美
国儿科学学会于2008年1月发布了儿童和0至18岁青少年的最新免疫计划，包括4个月大至18岁青少年的补救式免疫计划，这些青少年接种疫苗的时间较
晚，或比预期接种时间至少推迟了一个月。该项免疫计划发表在了美国一月份出版的《儿科》（Pediatrics）杂志上。
这项免疫计划显示，截至2007年12月1日，接种常规儿童疫苗的推荐人群为0至6岁的儿童和7至18岁的青少年。该计划同时还提到今年将会批准和推荐更多的疫苗。
来
自传染病委员会的作者在报告中写到：“当患者再次就医时，如果该患者的年龄不在推荐年龄之列，那么就应该严格控制疫苗的剂量。当某项联合疫苗的组成成分明
确、疫苗的其他成分并非禁忌、美国食品药品监督管理局批准该计划的剂量时，就可以应用批准后的联合疫苗了。供应者应该征询各自免疫实施咨询委员会的具体建
议，包括高风险的条件在内。”
如果疫苗接种后临床上出现了任何重大不良事件，都应该向免疫不良事件报告系统进行汇报。
0至6岁的儿童需要进行的常规儿童疫苗接种如下：
--乙肝疫苗：在出院之前要对所有新生儿接种单价乙肝疫苗。如果母亲为乙肝表面抗原（HBsAg）阳性，那么应该在12小时以内为新生儿接种乙肝疫苗和0.5mL的乙肝免疫球蛋白。
***在出生时第一次接种之后，还应该完成单价乙肝疫苗或含乙肝疫苗的联合疫苗的接种程序；第二次接种的时间是婴儿1个月至2个月大的时候，而最后一次接种的时间不应该早于24周。
***
在完成至少三次乙肝疫苗的接种之后，母亲为HBsAg阳性的婴儿在9个月至18个月大（通常在下次整岁体检和疫苗接种）时，应该检查HBsAg和
HBsAg抗体。出生首次接种疫苗之后注射联合疫苗时，应该给予4-剂量的乙肝疫苗。如果在出生首次接种疫苗之后又注射了单价乙肝疫苗，那么第4个月就不
需要再次注射了。
--轮状病毒疫苗：第一次注射的时间应该是在婴儿6周至12周大的时候，最后一次注射的时间则应该在婴儿32周大的时候，研究数据显示，年龄超出该范围时注射的安全性和疫苗的有效性都是不充分的。
--白喉、破伤风类毒素及无细胞百日咳吸附疫苗（DTaP）：接种该疫苗时婴儿的最小年龄为6周，第四剂量应该尽早在12个月大时给予，但是一定要在第三剂量后6个月才能接种。最后一次注射应该安排在4岁至6岁时接种。
-- B型流感嗜血杆菌疫苗：接
种该疫苗时婴儿的最小年龄为6周。如果婴儿在2个月至4个月大时已经接种了B型流感嗜血杆菌外膜蛋白复合物结合疫苗（PedvaxHIB or
ComVax; Merck），6个月大的时候就不需要再接种了。儿童成长到一岁或一岁以上时，B型DTaP/H（TriHIBit; Sanofi
Pasteu）联合产品就不能用于基础免疫，但是仍能做为B型流感嗜血杆菌结合疫苗。
--肺炎球菌疫苗：接种肺炎球菌疫苗的儿童最小年龄为6周，接种肺炎球菌多糖疫苗的儿童年龄则为2岁。所有未完全接种、24周至59周大的健康儿童都应该追加接种一次肺炎双球菌结合型疫苗。年龄在2岁或2岁以上、有潜在疾病风险的儿童都应该接种肺炎球菌多糖疫苗。
--流感疫苗：接种三价灭活流感疫苗的最小年龄为6个月，接种流感减毒活疫苗的最小年龄为2岁。6个月至59个月大的儿童、与0至59个月大的儿童有密切接触的人每年都应该注射该疫苗，5岁或5岁以上有风险的儿童、与高风险人群有密切接触的个人以及主动要求的父母等都应该注射该疫苗。
***无论是流感减毒活疫苗还是三价灭活流感疫苗对下列人群都是有益的：健康人、未孕的人、年龄在2岁至49岁之间的人、没有流感并发症等潜在疾病风险的人。6个月至35个月大的儿童接种三价灭活流感疫苗时需要0.25mL，而3岁或3岁以上的儿童则需要0.5mL。
***9岁以下的儿童（第一次接种疫苗或上个季度第一次接种且仅接种了首次剂量）应该在四周后或更长的时间后给予第二次剂量的接种。
--麻疹、流行性腮腺炎和风疹疫苗：接种该疫苗的最小年龄为12个月。第二剂量的接种在儿童4岁至6岁时给予，但是应在第一次接种后4周或更长的时间后再进行。首剂量接种和第二次接种都应该在年龄达到12个月或12个月以上时再进行。
--水痘疫苗：接种水痘疫苗的最低年龄为12个月。第二剂量的接种在儿童4岁至6岁时给予，但是应该在第一次接种后3个月或更长的时间后再进行。第一剂量接种后28天或更长的时间后不能重复接种第二剂量。
--甲型肝炎疫苗：建
议所有12个月至23个月大的儿童均接种甲肝疫苗，接种该疫苗的最小年龄为12个月大。第二剂量的接种应该在至少6个月之后进行。2岁时没有完成该疫苗接
种程序的儿童可以在随后的就医过程中进行补救式接种。同时也建议为其他儿童群体接种甲肝疫苗，例如在某些预防接种对象为年龄较大儿童的地区。
--脑膜炎疫苗：接
种四价脑膜炎球菌结合疫苗和四价脑膜炎球菌多糖疫苗的最小年龄为2岁。尽管推荐为高风险人群（包括2岁至10岁晚期补体缺陷、解剖性或功能性无脾的儿童在
内）接种四价脑膜炎球菌结合疫苗，但是接种四价脑膜炎球菌多糖疫苗也是可以的。3年前或更长时间以前接种了四价脑膜炎球菌多糖疫苗的人群和罹患脑膜炎疾病
风险依然很高的人群，应该及时接种四价脑膜炎球菌结合疫苗。
该
免疫计划也为7岁至18岁接种以下疫苗的人群提供了具体建议：白喉、破伤风类毒素及无细胞百日咳吸附疫苗（TdaP）；人乳头状瘤病毒疫苗；脑膜炎球菌疫
苗；肺炎球菌多糖疫苗；流感疫苗；甲肝疫苗和乙肝疫苗；灭活的脊髓灰质炎病毒疫苗；麻疹、腮腺炎和风疹疫苗和水痘疫苗。
另一型单独的补救式免疫计划为4个月至18岁的人群提供了建议，这些人开始接种的时间均较晚，或比推荐时间延迟至少1个月以上。传染病委员会表示，尽管剂
量随着时间的推移而逐渐消弱，仍不需要重新开始接种程序。
Immunization Schedule for Children and Teens Updated
1.Describe
changes in the recommended immunization schedules for pneumococcal
conjugate vaccine and quadrivalent meningococcal conjugate vaccine in
children.
