减毒活疫苗。 1 11麻疹,腮腺炎和风疹病毒活疫苗(MMR)是包含麻疹,腮腺炎和风疹抗原的固定组合疫苗,用于刺激对麻疹,腮腺炎和风疹的主动免疫。 1种MMR,也可以在美国以固定组合疫苗的形式在市场上购买,其中包含麻疹,腮腺炎,风疹和水痘抗原(MMRV; ProQuad )。 66
预防成人,青少年和12岁以上的儿童的麻疹,腮腺炎和风疹。 1 5 8 10 14 43 44 50
USPHS免疫实践咨询委员会(ACIP),AAP和美国家庭医师学会(AAFP)建议从12至15个月大时开始,采用2剂MMR方案为所有儿童接种麻疹,腮腺炎和风疹疫苗。 ,除非有禁忌之意。 5 8 14 43 44 (请参见注意事项中的禁忌症。)此外,建议所有未接种疫苗或以前仅接受过单次疫苗接种的18岁以下的儿童和青少年都接受MMR的追赶疫苗接种。 5 8 43 44
ACIP,AAP,AAFP,美国妇产科学院(ACOG)和美国内科医师学院(ACP)建议所有成年人接受1或2剂MMR,除非他们有对麻疹,腮腺炎和风疹免疫的证据。 14 44 50
包含MMR和水痘疫苗的固定组合疫苗(MMRV; ProQuad当有一定剂量的MMR和水痘疫苗接种时,可用于12个月至12岁的儿童。 27 65 66 72尽管使用MMRV(ProQuad )减少了在单次医疗护理就诊时同时接种两种疫苗的必要注射次数,有证据表明,MMRV(ProQuad)可使12至23个月大的婴儿发烧和高热惊厥的相对风险更高)比一剂MMR和一剂Varivax在不同的地点同时给予。 65 66 72 (请参阅“小心使用固定组合”。)
尽管已使用含有麻疹,腮腺炎或风疹抗原的单价疫苗来刺激针对麻疹,腮腺炎或风疹的主动免疫,但2 3 4 8 11 14 43 44 50这些单抗原疫苗在美国已不再市售。 70 MMR疫苗应用于完成成人,青少年或以前接受过单剂量单价疫苗的儿童的麻疹,腮腺炎和风疹的完全免疫。 70
CDC指出,由于先前的疫苗接种或自然疾病而已经对麻疹,腮腺炎或风疹免疫的个体可以接受MMR,而不会增加不良反应的风险。 70
麻疹免疫力的证据。一般认为1957年之前出生的人对麻疹免疫。 8 44 50 71如果有充分的麻疹免疫证明(2剂MMR或含麻疹的疫苗,在12个月大时或之后接种第一剂,第二剂在1957年出生),则可以认为1957年或此后出生的人具有麻疹免疫首次给药后至少28天),由医护人员诊断出的天然麻疹感染,实验室对麻疹免疫力的证据或实验室对麻疹感染的确认。 8 44 50 71除非有禁忌,否则应将所有无免疫力证据的人视为麻疹易感者,并应接受2剂MMR。 8 44 50此外,在1968年之前接种麻疹疫苗的人所接种的麻疹疫苗的免疫原性低于目前可用的疫苗,应接种MMR疫苗。 44 50
腮腺炎免疫力的证据。一般认为1957年之前出生的人对腮腺炎免疫。 8 10 44 50 71在1957年或之后出生的人,如果有足够的针对腮腺炎的疫苗接种证明(针对K-12年级的学龄儿童,大学生,医护人员,国际旅客;成人中至少1剂(高危人群),由医护人员诊断出的腮腺炎自然感染,腮腺炎免疫力的实验室证据或腮腺炎感染的实验室确认。 10 44 50 71所有无免疫力证据的人都应被视为易患腮腺炎,并应接种疫苗,除非有禁忌症。 8 10 44 50
风疹免疫力的证据。具有充分疫苗接种证明(≥12个月龄至少接种1剂MMR或含风疹疫苗)或血清学证据表明风疹免疫力的个体被视为对风疹免疫。 8 14 44 50 71 1957年之前的出生仅提供风疹免疫力的推定证据,并不保证免疫力。 14 71风疹的临床诊断不可靠,在评估免疫状况时不应考虑。 8 14 44所有育龄妇女,无论其出生年份如何,均应接受风疹免疫力测试,并应咨询先天性风疹综合症(CRS)。 8 44没有免疫力的未怀孕妇女应接种疫苗;那些怀孕的人应该在产后立即接种疫苗。 3 8 44 50 54 (请参阅“注意事项”中的怀孕。)
卫生保健人员应免疫麻疹,腮腺炎和风疹。 10 44 46没有对麻疹和腮腺炎免疫的证据的人(2剂含麻疹病毒和腮腺炎病毒的疫苗,在12个月大时或之后接种第一剂,在接种第一剂后至少28天接种第二剂)免疫力的证据,疾病的实验室确认)和无风疹免疫力的证据(在12个月大时或之后至少接种1剂含风疹病毒的疫苗,免疫力的实验室证据,疾病的实验室确认)应接受2剂量的MMR。 10 44 46 71仅接受单剂的卫生保健人员应接受第二剂。 10 44 46 71由于1957年之前出生只是免疫的推定证据,因此,对于没有1957年之前出生的未接种疫苗且没有实验室证据证明其对麻疹和麻疹具有免疫力的实验室人员,医疗机构应考虑在麻疹或腮腺炎爆发期间推荐2剂MMR对这些疾病的腮腺炎或实验室确诊,在该风疹暴发期间,应考虑为该年龄段的个体推荐1剂MMR。 10 44 46 71
旅行者在美国境外可能极易患麻疹,腮腺炎和风疹,因此在离开美国之前应对这些疾病免疫。 8 9 14 44 52麻疹在世界范围内广泛流行,在许多国家仍然流行。 8 9 44在美国报告的许多麻疹病例是由于在国外暴露于该疾病而引起的。 8 9 44 73流行性腮腺炎在许多国家9仍然是地方性流行,风疹在世界各地9流行,并且在许多国家中很流行。 14
如果感染了麻疹,艾滋病毒感染者面临严重并发症的风险就会增加。 8 31 32 44 76 ACIP,AAP,CDC,美国国立卫生研究院(NIH),IDSA,小儿传染病学会及其他组织指出,所有无症状的HIV感染儿童,青少年和成人均应按照通常推荐的免疫方法接受MMR时间表。 8 11 14 15 31 32 44 75 76此外,对于所有没有严重免疫抑制迹象且有资格进行疫苗接种的有症状的HIV感染者,应考虑使用MMR。 8 11 14 15 31 32 44 75 76严重免疫抑制的HIV感染者禁用MMR(即,小于12个月的儿童,CD4 + T细胞计数小于750 / mm 3 ; 1至5岁的儿童CD4 + T细胞计数<500 / mm 3的儿童;≥6岁的儿童,青少年和成人,CD4 + T细胞计数<200 / mm 3的儿童; <13岁的儿童,CD4 + T细胞的百分比<15%); 1 8 15 31 32 44 75 75 76如果需要预防麻疹(例如在旅行者中,暴露于麻疹后),则这些人应接受免疫球蛋白IM(IGIM)。 8 15 31 32 44 75 AAP和ACIP建议艾滋病毒感染者在接触麻疹后接受IGIM,无论其疫苗接种状况如何。 8 15 31 44
免疫状况不确定的国际收养儿童应重新接种疫苗或进行血清学检查,以确认对麻疹,腮腺炎和风疹的免疫力。 9 11儿童可能在其原籍国接受了单价麻疹疫苗,但大多数国家未使用MMR。 9因此,尽管可用血清学检查来验证≥12个月大儿童的免疫状况, 9 11 CDC指出,除非有文件证明儿童患有腮腺炎和风疹,否则MMR的使用优于血清学检查。 9 ACIP指出,最简单的方法是根据美国建议的儿童和青少年免疫接种计划,再接种1或2剂MMR。 11 (请参阅剂量和用法。)
MMR的暴露后疫苗接种(在暴露后72小时内给予)可能为麻疹提供一定的保护,并为未患此病的个体提供进一步的保护。 1 8 9 44 50 52
