Allurar Cutar Zazzabin Rawaya

Ana ba da shawarar alurar rigakafin zazzabin rawaya ga wadannan mutane:

Yara masu watanni 9 zuwa sama: A cikin jadawalin NPI na Nijeriya, ana ba yara alurar a watanni 9, lokaci guda da alurar Measles. Wannan ita ce mafi muhimmancin allura ga yara a Nijeriya saboda cutar na yaduwa a kasar.

Matafiya: Duk wanda ke tafiya zuwa yankunan da cutar ke yaduwa — musamman kasashen Afirka ta Yamma, Afirka ta Tsakiya, da wasu sassan Kudancin Amurka — ya kamata ya samu alurar. Kasashe da yawa sun sa tilas ga matafiya su nuna takardar shaida ta alurar (International Certificate of Vaccination or Prophylaxis, "Yellow Card") kafin shiga kasar.

Ma'aikata a bangaren kiwon lafiya: Wadanda ke aiki a dakunan gwaje-gwaje da ke mu'amala da kwayar cutar zazzabin rawaya.

Mazauna yankunan da cutar ke yaduwa: WHO ta ba da shawarar cewa duk kasashen da cutar ke yaduwa su sa alurar a cikin jadawalin rigakafin su na yau da kullum.

Yakin rigakafi na gaggawa: NCDC na gudanar da yakin rigakafin gaggawa a lokacin da ake ganin barkewar cutar a wata jiha, musamman a yankunan da ba su da isassun kayan aiki na kiwon lafiya.

Haramtacciyar allura a wadannan yanayi:

Ba a ba da alurar rigakafin zazzabin rawaya ga wadannan mutane ba:

Jarirai kasa da watanni 6: Ba a taba ba su wannan alurar ba saboda hadarin ciwon kwakwalwa (encephalitis). Wannan ka'ida ce ta WHO da ba ta da sauyi.

Jarirai masu watanni 6-8: Ba a ba da shawarar sai dai a lokacin barkewar annoba, inda hadarin cutar ya fi hadarin alurar.

Mutanen da ke da rauni a tsarin garkuwar jiki: Wadannan sun hada da masu cutar kanjamau (HIV) da CD4 kasa da 200 cells/mm³, masu shan magunguna masu rage garkuwar jiki (immunosuppressants), masu cutar kansar da ke shan chemotherapy, da wadanda suka yi dashen gabobin jiki.

Rashin lafiyar kwai: Mutanen da ke da matsanancin rashin lafiyar kwai (anaphylaxis) ba za su iya samun wannan alurar ba saboda ana amfani da kwan gwangwani (chicken embryo) wajen samar da ita.

Mutanen da ke da ciwon thymus: Wadanda suka taba yin tiyatar thymus ko masu cutar thymus (thymoma, myasthenia gravis) ba za su samu wannan alurar ba.

Mata masu juna biyu: Ba a ba da shawarar ba sai dai a lokacin barkewar annoba mai tsanani inda hadarin kamuwa ya yi yawa. NAFDAC ta tabbatar da wannan ka'ida.

Sakamako na yau da kullum (mild reactions, 10-30% na masu shan allura):

Mafi yawan mutanen da suka sha alurar suna samun sakamako masu sauki wadanda ke warwarewa cikin kwanaki 5-10:

• Zafin wurin da aka yi allurar, kumburin wuri, da jan fata

• Dan zazzabi (37.5-38.5°C) wanda ke farawa kwanaki 3-7 bayan allura

• Ciwon kai, gajiya, da ciwon tsokoki

• Rashin jin dadi gaba daya

Sakamako masu tsanani (rare, 1 cikin 250,000-500,000):

Wadannan sakamako ba su da yawa amma suna da muhimmanci:

• Viscerotropic disease (YEL-AVD): Cutar da ke kama kamar zazzabin rawaya da kanta — gazawar gabobin jiki da yawa. Yawan faruwa: kusan 0.3-0.4 cikin 100,000 allura. Hadarin yana karuwa ga tsofaffi (sama da shekaru 60) da wadanda ke samun alurar a karon farko.

