ตำราวัคซีนและการสร้างเสริมภูมิคุ้มกันโรค ปี 2556 (พิมพ์ครั้งที่ 3 ปี 2558) PDF

2556
2556
2556
ISBN : 978-616-11-1667-5
3 .. 2558
2,200

0 2590 3196, 0 2590 3199 0 2591 8425
http://thaigcd.dcc.moph.go.th

2

5

3
.. 2558

( )

()
()

BCG Bacillus Calmette Guerin Vaccine ()
CD4 Cluster of differentiation antigen 4
DTP Diphtheria and Tetanus toxoids, and Pertussis Vaccine combined ( -
-)
DT/dT Diphtheria and Tetanus toxoids combined ( -)
DTaP/Tdap Diphtheria and Tetanus toxoids, and acellular Pertussis Vaccine combined (
-- )
EPI Expanded Program on Immunization ( )
ERIG Equine Rabies Immunoglobulin ( )
HAV Hepatitis A Vaccine ( )
HB Hepatitis B Vaccine ( )
HBIG Hepatitis B Immunoglobulin ( )
HDCV Human Diploid Cell Rabies Vaccine ( Human Diploid Cell)
Hib Haemophilus influenza type b (Hib Vaccine (
)
HIV Human Immunodeficiency Virus ()
HRIG Human Rabies Immunoglobulin ( )
ID Intradermal ()
IM Intramuscular ()
IPV Inactivated Poliomyelitis Vaccine ( )
IU International Unit
JE Japanese Encephalitis Vaccine ( )
M Measles Vaccine ()
MMR Measles Mumps and Rubella Vaccine combined ( --)
Mnc Meningococcal Vaccine ()
MCV Meningococcal conjugate vaccine ()
MBD Mouse brain-derived inactivated vaccine (
)
NSS Normal Saline Solution ()
OPV Oral Poliomyelitis Vaccine ( )
PCEC Purified Chick Embryo Cell Rabies Vaccine ( Chick Embryo Cell)
PCV Pneumococcal conjugate vaccine ()
PDEV Purified Duck Embryo Cell Rabies Vaccine ( Duck Embryo Cell)
Pnc Pneumococcal Vaccine ()
PRP-T polyribosylribitol phosphate -Tetanus toxoid
PRP-OMP polyribosylribitol phosphate -Outer Membrane Protein complex
PS23 23-valent polysaccharide vaccine ()
PVRV Purified Vero cell Rabies Vaccine ( Vero cell)
R Rubella Vaccine ()
Rota Rotavirus vaccine ()
RIG Rebies Immunoglobulin ()
SC Subcutaneous ()
T Tetanus toxoid ()
TCID50 Tissue Culture Infectious Dose
TIG Tetanus Immunoglobulin ()
Ty Typhoid Vaccine ()
VAPP Vaccine Associated Paralytic Poliomyelitis
VAR Varicella Vaccine ()
Pfu/ Plaque-forming units/
./. /
./. /
./. /
./. /
.
./. /

1 13
2 25
3 37
4 41
5 (Sterilization Technique) 67
6 (EPI) 71
6-1 72

6-2 73

6-3 - (dT) 74
7 75
7.1 (BCG) 77
7.2 (HB) 83
7.3
A - (dT, DT) 93
B -- (DTP) 99
7.4 () (OPV, IPV) 109
7.5 -- (MMR) 119
7.6 129
7.7 137

8

147
8-1 149

8.1 153
8.2 (Hib) 159
8.3 (VAR) 165
8.4 (HAV) 173
8.5 Streptococcus pneumoniae (Pneumococcal 179
Vaccine: Pnc)
8.6 (Mnc) 189
8.7 Human Papillomavirus Vaccine 197
8.8 (Rabies Vaccine and 203
Rabies Immunoglobulin)
9 219
10 229
11 247
11.1 (Ty) 257
11.2 261
11.3 265
12 269
13 297
14 303

1

.. 2523

3
.. 2381

(Dr. Dan Beach Bradley) .. 2378

.. 2382
.. 2383
1
2556
13
1-1 ()
5

6
.. 2456
1-2 .. 2445

.. 2455

2

.. 2488
.. 2493
2556
14
.. 2496-2499
(BCG) .. 2510

(Integrated program) .. 2510-2512
-- (DTP) (OPV)

.. 2513

.. 25143

(Expanded Program on Immunization, EPI)

.. 2520
(Expanded Program on Immunization, EPI)
4 1 BCG, DTP,
OPV () (T)
EPI
.. 2520-2552

.. 2553

(Vendor Managed Inventory VMI)
90
2556
15

3

1-1 8
10 (
)
1-1 .. 2520

2520-2524 2525-2529 2530-2534 2535-2539 2540-2544 2545-2549
.. 2550
BCG BCG BCG BCG BCG BCG BCG
DTP DTP DTP DTP DTP DTP DTP DTP DTP-HB
DTP-HB
1
.. 2551
OPV OPV OPV OPV OPV OPV OPV
T T T T T T/dT dT T dT

.. 2548
Ty Ty Ty - - - -
.. 2533
dT dT dT dT dT dT
M M M M M M/MMR M MMR
9-12

.. 2553
R R R
MMR MMR MMR M R
.1
MMR
.. 2540
JE JE JE JE JE live vaccine
mouse brain derived
8

HB HB HB HB
2556
16

4-8
(BCG) .. 2525
1 .. 2535 4-6 (
1)
.. 2546 1

-- (DTP) DTP (DTwP)
2 4 .. 2525 6 . . 2534
11/2 -2 .. 2543
4
(OPV) DTP
.. 2520 OPV .. 2521
24 .. 2525
(M) .. 2527 912 .. 2539
1 .. 2540
1 -- (MMR) .. 2553
9-12 --
(R) 6 .. 2529
congenital rubella syndrome .. 2536
1
1
6 6 .. 2541
(HB) .. 2531
.. 2535 .. 2539
--- (DTP-HB)

.. 2548 DTP-HB 12
.. 2551
DTP-HB 2, 4 6
1 1
(Inactivated Japanese encephalitis vaccine
mouse brain derived vaccine: JE) 11/2 2
.. 2533
.. 2543
2556
17
21/2 3 .. 2544
.. 2556 8

(T) 2 .. 2536
.. 2548 - (dT)

- (dT) 1 2 ..
2525 .. 2536 DTP
6 1
(Ty) 1-6 .. 2521

.. 2533

.. 2547 .. 2551
7
.. 2553

6 2
H1N1 (2009) .. 2555
4

(
DTP, OPV, dT) ( , MMR)
( JE)
( 1
6
congenital rubella syndrome)
9

( 1-3)
.. 2551
( DTP OPV 5) 90 ( 1-2)
2556
18
1-3 1 2530-2551
: 30 - Cluster survey,
1-2
.. 2551

BCG 99.9
DTP OPV 3 98.7
DTP OPV 4 96.5
DTP OPV 5 79.4
HB 3 98.3
M 1 98.1
JE 2 94.6
JE 3 89.3
T (2 ) 96.7
: 30 - Cluster survey .. 2551
2556
19

.. 2540

.. 2520 2555
1-4 DTP 3
1 : .. 2520-2555
2556
20
1-5 DTP 3
1 : .. 2520-2555
1-6 OPV 3
1 : .. 2520-2555
2556
21
1-7 1 :
.. 2520-2555
1-8
: .. 2520-2555
2556
22

1. . . 2515; 1: 757-99.
2. . .
.. 2535. .
3. , . : . : , 2519: 218-9.
4. , .
5 .. 2520-2524. 2526; 9: 121-34.
5. , , , ,
. : 2550. 1. :
, 2550 : 14-23. (ISBN : 947-297-606-6)
6. , . : . 5. : , 2540:
59-60.
7. 2520-2545:
.
8. 2546-2555:
.
9. .. 2551.
.. 2551. (ISBN :
978-974-297-795-5)
2556
23

2

3
1 (toxoid) (toxin)

2 (inactivated vaccine killed vaccine)

2
2.1 (whole cell vaccine whole virion
vaccine)
3-4 1

2.2 (subunit vaccine)

2556
25
3 (live attenuated vaccine)
--

5 12
(cold chain)

5
1. (oral route)

2. (intradermal intracutaneous route)
25-27G 3/8-5/8
(cell-mediated immune response)

1.5 .

-
( 2-1)

}
}
}
}
2-1 (intradermal: ID) : BCG No.26 1/2
2556
26
-
(subcutaneous)
1
2
3
3. (subcutaneous route) 25-27G 3/8-5/8
45 ( 2-2)
--

}
}
}
}
2-2 (subcutaneous: SC) MMR, JE No.26 1/2
4. (intramuscular route)
( 2-3)
}
}
}
}
2-3 (intramuscular) : HB, DTP-HB, DTP, dT, TT

No.23-26 5/8-11/2
5
26-27G /8-1
5
2-12 25-27G /8-1
1 24-27G 1-11/2
23-25G 1-2
2556
27

(sciatic nerve)
adjuvant -
- (DTP)
(sterile abscess)

5. (intranasal route)

2-4 2-5

30 30

adjuvant
adjuvant
(Z-track)

2-4 2-5

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28

1.
1
2.
3.
1

4.

2-14
4 (
) 4
()5
5.
6.

7.

8. 3
--

( 400 . 2,000 . 1 . )
5-11 ( MMR)
6,7
2
-- 3

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29

9.
30
anaphylaxis

-- anaphylaxis
8-10 --
30
-- neomycin neomycin
anaphylactic shock
10. (whole cell : wP) (acellular : aP)
- DTwP DTaP
DTwP DTaP DTwP (
40.50) 3 (hypotonic
hyporesponsive episode) 48
DTaP
--
anaphylaxis

-- (encephalopathy) 7

- () DT dT 7
, infantile
spasm, progressive encephalopathy DT ( dT 7 )
cerebral palsy hydrocephalus

11. (febrile convulsion)
10-15 ./.
DTaP DTwP DTP
1-2 -- 5-12
1-2
12.

2,000
2556
30
1-2

1-2 2 3 1-2 6 4
( 4 )
13.
OPV BCG
14.

3

11,12
15. 1
16.

17.
17.1 CD4

17.2 BCG
17.3 CD4 15
--
17.4
17.5
3-6 13,14
(remission) 1
lymphocyte > 700 /. > 100,000 /.13
18. 2 ././
20 ./ 2
1 14
2

(maintenance physiologic dose)

19.

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31

20.
--

DTaP
3

15
21.

22.

23.

HBsAg anti-HBs
24.

(vaccine information statement VIS) VIS

25.
(lot number)
26.

27.

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32
2-1 1

(vaccine&dose no.) (recommended age) (minimum age) (recommended (minimum
interval) interval)
BCG - -
HB-1 1-4 4
HB-22 1-2 4 2-17 8
HB-33 6-18 24 - -
DTwP, DTaP-1 2 6 2 4
DTwP, DTaP-2 4 10 2 4
DTwP, DTaP-34 6 14 12 6
DTwP, DTaP-4 18 12 3 6
DTwP, DTaP-5 4-6 4 - -
Tdap5 4-6 , >11 4 , 7 - -
Td 11-12 7 10 5
OPV, IPV-1 2 6 2 4
OPV, IPV-2 4 10 2 4
OPV, IPV-3 6 14 12 6
OPV, IPV-46 18 12 3 6
OPV, IPV-5 4-6 4 - -
MMR-1 9-12 9 3-5 4
MMR-27 21/2-6 18 - -
Inacitvated JE-1 12-18 9 4 1
Inacitvated JE-2 13-19 10 11 3
Inacitvated JE-3 24-30 21 - -
Live JE-1 12 9 3-12 3
Live JE-2 12-24 12 - -
8
Hib-1 2 6 2 4
Hib-2 4 10 2 4
Hib-3 6 14 6-12 8
Hib-49 18 12 - -
PCV-18 2 6 2 4
PCV-2 4 10 2 4
PCV-310 6 14 6 8
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33

(vaccine&dose no.) (recommended age) (minimum age) (recommended (minimum
interval) interval)
PCV-4 12-15 12 - -
PPSV23-1 - 2 5 5
PPSV23-2 - 7 - -
Rota-111 2 6 2 4
Rota-2 4 10 2 4
Rota-3 (RV5) 6 14 - -
VAR-1 12-18 12 3-5 12
VAR-212 4-6 15 - -
HA-1 12-23 12 6-12 6
HA-2 >18 18 - -
TIV >6 6 1 13 4
LAIV 2-49 2 1 13 4
MCV-1 - 9 3 8
MCV-2 - 12 - -
Mnc-1 - 2 5 5
Mnc-2 - 7 - -
HPV-1 11-12 9 1-2 4
HPV-214 11-12 (+1-2 ) 9 +4-8 4-5 12
HPV-3 11-12 (+6 ) 9 +24 - -
1

2
HBsAg HBIG HB 1
3
DTP-HB HB 4 24
4
DTwP DTaP 3 4 6
DTwP DTaP 4 DTwP, DTaP-3 4
5
Tdap Td 1 DTwP DTaP 4-6
6
IPV 4 4
7
---
8
Hib PCV 7
9
Hib-4
10
PCV-3 ( 2+1)
2556
34
11
Rota 15 8
12
Varicella vaccine 1-12 1-2 2 4-6
4 3 > 13
2 4
13
Influenza vaccine 9 2 1
14
HPV
1. Bernard KW, Roberts MA, Sumner J, Winkler WG, Mallonee J, Baer GM, et al. Human
diploid cell rabies vaccine. Effectiveness of immunization with small intradermal or
subcutaneous doses. JAMA. 1982;247:1138-42.
2. , , , ,
. . : ,
, . .
. : ; 2554.3-25.
3. Statens Serum Institute [Internet]: Guidelines for injection of BCG VACCINE SSI
[update 2011 November 23; cited 2012 April 16] Avalable from : http://www.ssi.dk/
English/Vaccines/BCG Vaccine Danish Strain 1331/Guidelines for injection of BCG
Vaccine SSI.aspx.
4. . . : , ,
. . : ; 2554. . 41-60.
5. National Center for Immunization and Respiratory Diseases. General Recommendations
on Immunization --- Recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR Recomm Rep. 2011;60:1-64.
6. Siber GR, Werner BG, Halsey NA, Reid R, Almeido-Hill J, Garrett SC, et al. Interference
of immune globulin with measles and rubella immunization. J Pediatr. 1993;122:204-11.
7. Kaplan JE, Nelson DB, Schonberger LB, Hatch MH, Monath TP, Lazuick JS, et al.
The effect of immune globulin on the response to trivalent oral poliovirus and yellow
fever vaccinations. Bull World Health Organ. 1984;62:585-90.
8. Fasano MB, Wood RA, Cooke SK, Sampson HA. Egg hypersensitivity and adverse
reactions to measles, mumps, and rubella vaccine. J Pediatr. 1992;120:878-81.
9. Kemp A, Van Asperen P, Mukhi A. Measles immunization in children with clinical
reactions to egg protein. Am J Dis Child. 1990;144:33-5.
10. James JM, Burks AW, Roberson PK, Sampson HA. Safe administration of the measles
vaccine to children allergic to eggs. N Engl J Med. 1995;332:1262-6.
2556
35
11. Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L. Measles, mumps, and
rubella--vaccine use and strategies for elimination of measles, rubella, and congenital
rubella syndrome and control of mumps: recommendations of the Advisory Committee
on Immunization Practices (ACIP). MMWR Recomm Rep. 1998;47:1-57.
12. Shields KE, Galil K, Seward J, Sharrar RG, Cordero JF, Slater E. Varicella vaccine
exposure during pregnancy: data from the first 5 years of the pregnancy registry.
Obstet Gynecol. 2001;98:14-9.
13. Esposito S, Cecinati V, Brescia L, Principi N. Vaccinations in children with cancer.
Vaccine. 2010;28:3278-84.
14. American Academy of Pediatrics. Immunization in special clinical circumstances.
In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, eds. Red Book: 2012 Report
of the Committee on infectious Diseases. Elk Grove Village, IL: American Academy
of Pediatrics; 2012. 69-109.
15. Use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine as a five-dose
series. Supplemental recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR Recomm Rep. 2000;49:1-8.
2556
36

3

+2 +8o

1. (Heat sensitivity)

OPV
M, MMR
() DTP, DTP-HB, DTP-HB - Hib, yellow fever
BCG
Hib, DT
dT, T, HB, JE ()

2556
37
2. (Freeze sensitivity)

0o Alum HB, Hib, DTP, DTP-HB, DTP-HB -
Hib, DT, dT T
+2 +8o

HB
() Hib
DTP, DTP-HB, DTP-HB - Hib
DT
dT
T

3.

BCG, M, MR, MMR, JE Rota virus
JE HPV

+2 +8o OPV
()
(ice pack)

2556
38

+2 +8o

+2 +8o

3-1

BCG Live attenuated ID +2 +8o
bacteria
2
DTwP, DTaP, DT, dT, T Toxoids and IM +2 +8o
inactivated bacteria
or component
OPV Live attenuated virus Oral +2 +8o
HB Recombinant viral IM +2 +8o
antigen
MMR, M, MR Live attenuated SC +2 +8o
viruses 6
JE (mouse brain derived) Inactivated virus SC +2 +8o
Live JE Live attenuated virus
- Primary Hamster SC +2 +8o
Kidney Cell 1
- Chimeric virus SC +2 +8o
Rabies Inactivated virus
- PCEC - Purified Chick Em IM / ID +2 +8o
bryo Cell
- PVRV - Purified Vero Cell IM / ID +2 +8o
2556
39

Hib Polysaccharide- IM +2 +8o
protein conjugate
HA Inactivated virus IM +2 +8o
VAR Live attenuated virus SC +2 +8o
GSK
8
Influenza Inactivated virus IM +2 +8o
PPSV23 Polysaccharide IM / SC +2 +8o
PCV Protein Conjugate IM +2 +8o
Mnc Polysaccharide SC +2 +8o
MCV Protein Conjugate IM +2 +8o
IPV Inactivated virus IM +2 +8o
Ty Live attenuated Oral +2 +8o
bacteria
Ty Polysaccharide IM / SC +2 +8o
Rota virus Live attenuated virus Oral +2 +8o
HPV Recombinant viral IM +2 +8o
antigens
Cholera Inactivated bacteria oral +2 +8o

1. Department of Immunization, vaccines and Biologicals, World Health Organization. Ensuring
the quality of vaccine at coutry level: Part III: Storage and distribution of vaccines and diluents.
Genva: WHO: 2003.
2. Department of Immunization, vaccines and Biologicals, World Health Organization. Immunization
in practice (2004): Module 3 The cold chain. Geneva: WHO; 2004.
3. Vaccine storage temperature recommendation 2011. Available from http://www.cdc.gov/pubs/
pinkbook/pink-appendx.htm#appc.
4. .
.. 2547.: ; 2547.
2556
40

4
1-5
5
1. (vaccine reaction)
1.1 ( 4-1)

1-2 M, MMR 5-12 VAR
5-26
2556
41
4-1

( )
BCG 90-95 - -
Hib 5-15 2-10 -
HBV 30 1-6 -
5
M / MMR 10 5-10 5
OPV 1 1*
T/dT 10** 10 25
DTwP*** 50 50 60
VAR 20 10-15 -
*
** 50-85
***
1.2 ( 4-2)

anaphylaxis hypotonic hyporesponsive episode
4-2

( 1 )
BCG 2-6 100-1,000
(BCG osteitis) 1-12 1-700
BCG (disseminated 1-12 2
BCG-itis)
HBV Anaphylaxis 0-1 1-2
Guillain-Barre syndrome 1-6 5
M / MMR * 5-12 333
15-35 33
Anaphylaxis 0-1 1-150
Encephalitis/encephalopathy 6-15 0.5
OPV Vaccine-associated paralytic 4-30 1.4-3.4 **
poliomyelitis (VAPP)
2556
42

( 1 )
T Brachial neuritis 2-18 5-10
Anaphylaxis 0-1 1-6
(sterile abscess) 1-6 6-10
DTwP 0-24 1,000-60,000
( 3 ) 0-3 570
*** 0-24 570
(hypotonic,
hyporesponsive episode) 0-1 20
Anaphylaxis / shock 0-3 0-1
JE (Inactivated) Encephalopathy 0-17 10-1,000
angioedema 0-16 1-2.3

* ( anaphylaxis) 6 MMRV
MMR
** VAPP (1 1.4-3.4 ) (1 5.9 ) 1 6.7
***
2. (program error)

l
l OPV BCG
3.

5
2556
43

Hyperventilation

4. (coincidental event)

5. (unknown)

4-3

l l
l toxic shock syndrome

l

l l
l
l

l DTP DT dT TT l
l l

l l
l adjuvant DTP l

(+2o)
l
2556
44
4-4 3

1. BCG 1. : - BCG
osteitis 3-4
2. : disseminated fatal
infection -
severe combined immune BCG INH
deficiency syndrome rifampicin
2-3

2. DTP 1. : - acellular
whole cell
(sterile abscess)
2. :
encephalopathy, hypotonic
hyporesponsive episode (
)
3. : anaphylaxis
arthrus-like

3. HBV 1. : - sudden
2. : infant death syndrome,
3. : anaphylaxis demyelinating disease multiple
sclerosis
4. OPV Vaccine-Associated Paralytic
Poliomyelitis (VAPP)

2556
45

5. IPV - VAPP
- streptomycin, neomycin
polymyxin B

6. MMR 1. : 5-12 -
transient thrombocy Inflammatory bowel
topenia, disease
encephalitis encephalopathy -
MMR
skin test
2. :

neomycin 30

7. MMRV 1. :
4-12

MMRV
MMR

8. JE, Inactivated 1. : -
mouse brain 20 2
2. :
10

1:50-75,000 1:1
3. : angioedema
0.2-0.6
2
2556
46

9. JE, live attenuated 1. :

2. :
9.3 - 21 6.7
hypersensitivity

10. HAV 1. :

2. :

11. VAR 1. :

2. : (maculo
papular rash vesicle)
5-26
12. Hib 1. :
25
24
2. :
13. Influenza (TIV) 1. : (intradermal)
2. :
13
6-24
Guillain-Barre
syndrome 1
Guillain-Barre
syndrome
3. :
anaphylaxis
2556
47

14. 1. :
(Rabies)
15-25
2. :

10-20
3. : immune complex like
reaction
HDCV 2-21

angioedema
15. Meningococcal 1. :

1-2
2-18
(MCV4)
(MPSV4)
2. :
2-5
16. HPV 1. :
80
2. :

30

17. Ty: (Vi capsular 1. :
polysaccharide 7
vaccine) 2. :
1.5-3
0-1
48
2556
48

18. Yellow fever 1. :
2 - 5
5 10
2. :

25

6
3. :
anaphylaxis
serum sickness
1
19. Zoster 1. :

2. :
20. Rotavirus (RV) 1. :

1 : 68,000
21. PCV 1. :

2. :
1-2
22. PS23 1. :

2. :

3. : arthus-like

2

2556
49
4-5 3, 6

- anaphylaxis
-
-

BCG -

-
DTwP, DTaP, Tdap - Encephalopathy 7 (
DT )
- > 40.5o 48 .
- (collapse)
(shock-like) hypotonic hyporesponsive episode
48 .
- 3
- > 3 . 48 .
- progressive or unstable neurologic disorder infantile
spasm (
DT dT )
- Guillain-Barre syndrome 6

DT, dT - anaphylaxis
-
- Guillain-Barre syndrome
6
OPV - antibody deficiency
syndrome, leukemia IPV
- IPV
-
2556
50
4-5 3, 6 ()

IPV - neomycin, streptomycin, polymyxin
-
MMR - neomycin
-
-
(clinical category C)
-

- idiopathic thrombocytopenic purpura
Hib -

HBV -
- 2,000 1-2
HBV HB immunoglobulin
12
HAV - anaphylaxis
-
-
VAR - neomycin, erythromycin, kanamycin
-
(clinical category C) CD4 15%
-
-

- acyclovir, famcyclovir
valacyclovir 24
14

PCV PPSV - anaphylaxis
- 2 PPSV
MCV4, MPSV4 -
- Guillain-Barre Syndrome
- 2 MPSV4
2556
51
4-5 3, 6 ()

- anaphylaxis
- Guillain-Barre syndrome
6
Rotavirus - Severe combined
immunodeficiency
-
-
HPV -
-

1

pavulon

preservative
Staphylococcus aureus
7

l
l 6 BCG
2
l

l

l
(Adverse Event Following

Immunization : AEFI) 3

(adverse event AE)
2556
52

human-rhesus recombinant (RotaShieldTM)
.. 2542 9
(intussusception)

(severe adverse event)
4
1.
2.
3.
4.
1.
2.
3. -- adjuvant subcutaneous
(sterile abscess)
4.

