疫苗接种不良反应的处置.pptVIP

Seizures Seizures have been particularly associated with measles and the pertussis component of DTP vaccination Febrile seizures: a seizure occuring in association with pyrexia (temperature38 degrees celsius) Afebrile seizures: a seizure occuring in an apyrexial patient. Febrile seizures more common with Pertussis vaccination than with other vaccines. Any vaccine which provokes febrile response may potentially precipitate febrile seizures in a child. Such seizure are not associated with long term sequelae and do not predispose children to the development of epilepsy in later life. Encephalopathy and encephalitis The development of encephalopathy and encephalitis are possibly associated with Measles and Pertussis vaccine It is NOT certain that these vaccines are causative. Case definition of encephalopathy: 2 out of 3 of: 1. Seizures 2. Alteration of consciousness lasting for one day or more 3. Distinct change in behaviour for one day or more A temporal relationship with the administration of the vaccine must also exist Within 48hrs with DTP Within 7-12 days after measles or MMR 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 2021/2/6 * 过敏反应的治疗 有休克者成人皮下注射1:1 000肾上腺素0.5ml,儿童每次0.01ml/kg。如体重不明: 2岁以下 0.0625ml（1/16） 2-5岁 0.125ml（1/8） 6-11岁 0.25ml（1/4） 11岁以上 0.33ml 如5分钟内未好转,可重复使用,最多3次 肾脏或神经系统综合征较严重者,可用可的松, 成人 100～200mg/日,儿童每日2～4mg/kg; 也可用促皮质激素,成人25～50单位/日;儿 童每日2～3单位/kg,分2次肌内注射 2021/2/6 * 过敏反应的治疗 对重症紫癜肾炎病例宜早使用甲基泼尼松龙“冲 击”疗法,可使肾小球损伤恢复。 儿童剂量15～30mg/(kg·d)（总量不超过1g） 成人0.5～1g/(kg·d), 每日1次或每周3次,隔日静点,3次为一疗程,一般2个疗程,若效果不佳,过1～2周可再用1～2个疗程。 治疗期间监测血压,“冲击”前停用泼尼松,“冲击”后48h重新用泼尼松 2021/2/6 * 过敏反应的治疗 过敏性紫癜或