对于大多数情况(包括学校或托儿所中的麻疹暴发),麻疹暴露后72小时内的暴露后疫苗接种比使用IGIM更可取。 8 44如果禁忌使用疫苗(例如,小于6个月的婴儿,孕妇,免疫功能低下的人),或者接种后超过72小时但小于6天,则易感人群可立即接种IGIM。 8 9 44
如果在儿童保育机构,学校(小学,初中,初中,高中,大学,大学或其他中等教育机构)发生麻疹暴发,ACIP和AAP建议所有学生(及其兄弟姐妹)和所有学校在1957年或此后出生的人员应接种麻疹疫苗,除非他们有文件表明在≥12个月大时已接种过2剂麻疹疫苗或其他有麻疹免疫力的证据。 8
在麻疹暴发期间,如果认为可能接触天然麻疹,应给6个月以下的儿童接种疫苗。 8 44但是,应该认为这些儿童的免疫力不足,应从12到15个月大时开始接受常规的2剂量MMR疫苗接种方案。 8 44 (请参阅剂量和给药方式下的6至11个月大婴儿(MMR)。)
没有证据表明暴露后接种疫苗可以预防腮腺炎;但是,如果接触没有导致感染,可以进行4 8 44 52接触后疫苗接种,以防止随后的感染。 8 44 52
因为大约90%的不知道过去感染的成年人可以通过血清学检测获得免疫,所以除非是已知血清阴性,否则通常不建议1957年以前出生的人接受腮腺炎病毒活疫苗的暴露后疫苗接种。然而,如图8所示,也不排除对此类人员进行疫苗接种,并且可以在疫情暴发时进行。 44
在暴发流行的情况下,ACIP建议考虑对1-4岁的儿童和低危成年人使用第二剂MMR或腮腺炎疫苗(前提是自他们接受第一剂疫苗以来已至少28天)。 10 44此外,在暴发流行的情况下,ACIP指出,医疗机构应强烈考虑向1957年之前出生且没有免疫力的未接种疫苗的人员推荐2剂MMR。 10 44
未显示风疹疫苗的暴露后疫苗可以预防疾病。 3 8 14由于暴露后疫苗接种可为未感染该疾病的个体提供进一步的保护,并且由于没有证据表明对正在感染风疹的个体接种疫苗有害,因此,除非有禁忌之意,否则ACIP和AAP建议进行此类接种。 8 14 44
控制风疹爆发对于消除本地风疹和预防先天性风疹感染和CRS至关重要。 14 54由于在美国风疹的发生率很低,疾病预防控制中心指出,即使是一例风疹,也应视为潜在的暴发流行。 54在24小时内向当地卫生部门报告疑似风疹,CRS或先天性风疹感染病例;在等待实验室确认时不要延迟报告。 14 54一旦发现风疹病例,应立即采取控制措施;当孕妇可能与风疹患者接触时,保持控制措施至关重要。 54
风疹爆发期间,应在皮疹发作后隔离患者5-7天,并确定易感接触者并接种疫苗(除非禁忌)。 54暴露于风疹的孕妇如果没有足够的免疫力证明,应进行该疾病的血清学检查。 54应为易感孕妇提供关于宫内风疹感染风险的咨询,并应建议避免在可能接触风疹的地方进行活动,并在皮疹发作后至少6周内避免与已确诊,可能或疑似风疹的个体接触。在最后确定的患者中。 54
如果在总体环境中(例如,家庭,监狱,日托中心,军事场所,学校,礼拜场所,体育赛事,其他社交聚会)发生风疹暴发,应接种无足够风疹免疫力证明的暴露个体。 54如果在医疗机构(例如医院,医生办公室,诊所,疗养院,患者接受亚急性或长期护理的其他设施)发生暴发,应将没有足够免疫力证据的医护人员排除在工作之外,接种疫苗(尤其是在孕妇可能接触的地方)。 54尽管随后进行了疫苗接种,但暴露的医护人员应在最后一次接触风疹后的23天内被排除在直接患者护理之外。 54卫生保健机构应向没有血清学证据的免疫力的1957年之前出生的工人强烈推荐一种含风疹疫苗。 54如果发生社区范围内的暴发,应向任何风疹或CRS患者暴露并不能证明其具有免疫力的人应接种疫苗或限制接触风疹或CRS患者。 54
有关其他信息,请咨询CDC有关评估和管理可疑风疹暴发的建议,包括有关风疹病例分类标准(可疑,可能,确诊,无症状确诊),CRS病例分类标准(仅可疑,可能,确诊,感染)的信息。 ,风疹和CRS的实验室诊断,监视和控制措施以及防止将来风疹暴发的宣传活动。 54
MMR(MMR II):通过次Q注射进行管理。 1 11
MMRV(ProQuad ):通过sub-Q注入进行管理。 66
不要给予IM或IV。 1 66
根据患者年龄,将Q-sub施用至上三头肌或大腿前外侧。 1 11 66对于≥1岁的儿童,青少年和成人,通常首选上三头肌上外侧区域。 11
为确保适当的输送,应使用5/8英寸,23至25号规格的针头以45°角进行次Q注射。 1 11
注射之前,请确保针头不在血管中。 1个
由于接种疫苗后可能会发生晕厥,因此在服药后大约15分钟要观察被疫苗。 11晕厥最常见于青少年和年轻人。 11如果发生晕厥,请观察患者直至症状消失。 11
可以在同一次医疗保健就诊期间(使用不同的注射器和不同的注射部位)与大多数其他适合年龄的疫苗同时接种。 1 5 8 11 14 44 47 50 66 (请参见交互)。
如果在单次医疗保健就诊期间施用多种疫苗,则每种疫苗应使用不同的注射器和不同的注射部位。 11将注射部位分开至少1英寸(如果解剖学上可行),以适当归因于可能发生的任何局部不良反应。 11如果必须在一个肢体中接种多种疫苗,则三角型可能适用于较大的儿童和成人,但大腿前外侧是婴儿和幼儿的首选。 11
MMR(MMR II):通过将制造商提供的全部稀释剂添加到相应的冻干疫苗小瓶中并搅拌该小瓶来重构冻干疫苗。 1仅使用制造商提供的稀释剂。 1重组疫苗以黄色透明溶液的形式出现。 1个
MMRV(ProQuad ):通过添加制造商提供的全部稀释剂来重新配制冻干疫苗。 66轻轻搅动小瓶。 66仅使用制造商提供的稀释剂。 66重组疫苗以透明的浅黄色至浅粉红色液体出现。 66
使用不含防腐剂,防腐剂和清洁剂的无菌注射器和针头,以免灭活病毒疫苗。 1 66
为了最大程度地降低效力损失并确保足够的免疫剂量,重组后应立即给药;如果8小时内未使用,请丢弃重组疫苗。 1 (请参阅稳定性。)
MMR(MMR II):用于成人,青少年以及≥6个月的婴幼儿。 1个
MMRV(ProQuad ):用于12个月至12岁的儿童。 66
如果认为必须预防麻疹(例如,为了控制疫情,前往或居住在美国以外麻疹风险较高地区的儿童),年龄太小而无法接受常规初次麻疹免疫的儿童,则应每次注射0.5毫升MMR剂量。 8 9 44 70
此类儿童应被视为免疫接种不充分,应在他们的第一个生日后尽快采用常规的2剂量MMR方案重新接种。 8 9 44 (请参阅剂量和给药方式下的婴儿和儿童12个月至6岁(MMR)。)
初次免疫包括2剂。 1 5 8 11 44每个剂量为0.5 mL。 1 8 11 44
ACIP,AAP和AAFP建议第一剂在12至15个月大时服用,第二剂在4至6岁时(刚上幼儿园或一年级之前)。 1 5 8 11 44 52在第一次例行就诊期间可以给予较早的第二次剂量,但前提是自第一次剂量起至少已过4周(28天),并且第一和第二次剂量均在≥12个月大时给药。 5 8 11 44 52
初次免疫包括2剂,间隔至少4周。 5 8 52每个剂量为0.5 mL。 1个
对于未接种疫苗或未完全接种疫苗的个体,建议在11至12岁时进行补充接种。 8 43 44 52所有以前只接受过一剂的儿童和青少年都应接受第二剂。 8 44 52
每个剂量为0.5mL。 66
当指示同时施用第一或第二剂MMR和第一或第二剂水痘疫苗时,或在指示固定组合疫苗的任何成分且不禁忌其他成分的情况下,均可使用。 5 27 66
