My little 16 month old son Owen just came home from the hospital that has been his home since early Monday after successfully fighting a Rotavirus.

Man - this is NOT something you want your kids to come in contact with. The poor little guy has been though Hell.

Owen is not a, uh, big guy. You know those growth charts that plot age and weight? Well, he's looking up at the curves. Tho' lately he has been gaining weight at a greater rate than other kids his age. But he doesn't exactly have a lot of "reserve capacity".

BUT, he somehow contracted this most brutal bug and has been hospitalised since Monday at 7 am. I had to think about the timing considering I am a little punch-drunk at the moment. Sleep deprivation and stress, ya know.

He started showing symptoms (i.e., he threw up) at 11:15 on Thursday night. Was not well through Friday but showed signs of improvement on Saturday. But his fever peaked over Saturday night despite doses of Tylenol. 7 am Sunday, we're off to CHEO where they try to stick needles in his hand, but he was too dehydrated to present a good vein.

They found a vein in the crook of his arm and we're admitted. While hospitals are not places that one wants to frequent very often, it was the best place he could be given the circumstances.

So, Colleen spent a couple of nights with him and I did some day duty while at watch over our very ill little boy. We hope that he hasn't spread this any further.

Addy (4 year old) complained of a headache before bed last night and had a temp of a 100. Called Torii and she's in bed cuz she doesn't feel well. But both kids were fine this morning

It was a long few days but he seems much, much better and he is VERY happy to be home - as are we.

Doncha love parenthood?

When will "they" have a vaccination against EVERYTHING?

Oh, and yesterday was the day that Colleen and I should have been celebrating our 7th anniversary.

But most importantly, Owen is better and we can get on with our lives.

Neben den allgemeinen Untersuchungen stand heute das Impfen an. Ich habe die ganze Nacht nicht geschlafen, weil ich immer überlegt habe, was das Beste für mein Kind ist. Impfen finde ich wichtig, aber wie war die Frage. Wir haben uns dann aber gemeinsam (Stephan war mit zur Untersuchung)  für die 5-fach Impfung entschieden. Die 6-fach (mit HepathitisB) Impfung war mir dann doch zu stark, gerade auch unter dem Aspekt, dass ich mich auch erst gegen Hepathitis impfen lassen habe, als ich nach Südafrika vor vielen Jahren flog. Sollten wir dann mal eine größere Auslandsreise mit Gustav unternehmen, kann ich ihn immer noch dagegen impfen lassen.

Neben der 5-fach Impfung (die er in den Oberschenkel bekam *auha*) hat er noch eine Schluckimpfung gegen den Rotavirus (Durchfall und Brechen) bekommen.

Ich habe ja lange mit mir gehadert, ob ich nicht alles einzeln impfen lasse oder was ich überhaupt tue. Letztendlich habe ich mich dafür entschieden, weil ich noch voll stille und Gustav so eine gute Abwehr entwickelt hat und durch die Muttermilch immer noch bekommt. So hoffe ich, dass es die richtige Entscheidung war.

Natürlich hat er bei der Spritze total geschrieen und war bis eben total anhänglich. Jetzt ist er eingeschlafen und hoffentlicht bekommt er kein Fieber. Wir sind zwar seit heute gegen das Fieber ausgerüstet, es wäre aber schön, wenn wir die Zäpfchen nicht einsetzen müssen. Jetzt heißt es abwarten und Daumen drücken...

In 4 Wochen sind wir wieder dran, dann wird er gegen Pneumokokken geimpft.

Her sister, sweet Mimi has had mucousy poops for the past three or four days, accompanied by a very painful diaper rash. I'm wondering if it's the same medical issue manifesting itself in different ways in different people. Who the hell knows. I'm exhausted. Maybe my pediatrician will get back to me one day for some advice or thoughts on the matter. I will be very pissed if it all turns out to be rotavirus, which they have been vaccinated for, which I wasn't really 100% on giving them. If that is what it is, they will not have that vaccination again. For that matter, I should probably re-schedule their 18+ month visit, which includes a slew of shots for a time when they are a little stronger and not so vomity and poopy. I could really get into having a beer right now, at an outdoor cafe somewhere, in the warmth, under an umbrella or something. Maybe on a beach, white sand, clear blue water. Something frutier, more tropical would be appropriate for my island paradise where no babies have the shits and nobody throws up. And I get to sleep as long as I want to.