(co-incident)
AEFI

AEFI
AEFI
ADR
AEFI
l

l
2556
53
l

AEFI 4
1. (neurological syndrome)
2.
3.
4. ()

4

download AEFI website
http://epid.moph.go.th 506

. 02-2453082 02-2475069 . 02-5901795 02-5901784
outbreak@health.moph.go.th

AEFI AEFI

1.
-
-
-
-

2.
3.
-
-
2556
54
- ()
-
-
AEFI
download website http://epid.moph.go.th

(local reaction)
1. (pain)

1.1 Topical anesthetic technique 10
( 5% EMLATM)
30-60 7,8
MMR9
1.2 10
Ibuprofen nonsteroid anti-inflammatory drugs
(NSAIDS)
11
1.3 Z-track (
)

18 (deltoid) 12
2. (local inflammation) sterile abscess
inactivated adjuvant
DTP
adjuvant DTP, DT, dT, HB, HA

cloxacillin, cephalexin
2556
55
3. (Bleeding)

HB 153 23
1-2 4 VIII13
cryoprecipitate
cryoprecipitate 23
2

4. / BCG
1-2
Isoniazid (INH) 10 ././ 2-3
(osteitis) BCG
pyrazinamide BCG pyrazinamide

5.
( Staphylococcus aureus, Streptococcus Clostridium)
local atrophy, gangrene, tissue necrosis skin pigmentation
(system reaction)
1. DTP > 40.5 o
1 330 24 24
7
MMR 5-12 1-2 5
2. M MMR
(transient rash) 5 1-2
maculopapular
3-5 5-26

3.
DTP 1 1,750 48
3 4

DTaP DTwP
2556
56
encephalopathy DTP M / MMR 7
7 15
4. hypotonic-hyporesponsive
episode (HHE) 1 1,750 DTP6 1 30,000-100,000
MMR 2-3 2 14-17
(allergic reaction)

4
1.
2.
3.
4.
1.
chicken embryo fibroblast tissue culture
M MMR
anaphylaxis

neomycin17-20
M MMR

anaphylaxis
anaphylaxis

12
1. Scratch, prick puncture test 1:10
scratch, prick puncture positive control negative
control 15-20 (wheal)
3 . intradermal test
2. Intradermal test 1:100 0.02 .
(Intradermal) positive control negative control
5 .
desensitization

2556
57
desensitization
15-20
1. 1:10 0.05 .
2. 0.05 .
3. 0.10 .
4. 0.15 .
5. 0.20 .
desensitization anaphylaxis
anaphylaxis
2.
Thimerosal

ethyl mercury thimerosal
thimerosal
21 thimerosal
(IVIG) Rho (D) thimerosal

thimerosal
delayed-type patch 1-18
22,23 thimerosal
thimerosal6
3.

streptomycin, neomycin polymyxin B M MMR
neomycin kanamycin, erythromycin
neomycin delayed-type
48-96
anaphylaxis
4.
M, MMR, VAR
anaphylaxis

HB
HB
2556
58
DTP, DTaP, DT, dT TT anaphylaxis
DTaP DTwP
anaphylaxis
1/2-1 .
10
(Arthus reaction)
10
human diploid serum
sickness 6
angioedema
2

30
angioedema

11
1. Acute febrile reaction
2. Serum sickness 7-10

3 serum sickness maculopapular
( 90 )
2-3 serum sickness angioedema, glomerulonephritis, Guillain-Barre
syndrome, peripheral neuritis myocarditis serum sickness 2-3
2
serum sickness
3 serum sickness
-
- nonsteroid anti-inflammatory drugs (NSAIDS)

-
(prednisolone) 1.5-2 ././ 60 ./ 5-7
2556
59
3. Anaphylaxis

- angioedema
- stridor
-
-
anaphylaxis IgE
12

(skin test, SPT)
(Intradermal test, ID)
(anaphylaxis)
SPT ID
3-10
SPT 1:100 1
positive control negative control
negative control 3 .
positive control 15-20
ID
intradermal (ID) 1:1,000 0.02 .
positive control negative control
SPT ID 1:100
SPT
ID 1:100
type I hypersentsitivity
immediate reaction serum sickness

30
botulism

anaphylaxis ID
anaphylaxis
desensitization
2556
60
desensitization 12
desensitization (
4-6) (ID) (subcutaneous) ( 4-7)
desensitization
anaphylaxis diphenhydramine
desensitization hydrocortisone methylprednisolone
anaphylaxis aqueous epinephrine
( anaphylaxis) desensitization
desensitization
4-6 desensitization 15
Dilution (.)
1 1:1,000 0.1
2 1:1,000 0.3
3 1:1,000 0.6
4 1:100 0.1
5 1:100 0.3
6 1:100 0.6
7 1:10 0.1
8 1:10 0.3
9 1:10 0.6
10 0.1
11 0.3
12 0.6
13 1.0
2556
61
4-7 desensitization
15
Dilution

(.)
1 1:1,000 0.1
2 1:1,000 0.3
3 1:1,000 0.6
4 1:100 0.1
5 1:100 0.3
6 1:100 0.6
7 1:10 0.1
8 1:10 0.3
9 1:10 0.6
10 0.1
11 0.3
12 0.6
13 1.0
anaphylaxis12
(IVIG)
anaphylaxis epinephrine
angioedema
epinephrine 1:1,000 (1 ./.) 0.01 ./. 0.3 . 0.5 .
anterolateral diphenhydramine, hydroxyzine
epinephrine
epinephrine
epinephrine 5-15 3
24-48

epinephrine epinephrine
epinephrine
anaphylaxis
normal saline, Lactated Ringers solution isotonic

2556
62
dopamine
H1 H2
anaphylaxis
systemic glucocorticoid
anaphylaxis 8-24
anaphylaxis (biphasic anaphylaxis)
4-8 3
/

BCG

DTP

( )
angioedema
epinephrine 1:1,000 (1 ./.)
0.01 ./. 0.3 . 0.5 .
antarolateral
Anaphylaxis, shock 5-15
( 30 epinephrine 1:1,000 (1 ./.)
) 0.01 ./. 0.3 . 0.5 .
antarolateral
5-15
epinephrine epinephrine
0.1 ././ ( 0.6 X
. . epinephrine saline 100
. 1 ./.
0.1 ././) 1-4 ./

H1 H2
2556
63

1. Information for health-care workers-managing adverse events. Available at http://www.who.int/
immunization_safety/aefi/managing_AEFIs.
2. , . . :
, , . . :
; 2554. . 61-6.
3. , , : 2012-2013
. ; 2554 .23-37.
4. Immunization safety surveillance: Part 2 Adverse events following immunization (AEFI). WHO
Regional Office for the Western Pacific; 2009.
5. Supplementary information on vaccine safety: Part 2: Background rate of adverse event following
immunization. Geneva: World Health Organization; 2000.
6. CDC. Table 6. Contraindications and precautions to commonly used vaccines. General
Recommendations on Immunization: Recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR 2011; 60 (No. RR-2):40-41.
7. Taddio A, Nulman I, Goldbach M, Ipp M, Koren G. Use of lidocaine-prilocaine cream for
vaccination pain in infants. J Pediatr 1994; 124: 643-8.
8. Uhari M. A eutectic mixture of lidocaine and prilocaine for alleviating vaccination pain in
infants. Pediatrics 1993; 92: 719-21.
9. Halperin SA, McGrath P, Smith B, Houston T. Lidocaine-prilocaine patch decreases the pain
associated with subcutaneous administration of measles-mumps-rubella vaccine but does not
adversely affect the antibody response. J Pediatr 2000; 136: 789-94.
10. Lewis K, Cherry JD, Sachs MH, et al. The effect of prophylactic acetaminophen administration
on reactions to DTP vaccination. Am J Dis Child 1988; 142: 62-5.
11. Prymula R, Siegrist CA, Chlibek R, et al. Effect of prophylactic paracetamol administration
at time of vaccination on febrile reactions and antibody responses in children: two open-label,
randomised controlled trials. Lancet 2009;374(9698):1339-50.
12. Active and passive immunization. American Academy of Pediatrics. In: Pickering LK, ed.
Red Book: 2009. Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village,
IL: American Academy of Pediatrics 2009: 9-67.
13. Evans DI, Shaw A. Safety of intramuscular injection of hepatitis B vaccine in haemophiliacs.
BMJ 1990; 300: 1694-5.
14. Nieminen U, Peltola H, Syrjala MT, et al. Acute thrombocytopenic purpura following measles,
mumps, and rubella vaccination: a report on 23 patients. Acta Peadiatr 1993; 82: 267-70.
2556
64
15. Farrington P, Pugh S, Colville A, et al. A new method for active surveillance of adverse
events from diphtheria/tetanus/pertussis and measles/mumps/rubella vaccines. Lancet 1995;
345: 567-9.
16. Bottinger M, Christenson B, Romanus V, et al. Swedish experience of two dose vaccination
programme aiming at eliminating measles, mumps, and rubella. Br Med J 1987; 295: 1264-7.
17. Kelso JM, Jones RT, Yunginger JW. Anaphylaxis to measles, mumps, and rubella vaccine
mediated by IgE to gelatin. J Allergy Clin Immunol 1993; 91: 867-72.
18. Sakaguchi M, Ogura H, Inouye S. IgE antibody to gelatin in children with immediatetype
reactions to measles and mumps vaccines. J Allergy Clin Immunol 1995; 96: 563-5.
19. Sakaguchi M, Yamanaka T, Ikeda K, et al. IgEmediated systemic reactions to gelatin included
in the varicella vaccine. J Allergy Clin Immunol 1997; 99: 263-4.
20. Sakaguchi M, Nakayama T, Inouye S. Food allergy to gelatin in children with systemic
immediate-type reactions, including anaphylaxis to vaccines. J Allergy Clin Immunol 1996;
98: 1058-61.
21. Ball LK, Ball R, Pratt RD. An assessment of thimerosal use in childhood vaccines. Pediatrics
2001; 107: 1147-54.
22. Moller H. All these positive tests to thimerosal. Contact Dermatitis 1994; 31: 209-13.
23. Wantke F, Demmer CM, Gotz M, Jarisch R. Contact dermatitis from thimerosal. 2 years
experience with ethylmercuric chloride in patch testing thimerosal-sensitive patients. Contact
Dermatitis 1994; 30: 115-7.
2556
65

5
(Sterilization Technique)

1-3
1.
-

- non-intact
skin
-
70%
30
2556
67
2.
-

l

l

l
l (puncture-proof
safety box)
- (vial) (ampule)
5-1
5.1

(single-dose vial)

(multiple-dose vial)

(ampule)

24
-

2556
68

l 70%
70%

(
)

l 70% 70%

70%

-

-
l
l 70%
3.
4
l
l 3/4
2556
69
4.
(puncture-proof safety box)
5,6

l

l 3/4

l

1. WHO best practices for injections and related procedures toolkit. March 2010. Available from:
http://whqlibdoc.who.int/ publications/2010/9789241599252_eng.pdf.
2. Hutin Y et al. Best infection control practices for intradermal, subcutaneous, and intramuscular
needle injection. Bulletin of the World Health Organization. 2003; 81:491500. Available from:
http://www.who.int/bulletin/volumes/81/7/en/Hutin0703.pdf.
3. A reference outline for developing a national policy and plan of action for injection safety
in national immunization programmes. March 2003. Available from: www.who.int/.../publications/
safe_injections/en/outline_national_policy_injection_safety_E.pdf.
4. Protecting healthcare workers: preventing needlestick injuries toolkit. Geneva, World Health
Organization. 2006. Available from: http://www.who.int/occupational_health/activities/pnitoolkit/en/
5. Aide-memoire for a national strategy for health-care waste management. Geneva, World Health
Organization. 2000. Available from: http://www.who.int/occupational_health/activities/2amhcw_
en.pdf.
6. Aide-memoire: standard precautions in health care. Geneva, World Health Organization. 2007.
Available from: http://www.who.int/csr/resources/publications/EPR_AM2_E7.pdf.
2556
70

6
(EPI)

8 (BCG) (HB)
--- (DTP-HB) (OPV) --
(MMR) (JE) -- (DTP) - (dT)

.. 2553

2556
71
6-1

BCG
HB , 1
DTP-HB 2 , 4 , 6
OPV 2 , 4 , 6 , 18 , 4-6
DTP 18 4-6
- 12-16 (.6) 10
dT - 0, 1, 6
10
MMR 9-12 , 2 1/2
JE 12 (2 4 ) 2 1/2 ( MMR 2)
: MMR 2 .1 2 1/2
.. 2556
.1
2 1/2 MMR 2 .1
2556
72
6-2

BCG

HB1 HB1 24
1 HB2
2 DTP-HB1, OPV1
4 DTP-HB2, OPV2
6 DTP-HB3, OPV3
9 MMR1 9
1 JE1, JE2 2 4
1 1/2 DTP4, OPV4
2 1/2 JE3, MMR2
4 DTP5, OPV5
.1
MMR .1
MMR2
2 1/2 .1 2 1/2
7 (.1) MMR2 .1
1.
BCG*
2.
dT, OPV DTP, OPV 5
12 (.6) dT .6
1.
2. 1
1
* BCG
2556
73
6-3 - (dT)

(DTP-HB,DTP,dT,TT)
3 1
2 1
1 3
2 6
10
1 2
1
6 10
2 1 6
10
3 1
10 10
3 0
10
2
1
1 6 10
: dT
(Arthus reaction)
dT 10
2556
74

7
2556
75

7.1
(BCG Vaccine)

Mycobacterium tuberculosis

airborne transmission (cellular immunity)

101 1-6
200-800 2
CD4 200 4.87 3
24 4

6
12-18

.. 2553
8.8
HIV 1.1 141 .. 2545
128 9.7 .. 2542 1.4 5
2556
77
19 22
6 .. 25342542
3-4 49.97 .. 2547
63.11 .. 2552 76
10-14 5

33.4 .. 2533 50.4 .. 2542
35 5-9
100,000 42,000
.. 2527-2543 27

10 ..
2544-2553 48.37 63.72 2553
40,588 7 126 0.02
0.31 74.6 2.0
23.4 26,476 14,112
1.9 : 1 65 177.81 55-64
(113.51 ) 45-54 (78.96 )
0-4 5 .. 2549-2553 8.24 14.29

.. 2464 Calmette
Guerin
80
8 Mycobacterium bovis
(attenuated strain) Bacillus Calmette-Guerin Vaccine (BCG)
2
(freeze-dried) (.. 2555)
3
1. ( Tokyo 172)
2. Serum Institute of India ( Russian)
3. Sanofi Pasteur BCG
2556
78

1 0.5 -1.0
2-10
(BCG-TRC) 30
12-15 1
2 syringe
10
(normal saline) 1
(intradermal injection) BCG-TRC

0.1 serum institute of India 0.05
1 0.1 1

6-8
1 2-3
2-3
4-5 3-4

24-48

6-8
9

2556
79

3

severe combined immune
deficiency syndrome

(induration) (abscess)
1-2

1. 3-4

2.
isoniazid 4-6
rifampin
3.
4
4.

5.

6. (PPD skin test)
PPD skin test
PPD skin test
PPD skin test
7.

isoniazid 1-2
(latent tuberculosis infection)
isoniazid 6-9
2556
80

1.

2.
3.
4.
2
(TB meningitis)
(miliary TB) 52-100
( 0-8010-12)
5 5313
8314 7

+2 +8o
2 ( )

2
1. Marais BJ, Gie RP, Schaaf HS, et al. The clinical epidemiology of childhood pulmonary
tuberculosis: a critical review of literature from the pre-chemotherapy era. Int J Tuberc Lung
Dis 2004;8(3):278-85.
2. CDC. Prevention and treatment of tuberculosis among patients infected with human
immunodeficiency virus: principles of therapy and revised recommendations. Centers for
Disease Control and Prevention. MMWR Recomm Rep 1998;47(RR-20):1-58.
3. Antonucci G, Girardi E, Raviglione MC, Ippolito G. Risk factors for tuberculosis in HIV-
infected persons. A prospective cohort study. The Gruppo Italiano di Studio Tubercolosi
e AIDS (GISTA). JAMA 1995;274(2):143-8.
2556
81
4. Hesseling AC, Cotton MF, Jennings T, et al. High incidence of tuberculosis among HIV-
infected infants: evidence from a South African population-based study highlights the need
for improved tuberculosis control strategies. Clin Infect Dis. 2009;48(1):108-14.
5. World Health Organization, Progress WHO golbal tuberculosis control report 2011. Available from : http://
www.who.int/tb.
6. CDC. BCG vaccine. WHO position paper. Wkly Epidemiol Rec. 2004;79(4):27-38.
7. 2553, .
8. Comstock GW. Identification of an effective vaccine against tuberculosis. Am Rev Respir
Dis. 1988; 138: 479-80.
9. Lotte A, Wasz-Hockert O, Poisson N, et al. Second IUATLD study on complications induced
by intradermal BCG-vaccination. Bull Int Union Tuberc Lung Dis. 1988; 63: 47-59.
10. Wallgren A. Protective effect of BCG vaccination against various types of tuberculous disease.
Bull Int Un Tuberc. 1966; 38: 7-15.
11. WHO. WHO statement on BCG revaccination for the prevention of tuberculosis. WHO Bulletin
OMS. 1995; 73: 805-7.
12. Advisory Council for the elimination of Tuberculosis and the Advisory Committee on
Immunization Practices. The role of BCG vaccine in the prevention and control of tuberculosis
in the United States. MMWR Morb Mortal Wkly Rep. 1996;45(RR-4):1-18.
13. Padungchan S, Konjanart S, Kasiratta S, Daramas S, Ten Dam HG. The effectiveness of BCG
vaccination of the newborn against childhood tuberculosis in Bangkok. Bull World Health
Organization. 1986; 64: 247-58.
14. Sirinavin S, Chotpitayasunondh T, Suwanjutha S, Sunakorn P, Chantarojanasiri T. Protective
efficacy of neonatal Bacillus Calmette-Guerin vaccination against tuberculosis. Pediatr Infect
Dis J. 1991; 10: 359-65.
2556
82

7.2
(Hepatitis B Vaccine : HB)

double-stranded DNA Virus Family Hepadnaviridae, Genus
Orthohepadnavirus

60-90 (45-180 )1

HBsAg HBeAg
90 HBsAg HBeAg 10
80-90 1-4
30-50 2-5 2
25-30 3
2556
83

8 2
( 30) 360
600,000 4,5,6

50-75 8-10

( 6-8 10-12) 10
30 10

.. 2535
.. 2547 0-5 1.5-3.5
50 3.92
12 0.74 5
0.46 7 ( 5.4)
90

.. 2553 5,879 8 9.23
8 0.01 0.14
3,365 2,514 35
14.91
9.15, 7.14 6.94
10
2.85 .. 2544 9.23
.. 2553 35

15

(HB)

(HBsAg) (recombinant DNA
vaccine) HBsAg
HBsAg HBsAg
GSK (Engerix BTM), MSD (H-B Vax IITM),
sanofi pasteur (Euvax BTM), Kaketsuken (BimmugenTM) Heber Biotec S.A. (HeberbiovacTM)
2556
84

HBsAg
10 20 . . 40 . .
aluminium hydroxide thimerosal
0.5 .
1 .
()
0.5 ., 1 . 5 .
0.5 .

1 .

(3 0, 1-2 6-7)
40 . .
11-15 2
( 1 .) 6 9, 10
0.5 . 3
CD4 15
CD4 25 350 /..
2556
85
7.2-1
Hepatitis B
(Serum Institute
HEBER- of India),
Engerix BTM Euvax-BTM HB-Vax PROTM TM
BIOVAC-HB Hepavax-Gene,
Hepavax-Gene
TF
0-20 : 0.5 . 0-20 : 0.5 . 0-16 : 0.5 . 0-35 : 0.5 . 0-10 : 0.5 .
(10 .) (10 .) (5 .) (10 .) (10 .)
>20 : 1 . >20 : 1 . >16 : 1 . >35 : 1 . >10 : 1 .
(20 .) (20 .) (10 .) (20 .) (20 .)
* : 2 . * : 2 . * : 1 . * : 2 . * : 2 .
(40 .) (40 .) (40 .) (40 .) (40 .)
*

24 10
1-2 6-7 ( 24 )
2,000
2,000
1 2,000
12
1
2,000 4
8
( HBeAg )
hepatitis B immunoglobulin (HBIG) HBIG
HBIG
( 12 ), 1
2, 4, 6 1
2 11

2556
86

3 4
8 12
1-613
3-4 24

90-9513-14

24

14
3
10 15-16
17
(hemodialysis)

1-3
HBsAg anti-HBs HBsAg
anti-HBs 3 anti-HBs 1
(anti-HBs) 10 mIU/.
recombinant
(HBeAg )
93 HBIG 9811,18,19
.. 2535 .. 2535 0.7
20-22
2556
87
23 20 24

1.
1.1 ( 18 )

20
1.2 ( 18 )

2.
1
HBIG 24
( DTP-HB) 2, 4 6
5
0, 2, 4, 6
0, 1, 2, 4, 6 25
3.
HBeAg
HBIG 0.5 .

HBIG
HBIG 7 HBIG 7

4. HBIG
7.2-2
2556
88
7.2-2 26
HBsAg

a
HBIG 1 HB 3 HB 3
HB 3

(Responder)
- HBIG
(Nonresponder) (1 ) HB
3 b -
HBIG (2 ) HBsAg
anti-HBs anti-HBs
c HB c
d - <10 mIU/.
HB
- 10 mIU/.

a
HBIG 0.06 ./.
b
nonresponder HB 2 (6 ) HBIG (0.06 ./.) 2
1
c
anti-HBs 10 mIU/.
d
anti-HBs HBIG 4-6 HB HB
1-2 anti-HBs <10 mIU/. 2 3
+2 +8o
2
2556
89

1. Abram S. Benenson. Viral hepatitis B. In: control of communicable diseases. 15th edition.
1990: 200-207.
2. http://www.cdc.gov/hepatitis/HBV/index.htm
3. Snyder JD, Pickering LK. Viral hepatitis. In: Behrman RE, Kliegman RM, Jensen HB. eds.
Nelson Textbook of Pediatrics Philadelphia: WB Saunders. 2004: 1324-32.
4. Goldstein ST, Zhou F, Hadler SC, Bell BP, Mast EE, Margolis HS. A mathematical model
to estimate global hepatitis B disease burden and vaccination impact. Int J Epidemiol. 2005
Dec;34(6):1329-39.
5. Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B virus infection: epidemiology
and vaccination. Epidemiol Rev. 2006;28:112-25.
6. Hepatitis B vaccines. Wkly Epidemiol Rec. 2009 Oct 1;84(40):405-19.
7. Voranuch Chongsrisawat, Pornsak Yoocharoen, Apiradee Theamboonlers, et al. Hepatitis B
seroprevalence in Thailand: 12 years after hepatitis B vaccine integration into the national
expanded programme on immunization. Tropical Medicine and International Health, Vol.11,
No.10, Oct. 2006: 1496-1502.
8. 2553,
9. CDC. Alternative two-dose hepatitis B vaccination schedule for adolescents aged 11-15 years.
MMWR. 2000; 49:261.
10. Heron L, Selnikova O, Moiseieva A, et al. Immunogenicity, reactogenicity and safety of two-dose
versus three-dose (standard care) hepatitis B immunisation of healthy adolescents aged 11-15
years: a randomised controlled trial. Vaccine. 2007;25:2817-22.
11. Poovorawan Y, Sanpavat S, Pongpunlert W, Chumdermpadetsuk S, Sentrakul P, Safary A.
Protective efficacy of a recombinant DNA hepatitis B vaccine in neonates of HBe antigen
positive mothers. JAMA. 1989; 261: 3278-81
12. American Academy of Pediatrics. Hepatitis B. In: Pickering LK, Baker CJ, Kimberlin DW Long
SS eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Glove Village,
IL: American Academy of Pediatrics; 2012: 369-390.
13. Lolekha S, Bowonkiratikachorn P, Chimabutra K. Immunogenicity and reactogenicity of a
yeast-derived hepatitis B vaccine in Thai school children. J Med Assoc Thai. 1989;72 (suppl 1):
98-101.
14. Greenberg DP, Vadheim CM, Womg VK, et al. Comparative safety and immunogenicity of two
recombinant hepatitis B (HBV) vaccine given to infants at 2, 4, and 6 months of age. Pediatr
Infect Dis J. 1996; 15: 590-6.
15. Anonymous. Are booster immunizations needed for life long hepatitis B immunity. Lancet. 2000;
355: 561-5.
2556
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16. Poovorawan Y, Sanpavat S, Theamboonlers A, Safary A. Long term follow-up (11 to 13 years)
or high risk neonates, born to HBe Ag positive mothers and vaccinated hepatitis B. In: Margolis H,
Alter MJ, Liang TJ, Dienstag JL, Eds. Viral hepatitis and liver Disease. atlanta: International
Medical Press. 2002; 263-66.
17. Chongsrisawat V, Theamboonlers A, Khwanjaipanich S, et al. Humoral immune response
following hepatitis B vaccine booster dose in children with and without prior immunization.
Southeast Asian J Trop Med Public Health. 2000; 31: 623-6.
18. Poovorawan Y, Sanpavat S, Pongpunlert W, et al. Long-term efficacy of hepatitis B vaccine
in infants born to HBe Ag positive mothers: effect of vaccination with a yeast-derived vaccine
according to different schedules with and without concomitant hepatitis B immunoglobulin.
Pediatr Infect Dis J. 1992; 11: 816-21.
19. Poovorawan Y, Sanpavat S, Chumdermpadetsuk S, Safary A. Long term hepatitis B vaccine
in infants born to hepatitis B e antigen. Arch Dis Child. 1997; 77: 47-51.
20. Poovorawan Y, Theamboonlers A, Vimolket T, et al. Impact of hepatitis B immunization as
part of the EPI. Vaccine. 2000; 19: 943-9.
21. Poovorawan Y, Theamboonlers A, Hirsh P, et al. Persistence of antibodies to the surface
antigen of the hepatitis B virus (anti-HBs) in children subjected to the Expanded Programme
on Immunization (EPI), including hepatitis-B vaccine, in Thailand. Ann Trop Med Parasitol. 2000;
94: 615-21.
22. Chubuppakarn S, Panichart P, Theamboonlers A, Poovorawan Y. Impact of the hepatitis B mass
vaccination program in the southern part of Thailand. Southeast Asian J Trop Med Public Health.
1998; 29: 464-8.
23. Chang MH, Chen CJ, Lai MS, et al. Universal hepatitis B vaccination in Taiwan and the
incidence of hepatocellular carcinoma in children. Taiwan Childhood Hepatoma Study Group.
N Engl J Med. 1997; 336: 1855-9.
24. Wu Q, Zhuang GH, Wang XL, Wang LR, Li N, Zhang M. Antibody levels and immune
memory 23 years after primary plasma-derived hepatitis B vaccination: results of a randomized
placebo-controlled trial cohort from China where endemicity is high. Vaccine. 2011;29:2302-7.
25. Tharmaphornpilas P, Rasdjarmrearnsook AO, Plianpanich S, Sa-nguanmoo P, Poovorawan Y.
Increased risk of developing chronic HBV infection in infants born to chronically HBV infected
mothers as a result of delayed second dose of hepatitis B vaccination. Vaccine. 2009;27(44):6110-5.
26. Chongsrisawat V, Yoocharoen P, Theamboonlers A, et al. Hepatitis B seroprevalence in Thailand:
12 years after hepatitis B vaccine integration into the national expanded programme on
immunization. Trop Med Int Health. 2006 ;11:1496-502.
2556
91

7.3 A
-
(Diphtheria and Tetanus toxoids combined : DT dT)

--
- (DT, dT) (toxin)

(toxoid) adsorbed aluminum salt
2 1
1. 7 (DT) 0.5 .
purified diphtheria toxoid 25-30 Lf

purified tetanus toxoid 5-10 Lf
2. 7 (adult type dT)
0.5 .
purified diphtheria toxoid 1-2 Lf
2556
93

5 . (10 )
0.5 .
2
1. DT 7

(encephalopathy) 0.5 .
DTP DT
DTP
2. dT 7
(DTwP) (DTaP)
toxoid
toxoid
toxoid
dT 0.5 .
DTP, DT, dT, T 0, 1, 6 (primary series)
Tdap dT dT
10 DTP, DT dT Tdap
dT 1 10
dT (T)
3,4

7 DT DTP
2, 4, 6, 18 4-6 ( Tdap 4-6 )
DTP, DT dT ( Tdap )
11-12 dT 10
dT
dT
-
3 0, 1, 6 10
- 1 2 0, 6 2
1 2 3 6
10
- 3 10 1
10
2556
94
- Tdap 27-36
dT 1 TT, dT Tdap
5
dT
-
3 0, 1, 6 10
- 3
1 2 1 2 3
6
- (DTP 5 dT 11-16
6) dT 10
- Tdap Tdap dT 1
Tdap
Tdap dT T
dT ( DT
DTP 7 ) (tetanus toxoid: T) ()
. T dT DTP DT 3
5
. T dT DTP DT 3
5 dT ( DT DTP 7 )
. T dT DTP DT
dT ( DT DTP 7 )
3 tetanus antitoxin
( 7.3 A-1)
.
tetanus antitoxin 3
2556
95
7.3 A-1 *
*
dT** TIG*** dT** TIG***
(dT, DT, T DTP)
( DTP <7 ) ( DTP <7 )
3 3 - 3 3

3 - -

10 5

*
** Tdap dT 1 Tdap 4 6
*** Tetanus Immunoglobulin (TIG) 250 antitoxin 1500

: antitoxin 1:100 0.02 .

