‫‪4/24/2018‬‬ ‫اﻷﻣﺻﺎل واﻟﻠﻘﺎﺣﺎت ‪Al Moqatel -‬‬

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‫ﺛﺎﻧﯾﺎً‪ :‬اﻟﻠﻘﺎﺣﺎت ‪Vaccines‬‬

‫‪ .1‬اﻟﺗﻌرﯾف‬

‫ﺍﻟﻠﻘﺎﺡ‪ Vaccine‬ﻫﻭ ﻋﺒﺎﺭﺓ ﻋﻥ ﺍﻟﻤﻴﻜﺭﻭﺏ ﺍﻟﻤﺴﺒﺏ ﻟﻠﻤﺭﺽ‪ ،‬ﺃﻭ ﺠﺯء ﻤﻨﻪ‪ ،‬ﻭﺫﻟﻙ ﺒﻌﺩ ﺇﻀﻌﺎﻓﻪ ﺃﻭ ﻗﺘﻠﻪ‪.‬‬
‫ﻭﺘﺅﺩﻱ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻤﻔﻌﻭﻟﻬﺎ ﻓﻲ ﺘﻜﻭﻴﻥ ﺍﻷﺠﺴﺎﻡ ﺍﻟﻤﻀﺎﺩﺓ ﺒﻌﺩ ﻋﺩﺓ ﺸﻬﻭﺭ‪ ،‬ﻭﻟﻜﻥ ﻤﻔﻌﻭﻟﻬﺎ ﻴﺩﻭﻡ ﻟﻔﺘﺭﺓ ﻁﻭﻴﻠﺔ‪،‬‬
‫ﻗﺩ ﺘﻜﻭﻥ ﻤﺩﻯ ﺍﻟﺤﻴﺎﺓ‪ .‬ﺃﻤﺎ ﻋﻤﻠﻴﺔ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ ﺒﻘﺼﺩ ﺍﻜﺘﺴﺎﺏ ﻤﻨﺎﻋﺔ ﻀﺩ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻷﻤﺭﺍﺽ‪ ،‬ﻓﺘُﺴﻤﻰ‬
‫"ﺍﻟﺘﻠﻘﻴﺢ" ﺃﻭ "ﺍﻟﺘﻁﻌﻴﻡ" ‪.Vaccination‬‬

‫‪ .2‬أﻧواع اﻟﻠﻘﺎﺣﺎت‬

‫أ‪ .‬ﻟﻘﺎﺣﺎت ﺣﯾﺔ‬

‫ﻫﻲ ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺘﻲ ﺘﺤﺘﻭﻱ ﻋﻠﻰ ﻤﻴﻜﺭﻭﺒﺎﺕ‪ ،‬ﺃﻭ ﻓﻴﺭﻭﺴﺎﺕ‪ ،‬ﺤﻴﺔ‪ ،‬ﻟﻜﻨﻬﺎ ﻤﻀﻌﻔﺔ ﻭﻭﺍﻫﻨﺔ ﺒﺤﻴﺙ ﻻ‬
‫ﺘﺴﺒﺏ ﺃﻱ ﺃﻤﺭﺍﺽ ﻟﻺﻨﺴﺎﻥ‪ ،‬ﺒل ﺘﺤّﻔﺯ ﺠﻬﺎﺯ ﺍﻟﻤﻨﺎﻋﺔ ﻓﻘﻁ‪ .‬ﻭﻤﻥ ﺃﻤﺜﻠﺔ ﺫﻟﻙ‪ :‬ﻟﻘﺎﺡ ﺍﻟﺤﺼﺒﺔ ‪،measles‬‬
‫ﻭﻟﻘﺎﺡ ﺍﻟﺩﺭﻥ ‪ ،BCG‬ﻭﻟﻘﺎﺡ ﺸﻠل ﺍﻷﻁﻔﺎل ‪ ،Sabin‬ﺍﻟﺫﻱ ُﻴﻌﻁﻰ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ ﻓﻲ ﺸﻜل ﻨﻘﻁ‪.‬‬

‫ب‪ .‬ﻟﻘﺎﺣﺎت ﻏﯾر ﺣﯾﺔ‬

‫ﻫﻲ ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺘﻲ ﺘﺤﺘﻭﻱ ﻋﻠﻰ ﺍﻟﻤﻴﻜﺭﻭﺒﺎﺕ ﺍﻟﻤﻴﺘﺔ‪ ،‬ﺃﻭ ﻋﻠﻰ ﺃﺠﺯﺍء ﻤﻨﻬﺎ‪ ،‬ﻤﺜل‪ :‬ﻟﻘﺎﺡ ﺍﻟﺴﻌﺎل‬
‫ﺍﻟﺩﻴﻜﻲ‪ ،‬ﻭﻟﻘﺎﺡ ﺸﻠل ﺍﻷﻁﻔﺎل ‪ ،Salk‬ﻭﺍﻟﺫﻱ ﻴُﻌﻁﻰ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺍﻟﻌﻀﻠﻲ‪ ،‬ﻭﻟﻴﺱ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ‪.‬‬

‫ج‪ .‬ﺗوﻛﺳﯾد ‪Toxoid‬‬

‫ﻫﻲ ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺘﻲ ﺘﺤﺘﻭﻱ ﻋﻠﻰ ﺴﻤﻭﻡ ﺍﻟﺒﻜﺘﺭﻴﺎ‪ ،‬ﺒﻌﺩ ﺘﺤﻭﻴﻠﻬﺎ ﺇﻟﻰ ﺘﻭﻜﺴﻴﺩ ﻏﻴﺭ ﻀﺎﺭ‪ ،‬ﻤﺜل‪ :‬ﺘﻭﻜﺴﻴﺩ‬
‫ﺍﻟﺩﻓﺘﻴﺭﻴﺎ ‪ ،Diphtheria Toxoid‬ﻭﺘﻭﻜﺴﻴﺩ ﺍﻟﺘﻴﺘﺎﻨﻭﺱ ‪. Tetanus Toxoid‬‬

‫ﺃﻤﺭﺍﺽ ﺃﻭ ﺤﻤل‪ .‬ﻭﻫﺫﻩ ﺍﻟﺸﺭﻭﻁ ﻫﻲ‪:‬‬

‫ٍ‬ ‫ﻭﻗﺒل ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺤﺎﺕ‪ ،‬ﻫﻨﺎﻙ ﺸﺭﻭﻁ ﻴﺠﺏ ﻤﺭﺍﻋﺎﺘﻬﺎ‪ ،‬ﻜﻭﺠﻭﺩ‬

‫)‪ُ (1‬ﻴﻌﺩ ﺍﻟﻤﺎﻨﻊ ﺍﻟﻭﺤﻴﺩ ﻹﻋﻁﺎء ﺍﻟﻠﻘﺎﺤﺎﺕ ﻏﻴﺭ ﺍﻟﺤﻴﺔ‪ ،‬ﺍﻟﺘﻲ ﻏﺎﻟﺒﴼ ﻤﺎ ﺘﻜﻭﻥ ﺁﻤﻨﺔ‪ ،‬ﻫﻭ ﻭﺠﻭﺩ ﺘﺎﺭﻴﺦ‬
‫ﺘﻔﺎﻋل ﻟﻬﺫﺍ ﺍﻟﻠﻘﺎﺡ‪.‬‬
‫ٍ‬ ‫ﻤﺭﻀﻲ ﺴﺎﺒﻕ ﻟﺤﺩﻭﺙ‬

‫)‪ (2‬ﻴﺤﻅﺭ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺤﻴﺔ ﻟﻠﺤﻭﺍﻤل‪ ،‬ﺇ ّﻻ ﺇﺫﺍ ﻜﺎﻥ ﺨﻁﺭ ﺍﻟﻌﺩﻭﻯ ﻴﺘﻌﺩﻯ ﺍﻟﻀﺭﺭ ﺍﻟﺫﻱ ﺴﻭﻑ‬
‫ﻼ‪ ،‬ﺇﺫﺍ ﻜﺎﻥ ﻫﻨﺎﻙ ﻭﺒﺎء ﺤﻤﻰ ﺸﻭﻜﻴﺔ ﻤﻨﺘﺸﺭ ﻓﻲ‬
‫ﻴﺼﻴﺏ ﺍﻟﺠﻨﻴﻥ‪ ،‬ﻓﻲ ﺤﺎﻟﺔ ﻋﺩﻡ ﺍﻟﺘﻁﻌﻴﻡ‪ ،‬ﻭﺫﻟﻙ‪ ،‬ﻤﺜ ً‬
‫ﺍﻟﻤﻨﻁﻘﺔ‪ ،‬ﺃﻭ ﺍﻟﺘﻬﺎﺏ ﻜﺒﺩ ﻭﺒﺎﺌﻲ ‪ .A‬ﻓﻔﻲ ﻫﺫﻩ ﺍﻟﺤﺎﻻﺕ ﺇﺫﺍ ﺃﺼﻴﺒﺕ ﺍﻷﻡ ﺒﺎﻟﻌﺩﻭﻯ‪ ،‬ﻓﻬﻨﺎﻙ ﺨﻁﻭﺭﺓ‬
‫ﻋﻠﻴﻬﺎ ﻭﻋﻠﻰ ﺍﻟﺠﻨﻴﻥ؛ ﻟﺫﺍ ﻴﻤﻜﻥ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫)‪ (3‬ﺃ ّﻻ ﺘﻘل ﺍﻟﻔﺘﺭﺓ ﺍﻟﺯﻤﻨﻴﺔ ﺒﻴﻥ ﺇﻋﻁﺎء ﺃﻱ ﻨﻭﻋﻴﻥ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺤﻴﺔ ﻋﻥ ﺜﻼﺜﺔ ﺃﺴﺎﺒﻴﻊ‪ ،‬ﻟﺘﻔﺎﺩﻱ ﺸﺒﻬﺔ‬
‫ﺘﻌﺎﻭﻥ ﺍﻟﻨﻭﻋﻴﻥ ﻤﻥ ﺍﻟﻤﻴﻜﺭﻭﺒﺎﺕ ﺍﻟﺤﻴﺔ ﻤﻌﴼ‪ ،‬ﻭﺘﻨﺸﻴﻁ ﺃﻭ ﺘﺤﻔﻴﺯ ﺒﻌﻀﻬﻤﺎ‪ ،‬ﻤﺎ ﻴﺅﺩﻱ ﺇﻟﻰ ﺇﺼﺎﺒﺔ‬

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‫ﺍﻟﺠﺴﻡ ﺒﺄﻀﺭﺍﺭ ﺒﺎﻟﻐﺔ‪ .‬ﺃﻤﺎ ﻓﻲ ﺤﺎﻟﺔ ﺍﻷﻭﺒﺌﺔ‪ ،‬ﺍﻟﺘﻲ ﺘﺤﺘﻡ ﺇﻋﻁﺎء ﺃﻜﺜﺭ ﻤﻥ ﻨﻭﻉ‪ ،‬ﻓﻴﺠﺏ ﺍﺨﺘﻴﺎﺭ ﻤﻜﺎﻨﻴﻥ‬
‫ﻤﺨﺘﻠﻔﻴﻥ ﻤﻥ ﺍﻟﺠﺴﻡ ﻹﻋﻁﺎء ﺍﻟﺘﻌﻁﻴﻡ‪ ،‬ﻟﺘﻘﻠﻴل ﺭﺩ ﺍﻟﻔﻌل ﺍﻟﻤﻭﻀﻌﻲ ﻟﻪ‪.‬‬

‫)‪ُ (4‬ﻴﺘﺠﻨﺏ ﺍﻟﺘﻠﻘﻴﺢ ﻓﻲ ﺤﺎﻻﺕ ﺍﺭﺘﻔﺎﻉ ﺩﺭﺠﺔ ﺤﺭﺍﺭﺓ ﺍﻟﺠﺴﻡ‪ ،‬ﻷﻥ ﻤﻌﻅﻡ ﺍﻟﻠﻘﺎﺤﺎﺕ ﺘﺤﻔﻅ ﻓﻲ ﺩﺭﺠﺎﺕ‬
‫ﺤﺭﺍﺭﺓ ﻤﻨﺨﻔﻀـﺔ ﻟﻠﻐﺎﻴﺔ "ﺍﻟﻤﺠﻤﺩ "‪ .‬ﻟﺫﻟﻙ‪ ،‬ﻓﻬﻲ ﺘﻔﺴﺩ ﺒﺘﺄﺜﻴﺭ ﺍﻟﺤﺭﺍﺭﺓ ﺍﻟﻌﺎﻟﻴﺔ ﻟﻠﺠﺴﻡ‪ .‬ﻭﻜﺫﻟﻙ ﻻ‬
‫ﺘُﻌﻁﻰ ﻨﻘﻁ ﺸﻠل ﺍﻷﻁﻔﺎل ﻓﻲ ﺤﺎﻻﺕ ﺍﻟﻘﻲء ﺃﻭ ﺍﻹﺴﻬﺎل‪ ،‬ﻟﻀﻤﺎﻥ ﺍﻤﺘﺼﺎﺼﻬﺎ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺠﻬﺎﺯ‬
‫ﺍﻟﻬﻀﻤﻲ‪ ،‬ﺒﺼﻭﺭﺓ ﺴﻠﻴﻤﺔ‪.‬‬

