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【聯合線上企劃／採訪醫師：台大醫院胸腔內科主治醫師 郭炳宏】

東北鋒面連連來襲 日夜溫差大50歲以上成人流感併發肺炎重症感染率恐升

流感+肺炎重症致死率達2成！ 接種肺炎鏈球菌疫苗預防刻不容緩！

近日氣象報導不斷提醒東北鋒面將至，民眾外出時也明顯感受到日夜溫差加劇，當心流感好發期趁勢接踵而至。根據統計，至9月9號為止，流感併發症的人數已超過800人，其中有逾6成ⁱ為50歲以上成年人，更不乏有流感併發肺炎重症而死亡的案例發生。台大醫院胸腔內科主治醫師郭炳宏表示，流感並非患者致死主因，因流感而併發之肺炎鏈球菌等重症才是致死關鍵。這是因為流感為上呼吸道疾病，病毒會破壞上呼吸道的鼻咽表皮，引發存在鼻腔內的肺炎鏈球菌侵襲，易導致肺炎、腦膜炎、菌血症等重症。因此呼籲，50歲以上成年人，預防肺炎勿存僥倖，應當在好發期來臨之前，盡快施打保護時間較長的新型結合型肺炎鏈球菌疫苗。

流感併發肺炎重症死亡率高達2成 當心併發多重器官衰竭
隨著年齡增長，50歲以上成人的免疫力逐漸下降，郭炳宏醫師表示，一般成人流感同時併發肺炎重症，死亡率高達近2成。特別是患有糖尿病、洗腎、愛滋病、癌症等免疫系統疾病者，罹患流感的機率更是倍增，更容易引起肺炎鏈球菌侵襲，導致併發肺炎、腦膜炎等重症，死亡率更攀升至3成以上。

郭炳宏醫師更進一步表示，患有糖尿病、高血壓、腎臟病等慢性疾病的成人，若感染肺炎鏈球菌，除了引發導致肺部衰竭的肺炎外，也可能會引發腎臟或肝臟等多重器官衰竭，因此對於50歲以上高危險族群而言，併發肺炎鏈球菌感染是相當危險。

發病進程快速 「預防」成關鍵
郭炳宏醫師表示，肺炎鏈球菌從感染到發病進程快速，若無細心觀察，就醫時則可以已經出現呼吸衰竭等不可逆傷害。醫師呼籲，與其擔憂肺炎鏈球菌襲擊，不如及早接種肺炎鏈球菌疫苗，才是最有效預防侵襲性肺炎鏈球菌感染的方式。

「保護時間長短」為選擇肺炎鏈球菌疫苗關鍵
目前針對成人來說肺炎鏈球菌疫苗可分作新型「肺炎鏈球菌結合型疫苗」及舊型「肺炎鏈球菌多醣體疫苗」，主要的區別在於「保護時間」。具有「免疫記憶力」的新型「肺炎鏈球菌結合型疫苗」，能成功誘發免疫記憶，提高體內抗體濃度高，進而比舊型疫苗的保護時間更長，甚至能高達10年。倘若過去已有公費接種過舊型多醣體疫苗者，做第二劑的補強接種也可成功產生有效的抗體反應ⁱⁱ，且可有效降低鼻咽腔帶菌，產生群體保護效果。而舊型多醣體疫苗由於製作機轉問題，疫苗沒有免疫記憶力，保護效期只有2~4年ⁱⁱⁱ，即使後來繼續補打，效果仍有限。

郭炳宏醫師建議，5歲以下以及65歲以上成人，因免疫力較低，都應優先接種肺炎鏈球菌結合型疫苗。根據衛生署公布最新版本的結合型疫苗接種建議中，也建議針對65歲以上民眾以及50歲以上高危險族群，曾接種過舊型多醣體疫苗者，間隔1年以上，可再接種1劑新型結合型疫苗，用以補強免疫記憶力及強化體內抗體反應。秋冬疾病好發期將至，及早預防才能有效降低感染風險。

參考資料：
ⁱ2013年疾管署流感併發症流感併發人數39周統計資料
ⁱⁱPCV13 Clinical Development Program phase 3
ⁱⁱⁱPicture courtesy Prof. Zepp, Gutenberg-University, Mainz; References on note page

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