当考虑在12至47个月大的婴儿和儿童中使用时,ACIP规定提供者应向父母或照料者告知与MMRV(ProQuad)相关的益处和风险)与单个成分疫苗相比。 72 (请参阅“小心使用固定组合”。)
一剂含麻疹的疫苗(如MMR)和一剂MMRV(ProQuad)之间应至少间隔1个月),最好在两次水痘疫苗之间至少间隔3个月(Varivax )和一剂MMRV(ProQuad );但是,如果在第一剂之后至少28天施用第二剂含水痘疫苗,则无需重复第二剂。 5 66
初次免疫包括1或2剂,间隔至少4周(28天)。 1 8 11 44 52每个剂量为0.5 mL。 1 8 11 44
没有具体的剂量建议。 1 66
没有具体的剂量建议。 1 66
对疫苗或任何成分(包括明胶)过敏。 1 66 (请参阅“明胶过敏”下的“注意事项”。)
对新霉素过敏或过敏反应的历史。 1 66 (请参阅“新霉素过敏”下的“注意事项”。)
血液异常,白血病,任何类型的淋巴瘤或影响骨髓或淋巴系统的任何其他恶性肿瘤。 1 66 (请参阅在谨慎性下具有改变的免疫能力的人。)
原发性和获得性免疫缺陷,包括获得性免疫缺陷综合症(AIDS)或HIV感染,细胞免疫缺陷,低聚球蛋白血症和低聚球蛋白血症的其他临床表现。 1 66 (请参阅在谨慎性下具有改变的免疫能力的人。)
免疫抑制疗法(例如皮质类固醇,抗肿瘤药,放射线)。 1 66 (请参阅“相互作用下的特定药物和实验室测试”。)
先天性或遗传性免疫缺陷的家族史,除非在潜在的疫苗接受者中证明了免疫能力。 1 66 (请参阅在谨慎性下具有改变的免疫能力的人。)
高热性呼吸系统疾病或其他活动性高热感染。 1 66 (请参阅“小心同时患病”。)
活动性未经治疗的结核病。 1 66 (请参见“注意结核病”。)
怀孕。 1 66 (请参阅“注意事项”下的怀孕。)
因为MMR和MMRV(ProQuad )含有减毒活病毒,通常禁止在免疫能力改变的个体中使用,包括具有原发性或获得性免疫缺陷的个体或接受免疫抑制治疗的个体。 1 8 11 50 66 (请参阅禁忌症。)
据报道,免疫能力(如艾滋病)改变的人接种了含麻疹疫苗后,出现了麻疹包涵体脑炎(MIBE),肺炎和与传播的麻疹疫苗病毒感染有关的死亡。 1 31 32 44
MMR禁忌在HIV感染的儿童,青少年和成年人中出现严重的免疫抑制(例如,小于12个月的CD4 + T细胞计数小于750 / mm 3的儿童; 1-5岁的CD4 +婴儿) T细胞计数<500 / mm 3 ;≥6岁的儿童,青少年和成人,CD4 + T细胞计数<200 / mm 3 ; <13岁的儿童,CD4 + T细胞百分比<15% )。 1 31 32 44 75 76但是,感染麻疹的艾滋病毒感染者面临严重并发症的风险增加。 11 31 32 44 76因此,ACIP,AAP,NIH,IDSA,小儿传染病学会等指出,MMR可用于没有严重免疫抑制迹象的HIV感染儿童,青少年和成人。 8 11 14 15 31 32 44 75 76请勿使用MMRV(ProQuad )在感染了HIV的个体中; 27 66 76这种固定组合疫苗的安全性和有效性尚未在此类个体中建立。 66
ACIP指出,如果白血病,淋巴瘤或其他恶性肿瘤已经缓解,并且在接种疫苗前至少三个月终止了化疗,则可以考虑使用活病毒疫苗。 11
免疫功能低下的个体对MMR和功效的抗体反应可能会降低。 1 31 42 44
家庭中存在免疫力低下或感染HIV的个体并不排除使用MMR或MMRV(ProQuad )给其他家庭成员。 8 14 27 44
脑炎,脑病,MIBE,亚急性硬化性全脑炎(SSPE),格林-巴利综合征(GBS),无菌性脑膜炎,癫痫发作,共济失调,多发性神经炎,多发性神经病,眼部麻痹和感觉异常的报道很少。 1 44
CNS不良反应(脑炎,脑病)暂时与MMR相关,但因果关系尚未建立。 1 44麻疹疫苗接种后发生严重神经系统疾病的风险大大低于与野生型麻疹感染相关的脑炎和脑病的风险。 1 8
可能发烧(≥39.4°C);通常在MMR后6–12天可见,持续1–2天。 8接种含麻疹疫苗后很少发生高热惊厥。 1 8 31 44
MMR:在有脑损伤史,癫痫发作的个人或家族史或应避免发烧引起的压力的任何其他情况下,请多加注意。 1 8接受抗惊厥药的人在接种疫苗后应继续进行此类治疗。 8接种疫苗后监测患者的体温升高。 1个
MMRV(ProQuad ):对有脑损伤史,癫痫发作的个人或家族史或应避免发烧引起的压力的任何其他情况,请谨慎使用。 66 (请参阅“谨慎使用固定组合”。)
一项正在进行的研究的中期结果表明,服用MMRV(ProQuad)后5-12天出现高热惊厥的相对风险)在12至60个月大的儿童中(99%为12至23个月大的儿童)是同时服用Varivax剂量的2.3倍以及在单次医疗访问中给予的MMR剂量。 65 (请参阅“谨慎使用固定组合”。)
在给予MMR或含麻疹,腮腺炎或风疹抗原的单价疫苗后报告血小板减少症(单价疫苗在美国不再销售)。 1 8 37 38 39 40 44血小板减少症在已有血小板减少症的患者中恶化,并且在随后的剂量下可能恶化。 1 39
在患有血小板减少症或先前剂量的血小板减少症恶化的患者中考虑使用MMR时,请考虑潜在的益处和风险。 1麻疹,腮腺炎和风疹抗体的血清学检测可用于确定是否需要额外剂量以提供保护。 1个
MMR包含重组人白蛋白。 1个
MMRV(ProQuad )含有人白蛋白。 66由于人白蛋白是从合并的人血浆中制备的,因此它是传播人类病毒的潜在媒介,包括病毒性肝炎和HIV感染的病原体,并且从理论上讲可能具有传播Creutzfeldt-Jakob病原体的风险( CJD)或变体CJD(vCJD)。 66
过敏反应,类过敏反应,支气管痉挛,皮疹,荨麻疹,血管性水肿(包括周围或面部水肿),多形性红斑和史蒂文斯-约翰逊综合征的报道很少。 1 31 44
在接种疫苗之前,请询问接受者和/或父母或监护人对先前剂量的疫苗或类似制剂的反应。 1 66
对第一剂量有超敏反应的个体应进行麻疹,腮腺炎和风疹免疫力测试;如果结果表明有免疫力,则无需第二剂。 8对先前剂量有过敏反应的任何人都不应接受另一剂量,无论血清学检测结果如何。 8
如果发生过敏反应或类似反应,应容易获得肾上腺素和其他合适的药物。 1 66
MMR和MMRV(ProQuad )含有水解的明胶作为稳定剂1 66 ,在某些个体中很少会引起超敏反应。 31 34 35 44请勿用于对明胶或含明胶产品有过敏反应的个人。 1 11 31 44 66
立即发生反应(即有或没有荨麻疹的喘息和呼吸困难)和其他反应(即注射部位的红斑和肿胀),可能与明胶超敏反应有关。 31 34
尽管可以考虑在施用含明胶的疫苗之前对皮肤进行明胶敏感性测试,但尚无用于此目的的特定方案。 8 11因为在美国生产的疫苗中使用的明胶通常来自猪源,而食品明胶可能仅来自牛源,因此阴性的食品史并不能排除与疫苗中所含明胶反应的可能性。 8 44
MMR和MMRV(ProQuad )含有微量新霉素,并禁止对新霉素有过敏反应的患者服用。 1 66
新霉素过敏通常会导致延迟型(细胞介导的)超敏反应,表现为接触性皮炎。 1 8 11 66接种后48–96小时可能出现红斑性瘙痒性结节或丘疹。 1个
