1例成人接种乙型病毒性肝炎疫苗偶合过敏体质发生猝死的调查  

Investigation on sudden death of one adult case coupling to allergic constitution vaccinated with Hepatitis B vaccine

作　　者：王信 张彦丽 马敬仓[3] 刘景顺[3] 徐凌忠[4] WANG Xin;ZHANG Yan-li;MA Jing-cang;LIU Jing-shun;XU Ling-zhong(Tancheng Center for Disease Control and Prevention,Shandong276100,China)

机构地区：[1]郯城县疾病预防控制中心,山东276100 [2]单县中心医院 [3]菏泽市疾病预防控制中心 [4]山东大学公共卫生学院

出　　处：《医学动物防制》2021年第8期715-718,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)。

摘　　要：目的调查某病例在接种乙型病毒性肝炎疫苗(Hepatitis B vaccine,HepB)后发生死亡事件是否由注射该疫苗所导致。方法对病例开展个案调查,收集该病例病历资料、尸检病理诊断结论等,经市级疑似预防接种异常反应(adverse events following immunization,AEFI)调查诊断专家组调查诊断后,出具调查诊断意见。结果该病例于2019年8月28日因乙肝抗体为阴性,经预检无接种禁忌,告知疫苗品种、作用、禁忌,确认无误后于15:50在其右上臂接种HepB 60μg,当时无异常发现。8月29日20:38该病例乘坐K1028次列车从商丘至青岛,于20:30主诉头痛症状,21:06呼叫无应答,21:50120急救车医务人员发现其已无生命体征。河南省法医司法鉴定中心尸检病理诊断:(1)喉、气管粘膜充血;肺淤血、水肿,肺膜下少许出血斑点。(2)冠状动脉粥样硬化症;心外膜下少许出血斑点。(3)肝水肿;脾中央动脉玻璃样变性;肾淤血水肿。(4)心血IgE及过敏原检测结果;总IgE升高,户尘螨、桑树、蟑螂、腰果、矮豚草级别增加,苋级别显著增加。预防接种过程符合操作规程,疫苗质量合格。市级AEFI调查诊断专家组调查诊断意见:不属于AEFI。结论该病例接种疫苗偶合过敏体质,突发猝死,与预防接种无关。Objective To investigate whether the death of one case after being vaccinated with Hepatitis B vaccine(HepB)was caused by the vaccine.Methods The individual investigation on the case was conducted.The case of medical record data and conclusion of autopsy pathological diagnosis was collected,the opinion of investigation and diagnosis was issued after investigation and diagnosis by the expert group of investigation and diagnosis on adverse events following immunization(AEFI)of municipal vaccination.Results This patient with negative hepatitis B antibody and no inoculation taboos in the preliminary test informed was inoculated with HepB 60 micrograms on the right upper arm at 15:50 on August 28,2019 after being informed of the vaccine type,effect and taboos and correctness confirmation.No abnormality was found with the patient.The patient who took the train numbered K1028 from Shangqiu to Qingdao at 20:38 complained of headache symptoms at 20:30 on August 29,2019,and failed to response to the call at 21:06,and found to have no vital sign by medical staff in the 120 ambulance at 21:50.Henan Forensic Medical Evaluation Center concluded the following pathological diagnosis results of autopsy:(1)Hyperemia of larynx and tracheal mucosa;pulmonary congestion,edema,slight subpulmonary hemorrhage spots.(2)Coronary atherosclerosis;slight subepicardial hemorrhaging spots.(3)Hepatic edema;hyaline degeneration of central splenic artery;kidney congestion edema.(4)Serum IgE and allergen detection results;the levels graded at household dust mites,mulberry,cockroach,cashew nut and dwarf ragweed increased with the increase of total IgE,while the grade of amaranth increased significantly.The process of prophylactic vaccination conformed to the operation procedure,and the vaccine quality was found to be conforming.The investigational and diagnostic opinions of expert group on AEFI abnormal reaction of vaccination showed no AEFI.Conclusion The sudden death of the patient coupling to allergic constitution vaccinated with vaccination is i

关 键 词：乙型病毒性肝炎 疫苗 疑似预防接种异常反应 猝死综合征 调查 

分 类 号：R186[医药卫生—流行病学]