新知識｜流感疫苗不良反應：你可能承擔的風險有哪些？

韓國和台灣相繼出現許多施打流感疫苗而出現不良反應的案例，打疫苗真的會有不良反應嗎？

已有記錄流感疫苗不良的反應包括了：

腦炎（encephalitis）
癲癇（seizures）
急性瀰漫性腦脊髓炎（acute disseminated encephalomyelitis）
急性横貫性脊髓炎（transverse myelitis）
視神經炎（optic neuritis）
多發性硬化症（multiple sclerosis）
典型的格林─巴利症候群（Guillain– Barre syndrome）
慢性脫髓鞘多發性神經炎（Chronic inflammatory demyelinating polyneuropathy）
顏面神經痲痹（Bell’s palsy）
臂叢神經炎（brachial neuritis）
過敏性休克（anaphylaxis）
氣喘惡化（asthma exacerbation）
全身性紅斑狼瘡惡化（systemic lupus erythematosus）
血管炎惡化（vasculitis）
結節性多動脈炎（polyarteritis nodosa）
關節病變惡化（arthropathy）
中風（stroke）
心肌梗塞（myocardial infarction）
眼部─呼吸道綜合症（oculo－respiratory syndrome）
死亡

美國食品藥物管理局的內部不良事件通報系統（Adverse Event Reporting System； FAERS）中，疫苗不良反應的案件已超過可預防兒童疾病（most preventable childhood diseases combined）的案例了。

由於疫苗中有重金屬和過敏源，所以疫苗公司從沒有否認打疫苗有風險。就因為如此，美國政府其實有向人民徵收一項稅，這個稅收是用於賠償疫苗造成傷害的案件。除此之外，為了怕疫苗公司不願投入疫苗生產，於1986年後，美國通過《國家孩童疫苗傷殘法案》（National Childhood Vaccine Injury Act），至此後人民不能直接控告疫苗公司，而賠償金是向人民徵收的。

在台灣，我們有一筆費用稱「預防接種受害救濟基金徵收」，在第三條中明文「疫苗製造或輸入廠商應繳納一定金額，充作預防接種受害救濟基金，每一人劑疫苗，微收新台幣一點五元。但基金總額未達一億五千萬元或逾新台幣二億元時，中央主管機關得依基金收支運用情形調整之。」它是為因為疫苗受害人而準備的，主管單位應該協助受害人取得應得的賠償。

如果出現不良反應怎麼辦？

詳細記錄施打疫苗的時間、疫苗的廠牌、何種疫苗
如果出現不良反應立即就醫，告知醫師上述資訊
請醫師詳細記錄不良反應
補充魚油、提升免疫保健品
減糖、喝骨頭湯、多睡覺
如果承受傷害，向衛生福利疾病管制署申請賠償（https://www.cdc.gov.tw/Category/Page/ZKC1WQGEnIyUrkM6Xg7X0g）

除此外，疫苗中可能引發不良反應的東西有哪些？如果要施打，要注意哪些事項？請參見：「流感疫苗要打嗎？」、「如果真的要打流感疫苗，該怎麼打？」。

參考資料

1) Meissner HC, Nair N, Plotkin SA. The National Vaccine Injury Compensation Program: Striking a Balance Between Individual Rights and Community Benefit. JAMA. 2019;321(4):343–344.

2) Looker, Clare & Kelly, Heath. (2011). No-fault compensation following adverse events attributed to vaccination: A review of international programmes. Bulletin of the World Health Organization. 89. 371-8. 10.2471/BLT.10.081901.

3) https://www.immunize.org/catg.d/p3094.pdf

4) Chen RT. Vaccine risks: real, perceived and unknown. Vaccine. 1999 Oct 29;17 Suppl 3:S41-6.

5) Cunha, M. P., Dórea, J. G., Marques, R. C., & Leão, R. S. (2013). Vaccine adverse events reported during the first ten years (1998-2008) after introduction in the state of Rondonia, Brazil. BioMed research international, 2013, 853083.

6) Kimmel SR. Vaccine adverse events: separating myth from reality. Am Fam Physician. 2002 Dec 1;66(11):2113-20.

7) Nakayama T, Onoda K. Vaccine adverse events reported in post-marketing study of the Kitasato Institute from 1994 to 2004. Vaccine. 2007;25(3):570–576.