ACIP和AAP指出,对新霉素有过敏反应史的人不应该使用含有微量新霉素的疫苗,但如果疫苗的益处超过了对新霉素过敏的迟发性史,则可以考虑使用此类疫苗风险。 8 11
MMRV(ProQuad)制造商)指出,如果认为对新霉素有过敏反应史的患者在医疗上需要使用该疫苗,则应咨询过敏症专家或免疫学家,并且应仅在可以适当处理过敏反应的环境中使用疫苗。 66
MMRV(ProQuad)的MMR和MMR组件)是在鸡胚细胞培养物中产生的。 1 11 66
鸡蛋摄入后有过敏,类过敏或其他直接过敏反应(例如荨麻疹,口或喉咙肿胀,呼吸困难,低血压,休克)史的个体,接种疫苗后可能会出现立即型过敏反应的风险增加含有微量的鸡胚抗原。 1 66
在管理MMR或MMRV(ProQuad)之前要考虑潜在收益与潜在风险)对鸡蛋摄入有过敏反应或其他直接过敏反应史的个人。 1 66要格外小心,以防万一发生反应。 1 66
大多数对鸡蛋有过敏反应史的人对MMR或MMRV过敏反应的风险较低(ProQuad ); 1 8 11 17 18 19 20 21 22 23 24 25 26 31 44 66使用疫苗进行的皮肤测试无法预测哪些人会有反应。 1 8 66
具有非过敏性鸡蛋过敏的个体通常不会增加对鸡胚细胞培养物中产生的疫苗过敏反应的风险。 1 8 11 66 There is no evidence that individuals with allergies to chickens or feathers are at increased risk of allergic reactions to such vaccines. 1 8 66
MMR and MMRV (ProQuad ) contain live, attenuated virus. 1 66 There is a theoretical risk that transmission of vaccine virus could occur between vaccinees and susceptible contacts. 1 66
Transmission of live, attenuated measles or mumps virus from vaccinees to susceptible contacts has not been reported. 1个
Although small amounts of the live, attenuated rubella virus are excreted from the nose or throat of most vaccinees 7–28 days after vaccination, there is no evidence that the vaccine virus is transmitted to susceptible contacts. 1 14 52 However, rubella vaccine virus can be transmitted to infants via breast milk. 1 (请参阅“注意事项”中的“哺乳期”。)
Risk for transmission of live, attenuated varicella virus from individuals who receive MMRV (ProQuad ) to susceptible close contacts is greatest if recipient develops a varicelliform rash following vaccination and/or the vaccine recipient is immunocompromised. 27 Transmission of vaccine virus from vaccinees without a varicella-like rash has been reported, but not confirmed. 66
Arthralgia and, rarely, transient arthritis may occur following vaccination with MMR or monovalent rubella vaccine (monovalent vaccine no longer commercially available in the US). 3 14 44 52
Arthritis and arthralgia occur in up to 26% of susceptible adult women. 3 14 44 Symptoms usually begin 1–4 weeks after vaccination and persist for 1 day to 3 weeks. 14 Although these symptoms generally are well tolerated and rarely interfere with normal activities, they may persist for months or, rarely, for years. 3 14 44 Joint symptoms are infrequent and generally of brief duration in children; the incidence in adolescent girls appears to be greater than that in children but less than that in adult women. 3 14 44
When the fixed-combination vaccine containing measles, mumps, and rubella antigens (MMR) or the fixed-combination vaccine containing measles, mumps, rubella, and varicella antigens (MMRV; ProQuad ) is used, consider contraindications and cautions related to each antigen. 1 66
There is some evidence that the relative risk for febrile seizures in children 12–60 months of age after a dose of MMRV (ProQuad ) is higher than that reported when a dose of MMR and a dose of monovalent varicella vaccine (Varivax ) are given during a single health-care visit. 65 (See Fever or Febrile Seizures under Cautions.)
