预防接种

预防接种

为什么接种过水痘疫苗后还是会得水痘?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 604 次浏览 • 2017-01-04 10:13 • 来自相关话题

疫苗接种禁忌症的“严重的慢性疾病”的标准是什么?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 641 次浏览 • 2017-01-04 10:12 • 来自相关话题

宝宝得过手足口病,还用打手足口病疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 641 次浏览 • 2017-01-04 10:11 • 来自相关话题

界定偶合症发生时间上有限制吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 654 次浏览 • 2017-01-04 10:10 • 来自相关话题

打狂犬疫苗后,多久可以接种疫苗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 578 次浏览 • 2017-01-04 10:09 • 来自相关话题

肛周脓肿好了半年的宝宝能口服脊灰疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 659 次浏览 • 2017-01-04 10:08 • 来自相关话题

请问患有唐氏综合症的孩子可以打疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 1699 次浏览 • 2017-01-04 10:06 • 来自相关话题

刚出生宝宝容易出湿疹,这样能接种疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 622 次浏览 • 2017-01-04 10:05 • 来自相关话题

小孩子出生后不久就确诊为癫痫,请问哪些疫苗可以接种,哪些不能接种?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 595 次浏览 • 2017-01-04 10:04 • 来自相关话题

怀孕生孩子那些事 之 孕期疫苗接种

红太狼 发表了文章 • 0 个评论 • 788 次浏览 • 2016-06-01 22:39 • 来自相关话题

前一段时间,“疫苗事件”发生的时候,有人问我为什么不写文章。我说大家已经写得很多了,正面的,反面的,支持的,反对的,该说的都说了,不该说的也说了,我就没有必要再去凑热闹赶热点了。 现在事件过去了,提疫苗的人少了,我反而要写一篇关于疫苗 ...查看全部

前一段时间,“疫苗事件”发生的时候,有人问我为什么不写文章。我说大家已经写得很多了,正面的,反面的,支持的,反对的,该说的都说了,不该说的也说了,我就没有必要再去凑热闹赶热点了。

现在事件过去了,提疫苗的人少了,我反而要写一篇关于疫苗的文章,不过不是谈儿童的疫苗接种,是谈“孕期疫苗接种”。

疫苗是人类医学史上最伟大的发明之一,在发达国家,导致人类死亡的主要原因是慢性病,而在欠发达地区,传染性疾病依然是头号杀手,疫苗接种是最有效的预防传染性疾病的手段。

在孕期接种疫苗大家还是有顾虑和担心的:首先是担心孕期接种疫苗是否会对胎儿造成不良影响,其次是担心怀孕以后免疫状态的改变是否会影响疫苗接种的效果。

中国没有孕期接种的临床指南,以下所介绍的内容主要参考了美国相关的指南和其他的文献资料。
为什么要在孕期接种疫苗?

每个国家的传染性疾病发生的情况很不一致,因此每个国家都会根据自己的具体情况制订自己国家的疫苗接方案种。原则上讲,这些预防接种最好是在计划怀孕前就进行。但是,依然还是会有一些女性没有在怀孕前接受必要的疫苗接种。对于这些妊娠期妇女,如果传染性疾病暴露的风险比较高,而且一旦感染有可能会对母亲和胎儿带来较大的风险的话,还是需要进行免疫接种的,前提是疫苗是安全的。孕期进行免疫接种可以保护母亲和胎儿免受一些感染的伤害,还可以给出生后的婴儿提供被动保护。

应该向所有孕妇常规推荐破伤风,白喉和百日咳疫苗,以及流感疫苗。这些疫苗在孕期接种是很安全的,可以对新生儿提供很好的被动免疫,不会导致流产的发生。

分娩以后,应该接受所有推荐的,在孕前没有接种和孕期无法接种的疫苗, 例如麻疹、腮腺炎、风疹、水痘、破伤风类毒素、白喉、百日咳等。
孕期接种疫苗安全吗?

灭活病毒和细菌疫苗,类毒素,免疫球蛋白制剂可以在孕期安全应用,没有证据显示其会对胎儿或母亲本身有什么不良影响,如果有指证的话可以在整个孕期应用,包括早孕期。如果没有即刻应用的指证,可以延缓到中孕期以后再使用,推迟到中孕期应用还有一个好处,就是可以打消孕妇的顾虑,这样她们就不会将早孕期常见的不良事件(例如自然流产和出生缺陷)和疫苗接种联系在一起了。另外,妊娠28-32周接种更有利于抗体传递给胎儿。

活疫苗有感染胎儿的潜在风险,虽然没有证据显示会对新生儿和母亲造成伤害,但是对胎儿伤害的潜在风险不能完全除外,所以不建议在孕期使用活疫苗。但是如果母亲暴露的风险很大,感染以后会引起严重的并发症,有很高的死亡率,还是可以考虑使用活疫苗的。使用活疫苗的风险益处应该和感染专家商量以后再做决定,例如,如果孕妇暴露风险很大的话,可以使用黄热病活疫苗。 

如果孕妇意外之中接种了活疫苗或者是在疫苗接种以后4周内怀孕,应该向医生咨询疫苗对胎儿带来的可能风险,在这种情况下不一定要去终止妊娠,因为缺乏直接对胎儿造成伤害的证据。
孕期接种疫苗和非孕期接种一样有效吗?

尽管怀孕以后女性的免疫调节系统会发生较大的变化,但是孕期免疫接种的效果和非孕期妇女的免疫接种效果还是差不多的。

孕期推荐接种的疫苗有哪些?

怀孕期推荐使用的主要疫苗有以下:

流感疫苗:为避免在孕期感染流感引起的不良后果及住院治疗,孕妇接种灭活的流感疫苗非常有必要的。如前所述,孕期接种流感疫苗是安全的,在流感高发的季节,建议在医生的指导下进行接种。

百白破疫苗:在整个孕期都可以接种百白破疫苗,最佳的选择是在妊娠27-36周期间接种。

旅行前接种:有些孕妇需要出差或旅行,特别是出国旅行,在出发之前需要向专家咨询目的地的感染性疾病的发生情况,根据目的地疫情接种相应疫苗预防。
孕期应该避免接种的疫苗有哪些?

HPV
HPV疫苗属于灭活疫苗,理论上不会对妊娠造成不良影响。目前研究也没有发现疫苗对孕妇和胎儿产生不良的影响,但各国指南均建议孕妇不要接种,如果接种后发现怀孕应停止后续接种,其他剂次在分娩后继续进行。 

麻疹,腮腺炎,风疹(MMR)
MMR是减毒活疫苗,不建议在孕期应用,因为有潜在的感染母亲和胎儿的风险,但是到目前为止没有发现导致母儿不良结局的证据。 

水痘
水痘也是活疫苗,不建议在孕期应用,因为有潜在的感染母亲和胎儿的风险,但是到目前为止没有发现导致母儿不良结局的证据。

LAIV 
LAIV是流感减毒活疫苗,不建议在孕期接种,可以在产后或母乳喂养的母亲接种。

结核
虽然没有发现有什么不良影响,依然不建议在孕期接种BCG 疫苗预防结核。 

带状疱疹
是减毒活疫苗,不建议在孕期接种。
 
本文作者:段涛医生
本文地址:http://www.wjbb.com/know/1532
原文出处:http://apps.weibo.com/5076516542/8s0ZkcjX
条新动态, 点击查看
灰太狼

灰太狼 回答了问题 • 2012-09-04 20:50 • 1 个回复 不感兴趣

巨细胞病毒阳性,能接种疫苗吗?