• Neurotropic disease (YEL-AND): Ciwon kwakwalwa (encephalitis, meningitis, Guillain-Barré syndrome). Yawan faruwa: kusan 0.8 cikin 100,000 allura.

• Matsanancin rashin lafiya (anaphylaxis): 1.3 cikin 100,000 allura, yawanci cikin minti 30 bayan allura.

Binciken NCDC: A Nijeriya, tsarin sa ido kan illolin alurar (AEFI surveillance) na NPHCDA na tattara bayanan sakamako ta hanyar tsarin rahotanni na jiha.

Yadda ake ba da alurar rigakafin zazzabin rawaya:

Hanyar ba da allura: Ana yi ta hanyar allura karkashin fata (subcutaneous injection), yawanci a saman hannun hagu. Ana amfani da allura mai girman 25-gauge, 5/8 inch.

Adadin allura: Allura guda daya (0.5 mL) kawai ake bukata. WHO ta tabbatar a shekarar 2013 (kuma ta sake tabbatarwa a 2016) cewa allura daya tana ba da kariya na tsawon rayuwa — ba a bukatar sake yin allurar (booster).

Jadawalin NPI na Nijeriya:

• Watanni 9: Allura ta farko (tare da Measles)

• A yakin rigakafin gaggawa: Ana ba da allura ga duk masu shekaru 9 watanni zuwa sama da 60 shekaru

Ajiye alurar:

• Ana ajiye ta a yanayin sanyi (2-8°C) a cikin sarkar sanyi (cold chain)

• Bayan an bude kwalbar, dole ne a yi amfani da ita cikin awanni 6

• NAFDAC na sa ido kan ingancin alurar da ke shigowa Nijeriya

Yawan allura a Nijeriya:

• NPHCDA na samun alurar ne ta hanyar UNICEF Supply Division da kuma siyan kai tsaye daga masana'antu

• Gavi, the Vaccine Alliance, na tallafawa Nijeriya wajen siyan allurar don yaki na yau da kullum da na gaggawa

• A shekarar 2023, Nijeriya ta samu fiye da miliyan 30 na allurar rigakafin zazzabin rawaya

Ingancin alurar rigakafin zazzabin rawaya:

Kariya ta allura daya: Alurar rigakafin zazzabin rawaya tana daga cikin allurar da suka fi inganci a tarihin likitanci. Bayan allura guda daya:

• 80-85% na mutane suna samun kariya a cikin kwanaki 10

• 99% suna samun kariya a cikin kwanaki 30

• Kariyar tana dawwama na tsawon rayuwa — WHO ta tabbatar da haka a shekarar 2013

Binciken kimiyya:

• Nazarin da aka yi a Brazil, West Africa, da sauran wurare ya nuna cewa kariyar ta wuce shekaru 35-40 ba tare da wata matsala ba

• Neutralizing antibodies suna ci gaba da kasancewa a cikin jini na tsawon lokaci mai tsawo

Kariya a matakin al'umma (herd immunity):

• WHO ta ce idan akalla 80% na al'umma sun samu alurar, za a iya hana barkewar annoba

• A Nijeriya, NPHCDA na kokarin kaiwa ga wannan matsayi ta hanyar yakin rigakafi na yau da kullum da na gaggawa

Hadarin rashin kariya:

• Wasu mutane masu raunin garkuwar jiki na iya rashin samun cikakkiyar kariya

• Ana ba da shawarar gwajin jini (neutralization assay) ga matafiya masu raunin garkuwar jiki don tabbatar da kariya

Bayanin NCDC: NCDC na ci gaba da sa ido kan ingancin alurar a Nijeriya ta hanyar tsarin sa ido kan cututtuka (disease surveillance). Duk wani shari'ar zazzabin rawaya da aka tabbatar ana bincikenta don ganin ko mai cutar ya samu alurar ko a'a.

Proper vaccine storage is critical for maintaining potency and efficacy.