When the first dose of MMR and first dose of varicella vaccine (Varivax ) are indicated in infants and children 12 through 47 months of age, ACIP states that providers considering use of MMRV (ProQuad ) should advise the parent or caregiver about the benefits and risks associated with MMRV (ProQuad ) compared with the individual component vaccines. 72 Although MMRV (ProQuad ) results in 1 less injection, it is associated with a higher risk for fever and febrile seizures on days 5 through 12 after the first dose in children 12 through 23 months of age (ie, 1 extra febrile seizure for every 2300–2600 doses of MMRV [ProQuad ])。 72 ACIP states that if providers face any barriers to clearly communicating these benefits and risks (eg, language barrier), then MMR and monovalent varicella vaccine (Varivax ) should be administered instead of MMRV (ProQuad )。 72
When the first dose of MMR and first dose of varicella vaccine (Varivax ) are indicated in children ≥48 months of age and when second doses are indicated in those 15 months through 12 years of age, ACIP states that use of MMRV (ProQuad ) generally is preferred over separate injections of the component vaccines; 72 considerations should include provider assessment (eg, number of injections, vaccine availability, likelihood of improved coverage, likelihood of patient return, storage and cost considerations), patient preference, and potential for adverse effects. 72
The manufacturer recommends that MMRV (ProQuad ) be used with caution in individuals with a history of cerebral injury, personal or family history of seizures, or any other condition in which fever-induced stress should be avoided. 66 The ACIP states that a personal or family (ie, sibling, parent) history of seizures is a precaution for use of MMRV (ProQuad )。 72 Studies suggest that children with a personal or family history of febrile seizures or family history of epilepsy are at increased risk for febrile seizures compared with children who do not have such histories. 72 ACIP states that children with a personal or family history of seizures generally should receive a dose of MMR and a dose of varicella vaccine (Varivax ) because the risks of using MMRV (ProQuad ) in these children generally outweigh the benefits. 72
Safety and efficacy of MMRV (ProQuad ) in HIV-infected individuals not established; 27 66 do not use this fixed-combination vaccine in HIV-infected individuals. 27 76
MMR: May not protect all individuals from measles, mumps, and rubella. 1 Safety and efficacy for postexposure prophylaxis following exposure to measles, mumps, or rubella not established. 1个
MMRV (ProQuad ): May not protect all individuals from measles, mumps, rubella, and varicella. 66 Safety and efficacy for postexposure prophylaxis after exposure to measles, mumps, rubella, or varicella not established. 66
Immunity induced by measles, mumps, and rubella antigens is long-term in most individuals and may be lifelong. 8 14 44 52 Although antibody levels may wane, revaccination usually results in an anamnestic immune response. 58 60 61
Prevaccination serologic testing is not required before vaccination unless such testing is considered cost-effective. 8 44 46 52 There is no evidence of increased risk of adverse effects if MMR is given to individuals already immune to measles, mumps, and rubella. 8 52
When testing for mumps immunity, presence of mumps immunoglobulin G (IgG) by any commonly used serologic assay is acceptable evidence of mumps immunity. 44 52 Those with equivocal serologic test results should be considered susceptible to mumps. 44 52
The only reliable evidence of previous rubella infection is the presence of rubella IgG antibody. 8 44 52 54 Although tests for IgM antibody have been used to diagnose acute and recent rubella infection, IgM tests should not be used to determine rubella immunity since false-positive results can occur. 54 Occasionally an individual with a history of documented vaccination against rubella will have negative antibody results; such individuals may receive MMR and do not need to be retested for immunity. 52 Those with equivocal serologic test results should be considered susceptible to rubella. 44
Postvaccination serologic testing to confirm an immune response after vaccination with MMR is not recommended. 44
A decision to administer or delay vaccination in an individual with a current or recent febrile illness depends on the severity of symptoms and etiology of the illness. 1 11
ACIP states that minor acute illness, such as mild diarrhea or mild upper respiratory tract infection (with or without fever), generally does not preclude vaccination, but defer vaccination in individuals with moderate or severe acute illness (with or without fever). 11
Although it has been theorized that there is a link between the antigens contained in MMR and neurodevelopmental disorders in children (autism), 77 78 evidence has been insufficient to support an association between neurodevelopmental disorders and MMR. 77 78 79 In 2004, the Immunization Safety Review Committee of the Institute of Medicine (IOM) examined the hypothesis that MMR is causally associated with autism and concluded that the evidence favors rejection of a causal relationship between MMR and autism. 78
Theoretical risk that measles vaccination might exacerbate untreated tuberculosis. 11
MMR and MMRV (ProQuad ) are contraindicated in individuals with active untreated tuberculosis. 1 66
Defer MMR or MMRV (ProQuad ) in patients with active, untreated tuberculosis until antituberculosis therapy has been initiated. 1 8 11 66 Tuberculin skin test reactivity in the absence of active tuberculosis is not a contraindication to live, attenuated virus vaccines. 11 Tuberculin skin test is not a prerequisite for administration of MMR or MMRV (ProQuad )。 8 44 66 (See Specific Drugs and Laboratory Tests under Interactions.)
Improper storage or handling of vaccines may result in loss of vaccine potency and reduced immune response in vaccinees. 1 53
Do not administer MMR or MMRV (ProQuad ) that has been mishandled or has not been stored at the recommended temperature. 1 53 66 (See Storage under Stability.)
Protect lyophilized and reconstituted vaccine from light at all times; 1 53 66 exposure to light may inactivate the vaccine virus. 1 53 66
Avoid freezing or exposing the diluent supplied by the manufacturer to freezing temperatures; 1 53 66 diluent may be refrigerated or stored at room temperature. 1 53 66 (See Storage under Stability.)
