자..이제 우리 병원에 새롭게 입성한 Tdap (아다셀)을 살펴보자
(업체쪽에서는 대한소아과학회에선 올해부터 11-12세 땐 Td 대신 Tdap 백신 접종을 권장한다고 했는데...
내가 확인은 못했고 )
Tdap은 성인용 디프테리아,파상풍,백일해 백신에 해당하는데 DTaP에 비해 백일해 백신 용량을 1/3~1/4로
줄인 제품으로 소문자 d혹은 p는 원래 디프테리아[D]나 백일해[P]백신보다 톡소이드[백신에 사용되는 독소]
양이나 종류를 감소시켰다는 뜻이다
자..그러면 각론으로 들어가서
1. 백일해 백신의 개발 과정...
포르말린으로 불활성화한 B. pertussis 균주로 제조된 전세포백일해백신(whole-cell pertussis vaciine . wP)은 1930년대
개발되어 1940년대 중반부터 DTwP혼합백신으로 널리 접종되었고 이 백신은 여러 연구를 통해 4회 접종으로 70-90%
의 높은 예방효과를 보여 광범위하에 사용되었지만 위에서 언급한것 처럼 여러 이상반응이 보고되면서 전 세포 혼합
백신의 안정성에 문제가 제기되었고 그 결과 이러한 이상반응을 줄이기위해 1977년 일본에서 최초로 백일해의 병원성
항원인 PT(pertussis tixin)와 FHA(filamentous hemagglutinin)을 이용한 개량백일해백신(aP : acelluar, purified pertussis vaciine)이 개발되었r고 다른 나라에서도 여러 종류의 개량백신이 개발되고 있으며 WHO또한 1999년 발간
된 자체평가 보고서에서 1997년부터 개량DTaP에 대한 평가를 실시한 결과 안전성과 효능 부작용이 DTwP보다 훨씬
우수하다고 평가하였지
2. 백신의 종류 및 현재 생산백신
전세포백신(DTwP)은 이상반응에 대한 논란으로 현재 국내에서 제조유통되는 백신은 없으나 상대적으로 저렴한 비용과
효과 때문에 다른나라에서는 접종되고있다고 하네..
개량백일해백신에는 고도로 정제된 B. pertussis 균주의 불활성화 성분만을 포함하는데..
전 세계적으로 다양한 조합의 항원성분을 포함한 개량백일해 백신들이 개발 시판되었고 현재 미국에서 유통되고 있는
DTaP백신중 Tripedia(Aventis Pasteur)에는 FHA 와 PT가 동량으로 함유되어 있고 Dapacel(Aventis Pasteur)에는 PT,
FHA외에0도 fimbriae type 2, 3의 4종류의 항원성분이 포함되어 있어 우리병원에 있는 Infanrix(Glaxo Smithkline)에는
PT 와 FHA외에 thfidd의 PERT(pertactin)가 포함되어 있다
3. 면역원성 및 효과
체액성 면역은 개량백일해백신은 접봉후 각 각의 항원에 대한 항체 생성을 ELISA등의 방법으로 측정해본 결과 전세포백신과 비교해 항체가가 같거나 높은것으로 나타났고 PERT에 대한 항체가는 백신에 포함된 항원의 양과 일정정도 상관관계를 보였지만 PT와 항체가는 상관관계를 보이지 않았데..
실제로 유아에 백신을 접종하면 PT, FHA, PERT에 대한 특정 T-cell의 반응이 증가하는데 여기에 IL-2와 INF-gamma 가 관여한다고하네....아래글도 참조하세요
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Q. 백일해 항원의 종류가 PT, FHA, PRN, FIM등 다양하게 있는데.. 그들이 백신의 면역기능 향상에 기여(?)하는 기전은
A. 백신은 항원성은 그대로 유지하고 병원성만 약화시킨 병원체를 투여하여 항체생성을 유도합니다. 생성된 항체는 나중에
병원균이 침입했을 때 각 항원에 작용하여 제거, 중화, 세균부착억제 등의 항원-항체반응을 통해 병원균 감염을 예방합
니다. 백일해 항원의 종류에 따른 항체의 작용기전은 아래와 같습니다.