This latest offering by Offit is entitled "Inoculated Against Facts", and appeared in the NYT on the of 31st of March in response to the media frenzy surrounding the Hannah Poling vaccine court settlement. Offit is obviously worried that the Poling case is going to have fewer people vaccinating, because he spends a lot of time trying to make it seem as though the decision to settle this case was nonsensical, and that the underlying health problem for Hannah Poling (even though no one knows if it existed before the vaccines or not) is extremely rare. He even goes so far as to as to say the "...vaccine court judges have turned their back on science by dropping preponderance of evidence as a standard." He complains that now petitioners need only "propose a biologically plausible mechanism" in order to prevail in vaccine court. Thankfully, the Polings (who are a physician, lawyer and nurse between them) seem quite committed to setting the record straight on both medical and legal fronts, and have done so here, as a rebuttal to this op-ed in the New York Times, and in the Atlanta Journal-Constitution, (text at the end of this post).

As usual, there is some (junk) food for thought in the comments, courtesy of the New York Times faithful, intelligent, well-educated readers. I'm getting a little hardened to all the tedious rhetoric in those comments, by people who clearly just repeat the propaganda, with very little understanding of what it means. But the best one is this one, from JJ, from Boulder, Colorado. Here's a partial quote:

It's called "public health" for a reason: the health of the public is put first, and for good reason. I say this as a parent of a 3 yr old who has received all shots on time; I asked appropriate questions about those shots as they came up (re. thimerosal, etc.) but never questioned whether I would vaccinate, because I believe in something called civic responsibility.

I was absolutely gobsmacked. Do you think that if JJ had gotten his/her child vaccinated, and s/he stopped speaking and lost all eye contact within a week, that they'd be together at pro-vaccine demonstrations these days, with their kid in an over-sized, disabled child's stroller, with a big sign proclaiming the pride in the sacrifice of their child for the benefit of everyone else? The only persons confident enough to moralize about people not risking their children's well-being for the greater good are those who have already made the "sacrifice" and emerged unscathed. Those who are not so lucky have a very different perspective.