Inspect all vaccines upon delivery and monitor during storage to ensure that the appropriate temperature is maintained. 53
Discard reconstituted MMR vaccine if not used within 8 hours;不要冻结。 1 53 Discard reconstituted MMRV (ProQuad ) vaccine if not used within 30 minutes;不要冻结。 66 (See Storage under Stability.)
Category C. 1 66
Contraindicated during pregnancy. 1 11 44 50 66
Manufacturer states pregnancy should be avoided for 3 months after vaccination. 1 66 ACIP, AAP and others state avoid pregnancy for 1 month following vaccination. 8 11 52
Routine pregnancy testing before administering MMR not recommended. 11 If a pregnant woman is vaccinated or became pregnant within 1–3 months after vaccination, advise her of the theoretical risks to the fetus. 1 2 11 44 66 Inadvertent vaccination during pregnancy should not be regarded as a reason to consider termination of pregnancy. 11 44
Not known whether measles or mumps vaccine virus is distributed into milk. 1 Rubella vaccine virus is distributed into milk and may be transmitted to breast-fed infants; infants may have serologic evidence of rubella infection without severe disease. 1 Manufacturer recommends caution in nursing women. 1个
ACIP and AAP state breast-feeding is not a contraindication to MMR since live vaccines appear to pose no special problems for the mother or her nursing infant. 8 11 14 44
MMR: Safety and efficacy not established in children <6 months of age. 1 8
MMRV (ProQuad ): Safety and efficacy not established in children <12 months of age or children or adolescents ≥13 years of age. 66
Routine immunization against measles, mumps, and rubella is initiated at 12 through 15 months of age. 8 44 Infants 6 through 11 months of age may receive MMR if protection against measles is considered necessary (eg, for measles outbreak control, for travelers). 8 9 44 70 Infants <6 months of age usually have partial or complete protection against measles because of maternally derived antibodies. 8 44
There is some evidence that infants born to mothers who had wild-type measles may not develop sustained antibody levels if vaccinated at <12 months of age and later revaccinated. 1个
MMR: Clinical studies did not include sufficient numbers of seronegative individuals ≥65 years of age to determine whether these individuals respond differently than younger individuals. 1 Other reported clinical experience has not identified differences in responses between geriatric and younger individuals. 1个
MMRV (ProQuad ): Not indicated in adults, including geriatric adults. 66
MMR: Fever, 1 31 44 52 transient rash, 1 31 44 52 injection site reactions (pain, induration, edema). 1 44
MMRV (ProQuad ): Adverse effects similar to those reported when varicella vaccine and MMR are administered simultaneously at separate sites, 66 but higher incidence of fever (≥38.9°), 66 febrile seizures, 65 and measles-like rash. 66
MMR and MMRV (ProQuad ) are live, attenuated virus vaccine. 1 11 66 Some oral live vaccines (eg, rotavirus vaccine live oral, typhoid vaccine live oral, poliovirus vaccine live oral (OPV; no longer commercially available in the US) can be administered simultaneously with or at any interval before or after MMR or MMRV (ProQuad )。 1 8 11 However, because of theoretical concerns that the immune response to intranasal live vaccines or other parenteral live virus vaccines might be impaired if given within 28–30 days of another live virus vaccine, if MMR and intranasal or parenteral live vaccines are not administered on the same day, they should be administered at least 4 weeks (ie, 28 days) apart to minimize the potential for interference. 1 8 11 (See Specific Drugs and Laboratory Tests under Interactions.)
MMR or MMRV (ProQuad ) may be administered simultaneously with (using different syringes and different injection sites) or at any interval before or after inactivated vaccines, recombinant vaccines, polysaccharide vaccines, or toxoids. 11 14 44 66 (See Specific Drugs and Laboratory Tests under Interactions.)
药物或测试 | 相互作用 | 评论 | |||||||
---|---|---|---|---|---|---|---|---|---|
Blood products (eg, whole blood, packed RBCs, plasma) | Antibodies contained in blood products may interfere with the immune response to MMR or MMRV (ProQuad ) 8 11 44 66 | Do not administer MMR simultaneously with or for specified intervals before or after administration of blood products 8 11 44 Defer MMR for ≥3 months following administration of RBCs (with adenine-saline added); for ≥6 months following administration of packed RBCs or whole blood; or for ≥7 months following administration of plasma or platelet products 11 After administering MMR, avoid blood products for 2 weeks; if use of a blood product is considered necessary during this period, give a repeat vaccine dose after the recommended interval unless serologic testing is feasible and indicates a response to the vaccine was attained 11 | |||||||
Diphtheria and tetanus toxoids and acellular pertussis vaccines adsorbed (DTaP), tetanus and reduced diphtheria toxoids and acellular pertussis vaccines adsorbed (Tdap) | MMR or MMRV (ProQuad ) may be administered concurrently (using different syringes and different injection sites) or at any interval before or after DTaP or Tdap 1 11 44 66 | ||||||||