15-20 antitoxin
3 . antitoxin TIG TIG
antitoxin desensitization ( )
antitoxin adrenaline

Arthus reaction
2-8
10 DTP
TIG serum sickness 7, 8

2
DT DTP ( 7.3 B)
2 1 80
(0.01 IU/ml) 3
3 2 6 95
5-10
2556
96
(Tdap)9 4-6
Tdap
dT 1 Tdap 1
+2 +8o
2
1. . . : ,
, , . 2012-2013 .
: . 2555: 165-82.
2. American Academy of Pediatrics. Diphtheria and Tetanus In: Pickering LK, Baker CJ, Kimberlin DW Long
IL: American Academy of Pediatrics; 2012: 307 - 311, and 707 - 712.
3. CDC. Diphtheria, tetanus and pertussis: Recommendations for vaccine use and other preventive
measures. Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR
1991; 40(RR-10): 1-28.
4. Arnon SS. Tetanus (Clostidium tetani) In: Behrman RE, Kliegman RM, Jensen HB, eds. Nelson
Textbook of Pediatrics. Philadelphia: WB Saunders. 2004: 951-3.
5. CDC. Update recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular
pertussis vaccine (Tdap) in pregnancy women - Advisory Committee on Immunization Practices
(ACIP) 2012. MMWR Morb Mortal WKly Rep. 2013, Feb 22; 62 : 131-5.
6. CDC. Tetanus. In: Epidermiology and prevention of vaccine-preventable diseases Pink book 2012.
12th ed. Available from : www. cdc.gov/vaccines/pubs/pinkbook/index.html.
7. Rubbo SD, Suri JC. Passive Immunization against tetanus with human immune globulin. BMJ.
1962; 5297: 79-81.
8. McComb JA. The prophylactic dose of homologous tetanus antitoxin. N Engl J Med. 1964;
270: 175-8.
9. CDC. Preventing tetanus, diphtheria and pertussis among adolescent: use of tetanus toxoid,
reduced diphtheria toxoid and acellular pertussis vaccine: Recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR. 2006;55:1-34.
2556
97

7.3 B
--
(Diphtheria, Tetanus toxoids, and Pertussis vaccine
combined : DTP,Tdap)

Corynebacterium diphtheriae

1-6
1

.. 2545 2552 212

0.00 0.02 .. 2553
77 15 ( 19.5)
.. 2554 28
0.02 11 ( 39.3)
11 10 3
11 35 4 1
2556
99
.. 2555

2555 32 2
8 9 472 1120 (12.6
) 010 (11.4 ) 21 30 (7.5
) 10

Clostridium tetani

(anaerobic)

.. 25452554 10 5 ( .. 2550 2554)
13

2
Bordetella pertussis

polymerese chain reaction

2 1 3 paroxysms (
) (whooping) (CDC 2010 www.cdc.gov)

10 ( .. 25452554)
525 0.010.04 .. 2552
72 60
.. 2554
12 3
2 1 7 15 2 610 2
2556
100
41 1

1. -- (whole cell) DTwP

toxoid (inactivated pertussis) adsorbed
aluminum salts 0.01% thimerosal
7
2. -- (acellular) DTaP toxoid
DTwP
DTaP
DTwP
pertussis toxin (PT), filamentous hemagglutinin (FHA), pertactin (Pn)
fimbrial agglutinogen (Fim)
3. -- (acellular) 7
Tdap 2

3
1. DTwP 0.5 .
purified diphtheria toxoid 25-30 Lf*
Bordetella pertussis (whole cell) 20,000
(*Lf Limits of flocculation toxin toxoid
1 antitoxin)
2. DTaP toxoid DTwP
7.3 B-1
3. Tdap toxoid 1-2 Lf toxoid
7.3 B-1
2556
101
7.3 B-1 DTaP Tdap

FHA PT Pn Fim 2&3
Acelluvax Biocine 2.5 mg 5 mg 2.5 mg - DTaP
Tetraxim / SP 25 mg 25 mg - - DTaP+IPV /
Pentaxim / DTaP+IPV+Hib /
Hexavac DTaP+IPV+Hib+HB
Adacel SP 5 mg 2.5 mg 3 mg 5 mg Tdap
Infanrix / Infanrix-IPV- GSK 25 mg 25 mg 8 mg - DTaP /
Hib / Infanrix-Hexa DTaP+IPV+Hib /
DTaP+IPV+Hib+HB
Boostrix GSK 8 mg 8 mg 2.5 mg - Tdap

5 . ( 10 )
0.5 .
4
DTwP DTaP 0.5 .
7 Tdap 0.5 .
7

1. 7
DTwP DTaP DTaP
DTaP
DTaP DTwP
DTwP
1.1. (primary immunization) DTwP DTaP
2 4 3 2 ( 2, 4, 6 )
4 18 --
1 4-6
3-4 -
4
3 2, 4,
6 --- (DTwP-HB) DTaP

2556
102
1.2. (booster dose) 4 4-6
DTwP, DTaP Tdap
1.3.
2 5 --
4 5 6 7 4
2. 7
2.1 DTwP DTaP 7 dT
Tdap -- (DTwP/DTaP)
dT 10 dT 3
0, 1, 6 Tdap dT 1 Tdap 1 11-18
DTP
18 Tdap Tdap
Tdap 5, 6
Tdap 1
Tdap
7-9
1. Tdap dT T
Tdap 1 27-36
9

2.
(dT) 3
2 4 3 6-12 Tdap dT 1
27-36
3. dT Tdap Tdap
dT
dT
Tdap dT 1 dT 10 (-
)
(T)
dT

2556
103

DTP
3-4 2
20-30

(sterile abscess) DTP adjuvant
Arthus reaction

Guillain-Barre syndrome Brachial neuritis
4,10
DTwP
anaphylaxis 2:100,000 48 1:1,750
(febrile convulsion) (hypotonic hyporesponsive
episodes; HHE) 1:1,750 40.5o 48 0.3
(encephalopathy)
(permanent brain damage)4 DTaP DTwP
2-3 11 DTaP
4 5 3 12
Tdap dT
13-14

1. DTwP DTaP 7
(dT)
(Tdap)
2. whole cell (DTwP) acellular (DTaP, Tdap)
encephalopathy 7 DTP DT
, febrile convulsion, HHE,
DTaP
(transient urticaria)
serum sickness
IgE-mediated4 (
) IgE-mediated anaphylaxis DTP Tdap,
DT, dT T
3. DTP
DT
DTaP DTwP
2556
104
4.
DTwP DTaP
5.

DTP 2
30 15
11.5
100 16
10 17
2 3
16 4 150
4 10 18

DTwP DTaP 75-90 DTwP DTaP
19-22 DTaP DTwP
14 DTwP DTaP 23
24
acellular
2-5 22
DTaP
DTaP 3 2, 4 6
4
Tdap 3 4-6 13-14, 25-26
DTaP DTwP 4-6 26-27 dT
28
2556
105

+2 +8o

18

1. 2543.
Annual Epidemiological Surveillance Report 2000. :
. 2543: 110-7.
2.
2543. Annual Epidemiological Surveillance Report 2000. :
. 2543: 341-61.
3. . . : ,
, . . :
(2541) . 2545: 6-11.
4. American Academy of Pediatrics. Diphtheria, Pertussis and Tetanus In: Pickering LK, Baker CJ,
Kimberlin DW Long SS eds. Red Book: 2012 Report of the Committee on Infectious Diseases.
Elk Glove Village, IL: American Academy of Pediatrics; 2012: 307 - 311, 553 - 566, and 707 - 712.
5. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and acellular
pertussis (Tdap) vaccine from the advisory committee on immunization practices, 2010.
MMWR/January 14, 2011 / 60 (1); 13-15. Available from http://www.cdc.gov/mmwr/preview/
mmwrhtml/mm6001a4.htm?s_cid=mm6001a4_w. Accessed on July 11, 2012.
6. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and
acellular pertussis (Tdap) vaccine in adults aged 65 years and older- advisory committee
on immunization practices (ACIP), 2012. MMWR /June 29, 2012 / 61(25); 468-470. Available
from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6125a4.htm Accessed on July 11, 2012.
7. CDC. Guidelines for vaccinating pregnant women. Available from http://www.cdc.gov/vaccines/
pubs/preg-guide.htm Accessed on July 11, 2012.
8. CDC. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid and
acellular pertussis vaccine (Tdap) in pregnant women and persons who have or anticipate
having close contact with an infant aged <12 months Advisory Committee on Immunization
Practices (ACIP), 2011. MMWR. 2011; 60 (No. 41): 1424-6. Available from http://www.cdc.gov/
mmwr/preview/mmwrhtml/mm6041a4.htm Accessed on July 11, 2012.
9. Updated recommendations for use of tetanus toxoid, reduced diphtheria toxoid, and acellular
pertussis vaccine (Tdap) in pregnant women--Advisory Committee on Immunization Practices
(ACIP), 2012. MMWR Morb Mortal Wkly Rep. 2013;62(7): 131-5.
2556
106
10. Tsairis P, Dyck PK, Mulder DW. Natural history of brachial plexus neuropathy. Arch Neurol
1972; 27: 109-117.
11. Blumberg DA, Mink CM, Cherry JD, et al. Comparison of acellular and whole-cell pertussis
component diphtheria-tetanus-pertussis vaccine in infants. J Pediatr. 1991; 119: 194-204.
12. CDC. Use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine as five-dose series:
supplement recommendation of Advisory Committee on Immunization Practice (ACIP). MMWR.
2000; 49 (RR-13): 1-8.
13. Turnbull FM, Heath TC, Jalaludin BB, Burgess MA, Ramalho AC. A randomized trial of two
acellular pertussis vaccines (dTpa and pa) and a licensed diphtheria-tetanusvaccine (Td) in
adults. Vaccine. 2000; 19: 628-36.
14. Tran Minh NN, He Q, Ramalho A, et al. Acellular vaccines containing reduced quantities
of pertussis antigens as a booster in adolescents. Pediatrics. 1999; 104:e70.
15. Miller LW, Older JJ, Drake J, et al. Diphtheria immunization : Effect upon carriers and the control
of outbreaks. Amer J Dis Child. 1972; 123: 197-9.
16. Russell A. Scottish diphtheria immunization campaign : 1941-1942. Proc Roy Soc Med. 1943; 36:
503-12.
17. Scheibel I, Bentzon MW, Christensen PE, et al. Duration of immunity to diphtheria and
tetanus after active immunization. Acta Pathol Microbiol Scand. 1966; 67: 380-92.
18. Peebles TC, Levine L, Eldred MC, et al. Tetanus - toxoid emergency boosters: a reappraisal.
New Engl J Med. 1969; 280: 575-81.
19. Gustafsson L, Hallander HO, Olin P, et al. A controlled trial of two-component acellular, a
five-component acellular, and a whole-cell pertussis vaccine. N Engl J Med. 1996; 334: 349-55.
20. Greco D, Salmaso S, Mastrantonio P, et al. A controlled trial of two acellular pertussis vaccine
and one whole-cell pertussis vaccine against pertussis. N Engl J Med. 1996; 334: 341-8.
21. Schmitt HJ, von Konig CHW, Neiss A, et al. Efficacy of acellular pertussis vaccine in early
childhood after household exposure. JAMA. 1996; 275: 37-41.
22. Miller E, Ashworth LAE, Redhead K, et al. Effect of schedule on reactogenicity and antibody
persistence of acellular and whole cell pertussis vaccine: value of laboratory tests as predictors
of clinical performance. Vaccine. 1997; 15: 51-60.
23. CDC. Pertussis epidemic - washington, 2012. MMWR Morb Mortal Wkly Rep 2012;61:517-22.
24. Grob PR, Crowder MJ, Robbins JF. Effect of vaccination on the severity and dissemination
of whooping cough. BMJ. 1981; 282: 1925-8.
25. Ward JI, Cherry JD, Chang S-J, et al. Efficacy of an acellular pertussis vaccine among adolescents
and adults. N Engl J Med. 2005; 353: 1555-63.
26. Kosuwon P, Warachit B, Hutagalung Y, et al. Reactogenicity of reduced antigen content
diphtheria-tetanus-acellular pertussis vaccine (dTap) administered as a booster to 4-6 year-old
children primed with four doses of whole-cell pertussis vaccine. Vaccine. 2003; 21: 4194-4200.
2556
107
27. Scheifele DW, Halperin SA, Ochnio JJ, Ferguson AC, Skowronski DM. A modified vaccine
reduces the rate of large injection site reactions to the preschool booster dose of diphtheria-
tetanus-acellular pertussis vaccine: results of a randomized, controlled trial. Pediatr Infect Dis
J. 2005;24(12):1059-66.
28. Murphy TV, Slade BA, Broder KR, et al. Prevention of pertussis, tetanus, and diphtheria
among pregnant and postpartum women and their infants recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2008;57(RR-4):1-51.
2556
108

7.4
( )
(Poliomyelitis vaccine: OPV, IPV)

single-stranded RNA virus Family Picornaviridae,
Genus Enterovirus 3 1, 2 3

7-14 1 (3-35 ) 95

5 0.1-2
(Acute Flaccid Paralysis, AFP)
2 1 100-200

350,000 125 .. 2531
.. 2543

.. 2555 3
2556
109
223 3 1 3
1
2558
.. 2495 425
.. 2525
90 15
.. 2535
1-2 .. 2537

1 .. 25404

4
3 1
(AFP)
.. 2555 AFP 15 290 5 2.3
AFP (
80) 74.48

2
1. (OPV, Sabin) : attenuated live oral poliomyelitis vaccine
2. (IPV, Salk) : inactivated poliomyelitis vaccine
1. Oral Poliomyelitis Vaccine (OPV)

3 ( 1, 2 3)

6-7
Vaccine Associated
Polio Paralysis (VAPP)

8

IPV 2
OPV
2556
110

OPV primary monkey kidney cell MRC- 5 cell
OPV 6
Poliovirus vaccine type 1 (strain LS. c, 2 ab) 1,000,000 TCID50
Poliovirus vaccine type 2 (strain P 712, Ch, 2 ab) 100,000 TCID50
Poliovirus vaccine type 3 (strain Leon, 12 ab) 600,000 TCID50
streptomycin neomycin (<25 )
multiple dose trivalent monovalent OPV (mOPV) bivalent
OPV (bOPV)
trivalent mass immunization OPV combined vaccine
BCG, DTP, HBV, Measles, Hib rota
2. Inactivated Poliomyelitis Vaccine (IPV)

Vero cell line
( African green monkey) MRC5 diploid cell
formaldehyde aluminium hydroxide adjuvant IPV
DTP OPV
OPV

IPV 1
type 1 (Mahoney) 40 D antigen units
type 2 (MEF-1) 8 D antigen units
type 3 (Saukett) 32 D antigen units
phenoxyethanol, streptomycin, neomycin polymyxin-B
aluminium hydroxide adjuvant
IPV

Tetraxim Sanofi Pasteur DTaP, IPV
Pentaxim , Pediacel Sanofi Pasteur DTaP, IPV, Hib
ADACEL Polio Sanofi Pasteur Tdap, IPV
Infanrix IPV/Hib GlaxoSmithKline DTaP, IPV, Hib
Infanrix Hexa GlaxoSmithKline DTaP, IPV, Hib, HB
Boostrix - Polio GlaxoSmithKline Tdap, IPV
2556
111

2
OPV IPV
OPV 0.1-0.5 . (2-3 )
OPV (multiple doses)

(ampule) 1 (single dose)

IPV IPV
DTP

OPV IPV
IPV
OPV DTP 4 2, 4, 6
4 18 5 4-6
3 2
4 6 1 5 4-6 4
4
6 3 0, 2
129
IPV IPV
2 2 4 3 6-18
4-6 2 ( 3 4 4)
IPV DTP 5 DTP OPV
IPV OPV
IPV Vaccine Associated Polio Paralysis (VAPP)
IPV 2 2, 4 OPV 6-18 4-6 (Sequential
IPV OPV) VAPP 50%10 seqnential

OPV IPV
OPV
1.
2.
3.
2556
112
4.

5.
6.
OPV
1. OPV
(Vaccine Associated Polio Paralysis ; VAPP)
2.

Sabin strain circulating
vaccine derived polio-virus (cVDPV) wild polio virus

OPV cVDPV

neurovirulence immunodeficiency associated vaccine derived polio - virus (iVDPV)
11
3. OPV
4. enterovirus
2,12
IPV
1. IPV VAPP
IPV OPV
2. IPV enterovirus
3. 2
4. colostrum
5. IPV DTP
IPV
1. IPV IPV
2. 2
OPV
3. IPV
4.
2,12
VAPP OPV
sequential IPV/OPV IPV 2 OPV
2556
113
VAPP OPV
( 5 )

OPV
VAPP 1.4 1
27.2
1 2.2 1 17.5 2,7
18 3,200-6,800 2
VAPP 2 .. 2544-2547 1 24 .. 2550 2552
VAPP 4 1 12 13
IPV IPV
DTP ( DTwP DTaP)
DTP

1. OPV (immune deficiency)
IPV WHO
OPV

2. OPV
IPV
3. (anaphylaxis)
streptomycin, neomycin polymyxin-B
4. IPV

OPV

(secretory IgA)
OPV

OPV 2 90
3 3 1 97
2 3 1002,6 .. 2509 1
OPV 3 2
2556
114
2 3 90 1
70 OPV 3 2 3 1
86 11/2
1 OPV 2 3 9
1 OPV OPV 3
OPV 2
enterovirus
.. 2535
1-2 OPV 3-4
1 79.7 2 97.1
3 70.5 3 3
55.1 4 3 77.914
5 4-6 3
OPV
IPV 2 90
3 99 3
4 IPV 2,7
IPV
IPV
wild polio virus

4

1. OPV 3 1
90
2. (acute flaccid
paralysis, AFP) 2 15
3. 48
72
4. OPV (National immunization day) 2
4-6 ( OPV )

2556
115
(AFP)
AFP

14 AFP 2 8-10 (
1-2 ) 2 24
( +2 +8o)
OPV
AFP
15 5 OPV

OPV - -20o 2
- -20 0o 1
- +2 +8o 90
- -15o
8
- (100o)
-
IPV - +2 +8o
-
2556
116

1. James Chin. Poliomyelitis, Acute. In: Control of communicable diseases manaul. 17th edition.
2000: 398-405.
2. American Academy of Pediatrics. Poliovirus infection In: Pickering LK, Baker CJ, Kimberlin DW Long
IL: American Academy of Pediatrics; 2012: 588 - 593.
3. World Health Organization. Global Polio eradication-polio cases count. available from http://
www.polioeradication.org/Dataandmonitoring/Poliothisweek.aspx.
4. MOPH. Poliomyelitis annual summary surveillance report 1997; 269.
5. 2553,
6. Sutter RW, Cochi SL, Melnick JL. Live attennated polioviruses vaccines. In : Plotkin SA,
Orenstein RA, eds. Vaccine. 3rd ed. Philadelphia: WB Saunders; 1999: 364-408.
7. Alkinson W, Wolfe C. In: Humistons, Nelson R, eds. Poliomyelitis in epidemiology and prevention
of vaccine preventable diseases. 6th ed. CDC. 2000: 85-100.
8. WHO. Polio vaccines and polioimmunization in the pre eradication era: WHO position paper.
Weekly epidemiological record. 2010: 85; 213 8.
9. Sangkawibha N, Tuchinda P, Bukkavesa S, et al. Antibody response and virus excreting after
oral vaccination with trivalent live poliomyelitis vaccine. J Med Assoc Thai. 1969; 52: 701-12.
10. CDC. Poliomyelitis prevention in the United States: Introduction of a sequential vaccination
schedule of inactivated poliovirus vaccine followed by oral polio vaccine: recommendations
of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1997;46(RR-3):1-25.
11. Yoneyama T, Yoshida H, Shimizu H, Yoshii K, Nagata N, Kew O, et al. Neurovirluence of
Sabin 1- derived polioviruses isolated from an immunodeficient patient with prolonged viral
excretion. Dev Biol (Basel). 2001;105:93-8.
12. Sutter RW, Prevots R, Cochi SL. Poliovirus vaccines. Ped Clin North Am. 2000; 47: 287-308.
13. Office of Polio Eradication . CDC; Enterovirus Ref. Centre. Ministry of Public Health.
14. Subcharoen A, Ruppodom W, Pojjaroen-Anat C, Chomprarg C, Punssuwanna Y, Orcchachi JP.
A survey on serological response to oral polio vaccine in Thailand 1992. The 36th Thai congress
of Pediatrics. April 22-23, 1993: 49-50 (Abstract).
2556
117

7.5
--
(Measles Mumps and Rubella Vaccine : MMR)

2-5
3-4 .. 2506
991
measles virus 8-12

1-5
1-2
(prodromal phase)
4
.. 2514
93.67 .. 2527

2 .. 2554
3,156 4.93
337 10.67
9.19, 5.86, 4.05, 2.72

0 - 4 29.25 .. 2554
2556
119
10
3
(Genotype) D9 D8
2 60

.. 2563
2 4-6
2 1/2
rubella virus
14-21
1
3

(congenital rubella syndrome)

2-3 7

.. 2505-2507

.. 25483
.. 2518 .. 2527
.. 2534 .. 2529
.. 2536
1-2
.. 25402 .. 2554
517 0.81 0 - 4
2.54 ( .. 2553
9
(MMR) 1 .. 2553
MMR 9 ) 25 34 1.24
.. 2554 6
2 1
18 - 54

2556
120
mumps 16-18

(cerebrospinal fluid) 10

.. 2554
10,077 15.75
5 - 9 72.90 0 - 4
59.54 10 14 15 24 25 34
27.52 11.79 9.35 .. 2554
7 (2 )
2 19
-- (MMR)

MMR
(live attenuated vaccine) (lyophilized)
(diluent) MMR 7.5-1
neomycin 25
MMR 3 ( 7.5-1)
1.
(Enders attenuated Edmonston strain)
(cell culture of chick embryo) Edmonston Zagreb
(EZ 19) human diploid cells
2. 3
2.1 (Jeryl Lynn B level)

2.2 9 (Urabe - Am 9)

2.3 Leningrad-Zagreb

2556
121
3. Wistar RA 27/3
human diploid cell (WI - 38)
7.5-1 MMR
TrimovaxTM TrivivacTM PriorixTM MMRTM MMRIITM
(sanofi (SEVAPHARMA/ (GSK) (Serum Insti- (MSD)
pasteur) BGT) tute of India)
Measles Schwartz Schwartz Schwartz Edmonston Edmonston
1,000 TCID50 1,000 TCID50 1,000 TCID50 Zagreb 1,000 TCID50
1,000 TCID50
Mumps Urabe AM 9 Jeryl-Lynn Modified Leningrad- Jeryl-Lynn
5,000 TCID50 5,000 TCID50 Jeryl-Lynn Zagreb 5,000 12,500
(RIT 4385) TCID50 TCID50
5,000 TCID50
Rubella Wistar RA Wistar RA Wistar RA Wistar RA Wistar RA
27/3 1,000 27/3 1,000 27/3 1,000 27/3 1,000 27/3 1,000
TCID50 TCID50 TCID50 TCID50 TCID50
TCID50 = Tissue culture infective dose 50 cell culture
50

1 1 0.5 .

0.5 .

-- 2
9-12 4-6 .1

2556 2 2 1/2 2
(primary failure)
9
-- 2
.1 2 1/2 MMR2
.1 12
2 2 1/2 4-6 4
2556
122

6 12 2 1/2
1 2 1
2 12 5
MMR
MMR clinical category C (CDC classification)
immunological category 3 CD4 <15% (CDC
classification)1 MMR
MMR
1
MMR
1
MMR
- 5 5-12 1-2 6
- 5 7-10
1-2
-
- (parotitis)
- (allergic reaction)
immediate anaphylactic reaction 1 1
- (thrombocytopenia) 2 MMR
30,000-40,000 1 100,000
-
l Aseptic meningitis MMR mumps
Urabe 1 862 - 1 295,0007-9

(1 1,000,000) Jeryl-Lynn10
l Encephalopathy / encephalitis 6-15
1 2
- 0.5
25 10 1-3
2556
123
1
1. MMR
MMR
28 MMR 28

MMR

2.
3. neomycin anaphylaxis
4. 2 ././ 20 ./
14 MMR 1
5. remission chemotherapy
12
6. MMR
B cell defect, complement deficiency, phagocytic dysfunction

95
12 98 15 1
MMR
(primary failure)
(secondary failure)
2
95
64-95% 1 88-95% 2 11
>95% 1 12
15
35 9-12
-- 9 85-95
96-99 63-95 Moraten
Edmonston B-Zagreb Jeryl-Lynn
Rubini 13
Rubini 6.3 61.6 Jeryl-Lynn
Rubini Urabe
84-9714-15
2556
124
.. 2543-2546

1. MMR
72 6816 0.25 ./.
6 1
6 ( 6 72 )
MMR
2.
0.5 ./.
3.

4.
17 ( 7.5-2)
5. MMR

6 MMR
6. ()
MMR

7. MMR tuberculin skin test
MMR 4-6 tuberculin skin test
8. MMR autism inflammatory bowel disease
9. MMR
egg cross-reacting protein skin test
skin test 30 1
MMR +2 +8o

2556
125
7.5-2 MMR

()
()
Tetanus prophylaxis (TIG) 250 unit (10 mg lgG/kg) IM 3
Hepatitis A prophylaxis (IG)
- Contact prophylaxis 0.02 ml/kg (3.3 mg lgG/kg) IM 3
- International travel 0.06 ml/kg (10 mg lgG/kg) IM 3
Hepatitis B prophylaxis (HBIG) 0.06 ml/kg (10 mg lgG/kg) IM 3
Rabies prophylaxis (HRIG) 20 IU/kg (22 mg lgG/kg) IM 4
Varicella prophylaxis (VZIG) 125 units/10 kg (20-40 mg 5
lgG/kg) IM (maximum 625 units)
Measles prophylaxis (IG)
- Standard contact 0.25 ml/kg (40 mg lgG/kg) IM 5
(normal host)
- Immunocompromised contact 0.50 ml/kg (80 mg lgG/kg) IM 6
Blood transfusion :
- Red blood cells (RBCs), 10 ml/kg (negligible lgG/kg) IV 0
washed
- RBCs adenine-saline added 10 ml/kg (10 mg IgG/kg) IV 3
- Packed RBCs (Hct 65%) 10 ml/kg (60 mg IgG/kg) IV 5
- Whole blood (Hct 35%-50%) 10 ml/kg (80-100 mg IgG/kg) IV 6
- Plasma / platelet products 10 ml/kg (160 mg IgG/kg) IV 7
Replacement therapy for 300-400 mg/kg IV 8
immune deficiencies (IVIG)
Respiratory syncytial virus 750 mg/kg IV (as RSV-IGIV) 9
prophylaxis
Immune thrombocytopenic 400 mg/kg IV 8
purpura (IVIG) 1000 mg/kg IV 10
Kawasaki diseases (IVIG) 2 g/kg IV 11
2556
126

1. Watson JC, Hadler SC, Dykewicz CA, Reef S, Phillips L. Measles, mumps, and rubella--vaccine
use and strategies for elimination of measles, rubella, and congenital rubella syndrome and
control of mumps: recommendations of the Advisory Committee on Immunization Practices
(ACIP). MMWR Recomm Rep. 1998, May 22;47(RR-8):1-57.
2. 2544.: .
3. CDC. Elimination of rubella and congenital rubella syndrome--United States, 1969-2004.
MMWR Morb Mortal Wkly Rep. 2005;54(11):279-82.
4. Techasena W, Wongwacharapiboon P, Terawanich S, Pattamadilok S. A comparison study of
measles antibody between two doses vaccination at 9, 18 months and single dose at 9 months
in children 4-6 years old. J Med Assoc Thai. 2011, Mar;94(3):309-15.
5. CDC. Recommended Immunization Schedules for Persons Aged 0 Through 18 Years United
States, 2012. MMWR Morb Mortal Wkly Rep. 2012;61(5):1-4.
6. Peltola H, Heinonen OP. Frequency of true adverse reactions to measles-mumps-rubella vaccine.
A double-blind placebo-controlled trial in twins. Lancet. 1986, Apr 26;1(8487):939-42.
7. Miller E, Goldacre M, Pugh S, et al. Risk of aseptic meningitis after measles, mumps, and rubella
vaccine in UK children. Lancet. 1993, Apr 17;341(8851):979-82.
8. Al-Mazrou Y, Tumsah S, Khalil M, et al. Safety evaluation of MMR vaccine during a primary
school campaign in Saudi Arabia. J Trop Pediatr. 2002, Dec;48(6):354-8.
9. Fujinaga T, Motegi Y, Tamura H, Kuroume T. A prefecture-wide survey of mumps meningitis
associated with measles, mumps and rubella vaccine. Pediatr Infect Dis J. 1991, Mar;10(3):204-9.
10. Fescharek R, Quast U, Maass G, Merkle W, Schwarz S. Measles-mumps vaccination in the FRG:
an empirical analysis after 14 years of use. II. Tolerability and analysis of spontaneously
reported side effects. Vaccine. 1990, Oct;8(5):446-56.
11. American Academy of Pediatrics. Mumps. In: Pickering LK, Baker CJ, Kimberlin DW Long
12. American Academy of Pediatrics. Rubella In: Pickering LK, Baker CJ, Kimberlin DW, Long
SS, eds. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove
Village, IL: American Academy of Pediatrics. 2009:579-584.
13. Just M, Berger R, Gluck R, Wegmann A. Evaluation of a combined vaccine against measles-
mumps-rubella produced on human diploid cells. Dev Biol Stand. 1986;65:25-7.
14. Vesikari T, Andre FE, Simoen E, et al. Comparison of the Urabe Am 9-Schwarz and Jeryl
Lynn-Moraten combinations of mumps-measles vaccines in young children. Acta Paediatr
Scand. 1983, Jan;72(1):41-6.
2556
127
15. Popow-Kraupp T, Kundi M, Ambrosch F, Vanura H, Kunz C. A controlled trial for evaluating
two live attenuated mumps-measles vaccines (Urabe Am 9-Schwarz and Jeryl Lynn-Moraten)
in young children. J Med Virol. 1986, Jan;18(1):69-79.
16. Ruuskanen O, Salmi TT, Halonen P. Measles vaccination after exposure to natural measles.
J Pediatr. 1978, Jul;93(1):43-6.
17. American Academy of Pediatrics. Measles. In: Pickering LK, Baker CJ, Kimberlin DW Long
2556
128

7.6
(Japanese Encephalitis Vaccine: JE)

Japanese B Encephalitis (JE) Flavivirus
1:100-1:1,000
1-4
10-202,3,5 2 3
6

Culex tritaeniorhynchus, Culex gelidus7

10 ( .. 2545 2554)
36 78 0.06 0.13 .. 2554
52 16 7
4 65
19.23 10 14 15 24 17.31 11.54 8

-
15
46 15 9

.. 2533 2
3 .. 2544
2556
129

1.
1.1 (mouse
brain-derived inactivated vaccine MBD)

2 Nakayama Beijing
Beijing 10 Beijing

1.2 SA 14-14-2
Vero cell IXIAROTM Intercell
( 17 )

1.3 Beijing-P3
Vero cell propiolactone column chromatography
Liaoning Chengda Biotechnology Co.,Ltd JEVACTM
.. 2551

2.
2.1 SA 14-14-2
SA 14 (primary hamster kidney
cell) SA 14-14-2
Chengdu Institute of Biological Products
CD-JE VAXTM
MBD
2.2 (chimeric virus vaccine)
PrM E SA 14-14-2
PrM E 17D ()
membrane envelope core
nonstructural protein sanofi pasteur IMOJEVTM

MBD 1 80 97
thimerosol gelatin stabilizer
(liquid form) Beijing 0.5 . 1 Nakayama
1 . 1
2556
130
IXIAROTM 0.5 . 6
Aluminium hydroxide 250 (0.1%) adjuvant 0.5 .
JEVACTM 0.5 . reference standard China National Institute
for the Control of Pharmaceutical and Biological Products Dextran40 15 .
10 . ( 2) stabilizer
0.5 .

