COVID-19疫情的擴散，讓每個人感染病毒的機率大幅增加，除了努力維持社交距離之外，增加疫苗接種的人口比例，是阻止大流行是最有效的方法。

作為一名婦產科醫師，我關心的議題自然圍繞在Covid-19對於孕婦及胎兒的影響。就目前的研究數據顯示，孕婦如果感染新冠肺炎，引發重症或需要呼吸器的比例相較於一般人增加許多，同時導致早產或流產的機率也會增加，雖然在感染病毒後產生症狀的孕婦大約只有3分之一，死亡率只有約2%，但這些數據都顯示孕婦感染Covid-19病毒的危險遠比打疫苗的副作用還高。

許多病人問我孕婦可不可以打COVID-19疫苗?孕婦應該打哪一種比較好?在閱讀文獻資料後，我想在此為大家整理一些相關的最新資訊。

在美國，英國，澳洲與紐西蘭的婦產科醫學會，雖然沒有禁止孕婦施打腺病毒疫苗(例如AZ與嬌生)，但目前都建議讓孕婦優先選擇施打mRNA疫苗（例如莫德納與輝瑞）。這個建議原因不是腺病毒疫苗會造成流產或畸形，也不是因為腺病毒在孕婦身上會造成比一般人更多的副作用。而是因為目前在公開的資料中，施打過mRNA 的孕婦追蹤的資料較多。

再者，腺病毒疫苗在50歲以下的民眾會出現罕見的血小板低下與血栓（簡稱TTS) 的副作用。在50歲以下接種腺病毒疫苗的民眾當中，TTS出現的機率約為五萬分之一 （每年發生車禍死亡機率約為千分之一），所以目前在歐美部份國家有兩種以上疫苗可以選擇的前提下，會有讓孕婦優先選擇施打mRNA疫苗的建議。

根據台灣衛生福利部疾病管制署所公佈的疫苗接種注意事項， 孕婦若為COVID-19 之高職業暴露風險者或具慢性疾病而易導致重症者，可與醫師討論接種疫苗之效益與風險後，評估是否接種疫苗。而哺乳中的婦女若為曝露在Covid-19風險當中 (如醫事人員)，應完成接種。雖然AZ疫苗的對母乳或受哺嬰兒之影響尚未完全得到評估，但一般認為並不會造成相關風險。接種COVID-19疫苗後，仍可持續哺乳。

目前台灣除了進口除了AZ疫苗之外，未來也將逐步採購及接受國際捐贈，疫苗的種類也將增加嬌生以及莫德納，雖然疫苗目前仍屬珍稀資源，優先施打順序與分配仍應遵照政府相關規定，但未來若能讓民眾能有選擇的空間，我支持孕婦應有自由選擇疫苗的權利。

在此之前，請大家乖乖宅在家裡，勤洗手，戴口罩，預祝大家端午佳節平安。
=============================================
The spread of COVID-19 in Taiwan has greatly increased the risk of the virus infection for everyone. Now not only do we need to maintain social distancing but also are preparing for mass vaccination to create herd immunity to protect those vulnerable around us.

As an obstetrician, naturally I read mostly about the effect of COVID-19 and its vaccines to mothers and babies. As of the effect of COVID-19, epidemiological studies show that the COVID-19 infection, compared to non-pregnant people, not only increases risk of maternal morbidity and mortality but also fetal prematurity and stillbirths. Although only 1/3 of infected mothers will develop symptoms, with mortality rate of 1 in 50 people, it is not a risk that any mother would be willing to take.

Thanks to the excellent pharmacovigilance systems around the world, we have now learned a lot more about effect of COVID-19 vaccines in mothers than the beginning of the year, as clinical trials often exclude pregnancies in their participants. Most of the obstetrics and gynecology professional bodies around the world are recommending pregnant women to be preferentially offered mRNA vaccines (such as those from Pfizer-BNT and Moderna). Although the adenovirus vaccines (such as those from AstraZeneca and Johnson-Johnson) are not contraindicated in pregnancy, currently there is more published data about the safety of the mRNA vaccines in pregnancy than the adenovirus ones. Moreover, the small but significant risk of
Thrombosis with Thrombocytopenia Syndrome (TTS) with the adenovirus vaccines that is observed mostly in younger people has prompted many countries to recommend alternative vaccines to people under the age of 50.

With the uncertainties surrounding vaccination timing in Taiwan, pregnant women may be faced with the difficult choice of whether to take the adenovirus vaccine that is available now or to take the risk of virus exposure and wait for the mRNA vaccines. I would encourage pregnant women to speak with their health professionals regarding this issue. And I hope this article empowers my readers with some useful information.

最新刊登在《Nature》的論文，比起葡萄糖，癌細胞還有更喜歡的能量來源 - Glutamine

#PleaseShare #COVID19
#武漢肺炎防疫重點英文版

According to the WHO and Chinese officials, the incubation period of the novel corona virus between disease exposure to the onset of symptoms ranges from 2 to 12 days (7 days on average).

However,based on the general view,the incubation period of COVID-19could be up to 14 days.

Based on the current literature related toCOVID-19, the clinical expression ofCOVID-19caninclude fever, weakness, respiratory symptoms (mainly dry cough) and in some cases,breathing difficulties can follow.

About 1 to 2 percent of the patients might develop severe pneumonia, adult respiratory distress syndrome (ARDS), multiple organ failure or shock, leading to death.Most of the deceased patients had concurrent chronic disease such as diabetes, liver disease, kidney disease or cardiovascular disease.