• Unopened vaccine (lyophilized powder):

• Temperature: 2°C to 8°C (35°F to 46°F); aim for 5°C (41°F)

• Protection from light: Keep in original packaging

• Duration: Until expiration date on vial

• Freezing: Must not be frozen

Active Ingredient:

Yellow fever virus 17D-204 strain (live, attenuated) – minimum 1000 international units (IU) per 0.5 mL dose (equivalent to ≥4.74 log₁₀ plaque-forming units)

Produced in specified pathogen-free (SPF) chicken embryos, free of avian leukosis virus

Non-medicinal Ingredients (Excipients):

Sorbitol (stabilizer)

Gelatin (stabilizer)

Sodium chloride

L-Histidine hydrochloride

L-Alanine

Potassium chloride

Disodium phosphate dihydrate

Potassium dihydrogen phosphate

Calcium chloride

Magnesium sulfate

Lactose (in some formulations)

Water for injection

Notable absence:

No preservatives (sodium thimerosal or other antimicrobial agents) are added

Physical form:

Lyophilized (freeze-dried) powder supplied in hermetically sealed vials under nitrogen atmosphere

Reconstituted vaccine: slight pink-brown suspension

Mu'amalar alurar da wasu magunguna da allurar:

Alurar rigakafin zazzabin rawaya tana da muhimman mu'amala da wasu magunguna:

Wasu allurar masu rai (live vaccines): Idan ba a ba da alurar MMR, Varicella, ko wasu allurar masu rai a rana guda tare da alurar zazzabin rawaya ba, sai a jira akalla kwanaki 28 tsakaninsu. A cikin jadawalin NPI na Nijeriya, ana ba da alurar zazzabin rawaya tare da Measles a watanni 9, wanda ya dace da ka'idojin WHO.

Magunguna masu rage garkuwar jiki: Corticosteroids (sama da 20mg prednisolone/rana na fiye da makonni 2), methotrexate, azathioprine, cyclophosphamide, da sauransu — dole ne a daina su akalla makonni 4 kafin shan allurar.

Magungunan HIV: Mutanen da ke shan magungunan ART (antiretroviral therapy) kuma suna da CD4 sama da 200 cells/mm³ za su iya samun alurar, amma dole ne a tuntubi likita mai kula da su. NCDC na ba da shawarar tantance yanayin garkuwar jiki kafin ba da alurar.

Chloroquine da sauran magungunan zazzabin cizon sauro: Ba su da wata illa mai muhimmanci akan tasirin alurar. Ana iya shan su tare ba tare da matsala ba.

Recommendation: Yellow fever vaccine should be avoided during pregnancy unless travel to a high-risk yellow fever-endemic area is unavoidable and cannot be postponed, and a high level of protection against mosquito bite exposure is not feasible.

Rationale: Wild yellow fever virus can cause severe infection in pregnancy and has been associated with fetal transmission and poor outcomes. However, the live attenuated vaccine virus carries theoretical risk, particularly in the first trimester. Limited data from surveillance of several hundred women who inadvertently received yellow fever vaccine during pregnancy have not demonstrated significant adverse fetal outcomes, suggesting that inadvertent vaccination during pregnancy is not an indication for pregnancy termination. ​

Special considerations:

Seroconversion rates (antibody response) following vaccination are lower in pregnant women compared to non-pregnant individuals; post-immunization serology (blood test to confirm immunity) may be considered ​

Individual risk assessment must carefully weigh the risk of yellow fever infection (which carries substantial maternal and fetal morbidity and mortality) against theoretical vaccine risks

If vaccination is deemed necessary, it should ideally be administered in the second or third trimester, though the vaccine can be given at any stage if infection risk is high ​

Healthcare providers should document the indication for vaccination and counsel women regarding theoretical risks

Women of childbearing potential should be counseled to avoid pregnancy for 2 months following yellow fever vaccination, though data do not support this as a strict requirement

Recommendation: Yellow fever vaccination should generally be avoided in women who are actively breastfeeding, particularly those breastfeeding infants under 9 months of age.

Rationale: Three documented cases of vaccine-strain yellow fever virus transmission through breast milk have been reported, resulting in meningoencephalitis in exclusively breastfed infants whose mothers received yellow fever vaccine during their infants' first month of life. Although the exact mode of transmission has not been definitively established, the risk of vaccination during breastfeeding is considered a precaution rather than an absolute contraindication.

