〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 derder »

熊哥 寫:
andy 寫:劉醫師說,自己從不會在看病時告訴病人,「我不知道你生什麼病。」。
這句話太膨脹了吧 ! 也許婦科的病比較單純...我們內科的病, 很多都莫名其妙 !
我不是上帝!
我絕不做上帝, 假裝我知道一切 !

http://mypaper.pchome.com.tw/bear1002/post/1320546949
------------------------------------------------------------------------
我反而常說,「我不知道你生什麼病。」
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 X-MAN »

Global Advisory Committee on Vaccine Safety

WHO > Programmes and projects > Vaccine Safety > Causality assessment of adverse events following immunization

Main content Causality assessment of adverse events following immunization
Appears in WER 23 March 2001:

- English/French [pdf 160kb]
Since the inception of vaccination, it has been recognized that adverse events following immunization (AEFIs) will occur. The frequency of AEFIs is directly related to the number of vaccine doses administered. AEFIs can be causally related to the inherent properties of the vaccine, linked to errors in the administration, quality, storage and transport of the vaccine (programmatic errors), but it must be recognized that when large populations are vaccinated, some serious events that occur rarely with or without vaccination will be observed coincidentally following vaccination. Thus, investigating causality of AEFIs, particularly those that are most serious, is challenging.

The clearest and most reliable way to determine whether an adverse event is causally related to vaccination is by comparing rates of the event in a vaccinated and non-vaccinated group in a randomized clinical trial. Such trials, however, can never be large enough to assess very rare events, and postmarketing surveillance systems are required to identify events potentially related to vaccination. Postmarketing surveillance capability is improving; more countries now have AEFI monitoring systems, and more importance is attached to the reporting of suspected links between vaccination and adverse events. These systems have been successful in bringing to light serious AEFIs after vaccines have been marketed. A recent example is intussusception after administration of reassortant rhesus rotavirus vaccine.

Assessments of whether a given vaccine causes a particular adverse reaction vary from the casual observation to the carefully controlled study. The majority of individuals are not trained in interpreting such studies and are unlikely to understand the enormous difference in significance between these two extremes. Nonetheless, the public frequently forms a decision about a vaccine safety based on the information available to them, often a report based on unscientific observations or analyses that fail to stand the scrutiny of rigorous scientific investigation. Certain reports of AEFIs published in the medical literature over the past few years have resulted in controversy. The studies on which these reports are based, while generating provocative hypotheses, have generally not fulfilled the criteria that would be needed to be able to draw conclusions about vaccine safety with any degree of certainty. Yet these reports have had a major influence on public debate and opinion-making. When this debate spills over to the political arena, to policy-making and to determining the public acceptance of a vaccine by balancing the known benefits against possible but unverified risks, it is clear that a correct assessment of causality is vital.
Submitting a study to a scientific process rather than to partially informed opinion is crucial in determining whether a vaccine actually causes a given reaction. If undertaken carelessly or without scientific rigour, the study results will be inconclusive at best, may result in the inappropriate withdrawal of a valuable vaccine from use, or at worst may result in the exposure of a population to a dangerous vaccine. In 1999, WHO launched the Immunization Safety Priority Project to establish a comprehensive system to ensure the safety of all immunizations given in national immunization programmes. The development of mechanisms to respond promptly and effectively to vaccine safety concerns is a major area of focus of this project. As part of this effort, the Global Advisory Committee on Vaccine Safety (GACVS) was constituted by WHO in September 1999. The Committee's mandate is to enable WHO to respond promptly, efficiently and with scientific rigour to vaccine safety issues of potential global importance.

