漁魚兒 ---眸影搖紅
背起詩囊/ 流浪/ 打開 一扇扇窗/ 眸影搖紅/ 四季芬芳
嗬嗬，在標題上自封“護理專家”。。。這個時候不要謙虛，要把我這個從事護理臨床和教學多年的老護士所知道的轉告給朋友們，給那些尚不知道的朋友提個醒哈。大家萬眾一心，齊心協力 ，共同戰勝新冠 ，讓日子重新回到從前：我們可以不用帶口罩，不用時時刻刻提心吊膽每日如臨大敵，不用隔離了又隔離以至於抑鬱悲戚。我們可以隨時親吻孩子和愛人，可以擁抱陌生的朋友和熟悉的鄰居，可以回到故土去見見我們久別的親人們。。。讓歲月靜好早日回到我們身邊來。我就是想盡一份一個普通職業護士的天職！！！再次致謝文學城終於給我開通博客啦。
昨天貼出一篇關於疫苗接種的小文 ，收到幾個問題。這幾個問題可能也是很多朋友的疑問，於是追加這篇，希望可以幫到那些還沒有打疫苗或者還在猶豫不決的朋友，尤其是懷孕的姐妹們 。
懷孕的女子可以打新冠疫苗嗎？
根據今天我們聖村一直戰鬥在前線的Dr. Wang分享，新英格蘭醫學雜誌昨天（4/22/21）發表了CDC的初步統計數據，35691孕婦接種了mRNA 疫苗，到目前為止還沒有發現明顯的安全性問題。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. 當然，長期的可能性影響，還是未知數 。副作用包括：懷孕的人注射部位疼痛比沒有懷孕的人比例更高，而頭疼，肌肉疼痛，寒戰，發燒這些症狀頻率反而少一些。有興趣的朋友可以讀英文原版：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
有自身免疫係統疾病的人，可以接種新冠疫苗嗎？
完全可以！ 趕緊去打，越快越好！有自身免疫係統疾病的人群，以及那些體重超標(overweight), 或者患有肥胖症（obese），高血壓，阻塞性肺病（COPD），糖尿病，癌症等等，是排在65歲老人之後的最早一批被納入保護的人群。您應該盡早去接種哈，不要再猶豫不決了，以求更早獲得免疫保護，既保護了您自己，也保護了您的家人和社區！！！
那些人群不能接種新冠疫苗？
根據最新的CDC指示 ，隻有那些對疫苗中的任何一種成分有嚴重過敏性反應的人群，不能接種新冠疫苗。CDC還對嚴重過敏性做了定義：嚴重過敏性反應是指那些需要注射epinephrine or EpiPen的人群。Epinephrine就是腎上腺素，用來急救的。這種嚴重過敏性反應往往發生在接種之後的幾分鍾到半個小時。那是為什麽我們會讓這些高危人群在接種之後呆足 30分鍾的原因。而普通人群隻需要等15分鍾就可以離開。CDC界定的（An immediate allergic reaction）即刻嚴重過敏性反應的時間是在4個小時之內，症狀主要集中在呼吸道(respiratory distress)。症狀包括尋麻疹（hives），水腫（swelling）最可怕的是水腫在舌頭喉嚨部位，哮喘（wheezing）。那是爭分奪秒的急救時間啊。嚴重的需要住院治療和觀察。
- 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).
目前接種新冠疫苗的年齡段有什麽變化？
瑞輝建議給所有符合條件的16歲以上的人群接種 。家裏有高中生的，趕緊去打吧！現在年輕人住院人數劇增，老人因為受到疫苗保護，因為新冠住院的反而越來越少。The Pfizer-BioNTech vaccine is recommended for people aged 16 years and older (CDC, 4/16/21)。
Moderna 還沒有修改年齡段，還是隻給18歲以上的人群接種。繼續關注。（The Moderna vaccine is recommended for people aged 18 years and older，CDC，4/5/21）
Johnson & Johnsons 的接種年齡跟Moderna一樣，18歲以上人群。The J&J/Janssen vaccine is recommended for people aged 18 years and older (CDC,4/13/2121).
新冠疫苗兩針的間隔時間是多少？
瑞輝兩針間隔21天 ，Modern 間隔 28天。這個問題大家現在都應該銘記於心啦。
很多接種點在接種第一針疫苗時會當場預約第二針的接種時間。不能同一天接種多種不同種類的疫苗。比如接種新冠疫苗外加流感疫苗就不行 。接種不同種類的疫苗至少需要間隔14天 （There should be a minimum interval of 14 days before or after administration with any other vaccines) (CDC，2021）。
有一群人長期遭受四季過敏困擾，需要常年打過敏針。如果你跟我一樣住在密蘇裏的聖路易斯，它雖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). 我原來以為是top 10呢。這樣的人群可以打新冠疫苗嗎？Yes！ 我家就有常年打過敏針的老兄。打新冠疫苗之前仔細谘詢過醫生，答案是可以的。過敏針劑量小，不同於傳統意義上的疫苗。但是要記住，你打了過敏針之後需要至少2天（24小時）的間隔時間才能去打新冠疫苗哈。
如果錯過了第二針預約時間，還能打嗎？最長可以等多久打第二針 ？
有朋友問這個問題，問的好！ 可以的！！ 根據CDC指示：你最好在建議的時間內打第二針劑，如果有特殊情況不能打上，必須在6周（42天 ）以內完成接種。也就是接種第一劑之後42天之內打。你可以晚一點打，但是不能比規定打的時間早去接種 。你想早打我們也不會給你早打的。咱們來看看CDC 原文：
CDC給瑞輝的指示：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.
- Second doses should be administered as close to the recommended interval as possible.
- 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給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
- Second doses should be administered as close to the recommended interval as possible.
- 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.
嗬嗬，殘酷的讀博訓練，說話必須要有科學證據支持，我盡力而為之。護理是科學和藝術的完美結合！除了那些必不可少的人文關懷，護理也必須是科學的，Evidence-based practice for nursing. 大家一起加油，各盡所能，爭取早日戰勝新冠！！！
