看研究論文最有趣的就是,總是有人想把醫療做得更好更完善,進而設計研究,證實自己的想法是否正確,而這些研究能夠進一步挑戰我們目前舊有的作法,或許在未來會形成新的共識也不一定。
先聲明,疫苗的施打方法,我們還是要遵照疾管局的建議來施打,畢竟疫苗的數量需要被控管,可稱得上是戰備物資了,如何分配這些有限資源,每一年疾管局的專家們都傷透腦筋,所以,不管如何,疫苗的施打方法,以疾管局每年最新的公告為主喔!
今天看到這一篇研究提到:
患有慢性腎臟病、或已經需要規則洗腎的患者,眾所皆知,身體的免疫力較差,而接受流感疫苗接種所產生的抗體量,也較正常人來的少一點。
雖然,抗體量少,不代表就沒有保護力,不過卻給了我們一個想法:如果我們給這個免疫較弱的族群,高劑量的疫苗注射,能不能更增加保護力?
這篇研究用的高劑量疫苗,是平常標準劑量( 15 μg)的四倍– 60 μg,意思差不多就是一次打四支的劑量,來看有沒有幫忙。
結果顯示,高劑量的這組患者,能夠減少住院率大約 7% (HR: 0.93,95% CI, 0.83~1.0),不過全死亡率(all-cause mortality)沒有差異。
如果轉換成個案數來看的話,每 100個洗腎患者接受高劑量流感疫苗注射的話,大約能夠減少 5.3個患者去住院。
如果我們將洗腎患者再依照年紀分組呢?
作者發現,65歲以上的年長者,高劑量的保護力更為明顯,減少住院率大約 12% (HR, 0.88; 95% CI, 0.79 to 0.97 ),甚至連死亡率 ( table 4 中有,但內文沒有提) 也降低了 10% (HR: 0.90 95% CI, 0.81 to 0.99)。
這也符合了我們直觀的猜想:越年長,免疫力越差,加大疫苗劑量的保護效果越明顯。
在討論中,作者回顧了與流感疫苗相關的研究,提到過去也有人做過“打一次標準劑量之後,隔幾個禮拜在打一次標準劑量(booster dose)”的研究,就像B型肝炎疫苗的打法,但是其實這樣分開打的效果,還不如直接雙倍劑量一起打呢!因此作者選擇用一次打四倍的高劑量來設計這個研究。
這篇研究開啟了我們新的想法:既然不同的疫苗劑量,有機會降低洗腎患者的流感住院率,尤其是65歲以上的長者,效果更為明顯,那麼,還有沒有不一樣的施打方式,能夠更進一步保護這群免疫力較差的族群嗎?或者哪一個族群也能夠這樣試著增加免疫力?又或者現有的流感疫苗,還能夠做甚麼樣的改良,才能夠引發出更好的保護力呢?
或許更令人深省的是,有人如此積極的想要增加洗腎患者對於流感的保護力,就怕標準劑量不夠力,連一次打四倍劑量都在嘗試了,怎麼還會有人不想接受目前所建議的,標準劑量的流感疫苗呢?
讓脆弱的自己暴露在流感的威脅之下?
拜託嘛,政府的美意,免費的耶,就一年一次,打一下嘛~ 🙂
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