Building on the seminal work on determining causality of the Surgeon Generalís Advisory Committee on Smoking and Health (1964), the generally established criteria underpinning vaccine adverse event causality assessment that the GACVS uses may be summarized as follows:
Consistency. The association of a purported adverse event with the administration of a vaccine should be consistent, i.e. the findings should be replicable in different localities, by different investigators not unduly influencing one another, and by different methods of investigation, all leading to the same conclusion(s).
Strength of the association. The association should be strong in the magnitude of the association (in an epidemiological sense), and in the dose-response relationship of the vaccine with the adverse effect.
Specificity. The association should be distinctive, the adverse event should be linked uniquely or specifically with the vaccine concerned, rather than its occurring frequently, spontaneously or commonly in association with other external stimuli or conditions.
Temporal relation. There should be a clear temporal relationship between the vaccine and the adverse event, in that receipt of the vaccine should precede the earliest manifestation of the event or a clear exacerbation of an ongoing condition. For example, an anaphylactic reaction seconds or minutes following immunization would be strongly suggestive of causality; such a reaction several weeks after vaccination would be less plausible evidence of a causal relation.
Biological plausibility. The association should be coherent; that is, plausible and explicable biologically according to known facts in the natural history and biology of the disease.
Clearly, not all these criteria need to be present, and neither does each carry equal weight for a causal relationship between an adverse event and the vaccine to be determined. In addition to the general principles mentioned above, there are a number of provisos or considerations that need to be applied for determining causality in the special field of vaccine safety. They are:The requirement for biological plausibility should not unduly influence negatively a consideration of causality. Biological plausibility is a less robust criterion than the others described. If an adverse event does not fit into known facts and the preconceived understanding of the adverse event or the vaccine under consideration, it clearly does not necessarily follow that new or hitherto unexpected events are improbable. ìBiological plausibilityî is most helpful when it is positive; it is less so when negative.
Consideration of whether the vaccine is serving as a trigger (trigger in this context is an agent that causes an event to happen which would have happened some time later anyway). When acting as a trigger, the vaccine may expose an underlying or pre-existing condition or illness. An example of the latter would be an auto-immune condition triggered non-specifically by the immune stimulus of the vaccine.
In the case of live attenuated vaccines, if the adverse event may be attributable to the pathogenicity of the attenuated vaccine microorganism and thus not be distinguishable (except, perhaps, in severity) from the disease against which the vaccine is being administered, a causal connection is more plausible. Identification of the vaccine organism in diseased tissue and/or in the body fluids of the patient in such a situation would add weight to causality. There are exceptions to both these above points.
An association between vaccine administration and an adverse event is most likely to be considered strong when the evidence is based on:Well-conducted human studies that demonstrate a clear association in a study design that is determined a priori for testing the hypothesis of such association. Such studies will normally be one of the following, in descending order of probability of achieving the objective of the study: randomized controlled clinical trials, cohort studies, and case-controlled studies and controlled case-series analyses. Case reports, however numerous and complete, do not fulfil the requirements for testing hypotheses, although on occasion such reports can be compelling if there are clear biological markers of the association, as is the case for vaccine-associated paralytic poliomyelitis.
An association that is demonstrated in more than one human study and consistent among the studies. The studies would need to have been well conducted, by different investigators, in different populations, with results that are consistent, despite different study designs. Demonstrable association in the studies between dose and the purported adverse effect (either the dose or the number of doses administered, or both) will, in many cases, strengthen the causal association between the vaccine and the adverse event. This is not always the case, especially if there is an immunological relationship. A strong similarity of the adverse event to the infection the vaccine is intended to prevent, and there is a non-random temporal relationship between administration and the adverse incident.
It is important that there should be a strict definition of the adverse event in clinical, pathological and biochemical terms, as far as that is achievable. The frequency in the nonimmunized population of the adverse event should be substantially different from that in the immunized population in which the event is described, and there would not normally be obvious alternative reasons for its occurrence that are unrelated to immunization.
An adverse event may be caused by a vaccine adjuvant or excipient, rather than by the active component of the vaccine. In this case, it might spuriously influence the specificity of the association between vaccine and adverse event. As far as possible, safety issues should be clarified in premarketing controlled clinical studies, with attention being given in such studies to safety issues and their monitoring, although with extremely rare unexpected events, this may not be achievable because of the need for extremely large sample sizes to detect them.

When adverse events are attributable to a vaccine, it is important to determine whether there is a predisposed set of subjects (by age, population, genetic, immunological, environmental, ethnic, sociological or underlying disease conditions) for any particular reaction. Such predisposition is most likely to be identified in case-controlled studies.

A systematic effort should always be made to exclude confounding programmatic errors and variability and aberrations in vaccine manufacture. The latter quality issues are most likely to be revealed by careful attention to batch and lot testing.

Since observational studies are not randomized and since individuals who are ill are generally less likely to be immunized (but more likely to have an adverse outcome), epidemiological studies on vaccine safety need to pay special attention to contraindications as potentially confounding factors. The consequences of this bias may be false-negative studies.



New in August 2009
Report of Committee meeting [pdf 254kb]



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X-MAN
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 X-MAN »

我很好奇法醫研究所是依據WHO 的 Causality assessment of adverse events following immunization 的那一項來排除不是疫苗造成?

最近是否犀牛橫行?
g96510083
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 g96510083 »

2009/11/19在校接種國光藥廠H1N1新流感疫苗
2009/11/20腳出現紅疹
2009/11/21到診所就醫,懷疑是注射疫苗引發過敏反應,劉母通報1922防疫專線
2009/11/24發燒不退全身紅疹,4天後住進中縣區域醫院
2009/12/02轉診中國附醫,免疫球蛋白治療未好轉
2009/12/15出現敗血症跡象轉台大醫院
2009/12/18腦幹出血
2009/12/21上午7時45分死亡
2009/12/24解剖遺體採取檢體送驗

Q1:Parvo B19 是原發感染,還是繼發感染??
一般感染時,病毒感染後DNA可以在血液中存在多久, RE system中存在多久??
經過二次免疫球蛋白撲殺後,病毒感染後DNA可以在血液中存在多久, RE system中存在多久


Q2: Hemophagocytosis是何時出現的?
中國附醫不是有做Bone marrow , 哪時候有沒有Hemophagocytosis ??


http://www.cdc.gov/ncidod/eid/vol6no6/fisman.htm
http://www.eric.vcu.edu/pub/MR/MR_2005120506_bar.pdf
盡心盡力,沒人在意 掏心掏肺,當場作廢 江河日下,人心不古 依法看診,安全下庄
王維‧<酌酒與裴迪>
酌酒與君君自寬人情翻覆似波瀾。白首相知猶按劍,朱門先達笑彈冠。
草色全經細雨濕,花枝欲動春風寒。世事浮雲何足問不如高臥且加餐。
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 lijen »

g96510083 寫: Q2: Hemophagocytosis是何時出現的?
中國附醫不是有做Bone marrow , 哪時候有沒有Hemophagocytosis ??


http://www.cdc.gov/ncidod/eid/vol6no6/fisman.htm
http://www.eric.vcu.edu/pub/MR/MR_2005120506_bar.pdf
家屬拒絕做bone marrow
g96510083
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 g96510083 »

Slow Clearance of Human Parvovirus B19 Viremia following Acute Infection

http://www.journals.uchicago.edu/doi/fu ... ookieSet=1
PARVO B19可以在感染後,持續存在血液中數十周,所以PARVO B19與HEMOPHAGOCYTOSIS的關聯性似乎需要再重新釐清摟
parvo b19在感染後可以在血中存在數十週
parvo b19在感染後可以在血中存在數十週
盡心盡力,沒人在意 掏心掏肺,當場作廢 江河日下,人心不古 依法看診,安全下庄
王維‧<酌酒與裴迪>
酌酒與君君自寬人情翻覆似波瀾。白首相知猶按劍,朱門先達笑彈冠。
草色全經細雨濕,花枝欲動春風寒。世事浮雲何足問不如高臥且加餐。
uesugi
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 uesugi »