赞同来自:

这类检测结果,可能不宜作为疫苗接种禁忌的依据。建议根据症状、体征来确定疫苗接种禁忌证。供参考!
这类检测结果,可能不宜作为疫苗接种禁忌的依据。建议根据症状、体征来确定疫苗接种禁忌证。供参考!
可根据是“急性疾病”、“严重的慢性疾病”、“慢性疾病的急性发作期”和“免疫功能低下”等指标判断是否属于疫苗接种的禁忌症,多参考已有的临床诊断结果。供参考
可根据是“急性疾病”、“严重的慢性疾病”、“慢性疾病的急性发作期”和“免疫功能低下”等指标判断是否属于疫苗接种的禁忌症,多参考已有的临床诊断结果。供参考
接种疫苗,不要影响因疾病需要的服药治疗。后面的用药治疗也不会影响疫苗的效果
接种疫苗,不要影响因疾病需要的服药治疗。后面的用药治疗也不会影响疫苗的效果
1个月时卵圆孔未闭,如果没有任何缺氧的症状,可不要给小孩贴上“心脏有问题”的标签。建议按照程序正常接种疫苗
1个月时卵圆孔未闭,如果没有任何缺氧的症状,可不要给小孩贴上“心脏有问题”的标签。建议按照程序正常接种疫苗
慢性轻微咳嗽,建议按照程序接种疫苗。乙肝疫苗完成剩余接种剂次即可。在接种疫苗方面,家长不能太纠结,否则接种医生会更纠结!

接种疫苗本身没有特别的风险。接种疫苗一般不会引起疾病加重,但是会担心疾病的变化与接种疫苗在时间上的偶合。
慢性轻微咳嗽,建议按照程序接种疫苗。乙肝疫苗完成剩余接种剂次即可。在接种疫苗方面,家长不能太纠结,否则接种医生会更纠结!

接种疫苗本身没有特别的风险。接种疫苗一般不会引起疾病加重,但是会担心疾病的变化与接种疫苗在时间上的偶合。
接种疫苗后的局部硬结反应,一般1-2个月可恢复。局部热敷有助于硬结吸收
接种疫苗后的局部硬结反应,一般1-2个月可恢复。局部热敷有助于硬结吸收
建议根据是否有缺氧症状来确定疫苗接种
建议根据是否有缺氧症状来确定疫苗接种
疫苗定价由物价部门管理,存在相同品种、不同企业疫苗价格不同的情况。不同企业生产的同品种、规格的疫苗,其预防效果和安全性基本一致(达到疫苗审批的标准)
疫苗定价由物价部门管理,存在相同品种、不同企业疫苗价格不同的情况。不同企业生产的同品种、规格的疫苗,其预防效果和安全性基本一致(达到疫苗审批的标准)
可能与疫苗没有任何关系
可能与疫苗没有任何关系
不是,有过惊厥不是疫苗接种禁忌。按照程序正常接种疫苗吧
不是,有过惊厥不是疫苗接种禁忌。按照程序正常接种疫苗吧

为什么接种过水痘疫苗后还是会得水痘?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 604 次浏览 • 2017-01-04 10:13 • 来自相关话题

疫苗接种禁忌症的“严重的慢性疾病”的标准是什么?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 641 次浏览 • 2017-01-04 10:12 • 来自相关话题

宝宝得过手足口病,还用打手足口病疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 641 次浏览 • 2017-01-04 10:11 • 来自相关话题

界定偶合症发生时间上有限制吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 654 次浏览 • 2017-01-04 10:10 • 来自相关话题

打狂犬疫苗后,多久可以接种疫苗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 578 次浏览 • 2017-01-04 10:09 • 来自相关话题

肛周脓肿好了半年的宝宝能口服脊灰疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 659 次浏览 • 2017-01-04 10:08 • 来自相关话题

请问患有唐氏综合症的孩子可以打疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 1699 次浏览 • 2017-01-04 10:06 • 来自相关话题

刚出生宝宝容易出湿疹,这样能接种疫苗吗?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 622 次浏览 • 2017-01-04 10:05 • 来自相关话题

小孩子出生后不久就确诊为癫痫,请问哪些疫苗可以接种,哪些不能接种?

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 595 次浏览 • 2017-01-04 10:04 • 来自相关话题

请问宝宝肠套叠可以打预防针么?宝宝现在两岁多,去年5次肠套叠,最近几个月没犯了

回复

红太狼 回复了问题 • 1 人关注 • 1 个回复 • 774 次浏览 • 2014-08-22 21:48 • 来自相关话题

怀孕生孩子那些事 之 孕期疫苗接种

红太狼 发表了文章 • 0 个评论 • 788 次浏览 • 2016-06-01 22:39 • 来自相关话题

前一段时间,“疫苗事件”发生的时候,有人问我为什么不写文章。我说大家已经写得很多了,正面的,反面的,支持的,反对的,该说的都说了,不该说的也说了,我就没有必要再去凑热闹赶热点了。 现在事件过去了,提疫苗的人少了,我反而要写一篇关于疫苗 ...查看全部

前一段时间,“疫苗事件”发生的时候,有人问我为什么不写文章。我说大家已经写得很多了,正面的,反面的,支持的,反对的,该说的都说了,不该说的也说了,我就没有必要再去凑热闹赶热点了。

现在事件过去了,提疫苗的人少了,我反而要写一篇关于疫苗的文章,不过不是谈儿童的疫苗接种,是谈“孕期疫苗接种”。

疫苗是人类医学史上最伟大的发明之一,在发达国家,导致人类死亡的主要原因是慢性病,而在欠发达地区,传染性疾病依然是头号杀手,疫苗接种是最有效的预防传染性疾病的手段。

在孕期接种疫苗大家还是有顾虑和担心的:首先是担心孕期接种疫苗是否会对胎儿造成不良影响,其次是担心怀孕以后免疫状态的改变是否会影响疫苗接种的效果。

中国没有孕期接种的临床指南,以下所介绍的内容主要参考了美国相关的指南和其他的文献资料。
为什么要在孕期接种疫苗?

每个国家的传染性疾病发生的情况很不一致,因此每个国家都会根据自己的具体情况制订自己国家的疫苗接方案种。原则上讲,这些预防接种最好是在计划怀孕前就进行。但是,依然还是会有一些女性没有在怀孕前接受必要的疫苗接种。对于这些妊娠期妇女,如果传染性疾病暴露的风险比较高,而且一旦感染有可能会对母亲和胎儿带来较大的风险的话,还是需要进行免疫接种的,前提是疫苗是安全的。孕期进行免疫接种可以保护母亲和胎儿免受一些感染的伤害,还可以给出生后的婴儿提供被动保护。

应该向所有孕妇常规推荐破伤风,白喉和百日咳疫苗,以及流感疫苗。这些疫苗在孕期接种是很安全的,可以对新生儿提供很好的被动免疫,不会导致流产的发生。

分娩以后,应该接受所有推荐的,在孕前没有接种和孕期无法接种的疫苗, 例如麻疹、腮腺炎、风疹、水痘、破伤风类毒素、白喉、百日咳等。
孕期接种疫苗安全吗?