8) Hambidge SJ, Glanz JM, France EK, McClure D, Xu S, Yamasaki K, Jackson L, Mullooly JP, Zangwill KM, Marcy SM, Black SB, Lewis EM, Shinefield HR, Belongia E, Nordin J, Chen RT, Shay DK, Davis RL, DeStefano F; Vaccine Safety Datalink Team. Safety of trivalent inactivated influenza vaccine in children 6 to 23 months old. JAMA. 2006 Oct 25;296(16):1990-7.

9) France EK, Glanz JM, Xu S, Davis RL, Black SB, Shinefield HR, Zangwill KM, Marcy SM, Mullooly JP, Jackson LA, Chen R. (2004, Nov). Safety of the trivalent inactivated influenza vaccine among children: a population-based study. Arch Pediatr Adolesc Med, 158(11):1031-6.

10) McMahon AW, Iskander J, Haber P, Chang S, Woo EJ, Braun MM, Ball R.(2005, Feb). Adverse events after inactivated influenza vaccination among children less than 2 years of age: analysis of reports from the vaccine adverse event reporting system, 1990-2003. Pediatrics, 115(2):453-60.

11) Goodman, M. J., Nordin, J. D., Harper, P., Defor, T., & Zhou, X. (2006). The safety of trivalent influenza vaccine among healthy children 6 to 24 months of age. Pediatrics, 117(5), e821–e826.

12) Izurieta, H. S., Haber, P., Wise, R. P., Iskander, J., Pratt, D., Mink, C., Chang, S., Braun, M. M., & Ball, R. (2005). Adverse events reported following live, cold-adapted, intranasal influenza vaccine. JAMA, 294(21), 2720–2725.

13) Vellozzi, C., Burwen, D. R., Dobardzic, A., Ball, R., Walton, K., & Haber, P. (2009). Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine, 27(15), 2114–2120.

14) DeStefano, F., Verstraeten, T., Jackson, L. A., Okoro, C. A., Benson, P., Black, S. B., Shinefield, H. R., Mullooly, J. P., Likosky, W., Chen, R. T., & Vaccine Safety Datalink Research Group, National Immunization Program, Centers for Disease Control and Prevention (2003). Vaccinations and risk of central nervous system demyelinating diseases in adults. Archives of neurology, 60(4), 504–509.

15) Payne, D. C., Rose, C. E., Jr, Kerrison, J., Aranas, A., Duderstadt, S., & McNeil, M. M. (2006). Anthrax vaccination and risk of optic neuritis in the United States military, 1998-2003. Archives of neurology, 63(6), 871–875.

16) Lauer K, Firnhaber W. (1990). The possible risk of vaccinations for the first manifestation of multiple sclerosis [in German] Aktuelle Neurologie, 17(2):42–46.

17) Mokhtarian, F., Shirazian, D., Morgante, L., Miller, A., Grob, D., & Lichstein, E. (1997). Influenza virus vaccination of patients with multiple sclerosis. Multiple sclerosis (Houndmills, Basingstoke, England), 3(4), 243–247.

18) Confavreux, C., Suissa, S., Saddier, P., Bourdès, V., Vukusic, S., & Vaccines in Multiple Sclerosis Study Group (2001). Vaccinations and the risk of relapse in multiple sclerosis. Vaccines in Multiple Sclerosis Study Group. The New England journal of medicine, 344(5), 319–326.

19) Miller, A. E., Morgante, L. A., Buchwald, L. Y., Nutile, S. M., Coyle, P. K., Krupp, L. B., Doscher, C. A., Lublin, F. D., Knobler, R. L., Trantas, F., Kelley, L., Smith, C. R., La Rocca, N., & Lopez, S. (1997). A multicenter, randomized, double-blind, placebo-controlled trial of influenza immunization in multiple sclerosis. Neurology, 48(2), 312–314.

20) Geier MR, Geier DA, Zahalsky AC. (2003). Influenza vaccination and Guillain Barré syndrome. Clinical Immunology, 107(2):116–121.

21) Haber, P., DeStefano, F., Angulo, F. J., Iskander, J., Shadomy, S. V., Weintraub, E., & Chen, R. T. (2004). Guillain-Barré syndrome following influenza vaccination. JAMA, 292(20), 2478–2481.

22) Brostoff, J. M., Beitverda, Y., & Birns, J. (2008). Post-influenza vaccine chronic inflammatory demyelinating polyneuropathy. Age and ageing, 37(2), 229–230.

23) Kelkar, Praful. (2006). Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) With Rapid Progression After Influenza Vaccination: A Report of Three Cases. Journal of Clinical Neuromuscular Disease. 8. 20-25.