(omg)
最後由 uesugi 於 週日 1月 19, 2014 11:56 pm 編輯,總共編輯了 2 次。
cwayne59
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 cwayne59 »

g96510083 寫:Slow Clearance of Human Parvovirus B19 Viremia following Acute Infection

http://www.journals.uchicago.edu/doi/fu ... ookieSet=1
PARVO B19可以在感染後,持續存在血液中數十周,所以PARVO B19與HEMOPHAGOCYTOSIS的關聯性似乎需要再重新釐清摟
fg1.gif
請問病毒會在tissue中會持續多久?
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 poki »

albarto1688 寫:(打小人) (打小人) (打小人)
怎麼不說說你的想法還有看法?
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 poki »

X-MAN 寫:我很好奇法醫研究所是依據WHO 的 Causality assessment of adverse events following immunization 的那一項來排除不是疫苗造成?

最近是否犀牛橫行?
這個東西不是用來排除的; 而是看有無因果關係,
你倒是可以講一講, 符合哪些點, 先列在下面讓你好發揮:

PS. 什麼是"犀牛橫行"???? 近是否野豬橫行?



Building on the seminal work on determining causality of the Surgeon Generalís Advisory Committee on Smoking and Health (1964), the generally established criteria underpinning vaccine adverse event causality assessment that the GACVS uses may be summarized as follows:

* Consistency. The association of a purported adverse event with the administration of a vaccine should be consistent, i.e. the findings should be replicable in different localities, by different investigators not unduly influencing one another, and by different methods of investigation, all leading to the same conclusion(s).
* Strength of the association. The association should be strong in the magnitude of the association (in an epidemiological sense), and in the dose-response relationship of the vaccine with the adverse effect.
* Specificity. The association should be distinctive, the adverse event should be linked uniquely or specifically with the vaccine concerned, rather than its occurring frequently, spontaneously or commonly in association with other external stimuli or conditions.
* Temporal relation. There should be a clear temporal relationship between the vaccine and the adverse event, in that receipt of the vaccine should precede the earliest manifestation of the event or a clear exacerbation of an ongoing condition. For example, an anaphylactic reaction seconds or minutes following immunization would be strongly suggestive of causality; such a reaction several weeks after vaccination would be less plausible evidence of a causal relation.
* Biological plausibility. The association should be coherent; that is, plausible and explicable biologically according to known facts in the natural history and biology of the disease.
iht
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 iht »

熊哥 寫:
andy 寫:劉醫師說,自己從不會在看病時告訴病人,「我不知道你生什麼病。」。
這句話太膨脹了吧 ! 也許婦科的病比較單純...我們內科的病, 很多都莫名其妙 !
我不是上帝!
我絕不做上帝, 假裝我知道一切 !

http://mypaper.pchome.com.tw/bear1002/post/1320546949
+1
好歹當銀蛋時也該是大科都走過的
怎麼還會講出這麼沒道理的話

雖說關心則亂
不過今天他在媒體與一般大眾的眼中不是只有"父親"這個角色而已
現在他的行為與看法無論是對錯與否
只是讓別人覺得醫界在什麼議題上都眾說紛紜無一為是
對大家的專業形象與說服力造成更大的傷害而已

台灣太小了
今天醫學協會或是衛生機構背書的東西
只要有一位醫師出來公開質疑就會對民眾信任度造成傷害
大部分的民眾並不能了解醫療有許多的灰色地帶
只會聽到"啊某某醫師都說這不行了..."

有些醫師在法庭上或媒體前的事後諸葛行為更不可取
難道說這些人都沒想到
你一時宣言或許會讓人覺得你很"厲害"
但其實是對整個醫護界造成更大的傷害嗎

我想這也是醫界常讓別人抓住漏洞痛宰的原因之一吧

===
好像有點扯太遠了,對不起 (跪拜禮new)
promyelocyte
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 promyelocyte »

這個結果其實我不是很相信啦!不過我不是相關科別的,所以無法評論。
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 poki »

promyelocyte 寫:這個結果其實我不是很相信啦!不過我不是相關科別的,所以無法評論。
講一下啦!
名嘴都可以講得口沫橫飛了, 妳太謙虛了.
(我也是外行)
頭像
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 Necropsy »

搞不好得H1N1死亡的案例
有些也是因B19或其他不知名的病原而致死的

總之,
死亡+ 有H1N1感染 -->新聞
死亡 + 有打疫苗 --->新聞

真相 --->不重要

這就是台灣


(不要啊) (不要啊) (不要啊)
沒有鬼神,沒有命運
只有努力&機率
努力可以改變機率
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 X-MAN »

poki
這個東西不是用來排除的; 而是看有無因果關係,
你倒是可以講一講, 符合哪些點, 先列在下面讓你好發揮:

PS. 什麼是"犀牛橫行"???? 近是否野豬橫行?



