.30 疱 60 疱 114 54
55
56
Tan(2004) 324.7 3.13 20 14 Tan 5-9 4.13-10.34% 10-14 1.40-1.94% 15-19 0.29-1.22% 91 5-9 3.95% 10-14 0.47% 15-19 0.19% Somekh(2000) Jaeggi (1998) 2 5~6 ( 2004) ( ) Maharshak (1999) Somekh (2000) 1991 57
6 1994 3 4 1991 6 1995 1 9% 11.5% (1.16%) Maharshak (1999) Somekh (2000) 10.4 9.4 9.3 Maharshak (1999) Somekh (2000) 8.1 10.6 5.52 Jaeggi (1998) 1986-1996 2 16 (113 ) (4.8 Jaeggi 6.6 ) (50% Jaeggi 38%) Jaeggi (1998) 9 4.75 ICU (20.83%) Jaeggi (1998) (8%) ( ) Maharshak (1999) Somekh (2000) 12% 16.8% (11.42%) Maharshak (1999) Somekh (2000) 6.6 11.7 9.4 Maharshak (1999) Somekh (2000) 5.7 8.8 5.06 Preblud(1986) (1999) (2000) ( 4-3-1) ( 4-3-3) 58
107 57 53.7% 71 42 59.2% (684/8459=8.1%) (640/1982=32.3%) Lieu(1994) 35 5 2 344.8 700 1,500-2,000 22-32.3 7,586 11,034 847 91 10,562. 疱 疱 0-4 ( 58.48 ) Coplan(2001) 4 ( 14.6 ) 疱 60 疱 ( 114.28 ) Coplan(2001) ( 9.3 ) 12.3 Lin(2000) 1986-1995 (Health Information Management and Exchange CHIEM) 疱 疱 疱 4 疱 疱 疱 ( 22.35 ) ( 11.96 ) 1.86 疱 疱 ( 11.63 ) ( 9.74 ) 1.19 Coplan(2001) 1994 8,000 5-9 Kaiser Permanente Medical Care Program, Northern California(KPMCP) 疱 5-9 59
2.6 疱 2.1 Coplan(2001) 5-9 疱 疱 60
(Guess 1985 Yawn 1997) (Coplan 2001) (Choo 1995) Halloran(1994) 91 ( 4-1-4) 55.8% 2.3 (0.558/(1-0.558) + 1) Beutels (1996) 12 (Preblud 1986) (Meyer 2000) 12 2.3 91 285,900. 61
0-4 5-9 11 12 1 12 13.24% 9 60 60 0.3% 60 10.18% 30 (7.08%) 30 9 60 (13.83%) (11.42%) 71 42 59.2% 107 57 53.7% (684/8459=8.1%) (640/1982=32.3%) 91 847 疱 疱 疱 ( 22.35 ) ( 11.96 ) 1.86 62
疱 疱 63
1. - http://www.hato.com.tw/medicine/med_cont.asp?health_id=107 2004/12/01 2. http://203.65.72.83/ch/di/showpublication.asp?recno=738 2003/06/17 3. 2002 12 197-204 4. 1999 42 250-1 5. 2000 46 292-5 6. Anonymous. Chickenpox in Canada, 1924-87. Can Med Assoc J 1988 138 133-4. 7. Asano Y, Nagal T, Miyata T. Long-term prospective immunity of recipients of the Oka strain of live varicella vaccine. Pediatrics 1986 667-71. 8. Beutels P. Clara R. Tormans G. Van Doorslaer E. Van Damme P. Costs and benefits of routine varicella vaccination in German children. J Infect Dis 1996 174 (Suppl 3) S335-41. 9. Bovill B. Bannister B. Review of 26 years' hospital admissions for chickenpox in North London. J Infection 1998 36 (Suppl 1) 17-23. 10. Brisson M, Edmunds WJ, Gay NG, Miller E. Deaths from chickenpox: Deaths from chickenpox in adults are decreasing. BMJ 2002 324 609. 11. Choo PW. Donahue JG. Manson JE. Platt R. The epidemiology of varicella and its complications. J Infect Dis 1995 172 706-12. 12. Coplan P. Black S. Rojas C. Shinefield H. Ray P. Lewis E. Guess H. Incidence and hospitalization rates of varicella and herpes zoster before varicella vaccine introduction: a baseline assessment of the shifting epidemiology of varicella disease. Pediatr Infect Dis J 2001 20 641-5. 13. Fornaro P. Gandini F. Marin M. Pedrazzi C. Piccoli P. Tognetti D. Assael BM. Lucioni C. Mazzi S. Epidemiology and cost analysis of varicella in Italy: results of a sentinel study in the pediatric 64