Age 6 months to 9 months:

Vaccination is contraindicated in routine circumstances due to increased risk of vaccine-associated encephalitis (YEL-AND). During the pre-restriction era (1950s), 15 encephalitis cases were reported in infants, with 13 (87%) occurring in infants under 4 months and all cases occurring in infants under 7 months. The risk of YEL-AND is inversely proportional to age in this age group. ​

Vaccination may be considered only when travel to yellow fever-endemic areas is unavoidable and the risk of wild-type yellow fever infection is very high (such as during confirmed epidemics or outbreaks). Expert consultation is mandatory, and a thorough individual risk-benefit assessment must be documented.

Age 9 months to 2 years:

Vaccination is recommended for infants and young children traveling to yellow fever-endemic areas. However, immunogenicity studies demonstrate lower seroprotection rates in children vaccinated before age 2 years:

Seroprotection rate within 5 years post-vaccination: approximately 52% in children vaccinated before age 2 years

This is substantially lower than the >90% seroprotection rate in children vaccinated at age ≥2 years

Booster vaccination in early childhood: Children vaccinated before age 2 years are recommended to receive a reinforcing (booster) dose once they reach age 2 years or older, depending on planned travel to yellow fever-endemic areas. This recommendation is based on evidence of waning seroprotection 3 months to 5 years following primary vaccination in infants. Recent breakthrough infection data suggest this approach may enhance long-term protection. ​

Age ≥9 years to adolescence:

Children in this age group have immunogenicity and safety profiles similar to adults. Standard vaccination schedules and recommendations apply. A single dose provides sustained protective immunity.

General pediatric considerations:

The vaccine is well-tolerated in children

Mild systemic adverse events (fever, headache, myalgia) are reported in 20–40% of younger vaccinees, with rates typically lower in older children than infants

Serious adverse events are rare in children, with the exception of increased risk in the 6–9 months age group

Vaccination in children can be given concurrently with routine immunizations at separate injection sites

Travel-related mosquito bite prevention is essential for all children, especially those too young for vaccination or in the precautionary age groups

Recommendation: Yellow fever vaccination for individuals aged 60 years and older requires individualized risk-benefit assessment. Vaccination should only be administered when there is a significant and unavoidable risk of acquiring yellow fever infection based on travel itinerary and duration in endemic areas.

No specific cases of overdose with yellow fever vaccine have been documented in the medical literature. The vaccine is supplied as a single-dose vial containing 0.5 mL (one dose), and multi-dose vials are used in limited circumstances under strict medical supervision.

Matakan kariya da lura kafin da bayan shan alurar:

Kafin shan allurar:

• Dole ne likita ya duba tarihin lafiyar mai shan allura, musamman game da rashin lafiyar kwai, yanayin garkuwar jiki, da tarihin cututtuka

• A tambayi ko mai shan allurar na da juna biyu ko yana shirin haihuwa

• A duba ko mai shan allurar na shan wasu magunguna da za su iya shafar garkuwar jiki

• Tsofaffi masu shekaru 60+ — dole ne a yi la'akari da hadari da amfanin kafin ba da alurar saboda karuwar hadarin YEL-AVD

Bayan shan allurar:

• Sai a jira akalla minti 30 a wurin da aka yi allurar don sa ido kan rashin lafiya mai tsanani (anaphylaxis)

• A gaya wa mai shan allurar cewa dan zazzabi da rashin jin dadi na iya faruwa cikin kwanaki 3-10

• Mata su guji daukar ciki na akalla makonni 4 bayan shan allurar

• A ba da takardar shaida ta kasa da kasa (Yellow Card) wacce take da amfani na tsawon rayuwa (WHO ta tabbatar tun 2016)

Matakan NPHCDA na musamman: A lokacin yakin rigakafi na gaggawa, ana ba da horo na musamman ga ma'aikatan kiwon lafiya don gane sakamako masu tsanani da sauri tare da samar da magungunan gaggawa (epinephrine).