灭活病毒和细菌疫苗,类毒素,免疫球蛋白制剂可以在孕期安全应用,没有证据显示其会对胎儿或母亲本身有什么不良影响,如果有指证的话可以在整个孕期应用,包括早孕期。如果没有即刻应用的指证,可以延缓到中孕期以后再使用,推迟到中孕期应用还有一个好处,就是可以打消孕妇的顾虑,这样她们就不会将早孕期常见的不良事件(例如自然流产和出生缺陷)和疫苗接种联系在一起了。另外,妊娠28-32周接种更有利于抗体传递给胎儿。

活疫苗有感染胎儿的潜在风险,虽然没有证据显示会对新生儿和母亲造成伤害,但是对胎儿伤害的潜在风险不能完全除外,所以不建议在孕期使用活疫苗。但是如果母亲暴露的风险很大,感染以后会引起严重的并发症,有很高的死亡率,还是可以考虑使用活疫苗的。使用活疫苗的风险益处应该和感染专家商量以后再做决定,例如,如果孕妇暴露风险很大的话,可以使用黄热病活疫苗。 

如果孕妇意外之中接种了活疫苗或者是在疫苗接种以后4周内怀孕,应该向医生咨询疫苗对胎儿带来的可能风险,在这种情况下不一定要去终止妊娠,因为缺乏直接对胎儿造成伤害的证据。
孕期接种疫苗和非孕期接种一样有效吗?

尽管怀孕以后女性的免疫调节系统会发生较大的变化,但是孕期免疫接种的效果和非孕期妇女的免疫接种效果还是差不多的。

孕期推荐接种的疫苗有哪些?

怀孕期推荐使用的主要疫苗有以下:

流感疫苗:为避免在孕期感染流感引起的不良后果及住院治疗,孕妇接种灭活的流感疫苗非常有必要的。如前所述,孕期接种流感疫苗是安全的,在流感高发的季节,建议在医生的指导下进行接种。

百白破疫苗:在整个孕期都可以接种百白破疫苗,最佳的选择是在妊娠27-36周期间接种。

旅行前接种:有些孕妇需要出差或旅行,特别是出国旅行,在出发之前需要向专家咨询目的地的感染性疾病的发生情况,根据目的地疫情接种相应疫苗预防。
孕期应该避免接种的疫苗有哪些?

HPV
HPV疫苗属于灭活疫苗,理论上不会对妊娠造成不良影响。目前研究也没有发现疫苗对孕妇和胎儿产生不良的影响,但各国指南均建议孕妇不要接种,如果接种后发现怀孕应停止后续接种,其他剂次在分娩后继续进行。 

麻疹,腮腺炎,风疹(MMR)
MMR是减毒活疫苗,不建议在孕期应用,因为有潜在的感染母亲和胎儿的风险,但是到目前为止没有发现导致母儿不良结局的证据。 

水痘
水痘也是活疫苗,不建议在孕期应用,因为有潜在的感染母亲和胎儿的风险,但是到目前为止没有发现导致母儿不良结局的证据。

LAIV 
LAIV是流感减毒活疫苗,不建议在孕期接种,可以在产后或母乳喂养的母亲接种。

结核
虽然没有发现有什么不良影响,依然不建议在孕期接种BCG 疫苗预防结核。 

带状疱疹
是减毒活疫苗,不建议在孕期接种。
 
本文作者:段涛医生
本文地址:http://www.wjbb.com/know/1532
原文出处:http://apps.weibo.com/5076516542/8s0ZkcjX

朝令夕改:混乱的第30个“儿童预防接种日”宣传主题

红太狼 发表了文章 • 2 个评论 • 3914 次浏览 • 2016-04-21 17:32 • 来自相关话题

2016年4月25日为第30个全国“儿童预防接种日”,每年的儿童预防接种日照例都会有一个宣传主题,来宣传预防接种的重要性。在2016年3月份爆发的震惊世界的山东疫苗案件暴露中国的疫苗监管环节存在监管漏洞(见WHO的声明)。在此大背景下,4月份的“儿童预防接种日 ...查看全部
2016年4月25日为第30个全国“儿童预防接种日”,每年的儿童预防接种日照例都会有一个宣传主题,来宣传预防接种的重要性。在2016年3月份爆发的震惊世界的山东疫苗案件暴露中国的疫苗监管环节存在监管漏洞(见WHO的声明)。在此大背景下,4月份的“儿童预防接种日”的传宣主题选择显得尤为重要和敏感。
 
接种日主题朝令夕改:三天一变,变了三次

① 2016年4月15日,确定“开展预防接种,享受健康生活”为今年儿童预防接种日主题。

② 2016年4月18日,确定“信任预防接种,享受健康生活”为今年儿童预防接种日主题。

③ 2016年4月21日,确定“依法预防接种,享受健康生活”为今年儿童预防接种日主题。

 
“开展”→“信任”→“依法”,该现象被戏称为“依法不信任”。
 
接种日主题朝令夕改进一步消弱了疾控中心的公信力
这种接种日主题确定的随意性和多变性反映了中国疾控中心的非专业性和不严肃性、决策的不透明性和可操作性,及可能的一言堂现象。也说明内部存在激烈的博弈。
 
接种日主题朝令夕改造成了巨大资源的浪费
在4月25日接种日来临前频繁变动主题,会令全国各地的预防接种点已经制作好的宣传材料统统作废,这无疑进一步增加了各地接种机构的工作量,以及伴随的资源浪费,而这些浪费最终都得由纳税人买单。


最后,“依法预防接种,享受健康生活”为第30个全国“儿童预防接种日”宣传主题,为了孩子和家人的健康,请及时接种疫苗。如果经济条件允许,二类疫苗,尤其是多联疫苗,也需要接种。毕竟,“一盎司的预防胜过一磅的治疗(Anounce of prevention worth more than a pound of curative medicine)”,这句名言最初由Henry de Bracton (1200/1210-1268)提出,和中国的“上医治未病”有异曲同工之妙。

本文作者:红太狼
本文地址:http://www.wjbb.com/know/1505
 

加拿大预防接种指南:怀孕和哺乳人群的预防接种

豌豆爸爸 发表了文章 • 0 个评论 • 911 次浏览 • 2015-04-17 15:27 • 来自相关话题

Pregnancy provides an opportunity for evaluation of a woman's immunization status. Pregnant women are a vulnerable population. The ...查看全部

Pregnancy provides an opportunity for evaluation of a woman's immunization status. Pregnant women are a vulnerable population. They have an altered immune response and, for some infections, are at increased risk of infection and at increased risk of severe outcomes once infected. The fetus, neonate and young infant can also be impacted by infections that can results in congenital abnormalities or severe illness.

One of the challenges of developing recommendations for pregnant and breastfeeding women is the lack of studies that would allow making evidence-based decisions. Only a few methodologically robust studies of vaccine administration in pregnant and breastfeeding women exist; most safety data available are derived from registries where outcomes are passively reported.

When considering vaccination for pregnant or breastfeeding women, it is important to distinguish between live and inactivated vaccines. There is no theoretical reason to suspect that inactivated vaccines would be associated with an increased risk of adverse events when administered during pregnancy or in breastfeeding women. Live vaccines, however, such as measles, mumps, rubella, varicella, and yellow fever, should generally not be given during pregnancy because of the theoretical risk of harm to the foetus if transmission of the vaccine virus to the fetus occurs.