practice. Italian Sentinel Group on Pediatric Infectious Diseases. Pediatr Infect Dis J 1999 18 414-9. 14. Galil K. Brown C. Lin F. Seward J. Hospitalizations for varicella in the United States, 1988 to 1999. Pediatr Infect Dis J 2002 21 931-5. 15. Guess HA, Broughton DD, Melton LJ, Kurland LT. Population-based studies of varicella complications. Pediatrics 1986 78 723-7. 16. Halloran ME. Cochi SL. Lieu TA. Wharton M. Fehrs L. Theoretical epidemiologic and morbidity effects of routine varicella immunization of preschool children in the United States. Am J Epidemiol 1994 140 81-104. 17. Hsu HC. Lin RS. Tung TH. Chen TH. Cost-benefit analysis of routine childhood vaccination against chickenpox in Taiwan: decision from different perspectives. Vaccine 2003 21 3982-7. 18. Ipp M. Chickenpox and the chickenpox vaccine. http://www.utoronto.ca/kids/varicela.htm 2003/6/17 19. Jaeggi A. Zurbruegg RP. Aebi C. Complications of varicella in a defined central European population. Arch Dis Child 1998 79 472-7. 20. Kuter BJ, Weibel RE, Guess HA, et al: Oka/Merck varicella vaccine in health children: final report of a 2-year efficacy study and 7-year follow up studies. Vaccine 1991 9 643-7. 21. Law B. Fitzsimon C. Ford-Jones L. McCormick J. Riviere M. Cost of chickenpox in Canada: part II. Cost of complicated cases and total economic impact. The Immunization Monitoring Program-Active (IMPACT). Pediatrics 1999 104(1 Pt 1) 7-14. 22. Lieu TA, Cochi SL, Black SB, Halloran ME, Shinefield HR, Holmes SJ, Wharton M, Washington AE. Cost-effectiveness of a routine varicella vaccination program for US children. JAMA 1994 271 375-81. 23. Lin F. Hadler JL. Epidemiology of primary varicella and herpes zoster hospitalizations: the pre-varicella vaccine era. J Infect Dis 2000 181 1897-905. 24. Maharshak N. Somekh E. Hospitalization for varicella in central Israel. Acta Paediatr 1999 88 1279-83. 65
25. Mangano MF, White CJ: Varicella vaccine reflux. Pediatricas.199289 353-4. 26. Meyer PA. Seward JF. Jumaan AO. Wharton M. Varicella mortality: trends before vaccine licensure in the United States, 1970-1994. J Infect Dis 2000 182 383-90. 27. McKendrick MW. Acyclovir for childhood chickenpox. Cost is unjustified. Br Med J 1995 310 108-9. 28. Miller E, Vurdien J, Farrington P. Shift in age in chickenpox. Lancet 1993 341 308-9. 29. Noah N. Adults still account for many deaths from chickenpox. BMJ 2002 325 221-2. 30. Preblud SR: Complications and costs. Pediatrics 1986 78 728-35. 31. Rawson H, Crampin M, Noah N. Deaths from chickenpox in England and Wales 1995-7:analysis of routine mortality data. BMJ 2001 323 1091-3. 32. Somekh E. Maharashak N. Shapira Y. Greenberg D. Dagan R. Hospitalization for primary varicella-zoster virus infection and its complications in patients from southern Israel. Infection 2000 28 200-4. 33. Tan HF, Tseng HF, Chang CK, Ke D, Lee-Hsieh J. The incidence of varicella in southern Taiwan: a life table method estimation among susceptible population. Vaccine 2004 22 2730-36. 34. WHO. Vaccines, Immunization and Biologicals. http://www.who.int/vaccines/en/varicella.shtm1. 66