*Prevension
There is no vaccine to prevent corona virus infections. Daily preventative steps to take include avoiding affected regions, avoiding local hospitals or clinics unless necessary, avoiding eating uncooked meat or eggs,avoiding being in contact with animals and dead animals,and maintain good health habits.

Steps to practice good health habits are as follows:

Please keep your hands clean and wash your hands with soap frequently. If soap and water are not available, use an alcohol-based hand sanitizers.

However, soap and water should be used preferentially if hands are visibly dirty. You should wash your hands immediately after coughing or sneezing; after using the toilet; and if your hands touch any secretions from your respiratory tract, stool or body fluids such as urine. In addition, please refrain from touching your eyes, nose and mouth with your hands.

Pay attention to respiratory tract hygiene and cough etiquette.

a. If you have respiratory symptoms, please wear a medical-grade face mask and keep at least 1 meter away from others while talking to them.

b. If your hands touch any secretions from your respiratory tract, please wash your hands with soap and water thoroughly.

c. If you develop a cough or other respiratory symptoms, you should wear a medical face mask. When your mask is contaminated by secretions of nose or mouth, please fold it, throw it into the trash immediately, and wear a new one.

d. You should cover your mouth and nose with a tissue or handkerchief when coughing or sneezing. If you don’t have a tissue or handkerchief, cough or sneeze into your upper sleeve.

*Use of masks
a. Medical-grade face masks are mainly used for preventing the spread of disease and protect people around you. People are advised to wear medical masks when you go to see a doctor or accompany a patient; when you have symptoms of respiratory infections; and if you go out with people with weak immune systems or chronic disease. You should wash your hands frequently to protect yourself from catching illness in other situations.

b. To wear a medical mask properly, you should ensure that the water-repellent side (usually green) faces outwards. You should not remove your mask when talking, coughing or sneezing to prevent the spread of disease. You should replace your face mask if it is visibly soiled.

c. Steps to put on a medical face mask:
i. Open the package and examine if the mask is damaged.

ii. Put the elastic bands around both ears, fit the metallic strip over the nose bridge and extend the mask to cover your chin.

iii. Press firmly down on the metallic strip so that it fits around your nose

iv. Ensure that there are no gaps

d. You don’t need a face mask in open spaces, including walking on the streets or doing outdoor exercises.

*What to do while sick
If you have flu-like symptoms, including fever, headache, runny nose, sore throat, cough, muscle aches, fatigue/tiredness, and sometimes diarrhea. After your symptoms develop, you should rest, take and record your temperature regularly, drink water and eating nourishing food, observe your condition and take symptom-relieving drugs such as pain relievers/fever reducers to observe if they work.

You should rest at home for at least 24 hours after the symptoms improve.

You should seek medical attention if your fever lasts longer than 24 hours or is accompanied by other symptoms, such as purulent nasal discharge and purulent sputum, severe vomiting or shortness of breath.

You should inform the doctor of any history of travel, occupation, contact, and cluster (TOCC) when seeking medical attention.

You should follow the triage arrangement at the hospital if you have a fever to ensure efficient medical care and the health of medical personnel.

You should avoid going to school or work, attending gatherings and visiting crowded or poorly-ventilated public spaces while sick. You should avoid using public transportation to prevent the spread of disease if you need to go outside.

While staying at home, you should stay in a specific room, keep good airflow in the house, and avoid close contact with other people in your home, such as eating at the same table, kissing, hugging or sexual contact.

People living with the sick person should also pay attention to personal hygiene, wash hands frequently and refrain from touching eyes, nose and mouth with hands. Babies, children and the elderly or people with compromised immune system in the same household must keep at least 1 meter away from the sick person.

If the living environment requires disinfection, you can apply 1:100 diluted bleach (500 ppm).

That is, household chlorine bleach (a 5-6% sodium hypochlorite solution, providing 50,000–60,000ppm available chlorine) is diluted in water at 1:100 to clean object surfaces, such as doorknobs, desks and switches.

You can use disposable teaspoons (one teaspoon is about 20 cc), small Yakult bottles (one bottle is about 100 cc) and large plastic bottles (one bottle is about 1,250 cc) and follow the instructions below to make diluted bleach: �

a. Large amount: mix 100 cc of bleach (5 teaspoons or 1 small Yakult bottle) in 10 liters of water (8 large plastic bottles) and fully stir the solution before using.

b. Small amount: pour 10 cc of bleach into 1 liter of water and fully stir the solution before using.

For more information:
https://www.cdc.gov.tw/File/Get/HAvRHGs_EjKeROHYmzWm5w

Boarding date: Monday, November 11, 2019
Airline: ANA (ANA WINGS operated)
Flight number: NH2152
Departure: Sapporo (New Chitose) -CTS
Arrival: Tokyo (Narita) -NRT
Departure time: 7:45
Arrival time: 9:25
Duration: 1 hour 40 minutes
Equipment: B737-800
Aircraft number: JA61AN
Registration date: August 2010
Seat: Normal seat (5K)
Ticketing: ANA Airlines Award Tickets

This is a flight to Tokyo on Monday morning. Usually there are many business people boarding, but this time there were no diamond members to board preferentially and there were many vacant seats.
That is because it is not for Haneda Airport, which is a business route, but for Narita Airport.


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