哮喘儿童疫苗接种攻略!

2016-08-15 审稿专家:黄建宝 主任医师 作者:张喜 住院医师 湖南省儿童医院呼吸二科

疫苗在感染性疾病的防治中起着重要作用,有助于降低感染性疾病的发生率和死亡率。原则上哮喘儿童必须且有必要接种疫苗,虽然是过敏性相关性疾病,但支气管哮喘并不是接种疫苗的绝对禁忌症。应禁忌或暂缓接种疫苗的情况1、患有皮炎、化脓性皮肤病、严重湿疹的小儿不宜接种,等待病愈后方可进行接种。2、体温超过37.5℃,有腋下或淋巴结肿大的小儿不宜接种,应查明病因治愈后再接种;3、患有严重心、肝、肾疾病和活动型结核病

疫苗在感染性疾病的防治中起着重要作用,有助于降低感染性疾病的发生率和死亡率。原则上哮喘儿童必须且有必要接种疫苗,虽然是过敏性相关性疾病,但支气管哮喘并不是接种疫苗的绝对禁忌症。


应禁忌或暂缓接种疫苗的情况

1、患有皮炎、化脓性皮肤病、严重湿疹的小儿不宜接种,等待病愈后方可进行接种。

2、体温超过37.5℃,有腋下或淋巴结肿大的小儿不宜接种,应查明病因治愈后再接种;

3、患有严重心、肝、肾疾病和活动型结核病的小儿不宜接种;

4、神经系统包括脑发育不正常,有脑炎后遗症、癫痫病的小儿不宜接种;

5、患有严重疾病、严重营养不良、严重佝偻病、先天性免疫缺陷或正接受免疫抑制治疗者的小儿不宜接种;

6、在哮喘急性发作期不宜接种,待病情缓解再接种;

7、当孩子有腹泻时,尤其是每天大便次数超过4次的患儿,须待恢复两周后,才可服用脊灰疫苗;

8、高热(体温超过39度)暂缓接种疫苗;感冒已进入恢复期仅流鼻涕等症状,是可以接种的。

9、接受血液制剂后与麻疹、风疹、腮腺炎、水痘等疫苗应注意接种苗间隔时间;

10、空腹饥饿时不宜预防接种。


只有在哮喘急性发作(出现喘息、咳嗽、气促、胸闷等症状),尤其是应用全身型糖皮质激素时应暂缓接种。在哮喘的缓解期且健康情况较好时应进行疫苗接种。


警惕过敏体质的患儿:对疫苗成分过敏或者接种后有过敏反应

容易引起过敏的疫苗成分包括:凝胶、鸡蛋、酵母、乳胶、新霉素和硫柳汞。


含有凝胶的疫苗有:白百破、流感、乙脑、麻腮风、狂犬病、伤寒、水痘和单纯疱疹疫苗,特别是麻腮风、水痘和乙脑。


含有酵母成分的疫苗有:乙肝,但是与酵母过敏有关的疫苗反应很少见。


疫苗安剖的瓶塞或者注射器的柱塞可能含有橡胶,对乳胶过敏的患儿有一定的风险,目前报告的发生率仅为0.0175%。个别报告可能与新霉素和硫柳汞有关的疫苗过敏反应分别为麻腮风和流感疫苗。


含有鸡蛋蛋白的疫苗有:麻疹、风疹、部分狂犬病疫苗、流感。其中麻疹、风疹和部分狂犬病疫苗其鸡蛋蛋白含量为纳克级,可忽略不计,所以可以进行正常接种;但是流感疫苗含有微克级的鸡蛋蛋白,有可能会导致对鸡蛋过敏儿童的过敏反应,所以家长应该注意提供患儿既往有无对此种疫苗或者对鸡蛋尤其是生鸡蛋的过敏史病史,如果有,医生应对其发生过敏的可能性进行评估。


由于流感病毒可能在鼻腔中复制而诱发哮喘发作,所以减毒流感疫苗不能用于2岁以下婴幼儿、哮喘或反应性气道疾病患儿、既往12个月内有喘息或哮喘发作的2~4岁的儿童。


对任何疫苗有过敏反应者应禁忌下一次同样疫苗的接种,所以家长应该注意提供患儿既往有无疫苗相应成分的过敏史,特别是对于过敏体质的儿童;对于有过疫苗引起的速发型过敏反应者,医生应充分评估是否可以进行以后的预防接种;如特别需要接种,可进行以上成分的皮肤试验,必要时可采用分级剂量的方法进行分次注射。


专家简介

黄建宝,副主任医师,湖南省儿童医院呼吸二科副主任,医学硕士。一直从事儿科呼吸急救临床、科研、教学和科技普及工作,积累了较丰富的临床经验。擅长支气管哮喘、慢性咳嗽、重症肺炎、重症哮喘发作等的诊断及救治和小儿支气管纤支镜术。

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    2016-09-08 ylzr123

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    2016-08-16 doctorJiangchao

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    2016-08-16 doctorJiangchao

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