Building on the seminal work on determining causality of the Surgeon Generalís Advisory Committee on Smoking and Health (1964), the generally established criteria underpinning vaccine adverse event causality assessment that the GACVS uses may be summarized as follows:

* Consistency. The association of a purported adverse event with the administration of a vaccine should be consistent, i.e. the findings should be replicable in different localities, by different investigators not unduly influencing one another, and by different methods of investigation, all leading to the same conclusion(s).
* Strength of the association. The association should be strong in the magnitude of the association (in an epidemiological sense), and in the dose-response relationship of the vaccine with the adverse effect.
* Specificity. The association should be distinctive, the adverse event should be linked uniquely or specifically with the vaccine concerned, rather than its occurring frequently, spontaneously or commonly in association with other external stimuli or conditions.
* Temporal relation. There should be a clear temporal relationship between the vaccine and the adverse event, in that receipt of the vaccine should precede the earliest manifestation of the event or a clear exacerbation of an ongoing condition. For example, an anaphylactic reaction seconds or minutes following immunization would be strongly suggestive of causality; such a reaction several weeks after vaccination would be less plausible evidence of a causal relation.
* Biological plausibility. The association should be coherent; that is, plausible and explicable biologically according to known facts in the natural history and biology of the disease.
敬愛的POKI大:

因果關係已敘述如下:

http://forum.doctorvoice.org/viewtopic.php?f=24&t=41471
請查收.

HS & DIC 皆可經由AUTOIMMUNE & VIRAL INFECTION 導致而成.因此要解釋到底是B19 還有VACCINE 引起時HS & DIC 必須要符合WHO上述條件,
相信很多醫師對於B19的引起的疾病NATURE HISTORY 已經於論壇討論過,因此在此要向你請益的是你仍然認同劉小弟的HS & DIC 是B19造成的嗎? ( Biological plausibility. The association should be coherent; that is, plausible and explicable biologically according to known facts in the natural history and biology of the disease)
至於犀牛橫行,對於犀牛我曾引用過,有興趣請看過去我的有關犀牛PO文.
至於什麼是野豬橫行就要向你請益.
image
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 image »

poki 寫:
promyelocyte 寫:這個結果其實我不是很相信啦!不過我不是相關科別的,所以無法評論。
講一下啦!
名嘴都可以講得口沫橫飛了, 妳太謙虛了.
(我也是外行)
插個嘴....
贊成cwayne大說的(也就是衛生署說的~不可以...機構廢言啊)
因為
你用hemophagocytosis histio....跟Parvovirus B19去查,可以查到pqper
可是用hemophagocytosis histio....跟vaccination去查查不到.....?
cwayne59 寫:
TUFU 寫:看到這病人的解剖報告噬血症候群(hemophagocytic syndrome;HS)
我當下第一個想到的是2001年花蓮吳氏夫婦悴死的事件
如果有不記得的可以參考一下這裡

這個死的更突然又是夫婦
看看他們發病的經過到死亡幾乎不到一天
家屬到醫院的座談,氣憤的情形
各種原因甚囂塵上,中毒等等

同樣的噬血症候群,一樣用PCR找出DNA
我想絕對做了不止B19的病毒,尤其是已經發現了HS syndrome
如果其他病毒的DNA都找不到,而這病毒的DNA又存在多個器官
就像吳氏夫婦漢它病毒的DNA PCR TEST我們到底要不要信?
雖然解剖本來就未必能解決所有的疑難雜症
不過就目前的資料,假定這是一個CPC的case,就當它沒有打疫苗好了
(也不管疫苗是否有可能間接或直接引起B19感染)
對於B19引起這病例的HS大家是否能接受?
台下會不會一片驚呼B19這麼溫和的病毒引起這麼厲害的反應?
我不會認為PARVOVIRUS B19是溫和的病毒
只能說它比較常引起的疾病表徵是FIFTH DISEASE
但是重症CASE也是有的
就像這次的H1N1也是"溫和"的流行
但是看過H1N1引起重症的人
也不會認為它是溫和的病毒吧
病毒在不同的Host中的表現
本來就不是醫師能100%預期的
尤其當患者有使用過免疫抑制劑(如Steroid)的情況下
就更複雜了
poki
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 poki »

X-MAN 寫:
poki
這個東西不是用來排除的; 而是看有無因果關係,
你倒是可以講一講, 符合哪些點, 先列在下面讓你好發揮:

PS. 什麼是"犀牛橫行"???? 近是否野豬橫行?



Building on the seminal work on determining causality of the Surgeon Generalís Advisory Committee on Smoking and Health (1964), the generally established criteria underpinning vaccine adverse event causality assessment that the GACVS uses may be summarized as follows:

* Consistency. The association of a purported adverse event with the administration of a vaccine should be consistent, i.e. the findings should be replicable in different localities, by different investigators not unduly influencing one another, and by different methods of investigation, all leading to the same conclusion(s).
* Strength of the association. The association should be strong in the magnitude of the association (in an epidemiological sense), and in the dose-response relationship of the vaccine with the adverse effect.
* Specificity. The association should be distinctive, the adverse event should be linked uniquely or specifically with the vaccine concerned, rather than its occurring frequently, spontaneously or commonly in association with other external stimuli or conditions.
* Temporal relation. There should be a clear temporal relationship between the vaccine and the adverse event, in that receipt of the vaccine should precede the earliest manifestation of the event or a clear exacerbation of an ongoing condition. For example, an anaphylactic reaction seconds or minutes following immunization would be strongly suggestive of causality; such a reaction several weeks after vaccination would be less plausible evidence of a causal relation.
* Biological plausibility. The association should be coherent; that is, plausible and explicable biologically according to known facts in the natural history and biology of the disease.
敬愛的POKI大:

因果關係已敘述如下:

http://forum.doctorvoice.org/viewtopic.php?f=24&t=41471
請查收.

