ISSN 1021-3651 91 1 25 18 1 1 某軍事單位疑似爆發集體感染流行性腦脊髓膜炎之流行病學調查 15 生物及化學恐怖活動 39 合約實驗室病毒檢驗結果趨勢圖 42 國內重要疫情摘要報告 44 國際疫情及新知 51 台澎金馬地區各類法定傳染病個案報告表 某軍事單位疑似爆發集體感染流行性腦脊髓膜炎之流行病學調查 90 6 4 1 20 24 2 49 前言 Neisseria meningitidis 13
18 1 2 A 50 B 20 C 8-12 A 1-2 W-135 X Y Z 1-2 8 15 22 35 300 35 20-30 90 7 61 33 7 3 90 6 4 1 20 材料及方法 1 5 14 5 31 2 6 1 90 5 16 6 4 24 24
18 1 3 2 3 90 6 4 2 49 24 22-25 5-15 1 5CC 2CC 0.025 SPS 35 5 14-17 48 35 5 Neisseria meningiditis 1 2-5 4-8 35~37 5~10% 18~24
18 1 4 4 90 5 16 6 4 N. meningitidis 結果 90 5 14 5 25-27 5 31 7 7 40 6 1 1 20 4 30 7 30 6 4 B 5 16 6 4 26 10 26
18 1 5 24 24 24 10 8 22 2 24 N. meningitidis 3 3 5-15 1 6 5 2 49 5 24 500 30 5 638 140 24 10 8 1 7 10 10
18 1 6 24 2 49 140 討論及結論 Meningococcal meningitis 1805 Vieusseaux 9 24 10 1884 Marchiatava Chlli 1887 Weichselbaum 1895 Jaeger 11 4 10 5% 10% 60~80% 95% 12
18 1 7 13-14 73 8 N. meningitides invasive meningococcal disease 12 bactericidal antibodies multiple myeloma 15 C 3 10~20% 16 A 13,17 13 13,18 13 HIV
18 1 8 12 influenza stiffness 50% 10% 11,19 G penicillin G 11,19 7 cefotaxime ceftriaxone rifampin coloniza 19
18 1 9 2-4 dexamethasone 20 WHO 2 3 13 sulfadiazine rifampin 21 13 A, C, Y, W-135 建 議
18 1 10
18 1 11 撰稿者 1,2 3 1. 2. 3. 參考文獻 1. 2.Murray PR, Drew WL, Kobayashi GS, et al. Medical Microbiology, CV Mpsby Co., London, 1990:85-90 3.cdc 4. 5. 1993 6.Murray PR., Baron EJ, Pfaller MA., Tenover FC, Yolken RH..Manual of Clinical Microbiology, 7 th eds. American Society for Microbiology, Washington, D.C. 1999. 7. Isenberg HD. Essential Procedures for Clinical Microbiology, American Society for Microbiology, Washington, D.C. 1998. 8. Koneman EW, Allen SD, Janda WM, et al. Color Atlas Textbook of Diagnostic Microbiology, 5 th eds. Lippincott-Raven Publisher, Philadelphia, PA. 1997. 9.Stephens DS. Unloaking the meningococcus: dynamics of carriage and disease. Lancet 1999;353:941-2. 10.Mary PG, Arnold LS.: Meningococcal disease. In: Ralph DF, James DC. eds. Pediatric infectious disease. 3 rd ed. WB. Sauncers Company, Harcourt Brace Jovanovich, Inc. 1992: p1185-97. 11.Apicella MA. Neisseria meningitides. In: Mandell GL, Douglas RG, Bennett JE. eds. Principles and practice of infectious disease, 5 th edition. 2000. 12.Tzeng YL, Stephens DS. Epidemiology and pathogenesis of Neisseria meningitidis. Microbes Infect 2000; 2(6): 687-700. 13.Tikhomirov E, Hallaj Z. Control of epidemic meningococcal disease. WHO practical guidelines. 2 nd edition.1998: 1-48. 14.Caugant DA, Hoiby EA, Rosenqvist E, et al. Transmission of Neisseria meningitidis among asymptomatic military recruits and antibody analysis. Epidemiol Infect 1992; 109(2): 241-53. 15.Stephens DS, Hajjeh RA, Baughman WS, et al. Sporadic meningococcal disease in adults: results of a 5-year population-based study. Ann Intern Med 1995;
18 1 12 123(12): 937-40. 16.Figueroa J, Andreoni J, Densen P. Complement deficiency states and meningococcal disease. Immunol Res 1993; 12(3): 295-311. 17.Moore PS, Reeves MW, Schwartz B, et al. Intercontinental spread of an epidemic group A Neisseria meningitidis strain. Lancet 1989; 2(8657): 260-3. 18Kriz P, Bobak M, Kriz B. Parental smoking, socioeconomic factors, and risk of invasive meningococcal disease in children: a population based case-control study. Arch Dis Child 2000; 83(2): 117-21. 19.Griffiss JM. Meningococcal infections. In: Isselbacher KJ, Braunwald E, Wilson JD, et al. eds. Harrison s principles of internal medicine. 3 rd edition. 1994: p641-1. 20.Schaad UB, Lips U, Gnehm HE, et al. Dexamethasone therapy for bacterial meningitis in children. Swiss Meningitis Study Group. Lancet 1993; 342(8869): 457-61. 21.Pearce MC, Sheridan JW, Jones DM, et al. Control of group C meningococcal disease in Australian aboriginal children by mass rifampicin chemoprophylaxis and vaccination. Lancet 1995; 346(8966): 20-3.
18 1 13 表一 流行性腦脊髓膜炎接觸者預防性抗生素使用之建議 Sulfadiazine 500mg, Rifampin* 1000mg, 1 5mg/Kg, 1 10mg/Kg, 600mg, Ciprofloxacin** 500mg Ceftriaxone 15 125mg 250mg Sulfadiazine *Rifampin **Ciprofloxacin 18
18 1 14 圖一營區簡圖 圖二病例之寢室 位簡圖 床