CD-JE VAXTM 0.5 . SA 14-14-2
5.4 log10 PFU 4.8 . 3 . stabilizer
0.5 .
IMOJEVTM 0.5 . chimeric
4-5.8 log10 PFU stabilizer
0.5 .

MBD (subcutaneous injection) 3
0.25 . ( Beijing) 0.5 . ( Nakayama)
3 3 12-18 2 1-4
3 2 6-12
3 4-5 4
IXIAROTM
0.5 . 2 4 1-2
JEVACTM 0.5 . 2 1-4 3
2 1

CD-JE VAXTM 0.5 . 2 3-12 9
IMOJEVTM 0.5 . 1 1
1-2 1

12-18 IXIAROTM
SA 14-14-2 9
MBD
4
()
2556
131
0, 7 30 0, 7 14
IXIARO 2
MBD
17
CD-JE VAXTM IMOJEVTM
MBD MBD
CD-JE VAXTM MBD 7.6-1

7.6-1 live-attenuated JE vaccine inactivated mouse

brain derived JE vaccine
inactivated JE live-attenuated JE
2 3-12
1 2 3-12
2-3 * 1 1
> 4 *
* : Inactivated JE 3

1.
MBD
10-20
2 10-14 angioedema 1-3 0.2-0.6
214-16 (encephalopathy)
( 1:100,000)17,18 anaphylaxis
IXIAROTM 1
26 21 13 13
19
JEVACTM 4 1
1-2 20
2.
CD-JE VAXTM 3
921
2556
132
IMOJEVTM 12.4 4.6
4 26 22.8 16.6
22 32 23 9 21
28 26 20 18
23

1.
2.
3. 1
4.
1.
MBD 2 1 80
1
1 2 1 90-10010,11,14,24
3-5 25
4-5 3

4-5
-- ()
IXIAROTM 2 2 98 6
1 95 83 19,26 1
2 1-2
JEVACTM 90 2 1 20
2.
CD-JE VAXTM 89.3 95 30
90 2 100 ()21
1 91.3
96.5 1 5 27,28 2
2
2556
133
IMOJEVTM 99.122 9623
5 9329 1
8423 1
1-2

+2 +8o 1-3

1. , . .. 2514 :
. 2519; 15: 129-45.
2. , , . :
96 . 2527; 36: 353-60.
3. Poneprasert B. Japanese encephalitis in children in northern Thailand. Southeast Asian J
Trop Med Public Health 1989; 20: 599-603.
4. Thisyakorn U, Nimmannitya S. Japanese encephalitis in Thai children, Bangkok, Thailand.
Southeast Asian J Trop Med Public Health 1985; 16: 93-7.
5. , , , , , .
.
2525; 24: 1-19.
6. Schneider RJ, Firestone MH, Edelman R, Chieowanich P, Pornpibul R. Clinical sequelae after
Japanese encephalitis: a one year follow-up study in Thailand. Southeast Asian J Trop Med
Public Health 1974; 5: 560-8.
7. Gould DJ, Edelman R, Grossman RA, Nisalak A, Sullivan MF. Study of Japanese encephalitis
virus in Chiangmai Valley. Thailand IV. vector studies. Am J Epidemiol 1974; 100: 49-56.
8. Annual Epidemiological Surveillance Report 2010: ISSN 0857-6521. http://boe.moph.go.th/
9. Olsen SJ, Supawat K, Campbell AP, Anantapreecha S, Liamsuwan S, Tunlayadechanont S,
et al. Japanese encephalitis virus remains an important cause of encephalitis in Thailand.
Int J Infect Dis 2010;14(10):e888-92.
10. Nimmannitya S, Hutamai S, Kalayanarooj S, Rojanasuphot S. A field study on Nakayama and
Beijing strains of Japanese encephalitis vaccines. Southeast Asian J Trop Med Public Health
1995; 26: 689-93.
11. Rojanasuphot S, Charoensook O, Ungohusak K, Srijaggrawalwong A, Panthumachinda B. A
field trial of inactivated mouse brain Japanese encephalitis vaccines produced in Thailand.
Mosq Borne Dis Bull 1991; 8: 11-6.
2556
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12. Hoke CH, Nisalak A, Sangawhipa N. Projection against Japanese encephalitis by inactivated
vaccines. N Engl J Med 1988; 319: 608-14.
13. Poland JD, Cropp CB, Craven RB, Monath TP. Evaluation of the potency and safety of
inactivated Japanese encephalitis vaccine in US inhabitants. J Infect Dis 1990; 161: 878-82.
14. , , , .
EPI. 2534; 30: 1-7.
15. Andersen MM, Ronne T. Side-effects with Japanese encephalitis vaccine. Lancet 1991; 337: 1044.
16. Ruff TA, Eison D, Fuller A, Kass R. Adverse reactions to Japanese encephalitis vaccine.
Lancet 1991; 338: 881-2.
17. Ohtaki E, Matsuishi Y, Komori H, Yamashita Y, Matsuishi T. Acute disseminated encephalomyelitis
after Japanese B encephalitis vaccination. Pediatr Neurol 1992; 8: 137-139.
18. Ohtaki E, Murakami Y, Hirano Y, Maekawa K. Acute disseminated encephalomyelitis after
treatment with Japanese B encephalitis vaccine (Nakayama-Yoken and Beijing strains). J Neurol
Neurosurg Psychiatry 1995; 59: 316-17.
19. Tauber E, Kollaritsch H, Korinek M, et al. Safety and immunogenicity of a Vero-cell-derived,
inactivated Japanese encephalitis vaccine: a non-inferiority, phase III, randomised controlled
trial. Lancet 2007; 370: 1847-53.
20. Zhou Libao, Zhao Xin, Wu Xutao, et al. Adverse reaction and immunogenicity of inactivated
Japanese encephalitis vaccine prepared on Vero cells. China J Biological 2009; 22: 809-11.
21. Chotpitayasunondh T, Sohn YM, Yoksan S, Min J, Ohrr H. Immunizing children aged 9 to
15 months with live attenuated SA14-14-2 Japanese encephalitis vaccine in Thailand. J Med
Assoc Thai. 2011; 94: 195-203.
22. Torresi J, McCarthy K, Feroldi E, Meric C. Immunogenicity, safety and tolerability in adults of
a new single-dose, live-attenuated vaccine against Japanese encephalitis: Randomised controlled
phase 3 trials. Vaccine. 2010 ; 28: 7993-8000.
23. Chokephaibulkit K, Sirivichayakul C, Thisyakorn U, et al. Safety and immunogenicity of a
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2- to 5-year-olds and naive 12- to 24-month-olds: multicenter randomized controlled trial.
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26. Schuller E, Jilma B, Voicu V, et al. Long-term immunogenicity of the new Vero cell-derived,
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follow-up phase 3 study. Vaccine 2008; 26: 4382-6.
2556
135
27. Ohrr H, Tandan JB, Sohn YM, Shin SH, Pradhan DP, Halstead SB. Effect of singledose of
SA 14-14-2 vaccine 1 year after immunisation in Nepalese children with Japanese encephalitis:
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28. Tandan JB, Ohrr H, Sohn YM, et al. Single dose of SA 14-14-2 vaccine provides long-term
protection against Japanese encephalitis: a case-control study in Nepalese children 5 years
after immunization. Vaccine. 2007; 28: 5041-5.
29. Nasveld PE, Ebringer A, Elmes N, et al. Long term immunity to live attenuated Japanese
encephalitis chimeric virus vaccine: randomized, double-blind, 5-year phase II study in healthy
adults. Hum Vaccin. 2010; 6: 1038-46.
2556
136

7.7
(Influenza vaccine)

influenza virus 3 A, B C
A B C
30 1
5-7

2-4
hemagglutinin (H) neuraminidase (N)

glycoprotein envelope 2 5
1. Antigenic shift A H / N
H1N1 H2N2 H3N2 antigenic shift
10
antigenic shift Spanish Flu (H1N1) .. 2461-2463
20-100 .. 2552-2553 18,000
H1N1 H3N2
2556
137

()
Asiatic (Russian) Flu6 18891890 1 0.15
H3N8
1918 flu pandemic 19181920 20 - 100 2.0 H1N1
(Spanish flu)7
Asian Flu 19571958 1.0 - 1.5 0.13 H2N2
Hong Kong Flu 19681969 0.75 1.0 <0.1 H3N2
2009 flu pandemic8 20092010 18,000 0.03 H1N1
2. Antigenic drift (mutation)

H N mutation
H N
1-3
.. 2546-2551
17,00030,000 .. 2552
2009
62,000-120,000 6

- -1
3 100-190
0.01-0.36 9
.. 2552 10-14 , 5-9 0-4
461.3, 438.5 438.5
55-64 , 45-54 65 0.53, 0.48 0.44 9

1. (inactivated killed virus vaccine)
3
1.1 (inactivated whole virus vaccine)

1.2 (split virion)

FluarixTM
2556
138
GSK VaxigripTM sanofi pasteur IntanzaTM
sanofi pasteur (intradermal)
1.3 (subunit vaccine)
hemagglutinin (H) neuraminidase (N)
AgrippalTM Chiron
InfluvacTM Abbott
(adjuvant) Inflexal VTM virosomal adjuvant
Crucell FluadTM adjuvant MF59 Chiron
2. (live attenuated influenza vaccine)5
(reassortment)
(25o) (cold adapted)
cold adapted
reassortment (H N)
cold adapted

37o
split vaccine subunit vaccine

1 (0.5 .) hemagglutinin (H HA) neuraminidase
A H1N1 H3N2 3 (trivalent)
H 15

.. 2555 4 (tetravalent)
A (H3N1) A (H1N1) 2 (lineages) Victoria
Yamagata
4

106

2

2556
139
6
.. 255710 A/California/7/2009
(H1N1) - like strain, A/Texas/50/2012 (H3N2) - like virus B/Massachusetts/2/2012 - like virus
.. 2556-255711 A/California/7/2009 (H1N1) pdm09-like virus,
A/Victoria/361/2011 (H3N2)-like virus B/Massachusetts/2/2012 - like virus

7012

6 split vaccine
subunit vaccine adjuvant 6 subunit vaccine
adjuvant MF59 65
3 (0.25 .) 9
2 2 12 1
(intradermal) IntanzaTM 18
9 60 15 60
9
1 2
(CD4 > 25%)

1
13 9
2 1

1 2-49 9
2 610
1
2556
140
7.7-1

(.)
FluarixTM Split 6 35 0.25 1 2 *
VaxigripTM Split 3 8 0.5 1 2 *
Agrippal S1TM Subunit > 9 0.5 1
InfluvacTM Subunit
Inflexal VTM Subunit
virosomal
adjuvanted
Intanza Spilt 18 59 0.1 1
60 (9 )
0.1
(15 )
FluadTM Subunit 65 0.5 1
with MF 59
adjuvant
FluMistTM** Live 2 8 0.5 1 2
attenuated 9 49 0.5 (intranasal) 1
0.25 ml
* 9 2 4
1
** ; 9 2
6 10 1

14
6
()
1.
l 6 4 (59 )
l 65
2556
141
l (6 18 )
Reye syndrome
l 2 3
l (BMI > 40)
2.
l
6
3.
l
.. 2549
2009 (H1N1)
.. 2555-2556 4.5
1.

2. 65
3. 100
4.
5. 6 - 2
6. 4
7.

.. 2546
2-49 2

- ovalbumin
(<1 )15 anaphylaxis
angioedema
-
2556
142
-
14

2 4-11
FluadTM adjuvant subunit 16-17
IntanzaTM
18-19
(febrile convulsion) <4
( 13 )
16 <1 1,000 20

2 14, 21
14
714
9
9
2 1
1

70-90
H N
H5N1 FluadTM adjuvant subunit
16,17 IntanzaTM
15 . 22 9 .
15 .23
70-95
14
2556
143

-
-
24
-
reassortment

+2 +8o
1

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24. American Academy of Pediatrics. Influenza. In: Pickering LK, Baker CJ, Kimberlin DW Long
2556
145

8
2556
147

8-1

- 2 - 2 - 2 1-3 2
(Haemophilus - :
influenzae l PRP-T
type b) 6 3 , 7-11 2
12-24
l 1 12-18
2

l 24
2 2
- 1 - 1 2 6-12
(Hepatitis A) - ( 1-18 )

-

-

2556
149

- - 1-12 2
(Varicella- 12-18 2 4-6
zoster) 1 4
- 3
- 13 2
4
1 -
- CD4 15 2
3
-
CD4
15
- - 0, 7, 21 ( 28)
(Rabies) - - 0, 3, 7, 14, 30
(
)
- - 2 2 5
(Streptococcus - 65 1
pneumoniae) 2
23-
valent
polysaccharide

cochlear
- 6 -
(Streptococcus 5 6-8
pneumoniae) - l 2-6 3
10-valent l 7-23 2
conjugate l 24-59
(PCV-10) 2
13 valent con- l 5
jugate (PCV- PCV-13 2 6-8
13) cochlear - 12-15
- 50 1
- 2+1 (
3 ) 2, 4 12-15
-
PCV
23- valent polysaccharide
2 2
PCV 2 23- valent
polysaccharide 5
- 50 PCV-13 1
2556
150

- - monovalent 2 2, 4
(Rotavirus) 6 15 4
8
- pentavalent 3 2, 4,
6 4
8
- 2 OPV

- HPV 2 4 3 0, 1-2 6
(Human Papil- 9-26
lomavirus) 11-12
- 26

- 4
9-26
- - -
6 - 4
Inactivated 2, 4, 6, 18 4-6
Poliomyelitis 4 4 5
Vaccine (IPV) 4-6
( - IPV Vaccine
Associated Polio Paralysis (VAPP) IPV
- 2 2, 4 OPV
- 6-18 4-6 (Sequential IPV OPV)
VAPP
) 50%
- - DTaP - 7 DTaP DTwP
- 6 DTaP 2 5
7 3 2
DTaP - Tdap 4 ( 2, 4, 6 ) 4 18
5 4-6
7 DTaP Tdap DTaP DTwP

Tdap - 7 DTaP
DTwP dT
-- (DTwP/DTaP)
dT 10
3
dT 0, 1, 6
Tdap dT 1

2556
151

- Tdap 1 11-18
19-64 Tdap
65
20

- 2 -
* (Neis-
seria menin- 1.
gitidis)
polysaccharide
(MPSV 4)
2.

3.

4.

- MCV4-DT (MenactraTM) - 9-23 2 3
9 -55 - 2
(MCV4) - MCV4-CRM (MenveoTM) 2-55 ( 1-3) 1
- MPSV4
2 2
- 11-18
1 16
16
2
- 5

( 4) 5
* - 9 -
(Yellow fever)
:

*
0-2580-5726 0-2134-0134, 0-2134-0139
02-249-4110, 02-240-2057
2556
152

8.1
(Rotavirus Vaccine)
2

(lactase)

1 1
2

30-60
3-5 3-5
956 125
611,000 7 20 4

8 (nosocomial
transmission) 9,10
2556
153
0.5-4
-5
VP7 glycoprotein (G)
VP4 protease-cleaved hemagglutinin (P) 10 G
9 P 4 G1P[8], G4P[8], G2P[4], G3P[8]11 G9
.. 2539-254011,12

.. 2541-2542 Rhesus-human reassortant tetravalent
vaccine (RotashieldTM) (intussusception)

2
RotaTeqTM reassort RotarixTM

1. RotaTeqTM bovine-human reassortant pentavalent live-attenuated oral vaccine
Merck 5 G1, G2, G3, G4, P8
2. RotarixTM human-derived monovalent live-attenuated oral vaccine
GSK RIX4414 G1P[8] 106 CCID50/.

RotaTeqTM 2 .
RotarixTM 1.5 . (prefilled syringe)

8.1-1 2

RotaTeqTM 3 2, 4, 6
6-15 4
(
32 )
RotarixTM 2 2, 4
2556
154

6
8.1-1 2 OPV
OPV
5-12
(intussusception) 13
2
6 .. 2554

14,15
(intussusception) RotaTeqTM RotarixTM
14,15 (post marketing)
2
1:5,000-1:68,000
16,17
1.
2 severe combined immunodeficiency syndrome (SCID)
3. 18
1.
SCID /
42

2
2556
155
2.
19
3.
RotarixTM
RotateqTM

RotaTeqTM
68,000 4 3
98 7414
RotarixTM
63,000 2
85 10015
Systematic review 2 RotaTeqTM
RotarixTM 20

70-8021-23

+2 +8o
2556
156

1. Bass MD. Rotavirus and other agents of gastroenteritis. In: Behrman RE, et al, eds. Nelson
textbook of Pediatrics. 17th ed. Saunders: Pennsylvania, 2004: 1081-3.
2. Velazquez FR, Matson DO, Calva JJ, et al. Rotavirus infections in infants as protection
against subsequent infections. N Engl J Med 1996; 335: 1022-8.
3. Parashar UD, Bresee JS, Glass RI. The global burden of diarrhoeal disease in children. Bull
World Health Organ 2003; 81: 236.
4. Parashar UD, Hummelman EG, Bresee JS, Miller MA, Glass RI. Global illness and deaths
caused by rotavirus disease in children. Emerg Infect Dis 2003; 9: 565-72.
5. Jiraphongsa C, Bresee JS, Pongsuwanna Y, et al. Epidemiology and burden of rotavirus
diarrhea in Thailand: results of sentinel surveillance. J Infect Dis 2005;192 Suppl 1:S87-93.
6. Parashar UD, Bresee JS, Gentsch JR, Glass RI. Rotavirus. Emerg Infect Dis 1998; 4: 561-70.
7. Parashar UD, Gibson CJ, Bresse JS, Glass RI. Rotavirus and severe childhood diarrhea. Emerg
Infect Dis 2006; 12: 304-6.
8. Ijaz MK, Sattar SA, Johnson-Lussenburg CM, Springthorpe VS, Nair RC. Effect of relative
humidity, atmospheric temperature, and suspending medium on the airborne survival of human
rotavirus. Can J Microbiol 1985; 31: 681-5.
9. Clark HF, Lawley D, DiStefano D, Matthijnssens J, Dinubile MJ. Distribution of rotavirus
genotypes causing nosocomial and community-acquired acute gastroenteritis at the Childrens
Hospital of Philadelphia in the new rotavirus vaccine era. Hum Vaccin. 2011 ;7:1118-23.
10. Bruijning-Verhagen P, Quach C, Bonten M. Nosocomial rotavirus infections: A Meta-analysis.
Pediatrics 2012 ;129:e1011-9.
11. Santos N, Hoshino Y. Global distribution of rotavirus serotypes/genotypes and its implication
for the development and implementation of an effective rotavirus vaccine. Rev Med Virol
2005; 15: 29-56.
12. Cunliffe NA, Bresee JS, Gentsch JR, Glass RI, Hart CA. The expanding diversity of rotaviruses.
Lancet 2002; 359: 640-2.
13. King L. Pediatrics, Intussusception. eMedicine website. Available at: www.emedicine.com/
EMERG/topic385.htm
14. Vesikari T, Matson DO, Dennehy P, et al. Safety and efficacy of a pentavalent human-bovine
(WC3) reassortant rotavirus vaccine. N Engl J Med 2006; 354: 23-33.
15. Ruiz-Palacios GM, Perez-Schael I, Velazquez FR, et al. Safety and efficacy of an attenuated
vaccine against severe rotavirus gastroenteritis. N Engl J Med 2006; 354: 11-22.
16. Patel MM, Lopez-Collada VR, Bulhoes MM, et al. Intussusception risk and health benefits
of rotavirus vaccination in Mexico and Brazil. N Engl J Med 2011;364:2283-92.
17. Richardson V, Hernandez-Pichardo J, Quintanar-Solares M, et al. Effect of rotavirus vaccination
on death from childhood diarrhea in Mexico. N Engl J Med 2010;362:299-305.
2556
157
18. Centers for Disease Control and Prevention. Addition of history of intussusception as a
contraindication for rotavirus vaccination. MMWR Morb Mortal Wkly Rep 2011;60:1427
19. Steele AD, Madhi SA, Louw CE, et al. Safety, reactogenicity, and immunogenicity of human
rotavirus vaccine RIX4414 in human immunodeficiency virus-positive infants in South
Africa. Pediatr Infect Dis J 2011;30(2):125-30.
20. Soares-Weiser K, Maclehose H, Ben-Aharon I, Goldberg E, Pitan F, Cunliffe N. Vaccines for
preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2010:CD008521.
21. Paulke-Korinek M, Rendi-Wagner P, Kundi M, Kronik R, Kollaritsch H. Universal mass vaccination
against rotavirus gastroenteritis: impact on hospitalization rates in austrian children. Pediatr
Infect Dis J 2010;29(4):319-23.
22. CDC. Reduction in rotavirus after vaccine introduction--United States, 2000-2009. MMWR
Morb Mortal Wkly Rep 2009;58(41):1146-9.
23. Buttery JP, Lambert SB, Grimwood K, et al. Reduction in rotavirus-associated acute gastro
enteritis following introduction of rotavirus vaccine into Australias National Childhood vaccine
schedule. Pediatr Infect Dis J 2011;30(1 Suppl):S25-9.
2556
158

8.2

(Haemophilus influenzae type b Vaccine: Hib)

Haemophilus influenzae
(type b) H. influenzae type b (Hib) 2

1-2
H. influenzae
40-80
(nontypeable strain) 2-5 90
5 1-2

2-4
61-130
40-56 5 35-44
22-30 5
99

18 5 3
7.1 5 4 0.98
5 5
2556
159
(Prospective population-based surveillance)
5 .. 2543-2544
6.1 5 6

(conjugated polysaccharide vaccine)

--

1. PRP-OMP (polyribosylribotol phosphate conjugated to an outer membrane protein
complex of N. meningitides) Pedvax HIBTM MSD outer membrane protein
group B Neisseria meningitidis
2. PRP-T (polyribosylribotol phosphate conjugated to tetanus toxoid)
Act-HIBTM Sanofi Pasteur HiberixTM GSK)
TETRActHIBTM( DTwP), PediacelTM ( DTaP IPV), PentaximTM (
DTaP IPV) Sanofi Pasteur Infanrix-IPV/HibTM ( DTaP IPV),
Infanrix-HexaTM ( DTaP, IPV HBV) GSK tetanus toxoid
3. CRM-197 (Non toxic mutant of diphtheria toxin)
QuinvaxemTM ( DTwP HBV) Novartis/Biogenetech

1 (0.5 .) (polysaccharide)
7.5-10 tetanus toxoid, Neisseria meningitidis
serogroup B CRM-197

0.5 . 1

PRT-T PRP-CRM197 3 2, 4, 6 PRP-OMP 2 2, 4

2 6
12-18 (primary series)
2
2556
160
2 (
5 ) 2
2
18 2
8.2-1
7-10 7
8.2-1
PRP-T PRP-CRM 197
2-6 0, 2, 4 12-18
7-11 0, 2 12-18
2
12-24
> 24 0, 2
:
- PRP-OMP PRP-T PRP-CRM197 1
1

8
6 24
-- (DTP)
9-10

1.
2.
3. DTP
DTP PRP-T PRP-OMP
DTP PRP-T DTP
DTP ( Act-HIBTM DTwP
Sanofi Pasteur HiberixTM Tritanrix-HBTM GSK )
DTaP DTaP Hib
4. 2
1 2
2556
161

PRP-T 3
PRP-OMP 2 11-13

901 6414
90
2 15 2
16 2
13

+2 +8o
2-3
2556
162

1. Barbour ML. Conjugate vaccines and the carriage of Haemophilus influenzae type b. Emerg
Infect Dis 1996; 2: 176-82.
2. American Academy of Pediatrics. Haemophilus influenzae infection. In: Pickering LK, Baker
CJ, Kimberlin DW Long SS eds. Red Book: 2012 Report of the Committee on Infectious Diseases.
Elk Glove Village, IL: American Academy of Pediatrics; 2012: 345 - 352.
3. Batmunkh Nyambat, Duc Anh Dang, Hien Anh Nguyen, et al. Rapid assessment of Hib
disease burden in Vietnam. BMC Public Health. 2011; 11: 260.
4. Minz S, Balraj V, Lalitha MK, et al. Incidence of Haemophilus influenzae type b meningitis
in India. Indian J Med Res. 2008 Jul;128(1):57-64.
5. Shetty S, Cohen AL, Edmond K, et al. A systematic review and critical evaluation of invasive
Haemophilus influenzae type B diseaseburden studies in Asia from the last decade: lessons
learned for invasive bacterial disease surveillance. Pediatr Infect Dis J. 2010 Jul;29(7):653-61.
6. Muangchana C, Chunsuttiwat S, Rerks-Ngarm S, Kunasol P. Bacterial meningitis incidence in
Thai children estimated by a rapid assessment tool (RAT). Southeast Asian J Trop Med
Public Health. 2009 May;40(3):553-62.
7. American Academy of Pediatrics. Haemophilus influenzae infection. In: Pickering LK, Baker
CJ, Long SS, eds.Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed
Elk Grove Village, IL:American Academy of Pediatrics, 2009: 314-21.
8. Daum RS, Watson B, Clark HF, et al. New developments in vaccines: vaccines for Haemophilus
influenzae type b. Adv Pediatr Infect Dis 1991; 6: 1-17.
9. Ferreccio C, Clemens J, Avendano A. The clinical and immunologic response of Chilean
infants to Haemophilus influenzae type b polysaccharide-tetanus protein conjugate vaccine
coadministered in the same syringe with diphtheria-tetanus toxoids-pertussis vaccine at two,
four and six months of age. Pediatr Infect Dis J 1991; 10: 764-71.
10. Clemens JD, Ferreccio C, Levine M. Impact of Haemophilus influenzae type b polysaccharide-tetanus
protein conjugate vaccine on response to concurrently administered diphtheria-tetanus-pertussis
vaccine. JAMA 1992; 267: 673-8.
11. Bulkow LR, Wainwright RB, Letson GW. Comparative immunogenicity of four Haemophilus
influenzae type b conjugate vaccines in Alaska native infants. Pediatr Infect Dis J 1993; 12:
484-92.
12. Decker MD, Edwards KM, Bradley R, Palmer P. Comparative trial in infants of four conjugate
Haemophilus influenzae type b vaccines. J Pediatr 1992; 120: 184-9.
13. Chotpitayasunondh T, Panpitpat C, Thisyakorn U. Safety and immunogenicity of Haemophilus
influenzae type b polysaccharidetetanus toxoid conjugate vaccine combined with diphtheria,
tetanus, and pertussis vaccines in Thai infants. Southeast Asian J Trop Med Public Health
1997; 28: 91-8.
2556
163
14. Murphy TV, Pastor PN, Medley FB. Decreased Haemophilus colonization in children vaccinated
with Haemophilus influenzae type b conjugate vaccine. J Pediatr 1993; 122: 517-23.
15. Chotpitayasunondh T. Bacterial meningitis in children: etiology and clinical features, and
11-year review of 618 cases. Southeast Asian J Trop Med Public Health 1994; 25: 107-15.
16. Lolekha S. Prevalence of immunity against Haemophilus influenzae type b in Thai infants
and children (Abstract). The 36th Thai Congress of Pediatrics, 1993; 23: 53-5.
2556
164

8.3
(Varicella Vaccine : VAR)

varicella-zoster virus (VZV)
2-3

2-3

3-4

1 2
airborne, droplet contact
15 2

90 95

60 10
20 3

2556
165
.. 2554 81,858
128.86 3
10-14 17.89 15-24 16.67 5-9
14.32 5
325.68, 270.42, 246.35, 216.84, 213.72
4-6
(lyophilyzed)
(live attenuated) 3 8.3-1
8.3-1

(PFU)
OKAVAX sanofi pasteur OKA 1,000 Kanamycin
Erythromycin
Varilix GSK OKA 2,000 Neomycin
Varicella Vaccine-GCC Green Cross/ MAV/06 1,400
Biogenetech
--- (MMRV)
GSK 7
4-7
OKA (master seed)

1. 1,000-2,000 pfu
2. GSK neomycin 25 mg. sanofi
psteure erythromycin 25 mg. kanamycin 50 mg.
MMRV GSK
103.7 104.4 CCID50

4-7
0.5 .
8
1
1-12 2 12-18 2 4-6
4 3
2556
166
12-18 2 4 4
3
13 2 4
-- MMRV
9,10

1
1.