Ideally, the immunization status of women intending to become pregnant should be reviewed and vaccines updated as necessary prior to conception. Live vaccines, for example, can be given to non-pregnant women with the advice to avoid pregnancy for at least 28 days following immunization. Some pregnancies are unplanned, however, and immunization status will need to be assessed during the pregnancy.

Maternal Benefits

The objective of vaccination during pregnancy is to protect the mother and, potentially, the fetus and newborn. Pregnant women respond adequately to vaccines even though pregnancy is an immunologically altered state. Clinical trials of tetanus toxoid and inactivated polio vaccine administered during pregnancy have demonstrated normal adult immunologic responses. Vaccines recommended for the protection of a pregnant woman's health include:

inactivated influenza vaccine
hepatitis B vaccine for a woman with ongoing exposure risks
hepatitis A vaccine for a woman who is a close contact of a person with hepatitis A or who is travelling to an endemic area
tetanus toxoid and reduced diphtheria toxoid-containing vaccine if indicated
meningococcal vaccine in an outbreak setting or post-exposure
pneumococcal polysaccharide or conjugate vaccine for women in a high risk group due to underlying illnesses

acellular pertussis-containing vaccine (Tdap) for all pregnant women who are 26 weeks of pregnancy or greater who have not previously received Tdap vaccine in adulthood ; imunization should not be delayed until close to delivery since this may provide insufficient time for optimal transfer of antibodies and direct protection of the infant against pertussis

Maternal Safety

Inactivated vaccines are generally safe in pregnancy. Reactions following vaccination with inactivated vaccines are usually limited to the injection site. No increase in anaphylactic reactions or events that might induce preterm labour has been observed. Vaccines that contain thimerosal are considered safe in pregnancy and the National Advisory Committee on Immunization (NACI) has concluded that there is no safety reason to avoid the use of thimerosal-containing vaccines for pregnant women.

Benefits of Immunization in Pregnancy for the Fetus and Infant

The beneficial effects of maternal vaccination for the newborn have been well documented. Maternal vaccination protects the mother from vaccine-preventable diseases that she otherwise may transmit to her fetus or infant. In addition, protective concentrations of maternal antibodies may be transferred to the fetus transplacentally, with the majority of transfer occurring during the third trimester. Maternal antibodies typically have a half-life of 3 to 4 weeks in the newborn, and progressively decrease during the first 6 to 12 months of life. Recommended infant immunization schedules take into consideration the potential effect that maternally transferred antibodies may have on infant vaccinations.

Safety of Immunization in Pregnancy for the Fetus/Infant

There is no theoretical reason to suspect that adverse events will occur in the fetus or infant following maternal vaccination with inactivated vaccines during pregnancy. There are no published data indicating that currently authorized inactivated vaccines are teratogenic or embryotoxic, or have resulted in specific adverse pregnancy outcomes.

In general, live attenuated viral or bacterial vaccines are contraindicated in pregnancy, as there is a theoretical risk to the fetus; however, when benefits outweigh risks, vaccination with a live attenuated vaccine may be considered (e.g., yellow fever vaccine in a pregnant woman travelling to an endemic area).

Imunization During Pregnancy (refer to Table 1)
Recommended vaccines
Inactivated influenza vaccine

All pregnant women, at any stage of pregnancy, should be considered high priority for receiving inactivated influenza vaccine, because of their increased risk of influenza-associated morbidity, evidence of adverse neonatal outcomes associated with maternal influenza, evidence that vaccination of pregnant women protects their newborns from influenza and influenza-related hospitalization, and evidence that infants born during the influenza season to vaccinated women are less likely to be premature, small for gestational age, and low birth weight. Live attenuated influenza vaccine should not be given to pregnant women, as discussed in the previous section.

There is good evidence demonstrating the safety of inactivated influenza vaccine during pregnancy. Active surveillance following influenza vaccination during pregnancy has not shown evidence of harm to the mother or fetus associated with influenza immunization. Although the cumulative sample size of these studies is relatively small, particularly for immunisation in the first trimester, passive surveillance has not raised any safety concerns, despite widespread use of influenza vaccine in pregnancy over several decades. Surveillance following the use of both adjuvanted and unadjuvanted pH1N1 vaccine in more than 100,000 pregnant women in Canada and almost 500,000 pregnant women in Europe did not reveal any safety concerns.

Women who did not receive influenza vaccination during pregnancy should receive influenza vaccine post-partum before discharge from hospital if it is influenza season.

Refer to Influenza Vaccine in Part 4 for additional information.

Hepatitis B vaccine

All pregnant women should be routinely tested for hepatitis B surface antigen (HBsAg). A pregnant woman who has no markers of hepatitis B (HB) infection but who is at high risk of HB should be offered a complete HB vaccine series at the first opportunity during the pregnancy and should be tested for antibody response. HB vaccine can be used safely in pregnancy and should be administered when indicated, because acute HB in a pregnant woman may result in severe disease for the mother and chronic infection in the infant. The safety of combined hepatitis A-hepatitis B vaccine given during pregnancy has not been studied in clinical trials; however, there is no theoretical reason to suspect an increased risk of adverse events to mother or infant. Refer to Hepatitis B Vaccine in Part 4 for additional information.
 
Vaccines that may be indicated
Hepatitis A vaccine

The efficacy and safety of hepatitis A vaccines given during pregnancy has not been studied in clinical trials, but there is no theoretical reason to suspect an increased risk of adverse events to the mother or the infant. Hepatitis A can cause severe disease in pregnancy, and the vaccine should be considered for pregnant women when potential benefits outweigh risks, such as for post-exposure prophylaxis or for travel to high risk endemic areas. Refer to Hepatitis A Vaccine in Part 4 for additional information.

Tetanus toxoid, diphtheria toxoid, acellular pertussis vaccines

Susceptible pregnant women may receive tetanus toxoid-reduced diphtheria toxoid-containing vaccine (Td) if indicated. Follow-up data on pregnant women who have received tetanus toxoid-containing vaccine (often in the first trimester) have not revealed an increased risk of adverse events. There is no theoretical reason to suspect an increased risk of adverse events to mother or infant following the administration of Td vaccine.

Immunization with Tdap to date has been shown to be safe in pregnant women and allows high levels of antibody to be transferred to newborns during the first two months of life when the morbidity and mortality from pertussis infection is the highest. All pregnant women at 26 weeks of pregnancy or later, who have not received a dose of pertussis-containing vaccine in adulthood, should be encouraged to receive Tdap vaccination. Immunization should not be delayed until close to delivery since this may provide insufficient time for optimal transfer of antibodies and direct protection of the infant against pertussis.   In special circumstances, such as a pertussis outbreak, all pregnant women who are 26 weeks gestation or greater may be offered Tdap vaccination, irrespective of their immunization history based on the advice of local public health officials.  Refer to Tetanus Toxoid, Diphtheria Toxoid and Pertussis Vaccine in Part 4 for additional information.
Top of PagePoliomyelitis vaccine

Inactivated poliomyelitis vaccine (IPV) may be considered for pregnant women who require immediate protection and are at increased risk of exposure to wild poliovirus. Limited data have not revealed an increased risk of adverse events associated with IPV vaccine administered to pregnant women. There is no theoretical reason to suspect an increased risk of adverse events to mother or infant following IPV administration. Refer to Poliomyelitis Vaccine in Part 4 for additional information.