Pertussis Toxin (PT): 백일해균 독소. 호흡기 점막에의 부착, 임파구 증식, 대식 세포 이동의 억제, T 임파구 분열의
억제 등의 기능을 하는 중요한 항원 성분 → 항체의 작용기전: 백일해균 부착억제
Filamentous Hemagglutinin (FHA): 섬유상 적혈구 응집소. 호흡기 점막에 부착하는데 중요한 기능
→ 항체의 작용기전: 백일해균 부착억제
Pertactin (PRN): 백일해균의 외막단백. 호흡기 점막에 부착하는데 중요한 기능
→ 항체의 작용기전: 백일해균 부착억제
Fimbriae(FIM) type 2 and 3: 응집원(agglutinogen). 호흡기 점막에 부착하는데 중요한 기능
→ 항체의 작용기전: 백일해균 부착억제
(ref. 소아과 1997 40:167-172)
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4. 동시접종 및 교차 접종
DTaP는 MMR< IPV, 수두, B형간염, A형간염, 뇌수막염, 인플루엔자백신과 동시 접종이 가능해
하지만 현재 접종되고 있는 DTaP백신은 제조사마다 백신제제가 표준화 되어 있지 않기 때문에 기초접종 3회는 동일제조사의 백신으로 접종하는 것이 원칙이고 추가접종의 경우에는 기초접종시와 다른 백신과 교차접종이 가능하다고한다.
자....우리병원에는 무엇이 있는지 살펴볼까?
티디퓨어백신(XTD) --> Td 백신임
0.5㎖ 중 성인용 흡착 diphtheria toxoid 2IU 이상 ----d
흡착 tetanus toxoid 20IU 이상 –T
아다셀(XADAC) --> Tdap 백신
11~64세 1회 접종--과거에는 7세이후에는 Td하라고 했으나
사춘기아이 혹은 성인에게서도 빌생할수있으므로 Tdap 권장
0.5㎖ 중 tetanus toxoid ≥20IU 5LF – T
diphtheria toxoid ≥2IU 2LF – d
B. pertussis toxoid 2.5㎍ – aP
FHA 5㎍
FHA 2+3 5㎍
디피티트리백신(XDPT5) ---> DTaP
0.5㎖ 중 diphtheria toxoid 16.7LF 이하 –D
tetanus toxoid 26.7㎍ 이하 à T
inactivated purified protective antigen of B.pertu 4IU 이상 aP
인판릭스 ( XINFA) à DTaP
PT와 FHA이외에도 pertactin이라는 성분이 더 추가되어 백일해의 면역력을 증강시킴
첨가제인 젤라틴과 보존제인 치메로살을 첨가하지않음
0.5㎖ 중 diphtheria toxoid (균주명: Mass 8주) 30IU 이상 – D
tetanus toxoid (Massachusetts 주) 40IU 이상 – T
백일해균 항원 B. pertussis toxoid 25㎍ – aP
inactivated B. pertussis filamentous haemagglutini 25㎍
inactivated B. pertussis 69kDa outer membrane prot 8㎍
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Q 어떤제품은 IU로 표기되고...어떤것은 LF...mcg등..다양한 단위를 사용하는데..
다른 단위를 사용하는 이유와 ...비교하는 방법이 있나요?
A. 다른 단위를 사용하는 이유는 국가, 회사마다 사용하는 단위가 다르기 때문입니다.
mcg는 절대적인 단위이지만 IU와 Lf는 각 항원과 항체가 반응하는 양에 따라 나타내는 생물학적 단위이므로
mcg, IU와 Lf 간의 단위환산방법은 확인할 수 없습니다.
처방의약품에서도 동일한 성분이 함유되어 있더라도 제형에 따라 효과에 차이가 있듯이 백신에서도 동일한 항원으로
나타내더라도 사용하는 균주가 다르기 때문에 다른 제조사 백신의 항원량을 절대적으로 비교하는 것보다는 임상시험에
서 나타나는 효과를 비교하는 것이 좋습니다.
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시간나면 ..아래도 읽어 봐주고............ end
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diphtheria, tetanus, acellular pertussis vaccine
What is diphtheria, tetanus, acellular pertussis vaccine?
Diphtheria, tetanus, and pertussis are serious diseases caused by bacteria.
Diphtheria causes a thick coating in the nose, throat, and airways. It can lead to breathing problems, paralysis, heart failure, or death.
Pertussis (whooping cough) causes coughing so severe that it interferes with eating, drinking, or breathing. These spells can last for weeks and can lead to pneumonia, seizures (convulsions), brain damage, and death.
Tetanus (lockjaw) causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim cannot open the mouth or swallow. Tetanus leads to death in about 1 out of 10 cases.
Diphtheria and pertussis are spread from person to person. Tetanus enters the body through a cut or wound.
The diphtheria, tetanus acellular, and pertussis pediatric vaccine (also called DTaP) is used to help prevent these diseases in children who are ages 6 weeks to 6 years old (before the child has reached his or her 7th birthday).
This vaccine works by exposing your child to a small dose of the bacteria or a protein from the bacteria, which causes the body to develop immunity to the disease. This vaccine will not treat an active infection that has already developed in the body.
Like any vaccine, the DTaP vaccine may not provide protection from disease in every person.
What is the most important information I should know about diphtheria, tetanus, acellular pertussis vaccine?