_____________________h

By Jon S. Poling

For the Atlanta Journal-Constitution

Published on: 04/11/08

Autism in the U.S. has reached epidemic levels, at 1 in 150 children. Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, has recently upgraded autism to "an urgent health threat." The most contentious issue of the autism debate is the link to routine childhood vaccines. My daughter's case, Hannah Poling v. U.S. Department of Health and Human Services, has changed this debate forever. Hannah has pointed us in a new and promising direction —- the mitochondria. On Nov. 9, 2007, HHS medical experts conceded through the Department of Justice that Hannah's autism was triggered by nine childhood vaccinations administered when she was 19 months of age. This concession was granted without any courtroom proceedings or expert testimony, effectively preventing any public hearing discussing what happened to Hannah and why. Contrary to some reports, the Special Masters, "judges" who preside over the "vaccine court," did not issue a decision. Four months later, on March 6, with trepidation my wife, Terry, and I stepped forward to announce this news —- providing hope and awareness to other families. The HHS expert documents that led to this concession and accompanying court documents remain sealed, though our family has already permitted release of Hannah's records to those representing the almost 5, 000 other autistic children awaiting their day in vaccine court. Mitochondria key To understand Hannah's case, it is important to understand mitochondria, which act like batteries in our cells to produce energy critical for normal function. Because the government's concession hinged on the presence of Hannah's underlying medical condition, mitochondrial dysfunction, some claim the decision is relevant to very few other children with autism. As a neurologist, scientist and father, I disagree. Emerging evidence suggests that mitochondrial dysfunction may not be rare at all among children with autism. In the only population-based study of its kind, Portuguese researchers confirmed that at least 7.2 percent, and perhaps as many as 20 percent, of autistic children exhibit mitochondrial dysfunction. While we do not yet know a precise U.S. rate, 7.2 percent to 20 percent of children does not qualify as "rare." In fact, mitochondrial dysfunction may be the most common medical condition associated with autism. Biological markers Although unlikely, if the Portuguese studies are incorrect and mitochondrial dysfunction were found to be a rarity occurring in less than 1 percent of all autism, it would still impact up to 10,000 children (250,000 worldwide), based on current estimates that 1 million people in the U.S. (25 million worldwide) have autism. If, on the other hand, the research showing that 7.2 percent to 20 percent of children with autism have mitochondrial dysfunction is correct, then the implications are both staggering and urgent. Autism researchers do not currently understand whether mitochondrial dysfunction causes autism or is simply a secondary biological marker. Autism clearly has many different causes, and should really be separated into multiple autism(s). I propose that we clearly identify and research the subpopulation term of "mitochondrial autism," which is distinguished by its unique biological, but not genetic, markers. Based on what we know now, it is time to follow the prestigious Institute of Medicine 2004 report regarding autism and vaccines: "Determining a specific cause (for autism) in the individual is impossible unless the etiology is known and there is a biological marker. Determining causality with population-based methods requires either a well-defined at-risk population or a large effect in the general population." A paradigm shift When the IOM report was published, mitochondrial dysfunction defining an autistic subpopulation was not firmly established. Today there is no doubt that mitochondrial dysfunction represents a distinct autism subpopulation biological marker. I urge health officials and the IOM to embrace their own report and pursue this breakthrough in the science of autism. National public health leaders, including those at CDC, must now recognize the paradigm shift caused by this biological marker with regard to their current position of dispelling a vaccine-autism link. In light of the Hannah Poling concession, science must determine more precisely how large the mitochondrial autism subpopulation is: 1 percent, 7.2 percent, 20 percent? Based on the 2004 IOM analysis, if the mitochondrial autism subpopulation is found to be relatively uncommon, then all conclusions from prior epidemiological studies refuting an autism-vaccination link must be discarded. New studies then need to be performed exclusively with the mitochondrial subpopulation. If mitochondrial autism turns out to be common, then we could re-analyze the data from prior studies to determine if these studies were powered sufficiently based on a predicted effect size. If not powered appropriately, the conclusion refuting an autism-vaccine link would again have to be rejected. These statistical concepts are basic. The current vaccine schedule, co-sponsored by the CDC and the American Academy of Pediatrics, injures a small but significant minority of children, my daughter unfortunately being one of those victims. Every day, more parents and some pediatricians reject the current vaccine schedule. In an abundance of caution, meaningful reform must be performed urgently to prevent the re-emergence of serious diseases like polio or measles. Need for research As a neurologist, I have cared for those afflicted with SSPE (a rare but dreaded neurological complication of measles), paralytic polio and tetanus. If these serious vaccine-preventable diseases again become commonplace, the fault will rest solely on the shoulders of public health leaders and policymakers who have failed to heed the writing on the wall (scribbled by my 9-year old daughter). The mitochondrial autism scenario that my daughter has so eloquently painted has the CDC and public health experts logically cornered. Denial and fear tactics won't close Pandora's Box. Whether we find that mitochondrial autism is rare or common, there is urgent research left to be done to fully understand the interrelationship of vaccines, autism and mitochondria. Reform of the vaccine schedule will be an important part of the solution, whether vaccines play a major or minor role in autism. Our public health agencies and programs need a reconstruction plan. Day one of the reconstruction hopefully starts at the Vaccine Safety Advisory Committee's Working Group, to be held at HHS headquarters today in Washington. > Dr. Jon S. Poling is a practicing neurologist in Athens and clinical assistant professor at the Medical College of Georgia.

essa coisinha asquerosa é a imagem que mais aparece no Google, quando se procura em imagens por "rotavírus". eu tive a infelicidade de pegar essa pereba nesse feriadão de páscoa que fui passar em Pelotas.