‫)‪ (5‬ﻻ ﺘُﻌﺩ ﺍﻹﻜﺯﻴﻤﺎ ﺃﻭ ﺤﻤﻰ ﺍﻟﻘﺵ‪ ،‬ﺃﻭ ﺍﻟﺭﺒﻭ‪ ،‬ﻤﻥ ﻤﻭﺍﻨﻊ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﺇّﻟﺎ ﻓﻲ ﺤﺎﻟﺔ ﻟﻘﺎﺡ ﺍﻟﺩﺭﻥ ‪ ،BCG‬ﻓﺈﻨﻪ‬
‫ﻻ ُﻴﻌﻁﻰ ﻓﻲ ﺤﺎﻻﺕ ﺍﻹﻜﺯﻴﻤﺎ‪.‬‬

‫)‪ (6‬ﺘُﻌﻁﻰ ﺍﻟّﻠﻘﺎﺤﺎﺕ ﺍﻟﺨﺎﺼﺔ ﺒﺎﻷﻁﻔﺎل‪ ،‬ﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﺃﻤﺭﺍﺽ ﻤﺯﻤﻨﺔ ﺒﺎﻟﻘﻠﺏ ﺃﻭ ﺍﻟﺼﺩﺭ‪ ،‬ﺤﺴﺏ‬
‫ﺠﺩﻭل ﺨﺎﺹ ﺒﻬﻡ‪ .‬ﺃﻤﺎ ﺍﻷﻁﻔﺎل ﺍﻟﻤﺒﺘﺴﺭﻭﻥ ﻓﻴﺠﺭﻱ ﺘﻁﻌﻴﻤﻬﻡ ﺘﻤﺎﻤﴼ‪ ،‬ﻤﺜل ﺍﻷﻁﻔﺎل ﻤﻜﺘﻤﻠﻰ ﺍﻟﻨﻤﻭ‪.‬‬
‫ﺒﻤﻌﻨﻰ ﺃﻥ ُﻴﺤﺴﺏ ﻋﻤﺭﻫﻡ ﺍﻟﺯﻤﻨﻲ ﻤﻨﺫ ﻴﻭﻡ ﻭﻻﺩﺘﻬﻡ‪ ،‬ﺒﻐﺽ ﺍﻟﻨﻅﺭ ﻋﻥ ﺃﻭﺯﺍﻨﻬﻡ‪ ،‬ﺃﻭ ﻋﻥ ﺃﻋﻤﺎﺭﻫﻡ‬
‫ﻼ"‪.‬ﻭﻓﻲ ﺤﺎﻟﺔ ﺃﻤﺭﺍﺽ ﺍﻟﻘﻠﺏ ﺍﻟﻤﺯﻤﻨﺔ‪ ،‬ﻴﻜﻭﻥ ﺍﻟﺘﻠﻘﻴﺢ ﻤﺭﺘﺒﻁﴼ ﺒﺎﻟﺤﺎﻟﺔ ﺍﻟﺼﺤﻴﺔ؛‬
‫ﺍﻟﺭﺤﻤﻴﺔ "‪ 7‬ﺸﻬﻭﺭ ﻤﺜ ً‬
‫ﻴﻨﻅﻡ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ ﺤﺴﺏ‬
‫ﻼ‪ ،‬ﺃﺜﻨﺎء ﻫﺒﻭﻁ ﺍﻟﻘﻠـﺏ‪ ،‬ﺃﻭ ﺃﺯﻤـﺔ ﺭﺒﻭﻴـﺔ ﺤﺎﺩﺓ‪ ،‬ﺒل ّ‬
‫ﻓﻼ ُﻴﻌﻁﻰ‪ ،‬ﻤﺜ ً‬
‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﺼﺤﻴﺔ ﻟﻠﻤﺭﻴﺽ‪.‬‬

‫)‪ (7‬ﺘﻌﻁﻰ ﺍﻟّﻠﻘﺎﺤﺎﺕ ﻟﻸﻁﻔﺎل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﻤﺭﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﻤﻜﺘﺴﺒﺔ "ﺍﻹﻴﺩﺯ"‪ ،‬ﻭﻻ ﻴﻌﺎﻨﻭﻥ‬
‫ﺍﻟﺩﺭﻥ ‪ ،BCG‬ﻭﻟﻘﺎﺡ ﺍﻟﺤﻤﻰ ﺍﻟﺼﻔﺭﺍء‪ .‬ﺃﻤﺎ َﻤ ْﻥ ﻴﻌﺎﻨﻭﻥ‬
‫ﺃﻋﺭﺍﻀﴼ‪ ،‬ﺒﺎﻟﻁﺭﻴﻘﺔ ﺍﻟﻌﺎﺩﻴﺔ ﻨﻔﺴﻬﺎ‪ ،‬ﻋﺩﺍ ﻟﻘﺎﺡ ّ‬
‫ﺃﻋﺭﺍﻀﴼ‪ ،‬ﻓﻘﺩ ﺃﻭﺼﻰ ﺍﻟﻤﺠﻠﺱ ﺍﻷﻤﺭﻴﻜﻲ ﻟﻠﺘﺤﺼﻴﻨﺎﺕ ﺒﻀﺭﻭﺭﺓ ﺇﻋﻁﺎﺌﻬﻡ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻏﻴﺭ ﺍﻟﺤﻴﺔ ﻓﻘﻁ‪،‬‬
‫ﺩﻭﻥ ﺍﻟﺤﻴﺔ؛ ﻭﻟﻜﻥ ﻤﻨﻅﻤﺔ ﺍﻟﺼﺤﺔ ﺍﻟﻌﺎﻟﻤﻴﺔ ﺘﺭﻯ ﻀﺭﻭﺭﺓ ﺇﻋﻁﺎﺌﻬﻡ ﺒﻌﺽ ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻟﺤﻴﺔ‪ ،‬ﻤﺜل ﻟﻘﺎﺡ‬
‫ﺸﻠل ﺍﻷﻁﻔـﺎل ﻭﺍﻟﺤﺼـﺒﺔ‪ ،‬ﺇﺫ ﻻ ﺩﻟﻴل ﻋﻠﻰ ﻭﺠـﻭﺩ ﺨـﻁﺭ ﻓﻲ ﺍﻟﺘﺤﺼﻴﻥ ﻀـﺩﻫﻤـﺎ‪ ،‬ﻟﺩﻯ‬
‫ﺍﻷﻁﻔﺎل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﻤـﺭﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﻤﻜﺘﺴﺒـﺔ‪ .‬ﻭﻋﻤﻭﻤﴼ‪ ،‬ﻴﺠﺏ ﺘﻭﺨﻰ ﺍﻟﺤﻴﻁﺔ ﻋﻨﺩ ﺇﻋﻁﺎء‬
‫ﻫﺫﻴﻥ ﺍﻟﻠﻘﺎﺤﻴﻥ ﻟﻬﺅﻻء ﺍﻟﻤﺭﻀﻰ‪.‬‬

‫ﺘﻘﺴﻡ ﺍﻟّﻠﻘﺎﺤﺎﺕ ﺇﻟﻰ ﺘﻘﺴﻴﻤﺎﺕ ﻋﺩﻴﺩﺓ‪ ،‬ﻭﻟﻜﻥ ﺍﻟﺘﻘﺴﻴﻡ ﺍﻟﻘﺩﻴﻡ‪ :‬ﺃﺴﺎﺴﻴﺔ‪ ،‬ﻭﻏﻴﺭ ﺃﺴﺎﺴﻴﺔ‪ ،‬ﻫﻭ ﺍﻷﻜﺜﺭ‬
‫ّ‬
‫ﺸﻴﻭﻋﴼ‪:‬‬

‫أ‪ .‬اﻟﻠﻘﺎﺣﺎت اﻷﺳﺎﺳﯾﺔ "اﻹﺟﺑﺎرﯾﺔ"‬

‫ﺴﻤﻴﺕ ﺒﺫﻟﻙ ﻷﻥ ﻤﻌﻅﻡ ﺩﻭل ﺍﻟﻌﺎﻟﻡ ﺠﻌﻠﺘﻬﺎ ﺇﺠﺒﺎﺭﻴﺔ ﻟﻸﻁﻔﺎل‪ ،‬ﻭﺘﻌﻁﻰ ﻤﺠﺎﻨﴼ‪ ،‬ﻭﻴُﻌﺎﻗﺏ ﻭﻴُﺠﺭﻡ ﻤﻥ‬
‫ﻻ ﻴﻌﻁﻴﻬﺎ‪ .‬ﻭﻫﻲ ﺘﺸﻤل ﺍﻵﺘﻲ‪:‬‬

‫)‪ (1‬ﺍﻟﺩﺭﻥ ‪.BCG‬‬

‫)‪ (2‬ﺸﻠل ﺍﻷﻁﻔﺎل ‪.Poliomyelitis‬‬

‫)‪ (3‬ﺜﻼﺜﻲ ﺍﻟﺒﻜﺘﻴﺭﻱ "ﺍﻟﺩﻓﺘﻴﺭﻴﺎ‪ -‬ﺍﻟﺘﻴﺘﺎﻨﻭﺱ‪ -‬ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ"‪.D.P.T .‬‬

‫)‪ (4‬ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩﻱ ﺍﻟﻭﺒﺎﺌﻲ ﺏ‪Hepatitis B .‬‬

‫)‪ (5‬ﺍﻟﺤﺼﺒﺔ ‪.Measles‬‬

‫)‪ (6‬ﺍﻟﺜﻼﺜﻲ ﺍﻟﻔﻴﺭﻭﺴﻲ "ﺍﻟﺤﺼﺒﺔ‪ -‬ﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‪ -‬ﺍﻟﻨﻜﺎﻑ" ‪.M.M.R‬‬

‫ب‪ .‬اﻟﻠﻘﺎﺣﺎت ﻏﯾر اﻷﺳﺎﺳﯾﺔ "اﻹﺿﺎﻓﯾﺔ"‬

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‫ﻫﺫﻩ ﺍﻟﻤﺠﻤﻭﻋﺔ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻻ ﺘُﻌﻁﻰ ﺒﺼﻭﺭﺓ ﺇﺠﺒﺎﺭﻴﺔ ﻓﻲ ﻜﺎﻓﺔ ﺍﻟﺩﻭل‪ ،‬ﺒل ﺘُﻌﻁﻰ ﻁﺒﻘﴼ ﻟﻅﺭﻭﻑ‬
‫ﺨﺎﺼﺔ ﺒﻜل ﻟﻘﺎﺡ؛ ﻭﻜﺫﻟﻙ ﺤﺴﺏ ﺍﻟﻅﺭﻭﻑ ﺍﻻﻗﺘﺼﺎﺩﻴﺔ ﻟﻤﺨﺘﻠﻑ ﺍﻟﺒﻠﺩﺍﻥ‪ .‬ﻭﻗﺩ ﺍﻨﺘﻘﻠﺕ ﺒﻌﺽ ﺍﻟﻠﻘﺎﺤﺎﺕ ﻤﻥ‬
‫ﻫﺫﻩ ﺍﻟﻤﺠﻤﻭﻋﺔ‪ ،‬ﺘﺤﻭﻟﺕ ﺇﻟﻰ ﺘﻠﻘﻴﺢ ﺇﺠﺒﺎﺭﻱ‪ ،‬ﻤﺜل ﻟﻘﺎﺡ ﺍﻟﻬﻴﻤﻭﻓﻴﻠﺱ ﺃﻨﻔﻠﻭﻨﺯﺍ ﺏ ‪Haemophilus‬‬
‫)‪ Influenza B (HIB‬ﻓﻲ ﺍﻟﺩﻭل ﺍﻟﻤﺘﻘﺩﻤﺔ‪.‬ﺒﻴﻨﻤﺎ ﻓﻲ ﺍﻟﺩﻭل ﺍﻟﻨﺎﻤﻴﺔ ﻟﻴﺱ ﺇﺠﺒﺎﺭﻴﴼ‪ ،‬ﻻﺭﺘﻔﺎﻉ ﺜﻤﻨﻪ‪.‬‬

‫ﻭﺘﺸﻤل ﺍﻟﻠﻘﺎﺤﺎﺕ ﻏﻴﺭ ﺍﻷﺴﺎﺴﻴﺔ‪ ،‬ﺍﻷﻤﺭﺍﺽ ﺍﻵﺘﻴﺔ‪:‬‬

‫)‪ (1‬ﺍﻟﻬﻴﻤﻭﻓﻴﻠﺱ ﺃﻨﻔﻠﻭﻨﺯﺍ ‪.Haemophilus Influenza B‬‬

‫)‪ (2‬ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩﻱ ﺍﻟﻭﺒﺎﺌﻲ ﺃ ‪.Hepatitis A‬‬

