129.3 🩺 內科專科考前版

129.3.0.1 1️⃣ 22E 更新

• PCV20 preferred over PCV15 + PPSV23 (single dose simplification)
• RSV vaccines in adults ≥ 60: Arexvy (GSK), Abrysvo (Pfizer), mRESVIA (Moderna mRNA)
• Shingrix expanded: 19+ immunocompromised
• Maternal RSV (Abrysvo at 32-36 wk): 對 newborn 提供 passive immunity → 取代 / 補充 nirsevimab
• High-dose / adjuvanted flu preferred for ≥ 65

129.3.0.2 2️⃣ Adverse Events 處理

• ACIP 報告系統 (VAERS): 美國
• TVSAP: 台灣
• 經典: anaphylaxis (rare), Guillain-Barre (flu < 1/M), myocarditis (mRNA COVID — young males), thrombosis (J&J/AZ adenovirus)
• Pre-vaccine screening: allergy history, current illness, immune status, pregnancy
• Anaphylaxis: epinephrine IM (anterolateral thigh)

129.3.0.3 3️⃣ 台灣健保 + 公費

• 公費 (兒童 routine, 65+ flu/PCV): 詳見 CDC 台灣網站
• 自費 (shingles, RSV, HPV adult, JEV adult, rabies pre-exposure)
• 65+ 公費 PCV13 + PPSV23 sequential (轉到 PCV20 待 ACIP 統一)

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