Rotavírus é um tipo de vírus da família Reoviridae, do gênero Rotavírus. São classificados sorologicamente em grupos, subgrupos e sorotipos. Até o momento, sete grupos foram identificados: A, B, C, D, E, F e G, sendo que os grupos A, B e C estão associados à doença no homem. O Rotavírus vêm sendo considerado em todo mundo o principal responsável por diarréia em crianças menores de 5 anos e tem sido a principal causa de surtos de diarréia em hospitais, berçários, creches e pré-escolas. Crianças prematuras ou com deficiência imunológica estão sujeitas à manifestação da doença com maior gravidade, podendo levar até a morte. Adultos também podem ser infectados, mas a doença tende a ser mais moderada, porém causando grande mal-estar. A criança ou adulto pode ser contaminado mais de uma vez devido à existência de mais de um sorotipo de rotavírus.

antes de mim, o safadinho já tinha se atracado no meu pai, na minha mãe, na minha irmã e no meu cunhado. só que quando cheguei lá, já estava todo mundo bem. sobrevivi saudável por dois dia. eis então que, dando uma volta de carro em busca do que fazer numa noite de sexta acabei decidindo, subitamente, voltar pra casa, já que comecei a me sentir estranha.

como se não bastasse Pelotas "possuir um leque de opções para divertimento noturno variadíssimo", o buteco que eu queria ir fechou na sexta. porque? porque era sexta-feira santa e ninguém come carne. como assim ninguém? eu como! e quem não come também come outras coisas, toma cerveja, quer sair com os amigos... mas não. eles preferiram fechar, em nome de cristo, creio eu :P

enfim. fui pra casa meio estranha. ainda bem que fui! não deu dois minutos e eu já estava quase morrendo no banheiro. como não gosto de sofrer, não tenho saco pra esperar a coisa passar e não tinha nada de bom pra fazer em Pelotas, fiz meu pai me levar pro pronto-socorro da Unimed. ah, claro, me diverti muito mais lá! saí chapada de tanto soro. a enfermeira dizia "ai, vou abrir um pouco mais esse soro"... e eu "isso, querida, abre tudo!!! entope essa veia de soro porque senão eu vou sumir de tanto vomitar!!!".

3 da manhã, papai e eu na avenida comprando remédios e logo voltando pra casa achando que o pior havia passado. 4h11 lá estou eu de novo urrando no banheiro porque náusea eu tinha de sobra, só que o que vomitar, putz... já tinha acabado há séculos. eu já não sabia mais o que acontecia na minha volta de tanto dramin, buscopan e plasil que me davam. às vezes eu acordava com meu pai ou minha mãe do lado perguntando como eu estava, mas eu não podia nem falar nem me mexer senão enjoava e vomitava tudo o que não tinha.

no domingo saí da cama. sem força nem pra ficar em pé. consegui voltar pra poa, mas ainda continuo enjoada e sem força pra nada. ainda bem que ainda não comecei a trabalhar. imagina o vexame chegar doente contaminando a até os computadores na minha volta?! :P

mas agora é sério:  Adultos também podem ser infectados, mas a doença tende a ser mais moderada, porém causando grande mal-estar. A criança ou adulto pode ser contaminado mais de uma vez devido à existência de mais de um sorotipo de rotavírus.

grande mal-estar é apelido. eu achei que ia morrer ou então vomitar todos os órgãos que eu tenho dentro de mim. ser contaminada outra vez? já aviso, me levem pra Unimed e me dêem 10 tubinhos de soro iguais aos que tomei da última vez!!!!

John Hopkins大學與Aridis Pharmaceuticals合作研發出一種新產品
用嘴巴含的輪狀病毒疫苗薄片

這薄薄一片含在嘴裡會自動融化
放出有效成分
它的靈感顯然是來自市面上販售的口氣清爽薄片(breath-refreshing strips)

他們很聰明的先用一種polymer把輪狀病毒疫苗包裹起來
使得輪狀病毒疫苗不會在薄膜的製造過程中遭到破壞
也不會在胃酸中遭到分解
一直到小腸中才會釋放出來

發明這項產品的只是幾位年輕的學生

看起來不是中國人就是印度人

這種劑型疫苗的另外一個強處是很穩定
儲存與運送不必低溫
非常方便
現有的疫苗必須低溫保存
在許多落後國家不可行
因為他們沒有冰箱
就算你送他們冰箱
他們也沒有電
有了這種劑型的疫苗
低溫保存的問題也就一併解決了

