How to vaccinate against special diseases and special medications?
April 25th every year is the "National Children's Vaccination Day". This year's theme is: Get vaccinated in time to build a healthy barrier. There is no need to say more about the importance of
vaccination, but what is the current vaccination procedure in my country?
1. Vaccination procedure (2020 version)
A picture illustrates the vaccination procedure of the 2020 version of the National Immunization Program.
(Picture taken from the "Prevention Circle" public account: https://mp.weixin.qq.com/s/_t6NNcXkm4UZRW66mE-Vpw)
Parents and vaccination doctor friends need to pay attention to the fact that the country has not yet officially released the 2020 version. The vaccination procedure of the National Immunization Program vaccine, but according to the "About the National Immunization Program Polio Vaccine and Measles Ingredient Vaccine Immunization" jointly issued by the National Health Commission, the Ministry of Finance, the Ministry of Industry and Information Technology, and the State Food and Drug Administration. "Notice on Program Adjustment Related Work" shows:
Starting from December 2019, the immunization program of 2 doses of inactivated polio vaccine and 2 doses of live attenuated polio vaccine will be implemented nationwide. Children aged 2 months and 3 months will receive one dose of inactivated polio vaccine, and children aged 4 months and 4 years old will receive one dose of live attenuated polio vaccine;
Starting from June 2020, all children across the country An immunization schedule of 2 doses of measles-mumps-rubella combined live attenuated vaccine is implemented within the scope, and 8-month-old and 18-month-old children each receive 1 dose of measles-mumps-rubella live attenuated vaccine. The specific implementation details of
shall be subject to the documents officially released by the state.
2. What should I do if vaccination is delayed during special periods?
Affected by the new coronavirus epidemic, many babies are not vaccinated in time. At present, vaccination work in various places has gradually returned to normal in a comprehensive and orderly manner. So how should babies be vaccinated?
According to the "Guidelines for the Prevention and Control of Children's Vaccination during the Epidemic of Novel Coronavirus-Infected Pneumonia (First Edition)" issued by Beijing Center for Disease Control and Prevention :
(The following recommendations only apply to the current epidemic of novel coronavirus-infected pneumonia. Period)
1. BCG vaccine: It is valid if completed at any time before the age of 4.
2. Hepatitis B vaccine: It is recommended to complete three doses of vaccination before 12 months of age, with an interval of at least 28 days between each dose. Vaccination over 12 months of age is also effective.
3. Polio vaccine and diphtheria-tetanus pertussis vaccine: It is recommended to complete three doses of basic immunization according to the immunization planning procedure, but three doses completed at any time before 12 months of age are effective, and the interval between each dose is at least 28 days.
4.A Group A meningococcal polysaccharide vaccine: It is recommended that it be completed according to the immunization planning procedure, but two doses of vaccination completed at any time before 12 months of age are effective, with an interval of 3 months between each dose.
5. Leprosy vaccine/measles vaccine: It is recommended that it be completed according to the immunization schedule, but one dose of vaccination completed at any time before 12 months of age is valid.
6. Japanese encephalitis vaccine and hepatitis A vaccine: It is recommended that it be completed according to the immunization planning procedure, but one dose of vaccination completed at any time before 24 months of age is effective.
At the same time, parents can also choose combined vaccines for their babies, which can reduce the number of vaccinations, reduce the number of adverse reactions after vaccination, and reduce the number of visits to community hospitals, thereby reducing the risk of cross-infection.
Some second-category vaccines (self-funded vaccines) have strict vaccination time limits, such as the 13-valent pneumonia vaccine and the 5-valent rotavirus vaccine (3 oral doses before 32 weeks of age, with an interval of 1 month between each time).
Regarding the 13-valent pneumonia vaccine, there is currently a new policy:
Beijing: Three basic injections can be completed within 1 year of age, and a booster injection can be given at 12-15 months of age.
Guangdong and Hainan: Those who start vaccination within 6 months of age should complete 3+1 (3 basic shots, 1 booster shot); those who start vaccination between 7 and 11 months old should complete 2+1 (2 basic shots, 1 booster shot) Needle booster needle).
Research shows that the immune effect of the 2+1 and 3+1 vaccination modes is the same. (Note: The interval between basic injections must be at least 28 days, and the interval between booster injections and the last basic injection must be greater than 2 months.)
3. Vaccination of children with special needs and vaccination after special medication
For a long time, there has been no unified statement on whether there are vaccination contraindications for children with special health conditions.
Parents often come to inquire about whether children with special needs, such as premature infants, neonatal jaundice, febrile convulsions, and children with a history of epilepsy, can be vaccinated?