‫)‪ (3‬ﺍﻟﺠﺩﻴﺭﻱ ﺍﻟﻤﺎﺌﻲ ‪.Chicken Pox‬‬

‫)‪ (4‬ﻓﻴﺭﻭﺱ ﺍﻷﻨﻔﻠﻭﻨﺯﺍ ‪.Influenza Vaccine‬‬

‫)‪ (5‬ﺍﻟﺘﻴﻔﻭﺌﻴﺩ ‪.Typhoid‬‬

‫)‪ (6‬ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﺌﻲ ‪.Meningitis‬‬

‫)‪ (7‬ﺍﻟﻜﻭﻟﻴﺭﺍ ‪.Cholera‬‬

‫)‪ (8‬ﺍﻟﺤﻤﻰ ﺍﻟﺼﻔﺭﺍء ‪.Yellow Lever‬‬

‫)‪ (9‬ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺍﻟﺴﺒﺤﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ ‪.Pneumocsccal Vaccine‬‬

‫)‪ (10‬ﺍﻟﺠﻤﺭﺓ ﺍﻟﺨﺒﻴﺜﺔ ‪.Anthrax‬‬

‫)‪ (11‬ﺍﻟﻁﺎﻋﻭﻥ ‪.Plague‬‬

‫)‪ (12‬ﺩﺍء ﺍﻟﻜﻠﺏ ‪.Rabies‬‬

‫)‪ (13‬ﻓﻴﺭﻭﺱ ﺭﻭﺘﺎ ‪.Rota virus‬‬

‫اﻟﻠﻘﺎﺣﺎت اﻹﺟﺑﺎرﯾﺔ ‪Compulsory Vaccines‬‬

‫‪ .1‬ﻟﻘﺎح اﻟدرن )‪Bacillus - Camette - Guerin vaccine (BCG‬‬

‫أ‪ .‬ﻧوع اﻟﻠﻘﺎح‬

‫ﺍﻟﺩﺭﻥ ‪ BCG‬ﻋﻠﻰ ﻤﻴﻜﺭﻭﺏ ﻤﻭﻫﻥ ﻤﺠﻔﻑ ﺒﺎﻟﺘﺒﺭﻴﺩ‪ .‬ﻭﻗﺒل ﺇﻋﻁﺎﺌﻪ‪ ،‬ﻻ ﺒﺩ ﻤﻥ ﺘﺨﻔﻴﻔﻪ‪،‬‬ ‫ﻴﺤﺘﻭﻱ ﻟﻘﺎﺡ ّ‬
‫ﺒﻤﺤﻠﻭل ﺍﻟﺘﺨﻔﻴﻑ‪ ،‬ﻗﺒل ﺍﻻﺴﺘﻌﻤﺎل ﻤﺒﺎﺸﺭﺓ‪ .‬ﻭﻴﻔﻘﺩ ﺍﻟﻠﻘﺎﺡ ﻓﺎﻋﻠﻴﺘﻪ ﺒﺴﺭﻋﺔ ﺒﻌـﺩ ﺘﺨﻔﻴﻔﻪ‪ ،‬ﻟﻬﺫﺍ ﻴُﻌﺩﻡ‬
‫ﺍﻟﻤﺘﺒﻘﻲ ﻤﻨﻪ ﺒﻌﺩ ﻤﺭﻭﺭ ‪ 24‬ﺴﺎﻋﺔ ﻋﻠﻰ ﺃﻜﺜﺭ ﺘﻘﺩﻴﺭ‪.‬‬

‫ب‪ .‬ﻋﻣر اﻟﺗﻌﺎطﻲ‬

‫ُﻴﻌﻁﻰ ﻓﻲ ﺍﻷﺴﺒﻭﻉ ﺍﻷﻭل ﻤﻥ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﻓﻲ ﻤﻌﻅﻡ ﺍﻟﺒﻠﺩﺍﻥ‪ ،‬ﺃﻭ ﺨﻼل ﺍﻷﺸﻬﺭ ﺍﻟﺜﻼﺜﺔ ﺍﻷﻭﻟﻰ ﻤﻥ‬
‫ﺍﻟﻭﻻﺩﺓ‪ .‬ﻭﻴﻤﻜﻥ ﺃﻥ ُﻴﻌﻁﻰ ﺒﻌﺩ ﻋﺎﻡ ﺇﺫﺍ ﻟﻡ ُﻴ ْﻌﻁ ﻓﻲ ﺍﻟﺤﺎﻟﺘﻴﻥ ﺍﻟﺴﺎﺒﻘﺘﻴﻥ‪ ،‬ﻭﺫﻟﻙ ﻓﻲ ﺤﺎﻟﺔ ﺴﻠﺒﻴﺔ ﺍﺨﺘﺒﺎﺭ‬
‫ﺍﻟﺘﻴﻭﺒﺭﻜﻠﻴﻥ ‪ ،Tuberculin test‬ﺃﻤﺎ ﻋﻨﺩ ﺇﻴﺠﺎﺒﻴﺔ ﺍﻻﺨﺘﺒﺎﺭ‪ ،‬ﻓﻴﻌﻁﻰ ﺍﻟﻁﻔل ﻋﻼﺠﴼ ﻋﻠﻰ ﺃﻨﻪ ﺤﺎﻟﺔ ﺩﺭﻥ‪.‬‬
‫ﻜﻤﺎ ﻴﻌﻁﻰ ﻓﻲ ﺒﺩﺍﻴﺔ ﻜل ﻤﺭﺤﻠﺔ ﺩﺭﺍﺴﻴﺔ‪ ،‬ﻟﻜل ﺍﻟﺤﺎﻻﺕ ﺴﻠﺒﻴﺔ ﺍﻻﺨﺘﺒﺎﺭ‪.‬‬

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‫ج‪ .‬اﻟﺟرﻋﺔ واﻟطرﯾﻘﺔ‬

‫‪ 0.05‬ﻤﻠﻠﻴﻠﻴﺘﺭ ﻓﻲ ﺍﻟﺠﻠﺩ‪ ،‬ﻟﻸﻁﻔﺎل ﺤﺩﻴﺜﻲ ﺍﻟﻭﻻﺩﺓ‪.‬ﻭ ‪ 0.1‬ﻤﻠﻠﻴﻠﻴﺘﺭ ﻓﻲ ﺍﻟﺠﻠﺩ‪ ،‬ﻟﻸﻁﻔﺎل ﺍﻟﻜﺒﺎﺭ‪.‬‬

‫ُﻴﺤﻘﻥ ﺍﻟﻠﻘﺎﺡ ﺩﺍﺨل ﻁﺒﻘﺎﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻓﻭﻕ ﻋﻀﻠﺔ ﺍﻟﻜﺘﻑ‪ ،‬ﻷﻥ ﻫﺫﺍ ﺍﻟﻤﻭﻀﻊ ﻟﻪ ﺃﻗل ﺍﺘﺼﺎل ﺒﺎﻟﺠﻬﺎﺯ‬
‫ﺍﻟﻠﻴﻤﻔﺎﻭﻱ‪ ،‬ﻭﻤﻥ ﺜﻡ ﻻ ﻴﺴﺒﺏ ﺃﻱ ﺃﻀﺭﺍﺭ ﺃﻭ ﻤﻀﺎﻋﻔﺎﺕ ﺨﻁﻴﺭﺓ‪ .‬ﻭﻟﻀﻤﺎﻥ ﺍﻟﺤﻘﻥ ﻓﻲ ﻁﺒﻘﺎﺕ ﺍﻟﺠﻠﺩ‪،‬‬
‫ﻭﻟﻴﺱ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻴﺠﺏ ﺘﻭﺍﻓﺭ ﺍﻟﺸﺭﻭﻁ ﺍﻵﺘﻴﺔ‪:‬‬

‫)‪ (1‬ﺃﻥ ﻻ ﺘﺯﻴﺩ ﺍﻟﺯﺍﻭﻴﺔ ﺒﻴﻥ ﺴﻥ ﺍﻹﺒﺭﺓ ﻭﺴﻁﺢ ﺍﻟﺠﺴﻡ‪ ،‬ﻋﻥ ‪ 15‬ﺩﺭﺠﺔ‪.‬‬

‫)‪ (2‬ﻭﺠﻭﺩ ﻤﻘﺎﻭﻤﺔ ﺃﺜﻨﺎء ﺍﻟﺤﻘﻥ‪.‬‬

‫)‪ (3‬ﻅﻬﻭﺭ ﺘﻭﺭﻡ ﺒﻌﺩ ﺤﻘﻥ ﺍﻟﺠﺭﻋﺔ ﻤﺒﺎﺸﺭﺓ‪.‬‬

‫د‪ .‬اﻟﺗﻔﺎﻋﻼت‬

‫ﻟﻪ ﺜﻼﺜﺔ ﺃﻨﻭﺍﻉ ﻤﻥ ﺍﻟﺘﻔﺎﻋﻼﺕ‪:‬‬

‫)‪ (1‬اﻟﺗﻔﺎﻋل اﻟطﺑﯾﻌﻲ‬

‫ﻭﻴﺤﺩﺙ ﺇﺫﺍ ﺃُﻋﻁﻰ ﺍﻟﻁﻔل ﺍﻟﺠﺭﻋﺔ ﺍﻟﺼﺤﻴﺤﺔ ﻤﻥ ﺍﻟﻠﻘﺎﺡ‪ ،‬ﺩﺍﺨل ﻁﺒﻘﺎﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻭﻜﺎﻥ ﺍﻟﻤﺤﻘﻥ‬
‫ﻤﻌﻘﻤﴼ‪ ،‬ﺇﺫ ﺘﺘﻜﺎﺜﺭ ﺠﺭﺍﺜﻴﻡ ﻟﻘﺎﺡ ﺍﻟﺩﺭﻥ ‪ BCG‬ﺒﺒﻁء ﺸﺩﻴﺩ‪ ،‬ﻭﻴﻅﻬﺭ ﻭﺭﻡ ﻁﺭﻱ ﺼﻐﻴﺭ ﺃﺤﻤﺭ ﺍﻟﻠﻭﻥ‪،‬‬
‫ﻗﻁﺭﺓ ﻨﺤﻭ ‪10‬ﻤﻠﻠﻴﻤﻴﺘﺭ ﻓﻲ ﻤﻭﻀﻊ ﺍﻟﺘﻠﻘﻴﺢ؛ ﻭﺒﻌﺩ ﻤﺩﺓ ﺘﺭﺍﻭﺡ ﺒﻴﻥ ﺃﺴﺒﻭﻋﻴﻥ ﻭﺜﻼﺜﺔ ﺃﺴﺎﺒﻴﻊ‪ ،‬ﻴﺘﺤﻭل‬
‫ﻭﻴﺼﺒﺢ ﻗﺭﺤﺔ ﻗﻁﺭﻫﺎ ﺤﻭﺍﻟﻲ ‪1‬ﺴﻡ‪ ،‬ﺜﻡ ﺘﻠﺘﺌﻡ ﺍﻟﻘﺭﺤﺔ ﻤﻥ ﺘﻠﻘﺎء ﻨﻔﺴﻬﺎ‬ ‫ﺍﻟﻭﺭﻡ ﺇﻟﻰ ﺨﺭﺍﺝ ﺼﻐﻴﺭ‪ُ ،‬‬
‫ﺘﺎﺭﻜﺔ ﻨﺩﺒﺔ ﻗﻁﺭﻫﺎ ﻨﺤﻭ‪ 5‬ﻤﻠﻠﻴﻤﻴﺘﺭ‪ ،‬ﻭﻫﺫﻩ ﺍﻟﻨﺩﺒﺔ ﻤﻔﻴﺩﺓ ﻷﻨﻬﺎ ﻋﻼﻤﺔ ﻋﻠﻰ ﺃﻥ ﺍﻟﻁﻔل ﺘﻠﻘﻰ ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫)‪ (2‬اﻟﺗﻔﺎﻋل اﻟﺷدﯾد‬

