疫苗接种不良反应的处置-1课件.ppt

Encephalitis and measles vaccination An analysis of claims for encephalitis following measles vaccine in the USA found clustering of events 8-9 days after vaccination (Wetbel 1998, Duclos 1998) This supports, but does not prove, the possibility that measles vaccine was causative. Risk is less than 1 case per million 惊 厥 惊厥分为： 热性惊厥 体温 38℃ 无热惊厥 体温正常 任何可能刺激机体发热的疫苗都有引起儿童热性惊厥的可能, 但不会长时间持续及发展成癫痫 无热惊厥未见报道 热性惊厥 治 疗 ( 1 )保持呼吸道通畅,用纱布缠裹压舌板使口张开，以防咬伤舌头 ( 2 ) 必要时供氧 ( 3 ) 止痉，如苯巴比妥钠每次5-8mg/kg肌肉注射，也可用10%水合氯醛，0.5ml/kg，灌肠。 ( 4 ) 退热, 物理降温和药物治疗 脑病和脑炎 可能与麻疹疫苗相关，但尚未证实因果关系 脑病的定义： 具备以下3条中的2条 惊厥 意识改变持续≥1天 行为出现显著改变持续≥1天 必须存在与接种疫苗在时间的关联 麻疹或者麻风腮疫苗接种后7 ~ 12天内 麻疹疫苗 脑 炎 美国接种麻疹疫苗后发生脑炎的分析显示：发病集中在接种后8~9天(Wetbel 1998, Duclos 1998) 该现象支持接种麻疹疫苗可能是导致脑炎原因, 但尚未证实。 危险性＜1 / 百万 脑 病 1 降低颅内压，控制脑水肿。应用20%甘露醇静注，每次1.0g/kg，开始每6小时1次，以后酌情递减。地塞米松可同时应用。 2 对症治疗及精心护理，惊厥者用止惊剂。保持气道通畅。记录每日出入量并维持热量。预防继发感染。 谢 谢 ！ The Goal of immunization The goal of vaccination is to prime the recipient’s immune response in order to generate memory cells, so a heightened immune response (both cell mediated and humoral) will be elicited upon exposure to the specific pathogen. The vaccine itself should produce limited undesirable effects and be relatively inexpensive and mass producible for population vaccinations. These factors are as important as efficacy when regulatory bodies and pharmaceutical companies consider possible vaccines. Attributes of a good vaccine: A good vaccine should elicit an appropriate immune response. Ideally the effect should be durable, offering long- term protection. The vaccine should have minimal and non-serious side effects. The product should be stable at extremes of temperature, over a prolonged period of time and under various exposures to light. Live Attenuated Vaccines Developed in the 1950’s and 60’s Attributes: Positive – immune response: almost as good a response as having real infection; memory cell production; capable of replicating within host cells cost: cheap bec