6811

2.

1
3
5 12
9,13

20 3-5 38o 10
varicella rash maculopapular rash 3-5 10 1.4
100 0.1 5-26
anaphylaxis, Stevens-Johnson syndrome, ,
Guillian-Barre syndrome

14
MAV/06 stain OKA
7
6 MAV/06
MMRV 2
MMR 2 4
15,16
2556
167
9,10
1.

2.
2 3
2.1 1
2.2 700 /3
100,000 /3
2.3 1 1
4
2.4
3.
CD4 15 2
9,10
1.
2.
prednisolone 2 ././ 14
1 3
3. 1

7
4.

-- (MMR) MMR
3
5. anaphylaxis neomycin
6. Reye syndrome
9

1-12 1 90-95 13
1 78 99
2 20
70-85 95
62 79 72-120 17,18
2556
168
1-12 10 (breakthrough
disease) 7.3 2.2 1 2
50 19
MAV/06 strain
seroconversion rate 100 OKA strain
seroconversion rate 91.5 20 5
seroconversion 1006 breakthrough
disease OKA strain
9
1. 1-4
15 21
2 22

2. -- (MMR)
1
--- (MMRV)
MMRV
2 4-6 16
3.

4. (post exposure prophylaxis)
- 72 5
80%17,18,23
- varicella immune globulin 125 /10 . ( 625 )
intravenous immune globulin (IVIG) 400 ./. 10 9
IVIG 3
VZIG IVIG 9
- 28
28 1,000 VZIG
IVIG 5 2
VZIG IVIG
- acyclovir 80 ././ 4 ( 3.2 /)
(secondary viremia) 7-9
VZIG IVIG 24,25
2556
169
- 5
acyclovir
65-100%
20% 26 3
4-9
+2 +8o
2

1. Myers MG, Stanberry LR, Seward JF. Varicella-zoster virus. In: Behrman RE, Kliegman RM,
Jensen HB, eds. Nelson Textbook of Pediatrics. Philadelphia: WB Saunders 2004: 1057.
2. Hope-Simpson RE. The nature of herpes zoster: a long-term study and a new hypothesis.
Proc R Soc Land 1965; 58: 9-20.
3. Migasena S, Simasathein S, Desakorn V. Seroprevalence of varicella zoster virus antibody in
Thailand. Int J Infect Dis 1997; 2: 26-30.
4. Aventis Pasteur. OKAVAX. In: MIMS annual Thailand 2003/2004. Singapore: Medimedia 2003;
587-8.
5. GlaxosmithKline. Varilrix. In: MIMS annual Thailand 2003/2004. Singapore: Medimedia 2003;
860-1.
6. Young Mo Sohn, Chul Joo Yu, Pyung Kil Kim, et al. Immunogenicity and safety of live
attenuated vaccine (MAV/06strain) on healthy children and immunocompromised children.
The Journal of The Korean Pediatr Society. Vol.38, No.6, 1995.
7. Vesikari T, Sadzot-Delvaux C, Rentier B, Gershon A. Increasing coverage and efficiency of
measles, mumps, and rubella vaccine and introducing universal varicella vaccination in Europe.
A role for the combined vaccine. Pediatr Infect Dis J. 2007;26:632-8.
8. Gillet Y, Habermehl P, Thomas S, Eymin C, Fiquet A. Immunogenicity and safety of concomitant
administration of a measles, mumps and rubella vaccine (M-M-RvaxPro) and a varicella vaccine
(VARIVAX) by intramuscular or subcutaneous routes at separate injection sites: a randomised
clinical trial. BMC Med 2009;7:16.
9. American Academy of Pediatrics. Varicella-Zoster Infectious. In: Pickering LK, Baker CJ, Kimberlin DW Long
10. CDC. Prevention of varicella recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR. 2007;56:1-40.
11. Lolekha S, Tanthiphabha W, Sornchai P, et al. Effect of climatic factors and population
density on varicella zoster virus epidemiology within a tropical country. Am J Trop Med
Hyg 2001;64(3-4):131-6.
2556
170
12. Macartney K, Mclntyre P. Vaccines for post-exposure prophylaxis against varicella (chickenpox)
in children and adults. Cochrane Database Syst Rev. 2008;16:CD001833.
13. Hadinegoro SR, Hindra IS, Han HH, Gatchalian S, Bock HL. Reactogenicity and immunogenicity of
a live-attenuated refrigerator-stable varicella vaccine (OKA stain) in healthy seronegative
subjects age 10 months to 12 years. Southeast Asian J Trop Med Public Health. 2009;40:991-9.
14. Civen R, Chaves SS, Jumaan A, et al. The incidence and clinical characteristics of herpes
zoster among children and adolescents after implementation of varicella vaccination. Pediatr
Infect Dis J 2009;28(11):954-9.
15. Czajka H, Schuster V, Zepp F, Esposito S, Douha M, Willems P. A combined measles,
mumps, rubella and varicella vaccine (Priorix-Tetra): immunogenicity and safety profile. Vaccine
2009;27(47):6504-11.
16. Marin M, Broder KR, Temte JL, Snider DE, Seward JF. Use of combination measles, mumps,
rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization
Practices (ACIP). MMWR Recomm Rep 2010;59(RR-3):1-12.
17. Brotons M, Campins M, Mendez L, et al. Effectiveness of varicella vaccines as postexposure
prophylaxis. Pediatr Infect Dis J 2010;29(1):10-3.
18. Asano Y, Nakayama H, Yazaki T, Kato R, Hirose S. Protection against varicella in family
contacts by immediate inoculation with live varicella vaccine. Pediatrics 1977;59(1):3-7.
19. Kuter B, Matthews H, Shinefield H. Ten-year follow-up of healthy children who received
one or two infections of varicella vaccine. Pediatr Infect Dis J 2004; 23: 132-7.
20. Asano Y. Varicella vaccine: the Japanese experience. J Infect Dis 1996; 174 (Suppl 3): s310-3.
21. Lim YJ, Chew FT, Tan AY, Lee BW. Risk factors for breakthrough varicella in healthy children.
Arch Dis Child 1998;79(6):478-80.
22. Kuter B, Matthews H, Shinefield H, et al. Ten year follow-up of healthy children who received
one or two injections of varicella vaccine. Pediatr Infect Dis J 2004;23(2):132-7.
23. Arbeter AM, Starr SE, Plotkin SA. Varicella vaccine studies in healthy children and adults.
Pediatrics 1986;78(4 Pt 2):748-56.
24. Ishida Y, Tauchi H, Higaki A, Yokota-Outou Y, Kida K. Postexposure prophylaxis of varicella
in children with leukemia by oral acyclovir. Pediatrics 1996;97(1):150-1.
25. Asano Y, Yoshikawa T, Suga S, et al. Postexposure prophylaxis of varicella in family contact
by oral acyclovir. Pediatrics 1993;92(2):219-22.
26. Marin M, Guris D, Chaves SS, Schmid S, Seward JF. Prevention of varicella: recommendations
of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2007;56
(RR-4):1-40.
2556
171

8.4
(Hepatitis A Vaccine: HAV)

single-stranded RNA Virus Family Picornaviridae,
Genus Hepatovirus Enterovirus type 72

28-30 (15-50 )1

70
2
3

4 (fulminant hepatitis A)
1:10,000 0.1
0.1-0.4 1 40
.. 2533

10 .. 2549-2553

400-500 0.5 0.8 .. 2548
2,421 3.89
634 5
2556
173
.. 25516
80
15

(seroprevalence) .. 2547 15
5.4 15-20 17.37

.. 2553 460 8 0.72
224 236 5-9 15-24
35-44 1.55
0.82, 0.35 0.28

(inactivated vaccine)
aluminium hydroxide adjuvant virosome hemagglutinin

aluminium hydroxide adjuvant

(virus suspension) aluminium
hydroxide adjuvant 3
1. HavrixTM GSK 1440 /.
720 / 0.5 .
2. VaqtaTM MSD 50 /.
25 / 0.5 .
3. AvaximTM sanofi pasteur 160 / 0.5 .
80 / 0.5 .
virosome aluminium hydroxide 1
1. EpaxalTM Crucell 24 / 0.5 .
12 / 0.25 .

3 0.25 0.5 . 1.0 .
2556
174

8.4-1 1
4
9-10 2 6-12
8.4-1

TM
Havrix 0.5 . (720 u) 1-18 1 . (1440 u) >19
VaqtaTM 0.5 . (25 u) 1-18 1 . (50 u) >19
AvaximTM 0.5 . (80 u) 1-15 0.5 . (160 u) >16
EpaxalTM 0.25 . (12 u) 1-16 0.5 . (24 u) >17

2-4
9-10

( 0.5 )
4 (systemic reaction) 24
1-14

1.

2. 1
1
3. alum, 2-phenoxyethanol ( HavrixTM
AvaximTM)
2556
175

2-4
1 1 6-12
94-100 11-12
16-25 13-15

1.

2.
3. 2 16-17
1 > 40
0.02 ./. 17
4. 2

+2 +8o
3

1. Abram S. Benenson. Viral hepatitis A. In: Control of communicable diseases. 15th edition.
1990: 197-200.
2. Borkowsky W, Krugman S. Viral hepatitis: A,B,C,E, and newer hepatitis agents. In: Katz SL,
Gershon AA, Hotez PJ, eds. Krugmans infectious diseases of children.
3. . : . . . 3.
: , 2537 : 202-35.
4. Pramoolsinsap C, Poovorawan Y, Hirsh P, Busagorn S, Attamasirirul K. Acute hepatitis A
superinfection in HBV carriers or chronic liver disease related to HBV or HCV. Ann Trop
Med Parasitol 1999; 93: 745-51.
5. , Major outbreak of Hepatitis A in Thailands Northern Province, 2005.

. ()
6. , , , , .
.. 2551.
.
()
2556
176
7. Chatproedprai S, Chongsrisawat V, Chatcharee P, et al. Declining trend in the seroprevalence
of infection with hepatitis A virus in Thailand. Annuals of Tropical Medicine & Parasitology
2007;101 (1):61-8.
8. 2553,
9. CDC. Prevention of hepatitis A through active or passive immunization: recommendations
of the Advisory Committee on Immunization Practices (ACIP). MMWR 1999; 48 (RR-12): 1-37.
10. Zuckerman JN, Kirkpatrick CT, Huang M. Immunogenicity and reactogenicity of Avaxim (160 AU)
as compared with Havrix (1440 EL.U) as a booster following primary immunization with
Havrix (1440 EL.U) against hepatitis A. J Travel Med 1998; 5: 18-22.
11. Innis BL, Snitbhan R, Kunasol P. Protection against hepatitis A by an inactivated vaccine.
JAMA 1994; 271: 1328-34.
12. Werzberger A, Mensch B, Kuter B. A controlled trial of a formalin-inactivated hepatitis A
vaccine in healthy children. N Engl J Med 1992; 327: 453-7.
13. Sandman L, Davidson M, Krugman S. Inactivated hepatitis A vaccine: a safety and immunogenicity
study in health professionals. J Infect Dis 1995; 171 (Suppl 1): s50-2.
14. Vimolket T, Theamboonlers A, Dumas R, Milcamps B, Forrat R, Poovorawan Y. Immunogenicity
and safety of a new inactivated hepatitis A vaccine in Thai young adults. Southeast Asian
J Trop Med Public Health 1998; 29: 779-85.
15. de Febres OC, de Petrola MC, de Escalona LC. Safety, immunogenicity and antibody persistance
of an inactivated hepatitis A vaccine in 4 to 15 years old children. Vaccine 2000; 18: 656-64.
16. Victor JC, Monto AS, Surdina TY, et al. Hepatitis A vaccine versus immune globulin for
postexposure prophylaxis. N Engl J Med 2007;357.1685-94.
17. CDC. Update: Prevention of hepatitis A after exposure to hepatitis A virus and in international
travelers. Updated recommendations of the Advisory Committee on Immunization Practices
(ACIP). MMWR 2007;56:1080-4.
2556
177

8.5
Streptococcus pneumoniae
(Pneumococcal Vaccine: Pnc)

35 90

1 1

S. pneumoniae 22
2
3 5 3 (invasive infection)
10 5
80 5 4
sterile body fluid 5 .. 2543-2548
6B ( 27.8), 23F ( 20), 14 (10.4), 19F ( 9.6), 6A
( 5.2) 19A ( 5.2)5 .. 2549-2553
6 .. 2554-2555 19A 24

.. 2541-2545 S. pneumoniae
2556
179
29.5-87.1
7 The Clinical and Laboratory Standards Institute
(CLSI) .. 25518 MIC (minimum inhibitory concentration)
cefotaxime ceftriaxone
(invasive pneumococcal
diseases IPD) 3

S. pneumoniae

S. pneumoniae 2
1. 23 (23-valent polysaccharide vaccine : PPSV23)
S. pneumoniae 23
1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A, 11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F
33F Pneumo 23TM sanofi pasteur
2. (Pneumococcal conjugate vaccine : PCV)
T-independent
2 (invasive pneumococcal
disease; IPD)
T-dependent 2
(boosting effect) (immune memory) herd immunity
9
2.1 PCV S. pneumoniae
7 4, 6B, 9V, 14, 18C, 19F 23F (Diphtheria
CRM197 protein) Prevnar7TM (PCV7) Wyeth .. 2553
Prevnar 13 Prevnar13TM (PCV13) Pfizer PCV710
2.2 PCV 10 SynflorixTM (PCV10) GSK
D non-typable Haemophilus influenzae (NTHi) oligosaccharide
18C 19F
PCV13 3, 6B 19A
15 ( 22F 33F) MSD CRM197 11

PPSV23 1 (0.5 .)
25 0.25%
PCV10 1 (0.5 .)
1, 5, 6B, 7F, 9V, 14 23F 1 4, 18C, 19F 3
2556
180
D Non-typable Haemophilus influenzae (NTHi) 13
18C tetanus toxoid 8 19F diphtheria toxoid
5 aluminium phosphate 12
PCV13 1 (0.5 .)
2 6B 4 CRM197 34 aluminium
phosphate
8.5-1

Synflorix 1, 4, 5, 6B, 7F, 9V, Protein D non-typeable H. 6 - 5
(PCV10) 14, 18C, 19F, 23F influenza (NTHi), tetanus toxoid
diphtheria toxoid
Prevnar 13 1, 3, 4, 5, 6A, 6B, 7F, Diphtheria toxin CRM197 6 - 5
(PCV13) 9V, 14, 18C, 19A, 19F, 23F > 50
2 0.5 .
PPSV23 0.5 . 1 2
IPD 8.5-2 5
2
cochlear implant 2 2-18
PCV PPSV23 PCV 2 10
PPSV23 PCV hyporesponsiveness 13
PPSV23 2
14
PCV10 PCV13 0.5

6 1-4 PCV7
PCV13 PCV7 PCV710
PCV7 3 PCV13 1
6 serotype PCV13 PCV13 4 9 PCV10
PCV7 15 PCV10 PCV13
16 primary series
2556
181
14-59 PCV7 4 PCV13 1
PCV7 8 10
PCV 2+1 ( 3 ) PCV10 PCV13 2, 4
12-15 EPI 17-18
5
PCV 2
8.5-3 PPSV23 2 2 6-18
PCV13 1 PS23 PCV7 10

PPSV23
2 8.5-2 PPSV23 2 2 5
PCV 1 65 14
PCV PCV IPD

1. 6 5 ( PCV 5 )
2. 6 8.5-2
PCV PCV10 PCV13 8.6-3 PPSV23
3. 8.5-2 6 PCV13 1
PPSV23 PCV7 10 PPSV23
4. PCV13 50 IPD 19
5. PCV10 NTHi 6 5
PPSV23 PCV 2
PCV PPSV2310
8.5-2 10
/
/

nephrotic syndrome
hemoglobinopathies

cochlear
2556
182
8.5-3 PCV

2-6 * PCV 3 6-8 PCV 1 12-15
7-11 PCV 2 6-8 PCV 1 12-15
12-23 PCV 2 6-8
24-59 ** PCV 1
24-71 *** PCV 2 6-8 PPSV23 1 PCV
2 PPSV23
1 5
6-18 ** PCV13 1 PPSV23 2 5
* 2+1 ( 3 ) 2, 4 12-15
** PCV10 24-59 2 6-8 PCV10
5
*** 8.6-2 24 24
PCV 2 PPSV23 2 5 >6
PCV13 1 PPSV23 2 5 PCV PPSV23
PPSV23 PPSV23 PCV PCV
PPSV23 2 5
PPSV23 50 PPSV23

48 ( 1) 20,21
(Arthus-like
reaction) 2 22
PCV PCV13 PCV10
PCV7 7 PCV
( 48) ( 35) ( 46) 37
39o 5 70 10
1. PCV PPSV23

2. PPSV23 PCV S. pneumoniae
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183
3.
PPSV23 PCV
4. PPSV23 2
5.

PPSV23 PPSV23
IPD 85-9021 IPD
86.9-87.323,24 IPD 56-81
PPSV23 IPD
PPSV23
25,26 PPSV23
27 PPSV23 2

PCV PCV7 IPD

PCV7 IPD 5 79
IPD 6A cross protection 6B
9928
3 29 30 herd immunity
2
6531 PCV7 PCV11 (
PCV10)
57 PCV10 protein D NTHi
NTHi PCV11
34 PCV7
6-732,33 PCV10 NTHi
PCV7
IPD 57 81
2 PCV10 PCV13 7
PCV7 PCV13 19A
19A PCV7
PCV10 PCV10 6A 19A
34,35 19A

FinIP PCV10 7 30,528
PCV10 2+1 3+1 IPD
92 100 IPD 9335
2556
184
The Clinical Otitis Media and PneumoniA Study (COMPAS) 23,738
PCV10 PCV10 3
2 2236 PCV13 1
2+1 IPD 7F 19A 76
70 PCV13 1 IPD
78 PCV13 2 37
PCV13 community acquired pneumonia
14 62.6 69.2
PCV7 PCV1338 Rochester
PCV13
39 herd immunity PCV13
IPD 40
PCV10 PCV13 IPD herd
immunity
+2 +8o
1. Gray BM, Converse GM III, Dillon HC Jr. Epidemiologic studies of Streptococcus pneumoniae
in infants: acquisition, carriage and infection during the first 24 months of life. J Infect Dis
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Haemophilus influenzae type b meningitis in Thailand. Vaccine 2004; 22: 975-83.
4. CDC. Direct and indirect effect of routine vaccination of children with 7-valent pneumococcal
conjugate vaccine on incidence of invasive pneumococcal disease-United States, 1998-2003.
MMWR 2005; 54: 893-7.
5. Phongsamart W, Srifeungfung S, Dejsirilert S, et al. Serotype distribution and antimicrobial
susceptibility of S. pneumoniae causing invasive disease in Thai children younger than 5 years old,
2000-2005. Vaccine 2007;25(7):1275-80.
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conjugate vaccine and drug susceptibility of Streptococcus pneumoniae isolated from invasive
or non-invasive diseases in central Thailand, 2006-2009. Vaccine 2010;28(19):3440-4.
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7. . . 2
. . 17-18 .. 2546:
4-28.
8. CDC. Effects of new penicillin susceptibility breakpoints for Streptococcus pneumoniae--United
States, 2006-2007. MMWR Morb Mortal Wkly Rep 2008;57(50):1353-5.
9. Pichichero M. Meningococcal Immunization Update: A New Conjugate Vaccine. Consultant
for Pediatricians. 2005;4:263-7.
10. Nuorti JP, Whitney CG. Prevention of pneumococcal disease among infants and children - use
of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide
vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP).
MMWR Recomm Rep 2010;59(RR-11):1-18.
11. Skinner JM, Indrawati L, Cannon J, et al. Pre-clinical evaluation of a 15-valent pneumococcal
conjugate vaccine (PCV15-CRM197) in an infant-rhesus monkey immunogenicity model. Vaccine
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12. http://www.who.int/immunization_standards/vaccine_quality/Synflorix_WHO_leaflet_EN_
May_2011.pdf.
13. OBrien KL, Hochman M, Goldblatt D. Combined schedules of pneumococcal conjugate and
polysaccharide vaccines: is hyporesponsiveness an issue? Lancet Infect Dis 2007;7(9):597-606.
14. CDC. Updated recommendations for prevention of invasive pneumococcal disease among
adults using the 23-valent pneumococcal polysaccharide vaccine (PPSV23). MMWR Morb
Mortal Wkly Rep 2010;59(34):1102-6.
15. Vesikari T, Wysocki J, Chevallier B, et al. Immunogenicity of the 10-valent pneumococcal
non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) compared to
the licensed 7vCRM vaccine. Pediatr Infect Dis J 2009;28(4 Suppl):S66-76.
16. Grimprel E, Laudat F, Baker CA, et al. Safety and immunogenicity of 13-valent pneumococcal
conjugate vaccine given with routine pediatric vaccination to healthy children in France.
Poster presented at: 27th Annual Meeting of the European Society of Paediatric Infectious
Disease (ESPID). June 9-13, 2009; Brussels, Belgium.
17. Vestrheim DF, Lovoll O, Aaberge IS, et al. Effectiveness of a 2+1 dose schedule pneumococcal
conjugate vaccination programme on invasive pneumococcal disease among children in
Norway. Vaccine 2008;26(26):3277-81.
18. Silfverdal SA, Hogh B, Bergsaker MR, et al. Immunogenicity of a 2-dose priming and booster
vaccination with the 10-valent pneumococcal nontypeable Haemophilus influenzae protein
D conjugate vaccine. Pediatr Infect Dis J 2009;28(10):e276-82.
19. CDC.Licensure of 13-Valent pneumococcal conjugate vaccine for adults aged 50 years and
older. MMWR 2012;61(21):394-5.
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20. National Immunization Program (NIP), CDC. Pneumococcal diseases. Epidemiology and prevention
of vaccine-preventable diseases (The Pink Book). Updated 7th edition 2nd Printing (February
2003); chapter 16: 1-12. (www.cdc.gov/nip/publications/pink/text.htm)
21. CDC. Prevention of pneumococcal disease: recommendations of the Advisory Committee on
Immunization Practices (ACIP). MMWR Recomm Rep 1997;46(RR-8):1-24.
22. Borgono JM, McLean AA, Vella PP, et al. Vaccination and revaccination with polyvalent
pneumococcal polysaccharide vaccines in adults and infants. Proc Soc Exp Biol Med
1978;157(1):148-54.
23. , , .
.. 2532;33:375-80.
24. Srifeungfung S, Chokephaibulkit K, Tribuddharat C. Serotypes and antimicrobial susceptibilities
of Streptococcus pneumoniae isolated from hospitalized patients in Thailand. Southeast Asian
J Trop Med Public Health 2007;38(3):469-77.
25. Klein JO, Teele DW, Sloyer JL, et al. Use of pneumococcal vaccine for prevention of recurrent
episodes of otitis media. In: Weinstein L, Fields BN, eds. Seminars in infectious disease.
New York: Thieme-Stratton Inc. 1982;305-10.
26. Jackson LA, Neuzil KM. Pneumococcal polysaccharide vaccines. In: Plotkin SA, Orenstein
WA, Offit PA, eds. Vaccines. 5th ed. Philadelphia, PA: WB Saunders Company; 2008:569604.
27. Shapiro ED, Berg AT, Austrian R, et al. The protective efficacy of polyvalent pneumococcal
polysaccharide vaccine. N Engl J Med 1991;325(21):1453-60.
28. Whitney CG, Pilishvili T, Farley MM, et al. Effectiveness of seven-valent pneumococcal
conjugate vaccine against invasive pneumococcal disease: a matched case-control study.
Lancet 2006;368(9546):1495-502.
29. Poehling KA, Talbot TR, Griffin MR, et al. Invasive pneumococcal disease among infants
before and after introduction of pneumococcal conjugate vaccine. JAMA 2006;295(14):1668-74.
30. Kellner JD, Church DL, MacDonald J, Tyrrell GJ, Scheifele D. Progress in the prevention of
pneumococcal infection. Cmaj 2005;173(10):1149-51.
31. Grijalva CG, Nuorti JP, Arbogast PG, Martin SW, Edwards KM, Griffin MR. Decline in pneumonia
admissions after routine childhood immunisation with pneumococcal conjugate vaccine in
the USA: a time-series analysis. Lancet 2007;369(9568):1179-86.
32. Jansen AG, Hak E, Veenhoven RH, Damoiseaux RA, Schilder AG, Sanders EA. Pneumo
coccal conjugate vaccines for preventing otitis media. Cochrane Database Syst Rev 2009;15(2):
CD001480.
33. Prymula R, Peeters P, Chrobok V, Kriz P, Novakova E, Kaliskova E, et al. Pneumococcal
capsular polysaccharides conjugated to protein D for prevention of acute otitis media caused
by both Streptococcus pneumoniae and non-typable Haemophilus influenzae: a randomised
double-blind efficacy study. Lancet 2006;367(9512):740-8.
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34. Kim CH, Kim JS, Cha SH, et al. Response to primary and booster vaccination with 10-valent
pneumococcal nontypeable Haemophilus influenzae protein D conjugate vaccine in Korean
infants. Pediatr Infect Dis J 2011;30(12):e235-43.
35. Palmu AA, Jokinen J, Nieminen H, et al. Effectiveness of the Pneumococcal Haemophilus
influenzea protein D conjugate (PHID-CV) against pneumococcal disease in infants- FINIP
Trial. The 30th Annual Meeting of the European Society for Paediatrics Infectous Diseases,
Thessaloniki, Greece, May 8-12, 2012 . Abstract 385, NCT number NCT00861380.
36. Tregnaghi MW, Sez-Llorens X, P. Lpez P, et al. Evaluating the efficacy of 10-valent
pneumococcal non-typeable Haemophilus influenzae protein-D conjugate vaccine (PHiD-CV)
against community-acquired pneumonia in Latin America. Abstract presented at the 29th
annual meeting of the European Society for Paediatric Infectious Diseases (ESPID), The Hague,
The Netherlands, June 7-11, 2011 Abstract 412.
37. Miller E, Andrews NJ, Waight PA, Slack MP, George RC. Effectiveness of the new serotypes
in the 13-valent pneumococcal conjugate vaccine. Vaccine 2011;29(49):9127-31.
38. Prez MC, Algorta G, Cedrs A, et al. Impact of universal pneumococcal vaccination on
hospitalizations for pneumonia and meningitis in children in Montevideo, Uruguay. The 8th
International Symposium on Pneumococci and Pneumococcal Diseases, Iguau Falls, Brazil,
March 11-15, 2012.
39. Pichichero M, Casey JR, Center K, et al. Efficacy of PCV13 in prevention of AOM and NP
colonization in children: first year of data from the US. The 8th International Symposium
on Pneumococci and Pneumococcal Diseases, Iguau Falls, Brazil, March 11-15, 2012. Poster
No 154.
40. Cox CM. Presented at the 1st National Immunization Conference Online, March 26, 2012.
Accessed April 5, 2012 from http://cdc.confex.com/cdc/nic2012/webprogram/Paper30196.html
2556
188

8.6
(Meningococcal Polysaccharide Vaccine

Conjugate vaccine)

Neisseria meningitides
5-101

6-24
hypogammaglobulinemia

13 A, B,
C, E, X, Y, Z, W-135, H, I, K L A, B, C, Y
W-135
2 (endemic) (epidemic)
(cluster)
2 A
B C 2 ( 1 )
( B) 15-18 (3/4
C, Y W-135)3
2556
189
Meningitis belt
A4
A C5 W-135 A2-3
B3
(sporadic)
( .. 25452554)
15-50 0.02-0.08

.. 2554 22
0.03 9.09 04
0.23 6 .. 2550
.. 2554
20 serogroup B
Y, W135 19.23
A B

1. (Meningococcal polysaccharide
vaccine; MPSV) 4 Tetravalent meningococcal
(A, C, Y W-135) polysaccharide vaccine (MPSV4) Menomune A/C/Y/W-135
sanofi pasteur A, C, Y, W-135 50 .3
2. (Meningococal conjugate vaccine; MCV)

T cell (T cell dependent) 2
(boosting effect) Tetravalent meningococcal (A, C, Y W-135) conjugate
vaccine MCV4 2
2.1. MCV4-DT (Menactra)
A, C, Y W-135 4 . (DT) 48
.3, 7
2.2 MCV4-CRM (MenveoTM)
A, C, Y W-135 10, 5, 5 5 . CRM197
non-toxic variant toxoid 32.7-64.1 .8
2556
190
Monovalent C A
C 2, 3 4 B
B cross react
B B
4
outer membrane vesicle New Zealand (OMV), Neisserial adhesin A
(NadA), Neisseria heparin-binding antigen (NHBA) factor H-binding protein (fHbp)
4 surface-express protein sereum bactericidal antibody
4 B
78-91% 9,10
(MPSV4) 1
0.5 . MCV4 1 0.5 .
MPSV4 0.5 . (subcutaneous) 2

2 MPSV4
MCV4 0.5 . (intramuscular) MCV4-DT
9 - 55 MCV4-CRM 2-55 9 -23
3 11 2 55 ()
5 2-55
complement deficiency 2
5 11-18
1 16
7, 8

2
( MCV4-DT 9 )

50 B

1.