This vaccine is given in a series of shots. The first shot is usually given when the child is 2 months old. The booster shots are then given at 4 months, 6 months, 15 months, and 18 months of age, and again between 4 and 6 years of age. Your child's individual booster schedule may be different from these guidelines. Follow your doctor's instructions or the schedule recommended by your local health department.
Be sure your child receives all doses of this vaccine recommended by your healthcare provider or by the health department of the state you live in. If the child does not receive the full series of vaccines, he or she may not be fully protected against the disease.
Your child can still receive a vaccine if he or she has a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until the child gets better before receiving this vaccine.
Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot. Keep track of any and all side effects your child has after receiving this vaccine. When the child receives a booster dose, you will need to tell the doctor if the previous shots caused any side effects.
Becoming infected with diphtheria, pertussis, or tetanus is much more dangerous to your child's health than receiving the vaccine to protect against these diseases. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.
What should I discuss with my healthcare provider before receiving this vaccine?
Your child should not receive this vaccine if he or she has ever had a life-threatening allergic reaction to any vaccine containing diphtheria, pertussis, or tetanus, or if the child has: Your child may not be able to receive this vaccine if he or she has ever received a similar vaccine that caused any of the following:
a very high fever (over 104 degrees);
a neurologic disorder or disease affecting the brain;
excessive crying for 3 hours or longer;
fainting or going into shock;
seizure (convulsions); or
Guillain-Barré syndrome (within 6 weeks after receiving a vaccine containing tetanus).
Before receiving this vaccine, tell the doctor if your child has:
a bleeding or blood clotting disorder such as hemophilia or easy bruising;
a history of seizures;
a neurologic disorder or disease affecting the brain (or if this was a reaction to a previous vaccine);
a weak immune system caused by disease, bone marrow transplant, or by using certain medicines or receiving cancer treatments; or
if the child is taking a blood thinner such as warfarin (Coumadin); or
if it has been less than 4 weeks since the child last received a DTaP vaccine.
Your child can still receive a vaccine if he or she has a cold or fever. In the case of a more severe illness with a fever or any type of infection, wait until the child gets better before receiving this vaccine.
The pediatric version of this vaccine (Daptacel, Infanrix, Tripedia) should not be given to anyone over the age of 6 years old. Another vaccine is available for use in older children and adults.
How is this vaccine given?
This vaccine is given as an injection (shot) into a muscle. Your child will receive this injection in a doctor's office or other clinic setting.
This vaccine is given in a series of shots. The first shot is usually given when the child is 2 months old. The booster shots are then given at 4 months, 6 months, 15 months, and 18 months of age, and again between 4 and 6 years of age. Your child's individual booster schedule may be different from these guidelines. Follow your doctor's instructions or the schedule recommended by your local health department.
Your doctor may recommend treating fever and pain with an aspirin-free pain reliever such as acetaminophen (Tylenol) or ibuprofen (Motrin, Advil, and others) when the shot is given and for the next 24 hours. Follow the label directions or your doctor's instructions about how much of this medicine to give your child.
It is especially important to prevent fever from occurring in a child who has a seizure disorder such as epilepsy. What happens if I miss a dose?
Contact your doctor if you will miss a booster dose or if you get behind schedule. The next dose should be given as soon as possible. There is no need to start over.
Be sure your child receives all doses of this vaccine recommended by your healthcare provider or by the health department of the state you live in. If the child does not receive the full series of vaccines, he or she may not be fully protected against the disease.
What happens if I overdose?
An overdose of this vaccine is unlikely to occur.
What should I avoid before or after receiving this vaccine?
There are no restrictions on food, beverages, or activity before or after receiving DTaP vaccine unless your child's doctor has told you otherwise.
Diphtheria, tetanus, acellular pertussis vaccine side effects
Your child should not receive a booster vaccine if he or she had a life-threatening allergic reaction after the first shot. Keep track of any and all side effects your child has after receiving this vaccine. When the child receives another diphtheria, tetanus, acellular pertussis vaccine in the future, you will need to tell the child's doctor if the first shot caused any side effects.
Becoming infected with diphtheria, pertussis, or tetanus is much more dangerous to your child's health than receiving the vaccine to protect against these diseases. Like any medicine, this vaccine can cause side effects, but the risk of serious side effects is extremely low.
Get emergency medical help if your child has any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Call your doctor at once if the child has any of these serious side effects:
extreme drowsiness, fainting;
fussiness, irritability, crying for an hour or longer;
seizure (black-out or convulsions); or
high fever.
Less serious side effects include:
mild fever or chills;
redness, pain, tenderness, or swelling where the shot was given;
mild fussiness or crying;
joint pain, body aches;
loss of appetite; or
mild nausea, diarrhea, or vomiting.
This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report vaccine side effects to the US Department of Health and Human Services at 1-800-822-7967.
Read more: http://www.drugs.com/mtm/diphtheria-tetanus-acellular-pertussis-vaccine.html#ixzz0t3BIwNsq