麻疹不活化ワクチン接種既往者に発生した異型麻疹の2例

TWO CASES OF ATYPICAL MEASLES AFTER INOCULATION OF MEASLES-INACTIVATING-VACCINE

I．はじめに

　日本では昭和41年はじめから麻疹ワクチンが市販され，これには不活化ワクチン（K）と，弱毒化生ワクチン（L）の2通りがある^1）。接種方式は，KL法，KKL法，KKK法，L＋γグロブリン法などがあつて，原則的にはKL法がすすめられていたが^1），一部の虚弱者では生ワクチンの発熱反応などを懸念して，KKK法が行なわれていた。

　一方，Kワクチンを数回接種したものが数年後自然麻疹に感染する状態におかれると，異型麻疹を生じることは，1965年Rauhら^2），Karzonら^3），1966年Norrbyら^4），1967年Fulginitiら^5），Naderら^6）によって既に報告され，発疹の状態についてはFulginitiら^5），Rauhら^2）の報告に記載されている。著者らは昭和43年春，麻疹の流行期に2例の異型麻疹患者を観察した。

Two cases of atypical measles developed in epidemic one year after three successive inoculations of measles-inactivating-vaccine were reported.

Case 1 ; A 5-year-old boy had high fever of 5 days' duration with slight catarrhal symptom of the upper respiratory tracts. Exanthema appeared three days after the attack of fever, and disappeared within 5 days. It was itchy miliar papules, reddish or normal skin in color, looked like a kind of contact dermatitis, and distributed mainly over the dorsa of hands, fingers, and feet, while small number of them were on the soles. A few, reddish papules, 2 mm in diameter, surrounded with pale area appeared one day later.

Roentgenogram of the chest revealed infiltration in the left, middle lung, which disappea-red in 10 days. Mild swelling of lymphnocles on the neck, axillae and groin accompanied with slight tenderness was proved.

Laboratory examination proved cosinophilia, 18%, erythrocyt segimentation rate, 24mm per hour, HI antibody titer of measles at the beginning of the disease, 1 : 8, and that after the disease, 1 : 256.

Case 2 ; An 8-year-old boy had high fever for 7 clays after common cold like symptom for 2 days. The exanthema appeared 4 days after the development of fever and existed for 6 days. The similar exanthema as that of case 1 appeared on the back of fingers, hands, feet, earlobes, and the trunk, and small hemorragic exanthema on the hard palate. Slight swelling and tenderness of lymphnodes were proved. Roentgenogram of the chest revealed mild hilar lymph adenitis. Laboratory test proved eosinophilia, 15.6 ; e.s.r., 27mm per hour ; HI antibody titer for measles, 1 : 64 at the beginning, and 1 : 512 after the disease fully developed.