211.3 🩺 內科專科考前版

211.3.0.1 1⃣ Polio Eradication Endgame

  • Wild polio: Pakistan + Afghanistan only 2024
  • cVDPV2: outbreaks in Africa from prior OPV2 use
  • nOPV2: novel attenuated for outbreaks
  • OPV cessation synchronized globally after wild eradication
  • IPV-only era goal
  • Wastewater surveillance critical

211.3.0.2 2⃣ 2022 NYS Polio Case

  • Imported cVDPV2
  • Unvaccinated adult, Rockland County
  • Paralytic disease
  • Wastewater detection in nearby counties
  • Vaccine catch-up campaign + surveillance
  • Reminder of complacency danger

211.3.0.3 3⃣ Taiwan EV-71 Surveillance

  • Active surveillance since 1998
  • Severe HFMD reporting
  • 2022-2024 outbreaks: minor compared to 1998 (vaccine + immunity)
  • Vaccine schedule pediatric inclusion ongoing

211.3.0.4 4⃣ Viral Myocarditis Differential

  • Coxsackie B (#1 viral)
  • HHV-6, parvovirus B19, CMV, EBV, COVID-19
  • Treatment: supportive + heart failure management
  • ICI + steroid in some autoimmune-mediated

211.3.0.5 5⃣ X-Linked Agammaglobulinemia + Enterovirus

  • B-cell deficiency → persistent CNS enterovirus
  • Chronic meningoencephalitis
  • IVIG + pleconaril investigational
  • Mortality high

211.3.0.6 6⃣ AFM Workflow

  • Acute weakness post-respiratory illness in child
  • LP + CSF PCR (EV-D68, EV-71, polio)
  • MRI cervical spine
  • IVIG / steroid debated
  • 通報 CDC
  • Rehab + follow-up

211.3.0.7 7⃣ 健保 / Taiwan

  • 通報 polio, EV-71 severe, HFMD outbreaks
  • 公費 IPV-containing vaccines (5-in-1 / 6-in-1)
  • EV-71 vaccine 自費 / 公費 depending policy
  • HFMD school exclusion

211.3.0.8 8⃣ Future Vaccines

  • Multivalent enterovirus vaccines (EV-71 + Coxsackie A6 + A10 + A16)
  • mRNA polio vaccines in development
  • EV-D68 vaccines in trial