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Manual dos Centro de Referência de Imunobiológicos Especiais

Manual dos Centro de Referência de Imunobiológicos Especiais

Manual dos Centro de Referência de Imunobiológicos Especiais

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No caso <strong>de</strong> vacinação <strong>dos</strong> HIV-positivos, recomenda o CDC a aplicação <strong>de</strong> duas <strong>dos</strong>es,<br />

com intervalo <strong>de</strong> três meses.<br />

Bibliografia<br />

1. American Aca<strong>de</strong>my of Pediatrics. Varicella-zoster infections. In: Peter G, editor. 1997 Red Book:<br />

Report of the Committee on Infectious Diseases. 24 th ed. Elk Grove Village, IL: American Aca<strong>de</strong>my<br />

of Pediatrics; 1997: p 573-585.<br />

2. Asano Y, Yazaki T, Miyata T et al. Application of a live attenuated varicella vaccine to hospitalized<br />

children and its protective effect on spread of varicella infection. Biken Journal 1975; 18:35-<br />

40.<br />

3. Asano Y, Nakayama H,Yazaki T et al. Protection against varicella in family contacts by immediate<br />

inoculation with live varicella vaccine. Pediatrics 1977; 59:3-7.<br />

4. Asano Y, Nakayama H, Yazaki T et al. Protective efficacy of vaccination in children in four episo<strong>de</strong>s<br />

of natural varicella and zoster in the ward. Pediatrics 1977; 59:8-12.<br />

5. Asano Y, Hirose S, Iwayama S, et al. Protective effect of immediate inoculation of a live varicella<br />

vaccine in household contacts in relation to the viral <strong>dos</strong>e and interval between exposure and<br />

vaccination. Biken Journal 1982; 25:43-45.<br />

6. Centers for Disease Control and Prevention. Prevention of varicella. Recommendations of the<br />

Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report<br />

1996; 45:N o<br />

. RR-11.<br />

7. Centers for Disease Control and Prevention. Prevention of varicella:updated recommendations<br />

of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly<br />

Report 1999; 48(N o<br />

. RR-6).<br />

8. Gershon AA, Steinberg SP, Gelb L. Live attenuated varicella vaccine use in immunocompromised<br />

children and adults. Pediatrics 1987; 78 suppl: 757-762.<br />

9. Gershon AA, Steinberg SP. Persistence of immunity to varicella in children with leukemia immunized<br />

with live attenuated varicella vaccine. New England Journal of Medicine 1989; 320:892-<br />

897.<br />

10. Pirofski L, Casa<strong>de</strong>vall A. Use of licensed vaccines for active immunization of the<br />

immunocompromised host. Clinical Microbiology Reviews 1998; 11:1-26.<br />

11. Takahashi M, Okuno Y, Otsuka T et col. Development of a live attenuated varicella vaccine.<br />

Biken Journal 1975; 18:25-35.<br />

4.5. Imunoglobulina humana antivaricela-zóster<br />

4.5.1. Eficácia em pessoas imunocompetentes<br />

A imunoglobulina humana antivaricela-zóster (IGHAVZ) po<strong>de</strong> evitar ou atenuar a varicela<br />

clínica em pessoas suscetíveis e sadios, se administrada por via IM nas primeiras 96 horas após o<br />

contato com varicela. Entretanto, não há indicação para usá-la na maioria <strong>de</strong>sses casos.<br />

Em grávidas que adquirirem varicela há maior risco <strong>de</strong> complicações, além da possibilida<strong>de</strong><br />

<strong>de</strong> transmitir doença grave para o feto, especialmente quando a infecção se manifesta nas<br />

primeiras 20 semanas ou nos cinco últimos dias <strong>de</strong> gestação.<br />

Não se sabe se a IGHAVZ aplicada na gestante suscetível comunicante <strong>de</strong> varicela apenas<br />

atenuará as manifestações clínicas da doença, sem proteger o feto <strong>de</strong> malformações. Além<br />

disso, a IGHAVZ aplicada nos cinco últimos dias <strong>de</strong> gravi<strong>de</strong>z provavelmente não terá tempo <strong>de</strong> ser<br />

absorvida, cruzar a placenta e proteger a criança. Ainda assim, a administração profilática <strong>de</strong><br />

IGHAVZ na gestante é indicada, para protegê-la e, talvez, ao feto.<br />

FUNASA - abril/2001 - pág. 30

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