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ホームIMICライブラリMMWR抄訳2018年(Vol.67)アウトブレイク中の流行性耳下腺炎を発症するリスクが・・・

MMWR抄訳

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2018/01/12Vol. 67 / No. 1

MMWR67(1):33-38
Recommendation of the Advisory Committee on Immunization Practices for Use of a Third Dose of Mumps Virus–Containing Vaccine in Persons at Increased Risk for Mumps During an Outbreak

アウトブレイク中の流行性耳下腺炎を発症するリスクが高い人に対するムンプスウイルス含有ワクチンの3回目の投与に関するAdvisory Committee on Immunization Practicesの勧告

2015年後半以降、アメリカでは流行性耳下腺炎のアウトブレイクやアウトブレイク関連の症例数が大幅に増加した。この公衆衛生上の問題に取り組むために、Advisory Committee on Immunization Practices(ACIP)は入手可能なエビデンスのレビューを実施した。取り上げられたトピックには、麻疹-流行性耳下腺炎-風疹(MMR)ワクチンの定期的な2回接種の導入以来の、流行性耳下腺炎の疫学、 有効性、防御期間、免疫原性、2回投与のワクチン不全の危険因子、また、 MMRワクチンの3回目の接種の有効性、免疫原性、安全性が含まれた。さらに、 MMRワクチンの3回目の接種の認識された有益性および有害性に起因するステークホルダーの価値観、受容性、実効性についても調査した。流行性耳下腺炎の予防のためのMMRワクチンの3回目の接種の使用に関する3件の疫学的研究は、2回のMMRワクチン接種率が高い集団(学校、大学)でアウトブレイク中に実施された。すべての試験で、アウトブレイク中に3回目の接種をした人はアウトブレイク前に2回の接種を受けた人に比べ、発病率が低下し、1件の研究では有意な差があった(1000人-年あたり6.7 vs. 14.5)。3回目の接種の2回接種に対する増分有効性は61%~88%であった。ステークホルダーの調査の結果、専門家は、学生および両親は流行性耳下腺炎やその合併症の予防にも高い価値を置き、MMRワクチンの3回目の接種の安全性に関する懸念はないと結論した。2017年10月の会議中に、ACIPはアウトブレイクのために流行性耳下腺炎の発症のリスクが高いグループまたは集団に属しているとして、公共の保健機関により同定され、既に2回のワクチン接種をした人に対して、ムンプスウイルス含有ワクチンの3回目投与を推奨した。この勧告の目的は、流行性耳下腺炎の疾患および流行性耳下腺炎に関連する合併症に対して、アウトブレイクの状況にある人々の保護を改善することある。 この勧告は、流行性耳下腺炎予防接種のための既存のACIP勧告を補足するものである。

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