神経疾患におけるワクチンの功罪  [in Japanese] Merits and Demerits of Vaccination for Patients with Neurological Diseases  [in Japanese]

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Author(s)

    • 横山 和正 YOKOYAMA KAZUMASA
    • 順天堂大学医学部神経学講座 多発性硬化症及び神経免疫難病研究・治療寄付講座 Treatment and Research in Multiple Sclerosis and Neuro-intractable Disease UNIT (TRI-MS/NID),Department of Neurology, Juntendo University Faculty of Medicine
    • 服部 信孝 HATTORI NOBUTAKA
    • 順天堂大学医学部神経学講座 多発性硬化症及び神経免疫難病研究・治療寄付講座 Treatment and Research in Multiple Sclerosis and Neuro-intractable Disease UNIT (TRI-MS/NID),Department of Neurology, Juntendo University Faculty of Medicine

Abstract

ワクチンというと皆さんはエドワードジェンナーについて学生時代に学んだかもしれません.当時経験的に知られていたのは,牛痘にかかったヒトは天然痘にかからないですむ,もしくは天然痘にかかったとしても死に至らず天然痘感染による症状が軽くすんでいたことから治療への応用が検討されました.他の医師が行った実験治療では多くの死亡事故もあったようです.それを踏まえてジェンナーが行ったのは,天然痘予防のためのウシ天然痘(牛痘)のヒトへの接種実験でした.現在ワクチンという呼び名で一般化したこの試みは見事に成功し数多くの人命が救われ,184年後の1980年5月,WHO(世界保健機関)は天然痘の根絶を宣言しました.<br>このようにワクチンは正しく使用すれば効果も高く,社会に貢献するのはあきらかですが例外もあります.本日参加された皆さんはワクチンの適応,時期,その限界や副作用についてもよく知っておく必要があると思います.繰り返しになりますが,ワクチンに限らず万人に対して同じ作用・効果を起こす薬剤は存在しませんし,個々のワクチン接種時の免疫状態によって効果や副作用が変化する可能性もあるのです.またご自身,家族,友人,会社,村,市,地方,県,国,世界と接種対象のスケールアップに伴いワクチンの主たる目的も変わってきます.<br>ワクチンはもともと個人の体内に存在していない異物(非自己)を,皮下,筋肉注射,静脈注射,経鼻,経口ルートから投与し,個人のもつ免疫能を強制的に賦活させるものです.よって,場合によっては死に至るような重篤な副作用を起こす可能性が常にあります.<br>今回の公開講座は広くワクチンの特集であり,他の演者からすでにそれぞれの分野における最新の報告が行われてきたかと思いますが,私の講演ではインフルエンザワクチンにより起こりうる神経系の副作用についてまずお話をします.また,最近話題になっている子宮頸癌ワクチンと神経系への副作用,さらには私の主たる研究である多発性硬化症のワクチンを利用した免疫治療が歴史的にどのように行われてきたかについて述べ,日本でも増加しているアルツハイマー病に対してのワクチンによる免疫治療とその誤算,最後に今後日本でもますます増えるであろう様々なワクチンにどう向き合うかの基本姿勢についてまとめて述べます.自己を病気から守るためには非自己である感染のみならず,自己に対しての過剰反応である免疫現象を理解することが必要不可欠なのです.

When it comes to vaccination, you might have heard about Edward Jenner when you were students. Based on experimental findings revealing that individuals with a history of cowpox virus infection were less likely to be infected with smallpox, and smallpox infection only led to mild infectious symptoms without resulting in death, researchers investigated the application of vaccines to treatment. It appears that experiments performed by other physicians caused numerous deaths. Jenner vaccinated humans against smallpox using cowpox virus. This attempt, currently referred to as vaccination, has proved to be successful and saved many people’s lives. Consequently, in May 1980, the WHO declared that smallpox had been eliminated.<br>Thus, appropriately used vaccination is highly effective and markedly benefits society. However, I think that we need to obtain accurate information on vaccination, such as the individuals for whom each type of vaccination should be indicated, the timing of its use, its limitations, and side effects. As is the case with any drug, no vaccine achieves the same effects in every person, and the beneficial and side effects of vaccines may differ according to each individual’s immune state. The purposes of vaccine use also differ according to the target person and area.<br>In vaccination, foreign substances (nonself antigens) that do not exist in the human body are administered through the skin, nose, or mouth, or using intramuscular or intravenous injections, in order to induce the involuntary activation of an individual’s immune function. In other words, vaccine is the key player to perturb the immunological milieu and therefore initiates break tolerance.<br>Therefore, vaccination may cause severe side effects, which are sometimes fatal.<br>In this public lecture on vaccination, other speakers have reported the latest relevant information, but I will describe the neurological side effects of influenza vaccine. I am also going to talk about the neurological side effects of cervical cancer vaccine, which has been a hot topic in Japan recently, the new reporting system in post-vaccination inflammatory CNS demyelinating event such as ADEM, and the history of therapeutic vaccination against multiple sclerosis, which is my main research theme. Also I discuss the failed vaccination trial against Alzheimer's disease, which is becoming increasingly prevalent worldwide, including Japan. I enclosed lead out in these studies, and how to tackle issues associated with vaccination, whose frequency is expected to increase globally. We have learned that a risk (疫eki; plague ) and a benefit (益eki; value) are two sides of the same coin. To protect ourselves from disease, we need to properly understand immunity and excessive immunological responses.

Journal

  • Juntendo Medical Journal

    Juntendo Medical Journal 60(Suppl.2), s53-s59, 2014

    The Juntendo Medical Society

Codes

  • NII Article ID (NAID)
    130005005476
  • Text Lang
    JPN
  • ISSN
    2187-9737
  • Data Source
    J-STAGE 
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