‫ﻓﻲ ﺒﻌﺽ ﺍﻷﺤﻴﺎﻥ ﻴﺤﺩﺙ ﺍﻟﺘﻬﺎﺏ ﻤﻭﻀﻌﻰ ﺸﺩﻴﺩ‪ ،‬ﺃﻭ ﺨﺭﺍﺝ ﺃﻜﺜﺭ ﻋﻤﻘﴼ‪ .‬ﻭﺃﺤﻴﺎﻨﴼ ﺘﺘﻭﺭﻡ ﺍﻟﻌﻘﺩ‬
‫ﺍﻟﻠﻴﻤﻔﺎﻭﻴﺔ‪ ،‬ﺍﻟﻭﺍﻗﻌﺔ ﻗﺭﺏ ﺍﻟﻤﺭﻓﻕ ﺃﻭ ﻓﻲ ﺍﻹﺒﻁ‪ .‬ﻭﻴﺤﺩﺙ ﺫﻟﻙ ﻷﻥ ﺍﻟﺤﻘﻨﺔ ﺩﺨﻠﺕ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﺇﻟﻰ‬
‫ﺃﻜﺜﺭ ﻤﻥ ﺍﻟﻼﺯﻡ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺨﻁﺄ‪ ،‬ﺃﻭ ﺒﺴﺒﺏ ﺇﻋﻁﺎء ﺠﺭﻋﺔ ﺃﻜﺒﺭ ﻤﻤﺎ ﻴﻨﺒﻐﻲ‪ ،‬ﺃﻭ ﻷﻥ ﺍﻟﻤﺤﻘﻥ ﻟﻡ‬
‫ﻴﻜﻥ ﻤﻌﻘﻤﴼ‪ .‬ﻭﺇﺫﺍ ﺒﻘﻲ ﺍﻟﺘﻔﺎﻋل ﻤﻭﻀﻌﻴﴼ‪ ،‬ﻓﻼ ﻴﻠﺯﻡ ﺃﻱ ﻋﻼﺝ ﺴﻭﻯ ﻭﻀﻊ ﺸﺎﺵ ﺠﺎﻑ‪ .‬ﺃﻤﺎ ﺇﺫﺍ‬
‫ﺘﻜﻭﻨﺕ ﻗـﺭﺤﺔ ﻜﺒﻴﺭﺓ‪ ،‬ﺃﻭ ﺘﻭﺭﻤﺕ ﺍﻟﻌﻘﺩ ﺍﻟﻠﻴﻤﻔﺎﻭﻴﺔ‪ ،‬ﻴُﻌﺭﺽ ﺍﻟﻁﻔل ﻋﻠﻰ ﺍﻟﻁﺒﻴﺏ ﻷﻨﻪ ﻗﺩ ﻴﻜﻭﻥ ﻓﻲ‬
‫ﺤﺎﺠﺔ ﺇﻟﻰ ﺍﻟﻌﻼﺝ ﺒﺄﺩﻭﻴﺔ ﺍﻟﺩﺭﻥ ﺘﻤﺎﻤﴼ ﻤﺜل ﻤﺭﻴﺽ ﺍﻟﺩﺭﻥ‪ ،‬ﻭﻟﻤﺩﺓ ﻗﺩ ﺘﺼل ﺇﻟﻰ ‪ 3‬ﺸﻬﻭﺭ‪.‬‬

‫)‪ (3‬اﻟﺗﻔﺎﻋل اﻟﻣﺑﻛر‬

‫ﺍﻟﺴﺎﺒﻘﺔ ﻤﻥ ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﺩﺭﻥ‪ ،‬ﻓﻘﺩ ﻴﻅﻬﺭ ﺍﻟﺘﻭﺭﻡ ﺍﻷﺤﻤﺭ‬

‫ﺇﺫﺍ ﻜﺎﻥ ﻟﺩﻯ ﺍﻟﻁﻔل ﺒﻌـﺽ ﺍﻟﻤﻨﺎﻋﺔ ّ‬
‫ﻗﺒل ﻤﺭﻭﺭ ﺃﺴﺒﻭﻋﻴﻥ‪ ،‬ﻭﻫﺫﺍ ﻴﻌﻨﻲ ﺃﻥ ﺍﻟﻁﻔل ﻗﺩ ﺘﻠﻘﻰ ﻟﻘﺎﺡ ‪ BCG‬ﻤﻥ ﻗﺒل‪ ،‬ﺃﻭ ﺃﻨﻪ ﻜﺎﻥ ﻗﺩ ﺃﺼﻴﺏ‬
‫ﺒﻤﺭﺽ ﺍﻟﺩﺭﻥ ﻨﻔﺴﻪ ﻤﻨﺫ ﻓﺘﺭﺓ‪ .‬ﻭﻋﻨﺩ ﺍﻟﺸﻙ ﻓﻲ ﺇﺼﺎﺒﺔ ﺍﻟﻁﻔل ﺒﺎﻟﺩﺭﻥ‪ ،‬ﺘﻠﺯﻡ ﺍﺴﺘﺸﺎﺭﺓ ﺍﻟﻁﺒﻴﺏ‪.‬‬

‫ﻫـ‪ .‬اﻟﺗﺣﻘق ﻣن وﺟود ﻧدﺑﺔ ‪BCG‬‬

‫ﻴﺠﺏ ﺍﻟﺘﺤﻘﻕ ﻤﻥ ﻭﺠﻭﺩ ﺘﻭﺭﻡ‪ ،‬ﺃﻭ ﻗﺭﺤﺔ‪ ،‬ﺃﻭ ﻨﺩﺒﺔ‪ ،‬ﻓﻲ ﻤﻭﻀﻊ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﻋﻨﺩ ﺯﻴﺎﺭﺓ ﺍﻟﻁﺒﻴﺏ‪ ،‬ﺍﻟﺘﻲ‬
‫ﺘﻠﻲ ﺇﻋﻁﺎء ﺍﻟﻁﻔل ﻟﻘﺎﺡ ‪ .BCG‬ﻓﺈﻥ ﻭﺠﺩﺕ ﻨﺩﺒﺔ ﻓﻬﺫﺍ ﻴﻌﻨﻲ ﺃﻥ ﺍﻟﻠﻘﺎﺡ ﻗﺩ ﻨﺠﺢ‪ .‬ﻭﺇﺫﺍ ﻟﻡ ﺘﻭﺠﺩ ﻨﺩﺒﺔ‪،‬‬
‫ﻓﻴﺠﺏ ﺘﻜﺭﺍﺭ ﺍﻟﺠﺭﻋﺔ ﺒﻌﺩ ﺜﻼﺜﺔ ﺸﻬﻭﺭ ﻋﻠﻰ ﺍﻷﻗل‪ ،‬ﻤﻥ ﺍﻟﺠﺭﻋﺔ ﺍﻟﺴﺎﺒﻘﺔ‪.‬‬

‫و‪ .‬اﻟﻣﺿﺎﻋﻔﺎت‬

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‫)‪ (1‬ﺘﻀﺨﻡ ﻓﻲ ﺍﻟﻐﺩﺩ ﺍﻟﻠﻴﻤﻔﺎﻭﻴﺔ ﺘﺤﺕ ﺍﻹﺒﻁ‪.‬‬

‫)‪ (2‬ﺤﺩﻭﺙ ﺨﺭﺍﺝ ﺒﺎﺭﺩ ‪ ،Cold Abscess‬ﻤﻜﺎﻥ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫)‪ (3‬ﺤﺩﻭﺙ ﻨﺎﺴﻭﺭ ﺠﻠﺩﻱ ﻤﻜﺎﻥ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫)‪ (4‬ﺍﻟﺘﺌﺎﻡ ﺍﻟﺨﺭﺍﺝ ﺃﻭ ﺍﻟﻨﺎﺴﻭﺭ ﻴﺅﺩﻯ ﺃﺤﻴﺎﻨﺎ ﺇﻟﻰ ﺤﺩﻭﺙ ﻨﺩﺒﺔ ﻜﺒﻴﺭﺓ‪ ،‬ﺘﺸﻭﻩ ﻤﻨﻅﺭ ﺍﻟﺠﻠﺩ ﻋﻠﻰ ﺍﻟﺫﺭﺍﻉ‪.‬‬

‫)‪ (5‬ﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﻤﺭﺽ ﻨﻔﺴﻪ ﻨﺘﻴﺠﺔ ﻋﺩﻡ ﺍﺴﺘﺨﺩﺍﻡ ﺠﺭﻋﺔ ﻤﻨﺎﺴﺒﺔ ﻤﻥ ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫ز‪ .‬ﻣواﻧﻊ اﻻﺳﺗﺧدام‬

‫)‪ (1‬ﺤﺎﻻﺕ ﺍﻻﺭﺘﻔﺎﻉ ﺍﻟﺸﺩﻴﺩ ﻓﻲ ﺩﺭﺠﺔ ﺍﻟﺤﺭﺍﺭﺓ‪ ،‬ﻭﺍﻟﻀﻌﻑ ﺍﻟﺸﺩﻴﺩ‪ ،‬ﻭﺨﻼل ﻓﺘﺭﺍﺕ ﺍﻟﻨﻘﺎﻫﺔ ﻤﻥ ﺃﻤﺭﺍﺽ‬
‫ﺃﺨﺭﻯ‪.‬‬

‫)‪ (2‬ﺍﻷﺸﺨﺎﺹ ﺍﻟﺫﻴﻥ ﻟﺩﻴﻬﻡ ﻨﺘﺎﺌﺞ ﺇﻴﺠﺎﺒﻴﺔ ﻻﺨﺘﺒﺎﺭ ﺍﻟﺘﻴﻭﺒﺭﻜﻠﻴﻥ‪.‬‬

‫)‪ (3‬ﺍﻷﺸﺨﺎﺹ ﺍﻟﺫﻴﻥ ﻴﺘﻌﺎﻁﻭﻥ ﺍﻷﺩﻭﻴﺔ ﺍﻟﻤﻨﺎﻋﻴﺔ‪.‬‬

‫)‪ (4‬ﺍﻟﻤﺼﺎﺒﻭﻥ ﺒﻤﺭﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ ﺍﻟﻤﻜﺘﺴﺒﺔ‪.‬‬

‫‪ .2‬ﻟﻘﺎح ﺷﻠل اﻷطﻔﺎل ‪Poliomyelitis Vaccine‬‬

‫أ‪ .‬أﻧواع اﻟﻠﻘﺎﺣﺎت‬

‫)‪ (1‬ﻟﻘﺎح ﺳﺎﺑﯾن ‪Sabin Vaccine‬‬

‫ﻫﻭ ﻟﻘﺎﺡ ﺤﻲ ﻤﻭﻫﻥ ﻴﺤﺘﻭﻱ ﻋﻠﻰ ﺜﻼﺜﺔ ﻓﻴﺭﻭﺴﺎﺕ‪ ،‬ﻤﻥ ﻋﺎﺌﻠﺔ ﻓﻴﺭﻭﺱ ﺸﻠل ﺍﻷﻁﻔﺎل‪ ،‬ﻭﻫﻭ‬
‫ﺍﻷﻜﺜﺭ ﺸﻴﻭﻋﴼ ﻟﻼﺴﺘﺨﺩﺍﻡ ﺤﻭل ﺍﻟﻌﺎﻟﻡ‪ .‬ﻭﺘﻌﻁﻰ ﻓﻲ ﺸﻜل ﻨﻘﻁ ﺒﺎﻟﻔﻡ‪ ،‬ﻋﻨﺩ ﺍﻜﺘﻤﺎل ﺍﻟﺸﻬﺭ ﺍﻟﺜﺎﻨﻲ‬
‫ﻭﺍﻟﺭﺍﺒﻊ ﻭﺍﻟﺴﺎﺩﺱ‪ .‬ﻭﺘُﻌﻁﻰ ﺍﻟﺠﺭﻋﺎﺕ ﺍﻟﻤﻨﺸﻁﺔ ﻤﻥ ﺍﻟّﻠﻘﺎﺡ‪ ،‬ﻋﻨﺩ ﻋﻤﺭ ﺴﻨﺔ ﻭﻨﺼﻑ‪ ،‬ﻭﺃﺭﺒﻊ ﺴﻨﻭﺍﺕ‪،‬‬
‫ﻭﺴﺕ ﺴﻨﻭﺍﺕ‪ .‬ﻭﻴﻤﻴﺯ ﻫﺫﺍ ﺍﻟﻠﻘﺎﺡ ﻤﺎ ﻴﻠﻲ‪:‬‬

‫)ﺃ( ﺴﻬﻭﻟﺔ ﺍﻻﺴﺘﺨﺩﺍﻡ ﻷﻨﻪ ﻴﺅﺨﺫ ﻋﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ‪.‬‬

‫)ﺏ( ُﺭﺨﺹ ﺍﻟﺜّﻤﻥ ﻤﻘﺎﺭﻨﺔ ﺒﻤﺜﻴﻠﻪ‪ ،‬ﺍﻟﺫﻱ ُﻴﻌﻁﻰ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺍﻟﻌﻀﻠﻲ‪.‬‬

‫)ﺝ( ﻗﺩﺭﺓ ﻤﻨﺎﻋﻴﺔ ﻋﺎﻟﻴﺔ ﻻﺤﺘﻭﺍﺌﻪ ﻋﻠﻰ ﺜﻼﺜﺔ ﺃﻨﻭﺍﻉ ﻤﻥ ﺍﻟﻔﻴﺭﻭﺱ‪ ،‬ﻭﻟﻴﺱ ﻨﻭﻋﴼ ﻭﺍﺤﺩﴽ‪.‬‬

‫)ﺩ( ُﻴﻌﻁﻰ ﻤﻨﺎﻋﺔ ﻤﻭﻀﻌﻴﺔ ﻟﻠﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ‪.‬‬

‫)ﻫـ( ﻴُﻌﻁﻰ ﻤﻨﺎﻋﺔ ﺨﻠﻭﻴﺔ‪ ،‬ﻓﻲ ﺍﻟﻭﻗﺕ ﻨﻔﺴﻪ‪ ،‬ﻟﻠﺠﺴﻡ ﻜﻠﻪ‪.‬‬

‫)ﻭ( ﺃﻗل ﻨﺴﺒﺔ ﻤﻀﺎﻋﻔﺎﺕ‪.‬‬

‫اﻻﺣﺗﯾﺎطﺎت اﻟواﺟب ﺗواﻓرﻫﺎ ﻋﻧـد اﻟﺗﻠﻘﯾﺢ‪:‬‬

‫ﺍﻟﺭﻀﺎﻋﺔ ﻤﻥ ﻟﺒﻥ ﺍﻷﻡ‪ ،‬ﻗﺒل ﺍﻟﺘﻠﻘﻴﺢ ﻭﺒﻌﺩﻩ‪ ،‬ﻟﻤﺩﺓ ﺴﺎﻋﺘﻴﻥ‪ ،‬ﻟﺘﺠﻨﺏ ﺤـﺩﻭﺙ ﻗﻲء‪ ،‬ﻭﻟﻀﻤﺎﻥ‬
‫)ﺃ( ﻋﺩﻡ ّ‬
‫ﺍﻤﺘﺼﺎﺹ ﻤﻥ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻬﻀﻤﻲ ﻟّﻠﻘﺎﺡ‪.‬‬