10 2
2556
191
2.
2-3
2
4 rifampicin, ciprofloxacin ceftriaxone
3 (mass chemoprophylaxis)

3.
MCV4 11-18
11-12 16 16
12
4.
(terminal complement component C5-C9 deficiency) properdin,
factor H factor D deficiency

(primary series) 2 2 2-55 3 9-23 11
,
2, 12-14 1

MPSV4 2-3 4
5 14 MCV4 9 -6 3 7
5 5
MCV4 MPSV4
MCV4 MPSV 12, 15

MPSV MCV4
3
2-18 MCV4 MPSV4 2-5
Guillain-Barre syndrome (GBS) MCV4 16

1. 2
3, 12
2. MPSV4 2
12
3. MCV4 GBS GBS
16
2556
192

MPSV4 2

2-5 3 MPSV4
3-5 hyporesponsiveness
C12 MCV4 hyporesponsiveness17
MCV4 MPSV4
MPSV418 memory T cell, nasopharyngeal
carriage, herd immunity,
(boosting effect)19 hyporesponsiveness
MCV4

waning 5

MPSV4 (MenomuneTM) MCV4 (MenactraTM) 2
98-100 MCV4
Serum Bactericidal Titer (SBA) 19,20 MPSV4 MPSV4
MCV4 MCV4
MPSV417
9 MCV4-DT 86-100%
MCV4-CRM11 MCV4 MPSV4 91% 1
58% 2-512 MCV4
MPSV4
+2 +8o
30 2
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193

1. Meningococcal infection, meningococcal meningitis. In: James C, ed. Control of Communicable
Diseases. Manual 17th ed. Baltimore: United Book Press, 2000: 340-5.
2. Pollard AJ, Finn A. Neisseriameningitidis. In: Long SS, Pickering LK, Prober CG, eds. Principles
and practice of pediatric infectious diseases. 3rd ed. Philadelphia: Churchill livingstone; 2008:
738-43.
3. American Academy of Pediatrics. Meningococcal infections. In: Pickering LK, Baker CJ,
4. Morley SL, Pollard AJ. Vaccine prevention of meningococcemia disease, coming soon? Vaccine
2002;20:666-87.
5. Caserta MT. Meningococcemia. In: McInerny TK, Adam HM, Campbell DE, Kamat DM, Kelleher
KJ. AAP Textbook of Pediatric Care.1st ed. American Academy of Pediatrics; 2008. Available
at https://www.pediatriccareonline.org/pco
6. . . 2552. .
Available at http://epid.moph.go.th/
7. Menactra Package Insert. Available at http://www.fda.gov/downloads/biologicsbloodvaccines/
vaccines/approvedproducts/ucm131170.pdf.
8. Menveo Package Insert. Available at http://www.fda.gov/downloads/biologicsbloodvaccines/
vaccines/approvedproducts/ucm201349.pdf.
9. Vogel U, Taha MK, Vazquez JA, Findlow J, Claus H, Stefanelli P, et al. Predicted strain coverage
of a meningococcal multicomponent vaccine (4CMenB) in Europe: a qualitative and quantitative
assessment. Lancet Infect Dis. 2013 May;13(5):416-25.
10. Kim E, et al. Presented at: 19th International Pathogenic Neisseria Conference (IPNC). 9-14
September 2012. Wrzburg, Germany. Poster P270.
11. CDC. Recommendation of the Advisory Committee on Immunization Practices (ACIP) for use
of quadrivalent meningococcal conjugate vaccine (MenACWY-D) among children aged 9
through 23 months at increased risk for invasive meningococcal disease. MMWR Morb Mortal
Wkly Rep 2011;60(40):1391-2.
12. CDC. Updated recommendations for use of meningococcal conjugate vaccines advisory
committee on immunization practices (ACIP), 2010. MMWR 2011; 60(3): 72-76.
13. CDC. Licensure of a meningococcal conjugate vaccine for children aged 2 through 10 years
and updated booster dose guidance for adolescents and other persons at increased risk for
meningococcal disease- advisory committee on immunization practices (APIP), 2011. MMWR
2011; 60(30): 1018-9.
14. CDC. Prevention and Control of Meningococcal Disease. Recommendations of the Advisory
Committee on Immunization Practices (ACIP). MMWR, May 27, 2005 / 54(RR07);1-21. Available
at http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5407a1.htm update
2556
194
15. . . : , ,
, . 2012-2013 . :
, 2555: 358-72.
16. CDC. Update: Guillain-Barre syndrome among recipients of Menactra meningococcal conjugate
vaccine--United States, June 2005-September 2006. MMWR Morb Mortal Wkly Rep
2006;55(41):1120-4.
17. MacDonald NE, Halperin SA, Law BJ, Forrest B, Danzig LE, Granoff DM. Induction of
immunologic memory by conjugated vs plain meningococcal C polysaccharide vaccine in
toddlers: a randomized controlled trial. Jama 1998;280(19):1685-9.
18. Pichichero M, Casey J, Blatter M, et al. Comparative trial of the safety and immunogenicity
of quadrivalent (A, C, Y, W-135) meningococcal polysaccharide-diphtheria conjugate vaccine
versus quadrivalent polysaccharide vaccine in two to ten year old children. Pediatr Infect
Dis 2005;24(1):57-62.
19. Pollard A, Perrett K, Beverley P. Maintaining protection against invasive bacteria with protein-
polysaccharide conjugate vaccines. Nat Rev Immunol 2009;9:213-20.
20. Keyserling H, Papa T, Koranyi K, et al. Safety, immunogenicity, and immune memory of a
novel meningococcal (groups A, C, Y, and W-135) polysaccharide diphtheria toxoid conjugate
vaccine (MCV-4) in healthy adolescents. Arch Pediatr Adolesc Med 2005;159(10):907-13.
2556
195

8.7
Human Papillomavirus Vaccine
(Human Papillomavirus, HPV)

HPV 100 (genotypes) 40

(persistent infection) HPV 1
(cervical intraepithelial neoplasia, CIN) 1 HPV 2
(low risk type) 6 11 90
(high risk type)
16, 18, 31, 33, 35 45
low grade
squamous intraepithelial lesion (LSIL) CIN1
high grade squamous intraepithelial lesion (HSIL) CIN2
CIN3 16 18 702
16 40-80 18
7-233,4 HPV

2
(age-standardized incidence rate) 24.5
100,000 10,000
5,000 14
350
2556
197
HPV

HPV

Papanicolaou (Pap) smear Visual Inspection
with Acetic acid (VIA) HPV HPV

HPV (capsid protein) L1 HPV
(genetic engineering) (virus-like
particles, VLPs)

HPV 2
1. 2 (bivalent) 16 18 baculovirus
L1 HPV 16 18 20 .,
aluminium hydroxide 500 . 3-desacylated monophosphoryl lipid A (MPL) adjuvant
50 . CervarixTM GSK
2. 4 (quadrivalent) 6, 11, 16 18
Saccharomyces cerevisiae L1 HPV
6, 11, 16 18 20, 40, 40 20 . aluminium hydroxyphosphate
sulfate adjuvant GardasilTM MSD

HPV 1
(pre-filled syringe) 0.5 .

1 (0.5 .) 3 0, 1-2 6

HPV 2 4 9-26
11-12
HPV 26

HPV

2556
198
4 9-26
11-12 13-21
22-26 5
26 6

persistant infection 7-9
11-12

10 10-12

mass psychogenic response13 30
- 4
HPV 2 4 HPV
CIN2 16 18
HPV 4 9514 2
9315
4 44
CIN2 HPV HPV
4 188 2
3015
CIN2 HPV
HPV 2 7015
31, 33, 45
4 6, 11 90
6316
14-19 56
32 8217
4 90.4
83.818
2556
199
HPV
9-15 46-55 19,20
seroconversion 96
21
HPV

-
HPV 16 18

-

+2 +8o

1. Munoz N, Bosch FX, de Sanjose S, et al. Epidemiologic classification of human papillomavirus
type associated with cervical cancer. N Engl J Med 2003; 348: 518-27.
2. Walboomers JM, Jacobs MV, Manos MM, et al. Human papillomavirus is a necessary cause
of invasive cervical cancer worldwide. J Pathol 1999; 189: 12-19.
3. Chaicharoen S, Herrero R, Munoz N, et al. Risk factors for cervical cancer in Thailand: a
case-control study. J Natl Cancer Inst 1998; 90: 50-7.
4. Thomas DB, Ray RM, Koetsawang A, et al. Human papillomaviruses and cervical cancer in
Bangkok. Risk factors for invasive cervical carcinoma with human papillomavirus type 16
and 18 DNA. Am J Epidemiol 2001; 153: 723-31.
5. Recommendations on the Use of Quadrivalent Human Papillomavirus Vaccine in Males - Advisory
Committee on Immunization Practices (ACIP), 2011. Morbidity and Mortality Weekly Report
(MMWR) December 23, 2011 / 60(50);1705-1708. Available at http://www.cdc.gov/mmwr/
preview/mmwrhtml/mm6050a3.htm. Accessed on July 11, 2013.
6. CDC. Recommendations on the use of quadrivalent human papillomavirus vaccine in males-
-Advisory Committee on Immunization Practices (ACIP), 2011. MMWR Morb Mortal Wkly
Rep 2011;60(50):1705-8.
7. Suwankanta N, Kietpeerakool C, Srisomboon J, Khunamornpong S, Siriaunkgul S. Underlying
histopathology of HIV-infected women with squamous cell abnormalities on cervical cytology.
Asian Pac J Cancer Prev 2008;9(3):441-4.
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200
8. Grulich AE, van Leeuwen MT, Falster MO, Vajdic CM. Incidence of cancers in people
with HIV/AIDS compared with immunosuppressed transplant recipients: a meta-analysis.
Lancet 2007;370(9581):59-67.
9. Moscicki AB, Ellenberg JH, Vermund SH, et al. Prevalence of and risks for cervical human
papillomavirus infection and squamous intraepithelial lesions in adolescent girls: impact of
infection with human immunodeficiency virus. Arch Pediatr Adolesc Med 2000;154(2):127-34.
10. Barr E, Sings HL. Prophylactic HPV vaccines: new interventions for cancer control. Vaccine
2008;26(49):6244-57.
11. Joura EA, Leodolter S, Hernandez-Avila M, et al. Efficacy of a quadrivalent prophylactic
human papillomavirus (types 6, 11, 16, and 18) L1 virus-like-particle vaccine against high-grade
vulval and vaginal lesions: a combined analysis of three randomised clinical trials. Lancet
2007;369(9574):1693-702.
12. Descamps D, Hardt K, Spiessens B, et al. Safety of human papillomavirus (HPV)-16/18 AS04-
adjuvanted vaccine for cervical cancer prevention: a pooled analysis of 11 clinical trials. Hum
Vaccin 2009;5(5):332-40.
13. Buttery JP, Madin S, Crawford NW, et al. Mass psychogenic response to human papillomavirus
vaccination. Med J Aust 2008;189(5):261-2.
14. Koutsky LA, for the FUTURE II Study Group. Quadrivalent vaccine against human papillomavirus
to prevent high-grade cervical lesions. N Engl J Med 2007; 356: 1915-27.
15. Paavonen J, Naud P, Salmeron J. Efficacy of human papillomavirus (HPV)-16/18 AS04-adjuvanted
vaccine against cervical infection and precancer caused by oncogenic HPV types (PATRICIA):
final analysis of a double-blind, randomized study in young women. Lancet 2009; 374: 301-14.
16. Food and Drug Administration. Highlights of prescribing information. Gardasil (human papillomavirus
quadrivalent [types 6, 11, 16 and 18]). Silver Spring, MD: Food and Drug Administration;
2011. Available at http://www.fda.gov/downloads/BiologicsBloodVaccines/Vaccines/Approved
Products/UCM111263.pdf. Accessed on July 11, 2013.
17. Markowitz LE, Hariri S, Lin C, Dunne EF, Steinau M, McQuillan G, et al. Reduction in Human
Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction
in the United States, National Health and Nutrition Examination Surveys, 2003-2010. J Infect
Dis. 2013 Aug;208(3):385-93.
18. Giuliano AR, Palefsky JM, Goldstone S, Moreira ED, Jr., Penny ME, Aranda C, et al. Efficacy
of quadrivalent HPV vaccine against HPV Infection and disease in males. N Engl J Med.
2011 Feb 3;364(5):401-11.
19. Olsson SE, Villa LL, Costa RL. Induction of immune memory following administration of a
prophylactic quadrivalent human papillomavirus (HPV) types 6/11/16/18 L1 virus-like particle
(VLP) vaccine. Vaccine 2007; 25: 4931-9.
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20. GlaxoSmithKline Vaccine HPV-007 Study Group, Romanowski B, de Borba PC. Sustained efficacy
and immunogenicity of the human papillomavirus (HPV)-16/18 AS04-adjuvanted vaccine:
analysis of a randomised placebo-controlled trial up to 6.4 years. Lancet 2009; 374: 1975-85.
21. Levin MJ, Moscicki AB, Song LY, et al. Safety and immunogenicity of a quadrivalent human
papillomavirus (types 6, 11, 16, and 18) vaccine in HIV-infected children 7 to 12 years old.
J Acquir Immune Defic Syndr 2010;55(2):197-204.
2556
202

8.8
(Rabies Vaccine and Rabies Immunoglobulin)

( .. 2555
)

Rabies

5 - 5 ( 8 ) 1

1
.. 2472 180 .. 2523
370
63,939 185
.. 2533 50 8 .. 2533 .. 2554

: = 2.1 : 1 (
.. 2547 2552)
2556
203
.. 2552 2554 3 79
66
23.4

( ) .. 2538-2553
46.42 .. 2538 17.79 .. 2553
2
2 ( 94)
( 4.14)

2
80

3-5
1 80
1 90 1-5 6-10

5

2556
204
8.8-1

()

1
8.8-1
2 3

Post-exposure
8.8-2 /

l
post-exposure
10
3 l

l
2 1
3
10

2556
205
8.8-1

1
l l
l
l

2 l l
l
l (abrasion) (rabies vaccine*)

l

3 l l
(laceration) l
l (rabies vaccine* RIG**)

l

l

***
l

* () 10
**
( 7
)

***
2556
206
8.8-2

- -

2
2 10

- -

- -

10 (
1-6 ) 10
- -

- -

2556
207
8.8-3 *

Purified Chick >103 Chiron Behring
Embryo Cell fixed rabies virus (inactivated) TCLD50/ml (Tissue GmbH sterile water
Rabies Vaccine Flury LEP-C25 beta-propiolactone Culture Infectious for injection
(PCECV) primary chick 0.025% Dose) antigenic

Rabipur embryo fibroblast value >2.5 IU/ml 1 ml
cells.
Purified Vero >1075 sanofi pasteur
Cell Rabies fixed rabies virus (inactivated) LMD50/0.5 ml
Vaccine PMWI 138- beta-propiolactone antigenic value GPO MBP (solution of
(PVRV) 1503-3M Vero 0.025% >2.5 IU/0.5ml sodium chloride
- VERORAB cells 0.4 %)

0.5 ml
Purified Vero 106 Human Biologicals
Cell Rabies fixed rabies virus (inactivated) PFU/ml. anti- Institute
Vaccine L.Pasteur beta-propiolactone genic value > 2.5 (A Division of (solution of sodium
(PVRV) 2061 15 passages 0.025% IU/0.5 ml. Indian Immunolo- chloride 0.9 %)
- Abhayrab Vero cells gical Limited (IIL)

0.5 ml.
Thiomersal
(preservative)

Chromato- 106- Liaoning Cheng

graphically fixed rabies virus (Inactivated) 107 LgLD50/ml Da Biotechnology
Purified Vero L.Pasteur beta-propiolactone antigenic value (sterile water for
Cell PV2061 Vero 0.025% > 2.5 IU/0.5ml infection)
Rabies Vaccine cells
(CPRV) 0.5 ml
- SPEEDA
2556
208

Purified Duck >107 Berna, Swiss Serum
Embryo Cell fixed rabies virus (inactivated) MLD50/1 ml and Vaccine Institute
Rabies Vaccine PM* beta-propiolactone antigenic value (sterile water for
(PDEV) (embryo- 0.025% >2.5 IU/1 ml injection) 1 ml
nated) duck eggs)

Thiomersal

(preservative)
Human Diploid >107 sanofi pasteur
Cell Ra- fixed rabies virus (inactivated) MLD50/ml sterile water
bies Vaccine PM** 1503-3M beta-propiolactone (Minimum Lethal for injection
(HDCV)** human diploid 0.025% Dose in mice)
cell antigenic value
>2.5 IU/ml 1 ml
*PM = Pitman Moore
**
2556
209
8.8-2
Post-exposure rabies immunization
(pre-exposure)

3
3

RIG
2 3 6
RIG ERIG 40 IU / kg ( skin 6 6

test ) HRIG 20 IU / kg
2 0 3 1

1 ml 0.5 ml
0, 3, 7, 14 30
0.1 ml 2
0, 3, 7, 30
2 0, 3, 7, 1 30, 90
10
- antigenic value 0.7 IU/0.1 ml

- ERIG 1 .
2556
210

- 1 . ( HDCV, PCECV, PDEV) 0.5 . ( PVRV,

CPRV)
- +2 +8o 8
2
. (Intramuscular, IM)
- HDCV, PCECV, PDEV 1 . PVRV,CPRV 0.5 .
(deltoid) (anterolateral)
-
- 1 0, 3, 7, 14 30
0 3 7 14 30
RIG
. (intradermal, ID)

(antigenic value) 0.7 IU/0.1 ml

(International peer-reviewed journals)
2556
211
2-2-2-0-2
- 0.1 . 1
0, 3, 7 30
0 3 7 14 30
2 2 2 0 2
RIG

l

l 8 RIG

-

- chloroquine
HIV
2556
212
(RIG)
8.8-4 (Rabies Immunoglobulin : RIG)

RIG
1. -
(Equine Rabies
Immunoglobulin, ERIG) - sanofi pasteur (Serum sickness)
: 5 ml (1000 1-2%
IU) : 40 IU/kg - Berma Swiss Serum
7-14
and Vaccine Institute
(anaphylaxis)

0.03%

2. -
(Human Rabies
Immunoglobulin, HRIG) - sanofi pasteur
: 2 ml (300 IU)
5 ml (750 IU) - Berma Swiss Serum
: 20 IU/kg and Vaccine Institute

(blood borne
infection)
RIG
- RIG 48
- RIG
7 RIG
- (HRIG)
(ERIG) (intradermal skin test)
ERIG
- ERIG 1:100 (normal saline solution)
- 0.02 ml 3 .
-
2556
213

l 15-20
- ERIG (wheal) 10 .
(flare)
- ERIG 10 .

l
- HRIG
- HRIG ERIG
adrenaline (epinephrine), antihistamine
l ERIG
- anaphylaxis adrenaline 0.1%

(1:1,000 1 ./.) adrenaline 0.5 . 0.01 ./
1 .
l ERIG 1 . ERIG
RIG
l

l RIG (neutralize)

RIG
RIG
l RIG
l RIG
(NSS 0.9%) 2-3

l HRIG

l RIG
: l

RIG 1 .
l RIG 8
2556
214
(pre-exposure immunization)

- HDCV, PCECV 1 . PVRV, CPRV
0.5 . (IM) 1 0.1 . 1
(ID) (deltoid) 0, 7 21 28
0 7 21 28
- 3 0, 3, 7
10

1. 0 2579 8908-14 50/2
0 2579 8918-19
e-mail: niah@dld.go.th 10900
2. 0 5422 1476 -
() 0 5422 6978 52190
0 5422 1476 5
e-mail: vrd_np@dld.go.th
3. 0 5531 2069-72 9 15 -
() 0-5531 2069 24
e-mail: vrd_sn@dld.go.th 65130
4. 0 43 262050
043 261165-6 40260
043 261246
e-mail: vrd_ne@dld.go.th
5. 0 4454 6104
() 0 4454 6147 . 13 9
e-mail: vrd_se@dld.go.th 32000
2556
215

6. 0 7577 0008-9 124/2 7
0 7577 0128-30
0 7577 000 8-9
0 7577 0128-30 102 80110
e-mail: vrd_sp@dld.go.th
7. 0 3874 2116-9 844 9
0 3874 2120 20220
e-mail: vrd_se@dld.go.th
8. 0 3222 8419 126 10
0 3222 8379
0 3222 8419 114 70120
e-mail: vrd_wp@dld.go.th

1.
88/7
. 0 2589 9850 0 2951 0000 99205, 99312
2. ()
22000
. 0 3901 4747
3.
148 3 57100
. 0 5379 3149-50
4.
40000
. 0 4324 2871-3
5.

. 0 4424 1522, 0 4425 8713 0 4429 5868 116

1. ()
2 10700
. 0 2411 3111 0 2411 0263
2556
216
2. ()
110 50200
. 0 5394 5422-4
3.
. 11 1114/3 10330
. 0 2256 4333 3576 ./ 0 2652 3122
* 0 2256 4333
.

1871
. 0 2252 0161-4 127
1. Puanghat A, Hunsoowan W. Rabies Situation in Thailand. J Med Assoc Thai 2005; 88: 1319-22.
2. Lurnlertdacha B, Wacharapluesadee S, Chanhome L, Hemachuda T. Bat Lyssavirus in Thailand.
J Med Assoc Thai 2005;88:1011-4.
3. . 2555.
, 2555
4. . .. 2547
.. 2554
5. . . ..
2538 - 2553
2556
217

9
(Combination vaccines)

1.

PRP-T DTwP
DTwP Act-HIBTM DTwP Sanofi Pasteur (D.T.COQTM)
HiberixTM DTwP GSK DTwP-HB
(TritanrixTM-HB)
2.
10,000
100 (
3,000 )
1
adjuvant (aluminum)
aluminum (antigen)
buffer stabilizer
(interferon)
2556
219

DTwP PRP-T HbOC
2,3 DTaP PRP-T
(anti-PRP) DTP anti-PRP
> 0.15 ./. 4
DTaP (DTaP-Hib) DTaP-Hib
97.5 1 99 3 5
IPV DTaP-Hib
HB DTaP IPV HB
6 DTaP-IPV-
Hib-HB 2 6 DTwP-HB
.. 2551
HA HB 7

MMR varicella MMRV
MMR
Pnc-Mnc, Pnc-Mnc-Hib
3.

MMRV 12-23
MMR 8
4.

4.1 PRP-T PRP-OMP
(primary series) PRP-T 3 PRP-OMP 2
PRP-T

4.2 DTaP
(acellular pertussis) DTaP
() 3 2, 4 6

( 18 4-6 )
DTwP DTaP
2556
220
4.3 IPV OPV IPV
DTaP Tdap
5.

DTwP-HB 2, 4, 6 HB 1
diphtheria tetanus toxoid
HB HB subunit vaccine
IPV

6.

