Thomas R E
Memorial University of Newfoundland, St John's.
Can Fam Physician. 2000 Mar;46:646-52, 655-6.
To provide, for family physicians without access to a travel clinic, evidence-based recommendations on vaccinating infants and children, adults, pregnant women, and immunocompromised patients traveling to non-Western countries.
Searches were undertaken of MEDLINE from 1990 to November 1998 (372 articles); the Cochrane Collaboration Library; publications of the National Action Committee on Immunization and the Committee to Advise on Tropical Medicine and Travel in Canada Communicable Disease Reports; the Canadian Immunization Guide; and Laboratory Centre for Disease Control, United States Centres for Disease Control, and World Health Organization websites. Evidence-based statements, randomized controlled trials, systematic reviews, and meta-analyses were selected. Vaccination recommendations are based on this evidence.
Physicians should complete vaccination schedules for children whose primary series is incomplete and vaccinate unvaccinated adults. Hepatitis A is widespread, and travelers to areas where it is endemic should be vaccinated. The elderly should be vaccinated against influenza and pneumococcal disease. Pregnant women should receive vaccines appropriate to their trimester. Immunocompromised patients should be vaccinated, but BCG and live vaccines are contraindicated. Travelers to areas where meningitis, typhoid, cholera, Japanese encephalitis, and rabies are endemic should be vaccinated if they are likely to be exposed. Those traveling to areas where tuberculosis is endemic should take precautions and should have skin tests before traveling and 2 to 4 months after return.
Family physicians can administer all necessary vaccinations. They can advise pregnant women and immunocompromised people about the balance of risk of disease and benefits of vaccination.
为无法使用旅行诊所的家庭医生提供关于为前往非西方国家旅行的婴儿、儿童、成人、孕妇和免疫功能低下患者接种疫苗的循证建议。
检索了1990年至1998年11月的MEDLINE（372篇文章）、Cochrane协作图书馆、加拿大免疫国家行动委员会和加拿大热带医学与旅行咨询委员会的传染病报告出版物、《加拿大免疫指南》以及疾病控制实验室中心、美国疾病控制中心和世界卫生组织网站。选择了循证声明、随机对照试验、系统评价和荟萃分析。疫苗接种建议基于这些证据。
医生应为主要系列疫苗接种不完整的儿童完成疫苗接种计划，并为未接种疫苗的成人接种疫苗。甲型肝炎广泛流行，前往该病流行地区的旅行者应接种疫苗。老年人应接种流感和肺炎球菌疾病疫苗。孕妇应根据其孕期接种适当的疫苗。免疫功能低下患者应接种疫苗，但禁忌接种卡介苗和活疫苗。前往脑膜炎、伤寒、霍乱、日本脑炎和狂犬病流行地区的旅行者，如果可能接触到病原体，应接种疫苗。前往结核病流行地区的旅行者应采取预防措施，旅行前和返回后2至4个月应进行皮肤测试。
家庭医生可以进行所有必要的疫苗接种。他们可以就疾病风险与疫苗接种益处之间的平衡向孕妇和免疫功能低下者提供建议。