Haemophilus b (Hib) vaccine | Simultaneous administration of MMR and Hib vaccine does not interfere with the immune response or increase adverse effects of either vaccine 1 14 | MMR or MMRV (ProQuad ) may be administered simultaneously (using different syringes and different injection sites) or at any time before or after Hib vaccine 11 14 44 55 66 | |||||||
Hepatitis B (HepB) vaccine | Although specific studies not available, HepB vaccine is an inactivated vaccine and interactions are not expected 11 | MMR or MMRV (ProQuad ) may be administered simultaneously (using different syringes and different injection sites) or at any interval before or after HepB vaccine 11 66 | |||||||
Immune globulin (IGIM, IGIV) or specific immune globulin (HBIG, RIG, TIG, VZIG) | Antibodies contained in immune globulin preparations may interfere with the immune response to MMR or MMRV (ProQuad ) 1 8 11 15 31 44 66 | MMR should not be administered simultaneously with or for specified intervals before or after administration of immune globulin preparations 1 8 11 31 Defer administration of MMR for ≥3 months following administration of tetanus immune globulin (TIG), hepatitis B immune globulin (HBIG), or immune globulin IM (IGIM) used for postexposure prophylaxis of hepatitis A virus (HAV); for ≥4 months following administration of rabies immune globulin (RIG); for ≥5 months following administration of IGIM used for measles prophylaxis in immunocompetent individuals; for ≥6 months following administration of cytomegalovirus immune globulin IV (CMV-IGIV) or IGIM for measles prophylaxis in immunocompromised individuals; for ≥8 months following administration of immune globulin IV (IGIV) for replacement therapy of immunodeficiencies or VZIG or IGIV for postexposure prophylaxis of severe varicella; for ≥8–10 months following administration of IGIV for treatment of idiopathic thrombocytopenic purpura (ITP); or for ≥11 months following administration of IGIV for Kawasaki syndrome 8 11 31 If MMR is administered simultaneously with an immune globulin preparation or were administered at less than the recommended interval, consider that vaccine-induced immunity may be compromised; give an additional vaccine dose after the specified interval unless serologic testing is feasible and indicates a response to the vaccine was attained 8 11 31 After administering MMR or MMRV (ProQuad ), avoid immune globulin preparations for 2 weeks; if use of an immune globulin is considered necessary during this period, give a repeat vaccine dose after the recommended interval unless serologic testing is feasible and indicates a response to the vaccine was attained 11 | |||||||
Immunosuppressive agents (eg, alkylating agents, antimetabolites, corticosteroids, radiation) | Use of MMR or MMRV (ProQuad ) in individuals receiving immunosuppressive therapy may result in more extensive vaccine-associated rash or disseminated disease 1 27 66 Corticosteroid therapy (prednisone or equivalent) in a dosage ≥2 mg/kg daily or ≥20 mg daily given for ≥2 weeks is considered immunosuppressive 11 31 44 Short-term (<2 weeks), low- to moderate-dose systemic corticosteroid therapy; long-term, alternate-day systemic corticosteroid therapy using low to moderate doses of short-acting drugs; topical corticosteroid therapy (eg, nasal, cutaneous, ophthalmic); or intra-articular, bursal, or tendon injections with corticosteroids should not be immunosuppressive in usual dosages 8 | Defer vaccination with MMR or MMRV (ProQuad ) until immunosuppressive therapy is discontinued 8 15 31 44 Optimum interval between discontinuance of immunosuppressive therapy and subsequent administration of a live viral vaccine has not been determined; 15 31 44 live viral vaccines generally should not be administered for at least 3 months after immunosuppressive therapy is discontinued 15 31 44 In patients who received corticosteroid therapy that is considered immunosuppressive, 44 delay administration of MMR for at least 3 months after the corticosteroid is discontinued 44 Manufacturer states MMR or MMRV (ProQuad ) may be used in patients receiving corticosteroids as replacement therapy (eg, Addison's disease) 1 2 3 4 66 | |||||||
Influenza vaccine | Intranasal live influenza vaccine: Simultaneous administration with MMR vaccine in children 12 through 15 months of age did not interfere with the immune response to any vaccine component and did not increase the frequency of adverse effects 67 Parenteral inactivated influenza vaccine: Since this influenza vaccine is an inactivated vaccine, interactions with live vaccines such as MMR or MMRV (ProQuad ) are unlikely 11 | Intranasal live influenza vaccine: If not given simultaneously, give at least 4 weeks apart, if possible 11 Parenteral inactivated influenza vaccine: May be administered simultaneously (using different syringes and different injection sites) or at any interval before or after MMR 11 | |||||||
Pneumococcal vaccine | Concomitant administration of PCV7 (Prevnar ) or PPSV23 (Pneumovax 23) and MMR did not result in reduced antibody response to MMR 8 68 Concomitant administration of PCV7 (Prevnar ) and MMRV (ProQuad ) did not result in reduced antibody response to MMR 66 | Pneumococcal vaccine may be administered concurrently (using different syringes and different injection sites) or at any interval before or after MMR or MMRV (ProQuad ) 47 48 66 | |||||||