24) Pritchard, J., Mukherjee, R., & Hughes, R. A. (2002). Risk of relapse of Guillain-Barré syndrome or chronic inflammatory demyelinating polyradiculoneuropathy following immunisation. Journal of neurology, neurosurgery, and psychiatry, 73(3), 348–349.

25) Wells C. E. (1971). A neurological note on vaccination against influenza. British medical journal, 3(5777), 755–756.

26) Zhou, W., Pool, V., DeStefano, F., Iskander, J. K., Haber, P., Chen, R. T., & VAERS Working Group (2004). A potential signal of Bell’s palsy after parenteral inactivated influenza vaccines: reports to the Vaccine Adverse Event Reporting System (VAERS)–United States, 1991-2001. Pharmacoepidemiology and drug safety, 13(8), 505–510.

27) Greene, S. K., Kulldorff, M., Lewis, E. M., Li, R., Yin, R., Weintraub, E. S., Fireman, B. H., Lieu, T. A., Nordin, J. D., Glanz, J. M., Baxter, R., Jacobsen, S. J., Broder, K. R., & Lee, G. M. (2010). Near real-time surveillance for influenza vaccine safety: proof-of-concept in the Vaccine Safety Datalink Project. American journal of epidemiology, 171(2), 177–188.

28) Stowe, J., Andrews, N., Wise, L., & Miller, E. (2006). Bell’s palsy and parenteral inactivated influenza vaccine. Human vaccines, 2(3), 110–112.

29) Hansen O. (2005). A case of acute brachial neuropathy following influenza vaccination [in Danish] Ugeskrift for Laeger, 167(11):1297–1298.

30) Bohlke K, Davis RL, Marcy SM, Braun MM, DeStefano F, Black SB, Mullooly JP, Thompson RS. (2003). Risk of anaphylaxis after vaccination of children and adolescents. Pediatrics, 112(4):815–820.

31) DiMiceli L, Pool V, Kelso JM, Shadomy SV, Iskander J.(2006). Vaccination of yeast sensitive individuals: Review of safety data in the US Vaccine Adverse Event Reporting System (VAERS). Vaccine, 24(6):703–707.

32) Peng MM, Jick H. (2004). A population-based study of the incidence, cause, and severity of anaphylaxis in the United Kingdom. Archives of Internal Medicine, 164(3):317–319.

33) Kramarz P, DeStefano F, Gargiullo PM, Davis RL, Chen RT, Mullooly JP, Black SB, Shinefield HR, Bohlke K, Ward JI, Marcy MS.(2009). Does influenza vaccination exacerbate asthma? Analysis of a large cohort of children with asthma. Archives of Family Medicine, 9(7):617–623.

34) Bueving HJ, Bernsen RMD, De Jongste JC, W. A. Van Suijlekom-Smit L, Rimmelzwaan GF, Osterhaus ADME, M. H. Rutten-Van Molken MP, Thomas S, Van Der Wouden JC.(2004). Does influenza vaccination exacerbate asthma in children. Vaccine, 23(1):91–96.

35) Castro M, Dozor A, Fish J, Irvin C, Scharf S, Scheipeter ME, Holbrook J, Tonascia J, Wise R. (2001). The safety of inactivated influenza vaccine in adults and children with asthma. New England Journal of Medicine, 345(21):1529–1536.

36) Nicholson KG, Nguyen-Van-Tam JS, Ahmed AH, Wiselka MJ, Leese J, Ayres J, Campbell JH, Ebden P, Eiser NM, Hutchcroft BJ, Pearson JCG, Willey RF, Wolstenholme RJ, Woodhead MA.(1998). Randomised placebo-controlled crossover trial on effect of inactivated influenza vaccine on pulmonary function in asthma. Lancet, 351(9099):326–331.

37) Pedroza A, Huerta JG, de la Luz Garcia M, Rojas A, Lopez-Martinez I, Penagos M, Franco-Paredes C, Deroche C, Mascarenas C. (2009).The safety and immunogenicity of influenza vaccine in children with asthma in Mexico. International Journal of Infectious Diseases, 13(4):469–475.

38) Stenius-Aarniala B, Huttunen JK, Pyhala R.(1986). Lack of clinical exacerbations in adults with chronic asthma after immunization with killed influenza virus. Chest, 89(6):786–789.