Pneumococcal vaccine

Recommendations for pneumococcal vaccines in pregnancy and for breastfeeding women are the same as for non-pregnant and non-breastfeeding adults. Pneu-P-23 is recommended for adults at high risk for invasive pneumococcal disease;  additionally, Pneu-C-13 is recommended for adults who are immunocompromised. There is no evidence to suggest a risk to the fetus or to the pregnancy from maternal immunization with inactivated vaccines, therefore, women who are breastfeeding can be vaccinated with Pneu-P-23 or Pneu-C-13 vaccine, if indicated. Refer to Pneumococcal Vaccine in Part 4 and Immunization of Immunocompromised Persons and Immunization of Persons with Chronic Diseases in Part 3 for additional information.

Meningococcal vaccine

Conjugate meningococcal vaccines have not been studied in pregnancy; however, there is no theoretical reason to suspect adverse events to mother or infant will occur and may be given in circumstances when the benefits outweigh the risks. Conjugate meningococcal vaccine should be considered for pregnant women in circumstances such as travel to a high risk area; post-exposure prophylaxis against a vaccine preventable strain if indicated; or during an outbreak if indicated. Refer to Meningococcal Vaccine in Part 4 for additional information.

Rabies vaccine

If a pregnant woman has had a potential exposure to rabies, post-exposure prophylaxis should be given. If pre-exposure prophylaxis is indicated for work or travel purposes, in general, avoidance of risk should be considered and pre-exposure immunization delayed unless substantial risk of exposure remains. Refer to Rabies Vaccine in Part 4 for additional information.

Other inactivated vaccines

Cholera and travellers' diarrhea vaccine, and Japanese encephalitis vaccine have not been studied in pregnant women. Administration of either vaccine to pregnant women may be considered only in high risk situations after evaluation of the benefits and risks. Inactivated parenteral typhoid vaccine should be used in high risk situations if protection against typhoid is required. Refer to vaccine specific chapters in Part 4 for additional information.
 
Vaccines not recommended
Human papillomavirus vaccine (HPV)

HPV vaccine is not recommended for use in pregnancy because data on efficacy and safety of HPV vaccination in pregnancy are limited. No adverse outcomes of pregnancy or adverse events to the developing fetus have been reported. Initiation of the HPV vaccine series should be delayed until after completion of pregnancy. If a woman is found to be pregnant after initiating the vaccination series, completion of the series should be delayed until after pregnancy. If a vaccine dose has been administered during pregnancy. No intervention is required if vaccine has been administered during pregnancy. Refer to Human Papillomavirus Vaccine in Part 4 for additional information.

Generally contraindicated vaccines
Measles-mumps-rubella vaccine

Measles-mumps-rubella vaccine (MMR live attenuated vaccine) is generally contraindicated in pregnancy because there is a theoretical risk to the fetus. However, in some situations, potential benefits may outweigh risks, such as during measles or rubella outbreaks, in which case vaccination may be considered. There is no evidence to date demonstrating a teratogenic or other risk from MMR vaccine. Inadvertent immunization with MMR vaccine is not a reason for pregnancy termination.

Pregnant women without documented evidence of prior immunization with a rubella-containing vaccine should be serologically screened for rubella antibodies. Those found not to be immune on serological testing should be vaccinated with one dose of MMR vaccine in the immediate post-partum period, before discharge from hospital (unless they have received Rh immune globulin [RhIg] - refer to Rh immune globulin and MMR vaccine). Women who have been appropriately immunized post-partum do not need to be serologically screened for rubella antibodies, either post-immunization or in subsequent pregnancies. Women who have been found to be serologically positive in one pregnancy do not need to be screened again in subsequent pregnancies.

Refer to Measles Vaccine, Mumps Vaccine, and Rubella Vaccine in Part 4 for additional information.

Univalent varicella vaccine

Varicella vaccine (a live attenuated vaccine) is contraindicated in pregnancy because there is a theoretical risk to the fetus; however, there is a lack of evidence to demonstrate a teratogenic or other risk from varicella vaccine. Inadvertent immunization with varicella vaccine is not a reason for pregnancy termination.

Pregnant women without documented evidence of prior immunization with 2 doses of varicella vaccine or evidence of varicella disease should be serologically screened for varicella antibodies. Those found to be susceptible to varicella should receive 2 doses of a univalent varicella vaccine, 6 weeks apart; the first dose should be given in the immediate post-partum period, before discharge from hospital (unless they have received Rh immune globulin [RhIg] - refer to Rh immune globulin). Once appropriately immunized, there is no need for serological confirmation of immunity.

Refer to Varicella (Chickenpox) Vaccine in Part 4 for additional information, including post-exposure prophylaxis with varicella zoster immune globulin for pregnant women exposed to varicella.

Other live attenuated vaccines

The use of other live attenuated vaccines during pregnancy must be evaluated on the basis of the individual risk and benefit. Live attenuated oral typhoid vaccine is contraindicated in pregnancy because of the lack of data on safety or efficacy; inactivated typhoid vaccine should be used if indicated. Live attenuated intranasal influenza vaccine should not be given to pregnant women; inactivated influenza vaccine should be used if indicated. Live oral polio vaccine (OPV) should not be administered to pregnant women; inactivated polio vaccine should be used if indicated. In addition, OPV is not available in Canada. BCG vaccine has not been studied in pregnant or breastfeeding women. BCG vaccine should not be given during pregnancy although no harmful effects of BCG vaccination on the fetus have been observed.

If a pregnant woman must travel to an area at high risk of yellow fever transmission and a high level of mosquito protection is not feasible, yellow fever (YF) vaccine may be administered when the risk of exposure is high and the travel cannot be postponed. In one study of women given YF vaccine early in pregnancy, there was slight increased risk of minor malformations (mainly skin) in the babies; no increased risk of major malformations was found. Since seroconversion rates following YF vaccine are lower during pregnancy; post-immunization serology should be considered. Inadvertent immunization with YF vaccine is not a reason for pregnancy termination.

Smallpox vaccine may be considered for a pregnant woman in the highly unlikely event of a high risk exposure.

Refer to vaccine specific chapters in Part 4 for additional information.

Live attenuated vaccines and Rh immune globulin

A risk-benefit assessment is needed for post-partum women who have received RhIg and require MMR or varicella vaccine. Immune globulin administration may impair the efficacy of live attenuated vaccines, such as MMR and varicella, as measles, rubella, and varicella antibodies may be present in the RhIg preparation. The risk of lowered vaccine efficacy in the long term needs to be weighed against the need for protection in the short-term. To optimize response to vaccine, rubella-, measles- or varicella-susceptible women who receive RhIg in the peri-partum period should generally wait 3 months before being vaccinated with MMR or varicella vaccine.

However, if there is a risk of exposure to rubella, measles, or varicella, a risk of recurrent pregnancy in the 3-month post-partum period, or a risk that vaccines may not be given later, MMR, univalent varicella vaccines or both may be given prior to discharge with a second dose at the recommended interval if indicated. If only one dose is needed, serologic testing for rubella and varicella should be done 3 months later and women who have not mounted an antibody response should be revaccinated. In the event that a post-partum woman receives MMR or varicella vaccines prior to receiving RhIg and a second dose is not indicated, serologic testing for rubella, varicella or both should be done 3 months later and the woman revaccinated if she has not mounted an antibody response.

