国家免疫规划技术工作组流感疫苗工作组.中国流感疫苗预防接种技术指南(2020-2021)[J].Chinese journal of Epidemiology,2020,41(10):1555-1576 |
中国流感疫苗预防接种技术指南(2020-2021) |
Technical guidelines for seasonal influenza vaccination in China (2020-2021) |
Received:September 04, 2020 |
DOI:10.3760/cma.j.cn112338-20200904-01126 |
KeyWord: 流感 疾病负担 疫苗 预防接种 技术指南 |
English Key Word: Influenza Disease burden Vaccine Vaccination Technical guidelines |
FundProject:国家科技重大专项(2018ZX10713001-005);国家自然科学基金(91846302);中美新发和再发传染病合作项目;中国疾病预防控制中心应急反应机制运行项目(131031001000015001);支持新疫苗纳入国家免疫规划的机制以及国家免疫规划专家委员会技术工作组能力建设(OPP1193638) |
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Abstract: |
流感是由流感病毒引起的一种急性呼吸道传染病,严重危害人群健康。流感病毒其抗原性易变,传播迅速,每年可引起季节性流行,在学校、托幼机构和养老院等人群聚集的场所可发生暴发疫情。每年流感季节性流行在全球可导致300万~500万重症病例,29万~65万呼吸道疾病相关死亡。孕妇、婴幼儿、老年人和慢性基础疾病患者等高危人群,患流感后出现严重疾病和死亡的风险较高。尤其是2020年全球新型冠状病毒(新冠)肺炎疫情严重流行态势仍将持续,今冬明春可能会出现新冠肺炎疫情与流感等呼吸道传染病叠加流行的情况。而接种流感疫苗是预防流感的最有效手段,可以减少流感相关疾病带来的危害及对医疗资源的占用。我国现已批准上市的流感疫苗有三价灭活流感疫苗(IIV3)、四价灭活流感疫苗(IIV4)和三价减毒活流感疫苗(LAIV3),IIV3包括裂解疫苗和亚单位疫苗,IIV4为裂解疫苗,LAIV为减毒疫苗。除个别地区外,流感疫苗在我国大多数地区属于非免疫规划类疫苗,实行自愿、自费接种。2018年和2019年,中国CDC均印发了当年度的《中国流感疫苗预防接种技术指南》。一年来,新的研究证据在国内外发表,新的疫苗产品在我国上市,为更好地指导我国流感预防控制和疫苗应用工作,国家免疫规划技术工作组流感疫苗工作组综合国内外最新研究进展,在2019年版指南的基础上进行了更新和修订,形成了《中国流感疫苗预防接种技术指南(2020-2021)》。本指南更新的内容主要包括以下几个方面:第一,增加了新的研究证据,尤其是我国的研究结果,包括流感疾病负担、疫苗效果、疫苗安全性监测、疫苗预防接种成本效果等;第二,更新了一年来国家卫生健康委员会流感防控有关政策和措施;第三,更新了我国2020-2021年度国内批准上市及批签发的流感疫苗种类;第四,更新了本年度IIV3、LAIV3和IIV4流感疫苗组份;第五,更新了2020-2021年度的流感疫苗接种建议。本指南建议:原则上,接种服务单位应为≥6月龄所有愿意接种流感疫苗且无禁忌证的人提供接种服务。对可接种不同类型、厂家疫苗产品的人群,可由受种者自愿选择接种任一种流感疫苗,无优先推荐。结合今年新冠肺炎疫情形势,为尽可能降低流感的危害和对新冠肺炎疫情防控的影响,推荐按照优先顺序对重点和高风险人群进行接种:医务人员,包括临床救治人员、公共卫生人员、卫生检疫人员等;养老机构、长期护理机构、福利院等人群聚集场所脆弱人群及员工;重点场所人群,如托幼机构、中小学校的教师和学生,监所机构的在押人员及工作人员等;其他流感高风险人群,包括≥60岁的居家老年人、6月龄~5岁儿童、慢性病患者、<6月龄婴儿的家庭成员和看护人员以及孕妇或在流感流行季节备孕的女性。首次接种或既往接种<2剂次流感疫苗的6月龄~8岁儿童应接种2剂次,间隔≥4周,对IIV或LAIV均建议上述原则;2019-2020年度或以前接种过≥2剂次流感疫苗的儿童,建议接种1剂次;≥9岁儿童和成人仅需接种1剂次。建议各地在疫苗供应到位后尽快安排接种工作,最好在10月底前完成免疫接种;对10月底前未接种的对象,接种单位在整个流行季节都可以提供接种服务。孕妇在孕期的任一阶段均可接种IIV。本指南适用于从事流感防控相关的各级疾病预防控制机构工作人员,预防接种点的接种人员,各级医疗机构儿科、内科、感染科等医务人员,以及各级妇幼保健机构的专业人员。根据国内外研究进展,本指南今后亦将定期更新、完善。 |
English Abstract: |
Influenza virus infection is a respiratory infectious disease that can seriously affect human health. Influenza viruses can have frequent antigenic variation and changes, which can result in rapid and widespread transmission resulting in annual epidemics and outbreaks in places of public gathering such as schools, kindergartens and nursing homes. According to WHO estimation, seasonal influenza epidemics have caused an annually 3 to 5 million severe cases and 290 000 to 650 000 deaths globally. Pregnant women, young children, the elderly, and persons with chronic illnesses are at high risk for severe illness and death associated with influenza virus infection. Especially, COVID-19 pandemic might co-circulate with other respiratory infectious diseases such as influenza in the coming winter-spring season. Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) which includes split-virus influenza vaccine and subunit vaccine, quadrivalent inactivated influenza vaccine (IIV4) which is split, and trivalent live attenuated influenza vaccine (LAIV3) which was newly licensed. Except for a few major cities, influenza vaccine is a category Ⅱ vaccine, which means influenza vaccination is voluntary, and recipients must pay for it. In 2018 and 2019, the China CDC issued the “Technical Guidelines for Seasonal Influenza Vaccination in China”. In the past year, new research evidences home and abroad have been published, and new seasonal influenza vaccine has been licensed in China. To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccination Technical Working Group (TWG), updated the 2019-2020 technical guidelines and compiled the “Technical guidelines for seasonal influenza vaccination in China (2020-2021)”. The main updates in this version include the following: First, new research evidences especially studies of China, including disease burden, effectiveness, Vaccine-avoidable disease burden, vaccine safety monitoring, and cost-effectiveness and cost-benefit. Second, policies and measures for influenza prevention and control issued by National Health Commission (PRC) in the past year. Thirdly, new type seasonal influenza vaccine licensed and issued in 2020-2021 in China. Fourth, northern hemisphere influenza vaccination composition for the 2020-2021 season which included trivalent and quadrivalent influenza vaccine. Fifth, Influenza vaccination recommendations for 2020-2021 influenza season. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. Considering the situation of globally pandemic of COVID-19, to decrease the risk of influenza virus infection and minimize the impact on COVID-19 prevention and control, we recommend the following priority for seasonal influenza vaccination: healthcare workers, including clinical doctors and nurses, public health professionals, quarantine professionals; vulnerable groups living in nursing homes or welfare homes and staffs who take care those vulnerable groups; people work or stay in high population density places, such as teachers and students in kindergartens, primary and secondary school, prisoners and staffs of prisons; other high risk group of influenza, including adults ≥60 years of age, children aged 6-59 months, persons with specific chronic diseases, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. People whoever get IIV or LAIV all apply to the principle. If they were vaccinated in 2019-2020 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the CDCs at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels. These guidelines will be updated periodically as new evidence becomes available. |
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