성인 예방접종 안내서 제2판 2018 [인플루엔자]

1. 기존 안내서에서는 모든 성인에서 일반 권장하였으나 2018년도 안내서에서는 연령에 따른 권장을 만 50세 이상으로 하였고 질환별, 직업 및 상황별 권장을 따로 두었습니다. UpToDate2019.10.25에도 비슷한 내용이 언급되어 있습니다.

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When influenza vaccine supply is limited, vaccination efforts should focus on individuals who:

Are at high risk for influenza-related complications, including those who:

Are 6 through 59 months of age

Are ≥50 years of age

Have chronic pulmonary (including asthma), cardiovascular (except isolated hypertension), renal, hepatic, hematologic (including sickle cell disease), metabolic (including diabetes mellitus), or neurologic (disorders of the brain and spinal cord, cerebral palsy, epilepsy, stroke, intellectual disability, moderate to severe developmental delay, muscular dystrophy, spinal cord injury) disorders

Are immune compromised due to any cause (including immunosuppression caused by medications or by HIV infection)

Are or will be pregnant during the influenza season

Are 6 months through 18 years of age and receiving aspirin- or salicylate-containing medications (and may be at risk for Reye syndrome after influenza virus infection)

Are residents of nursing homes or other long-term care facilities

Are Native Americans, including Alaska Natives

Are extremely obese (body mass index [BMI] ≥40 for adults)

Live with or care for persons at high risk of influenza-related complications, including:

Health care personnel who have the potential for exposure to patients and/or to infectious materials

Household contacts (including children) or caregivers of children ≤59 months (<5 years) or adults ≥50 years of age, particularly contacts of children <6 months

Household contacts (including children) or caregivers of persons with medical conditions that put them at increased risk for severe complications of influenza

Data from:

Grohskopf LA, Alyanak E, Broder KR, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices - United States, 2019-20 influenza season. MMWR Recomm Rep 2019; 68:1.

Centers for Disease Control and Prevention. People at high risk for flu complications. Available at: http://www.cdc.gov/flu/about/disease/high_risk.htm (Accessed on August 24, 2019.)

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2. 금기사항에서 계란 알레르기가 있는 대상자에 대한 내용을 삭제하였습니다. UpToDate2019.10.25에도 비슷한 내용이 언급되어 있습니다.

Influenza vaccination is contraindicated in patients who have had a severe allergic reaction (eg, anaphylaxis) to an influenza vaccine. Such patients should undergo an allergy evaluation to determine if the reaction was caused by a vaccine component and whether an influenza vaccine can be given safely.

The intranasal live attenuated influenza vaccine(LAIV) and the majority of the intramuscular inactivated influenza vaccines are derived from culture fluid from chicken embryos. As a result, there is a small amount of egg protein in these vaccines. A history of severe allergic reaction to egg protein is considered by the US Food and Drug Administration (FDA) to be a contraindication to LAIV but not to the inactivated vaccines. However, since published data suggest that LAIV is safe in those with egg allergy (including anaphylaxis), patients with egg allergy may receive an influenza vaccine manufactured using eggs, including LAIV, if appropriate precautions are taken. Specific recommendations and the data supporting them are provided separately, UpToDate 2019.10.25

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3. 임신 초기에는 안전한 약물도 꼭 필요한 경우가 아니라면 자제하는 경우가 많습니다. 인플루엔자 감염은 임신부에서 많은 합병증, 사망과 관련되어 있어서 ACIP는 ㉠ 임신 단계에 관계 없이 임신부에게, ㉡인플루엔자 유행기에 임신 가능성이 있는 여성에게 불활성화 백신을 권고합니다.

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