To this end, pediatric experts and disease control experts from Shanghai, Hangzhou and Suzhou collaborated to write a series of articles on the "Expert Consensus on Vaccination for Children with Special Health Conditions". How should children with 12 special needs be vaccinated? Please read the following article:
12 How to vaccinate children with special needs? Expert consensus is here
In addition, how should children with some diseases and children with special medications be vaccinated?
1. Child vaccination using intravenous immunoglobulin (G-globulin):
Intravenous immunoglobulin (IVIG) is a drug with IgG as the main component extracted from the blood of healthy people. It has Antibody activity. IVIG is commonly used in pediatric clinical treatment for diseases such as Kawasaki disease, idiopathic thrombocytopenic purpura, and primary immunodeficiency diseases dominated by antibody deficiencies.
The latest research shows that after receiving IVIG 2g/kg treatment, specific measles antibodies can remain in the blood for 9 months. Therefore, the American Academy of Pediatrics recommends that after receiving high-dose IVIG (2g/kg), vaccination with measles-mumps-rubella vaccine (MMR) needs to be postponed for 11 months.
However, IVIG infusion does not affect the vaccination of varicella zoster virus vaccine (it was previously considered to have an effect, and an interval of 11 months was recommended). As for antibodies to other pathogens, there is currently a lack of evidence on whether IVIG contains antibodies to the corresponding pathogens. Therefore, patients receiving IVIG therapy will not be affected by other vaccines.
can be vaccinated with: vaccines other than measles-containing vaccines.
Withholding: Postponing vaccination of measles-containing vaccines until 8-9 months after receiving high-dose (2 g/kg) IVIG (the American Academy of Pediatrics recommends an interval of 11 months).
2. Children's vaccination using immunosuppressants :
There are five main types of commonly used immunosuppressants:
(1) glucocorticoids, such as cortisone and prednisone;
(2 ) Cytotoxic drugs, such as azathioprine, methotrexate, cyclophosphamide, mycophenolate mofetil, etc.;
(3) Fungal products, such as cyclosporine, tacrolimus, sirolimus, etc.;
( 4) Immune cells monoclonal antibody , such as CD3 monoclonal antibody (OKT3), rituximab, etc.;
(5) Cytokines and their receptor antagonists, such as infliximab, etanercept , tocilizumab, etc.
can be vaccinated:
(1) Patients who are receiving immunosuppressive treatment can be vaccinated with inactivated vaccine without interrupting immunosuppressive treatment; but patients receiving rituximab treatment should take 5 doses after the last dose Vaccination will be given after 1 month.
(2) For infants exposed to immunosuppressants in late pregnancy, inactivated vaccine, MMR and chickenpox vaccine should be vaccinated according to the vaccination schedule.
(3) Breastfed infants whose mothers receive immunosuppressive therapy can receive various vaccines without delay.
Vaccination is postponed: Vaccination of live attenuated vaccines needs to be postponed.
For patients who are safe to interrupt immunosuppressive therapy, the time to postpone vaccination needs to be determined based on the pharmacokinetics of the immunosuppressant used.
High-dose glucocorticoids [prednisone ≥ 20 mg/d or > 2 mg/(kg·d)] can be vaccinated 1 month after the end of treatment, and at least 3 months after the end of treatment with other non-biological immunosuppressants. Live attenuated vaccines. There is still a lack of research data on biological immunosuppressants.
3. Children's vaccinations using anti- epilepsy drugs:
can be vaccinated: epilepsy patients 6 months and older who have not had seizures (epilepsy has been controlled), regardless of whether they are taking anti-epileptic drugs, can receive all vaccines. People with a family history of epilepsy can also get vaccinated.
Vaccination postponement: For patients who have had epileptic seizures in the past 6 months, all vaccinations will be postponed.
Note:
For infants and young children with a history of epilepsy, it is recommended to postpone pertussis vaccination until progressive neurological disease has been ruled out or the cause of epilepsy has been diagnosed.
Only patients with acute encephalopathy due to non-other causes within 7 days of DPT vaccination are listed as contraindications for re-vaccination with the vaccine.
4. Vaccination for children with liver disease:
Liver disease refers to the destruction of liver morphological structure and abnormal liver function caused by different causes. Childhood liver disease has a high morbidity and mortality rate worldwide.
can be vaccinated:
(1) Patients with mild to moderate chronic liver disease abnormal liver function , elevated bilirubin can be vaccinated with various vaccines.
(2) Patients with liver cirrhosis can receive inactivated vaccines.
Vaccination postponement: Patients with acute liver function abnormalities, liver disease with bleeding tendency or liver failure will postpone vaccination of various vaccines.
Contraindicated vaccination: Live attenuated vaccines are contraindicated in patients with liver cirrhosis.