雖然這還是一項概念性的產品
尚有待許多試驗來證明可行性與效果
但是真的讓人感觸良多
科技一日千里
希望以後小朋友吃的藥都可以有這種方便的劑型
而且Johns Hopkins果然了得
大學部學生就有這樣的創意與環境研發出這樣的產品
我們佩服之餘真該急起直追

請看Headlines@Hopkins的報導

Al margen de que no salí del hotel desde que llegué hasta que salí rumbo al aeropuerto de vuelta a Chile debido al exceso de trabajo, debo decir que lo que más me llamó la atención es lo rápido que Chile se está quedando atrás en comparación a otros países sudamericanos -mucho más pobres que el nuestro- en materia de vacunas y el poco interés evidenciado por nuestras autoridades al respecto.

Resumo. El simposio discutió acerca de la necesidad de incorporar a la brevedad a los calendarios regulares de vacunación las vacunas contra el rotavirus, el neumococo y el virus papiloma humano. El primero, causa diarreas y la muerte de unos 20 mil niños al año en esta zona del mundo; el segundo, neumonías y menigitis gravísimas, con unos 18 mil muertos al año; el tercero, es el principal factor de riesgo de cáncer cervicouterino.

Venezuela anunció que incorporará la vacuna contra el neumococo en sel segundo semestre de este año, financiándola con recursos propios pagados a través del Fondo Rotatorio de la OPS, pagando U$ 35 por dosis (se requieren 3). La vacuna contra el rotavirus ya la incluyó hace un par de años y la de VPH espera agregarla en un par de años más.

Bolivia ha determinado inmunizar a todos sus niños contra el rotavirus a partir de julio de este año y dentro de su plan contempla incorporar la vacuna del neumococo en el año 2010. La vacuna del rotavirus será financiada en 50% por aportes de la Alianza GAVI. La del VPH quedará para después de 2012.

Ecuador ha tomado la decisión de incorporar la vacuna del neumococo en forma gradual, partiendo con niños de alto riesgo en el transcurso de este año. Luego hará estudios acabados para buscar modelos de financiamiento o incorporación gradual. Pero no descarta ir a una meganegociación con Venezuela a través del Fondo Rotatorio de Vacunas de la OPS.

Diarios mexicanos recogieron justo cuando estaba en Venezuela que la inmunización contra el neumococo ya alcanza la universalidad, tras un proceso de incorporación gradual que partió por poblaciones indígenas y pobres.

Costa Rica la incorporará en el transcurso de este año para todos los niños.

Y Uruguay hará lo propio, partiendo por la población adscrita al sistema público de salud.

Lo llamativo es que Chile es uno de los países con mayor cantidad de estudios y evidencia científica respecto de estas nuevas vacunas. Y llama la atención que con los recursos generados por el cobre y los impuestos, no se adopte la decisión de incorporar la vacuna contra el neumococo en forma universal, ya que es el agente que da más problemas. Por ahora sólo la tiene incorporada para un grupo muy reducido de niños en situación grave. Pasa lo propio con la del rotavirus, enfermedad que ocasiona miles de hospitalizaciones anuales y el virus papiloma, una situación que en pocos años será muy compleja dado los niveles de actividad a corta edad de las niñas chilenas.

No sólo eso, es sabido entre los especialistas en el tema, que el ministerio de Salud tiene una posición reacia a incorporar nuevas vacunas al programa de inmunización debido al costo de estas nuevas vacunas. Pero estudios de costo efectividad ya muestran que hoy en Chile se ahorra más dinero vacunando que atendiendo niños en UCI por neumonías o meningitis, se liberan camas hospitalarias y se descongestiona la red pública especialmente en invierno. Lo peor de todo es que los niños chilenos con dinero sí se vacunan contra estos tres problemas y los pobres no.

Chile se está quedando atrás y las autoridades no dan opciones o soluciones inteligentes.

¿Debemos aceptar esta inequidad?

Es  época epidémica de gastroenteritis aguda (GEA) consecuencia del virus llamado rotavirus, que provoca episodios más largos y persistentes de vómitos, diarrea y fiebre. Lo se de buena tinta porque el sábado estuve todo el día en el hospital ¡con mi peque! y por desgracias  ¡mi niño no era el único! Ya que había otros 25 niños con los mismos síntomas. Y según me comentaron los pedíatras de urgencias “es temporada alta para estos virus” y los demás centros hospitalarios también están saturados con estos.