‫)ﺏ( ﺘﻜﺭﺭ ﺍﻟﺠﺭﻋﺔ ﺇﺫﺍ ﺤﺩﺙ ﺇﺴﻬﺎل ﺃﻭ ﻗﻲء‪ ،‬ﻋﻘﺏ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﺒﻌﺩ ﺍﻟﻌﻼﺝ‪.‬‬

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‫)ﺝ( ﻻ ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻓﻲ ﺤﺎﻻﺕ ﺍﻹﺼﺎﺒﺔ ﺒﻌﺩﻭﻯ ﻓﻴﺭﻭﺴﻴﺔ ﺃﺨﺭﻯ‪ ،‬ﻟﺘﺠﻨﺏ ﺍﻟﺘﺩﺍﺨل ﺒﻴﻥ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ‪.‬‬

‫)ﺩ( ُﻴﺤﻔﻅ ﺍﻟّﻠﻘﺎﺡ ﻓﻲ ﺜﻼﺠﺔ ﻋﻨﺩ ‪ 4‬ﺩﺭﺠﺎﺕ ﻤﺌﻭﻴﺔ ﺃﺜﻨﺎء ﺍﻟﻨﻘل‪ ،‬ﻷﻨﻪ ﻴﺘﻠﻑ ﺇﺫﺍ ﺘﻌﺭﺽ ﻟﺩﺭﺠﺎﺕ‬
‫ﺤﺭﺍﺭﺓ ﻋﺎﻟﻴﺔ‪ .‬ﻭﻴﻤﻜﻥ ﺃﻥ ﻴﺤﻔﻅ ﻋﻨﺩ ﺩﺭﺠﺔ ‪ 20-‬ﻤﺌﻭﻴﺔ‪ ،‬ﻟﻭﻗﺕ ﻁﻭﻴل‪.‬‬

‫ﺘﻐﻴﺭ ﻟﻭﻨﻪ ﻤﻥ ﺍﻟﺒﻨﻔﺴﺠﻲ ﺍﻟﻔﺎﺘﺢ‪ ،‬ﺇﻟﻰ ﺍﻷﺼﻔﺭ ﺍﻟﻔﺎﺘﺢ‪ ،‬ﺃﻭ ﻴُﺼﺒﺢ ﻻ ﻟﻭﻥ ﻟﻪ‪.‬‬
‫)ﻫـ( ﻴُﻌﺩﻡ ﺍﻟﻠﻘﺎﺡ ﺇﺫﺍ ّ‬

‫)ﻭ( ﻓﻲ ﺤﺎﻟﺔ ﺘﻔﺸﻲ ﺍﻟﻤﺭﺽ‪ُ ،‬ﻴﻌﻁﻲ ﺍﻟﻔﻴﺭﻭﺱ ﺍﻟﻤﺴﺒﺏ ﻟﻠﻭﺒﺎء ﻓﻘﻁ‪ ،‬ﻭﻴﻌﻘﺒﻪ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ ﺜﻼﺜﻲ‬
‫ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﻟﻠﻭﻗﺎﻴﺔ‪ ،‬ﻤﻥ ﺍﻷﻨﻭﺍﻉ ﺍﻷﺨﺭﻯ‪.‬‬

‫)ﺯ( ﺍﻟﻔﺘﺭﺓ ﺍﻟﻤﺴﻤﻭﺡ ﺒﻬﺎ ﺒﻴﻥ ﻜل ﺘﻠﻘﻴﺢ ﺘﻜﻭﻥ ﺸﻬﺭﴽ ﻋﻠﻰ ﺍﻷﻗل‪.‬‬

‫)‪ (2‬ﻟﻘﺎح ﺳوﻟك ‪Salk Vaccine‬‬

‫ﻫﻭ ﻟﻘﺎﺡ ﻏﻴﺭ ﺤﻲ ﻴﺤﺘﻭﻱ ﻋﻠﻰ ﻨﻭﻉ ﻭﺍﺤﺩ ﻓﻘﻁ‪ ،‬ﻤﻥ ﺍﻟﺜّﻼﺜﺔ ﺃﻨﻭﺍﻉ ﺍﻟﻤﻜﻭﻨﺔ ﻟﻌﺎﺌﻠﺔ ﻓﻴﺭﻭﺱ ﺸﻠل‬
‫ﺍﻷﻁﻔﺎل‪ ،‬ﻭﻴﺤﻘﻥ ﻓﻲ ﺍﻟﻌﻀل‪ .‬ﻭﻴﻌﻁﻰ ﻟﻠﻤﺭﻀﻰ ﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪ ،‬ﻜﻤﺎ ﻴﻤﻜﻥ‬
‫ﺇﻋﻁﺎﺅﻩ ﺃﺜﻨﺎء ﺍﻟﺤﻤل‪ ،‬ﻷﻨﻪ ﻻ ﻴﻤﺭ ﻤﻥ ﺨﻼل ﺍﻟﻤﺸﻴﻤﺔ ﺇﻟﻰ ﺍﻟﺠﻨﻴﻥ‪.‬‬

‫اﻟﻣﺿﺎﻋﻔﺎت‪:‬‬

‫)ﺃ( ﺍﻹﺼﺎﺒﺔ ﺒﻤﺭﺽ ﺸﻠل ﺍﻷﻁﻔﺎل‪ ،‬ﻭﻫﻭ ﻨﺎﺩﺭﴽ ﺍﻟﺤﺩﻭﺙ ﺇّﻟﺎ ﻓﻲ ﺤﺎﻻﺕ ﺍﻷﻁﻔﺎل ﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ‬
‫ﻭﻴﻨﺼﺢ ﺒﺈﻋﻁﺎﺌﻬﻡ ﻟﻘﺎﺡ "ﺴﻭﻟﻙ"‪.‬‬
‫ﺃﻤﺭﺍﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪ُ ،‬‬

‫)ﺏ( ﻻ ﻴﻨﺼﺢ ﺒﺘﻌﺎﻁﻲ ﺍﻟﻠﻘﺎﺡ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ ﻟﻸﻡ ﺍﻟﺤﺎﻤل‪ ،‬ﻷﻥ ﺫﻟﻙ ﻗﺩ ﻴﺼﻴﺏ ﺍﻟﺠﻨﻴﻥ ﺒﺎﻟﻤﺭﺽ‬
‫ﻨﻔﺴﻪ؛ ﻭﻟﺫﺍ ُﻴﻔﻀل ﺇﻋﻁﺎء ﻟﻘﺎﺡ ﺴﻭﻟﻙ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺍﻟﻌﻀﻠﻲ‪.‬‬

‫)ﺝ( ﻗﺩ ﻴﻨﻘل ﺍﻷﻁﻔﺎل ﺍﻷﺼﺤﺎء‪ ،‬ﺍﻟﺫﻴﻥ ﺠﺭﻯ ﺘﻁﻌﻴﻤﻬﻡ‪ ،‬ﺍﻟﻌﺩﻭﻯ ﺒﺸﻠل ﺍﻷﻁﻔﺎل‪ ،‬ﻟﻠﻤﺨﺎﻟﻁﻴﻥ ﻟﻬﻡ ﻤﻥ‬
‫ﺍﻷﻁﻔﺎل ﺍﻟﻤﺼﺎﺒﻴﻥ ﺒﺄﻤﺭﺍﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪.‬‬

‫‪ .3‬اﻟﻠﻘﺎح اﻟﺛﻼﺛﻲ اﻟﺑﻛﺗﯾري ‪Diphtheria, Pertussis, Tetanus Vaccine: DPT‬‬

‫أ‪ .‬ﻧوع اﻟﻠﻘﺎح‬

‫ﻫﻭ ﻟﻘﺎﺡ ﻴﺤﺘﻭﻱ ﻋﻠﻰ ﺜﻼﺜﺔ ﻤﺸﺘﻘﺎﺕ‪ ،‬ﻫﻲ‪ :‬ﺴﻤﻭﻡ ﺍﻟﺩﻓﺘﻴﺭﻴﺎ ﺍﻟﻤﻀﻌﻔﺔ ‪،Diphtheria toxiod‬‬
‫ﻭﺴﻤﻭﻡ ﺍﻟﺘﻴﺘﺎﻨﻭﺱ ﺍﻟﻤﻀﻌﻔﺔ ‪ ،Tetanus toxiod‬ﻭﻤﻴﻜﺭﻭﺒﺎﺕ ﻏﻴﺭ ﺤﻴﺔ ﻟﻠﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ‪ .Pertussis‬ﻭﻫﺫﺍ‬
‫ﺍﻟﺘﺠﻤﻴﻊ ﻴﻀﻤﻥ ﺍﺴﺘﺠﺎﺒﺔ ﺃﻜﺜﺭ ﻟّﻠﻘﺎﺡ‪ ،‬ﺇﻀﺎﻓﺔ ﺇﻟﻰ ﺘﻘﻠﻴل ﻋﺩﺩ ﻤﺭﺍﺕ ﺍﻟﺤﻘـﻥ‪ .‬ﻭﻴﻌﻁﻰ ﻫﺫﺍ ﺍﻟﻠﻘﺎﺡ ﻤﻥ‬
‫ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﻓﻲ ﺍﻟﻌﻀل‪ .‬ﻭﻴﺘﻠﻑ ﺇﺫﺍ ﺘﻌﺭﺽ ﻟﻠﺘﺠﻤﻴﺩ‪ ،‬ﺃﻭ ﺃﺸﻌﺔ ﺍﻟﺸﻤﺱ‪.‬‬

‫ب‪ .‬اﻟﻌﻣر وطرﯾﻘﺔ اﻟﺗﻌﺎطﻰ‬

‫ﻴﻌﻁﻰ ﻫﺫﺍ ﺍﻟّﻠﻘﺎﺡ ﻋﻠﻰ ﺜﻼﺙ ﺠﺭﻋﺎﺕ ﻋﻨﺩ ﺘﻤﺎﻡ ﺍﻟﺸﻬﺭ ﺍﻟﺜﺎﻨﻲ ﻭﺍﻟﺭﺍﺒﻊ ﻭﺍﻟﺴﺎﺩﺱ ﻤﻥ ﺍﻟﻌﻤﺭ‪ ،‬ﻤﻊ‬
‫ﻟﻘﺎﺡ ﺸﻠل ﺍﻷﻁﻔﺎل‪ .‬ﻜﻤﺎ ﺘُﻌﻁﻰ ﺠﺭﻋﺔ ﻤﻨﺸﻁﺔ ﻤﻨﻪ ﻋﻨﺩ ﻋﻤﺭ ‪ 18‬ﺸﻬﺭﴽ‪ ،‬ﻭ‪ 3‬ﺴﻨﻭﺍﺕ‪ .‬ﻭﻻ ُﻴﻔﻀل‬
‫ﺇﻋﻁﺎﺅﻩ ﻋﻨﺩ ﺒﺩﺍﻴﺔ ﻜل ﻤﺭﺤﻠﺔ ﺩﺭﺍﺴﻴﺔ‪ ،‬ﺒل ﻴُﻌﻁﻰ ﻓﻘﻁ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻨﺎﺌﻲ ‪ ،DT‬ﺤﻴﺙ ﺜﺒﺕ ﺃﻥ ﺍﻟﻤﻀﺎﻋﻔﺎﺕ‪،‬‬
‫ﺍﻟﺘﻲ ﻴﺴﺒﺒﻬﺎ ﻟﻘﺎﺡ ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ‪ ،‬ﺒﻌﺩ ﻋﻤﺭ ‪ 3‬ﺴﻨﻭﺍﺕ‪ ،‬ﺨﻁﻴﺭﺓ ﺠﺩﴽ ﻋﻠﻰ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ‪ .‬ﻭﻴﻌﻁـﻰ‬
‫ﺍﻟﻁﻔـل ﺍﻟﺠﺭﻋـﺔ "‪0.5‬ﻤﻠﻠﻴﻠﻴﺘﺭ" ﺤﻘﻨﴼ ﺩﺍﺨل ﺍﻟﻌﻀﻠﺔ‪ ،‬ﻓﻲ ﺍﻟﺠﺯء ﺍﻟﺨﺎﺭﺠﻲ ﻤﻥ ﻤﻨﺘﺼﻑ ﺍﻟﻔﺨﺫ‪.‬‬

