Exploratory Research For Diagnostic Criteria Of Anaphylactic Shock After Immunization And Other Reference Diseases

ObjectiveWith the level of AEFI monitoring continuous improvement, the detection and reporting of AEFI related diseases are increasing, and to make an accurate diagnosis is particularly important, but also to ensure vaccine safety warning the key. At present, AEFI-related diseases have no diagnostic criteria in urgent need of the introduction of a unified national AEFI related disease diagnostic criteria to ensure that AEFI monitoring systems report the specificity of the related diseases. To vaccination in this study occurred after the diagnosis of anaphylactic shock as a template to determine the diagnostic criteria for research methods and content, but also accumulate experience for other AEFI related disease diagnostic criteria. To understand the characteristics and rules and report of anaphylactic shock induced by vaccination, in order to provide guidance basis for the report and diagnosis and standardized processing and scientific appraisal anaphylactic shock caused by immunization.MethodsWith systematic review method, to search China Hospital Knowledge Database (CHKD) and WANGFANG databases(2000-2010years)comprehensively, evaluate the quality of articles, then withdraw the related information from the qualified literature to carry on the analysis.With descriptive methodology to analysis the anaphylactic shock cases in national adverse event following immunization monitoring information system during2008-2010.Through access to domestic and foreign literature, to draft adverse event following immunization diagnostic reference standard. Then, we inviting expert to comment and amendments the standards.Results1.Systematic reviews of the anaphylactic shock after immunization76cases from52thesis were involved,56male cases,20female cases, and the proportion of Male and female is2.8:1. The maximum onset age is69, the minimum is1day, and all age groups could be occurred. Altogether involves17kinds vaccine,54cases are inactivated vaccine,20cases are attenuated live vaccine,2cases are meanwhile vaccination of attenuated live and inactivated vaccine, and the top three is rabies vaccine(14cases), hepatitis B vaccine(13cases), Japanese encephalitis inactivated vaccine(8cases). The shortest time between vaccination and anaphylactic shock is1minute, the longest is four hours, and the average is10minutes. The ultimate outcome is9deaths and67patients recover. The main symptoms and signs are shortness of breath, difficulty breathing, blood pressure drops, cyanosis, limb moist-chilling, pale face, consciousness not clear or lose. According to the principle of the Ministry of Health immunization work norms,"the diagnosis of anaphylactic shock", can be found reported in the literature, is not entirely accurate for the diagnosis of anaphylactic shock.2. Monitoring analysis and evaluation of the anaphylactic shock180anaphylactic shock cases were reported during2008-2010, and175cases are rare vaccine reaction. The maximum onset age is71, the minimum is1day, and all age groups could be occurred. Altogether involves25kinds vaccine,121cases are inactivated vaccine,54cases are live attenuated vaccine. The shortest time between vaccination and anaphylactic shock is1minute, the longest is18hours, the average is10minutes, and the cases happened in vaccination after30minutes account for86.2%. The main symptoms and signs are shortness of breath, difficulty breathing, blood pressure drops, cyanosis, limb moist-chilling, pale face, consciousness not clear or lose. Based on the clinical manifestations of anaphylactic shock and the occurrence interval time can be found in the monitoring reports of anaphylactic shock, and some diagnostic can be inaccurate.3. Research and formulation of diagnostic criteria of anaphylactic shock Drawn up diagnostic criteria of anaphylactic shock after vaccination and inviting expert review, and made same appropriate amendments. Diagnostic criteria for anaphylactic shock after vaccination:(1)in1hour after vaccination;②occurs severe symptoms and circulatory failure suddenly, a sharp decline in blood pressure to shock level namely10.7/6.7KPa (80/50mmHg) appears the following.③disturbance of consciousness or difficulty breathing④cyanosis or pale.⑤multi-merge rash or pruritus, early eye itching, tearing, positioning of nasal congestion, sneezing, or catarrhal rhinitis, dizziness, chest tightness, shortness of breath and abdominal pain or cramps, followed by laryngeal edema can be and bronchial and other respiratory symptoms. May be associated with for the limbs cold irritability, weak pulse, tachycardia, etc., in a very serious allergic reaction can also be manifested as bradycardia. Patients can have gastrointestinal symptoms such as nausea, vomiting, diarrhea and even incontinence, other performance.Conclusion1. Anaphylactic shock, systemic evaluation and monitoring of data analysis showed that the vast majority (87.3%and86.2%) of the vaccination due to anaphylactic shock occurred within30min after inoculation; the main clinical features of anaphylactic shock performance shortness of breath, difficulty breathing, blood pressure, cyanosis, clammy, pale, confusion or loss.2. Part of the vaccination clinical features of anaphylactic shock "does not fully comply with the diagnosis of anaphylactic shock; longer in some cases the incidence and vaccination intervals, does not meet the anaphylactic shock itself occurs interval; diagnosis of anaphylactic shock judgment is still a lack of uniform implementation of standards and causation.3. Diagnostic criteria for the development of anaphylactic shock after vaccination (suspected abnormal reaction to vaccination), it is necessary to consider the clinical diagnostic criteria of the disease, the time correlation, biological plausibility and the principle of reciprocity. Anaphylactic shock after vaccination diagnostic criteria specification survey diagnosis after vaccination anaphylactic shock has an important role in guiding.