护理专家谈新冠疫苗： 怀孕的女子可以打新冠疫苗吗 +++

呵呵，在标题上自封“护理专家”。。。这个时候不要谦虚，要把我这个从事护理临床和教学多年的老护士所知道的转告给朋友们，给那些尚不知道的朋友提个醒哈。大家万众一心，齐心协力 ，共同战胜新冠 ，让日子重新回到从前：我们可以不用带口罩，不用时时刻刻提心吊胆每日如临大敌，不用隔离了又隔离以至于抑郁悲戚。我们可以随时亲吻孩子和爱人，可以拥抱陌生的朋友和熟悉的邻居，可以回到故土去见见我们久别的亲人们。。。让岁月静好早日回到我们身边来。我就是想尽一份一个普通职业护士的天职！！！再次致谢文学城终于给我开通博客啦。 

昨天贴出一篇关于疫苗接种的小文 ，收到几个问题。这几个问题可能也是很多朋友的疑问，于是追加这篇，希望可以帮到那些还没有打疫苗或者还在犹豫不决的朋友，尤其是怀孕的姐妹们 。

怀孕的女子可以打新冠疫苗吗？

根据今天我们圣村一直战斗在前线的Dr. Wang分享，新英格兰医学杂志昨天（4/22/21）发表了CDC的初步统计数据，35691孕妇接种了mRNA 疫苗，到目前为止还没有发现明显的安全性问题。Preliminary findings did not show obvious safety signals among pregnant persons who received mRNA Covid-19 vaccines. However, more longitudinal follow-up, including follow-up of large numbers of women vaccinated earlier in pregnancy, is necessary to inform maternal, pregnancy, and infant outcomes. 当然，长期的可能性影响，还是未知数 。副作用包括：怀孕的人注射部位疼痛比没有怀孕的人比例更高，而头疼，肌肉疼痛，寒战，发烧这些症状频率反而少一些。有兴趣的朋友可以读英文原版：A total of 35,691 v-safe participants 16 to 54 years of age identified as pregnant. Injection-site pain was reported more frequently among pregnant persons than among nonpregnant women, whereas headache, myalgia, chills, and fever were reported less frequently. Among 3958 participants enrolled in the v-safe pregnancy registry, 827 had a completed pregnancy, of which 115 (13.9%) resulted in a pregnancy loss and 712 (86.1%) resulted in a live birth (mostly among participants with vaccination in the third trimester). Adverse neonatal outcomes included preterm birth (in 9.4%) and small size for gestational age (in 3.2%); no neonatal deaths were reported. Although not directly comparable, calculated proportions of adverse pregnancy and neonatal outcomes in persons vaccinated against Covid-19 who had a completed pregnancy were similar to incidences reported in studies involving pregnant women that were conducted before the Covid-19 pandemic. Among 221 pregnancy-related adverse events reported to the VAERS, the most frequently reported event was spontaneous abortion (46 cases). https://www.nejm.org/doi/full/10.1056/NEJMoa2104983

有自身免疫系统疾病的人，可以接种新冠疫苗吗？

完全可以！ 赶紧去打，越快越好！有自身免疫系统疾病的人群，以及那些体重超标(overweight), 或者患有肥胖症（obese），高血压，阻塞性肺病（COPD），糖尿病，癌症等等，是排在65岁老人之后的最早一批被纳入保护的人群。您应该尽早去接种哈，不要再犹豫不决了，以求更早获得免疫保护，既保护了您自己，也保护了您的家人和社区！！！

那些人群不能接种新冠疫苗？

根据最新的CDC指示 ，只有那些对疫苗中的任何一种成分有严重过敏性反应的人群，不能接种新冠疫苗。CDC还对严重过敏性做了定义：严重过敏性反应是指那些需要注射epinephrine or EpiPen的人群。Epinephrine就是肾上腺素，用来急救的。这种严重过敏性反应往往发生在接种之后的几分钟到半个小时。那是为什么我们会让这些高危人群在接种之后呆足 30分钟的原因。而普通人群只需要等15分钟就可以离开。CDC界定的（An immediate allergic reaction）即刻严重过敏性反应的时间是在4个小时之内，症状主要集中在呼吸道(respiratory distress)。症状包括寻麻疹（hives），水肿（swelling）最可怕的是水肿在舌头喉咙部位，哮喘（wheezing）。那是争分夺秒的急救时间啊。严重的需要住院治疗和观察。

• If you have had a severe allergic reaction (anaphylaxis) or an immediate allergic reaction, even if it was not severe: 1) to any ingredient in an mRNA COVID-19 vaccine (such as polyethylene glycol), you should not get an mRNA COVID-19 vaccine; 2) or after getting the first dose of the vaccine, you should not get a second dose of either of the mRNA COVID-19 vaccines.
• An allergic reaction is considered severe when a person needs to be treated with epinephrine or EpiPen^©or if they must go to the hospital. Learn about and when to call a doctor.
• An immediate allergic reaction means a reaction within 4 hours of getting vaccinated, including symptoms such as hives, swelling, or wheezing (respiratory distress)（CDC，2021).