‫ج‪ .‬اﻟﺗﻔﺎﻋﻼت واﻵﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ‬

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‫)‪ (1‬اﻟﺣﻣﻰ‬

‫ﻭﻴﻨﺼﺢ ﺒﺘﺨﻔﻴﻑ‬
‫ﺨﺎﻓﺽ ﻟﻠﺤﺭﺍﺭﺓ‪ُ ،‬‬
‫ٌ‬ ‫ﺘﺤﺩﺙ ﻤﺴﺎء ﻴﻭﻡ ﺍﻟﺘﻠﻘﻴﺢ‪ 24 ،‬ﺴﺎﻋﺔ‪ ،‬ﻭﻴﻌﻁﻰ ﺍﻟﻁﻔل‬
‫ﺍﻟﻤﻼﺒﺱ‪ ،‬ﻭﻋﻤل ﻜﻤﺎﺩﺍﺕ ﺒﺎﺭﺩﺓ‪ ،‬ﺇﺫﺍ ﻟﺯﻡ ﺍﻷﻤﺭ‪ ،‬ﻓﻲ ﻤﻭﻀﻊ ﺇﻋﻁﺎء ﺍﻟﻠﻘﺎﺡ‪.‬‬

‫)‪ (2‬اﻟﺗﻘرح اﻟﻣوﺿﻌﻲ‬

‫ﻗﺩ ﻴﺼﺎﺏ ﺍﻟﻁﻔل ﺒﺂﻻﻡ ﻭﺘﻘﺭﺡ ﻭﺍﺤﻤﺭﺍﺭ ﻭﺘﻭﺭﻡ‪ ،‬ﻓﻲ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ .‬ﻓﺈﺫﺍ ﺤﺩﺙ ﺫﻟﻙ ﻤﺒﻜﺭﺍ ً‪ ،‬ﺃﻱ‬
‫ﻓﻲ ﺍﻟﻴﻭﻡ ﺍﻟﺘﺎﻟﻲ ﻟﻠﺤﻘﻥ‪ ،‬ﻓﻬﻭ ﻨﺎﺠﻡ ﻋﻥ ﺍﻟﻠﻘﺎﺡ ﻓﻘﻁ‪ ،‬ﻭﻟﻴﺱ ﺍﻷﻤﺭ ﺨﻁﻴﺭﴽ‪ ،‬ﻭﺴﻭﻑ ﻴﺘﻭﻗﻑ ﺒﻌﺩ ﺜﻼﺜﺔ‪،‬‬
‫ﺃﻭ ﺃﺭﺒﻌﺔ ﺃﻴﺎﻡ‪.‬‬

‫)‪ (3‬اﻟﺧراج‬

‫ﺇﺫﺍ ﻅﻬﺭ ﺍﻷﻟﻡ ﺃﻭ ﺍﻟﺘﻭﺭﻡ ﻤﺘﺄﺨﺭﻴﻥ‪ -‬ﺃﻱ ﺒﻌﺩ ﺍﻟﺤﻘﻨﺔ ﺒﺄﺴﺒﻭﻉ ﺃﻭ ﺃﻜﺜﺭ‪ -‬ﻓﻘﺩ ﻴﻜﻭﻥ ﺫﻟﻙ ﺒﺴﺒﺏ‬
‫ﺨﺭﺍﺝ‪ .‬ﻭﻫﺫﺍ ﻴﺤﺩﺙ ﺇﺫﺍ ﻜﺎﻨﺕ ﺍﻹﺒﺭﺓ ﻏﻴﺭ ﻤﻌﻘﻤﺔ‪ .‬ﻭﻴﺴﺘﻠﺯﻡ ﻋﺭﺽ ﺍﻟﺨﺭﺍﺝ ﻋﻠﻰ ﺍﻟﻁﺒﻴﺏ‪ ،‬ﻓﻘﺩ‬
‫ﻴﺤﺘﺎﺝ ﺍﻟﻌﻼﺝ ﺇﻟﻰ ﺸﻕ ﻭﺘﻨﻅﻴﻑ ﻭﺘﻀﻤﻴﺩ‪.‬‬

‫)‪ (4‬اﻟﺗﺷﻧﺟﺎت‬

‫ﻴﻨﺩﺭ ﺤﺩﻭﺙ ﺘﻔﺎﻋل ﺸﺩﻴﺩ‪ ،‬ﻭﻟﻜﻥ ﺇﺫﺍ ﺤﺩﺙ ﺫﻟﻙ‪ ،‬ﻓﻤﺭﺩﻩ ﺇﻟﻰ ﺠﺯء ﺍﻟﺴﻌﺎل ﺍﻟﺩﻴﻜﻲ ﻓﻲ ﺍﻟﻠﻘﺎﺡ‪،‬‬
‫ﻭﻫﻭ ﺃﻜﺜﺭ ﺤﺩﻭﺜﴼ ﺒﻌﺩ ﺍﻟﺸﻬﺭ ﺍﻟﺴﺎﺩﺱ ﻤﻥ ﺍﻟﻌﻤﺭ‪ .‬ﻭﻓﻲ ﻫﺫﻩ ﺍﻟﺤﺎﻟﺔ ﻻ ﻴﻌﻁﻰ ﺍﻟﻁﻔل ﺠﺭﻋﺎﺕ ﺃﺨﺭﻯ‬
‫ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻼﺜﻲ‪ ،‬ﻭﻴﻤﻜﻥ ﺇﻜﻤﺎل ﺘﻠﻘﻴﺤﻪ ﺒﺎﻟﻠﻘﺎﺡ ﺍﻟﺜﻨﺎﺌﻲ ‪.DT‬‬

‫د‪ .‬ﻣواﻧﻊ اﻟﺗﻠﻘﯾﺢ ﺿد اﻟﺛﻼﺛﻲ اﻟﺑﻛﺗﯾري‬

‫)‪ (1‬ﺍﻻﺭﺘﻔﺎﻉ ﺍﻟﺸﺩﻴﺩ ﻓﻲ ﺩﺭﺠﺔ ﺍﻟﺤﺭﺍﺭﺓ‪ ،‬ﻭﺤﺎﻻﺕ ﺍﻟﻨﻘﺎﻫﺔ ﻤﻥ ﺍﻷﻤﺭﺍﺽ‪.‬‬

‫)‪ (2‬ﺍﻷﻨﻴﻤﻴﺎ ﻭﺍﻟﻀﻌﻑ ﺍﻟﺸﺩﻴﺩ ﻭﺍﻟﻭﻫﻥ ﺒﺴﺒﺏ ﺍﻷﻤﺭﺍﺽ‪.‬‬

‫)‪ (3‬ﺍﻷﻁﻔﺎل ﺍﻟﺫﻴﻥ ﺘﺒﻠﻎ ﺃﻋﻤﺎﺭﻫﻡ ﺃﻜﺜﺭ ﻤﻥ ﺜﻼﺙ ﺴﻨﻭﺍﺕ‪ ،‬ﺤﻴﺙ ﻴُﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻨﺎﺌﻲ ‪.DT‬‬

‫)‪ (4‬ﻓﻲ ﺤﺎﻻﺕ ﺘﻔﺸﻲ ﻤﺭﺽ ﺸﻠل ﺍﻷﻁﻔﺎل‪ ،‬ﻷﻥ ﺍﻟﺤﻘﻥ ﻓﻲ ﺍﻟﻌﻀل ﻗـﺩ ﻴﺴﺒﺏ ﺍﻟﺸﻠل ﺒﺴﺒﺏ ﺃﻥ‬
‫ﻓﻴﺭﻭﺱ ﺸﻠل ﺍﻷﻁﻔﺎل ﻴﺤﺘﺎﺝ ﺇﻟﻰ ﺃﻱ ﻤﻜﺎﻥ ﺒﻪ ﺠﺭﺡ‪ ،‬ﻟﻴﺩﺨل ﺇﻟﻰ ﺍﻟﺠﻬـﺎﺯ ﺍﻟﻌﺼﺒﻲ ﻤﻥ ﻁﺭﻴﻘﻪ‪.‬‬

‫)‪ (5‬ﻭﺠﻭﺩ ﺘﺎﺭﻴﺦ ﻤﺭﻀﻲ ﺒﺎﻹﺼﺎﺒﺔ ﺒﺎﺨﺘﻼل ﻓﻲ ﺍﻟﺠﻬﺎﺯ ﺍﻟﻌﺼﺒﻲ‪ ،‬ﺃﻭ ﺼﺩﻤﺔ‪ ،‬ﻓﻲ ﺨﻼل ‪ 72‬ﺴﺎﻋﺔ ﻤﻥ‬
‫ﺁﺨﺭ ﺘﻠﻘﻴﺢ ﻤﻥ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻼﺜﻲ‪ ،‬ﻭﻓﻲ ﻫﺫﻩ ﺍﻟﺤﺎﻟﺔ ﻴُﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻨﺎﺌﻲ‪.‬‬

‫‪ .4‬ﻟﻘﺎح اﻟﺣﺻﺑﺔ ‪Measles Vaccine‬‬

‫أ‪ .‬ﻧوع اﻟﻠﻘﺎح واﻟﺟرﻋﺔ واﻟطرﯾﻘﺔ‬

‫ﻴﺤﺘﻭﻱ ﻟﻘﺎﺡ ﺍﻟﺤﺼﺒﺔ ﻋﻠﻰ ﻓﻴﺭﻭﺴﺎﺕ ﺤﻴﺔ ﻤﻭﻫﻨﺔ‪ ،‬ﻭﻫﻭ ﻤﺠﻔﻑ ﺒﺎﻟﺘﺒﺭﻴـﺩ‪ ،‬ﻭﻴﻌﻁﻰ ‪ 0.5‬ﻤﻠﻠﻴﻠﻴﺘﺭ‪،‬‬
‫ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﺒﺎﻟﺫﺭﺍﻉ ﺍﻷﻴﻤﻥ‪.‬‬

‫ب‪ .‬اﻟﻌﻣر اﻟﻣﻧﺎﺳب ﻟﻠﺗﻠﻘﯾﺢ‬

‫ﺍﻟﻤﻌﺭﻀﺔ‬
‫ّ‬ ‫ﺘُﻌﺩ ﺃﻓﻀل ﺍﺴﺘﺠﺎﺒﺔ ﻟﺘﻠﻘﻴﺢ ﺍﻟﺼﺤﺒﺔ‪ ،‬ﻓﻲ ﻋﻤﺭ ‪ 15‬ﺸﻬﺭﴽ‪ ،‬ﻭﻟﻜﻥ ﻓﻲ ﺒﻌﺽ ﺍﻟﺒﻠﺩﺍﻥ‬
‫ﻟﻺﺼﺎﺒﺎﺕ ﺍﻟﻤﺒﻜﺭﺓ‪ُ ،‬ﻴﻌﻁﻰ ﻓﻲ ﻋﻤﺭ ‪ 9‬ﺃﺸﻬﺭ‪ ،‬ﺜﻡ ﻴﻌﻁﻰ ﻜﺠﺭﻋﺔ ﻤﻨﺸﻁﺔ ﻓﻲ ﻋﻤﺭ ‪ 15‬ﺸﻬﺭﴽ ﺒﻌﺩ ﺫﻟﻙ‪.‬‬

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‫ج‪ .‬اﻟﻣﺿﺎﻋﻔﺎت‬

‫ﻨﺎﺩﺭﺓ ﺍﻟﺤﺩﻭﺙ‪ ،‬ﻭﻫﻲ ﻻ ﺘﺘﺠﺎﻭﺯ ﺤﻤﻰ ﺘﻅﻬﺭ ﺒﻌﺩ ﺤﻭﺍﻟﻲ ﺃﺴﺒﻭﻉ ﻤﻥ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﻭﺍﻟﻁﻔﺢ ﺍﻟﺠﻠﺩﻱ‪ ،‬ﺍﻟﺫﻱ‬
‫ﻴﻅﻬﺭ ﺨﻔﻴﻔﴼ‪ ،‬ﻭﻴﺸﺒﻪ ﻁﻔﺢ ﺍﻟﺤﺼﺒﺔ‪ .‬ﻭﻴﻨﺼﺢ ﺒﺈﻋﻁﺎء ﻤﺨﻔﺽ ﻟﻠﺤﺭﺍﺭﺓ‪ ،‬ﻭﺍﻟﺘﻨﺒﻴﻪ ﺇﻟﻰ ﺇﻤﻜﺎﻥ ﺤﺩﻭﺙ‬
‫ﺍﻟﺤﻤﻰ ﻭﺍﻟﻁﻔﺢ ﺍﻟﺠﻠﺩﻱ ﺒﻌﺩ ﺍﻟﺘﻠﻘﻴﺢ‪ .‬ﻭﻗﺩ ﻴﺤﺩﺙ‪ ،‬ﻓﻲ ﺤﺎﻻﺕ ﻨﺎﺩﺭﺓ‪ ،‬ﺍﻟﺘﻬﺎﺏ ﺒﺎﻟﻤﺦ‪ ،‬ﺃﻭ ﺘﻨﺸﻴﻁ ﻟﻠﺩﺭﻥ‪.‬‬

‫د‪ .‬ﻣواﻧﻊ اﻟﺗﻠﻘﯾﺢ ﺿد اﻟﺣﺻﺑﺔ‬

‫)‪ (1‬ﺍﻟﻀﻌﻑ ﺍﻟﺸﺩﻴﺩ‪ ،‬ﻭﺍﻟﻨﻘﺎﻫﺔ‪ ،‬ﻤﺜل ﺃﻨﻭﺍﻉ ﻜﺜﻴﺭﺓ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ‪.‬‬