Biologic products during pregnancy

There is no known risk to the fetus or pregnant woman from administration of immune globulin for passive immunization. Immune globulin products should be administered to pregnant women as required.

In general, women should not receive immune modulators, such as infliximab or rituximab, during pregnancy. IgG immunoglobulins are known to pass the placental barrier and there is a risk that this treatment could deplete B-cells in both pregnant women and their fetus. It is particularly important not to administer live vaccines to pregnant women who receive monoclonal antibodies, such as TNF inhibitors. Refer to Immunization of breastfed infants for additional implications for the infant.

In general, women should not receive immune modulators, such as infliximab or rituximab, during pregnancy. IgG immunoglobulins are known to pass the placental barrier and there is a risk that this treatment could deplete B-cells in both pregnant women and their fetus. It is particularly important not to administer live vaccines to pregnant women who receive monoclonal antibodies, such as TFN inhibitors. Refer to Immunization of breastfed infants for additional implications for the infant.
 
Immunization of Household Contacts of Pregnant Women

A pregnant household member is not a contraindication for routine vaccination of her household contacts. On the contrary, pregnancy should be used as an opportunity to update immunization of susceptible household contacts. MMR and varicella-containing vaccines should be administered when indicated to children and other household contacts of pregnant women. Infants living in households with a pregnant woman can be vaccinated with rotavirus vaccine, as indicated. The risk of infection and disease from rotavirus vaccine virus is low because most women of childbearing age have pre-existing immunity to rotavirus through natural exposure and rotavirus infection during pregnancy is not known to pose a risk to the fetus.

In the unlikely event of vaccination against smallpox, extreme precautions should be taken for unvaccinated pregnant household and other close contacts of persons receiving smallpox vaccine to eliminate viral transfer to these contacts. Such precaution can include isolation of the vaccinee from his or her pregnant household contacts until the vaccine scab falls off.
 
Immunization during Breastfeeding (refer to Table 1)

Immunization of breastfeeding women

In general, routinely recommended vaccines may be safely administered to breastfeeding women. There are limited data available regarding the effects of maternal vaccination on breastfed infants; however, there have been no reported adverse events thought to be vaccine-related. There is no evidence that immunization during breastfeeding will adversely influence the maternal or infant immune response.

Annual influenza vaccination is recommended for breastfeeding women. Live attenuated influenza vaccine has a similar or lower immune response than inactivated influenza vaccine in adults; inactivated vaccine is preferred if the breastfeeding woman has a chronic health condition.

Women who are breastfeeding can be vaccinated with Td, Tdap, pneumococcal, meningococcal, hepatitis A, hepatitis B, IPV, rabies, typhoid, MMR, varicella and cholera vaccines, if they are indicated. HPV vaccine may be administered to breastfeeding women.

Japanese encephalitis (JE) vaccine has not been studied in breastfeeding women. Administration of JE vaccine to breastfeeding women who must travel to areas where the risk of JE infection is high should be immunized only if the risk of disease outweighs the unknown risk of vaccination to the woman and her breastfeeding infant.

There are a few instances when vaccination is not recommended during breastfeeding. Probable transmission of yellow fever vaccine strain virus from a mother to her infant through breastfeeding has been reported; therefore, breastfeeding mothers should not generally be vaccinated with yellow fever vaccine , unless potential benefits outweigh risks, such as travel to areas in which the risk of transmission is high and mosquito protection is not feasible. It is not known whether BCG vaccine is excreted in human milk. Because live vaccine may be excreted in human milk, caution should be exercised when considering BCG vaccine while breastfeeding. Smallpox vaccine is not recommended for breastfeeding women because of the theoretical risk for contact transmission from mother to infant. If smallpox vaccine is used for any reason in a breastfeeding woman, breastfeeding and other close contact with the baby should be avoided until the scab has separated from the vaccination site.

Refer to vaccine specific chapters in Part 4 for additional information.

Immunization of breastfed infants

In general, infants who are breastfed should receive all recommended vaccines according to the routine immunization schedule. In developed countries, there is no evidence that transfer of antibodies in human milk can affect the efficacy of live attenuated vaccines in breastfed infants.

The one exception to this recommendation is for breastfeeding women who are receiving immunosuppressive monoclonal antibodies (such as infliximab or rituximab), or who were on these drugs during pregnancy. Because monoclonal antibodies are excreted in human milk, women should be advised to discontinue nursing until circulating drug levels are no longer detectable. Infants who have been exposed to monoclonal antibodies, either during pregnancy or from breastfeeding, should not receive BCG vaccine at birth and should have B cell enumeration. B cell enumeration should be normal before vaccination with BCG or live vaccines. Consultation with an immunologist is advised.

Refer to Immunization of Immunocompromised Persons in Part 3 for additional information regarding monoclonal antibodies and immunization.
 
中文翻译:
本文地址:http://www.wjbb.com/know/1043
原文出处:http://www.phac-aspc.gc.ca/publicat/cig-gci/p03-04-eng.php

针头恐惧症:如何应对?

豌豆爸爸 发表了文章 • 0 个评论 • 961 次浏览 • 2015-02-04 12:08 • 来自相关话题

Q: Our 13-year-old daughter has always been afraid of needles. When she got the chicken pox vaccine, she screamed and hid under th ...查看全部

Q: Our 13-year-old daughter has always been afraid of needles. When she got the chicken pox vaccine, she screamed and hid under the exam table, but eventually agreed to have the shot. As a result of that shot, she developed the skin infection cellulitis and now will not consent to get the HPV vaccine. She has even refused to have a dental filling, and the cavity has become so large she needs a root canal.

A: The majority of children experience significant fears while growing up. If these fears persist, become irrational and disrupt normal behaviours, they are called phobias, and the feared object (or even thinking about that object) can trigger tummy aches, headaches, breathing problems and other physical complaints. It’s called the fight-or-flight response, and most of us have encountered it in our lives. But your daughter’s phobia is affecting her health, so it needs to be addressed.

Your family doctor can put you in contact with a specialist in desensitization and cognitive behavioural therapy techniques, which can help your daughter learn to cope with her fear of needles. The therapist will gradually introduce the thought of a needle: first maybe just imagining one, then seeing a picture, then having a wrapped needle in the room. She’ll also be taught relaxation techniques to use when she begins to feel panicky during these sessions, and taught to understand how her thoughts are making her fearful. For example, she may believe that every time she gets a shot she will contract cellulitis; the sessions will help her learn that although this is a possible complication, it is very rare.

The coping skills your daughter will learn through this kind of therapy will help her throughout life. Maybe I’ll even meet her in medical school someday!