2.Describe changes in the recommended immunization
schedule for live, attenuated influenza vaccine in children.
January
8, 2008 — The American Academy of Pediatrics has issued an updated
immunization schedule for children and adolescents aged 0 to 18 years,
as well as a catch-up immunization schedule for those aged 4 months to
18 years who start late or who are more than 1 month behind. The new
recommendations appear in the January issue of Pediatrics.
The
schedule indicates the recommended ages for routine administration of
currently licensed childhood vaccines, as of December 1, 2007, for
children aged 0 through 6 years, and for those aged 7 through 18 years.
It also notes that additional vaccines may be licensed and recommended
during the year.
"Any
dose not administered at the recommended age should be administered at
any subsequent visit, when indicated and feasible," the authors from
the Committee on Infectious Diseases write. "Licensed combination
vaccines may be used whenever any components of the combination are
indicated and other components of the vaccine are not contraindicated
and if approved by the Food and Drug Administration for that dose of
the series. Providers should consult the respective Advisory Committee
on Immunization Practices statement for detailed recommendations,
including for high risk conditions."
If
there are any clinically significant adverse events after immunization,
these should be reported to the Vaccine Adverse Event Reporting System.
For
children aged 0 through 6 years, recommended ages for routine
administration of currently licensed childhood vaccines are as follows:
--Hepatitis B vaccine: At
birth, give monovalent hepatitis B vaccine to all newborns before
hospital discharge. If the mother is positive for hepatitis surface
antigen (HBsAg), hepatitis B vaccine and 0.5 mL of hepatitis B immune
globulin should be given within 12 hours of birth.
***After the birth dose, the hepatitis B vaccine series should be
completed with either monovalent hepatitis B vaccine or a combination
vaccine containing hepatitis B vaccine, with the second dose given at
age 1 to 2 months and the final dose no earlier than age 24 weeks.
***After completion of at least 3 doses of a licensed hepatitis B
vaccine series, at ages 9 to 18 months (typically at the next
well-child visit), infants born to mothers who are positive for HBsAg
should be tested for HBsAg and antibody to HBsAg. When combination
vaccines are given after the birth dose, 4 doses of hepatitis B vaccine
may be given. The 4-month dose is not needed if monovalent hepatitis B
vaccine is used for doses after the birth dose.