HS & DIC 皆可經由AUTOIMMUNE & VIRAL INFECTION 導致而成.因此要解釋到底是B19 還有VACCINE 引起時HS & DIC 必須要符合WHO上述條件,
相信很多醫師對於B19的引起的疾病NATURE HISTORY 已經於論壇討論過,因此在此要向你請益的是你仍然認同劉小弟的HS & DIC 是B19造成的嗎? ( Biological plausibility. The association should be coherent; that is, plausible and explicable biologically according to known facts in the natural history and biology of the disease)
至於犀牛橫行,對於犀牛我曾引用過,有興趣請看過去我的有關犀牛PO文.
至於什麼是野豬橫行就要向你請益.
看不出有針對問題回答,
就算是你強調的那一點, 也看不出疫苗與hemophagocytosis的關係
確有文獻佐證parva B19 與hemophagocytosis的關係(如同image大姐所言)

我看起來, 疫苗與hemophagocytosis的關係
consistency -
Strength of the association -
Specificity -
Temporal relation +
Biological plausibility -

然而, parva B19 與hemophagocytosis的關係
consistency +
Strength of the association +
Specificity +
Temporal relation +
Biological plausibility +


我比較相信parva B19 與hemophagocytosis有因果關係啦
Dr. W
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 Dr. W »

cwayne59 寫:
TUFU 寫:看到這病人的解剖報告噬血症候群(hemophagocytic syndrome;HS)
我當下第一個想到的是2001年花蓮吳氏夫婦悴死的事件
如果有不記得的可以參考一下這裡

這個死的更突然又是夫婦
看看他們發病的經過到死亡幾乎不到一天
家屬到醫院的座談,氣憤的情形
各種原因甚囂塵上,中毒等等

同樣的噬血症候群,一樣用PCR找出DNA
我想絕對做了不止B19的病毒,尤其是已經發現了HS syndrome
如果其他病毒的DNA都找不到,而這病毒的DNA又存在多個器官
就像吳氏夫婦漢它病毒的DNA PCR TEST我們到底要不要信?
雖然解剖本來就未必能解決所有的疑難雜症
不過就目前的資料,假定這是一個CPC的case,就當它沒有打疫苗好了
(也不管疫苗是否有可能間接或直接引起B19感染)
對於B19引起這病例的HS大家是否能接受?
台下會不會一片驚呼B19這麼溫和的病毒引起這麼厲害的反應?
我不會認為PARVOVIRUS B19是溫和的病毒
只能說它比較常引起的疾病表徵是FIFTH DISEASE
但是重症CASE也是有的
就像這次的H1N1也是"溫和"的流行
但是看過H1N1引起重症的人
也不會認為它是溫和的病毒吧
病毒在不同的Host中的表現
本來就不是醫師能100%預期的
尤其當患者有使用過免疫抑制劑(如Steroid)的情況下
就更複雜了
(GOODJOB)
X-MAN
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 X-MAN »

Hemophagocytic Syndromes and Infection
David N. Fisman, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Authors and Disclosures

Posted: 11/01/2000; Emerging Infectious Diseases. 2000;6(6) © 2000 Centers for Disease Control and Prevention (CDC)

Print This
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Abstract and Introduction
Clinical Features
Epidemiology
HLH and Infection
Pathophysiology
Prognosis and Therapy
Conclusions
Acknowledgments
References

Information from Industry
Assess clinically focused product information on Medscape.
Click Here for Product Infosites – Information from Industry. Abstract and Introduction
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an unusual syndrome characterized by fever, splenomegaly, jaundice, and the pathologic finding of hemophagocytosis (phagocytosis by macrophages of erythrocytes, leukocytes, platelets, and their precursors) in bone marrow and other tissues. HLH may be diagnosed in association with malignant, genetic, or autoimmune diseases but is also prominently linked with Epstein-Barr (EBV) virus infection. Hyperproduction of cytokines, including interferon-gamma and tumor necrosis factor-alpha, by EBV-infected T lymphocytes may play a role in the pathogenesis of HLH. EBV-associated HLH may mimic T-cell lymphoma and is treated with cytotoxic chemotherapy, while hemophagocytic syndromes associated with nonviral pathogens often respond to treatment of the underlying infection.
not all these criteria need to be present, and neither does each carry equal weight for a causal relationship between an adverse event and the vaccine to be determined.
H1N1 Influenza (inactivated--flu shot) vaccine side-effects
What are the risks from 2009 inactivated H1N1 influenza vaccine? NEW Oct 2009
A vaccine, like any medicine, could cause a serious problem, such as a severe allergic reaction. But the risk of any vaccine causing serious harm, or death, is extremely small.

The virus in inactivated 2009 H1N1 vaccine has been killed, so you cannot get influenza from the vaccine. The risks from inactivated 2009 H1N1 vaccine are similar to those from seasonal inactivated flu vaccine:

Mild problems:

soreness, redness, tenderness, or swelling where the shot was given
fainting (mainly adolescents)
headache, muscle aches
fever
nausea
If these problems occur, they usually begin soon after the shot and last 1-2 days.

Severe problems:

Life-threatening allergic reactions to vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the shot.
In 1976, a certain type of swine flu vaccine was associated with cases of Guillain-Barré Syndrome (GBS). Since then, flu vaccines have not been clearly linked to GBS.
VACCINATION 能造成過敏免疫反應.
免疫反應能造成HS & DIC.

POKI大:你還沒有解釋什麼是野豬橫行?
poki
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文章: 4516
註冊時間: 週一 11月 13, 2006 5:24 am

Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 poki »

X-MAN 寫:
Hemophagocytic Syndromes and Infection
David N. Fisman, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Authors and Disclosures

Posted: 11/01/2000; Emerging Infectious Diseases. 2000;6(6) © 2000 Centers for Disease Control and Prevention (CDC)

Print This
processing....


