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The Optimal Strategy for Pertussis Vaccination: A Systematic Review and Meta-analysis of Randomized Control Trials and Real-World Data

為了解決English novel recomm的問題，作者NGUYEN SONG HUNG 這樣論述：

Background: Pertussis is an extremely infectious disease caused by Bordetella Pertussis that results in respiratory infection. Pertussis is endemic worldwide, especially in developing countries. Although routine infant vaccination considerably reduces the number of pertussis cases and the mortality

rate, severe cases and incidence rates have been recorded in infants prior to receiving the primary immunization schedule. Several strategies, cocooning strategies, vaccine during pregnancy, neonatal vaccination, and postpartum immunization, have been suggested to prevent infants before routine vac

cination schedule against pertussis infection. However, the efficacy of the postpartum immunization and cocooning approach remains limited. Therefore, vaccine during pregnancy or at birth could be potential options to solve this major public health issue.Our systematic review and meta-analysis of ra

ndomized control trials (RCTs) and real-world evidence aimed to evaluate the safety, efficacy, immunogenicity, and safety of pertussis vaccination in pregnancy and neonatal vaccination.Method: The databases from Embase, Cochrane database central, and PubMed/Medline were continuously updated from the

beginning until December 2020. RCTs, cohort studies, and case-control studies of infants immunized at birth or whose mothers had been vaccinated in pregnancy compared to control groups (vaccination at 2 or 3 months of age) were included. The number of pertussis cases, three antigen-specific pertuss

is IgG antibody levels (anti-pertussis toxin (anti-PT), anti-pertactin (anti-PRN), and anti-filamentous hemagglutinin (anti-FHA)), and severe adverse events (SAEs) in children before and after the primary vaccination series were examined. Two authors independently obtained data and assessed the qual

ity of the studies. Data extracted included the authors, study period, publication year, inclusion criteria, number of study participants, interventions, primary vaccination schedule, vaccine supplier, and outcome. A meta-analysis was performed using a random-effects model to pool the investigation.

Results: This study examined a total of thirty-two and twenty-nine studies in systematic review and meta-analysis, respectively. In compared to the control groups, pertussis vaccination in pregnancy considerably elevated the all pertussis IgG antibodies concentrations in the umbilical cord and in i

nfants prior to the primary vaccination schedule, anti-PT IgG (standardized mean difference (SMD), 1.51; 95% CI, 1.24 to 1.78), (SMD, 1.48; 95% CI, 1.15 to 1.81); anti-PRN IgG (SMD, 2.23; 95% CI, 1.67 to 2.8), (SMD, 2.09; 95% CI, 1.81 to 2.36); and anti-FHA IgG (SMD, 2.23; 95% CI, 1.62 to 2.84), (SM

D, 2.33; 95% CI, 2.01 to .66), respectively. Furthermore, vaccination in pregnancy lowered the pertussis incidence in infants prior to the primary vaccination schedule (odds ratio, 0.22; 95 percent CI, 0.14-0.33). When compared to those who were not vaccinated, infants who were vaccinated at birth s

howed higher concentration of pertussis anti-FHA IgG (SMD, 0.52; 95 percent CI, 0.33 to 0.71), anti-PT IgG (SMD, 0.55; 95 percent CI, 0.33 to 0.77), and anti-PRN IgG (SMD, 0.27; 95 percent CI, 0.05 to 0.48). Additionally, no significant variations in SAE rates were seen between vaccine in pregnancy

vs control group (risk ratios (RR), 1.18; 95% CI, 0.76-1.82) and neonatal vaccine vs control group (RR), 0.72; 95% CI, 0.34-1.54).Conclusions: Our results indicated that if pregnant women receive the pertussis vaccination during pregnancy, their infants are protected from pertussis before the primar

y vaccination. Cost-effectiveness has been an essential factor in considering maternal vaccination in the national immunization program. Vaccination at birth is another choice for infants whose mothers have not yet got acellular pertussis vaccine in gestational weeks.

台灣季節性流感使用儲備抗病毒藥物之策略與效果評估

為了解決English novel recomm的問題，作者蘇家彬 這樣論述：

1.台灣季節性流感預防與控制之策略流感對台灣仍然造成嚴重的公共衛生威脅。2017至18年間，台灣經歷了兩次季節性流感流行，分別由A/H3N2與B型流感病毒引起。台灣疾病管制署與傳染病防治諮詢會除了國家流感疫苗接種計畫以外，也針對季節性流感的預防與控制，利用多元化的策略以降低於易感族群的傳播，以及減少流感相關個案發生與死亡率。我們利用回顧此一預防與控制流感策略中的數個關鍵因素，包括加強流感監測，抗病毒藥物的儲備與管理，重症照護與醫療資源的分配，與公眾的風險溝通，以及感染管制的措施等。由於控制季節性流感流行有其複雜與挑戰性，醫療專業人士間的彼此合作對於保障台灣人民的健康具有關鍵的重要性。2.陰性

流感快篩與住院流感病患嚴重疾病之相關性偽陰性的流感快篩結果可能誤導醫師排除流感的診斷。本研究目的為評估陰性的流感快篩結果與加護病房住院的關係。分析2009年7月至2011年2月於臺灣某教學醫院之實驗室確診流感成人住院個案，實驗室檢驗方式為反轉錄聚合酶連鎖反應或病毒培養。結果發現，在134名流感病毒感染之成年個案中，有38名(28%)曾住加護病房。相較於流感快篩陽性的個案，流感快篩陰性的個案其入住加護病房的比例顯著較高 (46% vs. 13%, p value< 0.001)。流感快篩陰性的個案有較高的比例具有下呼吸道症狀以及胸部X光片浸潤。流感快篩陰性的個案，其快篩至治療的時間相較於流感快篩

陽性的個案顯著較長(1.94 days vs 0.03 days, p value< 0.001)。在入院時疾病較輕的個案當中，僅有流感快篩陰性以及延遲治療時間與入住加護病房相關。本研究結論，流感快篩陰性的流感個案更容易有嚴重疾病以及遲延抗病毒藥物治療。本結論可幫助改善流感住院病患之治療效果。3.比較克流感與瑞樂沙之臨床效果差異: 一個全國性的觀察性研究吸入性之瑞樂沙被認為相較於口服之克流感，其全身性抗病毒的能力較低。截至目前為止，尚未有直接比較克流感與瑞樂沙之臨床效果的全國性大型研究被報告。本研究目的為比較流感診斷後兩天內使用克流感或瑞樂沙之病患之臨床預後差別。本研究利用2013至2016年

間三個流感季之全民健保申報資料庫，追蹤病患診斷後兩周內是否有因流感相關原因住院或死亡。在利用傾向分數分組與加權來校正可能之干擾因素後，計算使用兩組藥物之個案其出現研究結果之風險比。本研究期間內共找出865,032 位於研究期間使用流感抗病毒藥物之個案，其中269,135 (31.1%)使用克流感，595,897 (68.9%) 使用瑞樂沙. 本研究並未發現兩種藥物之使用者於臨床出現研究結果風險比之差異 (RR 1.01, 95% CI: 0.96–1.06). 分族群研究發現18–64 years之年輕族群使用克流感組出現臨床結果之風險較低 (RR 0.92, 95% CI: 0.85–0.9

9). 在此觀察性世代研究中，我們並未發現使用兩種藥物的個案在出現研究結果的風險上有重大差異。