Mi niño empezó con vómitos, luego al cabo de las horas, diarrea, y finalmente fiebre bastante alta, la verdad es que te asustas bastante cuando los ves tan pequeños y sufriendo tanto , pero lo mejor es mantener la calma y acudir cuanto antes al especialista, ya que a parte de los síntomas que este virus provoca los niños ¡se pueden deshidratar!. Y  ¿Cómo sabemos si se están deshidratando?, pues debemos observar si existe sequedad de mucosas (principalmente en ojos y boca) y de piel, si existe menos cantidad de pis, si se produce un aumento de la sed o aparece espuma espesa en la boca, si los ojos se empiezan a  hundir, irritabilidad y sobretodo si el niño apenas se mueve…en el caso de mi niño, este sólo quería agua a toda costa, se puso muy irritable y comenzó a tener espuma en la boca ¡menos mal que ya estábamos en urgencias ¡sino me da algo! (ya que soy bastante nerviosa).

Debemos seguir las recomendaciones que nos de el pediatra, que generalmente serán darnos un antitérmico para bajar la fiebre ( si esta es mayor de 38º), seguir dieta normal pero si continua vomitando ofrecer oralsuero 5ml cada15 min y si lo va tolerando durante 1 hora ofrecérselo cada 5 min y pasadas 2 ó 3 horas ofrecer alimentos, control por su pediatra y si empeora, vomita los líquidos, decaimiento, síntomas de deshidratación volver.

¡Ah! y debéis tener especial cuidado si tenéis más niños en casa ¡ya que es bastante contagioso!, porque  que se transmite vía oral ( mi niña lo cogió también horas después, porque es muy cariñosa y no paraba de darle mimos a su hermano pequeño).

Vía: Entrebebes.com

輪狀病毒疫苗就是一個例子
葛蘭素(GSK)與默沙東(MSD)兩家藥廠都有輪狀病毒疫苗
分別叫做Rotarix與RotaTeq
兩種有什麼差別?
該如何選擇?

今年七月著名的醫學期刊The Lancet有一篇review
摘譯其內容
給爸爸媽媽們參考

輪狀病毒疫苗比較表請點rotarix-vs-rotateq.doc

特別提醒大家
閱讀此表時必須注意
兩種疫苗研究結果中的數字不宜直接比較
因為兩項疫苗研究進行時有關嚴重輪狀病毒感染的定義不同
兩種疫苗的研究也是在不同的國家做的

另外
兩種輪狀病毒疫苗的價錢略有不同
台大醫院96年11月的價錢是
葛蘭素的Rotarix,一劑要價2125,使用兩劑,總共要4250元
默沙東的RotaTeq一劑要價1775,使用三劑,總共要5325元

(以上價錢僅供參考,當中不含掛號費,診察費,與藥事服務費等,
每家醫院定價不同,而且隨時有可能調整)

延伸閱讀
輪狀病毒
輪狀病毒疫苗
輪狀病毒發生genotype replacement

肺炎鏈球菌自2000年在美國大規模使用以來
常見的肺炎鏈球菌已經出現serotype replacement的情形
也就是說
以往常見的肺炎鏈球菌血清型因為疫苗的使用而減少了
但是肺炎練球菌疫苗不包含的血清型卻變多了
這叫做serotype replacement

肺炎鏈球菌疫苗的使用有如此的現象
其他的疫苗的使用會不會也產生類似的結果呢?
最近看到一個來自巴西的報告
似乎輪狀病毒疫苗的使用也有類似的情形

在巴西
輪狀病毒感染是一個嚴重的健康問題
大部分的輪狀病毒屬於P[8]G1與P[8]G9
所以
自2006年三月開始
巴西政府就把輪狀病毒疫苗列為嬰兒常規使用的疫苗之一
每一個小孩都可以有免費的輪狀病毒疫苗可以使用
在巴西北部一個叫做Sergipe的地方
輪狀病毒疫苗的使用率達到51%
他們用的是GSK的產品Rotarix
這種疫苗只含有一種基因型(P[8]G1)的輪狀病毒疫苗