Abstract and Introduction
Clinical Features
Epidemiology
HLH and Infection
Pathophysiology
Prognosis and Therapy
Conclusions
Acknowledgments
References

Information from Industry
Assess clinically focused product information on Medscape.
Click Here for Product Infosites – Information from Industry. Abstract and Introduction
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is an unusual syndrome characterized by fever, splenomegaly, jaundice, and the pathologic finding of hemophagocytosis (phagocytosis by macrophages of erythrocytes, leukocytes, platelets, and their precursors) in bone marrow and other tissues. HLH may be diagnosed in association with malignant, genetic, or autoimmune diseases but is also prominently linked with Epstein-Barr (EBV) virus infection. Hyperproduction of cytokines, including interferon-gamma and tumor necrosis factor-alpha, by EBV-infected T lymphocytes may play a role in the pathogenesis of HLH. EBV-associated HLH may mimic T-cell lymphoma and is treated with cytotoxic chemotherapy, while hemophagocytic syndromes associated with nonviral pathogens often respond to treatment of the underlying infection.
not all these criteria need to be present, and neither does each carry equal weight for a causal relationship between an adverse event and the vaccine to be determined.
H1N1 Influenza (inactivated--flu shot) vaccine side-effects
What are the risks from 2009 inactivated H1N1 influenza vaccine? NEW Oct 2009
A vaccine, like any medicine, could cause a serious problem, such as a severe allergic reaction. But the risk of any vaccine causing serious harm, or death, is extremely small.

The virus in inactivated 2009 H1N1 vaccine has been killed, so you cannot get influenza from the vaccine. The risks from inactivated 2009 H1N1 vaccine are similar to those from seasonal inactivated flu vaccine:

Mild problems:

soreness, redness, tenderness, or swelling where the shot was given
fainting (mainly adolescents)
headache, muscle aches
fever
nausea
If these problems occur, they usually begin soon after the shot and last 1-2 days.

Severe problems:

Life-threatening allergic reactions to vaccines are very rare. If they do occur, it is usually within a few minutes to a few hours after the shot.
In 1976, a certain type of swine flu vaccine was associated with cases of Guillain-Barré Syndrome (GBS). Since then, flu vaccines have not been clearly linked to GBS.
VACCINATION 能造成過敏反應.
過敏反應能造成HS & DIC.

POKI大:你還沒有解釋什麼是野豬橫行?
沒有特別意思, 只是很好奇什麼是"犀牛橫行",
就另外亂扯一個, 讓你好奇一下而已,
Newlife
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 Newlife »

X-MAN 寫: VACCINATION 能造成過敏免疫反應.
免疫反應能造成HS & DIC.
以您的邏輯, 同理可推: 因為食用食物也能造成Urticaria的過敏免疫反應
而免疫反應能造成HS & DIC.
所以飲食也是造成HS & DIC 的原因 !? 那還有多少東西會造成 HS & DIC ?
X-MAN
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 X-MAN »

Newlife
以您的邏輯, 同理可推: 因為食用食物也能造成Urticaria的過敏免疫反應
而免疫反應能造成HS & DIC.
所以飲食也是造成HS & DIC 的原因 !? 那還有多少東西會造成 HS & DIC ?
請參考WHO assessment of adverse events following immunization
Newlife
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 Newlife »

X-MAN 寫:
Hemophagocytic Syndromes and Infection
David N. Fisman, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA

Authors and Disclosures

Posted: 11/01/2000; Emerging Infectious Diseases. 2000;6(6) © 2000 Centers for Disease Control and Prevention (CDC)

Print This
processing....


Abstract and Introduction
Clinical Features
Epidemiology
HLH and Infection
Pathophysiology
Prognosis and Therapy
Conclusions
Acknowledgments
References
這一篇的內容把它看完
HLH and Infection

Case reports and case series on the association of infections and HLH are summarized at URL: http://www.cdc.gov/ncidod/eid/vol6no6/fisman_refs.htm

Disseminated infection with an unusual organism in a patient with HLH may represent secondary infection in an immunocompromised host; however, the resolution of HLH following treatment of infection suggests that, in many cases, HLH is secondary to the underlying infection.

A diagnosis that takes into account all the underlying diseases associated with HLH would not be practical, and formal guidelines for evaluating patients with suspected infection-associated HLH have not been established. Nevertheless, all patients meeting the criteria for HLH should undergo initial diagnostic tests that include routine cultures of blood and urine and chest radiography to screen for such infections as miliary tuberculosis. Attempts should be made to screen for infection with EBV, CMV, and parvovirus B19, either through serologic testing or polymerase chain reaction, in-situ hybridization, or (in the case of CMV) immunofluorescent antigen testing. Serologic testing for HIV and human herpesvirus-6 infection should also be considered, and throat and rectal swabs should be taken for viral culture. Because of the association between HLH and fungal infections, lysis-centrifugation blood cultures and fungal antigen testing should be considered for all patients with HLH. Even if an infection known to be associated with HLH has been confirmed, cell marker and T-cell receptor gene rearrangement tests should be performed on bone marrow or other tissue specimens to determine whether an underlying T-cell lymphoma is present.

Extensive testing for underlying infecting organisms should be guided by epidemiologic data and the patient's medical history. For example, in a patient with underlying HIV infection, HLH has been associated with infections that commonly affect patients with AIDS (e.g., pneumococcal disease, pneumocystosis, histoplasmosis, and infection with Penicillium marneffei) and with T-cell lymphoma. Patients with a history of travel or animal exposure should be screened for such infections as leishmaniasis, brucellosis, rickettsioses, and malaria. In bone marrow transplant patients, attempts should be made to isolate adenovirus from urine, nasopharyngeal and rectal swabs, and tissue specimens.

