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ホームIMICライブラリMMWR抄訳2020年(Vol.69)破傷風トキソイド、弱毒化ジフテリアトキソイド、無細・・・

MMWR抄訳

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2020/01/24Vol. 69 / No. 3

MMWR69(3):77-83
Use of Tetanus Toxoid, Reduced Diphtheria Toxoid, and Acellular Pertussis Vaccines: Updated Recommendations of the Advisory Committee on Immunization Practices — United States, 2019

破傷風トキソイド、弱毒化ジフテリアトキソイド、無細胞性百日咳ワクチンの使用:最新のAdvisory Committee on Immunization Practicesの推奨事項 ― アメリカ、2019年

2005年以降、思春期および成人を対象に破傷風トキソイド/弱毒化ジフテリアトキソイド/無細胞性百日咳(Tdap)ワクチンの単回投与が、Advisory Committee on Immunization Practices(ACIP)によって推奨されている。Tdapの接種後、破傷風/ジフテリアトキソイド(Td)ワクチンのブースター接種は、10年ごと、または創傷治療で適応となる場合に推奨されている。以前はTdのみが推奨されていたが、2019年10月のACIP会議にてTdまたはTdapの使用を許可することを推奨事項として更新した。一般的な推奨事項として、11~18歳ではTdapを単回接種すべきであり、11~12歳の予防的ケア受診時が望ましい。19歳以上でTdapを接種したことがない人では、破傷風またはジフテリアトキソイド含有するワクチンの最終接種時からの間隔に関係なく、Tdap接種を単回接種すべきである。また、破傷風とジフテリアに対する予防を持続させるために、生涯にわたり10年ごとにTdまたはTdapをブースター接種すべきである。妊婦のTdap定期予防接種に関する推奨事項に変更はない。破傷風トキソイド含有ワクチンは、同ワクチンの最終接種から5年以上が経過した場合の創傷治療に適応となる。破傷風トキソイド含有ワクチンを11歳以上に適応する場合、Tdap未接種またはTdapの接種歴が不明な人にはTdapが望ましい。妊婦に破傷風トキソイド含有ワクチンを適応する場合、Tdapを使用するべきである。過去にTdapワクチン接種歴がある非妊娠女性では、TdまたはTdapを使用可能である。キャッチアップ接種として、7~18歳および19歳以上では、百日咳、破傷風、ジフテリアの予防接種歴がない場合、少なくとも1回のTdapの接種を含む3回の破傷風/ジフテリアトキソイド含有ワクチンを接種するべきである。小児期の予防接種スケジュールを完遂し、最後のワクチン接種が10年より前の妊婦では、新生児の破傷風予防のために、破傷風トキソイド含有ワクチンのブースター接種をすべきである。年齢および妊娠状態に基づくオフラベル使用に変更はなく、禁忌と予防措置は以前の推奨事項から変更されていない。

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