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昭和大学小児科学講座の若手勉強会の資料です。
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インフルエンザ
1.
2.
予防接種 ※接種間隔は 2~4週 ※鶏卵アレルギーは要注意者 ※接種 2週間後から5か月程度有効 6か月~3歳未満
1回0.25mL 2回 3歳~13歳未満 1回0.5mL 2回 13歳以上 1回0.5mL 1回
3.
症状 •潜伏期間は 2~3日、飛沫感染 •A型は高熱、B型は消化器症状 •発熱 95%、鼻炎
78%、咳 77% •頭痛 26%、筋肉痛 7% •合併症:脳症、鋳型気管支炎、心筋炎
4.
迅速検査の感度 •0~12時間:35% •12~24時間:66% •24~48時間:92% ※検査前確率:周囲流行、予防接種 ※24時間以内では翌日再検査も検討
5.
抗ウイルス薬 •有熱期を 1日短縮するのみ •重症化予防の効果 •外来の幼児や基礎疾患のある患者に推奨 •入院患者も推奨 •ゾフルーザ®は学会はノーコメント
6.
7.
概要 次スライド 4ブリスター 10歳未満 1キット 10歳以上
2キット 10mg/kg 15分間で 分2、5日間 分2、5日間 単回吸入 1日1回、3日位まで 2720 2942 4279 6216
8.
推奨 タミフル® リレンザ® イナビル®
ラピアクタ® 新生児 乳児(0-1y) 推奨 推奨されない 左記3剤が 使用困難な 場合に考慮 幼児(1-4y) 推奨 吸入困難 小児(5-9y) 推奨 可能なら場合のみ 10歳以上 推奨 推奨 呼吸器症状 あり 推奨 要注意 2019/2020 シーズンのインフルエンザ治療指針
9.
処方 • 37.5kg以上は75mg 2cp •
漢方は麻黄湯 • NSAIDs禁忌 (Reye症候群) • ゾフルーザ®と新剤型 のイナビル®懸濁用は 推奨も否定もせず
10.
学校保健安全法 【学童】 「発熱から5日」かつ「解熱後2日」 【幼児】 「発熱から5日」かつ「解熱後3日」
11.
参考 • ネルソン小児科学 • Up
To Date® • 2019/2020 シーズンのインフルエンザ治療指針 日本小児科学会 • 2019 予防接種に関するQ&A集 日本ワクチン産業協会 • 小児科ファーストタッチ 岡本光宏
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