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目的分析一例因接种乙脑疫苗后意外死亡的原因,提高预防接种门诊工作人员的风险意识,减少异常反应尤其是死亡的发生,消除预防接种后意外死亡给免疫规划工作带来的不良影响。方法对预防接种后的死亡病例进行现场调查和尸检,并对接种的同批号疫苗进行检测,综合分析死亡原因。结果受种者出生及生长发育均无异常,所接种的乙脑减毒活疫苗运输、存储和接种操作规范,同批次疫苗检测结果符合规定。结论受种者排除因疫苗质量和接种操作不当而引起意外死亡,无直接证据证明受种者死亡与接种乙脑减毒疫苗相关,属于偶合症。
Objective To analyze a case of accidental death after inoculation with JE vaccine and improve the risk awareness of vaccination clinic staff to reduce the occurrence of abnormal reactions, especially death, and eliminate the adverse effects of accidental death after vaccination on immunization planning. Methods On-the-spot investigation and autopsy were conducted on the deaths after vaccination. The vaccinated batches of the same vaccine were tested, and the causes of death were analyzed comprehensively. Results There were no abnormalities in the birth and growth of the recipients. The transport, storage and vaccination practices of the vaccinated JE live attenuated vaccine were consistent with the results of the batch vaccine test. CONCLUSIONS: Subjects were excluded from accidental death due to improper vaccine quality and vaccination operation. There is no direct evidence that the death of the vaccinee is associated with the JE attenuated vaccine, which is a syndrome.