Poliovirus vaccine inactivated (IPV) | Simultaneous administration of MMR and IPV does not interfere with the immune response or increase adverse effects of either vaccine 11 | MMR may be administered concurrently (using different syringes and different injection sites) or any time before or after IPV 11 44 | |||||||
Rho(D) immune globulin | Specific studies not available evaluating whether passively acquired antibodies from Rho(D) immune globulin interfere with the immune response to MMR 11 | Because of the importance of postpartum rubella vaccination in women who do not have evidence of immunity, vaccination of such women should not be delayed because they received Rho(D) immune globulin; 11 if possible, test for serologic evidence of immunity ≥3 months after vaccination 11 | |||||||
Rotavirus vaccine | No evidence to date that parenterally administered live vaccines such as MMR interfere with the immune response to rotavirus vaccine 11 | May be administered concomitantly with or at any interval before or after MMR 11 | |||||||
Test, Tuberculin | MMR may temporarily suppress tuberculin skin sensitivity 1 8 11 44 76 | Tuberculin tests (if required) should be administered before, simultaneously with, or at least 4–6 weeks after administration of MMR or MMRV (ProQuad ) 1 8 44 66 76 | |||||||
Typhoid vaccine | Oral live typhoid vaccine (Vivotif ): Specific data not available regarding immunogenicity when administered concurrently or within 30 days of MMR 11 69 Parenteral inactivated typhoid vaccine (Typhim Vi ): Since this typhoid vaccine is an inactivated vaccine, interactions with live vaccines such as MMR are unlikely 11 | Oral live typhoid vaccine (Vivotif ): Do not delay administration of typhoid vaccine if warranted 11 69 Parenteral inactivated typhoid vaccine (Typhim Vi ): May be administered simultaneously (using different syringes and different injection sites) or at any interval before or after MMR 11 | |||||||
Varicella vaccine | Simultane 对于消费者适用于麻疹病毒疫苗/腮腺炎病毒疫苗/风疹病毒疫苗/水痘病毒疫苗:非肠道注射用肠胃外注射 副作用包括: MMR:发烧,短暂皮疹,注射部位反应(疼痛,硬结,水肿)。 MMRV(ProQuad®):当水痘疫苗和MMR在单独的网站同时给药,但发热(≥38.9°),热性癫痫发作,和麻疹样皮疹的发生率较高相似这些不利影响的报道。 对于医疗保健专业人员适用于麻疹病毒疫苗/腮腺炎病毒疫苗/风疹病毒疫苗/水痘病毒疫苗:皮下注射粉剂 一般最常见的不良事件是注射部位反应和发烧。 [参考] 其他据报告,接种麻疹,腮腺炎和风疹疫苗后死亡。但是,在健康个体中尚未建立因果关系。据报导,在禁用了含麻疹疫苗且未接种疫苗的严重免疫力低下的人群中,由于传播了麻疹疫苗病毒感染而直接导致死亡。 [参考] 很常见(10%或更高):发烧(高达61.2%) 常见(1%至10%):病毒感染 罕见(0.1%至1%):不适,疲劳 罕见(0.01%至0.1%):中耳炎 非常罕见(小于0.01%):川崎综合征 上市后报告:念珠菌病,感染,耳痛,外伤,死亡[参考] 本地非常常见(10%或更多):注射部位疼痛/压痛/酸痛(高达41.1%),注射部位红斑(27%),注射部位肿胀(15.6%) 常见(1%至10%):注射部位淤青,注射部位皮疹,注射部位瘙痒 上市后报告:外溢,注射部位不适(持续时间灼伤和/或刺痛,湿疹,水肿/肿胀,蜂巢样皮疹,变色,血肿,硬结,肿块,囊泡,皮疹和耀斑),炎症,静脉穿刺部位出血,温暖的感觉,温暖的触摸[参考] 皮肤科很常见(10%或更多):皮疹(高达20.3%) 常见(1%至10%):麻疹样皮疹,水痘样皮疹,病毒性皮疹 非常罕见(小于0.01%):多形红斑 上市后报告:非典型麻疹,蜂窝组织炎,带状疱疹,麻疹,皮肤感染,水痘(疫苗株),过敏性紫癜,单纯疱疹,脓疱疮,脂膜炎,瘙痒,紫癜,皮肤硬结,史蒂文斯约翰逊综合征,晒伤,水痘如皮疹,粗糙/干燥[参考] 呼吸道常见(1%至10%):鼻漏,咳嗽,上呼吸道感染 罕见(0.1%至1%):鼻咽炎,鼻炎 罕见(少于0.1%):咳嗽,支气管炎 上市后报告:流行性感冒,呼吸道感染,支气管痉挛,鼻出血,肺炎,肺炎,肺部充血,鼻窦炎,打喷嚏,喉咙痛,喘息[参考] 神经系统罕见(0.1%至1%):嗜睡,嗜睡 稀有(0.01%至0.1%):高热惊厥 非常罕见(少于0.01%):脑膜炎,脑炎,脑血管意外,小脑炎,类似症状的小脑炎,格林·巴雷综合征,横贯性脊髓炎,周围神经炎 上市后报告:急性弥漫性脑脊髓炎(ADEM),高热惊厥或癫痫发作,无菌性脑膜炎,共济失调,贝尔氏麻痹,惊厥,头晕,梦境异常,脑炎,脑病,高热惊厥,头痛,失眠,麻疹包括体脑炎,眼球炎,多发性神经炎,多发性神经病,亚急性硬化性全脑炎,晕厥,横贯性脊髓炎,震颤,神经性耳聋[参考] 据报告,每三百万剂麻疹,腮腺炎和风疹疫苗的组合使用一次脑炎和脑病。其中一些病例可能是由麻疹疫苗引起的。 2000年报告的病例中,患有野生型麻疹的脑炎和脑病的严重神经系统疾病的风险为1。 有报道称,没有野生型麻疹感染史但确实接种过麻疹疫苗的儿童患有亚急性硬化性全脑炎(SSPE)。其中一些病例可能是由于生命的第一年未识别出的麻疹所致,也可能是由于麻疹疫苗接种所致。 根据美国(美国)估计的麻疹疫苗分布情况,SSPE病例与麻疹疫苗接种的关联性约为每百万剂疫苗中分配一例。每百万例麻疹中有6至22例SSPE与野生型麻疹病毒感染有关。 据报告,麻疹,腮腺炎和风疹疫苗接种后会导致无菌性脑膜炎。尽管已经显示出其他流行性腮腺炎疫苗株与无菌性脑膜炎之间的因果关系,但没有证据表明杰里尔·林恩(TM)腮腺炎疫苗与无菌性脑膜炎有关。 [参考] 胃肠道常见(1%至10%):腹泻,呕吐 罕见(0.1%至1%):腮腺肿胀 非常罕见(少于0.01%):腮腺炎样综合征 上市后报告:腮腺炎,腹痛,肠胃气胀,便血,口腔溃疡,嘴唇异常[参考] 精神科常见(1%至10%):烦躁 罕见(0.1%至1%):异常哭闹,神经质,失眠,嗜睡 上市后报告:躁动,冷漠,神经质[参考] 血液学罕见(0.1%至1%):淋巴结肿大 非常罕见(少于0.01%):血小板减少症,血小板减少性紫癜 上市后报告:再生障碍性贫血,淋巴结炎,局部淋巴结病,血小板减少症[参考] 使用麻疹后有血小板减少症的报道。麻疹,腮腺炎和风疹(MMR);和水痘疫苗接种。患有目前血小板减少症的人在接种疫苗后可能会出现更严重的血小板减少症。此外,首次服用MMR后经历血小板减少症的患者可能会重复服用血小板减少症。 [参考] 过敏症非常罕见(少于0.01%):过敏反应(包括过敏和类过敏反应) 上市后报告:过敏史和相关现象,如血管神经性水肿,面部水肿和周围性水肿,有或没有过敏史的人的过敏反应[参考] 新陈代谢罕见(0.1%至1%):厌食[参考] 肌肉骨骼非常罕见(少于0.01%):关节痛,关节炎 上市后报告:肌肉骨骼疼痛,肌痛,臀部,腿部或颈部疼痛,肿胀,僵硬[参考] 慢性关节炎与野生型风疹感染有关,并与从人体组织中分离出来的持久性病毒和/或病毒抗原有关。风疹疫苗的接受者可能会出现慢性关节症状。野生型风疹病毒感染后的关节痛和/或关节炎以及多发性神经炎的频率和严重程度随年龄和性别而变化,成年女性中最大,青春期前儿童中最小。儿童接种疫苗后,关节反应不常见(0至3%),持续时间短。在女性中,关节炎和关节痛的发病率高于儿童(12%至26%),并且反应往往更明显,持续时间更长(例如,数月或数年)。在青春期女孩中,这些反应的发生率介于儿童和成年女性之间。 [参考] 泌尿生殖非常罕见(少于0.01%):睾丸炎,附睾炎[参考] 眼科上市后报道:眼睑水肿,刺激,坏死性视网膜炎(仅在免疫功能低下者报告),视神经炎,视网膜炎,球后神经炎[参考] 参考文献1. Cerner Multum,Inc.“澳大利亚产品信息”。 00 2.“产品信息。ProQuad(麻疹/腮腺炎/风疹/水痘病毒疫苗)。”宾夕法尼亚州西点市的默克公司(Merck&Company Inc)。 某些副作用可能没有报道。您可以将其报告给FDA。 已知共有247种药物可与麻疹病毒疫苗/腮腺炎病毒疫苗/风疹病毒疫苗/水痘病毒疫苗相互作用。
检查互动最常检查的互动查看麻疹病毒疫苗/腮腺炎病毒疫苗/风疹病毒疫苗/水痘病毒疫苗和以下药物的相互作用报告。
麻疹病毒疫苗/腮腺炎病毒疫苗/风疹病毒疫苗/水痘病毒疫苗疾病相互作用与麻疹病毒疫苗/腮腺炎病毒疫苗/风疹病毒疫苗/水痘病毒疫苗共3种疾病相互作用,包括:
药物相互作用分类
药物状态
美国日本医生Heather Benjamin MD经验:11-20年 Heather Benjamin MD经验:11-20年 Suzanne Reitz MD经验:11-20年 Heather Miske DO经验:11-20年 Heather Miske DO经验:11-20年 渡邊剛经验:21年以上 村上和成 教授经验:21年以上 中山秀章 教授经验:21年以上 村田朗经验:21年以上 溝上裕士 医院教授经验:21年以上 临床试验
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