39) Tata LJ, West J, Harrison T, Farrington P, Smith C, Hubbard R.(2003). Does influenza vaccination increase consultations, corticosteroid prescriptions, or exacerbations in subjects with asthma or chronic obstructive pulmonary disease. Thorax, 58(10):835–839.

40) Abu-Shakra M, Zalmanson S, Neumann L, Flusser D, Sukenik S, Buskila D. (2000).Influenza virus vaccination of patients with systemic lupus erythematosus: Effects on disease activity. Journal of Rheumatology, 27(7):1681–1685.

41) Del Porto F, Lagana B, Biselli R, Donatelli I, Campitelli L, Nisini R, Cardelli P, Rossi F, D’Amelio R.(2006). Influenza vaccine administration in patients with systemic lupus erythematosus and rheumatoid arthritis: Safety and immunogenicity. Vaccine, 24(16):3217–3223.

42) Stojanovich L.(2006). Influenza vaccination of patients with systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Clinical and Developmental Immunology, 13(2-4):373–375.

43) Williams GW, Steinberg AD, Reinertsen JL, Klassen LW, Decker JL, Dolin R.(1978). Influenza immunization in systemic lupus eruthematosus. A double-blind trial. Annals of Internal Medicine, 88(6):729–734.

44) Gburek Z, Gozdzik J.(2002). The significance of vaccination in the pathogenesis of systemic vasculitis [in Polish] Reumatologia, 40(4):240–245.

45) Spaetgens B, van Paassen P, Tervaert JWC. (2009).Influenza vaccination in ANCA-associated vasculitis. Nephrology Dialysis Transplantation, 24(10):3258–3259.

46) Wharton CF, Pietroni R. Letter: Polyarteritis after influenza vaccination.(1974). British Medical Journal, 2(5914):331–332.

47) Chalmers A, Scheifele D, Patterson C, Williams D, Weber J, Shuckett R, Teufel A.(1994). Immunization of patients with rheumatoid arthritis against influenza: A study of vaccine safety and immunogenicity. Journal of Rheumatology, 21(7):1203–1206.

48) Asakawa J, Kobayashi S, Kaneda K, Ogasawara H, Sugawara M, Yasuda M, Hashimoto H. (2005). Reactive arthritis after influenza vaccination: Report of a case. Modern Rheumatology, 15(4):283–285.

49) Biasi D, Carletto A, Caramaschi P, Tonoli M, Bambara LM. (1994).A case of reactive arthritis after influenza vaccination. Clinical Rheumatology, 13(4):645.

50) Brown MA, Bertouch JV, Edmonds J. (1994).Rheumatic complications of influenza vaccination. Australian and New Zealand Journal of Medicine, 24(5):572–573.

51) Pou MA, Diaz-Torne C, Vidal S, Corchero C, Narvaez J, Nolla JM, Diaz-Lopez C. (2008).Development of autoimmune diseases after vaccination. Journal of Clinical Rheu matology, 14(4):243–244.

52) Smeeth L, Thomas SL, Hall AJ, Hubbard R, Farrington P, Vallance P. (2004).Risk of myocardial infarction and stroke after acute infection or vaccination. New England Journal of Medicine, 351(25):2611–2618.

53) Ritter O, Bonz A, Strotmann J, Langenfeld H. (2003).Myocardial infarction after influenza vaccination [in German] Zeitschrift fur Kardiologie, 92(11):962–965.

54) Kokia ES, Silverman BG, Green M, Kedem H, Guindy M, Shemer J.(2007). Deaths following influenza vaccination—background mortality or causal connection. Vaccine, 25(51):8557–8561.

55) De Serres G, Grenier JL, Toth E, Ménard S, Roussel R, Tremblay M, Fradet MD, Landry M, Robert Y, Skowronski DM. (2003).The clinical spectrum of the oculorespiratory syndrome after influenza vaccination. Vaccine, 21(19-20):2354–2361.

56) De Serres G, Skowronski DM, Guay M, Rochette L, Jacobsen K, Fuller T, Duval B. (2004).Recurrence risk of oculorespiratory syndrome after influenza vaccination: Randomized controlled trial of previously affected persons. Archives of Internal Medicine, 164(20):2266–2272.

57) Skowronski DM, De Serres G, Scheifele D, Russell ML, Warrington R, Davies HD, Dionne M, Duval B, Kellner J, MacDonald J. (2003).Randomized, double-blind, placebo-controlled trial to assess the rate of recurrence of oculorespiratory syndrome following influenza vaccination among persons previously affected. Clinical Infectious Diseases, 37(8):1059–1066.