新的孩童、青少年疫苗接种建议


  Oct. 3, 2005 (旧金山) - 在美国家庭医师协会(AAFP)的科学会议上,专家们提出,在沉寂许久以后,孩童疫苗接种的建议可能会有多项改变。
  
  Jonathan Temte医师对参与会议人员表示,家庭医师们在短期内应该注意来自AAFP及其它相关组织所公布的疫苗建议,范围会包含水痘、脑膜炎、A型肝炎及肺炎等;同时也必须要注意所谓「青少年平台(adolescent platform)」的创立过程,这项计画在于更积极的强调疫苗皆种的需要性,也对其它青少年会面对的一些健康问题提出看法。
  
  Temte是威斯康辛大学家庭医学的副教授;他表示,政府方面正在讨论,希望医师们能够针对11或12岁的孩童进行咨询,不只有关疫苗方面,同时也包含活动的程度、生活型态、药物滥用,及性方面的议题;这项构造式的访谈在于发堀一些会危害到青少年健康的风险因素,必要时必须对受访者提供解决的方法。
  
  在疫苗接种的建议方面,Temte希望与会者能够注意短期之内所公布的建议案,第二剂水痘疫苗可能会提前接种,也会有关于脑炎疫苗的例常接种方案;前者是比较有可能的,因为最近发生了一阵水痘流行,即使接受高度接种的族群里也有这种情况;对应的方式是,使用第二剂来增加保护的效果。
  
  在脑膜炎疫苗接种方面,AAFP最近核准了ACIP(联邦疫苗接种委员会)的一项建议,青少年必须在11岁时就接种疫苗,最晚也要在上高中之前施打。
  
  以前认为脑炎疫苗最晚应该在上大学之前施打,但这种想法正在改变当中;专家们已经看到了一种现象,该项疾病的第二次高峰期可能在10岁时即已发生。
  
  Temte表示,我们所知的是,第二次的高峰期发生在15到20岁,但实际上,我们看到的是,10岁到11岁之间,这个现象即已出现。
  
  Temte指出,同理,第一剂的提早接种可以赋予青少年更多的保护效果,因为免疫的期间介于8到10年;我们希望,例常的免疫接种工作可以达到和英国一样的效果;在英国,因为例常接种已经启动,所以脑膜炎也随之根除。
  
  Temte表示,来自美国疾病预防执行单位的「A级」建议指出,只有具有感染病毒的高危险孩童及青少年必须接种疫苗;但是,这项说法可能只适用于A型肝炎疫苗接种者,这项改变可能会在未来的几个月或几年内实施。
  
  Temete进一步表示,孩童疫苗会增加自闭症或其相关症状的风险,该项说法长期以来一直具有争议性,目前也没有较强的证据支持这种说法,医师们也不应该因此而避免使用适当的疫苗。
  
  为了说明他观点,Temte引用最近的资料指出,德国麻疹已经在美国消失,他在过去五年内也没听过到任何的水痘病例;他同时询问与会人员是否有人在过去十年内看过麻疹病患,但却只有少部分人员举手;这显示,这项高度传染性的疾病已经因为频繁的疫苗接种而几乎根除了。
  
  Temte同时指出,出生到5岁之间的高度疫苗接种率已经获得明显的成效,孩童的肺炎状况有了显著的降低;在1998到2003年间,发生率降低了94%;Temte表示,这是因为我们确实有在帮小孩作疫苗接种。

New Childhood, Adolescent Vacc

By Bonnie Darves
Medscape Medical News

Oct. 3, 2005 (San Francisco) — Several changes in childhood vaccinations may be in the works after a long period of relative quiet, experts noted here at the American Academy of Family Physicians (AAFP) Scientific Assembly.

Family physicians, in the near term, should watch for new recommendations from AAFP and other organizations regarding vaccination in four key areas: varicella, meningococcal disease, hepatitis A, and pneumonia. Also in the limelight is the notion of creating an "adolescent platform" for the purpose of proactively addressing vaccination needs as well as other health issues that adolescents may face, Jonathan Temte, MD, PhD, told attendees during his immunization update.

"There has been talk in the government about having physicians see children aged 11 or 12 to discuss not only vaccines but also activity levels, lifestyle, substance abuse, and sexuality issues," said Dr. Temte, an associate professor in the Department of Family Medicine at the University of Wisconsin in Madison. The structured visit would be aimed at identifying specific issues that might pose health risks for adolescents, Dr. Temte said, and would provide counseling if necessary.

Regarding vaccination recommendations, Dr. Temte advised attendees to expect near-term recommendations for a second dose of the varicella vaccine and earlier, routine vaccination against meningococcal disease. The former is probable, he said, because of a recent spate of varicella outbreaks "even in highly vaccinated communities. The thought is that we can improve overall protection with a second vaccine [dose]," he said.

In the case of meningococcal vaccination, the AAFP recently approved the federal Advisory Committee on Immunization Practices (ACIP) recommendation that adolescents as young as 11 years should receive the vaccine at that age or at least by the start of high school.

It has been previously thought that routine meningococcal vaccination should occur before patients start college, at the latest, but that thinking is changing. Experts have seen that the disease's second prevalence "peak" — after early infancy — may begin as early as age 10.

"We know that the secondary peak occurs at 15 to 20 years of age, but what we're seeing is that it actually starts to take off at 10 to 11 years," Dr. Temte said.

As such, giving the single dose earlier may confer greater protection through adolescence, Dr. Temte noted, because experts think immunity is "in the range of eight to 10 years." The hope is that routine vaccination will produce a pattern similar to that seen in the U.K., where meningococcal disease rates have plummeted since routine vaccination was initiated.

This trend toward earlier vaccination may also occur with hepatitis A, especially given the U.S. Food and Drug Administration's recent licensing revision that approves the vaccine's use in children as young as 12 months.

Dr. Temte said that the current "A" level recommendation of the U.S. Preventive Services Task Force, which calls for vaccinating only children and adolescents considered at high risk for contracting the virus, may soon be switched to a recommendation for universal hepatitis A vaccination for children and adults. "I think that's a possibility sometime in the next few months or within the year," he said.

Despite persisting controversy about an increased risk for autism or autism spectrum disorders from childhood vaccines, these concerns are not strongly supported by evidence and "should not prevent or deter physicians from using or recommending appropriate vaccinations," Dr. Temte said.

To illustrate his point, Dr. Temte cited recent data indicating that rubella has been eliminated in the U.S. and noted that he "hadn't heard of a single case of chicken pox in the last five years." He also asked session attendees how many cases of measles they had seen in the last decade, and pointed to the few raised hands as an indication that even that highly contagious illness has been nearly eradicated because of increased immunization.

Dr. Temte also pointed to significant gains, due to higher vaccination rates between birth and five years, in reducing the incidence of pneumonia among young children. Between 1998 and 2003, that incidence has plummeted by 94% in that population. "That's clearly because we're now vaccinating children," he said.

AAFP 2005 Scientific Assembly: Update on Childhood and Adolescent Immunizations. Presented Sept. 30, 2005.

Reviewed by Gary D. Vogin, MD

    
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