--Rotavirus vaccine: The
first dose should be given at ages 6 to 12 weeks, and the final dose in
the series by age 32 weeks, because data on safety and efficacy outside
of these age ranges are insufficient.
--Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP): Minimum
age for administration is 6 weeks, and the fourth dose may be given as
early as age 12 months, but not sooner than 6 months since the third
dose. The final dose in the series is given at ages 4 to 6 years.
--Haemophilus influenzae type b conjugate vaccine: Minimum
age for administration is 6 weeks. A dose at age 6 months is not needed
if H influenzae type b Neisseria meningitidis outer-membrane complex
protein conjugate (PedvaxHIB or ComVax; Merck) is given at ages 2 and 4
months. In children aged 12 months or older, DTaP/H influenzae type b
conjugate (TriHIBit; Sanofi Pasteur) combination products should not be
used for primary immunization but can be used as boosters after any H
influenzae type b conjugate vaccine.
--Pneumococcal vaccine: Minimum
age for administration is 6 weeks for pneumococcal conjugate vaccine
and 2 years for pneumococcal polysaccharide vaccine. All healthy
children aged 24 to 59 months having any incomplete schedule should
receive 1 dose of pneumococcal conjugate vaccine. Children aged 2 years
or older with underlying medical conditions should receive pneumococcal
polysaccharide vaccine.
--Influenza vaccine: Minimum
age for administration is 6 months for trivalent inactivated influenza
vaccine and 2 years for live, attenuated influenza vaccine. Children
aged 6 to 59 months and all close contacts of children ages 0 to 59
months should be vaccinated every year, as should children aged 5 years
or older with certain risk factors, individuals in close contact with
persons in groups at higher risk, and any child whose parents request
vaccination.
***Either live, attenuated or trivalent inactivated influenza vaccine
may be administered to healthy, nonpregnant persons, ages 2 to 49
years, without underlying medical conditions that predispose them to
influenza complications. Children receiving trivalent inactivated
influenza vaccine should receive 0.25 mL if they are 6 to 35 months old
or 0.5 mL if they are 3 years or older.
***Two doses, separated by 4 weeks or longer, should be given to
children younger than 9 years who are receiving influenza vaccine for
the first time or who were vaccinated for the first time last season,
but only received 1 dose.
--Measles, mumps, and rubella vaccine: Minimum
age for administration is 12 months. The second dose of this vaccine
should be given at ages 4 to 6 years, but it may be given sooner,
provided 4 weeks or longer have elapsed since the first dose and both
doses are administered at age 12 months or older.
--Varicella vaccine:
Minimum age for administration is 12 months. The second dose should be
given at ages 4 to 6 years, but it may be administered 3 months or
longer after the first dose. The second dose should not be repeated if
administered 28 days or more after the first dose.
--Hepatitis A vaccine: Hepatitis
A vaccine is recommended for all children aged 12 to 23 months, with 12
months being the minimum age for administration. The 2 doses in the
series should be given at least 6 months apart. Children who are not
fully vaccinated by age 2 years can be vaccinated at subsequent visits.
Hepatitis A vaccine is recommended for certain other groups of
children, such as in areas where vaccination programs target older
children.
--Meningococcal vaccine: Minimum
age for administration is 2 years for quadrivalent meningococcal
conjugate vaccine and for quadrivalent meningococcal polysaccharide
vaccine. Although quadrivalent meningococcal conjugate vaccine is
recommended for high-risk groups including children ages 2 to 10 years
with terminal complement deficiencies or anatomic or functional
asplenia, the quadrivalent meningococcal polysaccharide conjugate
vaccine may also be used. Individuals who received quadrivalent
meningococcal polysaccharide vaccine 3 years or more previously and who
are still at increased risk for meningococcal disease should be
vaccinated with the quadrivalent meningococcal conjugate vaccine.
The
schedule also gives specific recommendations for vaccinating persons 7
to 18 years of age with tetanus and diphtheria toxoids and acellular
pertussis vaccine (TdaP); human papillomavirus vaccine; meningococcal
vaccine; pneumococcal polysaccharide vaccine; influenza vaccine;
hepatitis A and B vaccines; inactivated poliovirus vaccine; measles,
mumps, and rubella vaccine; and varicella vaccines.
A
separate catch-up immunization schedule is also provided for those aged
4 months to 18 years who start late or who are more than 1 month
behind. A vaccine series does not need to be restarted, regardless of
the time that has elapsed between doses, the Committee on Infectious
Diseases concludes.
Pediatrics. 2008;121:219-220
[责任编辑:刘聪]
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