Chapter 116. Immunization Principles and Vaccine Use (Part 6)

Chia sẻ: Thuoc Thuoc | Ngày: | Loại File: PDF | Số trang:9

Thêm vào BST

Báo xấu

133
lượt xem 6
download

Download Vui lòng tải xuống để xem tài liệu đầy đủ

Risk Assessment Vaccines are considered safe when the risk of use is judged to be acceptable in relation to the benefits. For vaccines given to healthy individuals for diseases that are no longer common, acceptable risks are set at very low levels—indeed, far lower than for most medical products. However, "safety" does not and cannot ever mean "zero risk." The determination of safety is thus based on a scientific assessment of the data and a considered judgment of all the issues involved, including benefits and risks. Communities and individuals may differ, both among themselves and from health care professionals,...

Chủ đề:

Bình luận(0) Đăng nhập để gửi bình luận!

Lưu

Nội dung Text: Chapter 116. Immunization Principles and Vaccine Use (Part 6)

Chapter 116. Immunization Principles and Vaccine Use (Part 6) Risk Assessment Vaccines are considered safe when the risk of use is judged to be acceptable in relation to the benefits. For vaccines given to healthy individuals for diseases that are no longer common, acceptable risks are set at very low levels—indeed, far lower than for most medical products. However, "safety" does not and cannot ever mean "zero risk." The determination of safety is thus based on a scientific assessment of the data and a considered judgment of all the issues involved, including benefits and risks. Communities and individuals may differ, both among themselves and from health care professionals, in how they perceive the risks, benefits, and acceptability of vaccines and in how they judge the amount of uncertainty that is tolerable. Some parent advocacy groups, such as those that
oppose mandatory vaccination, feel that no amount of risk is acceptable, especially for childhood vaccines. Sources of Immunization Recommendations Harmonized recommendations for vaccine use in the United States are developed by several professional groups. Schedules for immunization of children and adolescents and of adults are shown in Figs. 116-1 and 116-2, respectively. Vaccines recommended for special use are shown in Table 116-2. Table 116-2 Special Vaccines for Infants, Children, and Adults Vacci Vacc Rou Indic Effi Adverse ne ine Type te of ations cacy Events Administr ation Anthra Inact SC For 90 No serious x ivated (6 doses high risk of % adverse effects avirulent primary exposure antibody known plus annual (e.g., persons response;
bacteria booster) in contact efficacy with or uncertain involved in manufacture of animal hides, furs, bone meal, wool, goat hair) and military risk of biowarfare exposure Tuber Live ID Not Var Regional culosis bacteria generally iable for adenitis, (BCG) (attenuated recommende adult disseminated Mycobacter d in U.S. pulmonary BCG infection in ium bovis) because of TB; best immunocompromi low risk of used to sed hosts TB and prevent
interference childhood with PPD TB, test meningitis , and Consi miliary der for PPD- disease negative children in prolonged contact with ineffectively treated adult TB patients or those with drug- resistant TB and for health care workers in high-risk settings.
Not for immunosupp ressed individuals Choler Kille Oral Travel 60– Frequent a d whole ers to 85%, short fever and local bacteria endemic duration reactions, pain, areas; swelling however, not recommende d for use by U.S. citizens because of extremely low risk. Not available in the U.S.
Plague Inact IM Labor 90 10% local ivated atory % reactions; rare bacteria workers; antibody sterile abscess and foresters in response; hypersensitivity endemic efficacy areas; uncertain ?travelers Rabies Inact IM Preex Virt 25% local ivated virus or ID posure ually reactions; 6% of grown in immunizatio 100% for patients receiving cell culture n for pre- or booster doses may (human travelers to postexpos develop immune diploid cell high-risk ure complex reactions or purified countries, immunizat with arthropathy, chick laboratory ion arthritis, embryo workers, and angioedema cell) or veterinarians grown in or cell culture postexposure and immunizatio
adsorbed to n following a aluminum bite from a phosphate proven or suspected rabies- infected animal Yello Live SC Travel Hig Rare w fever attenuated ers to h associated virus endemic neurologic areas; complications laboratory (encephalitis, workers encephalopathy) or viscerotropic disease (fever; hypotension; respiratory, renal, or hepatic failure; lymphocytopenia; thrombocytopenia
; and high risk of death) Japane Inact SC Travel 80– Anaphylaxi se B ivated virus ers to 90% s/severe delayed encephalitis endemic allergic reactions areas common; recipients should be observed for 10 days Typho Purif IM Travel 50– Local id ied Vi ers (≥2 years 80% reactions, mild polysacchar old) to high- ide (not for risk areas children
patients Oral Oral Travel 50– Nil live ers (≥6 years 80% attenuated old) to high- Ty21a strain risk areas as above, except within 24 h of antibiotic ingestion or in febrile patients Note: SC, subcutaneous; BCG, bacille Calmette-Guérin; ID, intradermal; PPD, purified protein derivative; TB, tuberculosis. Source: Recommendations of the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, American Academy of Pediatrics, American College of Physicians.