Japanese Encephalitis Vaccine: Recommendations of the Advisory Committee on Immunization Practices.

IF 33.7 1区 医学 Q1 Medicine
Susan L Hills, Emmanuel B Walter, Robert L Atmar, Marc Fischer
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引用次数: 59

Abstract

This report updates the 2010 recommendations from the CDC Advisory Committee on Immunization Practices (ACIP) regarding prevention of Japanese encephalitis (JE) among U.S. travelers and laboratory workers (Fischer M, Lindsey N, Staples JE, Hills S. Japanese encephalitis vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2010;59[No. RR-1]). The report summarizes the epidemiology of JE, describes the JE vaccine that is licensed and available in the United States, and provides recommendations for its use among travelers and laboratory workers.JE virus, a mosquitoborne flavivirus, is the most common vaccine-preventable cause of encephalitis in Asia. JE occurs throughout most of Asia and parts of the western Pacific. Approximately 20%-30% of patients die, and 30%-50% of survivors have neurologic, cognitive, or behavioral sequelae. No antiviral treatment is available.Inactivated Vero cell culture-derived JE vaccine (Ixiaro [JE-VC]) is the only JE vaccine that is licensed and available in the United States. In 2009, the U.S. Food and Drug Administration (FDA) licensed JE-VC for use in persons aged ≥17 years; in 2013, licensure was extended to include children aged ≥2 months.Most travelers to countries where the disease is endemic are at very low risk for JE. However, some travelers are at increased risk for infection on the basis of their travel plans. Factors that increase the risk for JE virus exposure include 1) traveling for a longer period; 2) travel during the JE virus transmission season; 3) spending time in rural areas; 4) participating in extensive outdoor activities; and 5) staying in accommodations without air conditioning, screens, or bed nets. All travelers to countries where JE is endemic should be advised to take precautions to avoid mosquito bites to reduce the risk for JE and other vectorborne diseases. For some persons who might be at increased risk for JE, the vaccine can further reduce the risk for infection. The decision about whether to vaccinate should be individualized and consider the 1) risks related to the specific travel itinerary, 2) likelihood of future travel to countries where JE is endemic, 3) high morbidity and mortality of JE, 4) availability of an effective vaccine, 5) possibility (but low probability) of serious adverse events after vaccination, and 6) the traveler's personal perception and tolerance of risk.JE vaccine is recommended for persons moving to a JE-endemic country to take up residence, longer-term (e.g., ≥1 month) travelers to JE-endemic areas, and frequent travelers to JE-endemic areas. JE vaccine also should be considered for shorter-term (e.g., <1 month) travelers with an increased risk for JE on the basis of planned travel duration, season, location, activities, and accommodations and for travelers to JE-endemic areas who are uncertain about their specific travel duration, destinations, or activities. JE vaccine is not recommended for travelers with very low-risk itineraries, such as shorter-term travel limited to urban areas or outside of a well-defined JE virus transmission season.

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日本脑炎疫苗:免疫做法咨询委员会的建议。
本报告更新了2010年CDC免疫实践咨询委员会(ACIP)关于美国旅行者和实验室工作人员预防日本脑炎(JE)的建议(Fischer M, Lindsey N, Staples JE, Hills s)。日本脑炎疫苗:免疫实践咨询委员会(ACIP)的建议。MMWR建议Rep 2010;59[No. 5]RR-1])。该报告总结了日本脑炎的流行病学,描述了在美国获得许可和可用的日本脑炎疫苗,并为旅行者和实验室工作人员使用该疫苗提供了建议。乙脑病毒是一种蚊媒黄病毒,是亚洲最常见的可通过疫苗预防的脑炎病因。乙脑发生在亚洲大部分地区和西太平洋部分地区。大约20%-30%的患者死亡,30%-50%的幸存者有神经、认知或行为后遗症。目前尚无抗病毒治疗方法。灭活Vero细胞培养衍生的乙脑疫苗(Ixiaro [JE- vc])是唯一在美国获得许可和可用的乙脑疫苗。2009年,美国食品和药物管理局(FDA)批准JE-VC用于年龄≥17岁的人群;2013年,许可扩展到包括≥2个月的儿童。大多数前往乙脑流行国家的旅行者患乙脑的风险很低。然而,一些旅行者的旅行计划增加了感染的风险。增加乙脑病毒暴露风险的因素包括:1)长时间旅行;2)在乙脑病毒传播季节旅行;3)在农村度过时间;4)参加广泛的户外活动;5)住在没有空调、屏风或蚊帐的住所。应建议前往乙脑流行国家的所有旅行者采取预防措施,避免蚊虫叮咬,以减少患乙脑和其他媒介传播疾病的风险。对于一些可能有较高乙脑感染风险的人,该疫苗可进一步降低感染风险。是否接种疫苗的决定应个体化,并考虑以下因素:1)与特定旅行路线相关的风险;2)未来前往乙脑流行国家的可能性;3)乙脑的高发病率和死亡率;4)有效疫苗的可得性;5)接种疫苗后发生严重不良事件的可能性(但概率较低);6)旅行者个人对风险的感知和承受能力。建议前往乙脑流行国家定居的人员、前往乙脑流行地区的长期旅行者(例如≥1个月)和经常前往乙脑流行地区的旅行者接种乙脑疫苗。也应考虑短期接种乙脑疫苗(例如:
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来源期刊
Mmwr Recommendations and Reports
Mmwr Recommendations and Reports PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
36.00
自引率
0.00%
发文量
3
期刊介绍: The MMWR series of publications is published by the Office of Science, Centers for Disease Control and Prevention (CDC), U.S. The MMWR Recommendations and Reports contain in-depth articles that relay policy statements for prevention and treatment in all areas in the CDC’s scope of responsibility (e.g., recommendations from the Advisory Committee on Immunization Practices).
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