221.3 🩺 內科專科考前版

221.3.0.1 1⃣ Yellow Fever Vaccine for Travelers

  • Pre-travel ID consultation
  • ICVP (International Certificate of Vaccination — yellow card)
  • Required for entry to many endemic countries
  • Single dose lifelong (WHO 2024)
  • Elderly (≥ 60 yr) — YEL-AVD risk; case-by-case (risk vs benefit travel)
  • Immunocompromise contraindicated (live attenuated)
  • Pregnancy: avoid if possible; risk-benefit if mandatory travel

221.3.0.2 2⃣ JE Vaccination Pediatric

  • WHO recommendation pediatric in endemic countries
  • Taiwan 公費 program established
  • Mass vaccination campaigns
  • Adult travelers > 1 month in endemic + rural

221.3.0.3 3⃣ WNV Epidemic Annual Surveillance

  • USA: state + CDC surveillance
  • Dead bird reporting (especially corvids)
  • Mosquito pool testing
  • Sentinel chicken flocks
  • Human surveillance
  • Blood + organ donor screening + retesting

221.3.0.4 4⃣ Flaviviruses Cross-Reactivity

  • IgM cross-reactivity:
    • Dengue, Zika, JE, Yellow Fever
  • PRNT (plaque reduction neutralization test) for specific identification
  • Travel history + clinical context critical
  • Multiple flaviviruses can co-circulate (returning travelers)

221.3.0.5 5⃣ Acute Flaccid Paralysis Differential

  • WNV (most common adult cause in epidemic season)
  • Polio (rare in vaccinated)
  • Enterovirus EV-D68, EV-71
  • GBS
  • ALS (chronic)
  • Transverse myelitis
  • Botulism

221.3.0.6 6⃣ Powassan Tick Awareness

  • USA NE/Great Lakes outdoor activities
  • Tick checks essential
  • Even brief tick attachment can transmit (vs Lyme 36-48 hr threshold doesn’t apply)
  • Permethrin clothing for hikers/hunters

221.3.0.7 7⃣ Climate Change Impact

  • Flavivirus range expansion (tropical to temperate)
  • WNV ↑ in cooler regions
  • Tick range expansion (Lyme, TBE, Powassan)
  • Increased mosquito season duration
  • Public health adaptation

221.3.0.8 8⃣ 健保 / Taiwan

  • 通報 JE + WNV + others
  • 公費 JE vaccine pediatric
  • 自費 YF + TBE + others for travelers
  • 衛生局 mosquito surveillance

221.3.0.9 9⃣ Future Vaccines

  • WNV human vaccine in development
  • Universal flavivirus vaccines researched
  • mRNA flavivirus vaccines

221.3.0.10 10. Mosquito + Tick Control

  • Public Health emphasis
  • Vector reduction
  • Community engagement
  • Surveillance systems