目前接种新冠疫苗的年龄段有什么变化？

瑞辉建议给所有符合条件的16岁以上的人群接种 。家里有高中生的，赶紧去打吧！现在年轻人住院人数剧增，老人因为受到疫苗保护，因为新冠住院的反而越来越少。The Pfizer-BioNTech vaccine is recommended for people aged 16 years and older (CDC, 4/16/21)。

Moderna 还没有修改年龄段，还是只给18岁以上的人群接种。继续关注。（The Moderna vaccine is recommended for people aged 18 years and older，CDC，4/5/21）

Johnson & Johnsons 的接种年龄跟Moderna一样，18岁以上人群。The J&J/Janssen vaccine is recommended for people aged 18 years and older (CDC,4/13/2121).

新冠疫苗两针的间隔时间是多少？

瑞辉两针间隔21天 ，Modern  间隔 28天。这个问题大家现在都应该铭记于心啦。

很多接种点在接种第一针疫苗时会当场预约第二针的接种时间。不能同一天接种多种不同种类的疫苗。比如接种新冠疫苗外加流感疫苗就不行 。接种不同种类的疫苗至少需要间隔14天 （There should be a minimum interval of 14 days before or after administration with any other vaccines) (CDC，2021）。

有一群人长期遭受四季过敏困扰，需要常年打过敏针。如果你跟我一样住在密苏里的圣路易斯，它虽然不是最糟糕的地方，但是位居 top 27 of the most challenging places to live (https://www.aafa.org/media/2933/aafa-2021-allergy-capitals-report.pdf). 我原来以为是top 10呢。这样的人群可以打新冠疫苗吗？Yes！ 我家就有常年打过敏针的老兄。打新冠疫苗之前仔细咨询过医生，答案是可以的。过敏针剂量小，不同于传统意义上的疫苗。但是要记住，你打了过敏针之后需要至少2天（24小时）的间隔时间才能去打新冠疫苗哈。

如果错过了第二针预约时间，还能打吗？最长可以等多久打第二针 ？

有朋友问这个问题，问的好！ 可以的！！ 根据CDC指示：你最好在建议的时间内打第二针剂，如果有特殊情况不能打上，必须在6周（42天 ）以内完成接种。也就是接种第一剂之后42天之内打。你可以晚一点打，但是不能比规定打的时间早去接种 。你想早打我们也不会给你早打的。咱们来看看CDC 原文：

CDC给瑞辉的指示：guideline for scheduling doses (4/16/2021)

• Persons age 16 years and older should receive 2 doses at least 21 days apart.
  • Second doses should be administered as close to the recommended interval as possible.
    • If it is not feasible to adhere to the recommended interval, you may schedule the second dose up to 6 weeks (42 days) after the first dose; there is limited efficacy data beyond this window, but a dose after this time does not need to be repeated.
    • Doses inadvertently given less than 21 days apart do not need to be repeated.
  • Both doses should be Pfizer-BioNTech COVID-19 Vaccine.
    • Every effort should be made to determine which vaccine product was received as the first dose.
    • In exceptional situations, if the vaccine product given as the first dose cannot be determined or is no longer available, any mRNA COVID-19 vaccine product may be administered at least 28 days after the first dose.
• Administer the vaccine series alone. Separate mRNA COVID-19 vaccine 14 days before or after administration of any other vaccine.
  • If mRNA COVID-19 vaccines are inadvertently administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.

CDD给Moderna的指示：guideline for scheduling doses (4/5/2021)

• Persons age 18 years and older should receive 2 doses at least 28 days apart.
  • Second doses should be administered as close to the recommended interval as possible.
    • If it is not feasible to adhere to the recommended interval, you may schedule the second dose up to 6 weeks (42 days) after the first dose; there is limited efficacy data beyond this window, but a dose after this time does not need to be repeated.
    • Doses inadvertently given less than 28 days apart do not need to be repeated
• Both doses should be Moderna COVID-19 vaccine.
  • Every effort should be made to determine which vaccine product was received as the first dose.
  • In exceptional situations, if the vaccine product given as the first dose cannot be determined or is no longer available, any mRNA COVID-19 vaccine product may be administered at least 28 days after the first dose.
• Administer the vaccine series alone. Separate mRNA COVID-19 vaccines 14 days before or after administration of any other vaccine.
  • If mRNA COVID-19 vaccines are inadvertently administered within 14 days of another vaccine, doses do not need to be repeated for either vaccine.

呵呵，残酷的读博训练，说话必须要有科学证据支持，我尽力而为之。护理是科学和艺术的完美结合！除了那些必不可少的人文关怀，护理也必须是科学的，Evidence-based practice for nursing. 大家一起加油，各尽所能，争取早日战胜新冠！！！