1. -- (DTwP)
DTwP 9-1
--
9-1

DTwP- HB 0.5 ./ DTP-HBTM SII/Masu
10 /vial
DTwP- HB 0.5 ./ Tritanrix-HBTM GlaxoSmithKline Hiberix

DTwP-Hib (PRP-T) 0.5 ./ TETRAct-HIBTM sanofi-pasteur
DTwP- HB-Hib 0.5 ./ QuinvaxemTM Biogenetech
(CRM197)

DTwP 0.5 .
2, 4 6
DTwP-Hib 15-18
2556
221

(
)

DTwP DTwP

2,9 DTwP-HB 2, 4, 6
18 DTwP 4 10
60.9, 95.2, 100 78.3 10

+2 +8o

2. (DTaP, Tdap)

IPV,
HB Hib 9-2
9-2

DTaP-IPV 0.5 ./ Infanrix-IPVTM GlaxoSmithKline
DTaP-IPV 0.5 ./ TetraximTM sanofi-pasteur
Tdap-IPV 0.5 ./ Adacel PolioTM sanofi-pasteur
Tdap-IPV 0.5 ./ Boostrix PolioTM GlaxoSmithKline
DTaP-IPV-Hib (PRP-T) 0.5 ./ PediacelTM sanofi-pasteur
DTaP-IPV-Hib (PRP-T) 0.5 ./ PentaximTM sanofi-pasteur
DTaP-IPV-Hib (PRP-T) 0.5 ./ Infanrix-IPV/HibTM GlaxoSmithKline
DTaP-IPV-Hib-HB (PRP-T) 0.5 ./ Infanrix-HexaTM GlaxoSmithKline
2556
222

DTaP 0.5 .
DTaP-IPV, DTaP-IPV-Hib DtaP-IPV-Hib-HB 2, 4, 6

HB 18 4-6 Tdap-IPV
DTwP DTaP-IPV 5
(
)
DTaP DTaP
DTaP DTwP
IPV DTaP Tdap

11 HB Hib DTaP DTaP
HB Hib 2,6
DTaP-IPV-HB-Hib (PRP-T)
DTaP-IPV-HB Hib (PRP-T)
12
+2 +8o
9-3 DTwP DTaP 1

2 DTP, polio, Hib 1. TETRAct-HIBTM , OPV (+HB )
(+HB 1 ) 2. TritanrixTM-HB + HiberixTM, OPV
3. QuinvaxemTM, OPV
4. PEDIAcelTM (+HB )
5. PENTAXIMTM (+HB )
6. Infanrix-IPV/HibTM (+HB )
7. Infanrix HexaTM
2556
223

4 DTP, polio, Hib ( HB 1. TETRAct-HIBTM, OPV
) 2. TritanrixTM-HB + HiberixTM, OPV
3. QuinvaxemTM, OPV
4. PEDIAcel TM
5. PENTAXIMTM
6. Infanrix-IPV/HibTM
7. Infanrix-HexaTM
6 DTP, polio, Hib, HB 1. TETRAct-HIBTM, HB , OPV
2. TritanrixTM-HB + HiberixTM, OPV
3. QuinvaxemTM, OPV
4. PEDIAcelTM, HB
5. PENTAXIMTM, HB
6. Infanrix HexaTM

1. DTaP (PEDIAcelTM, PENTAXIMTM InfanrixTM) 3
acellular pertussis

2. HB2 1
HB 6 2 4
3. Hiberix Infanrix Tritanrix
3.

(HA-HB) TwinrixTM
1 720 EU
20

1 1 ./
9-4
9-4
(.)
1-15 1 2 0 6-12
> 16 1 3 0, 1 6
2556
224

1
HA-HB

HA-HB
HA-HB
HA-HB 0, 1 6
100 HA-HB
13
HA-HB 0, 7 21

99 HA-HB 82
84
HA-HB14 72
100 89
60 100 95
(HA-HB) 1 HA HB
HA 2 HB
2 HA-HB 2 HA 1 HB
1 HA-HB (720 EU)
HA (1440 EU) HA-HB 3
HA 1
HA-HB 2
+2 +8o 24
4. ---
-- (MMR)
-- (MMRV)
2556
225

MMRV 2 Priorix TetraTM
ProQuadTM
Priorix TetraTM 9-5 MMR (PriorixTM)
(varilrixTM) Priorix TetraTM mump

9-5 --- (Priorix TetraTM)

3
Measles Schwarz 10
CCID50
( PriorixTM)
4.4
Mumps Jeryl Lynn 10 CCID50
RIT 4385 ( PriorixTM
3.7
10 CCID50)
Rubella Wistar RA 27/3 103 CCID50
( PriorixTM)
3.3
Varicella zoster OKA 10 PFU
( VarilrixTM)

0.5 .
9 12
12-15 2 4-6

MMRV
MMRV 12-15
2 4-6 12-23
(febrile convulsion) --

4-6

1. neomycin
neomycin (contact dermatitis)
2. /
2556
226
3. 1
4. primary secondary
immunodeficiencies
5.
4 12

MMRV (Priorix-tetraTM)
--
( 1.5 ) ( 0.18%)15 MMRV
--
MMRV --
11 23 MMRV (Priorix-tetraTM)
2 6 2 96.4
99.1 91.3 98.8
99.7 99.9 97.2 99.8 15
+2 +8o
1. Offit PA, Quales J, Gerber MA. Addressing parents concerns: do multiple vaccines overwhelm
or weaken the infants immune system? Pediatrics 2002;109:124-9.
2. Lolekha S, Hiranchote A, Simasathien S. Safety and immunogenicity of combined or associated
administration of PRP-T vaccine with diphtheria, tetanus and pertussis vaccine in Thai
Children. J Trop Pediatr 2001;47:24-9.
3. Recommendations for use of Haemophilus b conjugate vaccines and a combined diphtheria,
tetanus, pertussis, and Haemophilus b vaccine. Recommendations of the advisory Committee
on Immunization Practices (ACIP). MMWR Recomm Rep. 1993;42(RR-13):1-15.
4. Granoff DM. Assessing efficacy of Haemophilus influenzae type b combination vaccines.
Clin Infect Dis. 2001;33(Suppl 4):S278-87.
2556
227
5. Schmitt HJ, von Kries R, Hassenpflug B. Haemophilus influenzae type b disease: impact and
effectiveness of diphtheria-tetanus toxoids-acellular pertussis (-inactivated poliovirus)/H. influenzae
type b combination vaccines. Pediatr Infect Dis J 2001;20:767-74.
6. Edwards KM, Decker MD. Combination vaccines. Infect Dis Clin North Am 2001; 15: 209-30.
7. Lee SD, Chan CY, Yu MI. A two-dose combined hepatitis A and B vaccine in Chinese
youngsters. J Med Virol 1999;59:1-4.
8. Jacobsen SJ, Ackerson BK, Sy LS, et al. Observational safety study of febrile convulsion
following first dose MMRV vaccination in a managed care setting. Vaccine. 2009;27:4656-61.
9. Poovorawan Y, Theamboonlers A, Sanpavat S, et al. Comparison study of combined DTPw-HB
vaccines and separate administration of DTPw and HB vaccines in Thai children. Asian Pac
J Allergy Immunol. 1999;17:113-20.
10. Poovorawan Y, Hutagalung Y, Chongsrisawat V, et al. Long-term antibody persistence in
children primed and boosted with a DTPw-HBV vaccine at 2, 4, 6, 18, months of age. Vaccine.
2008;26:1535-40.
11. Halperin SA, Davies HD, Barreto L, et al. Safety and immunogenicity of two inactivated poliovirus
vaccines in combination with an acellular pertussis vaccine and diphtheria and tetanus
toxoids in seventeen- to nineteen-month-old infants. J Pediatr. 1997;130:525-31.
12. Kosalaraksa P, Thisyakorn U, Benjaponpitak S, et al. Immunogenicity and safety study of a
new DTaP-IPV-Hep B-PRP-T combined vaccine compared to a licensed DTaP-IPV-Hep B//
PRP-T comparator, both concomitantly administered with a 7-valent pneumococcal conjugate
vaccine at 2, 4, and 6 months of age in Thai infants. Int J Infect Dis. 2011;15(4):e249-56.
13. Joines RW, Blatter M, Abraham B, et al. A prospective, randomized, comparative US trial
of a combination hepatitis A and B vaccine (Twinrix) with corresponding monovalent vaccines
(Havrix and Engerix-B) in adults. Vaccine. 2001;19:4710-9.
14. Van Damme P, Leroux-Roels G, Law B, et al. Long-term persistence of antibodies induced
by vaccination and safety follow-up, with the first combined vaccine against hepatitis A
and B in children and adults. J Med Virol. 2001;65:6-13.
15. Czajka H, Schuster V, Zepp F, et al. A combined measles, mumps, rubella and varicella
vaccine (Priorix-Tetra): immunogenicity and safety profile. Vaccine. 2009;27:6504-11.
2556
228

10

(primary congenital immunodeficiency diseases) x-linked agammaglobulinemia, chronic
granulomatous disease
(secondary immunodeficiency disease)

(inactivated vaccines)

(live attenuated vaccine) 1, 2
10-1
10-2

10-3 10-4 10-5
10-6 10-7
10-8
1,2
1.

, ,
2556
229

2. BCG, OPV, MMR, Varicella, MMRV, live JEV,
Rota virus, live attenuated influenza vaccine (LAIV), Zoster, yellow fever, Ty21a typhoid vaccine
( 10-8)
- BCG
3
- OPV Measles MMR

MMR/measles VAR CD4 15
(clinical category C)
-

3.

(cocooning strategy)

-
- MMR, varicella rotavirus vaccine

rotavirus vaccine
- OPV Small pox vaccine

4. passive immunization immune globulin

4 (TIG), (HBIG),
(immune globulin) VZIG IVIG
5. Streptococcus pneumoniae Haemophilus influenzae
type b PCV Hib 2 PCV 2
PCV PPSV23) ( 10-3 10-4) MCV4
meningococcus
2556
230
14

1
6.
2 ././ 20 ./
10 . 14

10-21, 2

(replacement therapy) physiologic maintenance
7.

14 14
3

(Inactivated Influenza vaccine)
2
3-4
neutrophil lymphocyte 1000 cells/mL5
8.
3-6
2 3 (remission)
1 lymphocyte > 700/mL > 100,000/mL2, 6

Esposito 6
10-5
9. (inactivated
vaccine) 6
24 1, 2, 7, 8 ( 10-6)
10. Graft versus host disease (GVHD)
6
GVHD
GVHD9
GVHD 12 5
11. (Solid organ transplantation)

2556
231
6 graft dysfunction rejection
6
5,10

6
12-15

10
12. (Rheumatic disease)

. 2554 the European Leaque Against Rheumatism (EULAR)
11,12
- disease modifying
antirheumatic drugs (DMARD) biological agents tumor necrosis
factor antagonist ( adalimumab, infliximab etanercept) anti-B-lymphocyte monoclonal
antibody ( rituximab)
a. Methotrexate 15 .//
b. Cyclosporine 2.5 ././
c. Sulphasalazine 40 ././ 2
d. Azathioprine 1-3 ././
e. Cyclophosphamide 0.5-2.0 ././
f. Leflunamide 0.25-0.5 ././
g. 6-mercaptopurine 1.5 ././
h. Prednisolone > 2 ././ ( > 20 ./)

- VZV 2-4

- TNFa blocking agents
BCG 4
- BCG Kawasaki BCG
37-50
-
Hib, Pneumococcal vaccine (PCV PPSV23) Influenza vaccine

- Rituximab 6
Pneumococcal vaccine (PCV PPSV23) influenza
Rituximab
2556
232
-
10-1 2

B-lymphocyte BCG, OPV, Pneumococ-
(humoral) ( x-linked live typhoid cal vaccine
agammaglobulinemia vaccine, yellow (
common variable fever vaccine, measles/ MMR IVIG
immunodeficiency) smallpox varicella
live-attenuated vaccine)
influenza
( vaccine Pneumococcal measles
selective IgA deficiency OPV, BCG vaccine vricella vaccine
IgG subclass yellow fever
deficiency) vaccine

T-lymphocyte Pneumococcal
(cell-mediated and ( severe vaccine
humoral) combined immune
deficiency complete
DiGeorge syndrome) Pneumococcal
vaccine
(
DiGeorge syndrome
Wiskott-
Aldrich syndrome,
ataxia-telangiextasia)
2556
233

Complement Chronic granuloma- Pneumococcal
tous disease, leukocyte * vaccine
adhesion deficit
myeloperoxidas
deficiency

* (live attenuated bacterial vaccine) BCG Ty21 a typhoid vaccine
10-2
2
prednisolone

(topical therapy)
(inhaled therapy)
(local injection)

(physiologic maintenance)
< 2 ././ < 20 ./
(low or moderate doses) ( 10 .)
> 2 ././ >20 ./
14 (High dose, ( 10 .)
< 14 ) 2
> 2 ././ >20 ./ 1
14 (High dose, ( 10 .)
> 14 )

1.

2. immunosuppression
1 2
2556
234
10-3
1,2

2-6 3 PCV13 2 1 12-15
7-11 2 PCV13 2 1 12-15
( PCV13 2 2 )
12-23 2 PCV13 2
24-71 PCV 2 PCV13 8
PPSV23 PPSV23 1 PCV13 8
PPSV23 1 5 PPSV23
PCV 1-3 1 PCV13
PPSV23 1 PCV13 8 PPSV23
1 5 PPSV23
* < 2 PCV13 24-71 PCV

PCV13 2 8 6-18 PCV13 1 PCV7
PPSV23 13,14
10-4
2

2-6 3 2 12-15
7-12 2 2 12-15 2
2
12-14 2 2
15-59 1
> 5 * 1 Hib vaccine
* Hib vaccine Hib

vaccine 1 Hib vaccine 2, 15
2556
235
10-5 6

MMR 2 3 1
3-6
3-6
VZV 2 3 1
(remission) (remission) 1
1 lymphocyte > lymphocyte > 700/mL
700/mL > 100,000/mL; > 100,000/mL;
mainte- maintenance
nance 1
1
RV
OPV
IPV IPV
DTP, DTaP-IPV, < 7 primary series 1
Tdap-IPV (3 1 ) 3
2 6
3
> 7 primary series
(0, 1, 6 )
3 Tdap
dT 2
3
Hib primary series 1
3 3
Pneumococcal primary series PCV PCV 1
vaccine (PCV PPSV23 8 3
PPSV23) > 2
3
Inactivated influ- 2 1 1
enza vaccine < 9
1
2556
236

HAV 2 6 1

HBV 3 (0, 1, 6 ) 2
3
Inactivated JEV 3 (0, 1, 12 )
3 Live JEV
10-6 7, 8

Pneumococcal 3-6 3-4 PCV13 0, 2, 4 PPSV23
vaccine1 8 PCV 3
Diphtheria, 6-12 3 < 7 DTP/DTaP
tetanus 0, 2, 12
Pertussis2 > 7 DTaP 0, 2, 12
Hib3 6-12 3 0, 2, 12
IPV 6-12 3 0, 2, 12
HBV4 6-12 3 0, 2, 12
Inactivated influ- 4-6 1-2
enza vaccine5
MMR6 24 1-2 0, 1
HAV 2 2 0, 6-12
Inactivated JEV 12 3 0, 1-2, 12
Varicella 24
vaccine7
BCG
OPV
Rotavirus vaccine

1
PCV 3 3-6 8 (
4 ) PPSV23 1 8 PCV 3
GVHD PCV 4 PPSV23
2556
237
2

DTaP DTP 3 > 7 DTaP
Tdap
autologous allogenic Tdap
3
Hib 3 1 6
4
(Anti-HBS Antibody) 1 HBV 3
HBV 3
5
(inactivated influenza vaccine) 6

4 6
2 6 9
2 1
6
MMR 2 1
7
Varicella vaccine
24
2556
238
10-7 (Solid Organ Transplantation; SOT candidates
and recipients)16

SOT
SOT
6 1 2 4
(DTP/DTaP)1 2 3 4
3 4 6
4 5 6
(HAV)2 6 1 2 4
(HBV) 1 2 4
2556
2 3 8
(Hib) 6 1 2 4
2 3 4
3 4 8
(Influenza)3 6 1 2 4
6 1 2 4
(PCV13)4 2 3 4
3 4 8
(PPSV23) 2 -
(IPV)5 6 1 2 4
2 3 4
3 4 6
239
240

SOT
SOT
(BCG) -
2556
(MMR) 6 1 2 4
(VZV) 6 1 2 4
1
Td 10
2

6
3
9 2
4 1
4
PCV PPSV23 1 2 PCV 8
PPSV23 1 5 PPSV23
5
OPV 1
10-8 2557

1 2 4 6 9 12 18 2 2 1/2 4-6 11-12

1 BCG
2 HBV1 HBV2 DTwP-HBV1 DTwP-HBV2 DTwP-HBV3
--3 DTwP 1 DTwP dT

2
4 OPV1 OPV2 OPV3 OPV OPV
or IPV1 or IPV2 or IPV3 or IPV 1 or IPV 2
--5 MMR1 MMR2
6
JE1, JE2 1 JE3
2556

1 2 4 6 9 12 18 2-2 1/2 4-6 11-12

-- DTaP1 DTaP2 DTaP3 DTwP 1 DTwP Tdap
( 4 DTaP, 7 ; Tdap)3 2
6 JE4 (4-5
JE3)
7 (Hib: PRP-T, PRP-OMP) Hib1 Hib2 Hib3 Hib4
8 (HAV) HAV1, HAV2 6-12

9
(VZV) VZV1 VZV2
10 (Influenza) 6
11 PCV1 PCV2 PCV3 PCV4
(PCV PPSV23) 12-15 PPSV23 2 5
12(HPV) HPV 3
9-26
(Rota)13 Rota1 Rota2 (Rota3)
pentavalent
241

10-8.1 Hib

PRP-T
2 - 6 0, 2, 4, Booster
7 - 11 0, 2, Booster
> 12 - 59
Booster 12-18 2
10-8.2 PCV

2 - 6 3 6-8 12-15
7 - 11 2 6-8 12-15
12 - 23 2 6-8
24 - 59
- 1
- 2 6-8
1. BCG
BCG
BCG BCG
2. DTP-HBV
2, 4, 6
3. DTwP DTaP (Tdap) 7 1
4. IPV OPV IPV

5. --
(clinical stage C CD4
15) CD4 15
- 9-12 2 4-6
( 9 ) 1
( 12 ) 1
- 2 2 1/2
- 4
3
- --- (MMRV)

2556
242
6. 3 1 0, 1 , 1
1 3 4-5 (
6 CD4 > 15%
2 3-12 )
7. 2 1
12-18 2
Hib
8. 1 2 6-12
9. 1 CD4 15 2
1 2 4-6 2 4
3
10.
9 2 1
3 (0.25 .)
11. (PCV) 2 3 2
12-15 PCV
PPSV23 2 PCV 2
PPSV23 1 5 14-59
PCV7 4 PCV13 1 PCV7
8 6-18
PCV13 1 PCV7 PPSV23
12. 3 0, 1-2, 6 9 26
11-12

13. 2, 4 ( 6 pentavalent vaccine)

(revaccination)
CD4 15

CD4 (immune recovery) 25 350 /..
(>5 ) 6 CD4 15 viral load 50 copies/ml
1 CD4 15
2556
243
10-8.3 CD4 < 15%
1 2 6

HBV vaccine1 HBV1 HBV2 HBV3 3
2
JE vaccine () JE1 JE2 2
3
Measles vaccine MMR1 1
dT vaccine
10
7 4

1. 1
3 ()
CD4 15%
1 antiHBsAb > 10 mIU/ml 2 anti-HBsAb

anti-HBs Ab < 10 mIU/mL 3 (
)
anti-HBs Ab 10-100 mIU/mL 1
CD4
anti-HBs Ab 100 mIU/mL
2. 2
1 CD4 6
1
3. -- 1 CD4
6 MMR
4. -- (DTwP, DTaP Tdap) <7 DTwP
DTaP 7 dT Tdap

1. CDC. General recommendations on immunization --- recommendations of the Advisory Committee
on Immunization Practices (ACIP). MMWR Recomm Rep 2011;60(2):1-64.
2. American Academy of Pediatrics. Immunization in special clinical circumstances. In: Pickering LK, Baker CJ,
3. WHO. Revised BCG vaccination guidelines for infants at risk for HIV infection. Wkly Epidemiol
Rec 2007;82(21):193-6.
2556
244
4. CDC. Recommendations of the Advisory Committee on Immunization Practices (ACIP): use
of vaccines and immune globulins for persons with altered immunocompetence. MMWR
Recomm Rep 1993;42(RR-4):1-18.
5. Abzug MJ. Vaccination in the immunocompromised child: a probe of immune reconstitution.
Pediatr Infect Dis J 2009;28(3):233-6.
6. Esposito S, Cecinati V, Brescia L, Principi N. Vaccinations in children with cancer. Vaccine
2010;28(19):3278-84.
7. CDC. Guidelines for preventing opportunistic infections among hematopoietic stem cell
transplant recipients. MMWR Recomm Rep 2000;49(RR-10):1-125, CE1-7.
8. Tomblyn M, Chiller T, Einsele H, et al. Guidelines for preventing infectious complications
among hematopoietic cell transplant recipients: a global perspective. Preface. Bone Marrow
Transplant 2009;44(8):453-5.
9. Ljungman P, Engelhard D, de la Camara R, et al. Vaccination of stem cell transplant recipients:
recommendations of the Infectious Diseases Working Party of the EBMT. Bone Marrow
Transplant 2005;35(8):737-46.
10. Guidelines for vaccination of solid organ transplant candidates and recipients. Am J Transplant
2004;4 Suppl 10:160-3.
11. Heijstek MW, Ott de Bruin LM, Bijl M, et al. EULAR recommendations for vaccination in
paediatric patients with rheumatic diseases. Ann Rheum Dis 2011;70(10):1704-12.
12. Heijstek MW, Ott de Bruin LM, Borrow R, et al. Vaccination in paediatric patients with
auto-immune rheumatic diseases: a systemic literature review for the European League
against Rheumatism evidence-based recommendations. Autoimmun Rev 2011;11(2):112-22.
13. Nuorti JP, Whitney CG. Prevention of pneumococcal disease among infants and children - use
of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide
vaccine - recommendations of the Advisory Committee on Immunization Practices (ACIP).
14. CDC. Licensure of a 13-valent pneumococcal conjugate vaccine (PCV13) and recommendations
for use among children - Advisory Committee on Immunization Practices (ACIP), 2010.MMWR
2010;59(9):258-61.
15. CDC. Haemophilus b conjugate vaccines for prevention of Haemophilus influenzae type b
disease among infants and children two months of age and older. Recommendations of the
immunization practices advisory committee (ACIP). MMWR Recomm Rep 1991;40(RR-1):1-7.
16. Campbell AL, Herold BC. Immunization of pediatric solid-organ transplantation candidates:
immunizations in transplant candidates. Pediatr Transplant 2005;9(5):652-61.
2556
245

11
4-6

1,2
3
1.
2. (Selective use for travellers to
destinations of particular risks)

3. (Required vaccine)

2

2556
247

9
9 6-8

6 2

(
)

, toxoids, polysaccharide IPV
MMR, BCG, Varicella,
,

2
2556
248

Tdap, IPV HB

Pnc

MMR, OPV, BCG, Varicella, ()

/

Pnc
Hib, Mnc Pnc

Pnc :
- MMR ( HIV
CD 4 < 200 /.3 < 15% ) 2
- BCG ( BCG
)
- CD4 200 /.3
CD4 200-499 /.3
1,2
1. 3 ()
1.1 (BCG)
BCG
BCG 1 BCG

4 BCG
1.2 -- (DTP)
DTP

2556
249

DTP 7
DTwP DTaP 7
3 0, 1, 6 dT 10 Tdap
Tdap-IPV dT
1.3 (HB)

/

HB 3

3 0, 1, 6
0, 7 21 3 3
4 1 2

1.4 -- (MMR)

MMR 2
9-12 4-6 2 21/2
() MMR 2
4

1.5 (OPV, IPV)

1,2

OPV
OPV
1 OPV IPV
2556
250
IPV OPV
Tdap-IPV --
IPV
1.6 (JE)

Culex

JE
JE

Inactivated mouse brain JE vaccine 3 0, 7, 28
CD-JE VaxTM 1
1
(IxiaroTM)
2.

2.1 (Hib)
Hib 5
2-5
2 5

5
1-3 2 ( Hib)
2.2

(killed) 2
1-6 1
Enterotoxigenic Escherichia coli (ETEC)
2556
251
(travellers diarrhoea)

2.3

65
(COPD)

2

2.4 (HA)

40-50
4

HA 1 2 6-12
anti-HAV

2.5 (Pnc)
S. pneumoniae Pnc
sickle cell

(PCV) 2 5
2 6 1-4
PCV 50 23-valent polysaccharide (PPSV23)
2 2
(re-vaccination) 5
>65 65
2556
252
2.6

backpacker
(Pre-exposure
prophylaxis) 3 0, 7, 21-28
2 Rabies Immunoglobulin

2.7

60-70
(Vi capsular polysaccharide)
3 (Ty21a)

2.8

Meningitis belt 1,2 5 A, B, C, Y, W135

- Meningitis belt

2556
253
4
(A, C, Y, W135) 2 3-5
3.
2

3.1

9
10 5

1
10
6
CD4
200 /.3 6-9

45

6,7
1. (BOLIVIA) 2. (ECUADOR)
3. (PANAMA) 4. (VENEZUELA)
5. (BRAZIL) 6. (FRENCH-GUIANA)
7. (PERU) 8. (COLOMBIA)
9. (GUYANA) 10. (SURINAME)
11. (ANGOLA) 12. (BURUNDI)
13. (CHAD)
14. (EQUATORIAL GUINEA)
15. (GAMBIA) 16. (GUINEA-BISSAU)
17. (MALI) 18. (NIGERIA)
19. (ZENEGAL) 20. (SUDAN)
21. (UNITED REPUBLIC OF TANZANIA)
22. (BENIN) 23. (CAMEROON)
24. (REPUBLIC OF THE CONGO) 25. (ETHIOPIA)
26. (GHANA) 27. (KENYA)
28. (MAURITANIA) 29. (RWANDA)
2556
254
30. (SIERRA LEONE)
31. (TOGO) 32. (BURKINA FASO)
33. (CENTRAL AFRICAN REPUBLIC)
34. (COTE DIVOIRE) 35. (GABON)
36. (GUINEA) 37. (LEBERIA)
38. (NIGER) 39. (SAO TOME & PRINCIPE)
40. (SOMALI) 41. (UGANDA)
42. (DEMOCRATIC REPUBLIC OF CONGO)
43. (TRINIDAD AND TOBAGO)
44. (PARAGUAY)
45. (ARGENTINA)

US CDC Health Information for International
Travel (CDC Yellow book)2 WHO International travel and Health
(WHO Green book)1

()
3.2
meningococcal meningitis

5 (International certificate of vaccination)

Lot number

2556
255

1. World Health Organization. International travel and health 2011. WHO Press, Geneva, Swtizerland
2011. Available at http://www.who.int/ith.
2. Center of Diseases Prevention and Control. Health Information for International Travel 2012.
US Department of Health and Human Services, Public Health Service, Atlanta 2011. Available
at http://www.cdc.gov/travel.
3. . 2012-2013
. . 2554.
4. . , ,
, , , . Travel and adult immunization.
: 2552. . 91-99.
5. World Health Organization. International health regulation 2005. WHO Press, Geneva, Switzerland.
2005. Available online at http://www.who.int/ihr/en/.
6. .
http://thaigcd.
ddc.moph.go.th/laws/view/12.
7. .
2 http://
www.ddc.moph.go.th/law/showimg5.php?id=139.
2556
256

11.1
(Typhoid Vaccine)

Salmonella typhi

3 - 4

S. typhi

1-3
.. 2554 3,887
69 6.12
35-44 15.05 45-54 13.61
25-34 12.61 98.8 0.6 0.5
5 53.34, 28.97,
28.61, 25.97, 23.47
2
1. (Vi capsular polysaccharide typhoid vaccine, ViCPS) Typhim
TM
Vi Sanofi Pasteur purified Vi (Virulence) antigen
capsule S. typhi Ty2 phenol 0.25%
2. (Oral typhoid vaccine : Ty21a) Vivotif BernaTM
Swiss Serum and Vaccine Institute S. typhi Ty21a
(live attenuated vaccine) 2 (enteric-coated
capsule)
2556
257

0.5 . S. typhi 25 .

- 1 S. typhi Ty21a > 109
sucrose, ascorbic acid, amino acid mixture, lactose, magnesium stearate

- S. typhi > 2x109 sucrose, lactose, aspertane,
ascorbic acid, Hy-Case SF 2 2
buffer

(primary series) 2 0.5 .
2
2 2

- 1 1
4 ( 1, 3, 5 7) 1
< 37o () 6
5
- 1 1 1 4
( 1, 3, 5 7) < 37o 10 .
() 5-10
2 5

7
1.5-3 0-14 48

4.5/100,000
5
2556
258

9.7/100,000
5

4 cotrimoxazole, ampicillin,
chloramphenicol 24
mefloquine chloroquine6 3
proguanil hydrochloride
10 7 7

8
1
9 Ty21a 1
5
61-938-11
7-10 Salmonella
12
42-9613,14
herd immunity paratyphoid B
4915 2 3
12 5

+2 +8o
+2 +8o
2556
259

1. . . 10 2544
(FETP). . Available at: http://epid.moph.go.th/epi32.
2. , , , .

2540 - 2541. 2543;31,5: 146-52.
3. , .
. 2544;84:1513-7.
4. American Academy of Pediatrics. Salmonella infections. In: Pickering LK, Baker CJ, Kimberlin
DW Long SS eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Glove
Village, IL: American Academy of Pediatrics; 2012: 635 - 641.
5. Begier EM, Burwen DR, Haber P, Ball R. Post-marketing safety surveillance for typhoid fever
vaccines from the vaccine adverse event reporting system, July 1990 through June 2002.
Clin Infect Dis. 2004;38:771-9.
6. Recommendations of the Advisory Committee on Immunization Practices (ACIP) and the
American Academy of Family Physicians (AAFP) : General Recommendations on Immunization.
MMWR 2002; 51(RR02):1-36.
7. Kollaritsch H, Que JU, Kunz C , Wiedermann G, Herzog C, Cryz SJ Jr. Safety and immu
nogenicity of live oral cholera and typhoid vaccines administered alone or in combination
with anti-malarial drugs, oral polio vaccine or yellow fever vaccine. J Infect Dis. 1997;175:871-5.
8. Keitel WA, Bond Nl, Zahradnik JM, Cramton TA, Robbins JB. Clinical and serological responses
following primary and booster immunization with Salmonella typhi Vi capsular polysaccharide
vaccines. Vaccine. 1994;12:195-9.
9. Acharya IL, Lowe CU, Thapa R, et al. Prevention of typhoid fever in Nepal with the Vi
capsular polysaccharide of Salmonella typhi. N Engl J Med. 1987;317:1101-4.
10. Sur D, Ochiai RL, Bhattacharya SK, et al. A cluster-randomized effectiveness trial of Vi typhoid
vaccine in India. N Engl J Med. 2009;361:335-44.
11. DeRoeck D, Ochiai RL, Yang J, Anh DD, Alag V, Clemens JD. Typhoid vaccination: the
Asian experience. Expert Rev Vaccines. 2008;7:547-60.
12. Recommendations of the Advisory Committee on Immunization Practices (ACIP): Typhoid
Immunization. MMWR 1994;43(RR14):1-7.
13. Levine MM, Ferreccio C, Black RE, Germanier R. Laege-scale field trial of Ty21a live oral
typhoid vaccine in enteric-coated capsule formulation. Lancet. 1987;1:1049-52.
14. Simanjuntak CH, Paleologo FP, Punjabi NH, et al. Oral immunization against typhoid fever
in Indonesia with Ty21a vaccine. Lancet. 1991;338:1055-9.
15. Levine MM, Ferreccio C, Black RE, Lagos R, San Martin O, Blackwelder WC. Ty21a live
oraltyphoid vaccine and prevention of paratyphoid fever caused by Salmonella enteric Serovar
Paratyphi B. Clin Infect Dis. 2007;45:S24-8.
2556
260

11.2
(Yellow Fever Vaccine)

(Yellow fever virus) arbovirus
(Aedes aegypti)

2
15 2-3
10-14

.. 2523
60 2

Aedes aegypti
.. 2554 .. 2555
5
23 7 1
2556
261

10 10 2

17D
(freeze-dried)

0.5 . 17D 1,000
mouse LD50

1 (0.5 .)

