COVID-19 vaccines: addressing hesitancy in young people with allergies.
COVID-19 vaccines: addressing hesitancy in young people with allergies.
复制标题
DOI：
10.1016/s2213-2600(21)00370-2
复制
发表时间：
2021-10
期刊：
影响因子：
--
通讯作者：
Greenhawt M
中科院分区：
文献类型：
--
作者：
Abrams EM;Shaker M;Sinha I;Greenhawt M
评论www。thelancet。com/respiratory Vol 9 October 2021 1091已在全球范围内实施。任何恢复正常都依赖于疫苗的高吸收率。正如《新英格兰医学杂志》（The New England Journal of Medicine）最近的一篇文章所指出的那样，“我们指望疫苗把我们的世界还给我们”。2021年5月10日，美国食品和药物管理局（fda）扩大了对辉瑞- biontech mRNA COVID-19疫苗（BNT162b2）在12-15岁青少年中的紧急使用授权。这一批准现在要求更加注重在青少年人群中实现高免疫接种率。在这些人群中进行免疫接种具有双重直接好处，即保护儿童和青少年免受疾病发病率和死亡率的影响，并减少在临床弱势群体中的传播。1尽管有证据表明COVID-19疫苗既安全又有效，但越来越多的证据表明，儿童和青少年及其家庭对COVID-19疫苗犹豫不决。2美国疾病控制与预防中心（CDC）于2021年4月15日至4月23日在美国进行的一项调查发现，在1022名未接种疫苗的12-17岁青少年的父母和监护人中，只有55.5%的人“肯定”或“可能”允许他们的孩子接种COVID-19疫苗，在985名13-17岁的青少年中，只有51.7%的人“肯定”或“可能”接种COVID-19疫苗。在表示犹豫的家长中，一个常见的增加COVID-19疫苗接受可能性的因素是更多关于安全性的信息。事实上，对于有过敏症患者的家庭，包括哮喘患者，最主要的担忧之一就是害怕对疫苗产生过敏反应。这个问题很容易解决。必须向儿童和青少年及其家人，包括患有哮喘等过敏性疾病的儿童和青少年及其家人强调，对COVID-19疫苗产生过敏反应的风险极为罕见。一项系统综述和荟萃分析指出，基于mrna的COVID-19疫苗的过敏反应发生率为每百万剂量7.91例（95% CI 4.02 - 15.59）。4在美国马萨诸塞州波士顿的一项卫生保健员工的前瞻性研究中，在64 900名员工中，只有16名（0.025%,95% CI 0.014 - 0.040）被证实发生了COVID-19 mRNA疫苗过敏反应，这些员工全部完全康复，没有任何休克或插管事件。5迄今未报告COVID-19疫苗相关过敏反应死亡病例，过敏反应迅速消退，无长期后遗症，4初次反应后再次接种疫苗耐受性良好。临床医生必须向家庭重申这些信息，以减轻因担心过敏反应而对疫苗的犹豫。关于疫苗安全性（过敏或其他相关事件）的错误信息十分猖獗。疾病预防控制中心关于疫苗犹豫的调查发现，联邦、州和地方卫生官员以及初级保健卫生工作者是家庭中最值得信赖的COVID-19疫苗信息来源。临床医生在讨论家庭如何以及在何处获得信息，在临床遭遇中提供准确的信息，以及在必要时指导人们获得可靠的在线信息来源方面发挥着重要作用。7正如疾病预防控制中心所指出的那样，“努力向公众明确宣传青少年接种COVID-19疫苗的益处和安全性，特别是卫生保健专业人员，可以帮助提高对青少年COVID-19疫苗和疫苗接种覆盖率的信心”。2 .某些儿童群体及其家庭表现出较高的疫苗犹豫率；这些群体更有可能面临……
Comment www. thelancet. com/respiratory Vol 9 October 2021 1091 have been administered around the world. Any return to normalcy relies on high vaccine uptake. As noted by a recent piece in The New England Journal of Medicine,“we look to vaccines to give us back our world”. 1 On May 10, 2021, the US Food and Drug Administration expanded its emergency use authorisation for the Pfizer-BioNtech mRNA COVID-19 vaccine (BNT162b2) in adolescents aged 12–15 years. 2 This approval now demands increasing focus on achieving high immunisation rates within adolescent populations. Immunisation within these populations has the dual direct benefit of protecting children and adolescents against disease morbidity and mortality, and reducing spread among the clinically vulnerable. 1 Despite evidence that COVID-19 vaccines are both safe and effective, there is increasing evidence of COVID-19 vaccine hesitancy among children and adolescents and their families. 2 A survey, done in the USA between April 15 and April 23, 2021, by the Centers for Disease Control and Prevention (CDC), found that only 55· 5% of 1022 parents and guardians of unvaccinated adolescents aged 12–17 years would “definitely” or “probably” allow their child to receive a COVID-19 vaccine, and only 51· 7% of 985 adolescents aged 13–17 years would “definitely” or “probably” receive a COVID-19 vaccine. 2 Among parents who expressed hesitancy, a commonly reported factor that would increase the likelihood of COVID-19 vaccine acceptance was more information about safety. In fact, for families of individuals with allergies, including those with asthma, one of the major concerns is fear of an allergic reaction to the vaccine. 3, 4 This concern is easy to address. It must be emphasised to children and adolescents and their families, including to those with allergic conditions such as asthma, that the risk of having an anaphylactic reaction to a COVID-19 vaccine is exceptionally rare. A systematic review and meta-analysis noted that the incidence of an allergic reaction to an mRNA-based COVID-19 vaccine is 7· 91 cases per million doses (95% CI 4· 02–15· 59). 4 In a prospective study of health-care employees in Boston, MA, USA, COVID-19 mRNA vaccine anaphylaxis was confirmed in only 16 (0· 025%, 95% CI 0· 014–0· 040) of 64 900 employees, who all completely recovered without any episodes of shock or intubation. 5 No fatalities from COVID-19 vaccine-related anaphylaxis have been reported to date, the allergic reactions resolve rapidly without long-term sequelae, 4 and revaccination after an initial reaction is well tolerated. 6 Clinicians must reiterate such messaging to families to mitigate vaccine hesitancy due to concerns over anaphylaxis. Misinformation regarding vaccine safety (allergic or other related events) is rampant. The CDC survey on vaccine hesitancy found that federal, state, and local health officials and primary care health-care workers were the most trusted sources of COVID-19 vaccine information among families. 2 Clinicians have an essential role in discussing how and where families obtain information, in providing accurate information in the clinical encounter, and, when indicated, in directing people to reliable sources of online information. 7 As noted by the CDC,“efforts focusing on clearly communicating to the public the benefits and safety of COVID-19 vaccination for adolescents, particularly by health care professionals, could help increase confidence in adolescent COVID-19 vaccine and vaccination coverage”. 2Certain groups of children and their families have expressed higher vaccine hesitancy rates; these groups are more likely to face …