在事件后接种计划中使用天花疫苗的临床指南。

IF 33.7 1区 医学 Q1 Medicine
Mmwr Recommendations and Reports Pub Date : 2015-02-20
Brett W Petersen, Inger K Damon, Carol A Pertowski, Dana Meaney-Delman, Julie T Guarnizo, Richard H Beigi, Kathryn M Edwards, Margaret C Fisher, Sharon E Frey, Ruth Lynfield, Rodney E Willoughby
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引用次数: 0

摘要

本报告概述了美国国家战略储备中储存的三种天花疫苗的临床使用建议,这些疫苗适用于在故意或意外释放病毒后接种计划期间暴露于天花病毒或有天花感染高风险的人。在事件后接种天花疫苗没有绝对禁忌症。然而,在有某些医疗条件的人群中存在一些相对的禁忌症。疾病预防控制中心关于天花疫苗使用的建议是在考虑到天花感染的风险、接种疫苗后不良事件的风险以及接种疫苗的益处后制定的。天花疫苗是由活痘苗病毒制成的,可以预防天花疾病。它们不含天花的病原体——天花病毒。储存的三种天花疫苗是ACAM2000、安万特巴斯德天花疫苗(APSV)和Imvamune。监测和遏制活动,包括接种具有复制能力的天花疫苗(即能够在哺乳动物细胞中复制的疫苗病毒,如ACAM2000和APSV),将是实现流行病控制的主要应对战略。接触天花病毒的人是发展和传播天花的高危人群,除非存在严重免疫缺陷,否则应接种具有复制能力的天花疫苗。由于免疫反应差的可能性很高,不良事件的风险增加,严重免疫缺陷者(包括移植后4个月内的骨髓移植受者、CD4细胞计数较高的艾滋病毒感染者)预计不会从疫苗中受益,应避免接种天花疫苗
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Clinical guidance for smallpox vaccine use in a postevent vaccination program.

This report outlines recommendations for the clinical use of the three smallpox vaccines stored in the U.S. Strategic National Stockpile for persons who are exposed to smallpox virus or at high risk for smallpox infection during a postevent vaccination program following an intentional or accidental release of the virus. No absolute contraindications exist for smallpox vaccination in a postevent setting. However, several relative contraindications exist among persons with certain medical conditions. CDC recommendations for smallpox vaccine use were developed in consideration of the risk for smallpox infection, risk for an adverse event following vaccination, and benefit from vaccination. Smallpox vaccines are made from live vaccinia viruses that protect against smallpox disease. They do not contain variola virus, the causative agent of smallpox. The three smallpox vaccines stockpiled are ACAM2000, Aventis Pasteur Smallpox Vaccine (APSV), and Imvamune. Surveillance and containment activities including vaccination with replication-competent smallpox vaccine (i.e., vaccine viruses capable of replicating in mammalian cells such as ACAM2000 and APSV) will be the primary response strategy for achieving epidemic control. Persons exposed to smallpox virus are at high risk for developing and transmitting smallpox and should be vaccinated with a replication-competent smallpox vaccine unless severely immunodeficient. Because of a high likelihood of a poor immune response and an increased risk for adverse events, smallpox vaccination should be avoided in persons with severe immunodeficiency who are not expected to benefit from vaccine, including bone marrow transplant recipients within 4 months of transplantation, persons infected with HIV with CD4 cell counts <50 cells/mm3, and persons with severe combined immunodeficiency, complete DiGeorge syndrome, and other severely immunocompromised states requiring isolation. If antivirals are not immediately available, it is reasonable to consider the use of Imvamune in the setting of a smallpox virus exposure in persons with severe immunodeficiency. Persons without a known smallpox virus exposure might still be at high risk for developing smallpox infection depending on the magnitude of the outbreak and the effectiveness of the public health response. Such persons will be defined by public health authorities and should be screened for relative contraindications to smallpox vaccination. Relative contraindications include atopic dermatitis (eczema), HIV infection (CD4 cell counts of 50-199 cells/mm3), other immunocompromised states, and vaccine or vaccine-component allergies. Persons with relative contraindications should be vaccinated with Imvamune when available and authorized for use by the Food and Drug Administration. These recommendations will be updated as new data on smallpox vaccines become available and further clinical guidance for other medical countermeasures including antivirals is developed.

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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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