Note: Pre- and post-operative vaccination recommendations for children with congenital biliary atresia
Congenital biliary atresia Kasai can be vaccinated with inactivated vaccine 2 days before surgery, and live attenuated vaccine 21 days before surgery;
Congenital biliary atresia After Kasai recovers, children with mild to moderate liver function abnormalities and elevated bilirubin can be vaccinated routinely;
Children who receive hormone therapy after Kasai should be cautious about vaccinating live vaccines, and it is recommended to vaccinate with inactivated vaccines.
5. Child vaccination for autoimmune disease (AD):
Common AD in children include systemic lupus erythematosus, juvenile idiopathic arthritis, Sjogren's syndrome, multiple sclerosis, and rheumatoid Arthritis, myasthenia gravis, etc.
can be vaccinated: Inactivated vaccine can be vaccinated during the remission period of AD.
Vaccination postponement: Vaccination of various types of vaccines is suspended during the acute phase (active phase) of AD.
Other situations: Vaccination with live attenuated vaccines should be postponed during treatment with hormones, immunosuppressants, or targeted biological agents.
6. Vaccination for children with IgA vasculitis (IgA vasculitis, IgAV):
IgAV, formerly known as Henoch-Schönlein purpura (HSP), is a systemic vasculitis with small vessel vasculitis as the main lesion.
Can be vaccinated: IgAV patients can be vaccinated with various vaccines after recovery.
Vaccination postponement: Vaccination of live attenuated vaccines is suspended during IgAV patients' treatment with immunosuppressants.
7. Vaccination during leukemia chemotherapy:
All vaccinations are postponed;
Inactivated vaccines can be vaccinated 6 months after chemotherapy. After 12 months of immune function evaluation, live attenuated vaccines can be considered.
8. Vaccination for children with allogeneic hematopoietic stem cell transplantation (allo-HSCT):
mainly includes bone marrow transplantation, peripheral blood stem cell transplantation, and cord blood stem cell transplantation.
can be vaccinated:
(1) 1 year after transplantation, the immune function is normal, and can be vaccinated with various inactivated vaccines;
(2) 2 years after transplantation, if there is no chronic graft-versus-host disease (GVHD), stop After using immunosuppressants for 3 months, it is recommended that specialist outpatient clinics evaluate normal immune function and receive live attenuated vaccines.
Postponement of vaccination: People with chronic GVHD and those with abnormal immune function should postpone vaccination of various vaccines.
9. Vaccinations for children with solid-organ transplant (SOT):
Can be vaccinated:
(1) SOT recipients should receive as many vaccinations as possible before the transplant if there are no contraindications to vaccination.
(2) SOT recipients should receive inactivated vaccines at intervals of 2 weeks or more before transplantation, and live attenuated vaccines at intervals of 4 weeks or more before transplantation.
(3) SOT recipients can receive inactivated influenza vaccine one month after the transplant surgery, and various inactivated vaccines after 6 months.
Vaccination postponement: SOT recipients who have been taking low-dose immunosuppressants for a long time can receive varicella vaccine after specialist evaluation 6 months after SOT.
Contraindicated vaccination: SOT recipients are contraindicated in receiving other live attenuated vaccines except chickenpox vaccine after transplantation.
5. Precautions before and after vaccination during special periods
Before vaccination:
1. In order to avoid long waiting times and reduce the chance of contact with others, you can call the contact number reserved on the vaccination certificate before vaccination. Make an appointment and proactively inform children of their recent travel history.
2. The body temperature should be measured on the day of vaccination to confirm the health status of the child. If there is a body temperature ≥37.3℃, severe eczema, diarrhea, etc., please do not go to the vaccination clinic and make an appointment for vaccination separately.
3. On the day of vaccination, children should wear loose clothes that are easy to put on and take off. Parents must wear medical masks to protect themselves.
Vaccination:
1. Children and their parents should follow the vaccination clinic requirements and measure their body temperature before entering the clinic.
2. Keep an appropriate distance from other children and parents in the vaccination clinic, at least one meter.
3. Assist the staff at the registration desk to check relevant information and truthfully provide recent health information.
4. Try to keep children warm during vaccination, and dress them as soon as possible after vaccination.
5. After vaccination, you should observe the patient in the designated area of the clinic for 30 minutes before leaving.
After vaccination:
1. Pay attention to the health status of children after returning home. Vaccine-related fever usually appears within 24-48 hours after vaccination. The body temperature is mostly moderate to low fever and generally lasts no more than 48 hours. .
2. When caring for infants and young children on the same day, you should avoid rubbing the vaccination site. Local reactions with redness, swelling and induration less than 1.5 cm in diameter generally do not require any treatment. For local reactions of redness, swelling and induration with a diameter of 1.5-3 cm, you can use a clean towel to apply cold compress first. If induration occurs, apply hot compress several times a day for 10-15 minutes each time. Do not apply heat to local redness and swelling caused by BCG vaccination.