在2006年11月到2007年二月
Sergipe地區總共有129位小朋友因為罹患腸胃炎而就醫
分析發現輪狀病毒疫苗確實有效
因為有接受疫苗的人分離出輪狀病毒的比例較低

值得注意的是
21位輪狀病毒病患通通都是遭到基因型P[4]G2的輪狀病毒感染
含這種基因型的輪狀病毒是不包含在Rotarix疫苗裡面
換句話說
Rotarix疫苗的使用有效減少了以往在巴西常見的P[8]G1與P[8]G9
但卻篩選出以往罕見的基因型為P[4]G2的輪狀病毒
這無異是宣告輪狀病毒疫苗的使用也會有genotype replacement的現象

不過
也有人批評這項研究
例如病例數太少
不具代表性
或許研究期間剛好流行的是G2
跟疫苗的使用沒有必然的因果關係
這些疑點有賴將來更多的研究來釐清

EID 2007;13:1571.

輪狀病毒是造成嬰兒和小孩嚴重腹瀉的最主要病原。世界各地都有輪狀病毒流行，幾乎每個人在5歲之前都曾被輪狀病毒感染過。感染的高峰年齡是6個月到2歲。即使在乾淨、衛生的西方先進國家，還是會有輪狀病毒的存在。輪狀病毒感染在溫帶國家有明顯的季節性，最常在寒冷的季節流行。在台灣，輪狀病毒的感染季節較不明顯，一年四季都有，不過還是以秋冬較多。

輪狀病毒是由飲食或接觸，經口傳染。病患體內的病毒由大便排出，在無意間污染雙手、食物、或飲水而傳染。病患的口水或嘔吐物中也有病毒。此病毒傳染力極強，可以在短期間內造成流行。

輪狀病毒的潛伏期約2至3天，在發病初期出現如發燒、嘔吐、咳嗽、流鼻水等一般感冒的症狀，1至2天後會出現水瀉。大便通常不帶血絲、黏液，病程持續約3至7天。嚴重時若沒有及時治療，容易造成脫水、電解質失衡、休克甚至於死亡。所以家中幼兒若有嘴唇乾燥、哭不出眼淚、皮膚失去彈性、小便量明顯減少、眼眶凹陷、囟門凹陷、嗜睡甚至昏迷等症狀時，應盡速就醫治療。

目前並沒有有效對抗輪狀病毒的藥物，所以治療上以症狀治療為主，如：補充水分及電解質。如果幼兒持續嘔吐、嚴重腹瀉，最好注射點滴，以有效補充水分。如果症狀尚屬輕微，應設法讓小朋友經口攝取因為嘔吐及腹瀉而流失的水分跟電解質，通常只要經過短暫停止餵食，便可恢復餵食病童少許白開水，再慢慢餵食清淡飲食（例如稀飯），避免油膩或太甜的食物。嬰兒奶粉最好酌量稀釋後再喝，也可以讓小病童喝一些電解質水，市售的運動飲料經稀釋後，具有類似的功效。

注意清潔與良好的衛生習慣可以減少輪狀病毒感染，但是效果有限。所以發展疫苗應該是預防輪狀病毒感染的最佳方法。現在已經有若干藥廠投入輪狀病毒疫苗的研發，有的已經獲得少數國家核准上市使用。相信在不久的將來，安全有效的輪狀病毒疫苗將可以有效保護我們的小孩，免於輪狀病毒感染之苦。

(本文原刊登於中時生活)

延伸閱讀
輪狀病毒疫苗

輪狀病毒的傳染力很強，一般的預防方法效果不彰。所以，如果有安全有效輪狀病毒疫苗可以讓寶寶及早產生抵抗力，對寶寶來說是一個福音。輪狀病毒可以分成許多血清型，在台灣比較重要的血清型有G1P[8], G2P[4], G3P[8], G4P[8], G9P[8]等。選擇口服輪狀病毒疫苗除了必須注意其效果與安全性是否通過大規模臨床試驗的確認，也要注意是否可以有效保護不同血清型的輪狀病毒，以確保疫苗有足夠的保護力。

http://www.raising.org.tw/main6/08.htm

延伸閱讀
兩種輪狀病毒疫苗比較表