‫)‪ (2‬ﺍﻟﺤﺭﺍﺭﺓ ﺍﻟﻌﺎﻟﻴﺔ‪ ،‬ﻷﻨﻬﺎ ﺘﺅﺩﻱ ﺇﻟﻰ ﻓﻘﺩﺍﻥ ﻓﺎﻋﻠﻴﺔ ﺍﻟﺘﻠﻘﻴﺢ‪.‬‬

‫ﻭﺍﻟﺩﺭﻥ‪.‬‬
‫)‪ (3‬ﻤﺭﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪ ،‬ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺭﻁﺎﻨﻴﺔ‪ ،‬ﻭﺍﻟﻠﻭﻜﻴﻤﻴﺎ‪ّ ،‬‬

‫ﺍﻟﺴﺭﻁﺎﻥ‪.‬‬
‫)‪ (4‬ﺍﺴﺘﺨﺩﺍﻡ ﺍﻟﻜﻭﺭﺘﻴﺯﻭﻥ‪ ،‬ﺃﻭ ﺃﺩﻭﻴﺔ ﻋﻼﺝ ّ‬

‫‪ .5‬اﻟﻠﻘﺎح اﻟﺛﻼﺛﻲ اﻟﻔﯾروﺳﻲ ‪Measles ,Mumps, Rubella MMR‬‬

‫أ‪ .‬ﻧوع اﻟﻠﻘﺎح‬

‫ﻫﻭ ﻟﻘﺎﺡ ﺤﻲ ﻤﻭﻫﻥ ﻀﺩ ﺍﻟﺤﺼﺒﺔ ‪ ،Measles‬ﻭﺍﻟﺘﻬﺎﺏ ﺍﻟﻐﺩﺓ ﺍﻟﻨﻜﻔﻴﺔ ‪ ،Mump‬ﻭﺍﻟﺤﺼﺒﺔ ﺍﻷﻟﻤﺎﻨﻴﺔ‬

‫‪.Rubella‬‬

‫ب‪ .‬اﻟﺟرﻋﺔ واﻟطرﯾﻘﺔ وﻋﻣر اﻟﺗﻌﺎطﻲ‬

‫ﻴﻌﻁﻰ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻭﻫﻭ ﻋﺒﺎﺭﺓ ﻋﻥ ‪ 0.5‬ﻤﻴﻠﻠﺘﺭ‪ ،‬ﻭﺫﻟﻙ ﻋﻨﺩ ﺇﻜﻤﺎل ﺍﻟﻁﻔل ﺘﻤﺎﻡ‬
‫‪ 15‬ﺸﻬﺭﴽ‪.‬‬

‫ج‪ .‬اﻟﻣﺿﺎﻋﻔﺎت واﻷﺿرار اﻟﺟﺎﻧﺑﯾﺔ‬

‫ﺤﻤﻰ ﺘﻅﻬﺭ ﺒﻌﺩ ﺤﻭﺍﻟﻲ ﺃﺴﺒﻭﻉ ﻤﻥ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﻭﻁﻔﺢ ﺠﻠﺩﻱ ﺨﻔﻴﻑ ﻴﺸﺒﻪ ﻁﻔﺢ ﺍﻟﺤﺼﺒﺔ‪ ،‬ﺃﻭ ﺍﻟﺤﺼﺒﺔ‬
‫ﺍﻷﻟﻤﺎﻨﻴﺔ‪ ،‬ﻭﺃﺤﻴﺎﻨﴼ ﺘﻀﺨﻡ ﺒﺴﻴﻁ ﻓﻲ ﺍﻟﻐﺩﺓ ﺍﻟﻨﻜﻔﻴﺔ‪ .‬ﻭﻴﻨﺼﺢ ﺒﺈﻋﻁﺎء ﻤﺨﻔﺽ ﻟﻠﺤﺭﺍﺭﺓ‪ ،‬ﻤﻊ ﺍﻟﺘﻨﺒﻴﻪ ﺒﺈﻤﻜﺎﻥ‬
‫ﺤﺩﻭﺙ ﺍﻟﺤﻤﻰ ﻭﺍﻟﻁﻔﺢ ﺍﻟﺠﻠﺩﻱ ﺃﻭ ﺍﻟﺘﻀﺨﻡ ﺒﻌﺩ ﺍﻟﺘﻠﻘﻴﺢ‪.‬‬

‫د‪ .‬ﻣواﻧﻊ اﻟﺗﻠﻘﯾﺢ ﺿد اﻟﺛﻼﺛﻲ اﻟﻔﯾروﺳﻲ‬

‫)‪ (1‬ﺍﻟﻀﻌﻑ ﺍﻟﺸﺩﻴﺩ‪ ،‬ﻭﺍﻟﻨﻘﺎﻫﺔ ﻭﺍﻟﺤﺭﺍﺭﺓ ﺍﻟﻌﺎﻟﻴﺔ‪.‬‬

‫)‪ (2‬ﻤﺭﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪ ،‬ﻭﺍﻷﻤﺭﺍﺽ ﺍﻟﺴﺭﻁﺎﻨﻴﺔ‪ ،‬ﻭﺍﻟﻠﻭﻜﻴﻤﻴﺎ‪ ،‬ﻭﺍﻹﺼﺎﺒﺔ ﺒﺎﻟﺩﺭﻥ‪.‬‬

‫)‪ (3‬ﺍﺴﺘﺨﺩﺍﻡ ﺍﻟﻜﻭﺭﺘﻴﺯﻭﻥ ﺃﻭ ﺃﺩﻭﻴﺔ ﺍﻟﺴﺭﻁﺎﻥ‪.‬‬

‫‪ .6‬ﻟﻘﺎح اﻻﻟﺗﻬﺎب اﻟﻛﺑدي اﻟوﺑﺎﺋﻲ "ب" ‪Hepatitis B Vaccine‬‬

‫أ‪ .‬أﻧواع اﻟﻠﻘﺎﺣﺎت‬

‫ﻴﻭﺠﺩ ﻨﻭﻋﺎﻥ ﻤﻌﺭﻭﻓﺎﻥ ﻤﻥ ﺍﻟﻠﻘﺎﺤﺎﺕ‪ ،‬ﻀﺩ ﻤﺭﺽ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩﻯ ﺍﻟﻭﺒﺎﺌﻲ "ﺏ"‪:‬‬

‫ﺍﻟﻤﺤﻀﺭ ﻤﻥ ﺍﻟﺒﻼﺯﻤﺎ ﺍﻟﺒﺸﺭﻴﺔ‪ ،‬ﻤﻥ ﺤﺎﻤﻠﻲ ﺍﻷﻨﺘﻴﺠﻴﻥ ﺍﻟﺴﻁﺤﻲ ﻟﻠﻔﻴﺭﻭﺱ‪ ،‬ﻭﻤﻌﺎﻟﺠﺘﻪ‬

‫ّ‬ ‫)‪ (1‬ﺍﻟﻠﻘﺎﺡ‬
‫ﺒﺎﻟﻁﺭﻕ ﺍﻟﻤﺨﺘﻠﻔﺔ ﻟﻜﻲ ﻴﻔﻘﺩ ﺍﻟﻔﻴﺭﻭﺱ ﻗﺩﺭﺘﻪ ﻋﻠﻰ ﺍﻟﻌﺩﻭﻯ ﺃﻭ ﺇﺤﺩﺍﺙ ﺍﻟﻤﺭﺽ‪.‬‬

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‫)‪ (2‬ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﺤﻀﺭ ﺒﻁﺭﻴﻘﺔ ﺍﻟﻬﻨﺩﺴﺔ ﺍﻟﻭﺭﺍﺜﻴﺔ ﻋﻠﻰ ﺨﻼﻴﺎ ﺍﻟﺨﻤﻴﺭﺓ‪ ،‬ﻭﻫﻭ ﺍﻟﻠﻘﺎﺡ ﺍﻟﻤﺴﺘﻌﻤل ﻓﻲ ﺃﻜﺜﺭ‬
‫ﺒﻠﺩﺍﻥ ﺍﻟﻌﺎﻟﻡ‪.‬‬

‫ب‪ .‬اﻟﻌﻣر اﻟﻣﻧﺎﺳب ﻟﻠﺗﻌﺎطﻰ‬

‫ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻋﻠﻰ ﺜﻼﺙ ﺠﺭﻋﺎﺕ‪ ،‬ﻋﻨﺩ ﺇﺘﻤﺎﻡ ﺍﻟﺸﻬﺭ ﺍﻟﺜﺎﻨﻲ ﻭﺍﻟﺭﺍﺒﻊ ﻭﺍﻟﺴﺎﺩﺱ ﻤﻥ ﺍﻟﻌﻤﺭ‪ ،‬ﻤﻊ ﺍّﻟﻠﻘﺎﺡ‬
‫ﺍﻟﺨﺎﺹ ﺒﺸﻠل ﺍﻷﻁﻔﺎل ﻭﺍﻟﻠﻘﺎﺡ ﺍﻟﺜﻼﺜﻲ‪ .‬ﻭﻴﻤﻜﻥ ﺇﻋﻁﺎﺅﻩ ﻋﻨﺩ ﺍﻟﻭﻻﺩﺓ‪ ،‬ﻭﺒﻌﺩ ﺸﻬﺭ‪ ،‬ﺜﻡ ﺒﻌﺩ ﺨﻤﺴﺔ ﺸﻬﻭﺭ‬
‫ﻜﺠﺭﻋﺔ ﻤﻨﺸﻁﺔ‪.‬‬

‫ج‪ .‬اﻟﺟرﻋﺔ اﻟﻼزﻣﺔ واﻟطرﯾﻘﺔ‬

‫ﻴﻌﻁﻰ ﺍﻟﻁﻔل ﺠﺭﻋﺔ ﻤﻘﺩﺍﺭﻫﺎ ‪ 0,5‬ﻤﻴﻠﻠﺘﺭ ﺤﻘﻨﴼ ﺩﺍﺨل ﺍﻟﻌﻀل‪ ،‬ﻓﻲ ﺍﻟﺠﺯء ﺍﻟﺨﺎﺭﺠﻲ ﻤﻥ ﻤﻨﺘﺼﻑ‬
‫ﺍﻟﻔﺨﺫ ﺍﻷﻴﻤﻥ‪ .‬ﻭﻻ ﻴﺤﻘﻥ ﺍﻟﻁﻔل ﺍﻟﺫﻱ ﻋﻤﺭﻩ ﺃﻗل ﻤﻥ ﺴﻨﺘﻴﻥ ﻓﻲ ﻋﻀﻠﺔ ﺍﻹﻟﻴﺔ‪ ،‬ﻷﻥ ﺫﻟﻙ ﻗﺩ ﻴﺼﻴﺏ‬
‫ﺍﻟﻌﺼﺏ ﺍﻟﻭﺭﻜﻲ‪.‬‬

‫د‪ .‬اﻟﺗﻔﺎﻋﻼت واﻵﺛﺎر اﻟﺟﺎﻧﺑﯾﺔ‬

‫ﻻ ﺘﻭﺠﺩ ﻟﻠﻘﺎﺡ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩﻱ ﺍﻟﻭﺒﺎﺌﻲ "ﺏ" ﺃﻱ ﺁﺜﺎﺭ ﺠﺎﻨﺒـﻴﺔ‪ ،‬ﻭﻻ ﻴﺘﻌﺎﺭﺽ ﺇﻋﻁﺎﺅﻩ ﻤﻊ ﺇﻋﻁـﺎء‬
‫ﺍﻟﻠﻘﺎﺤﺎﺕ ﺍﻷﺨﺭﻯ‪.‬‬

‫اﻟﻠﻘﺎﺣﺎت اﻹﺿﺎﻓﯾﺔ‬

‫‪ .1‬اﻟﻠﻘﺎح ﺿد اﻟﻬﯾﻣوﻓﯾﻠس أﻧﻔﻠوﻧزا‪Haemophilus Influenza b Vaccine :‬‬

‫أ‪ .‬ﻧوع اﻟﻠﻘﺎح‬

‫ﺍﻟﺴﻜﺭﻴﺎﺕ ﺍﻟﻤﺘﻌﺩﺩﺓ ﻟﻘﺸﺭﺓ ﻤﻴﻜﺭﻭﺏ ﺍﻟﻬﻴﻤﻭﻓﻴﻠﺱ ﺃﻨﻔﻠﻭﻨﺯﺍ ﻨﻭﻉ "ﺏ"‪ ،‬ﻤﻊ ﺴﻤﻭﻡ ﺍﻟﺩﻓﺘﻴﺭﻴﺎ‪.‬‬
‫ّ‬