Because so many immunologic, neoplastic, genetic, and infectious disorders may be associated with HLH, clinicians should work closely with pathologists and microbiologists to clearly define precipitating or underlying illnesses.
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文章 X-MAN »

這一篇的內容把它仔細看完
Newlife
這一篇的內容把它看完

引言回覆:
HLH and Infection

Case reports and case series on the association of infections and HLH are summarized at URL: http://www.cdc.gov/ncidod/eid/vol6no6/fisman_refs.htm

Disseminated infection with an unusual organism in a patient with HLH may represent secondary infection in an immunocompromised host; however, the resolution of HLH following treatment of infection suggests that, in many cases, HLH is secondary to the underlying infection.

A diagnosis that takes into account all the underlying diseases associated with HLH would not be practical, and formal guidelines for evaluating patients with suspected infection-associated HLH have not been established. Nevertheless, all patients meeting the criteria for HLH should undergo initial diagnostic tests that include routine cultures of blood and urine and chest radiography to screen for such infections as miliary tuberculosis. Attempts should be made to screen for infection with EBV, CMV, and parvovirus B19, either through serologic testing or polymerase chain reaction, in-situ hybridization, or (in the case of CMV) immunofluorescent antigen testing. Serologic testing for HIV and human herpesvirus-6 infection should also be considered, and throat and rectal swabs should be taken for viral culture. Because of the association between HLH and fungal infections, lysis-centrifugation blood cultures and fungal antigen testing should be considered for all patients with HLH. Even if an infection known to be associated with HLH has been confirmed, cell marker and T-cell receptor gene rearrangement tests should be performed on bone marrow or other tissue specimens to determine whether an underlying T-cell lymphoma is present.

Extensive testing for underlying infecting organisms should be guided by epidemiologic data and the patient's medical history. For example, in a patient with underlying HIV infection, HLH has been associated with infections that commonly affect patients with AIDS (e.g., pneumococcal disease, pneumocystosis, histoplasmosis, and infection with Penicillium marneffei) and with T-cell lymphoma. Patients with a history of travel or animal exposure should be screened for such infections as leishmaniasis, brucellosis, rickettsioses, and malaria. In bone marrow transplant patients, attempts should be made to isolate adenovirus from urine, nasopharyngeal and rectal swabs, and tissue specimens.

Because so many immunologic, neoplastic, genetic, and infectious disorders may be associated with HLH, clinicians should work closely with pathologists and microbiologists to clearly define precipitating or underlying illnesses.
Newlife
Intern
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文章: 34
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 Newlife »

請再看仔細一點
Case reports and case series on the association of infections and HLH are summarized at URL: http://www.cdc.gov/ncidod/eid/vol6no6/fisman_refs.htm
Parvovirus B-19

1. Boruchoff SE, Woda BA, Pihan GA, Durbin WA, Burstein D, Blacklow NR. Parvovirus B19-associated hemophagocytic syndrome. Arch Intern Med 1990;150:897-9.
2. Hoang MP, Dawson DB, Rogers ZR, Scheuermann RH, Rogers BB. Polymerase chain reaction amplification of archival material for Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, and parvovirus B19 in children with bone marrow hemophagocytosis. Hum Pathol 1998;29:1074-7.
3. Koch WC, Massey G, Russell CE, Adler SP. Manifestations and treatment of human parvovirus B19 infection in immunocompromised patients. J Pediatr 1990;116:355-9.
4. Muir K, Todd W, Watson W, Fitzsimmons E. Viral-associated haemophagocytosis with parvovirus-B19-related pancytopenia. Lancet 1992;329:1139-40.
5. Shirono K, Tsuda H. Parvovirus B19-associated haemophagocytic syndrome in healthy adults. Br J Haematol 1995;89:923-6.
6. Tsuda H, Maeda Y, Nakagawa K, Nakayama M, Nishimura H, Ishihara A, et al. Parvovirus B19-associated haemophagocytic syndrome with prominent neutrophilia. Br J Haematol 1994;86:413-4.
7. Uike N, Miyamura T, Obama K, Takahira H, Sato H, Kozuru M. Parvovirus B19-associated haemophagocytosis in Evans syndrome: aplastic crisis accompanied by severe thrombocytopenia. Br J Haematol 1993;84:530-2.
8. Watanabe M, Shimamoto Y, Yamaguchi M, Inada S, Miyazaki S, Sato H. Viral-associated haemophagocytosis and elevated serum TNF-alpha with parvovirus-B19-related pancytopenia in patients with hereditary spherocytosis. Clin Lab Haematol 1994;16:179-82.
9. Yufu Y, Matsumoto M, Miyamura T, Nishimura J, Nawata H, Ohshima K. Parvovirus B19-associated haemophagocytic syndrome with lymphadenopathy resembling histiocytic necrotizing lymphadenitis (Kikuchi's disease). Br J Haematol 1997;96:868-71.
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文章 X-MAN »