中文翻译:
本文地址:http://www.wjbb.com/know/939
原文出处:http://www.todaysparent.com/kids/tween-and-teen/fear-of-needles/

美国儿科学会:教育短信提醒有助于儿童及时接种疫苗

灰太狼 发表了文章 • 1 个评论 • 1069 次浏览 • 2015-01-10 15:08 • 来自相关话题

在当今这个技术发达的世界,短信已经成为一种多面的沟通形式,并且它现在已经应用于医药领域。哥伦比亚大学医学中心和梅尔曼公共卫生学院的研究人员对短信在流感季节对疫苗接种率的影响力有多大进行了研究,并将他们的研究结果刊登在儿科学杂志上。 在 ...查看全部


在当今这个技术发达的世界,短信已经成为一种多面的沟通形式,并且它现在已经应用于医药领域。哥伦比亚大学医学中心和梅尔曼公共卫生学院的研究人员对短信在流感季节对疫苗接种率的影响力有多大进行了研究,并将他们的研究结果刊登在儿科学杂志上。

在2012至2013年流感季节,孩子们接受最初的流感接种后,就给其家长发送短信提醒。第二剂疫苗可保护孩子们免受病毒侵害,研究者还发现短信提醒可增加随访率。当短信中的教育信息说明了第二剂疫苗的重要性,家长就更有可能把他们的孩子再次带回到医生那里进行第二次接种。

“这种短信程序使医疗保健机构即使不在办公室里也能够照顾他们的病人,有点像现代出诊,”该研究报告的主要作者,梅尔曼公共卫生学院人口和家庭健康副教授和医疗中心儿科学副教授梅利莎斯托克韦尔,在新闻发布会上说:“即使在一个季节最终接受了两次接种的儿童,两次接种之间的时间间隔通常超过了推荐的28天。这使得病毒流行时儿童处于未受保护状态”。

研究人员调查了三个附属于曼哈顿的纽约长老会医院和哥伦比亚大学医学中心儿科诊所的儿童。在研究过程中,研究者评估了来自660个不同家庭、年龄在6个月至8岁之间的儿童的第二次疫苗接种情况。收到教育短信的家长中更可能把他们的孩子带回医院进行第二剂疫苗接种(比例为72.7%)。而接到简单的文字提醒的人将孩子带回医院进行第二剂接种的比例为66.7%,收到儿科医院办公室书面提醒的父母将孩子带回医院进行第二剂接种的比例为为57.1%。

这项研究的作者写道“这种随机对照试验为流感疫苗文本信息提示的最佳做法的建立提供了宝贵的资料,下一步将重点评估文本信息疫苗提醒在其他人口及其他疫苗中影响"。

父母要留意很多不同的事情,从养育一个健康、积极和适应社会的孩子,到确保他们及时按照预定时间注射疫苗。信息提醒是获得最高成功率的关键,而且手机已经成为父母以短信形式发声的个人助理。

中文翻译:碧水青竹
本文地址:http://www.wjbb.com/know/920
原文出处:http://www.medicaldaily.com/flu-vaccine-coverage-improves-text-message-reminders-will-likely-protect-more-315610
文章下载:http://pediatrics.aappublications.org/content/135/1/e83

美国儿科学会:青少年健康的处方,接种推荐的疫苗

灰太狼 发表了文章 • 1 个评论 • 847 次浏览 • 2014-11-19 13:55 • 来自相关话题

作者:特约撰稿人 Trisha Korioth 当您的孩子还是婴儿时,你会尽力准时去儿科医生那接种推荐的疫苗。当他处于青春期前期或已经进入青春期时,您的孩子仍然需要接种疫苗以预防相关疾病。 从11-12岁开 ...查看全部


作者:特约撰稿人 Trisha Korioth

当您的孩子还是婴儿时,你会尽力准时去儿科医生那接种推荐的疫苗。当他处于青春期前期或已经进入青春期时,您的孩子仍然需要接种疫苗以预防相关疾病。

从11-12岁开始,青少年就可以接种3-4种疫苗,如果他们是高危患者或落后推荐流程则需要增加疫苗。美国儿科学会支持在美国7至18岁青少年接种包括以下重要疫苗的推荐计划。

人类乳头瘤病毒(HPV)疫苗

现在给您的孩子接种此疫苗可以帮助防止日后某种形式的癌症。推荐给青少年女性的三剂量的人类乳头瘤病毒疫苗系列可以预防宫颈癌和生殖器疣。疾病预防控制中心不久也将推荐男孩也接种此疫苗。

脑膜炎球菌疫苗

脑膜炎球菌结合疫苗(MCV4)保护对抗细菌引起血液、大脑和脊髓的感染。MCV4建议在11或12岁接种,加强针建议在16岁使用,可以在脑膜炎疾病高发时持续提供保护。这种具有潜在致命性的疾病在拥挤的场所如大学宿舍和军营是最常见的。

破伤风、白喉、百日咳三联疫苗

破伤风、白喉、百日咳疫苗(Tdap)可以防止百日咳暴发,也被称为百日咳疫情。百日咳对婴儿是特别致命的,且给青少年接种该疫苗可以防止该疾病在社区的传播。这种疫苗还会加强一剂预防破伤风(牙关紧闭症),该病毒通过破损的皮肤进入机体,会引起肌肉僵硬。此疫苗还可以预防白喉、细菌性呼吸道疾病。

流感疫苗

流感疫苗建议每年接种,特别是6个月大的婴幼儿及老年人。如果父母们有问题或担忧他们的孩子是否应该接种灭活或减毒活疫苗,应该和他们的儿科医生商量一下。

留好记录

当孩子们准备上大学或离开家后,青少年应该携带他们的免疫记录复印件。若要查找记录,请联系您的儿科医生办公室。其他可能有此信息的来源包括孩子就读的学校和州立免疫注册登记处。

中文翻译:wf911112110
本文地址:http://www.wjbb.com/know/886
原文出处:http://aapnews.aappublications.org/content/32/12/32.4.full

美国医学会杂志(JAMA):孕妇接种百日咳疫苗是安全的

红太狼 发表了文章 • 0 个评论 • 2044 次浏览 • 2014-11-13 10:55 • 来自相关话题

据一项发表在《美国医学会杂志》的大型回顾性观察性研究显示,妊娠晚期的孕妇接种百日咳-白喉-破伤风(Tdap)疫苗是安全的,不会影响胎儿健康。 该研究的主要作者,来自美国明尼阿波里斯市HealthPartners健康教育研究所的Dr. ...查看全部

据一项发表在《美国医学会杂志》的大型回顾性观察性研究显示,妊娠晚期的孕妇接种百日咳-白喉-破伤风(Tdap)疫苗是安全的,不会影响胎儿健康。

该研究的主要作者,来自美国明尼阿波里斯市HealthPartners健康教育研究所的Dr. Elyse Kharbanda认为,Tdap疫苗不会增加早产、低出生体重或子痫前期等妊娠并发症风险。她说:“百日咳疫苗是预防百日咳最有效的武器,我们的研究证实,孕妇也应该接种这些疫苗。”

在2010年时,美国加州曾爆发百日咳疫情,导致部分新生儿死亡,因此加州首先建议所有孕妇接种Tdap疫苗。美国免疫接种咨询委员会建议,所有胎龄27周至36周的孕妇均应接种Tdap疫苗。

而在2012年期间,全美共计出现50,000例百日咳感染病例,其中20例死亡,绝大多数发生在3个月以下的婴儿。美国CDC的数据显示,这是自1955年以来数量最多的一年。

而在这项研究中,作者共分析了超过12万名孕妇的资料。当中约有12%的孕妇接种了Tdap疫苗。结果显示,早产、低出生体重或子痫前期等疾病的风险并未增加。但研究同时指出,绒毛膜羊膜炎的风险出现轻微增加。

来自波士顿麻省总医院的Dr. Laura Riley指出,Tdap疫苗并非活疫苗,因此不会增加胎儿感染百日咳的风险。部分孕妇可能出于类似担忧而拒绝接种疫苗,导致百日咳疫情的爆发。

此外,作者指出由于接种疫苗后所产生的抗体无法维持长时间,建议孕妇每次怀孕都接种疫苗。

参考文献:Kharbanda EO, Vazquez-Benitez G, Lipkind HS, et al. Evaluation of the Association of Maternal Pertussis Vaccination With Obstetric Events and Birth Outcomes.JAMA. 2014;312(18):1897-1904. http://jama.jamanetwork.com/article.aspx?articleid=1930817

出处:http://mp.weixin.qq.com/s?__biz=MjM5ODgxMjU4MA==&mid=201069326&idx=1&sn=b836d721479dc8c0389167513a02cc50#rd

美国梅奥诊所:为什么婴幼儿需要这么频繁接种这么多疫苗?

