209.3 🩺 內科專科考前版

209.3.0.1 1⃣ SSPE — Late Measles Complication

  • 5-15 yr post-measles infection
  • Latent CNS persistence
  • Progressive: cognitive decline → myoclonic seizures → motor deterioration → death
  • EEG: characteristic burst-suppression pattern
  • Treatment: isoprinosine + IFN-α (variable response)
  • Outcome: fatal in 1-3 yr
  • Prevention: vaccination
  • Higher risk if measles before age 2

209.3.0.2 2⃣ Immune Amnesia (Mina et al. 2019)

  • Measles wipes out pre-existing antibody repertoire
  • 2-3 yr post-measles susceptibility to other infections
  • Measured by antibody profile depletion
  • Major argument for measles vaccination (not just measles prevention but cross-protection of other diseases)

209.3.0.3 3⃣ Mumps Outbreaks in College / Religious Communities

  • Vaccine waning + close contact
  • Booster MMR for outbreak control
  • Public Health surveillance
  • Isolation of cases

209.3.0.4 4⃣ CRS Workflow if Maternal Rubella Infection

  • Serology + PCR confirm maternal
  • Amniocentesis fetal PCR
  • Consultation with maternal-fetal medicine
  • Termination counseling
  • If continued: serial fetal US + audiology + cardiac evaluation
  • Postnatal: newborn screening + isolation (contagious shedding)

209.3.0.5 5⃣ Adult Rubella Arthritis

  • Hands, wrists, knees
  • Usually self-limited 2-4 wk
  • NSAID
  • Distinguishes from RA: self-limited + viral context

209.3.0.6 6⃣ MMR + Egg Allergy

  • 2024 ACIP: routine MMR for egg-allergic patients (vaccine doesn’t contain significant egg)
  • No precautions needed for most egg-allergic
  • Anaphylaxis to prior MMR = absolute contraindication

209.3.0.7 7⃣ HIV + MMR

  • CD4 ≥ 200 (stable): MMR OK
  • CD4 < 200 or severe immunocompromise: defer
  • ART-stabilized adult HIV: vaccinate
  • Pediatric HIV: vaccinate per CD4 percentage

209.3.0.8 8⃣ Pregnancy + Measles Exposure

  • Susceptible pregnant + exposure
  • Measles IG within 6 days post-exposure
  • Don’t give MMR (live, contraindicated)
  • High-risk for severe maternal disease + fetal loss

209.3.0.9 9⃣ 健保 / Taiwan

  • 公費 MMR universal childhood (NIP)
  • 通報 measles + mumps + rubella mandatory
  • High vaccine coverage Taiwan (~ 95% national 2024)
  • Sporadic imported cases
  • Healthcare worker vaccination

209.3.0.10 10. Wakefield Fraud + Vaccine Hesitancy Legacy

  • 1998 Lancet paper falsely linking MMR to autism
  • Multiple subsequent studies refuted
  • 2010 retracted; Wakefield disbarred
  • Legacy: persistent vaccine hesitancy in some communities
  • Counter-messaging + community engagement critical