Autoimmune-associated hemophagocytic syndrome

Hemophagocytic syndrome (HPS) is a clinicopathological condition characterized by the activation of histiocytes with prominent hemophagocytosis in bone marrow and other reticuloendothelial systems. The occurrence of HPS is usually associated with underlying disorders such as infection and lymphoma. Recently, we described patients with autoimmune disease who developed HPS. In these cases there was no evidence of underlying infection and malignancy, and the occurrences of HPS were associated withactive autoimmune disease. Based on these observations, we described autoimmune-associated hemophagocytic syndrome (AAHS). This disease entity is becoming better known, and case reports presenting features compatible with clinical AAHS are increasing. Here, we review the clinical aspects, mechanisms, diagnosis, and treatment of AAHS according to our data and that in the literature.
Abstract
Hemophagocytic syndrome (HPS) is a clinicopathologic entity characterized by increased proliferation and activation of benign macrophages with hemophagocytosis throughout the reticuloendothelial system. Uncontrolled T-lymphocyte activation is responsible for increased TH1 cytokines secretion such as IFN-γ, IL-12 and IL-18 that promotes macrophage activation. Genetic defects specific for cytotoxic T lymphocytes (CTL) and natural killer (NK) cells have been identified in patients with primary HPS that are responsible for altered cell death and apoptosis induction or target killing. HPS may be secondary to malignancy, infection or autoimmune disease, and mechanisms involved are poorly understood. However, in adult-onset Still's disease, juvenile chronic arthritis and probably systemic lupus erythematosus, IL-18 might play a role in initiating macrophage activation.
g96510083
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Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 g96510083 »

Hemophagocytosis is not equal to Hemophagocytosis syndrome ....
hemophagocytosis只是免疫失調,Macrophage被過度激化的結果:
4月3日台灣醫學界發現病人的白血球減少,尤其是淋巴球,他們的骨髓細胞出現問題.他們發現病人有血球吞噬現象(hemophagocytosis)〔組織球吞噬紅血球(hemophagocytosis)則是一種嚴重的免疫失調現象統稱,人體內負責防衛工作的組織球失去常態,攻擊血球、釋放各式免疫調節物質造成免疫系統陷入混亂。〕。而IVIG有調節患者免疫反應的作用.在病患血清及肺臟檢體檢查,也證實SARS是一種病毒感染引起宿主之細胞激素風暴(cytokine storm),並首度發現SARS可以發生血球吞噬現象(hemophagocytosis)

Hemophagocytic lymphohistiocytosis (HLH) and related disorders
http://asheducationbook.hematologylibra ... 9/1/127#T1
Table 2. Proposed HLH diagnostic criteria, 2009.

A>>. Molecular diagnosis of hemophagocytic lymphohistiocytosis (HLH) or X-linked lymphoproliferative syndrome (XLP).
B>>. Or at least 3 of 4:
1. Fever
2. Splenomegaly
3. Cytopenias (minimum 2 cell lines reduced)
4. Hepatitis

C>>. And at least 1 of 4:
1. Hemophagocytosis
2. {uparrow} Ferritin
3. {uparrow} sIL2R{alpha} (age based)
4. Absent or very decreased NK function

D>>. Other results supportive of HLH diagnosis:
1. Hypertriglyceridemia
2. Hypofibrinogenemia
3. Hyponatremia
g96510083 寫:Slow Clearance of Human Parvovirus B19 Viremia following Acute Infection

http://www.journals.uchicago.edu/doi/fu ... ookieSet=1
PARVO B19可以在感染後,持續存在血液中數十周,所以發現PARVO B19 並不能就推定B19是HEMOPHAGOCYTOSIS的原因
X-MAN 寫:
Autoimmune-associated hemophagocytic syndrome

Hemophagocytic syndrome (HPS) is a clinicopathological condition characterized by the activation of histiocytes with prominent hemophagocytosis in bone marrow and other reticuloendothelial systems.
Abstract
Hemophagocytic syndrome (HPS) is a clinicopathologic entity characterized by increased proliferation and activation of benign macrophages with hemophagocytosis throughout the reticuloendothelial system. HPS may be secondary to malignancy, infection or autoimmune disease, and mechanisms involved are poorly understood. However, in adult-onset Still's disease, juvenile chronic arthritis and probably systemic lupus erythematosus, IL-18 might play a role in initiating macrophage activation.
劉小弟的確有紅斑等免疫失調反應
劉小弟也的確發現B19 , 但是B19 如上所述,可以存在太久時間,時間關連性薄弱 (咦)

So I prefer to X-man's opinion
盡心盡力,沒人在意 掏心掏肺,當場作廢 江河日下,人心不古 依法看診,安全下庄
王維‧<酌酒與裴迪>
酌酒與君君自寬人情翻覆似波瀾。白首相知猶按劍,朱門先達笑彈冠。
草色全經細雨濕,花枝欲動春風寒。世事浮雲何足問不如高臥且加餐。
poki
V4
V4
文章: 4516
註冊時間: 週一 11月 13, 2006 5:24 am

Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 poki »

g96510083 寫: 劉小弟的確有紅斑等免疫失調反應
劉小弟也的確發現B19 , 但是B19 如上所述,可以存在太久時間,時間關連性薄弱 (咦)

So I prefer to X-man's opinion

你的邏輯怪怪的,
好像是說出國半年, 窗戶破一個洞, 有可能是破半年了,
跟昨天遭小偷沒關係
Newlife
Intern
Intern
文章: 34
註冊時間: 週二 5月 27, 2008 10:45 am

Re: 〈快訊〉劉小弟解剖出爐:與新流感疫苗無關聯

文章 Newlife »

g96510083 寫:PARVO B19可以在感染後,持續存在血液中數十周,所以發現PARVO B19 並不能就推定B19是HEMOPHAGOCYTOSIS的原因
要說不能100%斷定可以同意
但也不能排除是parvovirus B19造成

parvovirus B19感染後可能會在體內數十週時間
這麼長的時間會不會就是parvovirus B19有可能誘發immune respose,造成hemophagocytosis的原因?


Parvovirus B19(有paper,非單一案例)引發Hemophagocytosis 的可能性大
還是國光H1N1 vaccine(沒有paper報告過vaccine會引發?)引起 hemophagocytosis的機率高?
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