豌豆爸爸 发表了文章 • 0 个评论 • 1480 次浏览 • 2014-09-02 19:57 • 来自相关话题

来自医学博士Jay L. Hoecker的回答。 比起大龄儿童,传染病对婴幼儿造成的问题更严重,所以新生儿需要接种多种疫苗。 虽然母体抗体可帮助新生儿防范多种疾病,但这种免疫力在孩子出生一个月后很快消失。 ...查看全部


来自医学博士Jay L. Hoecker的回答。

比起大龄儿童,传染病对婴幼儿造成的问题更严重,所以新生儿需要接种多种疫苗。

虽然母体抗体可帮助新生儿防范多种疾病,但这种免疫力在孩子出生一个月后很快消失。再者,孩子对某些疾病的免疫力无法从母体获得,比如百日咳。如果孩子没有接种疫苗而暴露在疾病环境中,可能会生病并传播疾病。

不要更改推荐的你孩子的疫苗接种时间表。研究表明,按照疾病预防控制中心建议的疫苗接种时间表,婴幼儿在同一时间接种多种疫苗是安全的。

谨记:家庭成员、保健提供者和其他婴幼儿经常接触人员,以及去杂货店之类的日常活动,都会使婴幼儿暴露在疾病环境中。即便孩子有点小毛病,比如感冒、耳痛或者低烧,也可以接种一些疫苗。定期咨询孩子的医生,跟进孩子的疫苗接种情况。

中文翻译:陈小晴
本文地址:http://www.wjbb.com/know/520
原文出处:http://www.mayoclinic.org/healthy-living/infant-and-toddler-health/expert-answers/vaccination-schedule/faq-20058197

美国梅奥诊所:孕期推荐接种哪些疫苗?哪些疫苗是应该避免的?

豌豆爸爸 发表了文章 • 1 个评论 • 1987 次浏览 • 2014-08-25 15:51 • 来自相关话题

来自医学博士Roger W. Harms的回答。 一般而言,含有灭活(减毒)病毒的疫苗可以在孕期使用,而含有活病毒的疫苗不推荐孕妇使用。 孕期常规推荐接种的疫苗有两种: - 流感疫 ...查看全部

来自医学博士Roger W. Harms的回答。

一般而言,含有灭活(减毒)病毒的疫苗可以在孕期使用,而含有活病毒的疫苗不推荐孕妇使用。

孕期常规推荐接种的疫苗有两种:

- 流感疫苗:流感疫苗推荐在流感季(尤其是11月至次年3月)怀孕的准妈妈们接种。流感疫苗由减活病毒制成,因此对准妈妈和宝宝均安全。避免使用鼻腔喷雾疫苗,那是由活病毒制成的。
- 百白破三联疫苗(Tdap):推荐准妈妈在孕期接种1剂量的百白破三联疫苗以保护新生儿免于感染百日咳,无论您接种最后一剂百白破三联疫苗或或破伤风白喉二联疫苗(Td)是在什么时候。理想情况下,疫苗应在孕期第27至36周间接种。

孕期接种流感疫苗和百白破三联疫苗可以保护您免受感染,也能在宝宝可以接种疫苗前帮助保护宝宝的健康。这非常重要,因为流感和百日咳对于新生儿来说相当危险。

如果您要去国外旅行或感染某些特定疾病的风险增加,医护人员也可能会建议您在孕期接种其他疫苗,例如甲肝和乙肝疫苗。

下列疫苗一般应避免在孕期接种:

- 水痘疫苗
- 人乳头瘤病毒(HPV)疫苗
- 麻风腮三联疫苗
- 带状疱疹疫苗

如果您打算怀孕,在您可能需要接种任何疫苗之前都需要咨询医护人员。活疫苗应在怀孕前至少一个月内接种。

中文翻译:dean
本文地址:http://www.wjbb.com/know/457
原文出处:http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/expert-answers/vaccines-during-pregnancy/faq-20057799

世界卫生组织对预防接种禁忌的看法

红太狼 发表了文章 • 0 个评论 • 1579 次浏览 • 2014-08-19 06:02 • 来自相关话题

世界卫生组织一直强调预防接种不应该有很多的禁忌。常规预防接种的益处大多高于发生不良反应的危险性。卫生人员应利用一切机会为所有的合格对象接种。 下列情况不应作为接种禁忌: 轻微传染病,如体温<38.5℃的上 ...查看全部

世界卫生组织一直强调预防接种不应该有很多的禁忌。常规预防接种的益处大多高于发生不良反应的危险性。卫生人员应利用一切机会为所有的合格对象接种。

下列情况不应作为接种禁忌:

  1. 轻微传染病,如体温<38.5℃的上呼吸道感染或腹泻;

  1. 超敏反应、哮喘或其他特应性表现;

  1. 惊厥家族史;

  1. 抗生素、低剂量皮质激素使用或局部作用(外用或吸入);

  1. 皮肤病、湿疹或局部皮肤感染;

  1. 慢性心、肺、肾、或肝脏疾病;

  1. 稳定的神经系统疾病(如大脑瘫痪);

  1. 出生后黄疸史;

  1. 哺乳婴儿、早产儿和低体重儿;

  1. 营养不良;

  1. 妊娠;

  1. 以前有百日咳、麻疹、流行性腮腺炎、风疹感染史;

  1. 传染病的潜伏期。

世界卫生组织同时也认为,有些严重疾病者接种后常可能出现不利后果,下列情况作为预防接种禁忌:

  1. 免疫异常:一般不使用活疫苗;

  1. 急性传染病:可能错把传染病临床表现当作预防接种不良反应而阻碍后续接种;

  1. 既往接种后有严重不良反应者:如前次接种后有超敏反应、休克、脑炎、惊厥等情况,不应接种后续剂次;

  1. 进行性神经系统疾患者不应接种含百日咳抗原的疫苗。

——摘自《预防接种实践与管理》,略有删改

出处:http://blog.sina.com.cn/s/blog_69a54c650102ux96.html
运用免疫学的原理,将相应的生物制品(抗原或抗体)通过适宜的途径接种于易感者机体,使其发生免疫反应,从而产生对疾病的特异抵抗力,提高人群免疫水平,达到预防相应传染病的发生的目的,这样的人工免疫方法称之为预防接种。 《中华人民共和国传染病防治法》第12条明确规定:国家实行有计划的预防接种制度。国家对儿童实行预防接种证制度。