摘要
目的调查某病例在接种卡介苗(Bacille Calmette-Guerin,BCG)先后发生免疫缺陷、淋巴结炎事件与注射疫苗之间的关联性。方法开展个案调查,收集受种方、接种方、疫苗生产企业等相关资料;开展预防接种异常反应(Adverse events following immunization,AEFI)调查诊断,提出诊断结论。结果病例于2016年6月23日9:00接种BCG;2016年7~8月因肺部感染等先后在4家医院就诊住院,基因检测报告:CYBB及NCF1突变,临床诊断为免疫缺陷病(慢性肉芽肿病);2016年8月双侧腋下软组织超声检查发现淋巴组织增大;2017年1月右侧腹股沟淋巴结肿大,PPD试验强阳性。2017年2~5月行脐带干细胞移植手术,并植入成功。2017年6月~2018年2月给予抗结核药物治疗。2017年8月,县级AEFI调查诊断为:接种BCG后发生淋巴结炎属于异常反应(Rare vaccine reaction,RVR),市级医学会开展伤残等级鉴定结论为:三级戊等伤残。预防接种过程符合操作规程,疫苗质量合格。结论某病例免疫缺陷病(慢性肉芽肿病)与接种BCG无关联,为偶合症(Coincidental illness,CI);淋巴结炎则属于RVR。
Objective To investigate the association between immunization with Bacille Calmette Guerin(BCG)and subsequent immunodeficiency,lymphadenitis events and vaccination in one case.Methods A case investigation was carried out to collect the relevant data of recipient,inoculator and vaccine manufacturers.Investigation and diagnosis were carried out about immunization abnormal reaction(Adverse events following immunization,AEFI),and the diagnosis conclusions were put forward.Results The case was inoculated with BCG at 9:00 am on June 23,2016.From July to August 2016,he was admitted to four hospitals successively due to pulmonary infection and other reasons.Gene test report:mutation of CYBB and NCF1,clinical diagnosis of immunodeficiency disease(chronic granulomatosis).In August 2016,ultrasound examination of bilateral subaxillary soft tissue showed enlargement of lymphoid tissue;right inguinal lymph node enlargement in January 2017 and the PPD test was strongly positive.Umbilical cord stem cell transplantation was performed from February to May 2017,and the implantation was successful.Anti-tuberculosis drugs were given from June 2017 to February 2018.In August 2017,a countylevel AEFI survey diagnosed Rare vaccine reaction(RVR)as lymphadenitis after BCG vaccination.The municipal medical association carried out disability grade identification conclusion was:grade 3 e disability.The vaccination process was in accordance with the operating procedures and the quality of the vaccine was up to standard.Conclusion In some cases,immunodeficiency disease(chronic granulomatosis)is not associated with vaccination with BCG,which is Coincidental illness(CI),but the lymphadenitis of this case was confirmed RVR.
作者
王文祥
沙娜
马敬仓
于民
徐凌忠
WANG Wenxiang;SHA Na;MA Jingcang;YU Min;XU Lingzhong(Cao County Health and Family Planning Comprehensive Supervision and Law Enforcement Bureau,Shandong274300,China;不详)
出处
《医学动物防制》
2020年第3期296-299,共4页
Journal of Medical Pest Control
基金
国家自然科学基金委员会面上项目(71673169).
关键词
疫苗
偶合症
卡介苗
免疫缺陷
伤残鉴定
Vaccine
Coincidental illness
Bacille Calmette Guerin
Immunodeficiency
Disability identification