(subcutaneous) 0.5 .

9

(lot number)

2

(transit passenger)
3
6-9

6
CD4 200 .. 15
3
2556
262
3-5

2-5 5-10

25

1. (Immediate hypersensitivity reactions)
1.8 100,000
2. (Yellow fever vaccine-associated neurologic disease)
Guillain-Barre 3-28 0.8 100,000
60
3. (Yellow fever vaccine-associated viscerotropic disease)

0.4 100,000 3, 6

7

8-11
95 1
30-35
10
(enhancement)

--
12
4 (Oral Ty21a)
3 13

14 chloroquin

15
2556
263

+2 +8 o

1. WHO. Global Alert and Response, Yellow Fever. http://www.who.int/csr/don/archive/disease/
yellow_fever/en/index.html.
2. MOPH.
( 2). http://www.ddc.moph.go.th/law/showimg5.php?id=139.
3. Gershman M, Staples JE. Yellow Fever. In: Center for Disease Control and Prevention. CDC
Health Information for International Travel 2012. New York: Oxford University Press; 2012:
332-45.
4. Monath TP. Yellow Fever. In: Plotkin SA, Orenstein WA, eds. Vaccines. Philadelphia: WB
Saunders. 3rd ed. 1999: 81580.
5. Jong EC. Immunization for Travelers. In; Jong EC, McMullen R, eds. The Travel and Tropical
Medicine Manual. 3rd ed. Philadelphia: Saunders; 2003: 379.
6. Whittembury A, Ramirez G, Hernndez H, et al. Viscerotropic disease following yellow fever
vaccination in Peru. Vaccine 2009; 27: 5974-81.
7. Kuhn S, Twele-Montecinos L, MacDonald J, Webster P, Law B. Case report: probable transmission
of vaccine strain of yellow fever virus to an infant via breast milk. CMAJ 2011; 183: E243-5.
8. World Health Organization. Yellow fever fact sheet. Wkly Epidemiol Rec 2010; 85: 33-6.
9. Staples JE, Monath TP. Yellow fever: 100 years of discovery. JAMA 2008; 300: 960-2.
10. Poland JD, Calisher CH, Monath TP, Downs WG, Murphy K. Persistence of neutralizing
antibody 30-35 years after immunization with 17D yellow fever vaccine. Bull WHO 1981; 59:
895-900.
11. Rosenzweig EC, Babione RW, Wisseman CL Jr. Immunological studies with group B arthropod-
borne viruses. IV. Persistence of yellow fever antibodies following vaccination with 17D strain
yellow fever vaccine. Am J Trop Med Hyg 1963; 12: 230-5.
12. Tauraso NM, Myers MG, Nau EV, et al. Effect of interval between inoculation of five smallpox
and yellow fever vaccines on antigenicity in man. J Infect Dis 1972; 126: 362-71.
13. Yvonnet B, Coursaget P, Deuel V, et al. Simultaneous administration of hepatitis B and yellow
fever vaccines. J Med Virol 1986; 19: 307-11.
14. Kaplan JE, Nelson DB, Schonberger LB, et al. The effect of immune globulin on trivalent
oral polio and yellow fever vaccinations. Bull WHO 1998; 62: 585-90.
15. Tsai TF, Bolin RA, Lazuick JS, et al. Chloroquine does not adversely affect the antibody
response to yellow fever vaccine. J Infect Dis 1986; 154: 726-7.
2556
264

11.3
(Cholera Vaccine)

(cholera) Vibrio cholerae
toxigenic 01 2 Inaba Ogawa
2 biotype El Tor Classical .. 2360
.. 2535
toxigenic 0139
01 0139 nontoxigenic 01
() 1
5
4-12 .

1

.. 1890

.. 2460
.. 2460 6
1 .. 2461-2463 19,413 13,918 71.69

2 .. 2468-2472 21,591 14,902 69.02
3 .. 2478-2480 15,557 10,005 64.31
4 .. 2486-2490 19,169 13,036 68.01
5 .. 2501-2502 19,359 2,372 12.25
6 .. 2506-2507 3,168 189 5.97
2556
265
1 5 Vibrio cholerae Classical cholera
6 Vibrio cholerae El Tor biotype

.. 2553

1,597 45.6 41.5 12.6

.. 2502

2
1. Monovalent oral vaccine
cholerae toxin B subunit DukoralTM Crucell
2. Bivalent oral vaccine Shantha Biotechnics
whole cells V. cholerae O1 V. cholera O1392 ShancholTM
Shantha

1. Monovalent oral vaccine 1 V. cholerae O1 (Inaba Ogawa,
classical El Tor) 1 cholerae toxin B subunit 1 .
1 5.6
2. Bivalent oral vaccine 1 Vibrio cholerae O1 (Inaba
Ogawa classical El Tor) O139 2,100 EU of LPS (ELISA
units of Lipopolysaccharide)3,4

1. Monovalent oral vaccine 1 3 . (vial)

2. Bivalent oral vaccine Shantha Biotechnics
1.5 . (vial)

1. Monovalent oral vaccine 1 (3 .) 150 1 6
2 1 ( 6 ) 1 2-3
25 75 3 1 6
2
1

2556
266
2. Bivalent oral vaccine (suspension)
2 14 1
Monovalent oral vaccine 7

2 86 3 50-60
3 Enterotoxigenic E. coli (ETEC) 67 2
Bivalent oral vaccine 7 10
3 2 675,6
3-5 503
2
2

2 +2 +8o
Monovalent oral vaccine 2
2556
267

1. American Academy of Pediatrics. Vibrio Infections. In: Pickering LK, Baker CJ, Kimberlin DW
Long SS eds. Red Book: 2012 Report of the Committee on Infectious Diseases. Elk Glove
Village, IL: American Academy of Pediatrics; 2012: 789 - 792.
2. WHO Weekly Epidemiological Record No.16, 20 April 2001.
3. WHO. Cholera Vaccines: WHO Position Paper. Geneva: World Health Organization; 26 March 2010.
4. shanchol .
5. Dipika Sur, Anna Lena Lopez, Suman Kanungo, et al. El Efficacy and safety of a modi ed
killed-whole-cell oral cholera vaccine in India: an interim analysis of a cluster-randomised,
double-blind, placebo-controlled trial. Lancet 2009; 374: 1694702.
6. John Clemens (2012). Killed oral cholera vaccines: from concept to public health reality (sound
recording of Plenary Lecture in 15th.Congress on Infecious Diseases) Bangkok, Thailand.
2556
268

12

(Adult Immunization)

(Tetanus vaccine)
(Diphtheria vaccine)
(Pertussis vaccine)
Streptococcus pneumoniae (Pneumococcal vaccine)
(Influenza vaccine)
(Rabies vaccine)
(Measles-mumps-rubella vaccine)
(Varicella vaccine)
2556
269
(Meningococcal vaccine)
(Hepatitis A vaccine)
(Hepatitis B vaccine)
(Typhoid vaccine)
JE (Japanese encephalitis vaccine)
(Human Papillomavirus vaccine)
12-1
12-2
12-1.
.. 2555

1
19 26 27 64 > 65
-- TT dT 10 dT TT 8
(TT Td Tdap)2 Tdap dT TT 1 3
2 ()4
-- 1-2 5
3 ()6

3 ()7
8 1 9 1
10 2 ()
11 3 ()
1 ( 1 )12 1
1 ( > 50 )13
14
1 ( > 60 )15
()
2556
270
12-2.
.. 2555

1
(CD4+ > 200 /uL)
-- TT Td 1-2 TT dT 10
16 TT Td
(TT Td 10
Tdap)2 Tdap 1 ( Tdap dT TT 1 3
/ Tdap
3 1 )3
2
( CD4 >500
)
-- 1 5

1
1 9
2 3

3 ()11
1 12 1 ( 1 12
12
1 )
1 ( 1 ( 1 ( > 50 )13
13 13
> 50 ) > 50 )

15

()
12.1-12.2
1.

(live-attenuated vaccine)

3 (
)
1
2.

88-98
15-30 (
)
2556
271
tetanus toxoids (TT)
10
10
Td (tetanus diphtheria toxoid) TT Td TT
Td TT

3.

diphtheria-tetanus-acellular pertussis vaccine (Tdap)
Tdap 1 Td TT
Tdap Td 1

1 Tdap
Td TT Tdap
(cocoon immunization)
Tdap 1 20 Td TT Tdap

4.

13 2
4
1-4

5.

- (MMR)
1 1 4
2556
272

1
- (MMR) 1 1 4

6. 2 4 (quadrivalent)
6, 11, 16 18 amorphous aluminium hydroxyphosphate sulfate
( HPV 16, 18) ( HPV 6, 11)
1 0, 2, 6 2 (bivalent) 16 18
ASO4 ( aluminium hydroxide 3-deacylated monophosphoryl lipid A)
( HPV 16, 18) 1 0, 1, 6
2 5-8.5
HPV HPV
(persistent infection) 90-96
HPV ( 31, 33, 45, 52 58)
2 HPV
persistent infection
3 (precancerous lesions CIN2, CIN3
adenocarcinoma in situ) HPV 16 / 18 98
2 HPV 31, 33, 45, 52
58
9-26
11-15
2 16-26
3

(safe sex)

HPV 16 HPV 18 70
Pap smear
7. 4 (quadrivalent) 19-26
(anal cancer)

26 4 (quadrivalent)
2556
273
2 (bivalent) (
HPV 16 HPV 18
)
8. inactivated influenza vaccine split virion vaccine
subunit vaccine
(seasonal
influenza) inactivate
influenza vaccine (intradermal
route)

GuillainBarre syndrome
pneumococcal vaccine
9.
65
(COPD)

2 3 ()
(
)

10.

2 6-12
3 (0, 1 6 )
anti HAV
11.
hemophilia, thalassemia

3 0, 1
6 antiHBs
1
2556
274
(non-responder) .. 2535
1
antiHBs 2-4 10 IU/ml

12. 23-valent pneumococcal polysaccharide vaccine
65
( invasive pneumococcal infections pneumococcal bacteremia
non-bacteremic pneumococcal pneumonia
S. pneumoniae non-vaccine serotypes ), 2 - 65
(asplenia), cardiomyopathy,
(COPD),
1
(re-vaccination) 5
65 65

( 30-50)

13. 13-valent conjugate pneumococcal vaccine
pneumococcal pneumonia invasive pneumococcal infections
50
1
14. Neisseria meningitidis

meningitis belt (http://www.path.org/menafrivac/meningitis-belt.php)
Neisseria meningitidis

70 meningococcal serogroup B
4 A, C, Y W-135
2 meningococcal polysaccharide vaccine (MPSV4)
1 2 10
3-5 meningococcal conjugate vaccine (MCV4)
1 booster effect

10 2 (yellow book)
(meningitis belt)
( )
(anatomic or functional asplenia) (re-vaccination)
2556
275
meningococcal polysaccharide vaccine
3-5 meningococcal conjugate vaccine meningococcal conjugate
vaccine 5
15. 50
post-herpetic neuralgia (PHN) 10 - 15
PNH
1 51.3
3 60 69
PHN 66.5

69

16. 3 0, 1
6 ( 2 3) 1 2
6 ( 2 3) 2 1
3 10 1 10
( CDC 2013 Tdap 1 27-36
dT Tdap )
(Tetanus vaccine)

3
10
3
1
30-60
10

.. 2541-25422 88-98
anti-tetanus toxin antibody > 0.15 IU/ml
15-30 3
tetanus-diphtheria toxoids (dT) TT

10 3 (primary immunization)
3 0, 4 6-12 12-3 (
) TT dT 1
81-94
2556
276

1 4 1
tetanus immune globulin (TIG) TIG

> 3 TIG
TIG 12-3
12-3 ** 4
5 7
(completed primary immunization) ()
- dT* 1 11-12 dT* 10
( Tdap 1 )

()
- dT* 2 4 1 6-12
( Tdap 1 )
- dT* 3 10

/
- (clean wounds) 3 *
dT* 2 4 1 6
- (contaminated wounds) 3 *
dT* 1 TIG 250
2 4 1 6
( tetanus toxoid >3 )
- (clean wounds) ** dT* 1
10
- (contaminated wounds) ** dT*
1 5
** Tdap dT 1
5 TT dT TT
dT
10 1
Td Tdap 3 Td
0, 1 6 Tdap 1 5
2556
277
(Diphtheria vaccine)

(epidemic)
4 100,000 < 0.1 100,000
5-14 15 ( 21.7
.. 2533-2542) 6 .. 2533-2537
10-100
40-49

3 92
72

7,8
( 20-60
susceptibility )9
.. 2537
17 5-14 15
15 > 3 10

2555
2
( 100 anti-diphtheria toxin antibody > 0.01 IU/ml) 85
(anti-diphtheria toxin antibody > 0.1 IU/ml)

dT TT dT
TT 10
1
81-90 11
(Pertussis vaccine)
--

5-10

.. 2533
2556
278
12 15
10-15
13
2
14 1
2

2
5
(Tdap) 1
10-12

dT TT Tdap dT 10 15
20 Tdap dT 1 dT
dT 10 Tdap (TT)
(Td)
Tdap

Tdap
DTaP 3
5
2
- Boostrix (GSK) 10
- Adacel (Sanofi Pasteur) 11 64
65 Boostrix
65 15 85-9016-18
(invasive
pneumococcal infection) ( 70 )
20-50
15-20 30-4019,20 serotypes S. pneumoniae
serotypes 1 (), 19, 6,
5, 23 serotypes 23-valent polysaccharide pneumococcal vaccine21
7
.. 2543
2556
279
45
22
Streptococcus pneumoniae 2
1. 23 1, 2, 3, 4, 5, 6B, 7F, 8, 9N, 9V, 10A,
11A, 12F, 14, 15B, 17F, 18C, 19A, 19F, 20, 22F, 23F 33F
66-9020,23 2

30-50
50-8024

10-7425,26
3-5 65
12-4
2. 13 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F,
and 23F
44-5323
6027
50 23
(package insert Pfizer)

2556
280
12-4. 23-valent polysaccharide penumococcal vaccine
S. pneumoniae23,28
1 (revaccination)
> 65 - 65
1 5
> 65
> 2 - 64 2 5
- (asplenia)
- *
-
- ,
-
-
-
-
- Cochlear implant
-
* chronic granulomatous disease,
, , nephritic syndrome, , , Hodgkin
disease, , systemic steroids
, multiple myeloma
(Influenza vaccine)

3-5

2
1. (inactivate vaccine) 2 split virion vaccine

surface antigen external antigen (H N) internal antigen
subunit vaccine external antigen
70-90
29-31 MF95 adjuvant (FluadTM)
65 adjuvant
32
2556
281
2. live-attenuated vaccine cold adapted virus

2-49
60-8533,34

antigenic drift

inactivate influenza vaccine
Intanza (Sanofi Pasteur) 9 18-59
60 15
adjuvant MF59 adjuvant MF59
intanza 3-7
35

6 18
36
.. 2555

1.
2. 65
3. 2-65
( )
4. 6 2
5. 4
6. (BMI > 35, > 100 )
7.

Northern Southern strain
H3N2 H1N1 B

2556
282
(Rabies vaccine for pre-exposure prophylaxis)

20
60,000 300,000
(bite prevention)
(preexposure prophylaxis)

()

1
()

37,38

39-42

(rabies immune globulin)

1 ( 0.1 .) (deltoid) 0, 7 21 28
() 37

(neutralizing antibody; Nab) 0.5 IU/.
Nab titer 6 Nab titer
0.5 IU/. 1 0.1 . 1
1

Nab titer 1-2 Nab titer 0.5 IU/.
(
)
Nab titer
2556
283

WHO category 2 3
39 ()
(Measles-mumps-rubella vaccine)

43 44,45
12 15 95
98 2
99
16 46
97
75-93
30 47
98 12 16
48 -- 9-12
85-95 63-95 96-99
Moraten Edmonston B-Zagreb
Jery2-Lynn Rubini49,50

1 (primary vaccine failure)
(secondary vaccine failure)
51
2 2 4-6 52

.. 2500

.. 2500
--
4
1.
2.
3.
4.
.. 2500

-- 1 53

2556
284
(Varicella vaccine)

varicella vaccine
70- 90 95 54,55
13 78-82 2
9956,57 breakthrough
1-4 58
breakthrough 50

59,60

61
62
2 4-8

prednisolone
CD4 15
5
gelatin neomycin anaphylaxis
(post-exposure varicella immunization)

90 3 index case
5 63 index case

index case
(zoster vaccine)
varicellla zoster virus
20-30
45 60
(postherpetic neuralgia) 10-18
trigeminal
2556
285

Merck (lyophilized) OKA
14 -15 o 1
60 64 51.3
60-69 postherpertic neuralgia
60-7065 anaphylaxis neomycin
gelatin
(Meningococcal vaccine)
(meningococcal meningitis)
quadrivalent vaccine Neisseria
meningitidis A, C, Y W-135 serogroup B66,67

70 meningococcal serogroup B
A

2 polysaccharide (MPSV4) conjugate (MCV4)
2
3
MCV4
MPSV4 hyporesponsiveness
boosting effect MCV4
55 56 MPSV4
conjugate 2 11-12
16 21
16 terminal
common complement deficiency 2 2 28 MCV4 5

1 10

(Hepatitis A vaccine)

2556
286
55 100,000

68-70
clotting factor concentrates

2 6-12
94-10071,72 20
73
12 40 14
12
40 14
Twinrix (GSK) 0, 1
6
(Hepatitis B vaccine)

3 0, 1 6

74,75
5 (Twinrix) 0, 1
6 4 0, 7, 21-30 12
40 mcg/mL 0, 1,
6 4 0, 1, 2 6 anti-HBs
10 mIU/mL 1
anti-HBs 3

76

(non-responder) 1-2
anti-HBs<10 mIU/mL ()
non-responder
non-responder
non-responder
2556
287
1-3 non-responder 3
0, 1 6 1-2 3 Anti-HBs
10 mIU/mL
(inactivated vaccine)

(index case) HBeAg HBV-DNA
hepatitis B immune globulin (HBIG)
24 77,78
12-5
7
14
12-5.

HBsAg+ve HBsAg-ve HBsAg
1. HBIG +
2.
2.1

2.2 HBIG (1 ) +
* HBIG HBsAg
(non-responder) (2 ) +ve
2.3 anti-HBs antiHBs
:
1 + <10 mIU/.
HBlG 1
10 mIU/.

* 3 HBIG
2 1 HBIG anti-HBs 1 1-2
HBIG 4-6 antiHBs < 10 mIU/mL 2
2556
288
(Typhoid vaccine)

Salmonella typhi
( )
79,80

2 79,80
1. 2 1
2
2 55-74
2. ()
6 4
1 24 7
33-66 5
4 5
JE (Japanese encephalitis vaccine)

Japanese encephalitis (JE)
Culex tritaeneorhynchus
amplifying host
JE
JE 7981

.. 2546-48
(personal communication) JE 10 6.5, 10-19
22.5, 19 6.6 15 -19 50
JE JE
10-19
1.
mouse brain derive 0, 7, 30 0, 7, 14
(CD.JE VAXTM) 2 3-12
2. 3 0, 1-4 , 1
1 4-5
mouse brain derive (CD.JE VAXTM)
JE 19

2556
289
(hyperendemic) 3
0, 7, 14-30 1 10 82,83
(CD.JE VAXTM)
SA14-44-2 88-96
5 9684,85 mouse brain derive
2 94
SA
14-14-2 Vero cells (IXIARO) 17
2 4 1 12
7-10 mouse brain derive
86
(Human Papillomavirus Vaccine)

1 87
6,300
(Human papillomavirus - HPV)
88-91 HPV
HPV
16 18 70 6
11 90

2
1) HPV 4 (Gardasil) 6, 11, 16, 18
MSD 0, 2, 6
2) HPV 2 (Cervarix) 16 18 GSK
0, 1, 6
70
90-100 CIN 1/2/3 100
4 6, 11 90
63 9-26
3 1 2 1-2 3 6
4 9-26 (CDC)
11- 12 13-21 3
22-26

11-12

2556
290
immediate hypersensitivity 4

30
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69. Poovorawan Y, Tieamboonlers A, Chumdermpadetsuk S, Gluck R, Cryz SJ, Jr. Control of
a hepatitis A outbreak by active immunization of high-risk susceptible subjects. J Infect Dis
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70. Teppakdee A, Tangwitoon A, Khemasuwan D, et al. Cost-benefit analysis of hepatitis a
vaccination in Thailand. Southeast Asian J Trop Med Public Health 2002;33(1):118-27.
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72. Werzberger A, Mensch B, Kuter B, et al. A controlled trial of a formalin-inactivated hepatitis
A vaccine in healthy children. N Engl J Med 1992;327(7):453-7.
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74. Cook IF, Murtagh J. Comparative immunogenicity of hepatitis B vaccine administered into
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75. Shaw FE, Jr., Guess HA, Roets JM, et al. Effect of anatomic injection site, age and smoking
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77. Mitsui T, Iwano K, Suzuki S, et al. Combined hepatitis B immune globulin and vaccine for
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EPI. 2534;30:1-7.
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2556
296

13
2556
297
2-5

.. 2553
2553

77 118
65.2
83.1 85.7

94.8 -- 24.7
20.8 19.5 11.7

76.6
18.2 .. 2550 - 2552
4,205 476
135 72 64, 27 23

3
62 55 485
24, 25, 9 4 24
285 25 138
/ (
) .. 2550 .. 2552
2,053, 2,046 2,214
6-7

2 .. 2554
1.

5-10

2556
298

100-200

90-95
.. 2535 .. 2555 20
20

l .. 2535
(Anti-HBc)

l .. 2535 Anti HBs IgG
1-2 100 mIU/ml

2.

3
1

1

.. 2547

(antigenic shift)
(re - assortment)

.. 2547

8

2556
299
3. -- ( MMR)

/

--

4.
varicella zoster virus (VZV)
varicella zoster

28

689
1

2556
300

3 l .. 2535
0, 1, 6 - /
Anti-HBc

-

l .. 2535
-
Anti-HBs IgG (
1-2
100 mIU/ml
)
1

-- 1

2
1

.. 2555
--

2556
301

1. . (2542). . ( 2) : ...
.
2. .

1/2553 24 .. 2553.
3. , . (2552).
- 2551.
. 19(1): 67-77.
4. . (2543). varicella - zoster .
, 10: 38-46.
5. . (2547). Chickenpox
. , 14: 10-20.
6. ,
.. 2554
7. Centers for Disease Control and Prevention. (1997). Immunization of Health-Care Workers.
MMWR; 46(RR-18) :1-42.
8. . . :
,
.. 2552. :
, 2552: 5-8.
9. Lolekha S, Tanthiphabha W, Sornchai P, et al. Effect of climatic factors and population density
on varicella zoster virus epidemiology within a tropical country. Am J Trop Med Hyg 2001;64
(3-4):131-6.
2556
302

14
1.

(Smallpox eradication) .. 25221
(Disease elimination)
(Disease control)

(Human Pappilloma Virus)

2556
303

2

1) 2)
3) 4)

2.

(Upstream production)
(Downstream production)

3 1) 2)
3)
20
10 4-6
( 1)
200-500 2

1 5,000
2556
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1 3
3. 4
8
()

2

1)
2) 3) 4)
5)
(WHO prequalification)

1)
2556
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2) 80
.. 2552
3,000
-

3)

4.
10 .. 2544

1)
2)

3)

4)

5)
6)

4

5. 5

9 .. 2548

2556
306
5.1
1)

2)

3)
5.2
1)

2)

3)
4)

5.3
1)

2)

3)

2556
307
4)

5)

6.

.. 2545

128 35 25 .. 2554
()
()
() 5 .. 2555

()6
1)

2)

3)

4)

5)
6)
7. 7

18 .. 2554

2556
308

7.1
1)

2)

3)

4)
7.2
10
10

1. 2

2. 5
GMP

3. 5

4.

4.1 5

4.2 5

(genetic engineering)
2556
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5. 5

6. 5 -

7. 10
( )
( ())
8. 10
( )
9. 10

10. 10

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-
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:

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BSL3 (GMP Pilot Plant) (TCELS)
10.4 8

2556
310

1. Plotkin S, Orenstein W, Offit P. Vaccines. 5th Edition. Philadelphia: W.B. Saunders, 2008.
2. Healy G. Vaccine production and development: The challenges of realizing a future free from
disease, Microbiologist, March 2006, 28-30.
3. . :
, 2 15-17 2553. ;
, 2554: 140.
4. .
. ; 2552.
5. . .
; , 2548: 8-9.
6. , ()
7. . . ; , 2554: 3-6.
2556
311

ตำราวัคซีนและการสร้างเสริมภูมิคุ้มกันโรค ปี 2556 (พิมพ์ครั้งที่ 3 ปี 2558) PDF

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ตำราวัคซีนและการสร้างเสริมภูมิคุ้มกันโรค ปี 2556 (พิมพ์ครั้งที่ 3 ปี 2558) PDF

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2556

2 (inactivated vaccine killed vaccine)

2.2 (subunit vaccine)

2-1 (intradermal: ID) : BCG No.26 1/2

2-2 (subcutaneous: SC) MMR, JE No.26 1/2

2-3 (intramuscular) : HB, DTP-HB, DTP, dT, TT

l toxic shock syndrome

(Adverse Event Following

2. Serum sickness 7-10

(intradermal injection) BCG-TRC

(Hepatitis B Vaccine : HB)

- (DT, dT) (toxin)

purified diphtheria toxoid 25-30 Lf

: antitoxin 1:100 0.02 .

.. 2545 2552 212

1. -- (whole cell) DTwP

Urabe 1 862 - 1 295,0007-9

(Japanese Encephalitis Vaccine: JE)

7.6-1 live-attenuated JE vaccine inactivated mouse

hemagglutinin (H) neuraminidase (N)

2. Antigenic drift (mutation)

split vaccine subunit vaccine

l (BMI > 40)

(Varicella Vaccine : VAR)

(Hepatitis A Vaccine: HAV)

PCV10 PCV13 0.5

2. PPSV23 PCV S. pneumoniae

PCV PCV7 IPD

(Meningococcal Polysaccharide Vaccine

MPSV4 0.5 . (subcutaneous) 2

Human Papillomavirus Vaccine

(Human Papillomavirus, HPV)

(Rabies Vaccine and Rabies Immunoglobulin)

l (abrasion) (rabies vaccine*)

l (rabies vaccine* RIG**)

Chromato- 106- Liaoning Cheng

RIG ERIG 40 IU / kg ( skin 6 6

- antigenic value 0.7 IU/0.1 ml

- 1 . ( HDCV, PCECV, PDEV) 0.5 . ( PVRV,

8.8-4 (Rabies Immunoglobulin : RIG)

- anaphylaxis adrenaline 0.1%

(NSS 0.9%) 2-3

DTaP-IPV, DTaP-IPV-Hib DtaP-IPV-Hib-HB 2, 4, 6

IPV DTaP Tdap

9-3 DTwP DTaP 1

9-5 --- (Priorix TetraTM)

* < 2 PCV13 24-71 PCV

* Hib vaccine Hib

2 HBV1 HBV2 DTwP-HBV1 DTwP-HBV2 DTwP-HBV3

--3 DTwP 1 DTwP dT

8 (HAV) HAV1, HAV2 6-12

1.5 (OPV, IPV)

5 (International certificate of vaccination)

(Yellow Fever Vaccine)

1 .. 2461-2463 19,413 13,918 71.69

Monovalent oral vaccine 7

1. (inactivate vaccine) 2 split virion vaccine

(post-exposure varicella immunization)

JE (Japanese encephalitis vaccine)

(Human Papillomavirus Vaccine)

1-2 100 mIU/ml

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