‫ب‪ .‬اﻟﺟرﻋﺔ واﻟطرﯾﻘﺔ وﻋﻣر اﻟﺗﻌﺎطﻲ‬

‫ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻋﻠﻰ ﺜﻼﺙ ﺠﺭﻋﺎﺕ‪ ،‬ﻋﻨﺩ ﺇﺘﻤﺎﻡ ﺍﻟﺸﻬﺭ ﺍﻟﺜﺎﻨﻲ ﻭﺍﻟﺭﺍﺒﻊ ﻭﺍﻟﺴﺎﺩﺱ ﻤﻥ ﺍﻟﻌﻤﺭ‪ ،‬ﻤﻊ ﺍﻟﻁﻌﻡ‬
‫ﺍﻟﺜﻼﺜﻲ‪ .‬ﻭﻴﻌﻁﻰ ﺍﻟﻁﻔل ﺠﺭﻋﺔ ﻤﻘﺩﺍﺭﻫﺎ ‪ 0.5‬ﻤﻴﻠﻠﺘﺭ ﺤﻘﻨﴼ ﺩﺍﺨل ﺍﻟﻌﻀل‪ ،‬ﻓﻲ ﺍﻟﺠﺯء ﺍﻟﺨﺎﺭﺠﻲ ﻤﻥ‬
‫ﻤﻨﺘﺼﻑ ﺍﻟﻔﺨﺫ ﺍﻷﻴﻤﻥ‪ .‬ﻭﻫﻭ ﻏﻴﺭ ﻤﻨﺎﺴﺏ ﻟﻸﻁﻔﺎل ﻓﻭﻕ ﺴﻥ ‪ 5‬ﺴﻨﻭﺍﺕ ﻷﻥ ﺍﻟﻬﻴﻤﻭﻓﻴﻠﺱ‪ ،‬ﺃﻨﻔﻠﻭﻨﺯﺍ ﻨﻭﻉ‬
‫"ﺏ" ﻏﻴﺭ ﺸﺎﺌﻊ ﻓﻭﻕ ﻫﺫﻩ ﺍﻟﻔﺌﺔ ﺍﻟﻌﻤﺭﻴﺔ‪ .‬ﻭﻴﺠﺏ ﺃﻥ ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻟﻜل ﺍﻷﻁﻔﺎل‪ ،‬ﺍﻟﺫﻴﻥ ﺃﺠﺭﻴﺕ ﻟﻬﻡ ﻋﻤﻠﻴﺔ‬
‫ﺍﺴﺘﺌﺼﺎل ﺍﻟﻁﺤﺎل‪ ،‬ﻭﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﺍﻷﻨﻴﻤﻴﺎ ﺍﻟﻤﻨﺠﻠﻴﺔ‪ ،‬ﻭﻜﺫﻟﻙ ﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﺃﻤﺭﺍﺽ ﻨﻘﺹ‬
‫ﺍﻟﻤﻨﺎﻋﺔ‪.‬‬

‫ج‪ .‬اﻟﻣﺿﺎﻋﻔﺎت واﻷﺿرار اﻟﺟﺎﻧﺑﯾﺔ‬

‫ﺘﻌﺩ ﻤﻀﺎﻋﻔﺎﺘﻪ ﻨﺎﺩﺭﺓ ﺍﻟﺤﺩﻭﺙ‪ ،‬ﻭﻫﻲ ﻋﺒﺎﺭﺓ ﻋﻥ ﺍﺤﻤـﺭﺍﺭ ﻭﺘـﻭﺭﻡ ﻓﻲ ﻤﻭﻀﻊ ﺍﻟﺤﻘﻥ‪ ،‬ﻴﺨﺘﻔﻲ ـ‬
‫ﻋﺎﺩﺓ ـ ﺨﻼل ﻴﻭﻡ ﺃﻭ ﻴﻭﻤﻴﻥ‪ ،‬ﻭﻨﺎﺩﺭﴽ ﻤﺎ ﻴﺼﺎﺏ ﺍﻷﻁﻔﺎل ﺒﺎﺭﺘﻔﺎﻉ ﻓﻲ ﺩﺭﺠﺔ ﺍﻟﺤﺭﺍﺭﺓ‪.‬‬

‫‪ .2‬اﻟﻠﻘﺎح ﺿد اﻻﻟﺗﻬﺎب اﻟﻛﺑدي اﻟوﺑﺎﺋﻲ أ ‪Hepatitis A Vaccine‬‬

‫ﻭﻴﻌﻁﻰ‬
‫ﻴﺤﺘﻭﻱ ﺍﻟﻠﻘﺎﺡ ﻋﻠﻰ ﺍﻟﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻼﻟﺘﻬﺎﺏ ﺍﻟﻜﺒﺩﻱ ﺍﻟﻭﺒﺎﺌﻲ "ﺃ"‪ ،‬ﻭﻫﻲ ﻏﻴﺭ ﺤﻴﺔ‪ُ ،‬‬
‫ﻟﻸﻁﻔﺎل‪ ،‬ﺍﻟﺫﻴﻥ ﺃﻋﻤﺎﺭﻫﻡ ﺃﻜﺜﺭ ﻤﻥ ﺴﻨﺔ‪ ،‬ﻋﻠﻰ ﺠﺭﻋﺘﻴﻥ‪ ،‬ﻤﻘﺩﺍﺭ ﺍﻟﺠﺭﻋﺔ ‪ 0.5‬ﻤﻴﻠﻠﺘﺭ ﺤﻘﻨﴼ ﻓﻲ ﺍﻟﻌﻀل‪،‬‬
‫ﻭﻴﻔﺼل ﺒﻴﻨﻬﻤﺎ ﺴﺘﺔ ﺸﻬﻭﺭ‪ .‬ﻭﻨﺎﺩﺭﴽ ﻤﺎ ﻴﻨﺘﺞ ﻋﻨﻪ ﻤﻀﺎﻋﻔﺎﺕ‪ ،‬ﺃﻭ ﺁﺜﺎﺭ ﺠﺎﻨﺒﻴﺔ‪.‬‬

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‫‪ .3‬اﻟﻠﻘﺎح ﺿد اﻟﺟدﯾري اﻟﻣﺎﺋﻲ ‪Chicken Pox Vaccine‬‬

‫ﻫﻭ ﻟﻘﺎﺡ ﻴﺤﻀﺭ ﻤﻥ ﺍﻟﺤﻤﺽ ﺍﻟﻨﻭﻭﻱ ﻟﻔﻴﺭﻭﺴﺎﺕ ﺍﻟﺠﺩﻴﺭﻱ ﺍﻟﻤﺎﺌﻲ‪ ،‬ﺒﺎﺴﺘﺨﺩﺍﻡ ﺍﻟﻬﻨﺩﺴﺔ ﺍﻟﻭﺭﺍﺜﻴﺔ‪ .‬ﻭﻴﻌﻁﻰ‬
‫ﻟﻸﻁﻔﺎل ﻓﻭﻕ ﻋﻤﺭ ﺴﻨﺔ‪ ،‬ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻭﻻ ﻴﻜﺭﺭ‪ .‬ﻭﻨﺎﺩﺭﴽ ﻤﺎ ﻴﻨﺘﺞ ﻋﻨﻪ ﻤﻀﺎﻋﻔﺎﺕ‪.‬‬

‫‪ .4‬اﻟﻠﻘﺎح ﺿد ﻓﯾروس اﻷﻧﻔﻠوﻧ از‬

‫ﻴﺤﻀﺭ ﻜل ﻋﺎﻡ ﺤﺴﺏ ﺍﻷﻨﻭﺍﻉ ﺍﻟﻤﻨﺘﺸﺭﺓ‪ ،‬ﻭﺤﺴﺏ ﺍﻟﺘﻭﺯﻴـﻊ ﺍﻟﺠﻐﺭﺍﻓﻲ‪ ،‬ﻭﻻ ُﻴﻌﻁﻰ ﻟﻸﻁﻔﺎل‬
‫ﻫﻭ ﻟﻘﺎﺡ ّ‬
‫ﺍﻟﺫﻴﻥ ﺃﻋﻤﺎﺭﻫﻡ ﺃﻗل ﻤﻥ ‪ 6‬ﺸﻬﻭﺭ‪ .‬ﻭﺍﻟﺠﺭﻋﺔ ﻟﻸﻁﻔﺎل ﻫﻲ ‪ 0.25‬ﺴﻡ ﻓﻲ ﺍﻟﻌﻀل ﺠﺭﻋﺔ ﺃﻭﻟﻰ‪ ،‬ﺜﻡ‬
‫‪0.25‬ﺴﻡ ﻓﻲ ﺍﻟﻌﻀل ﺠﺭﻋﺔ ﺜﺎﻨﻴﺔ‪ ،‬ﺒﻌﺩ ﺸﻬﺭ ﻤﻥ ﺍﻟﺠﺭﻋﺔ ﺍﻷﻭﻟﻰ‪ .‬ﺃﻤﺎ ﺍﻟﻜﺒﺎﺭ ﻭﺍﻷﻁﻔﺎل ﺃﻜﺜﺭ ﻤﻥ ‪3‬‬
‫ﺴﻨﻭﺍﺕ‪ ،‬ﻓﺠﺭﻋﺘﻬﻡ ‪0.5‬ﺴﻡ ﻓﻲ ﺍﻟﻌﻀل‪ ،‬ﻤﺭﺓ ﻭﺍﺤﺩﺓ ﻓﻘﻁ‪.‬‬

‫‪ .5‬اﻟﻠﻘﺎح ﺿد اﻟﺗﯾﻔوﺋﯾد ‪Typhoid Vaccine‬‬

‫أﻧواع اﻟﻠﻘﺎﺣﺎت‪:‬‬

‫ﺍﻟﺴﺎﺨﻥ‪ .‬ﻭﻴﻌﻁﻰ ﻤﻥ‬

‫ﺃ‪ .‬ﻟﻘﺎﺡ ﻤﺤﻀﺭ ﻤﻥ ﺍﻟﻤﻴﻜﺭﻭﺒﺎﺕ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻤﺭﺽ ﺍﻟﺘﻴﻔﻭﺌﻴﺩ ﻤﻴﺘﺔ‪ ،‬ﺒﻭﺍﺴﻁﺔ ﺍﻟﻔﻴﻨﻭل ّ‬
‫ﻨﻔﺼل ﺒﻴﻨﻬﻤﺎ ‪ 3‬ﺃﺴﺎﺒﻴﻊ ﺃﻭ ﺃﻜﺜﺭ‪ ،‬ﻭﺠﺭﻋﺔ ﻤﻨﺸﻁﺔ ﻜل ﺜﻼﺜﺔ‬
‫ﻁﺭﻴﻕ ﺍﻟﺤﻘﻥ ﺘﺤﺕ ﺍﻟﺠﻠﺩ ﻋﻠﻰ ﺠﺭﻋﺘﻴﻥ‪ ،‬ﱢ‬
‫ﺴﻨﻭﺍﺕ‪ .‬ﻭﻤﻘﺩﺍﺭ ﺍﻟﺠﺭﻋﺔ ‪ 0.5‬ﻤﻴﻠﻠﺘﺭ ﻟﻤﻥ ﺘﺯﻴﺩ ﺃﻋﻤﺎﺭﻫﻡ ﻋﻥ ﻋﺸﺭ ﺴﻨﻭﺍﺕ؛ ﻭ‪ 0.25‬ﻤﻴﻠﻠﺘﺭ ﻟﻤﻥ ﺘﻘل‬
‫ﺃﻋﻤﺎﺭﻫﻡ ﻋﻥ ﻋﺸﺭ ﺴﻨﻭﺍﺕ‪.‬‬

‫ﺍﻟﻤﺴﺒﺒﺔ ﻟﻤﺭﺽ ﺍﻟﺘﻴﻔﻭﺌﻴﺩ‪ ،‬ﻭﻫﻭ ﻜﺒﺴﻭﻻﺕ ﻤﻐﻠﻔﺔ ﻟﻤﻘﺎﻭﻤﺔ‬

‫ّ‬ ‫ﻤﺤﻀﺭ ﻤﻥ ﺍﻟﻤﻴﻜﺭﻭﺒﺎﺕ ﺍﻟﺤﻴﺔ ﺍﻟﻤﻭﻫﻨﺔ‪،‬‬
‫ّ‬ ‫ﺏ‪ .‬ﻟﻘﺎﺡ‬
‫ﺤﻤﻀﻴﺔ ﺍﻟﻤﻌﺩﺓ‪ ،‬ﻭﻴﺒﻠﻊ ﻤﻥ ﻁﺭﻴﻕ ﺍﻟﻔﻡ‪ .‬ﻭﻴُﻌﻁﻰ ﻟﻤﻥ ﺘﺯﻴﺩ ﺃﻋﻤﺎﺭﻫﻡ ﻋﻥ ‪ 6‬ﺴﻨﻭﺍﺕ‪.‬‬

‫‪ .6‬اﻟﻠﻘﺎح ﺿد اﻻﻟﺗﻬﺎب اﻟﺳﺣﺎﺋﻲ ‪Meningitis Vaccine‬‬

‫ﻭﻴﻌﻁﻰ‬
‫ﻟﻘﺎﺡ ﺭﺒﺎﻋﻲ ﻤﻜﻭﻥ ﻤﻥ ﺍﻷﻨﺘﻴﺠﻴﻥ ﺍﻟﻤﻀﺎﺩ ﻟﻠﺴﻜﺭﻴﺎﺕ ﺍﻟﻘﺸﺭﻴﺔ ﻷﻨﻭﺍﻉ‪ُ ،A,C,Y & W135‬‬
‫ﻟﻸﻁﻔﺎل ﺍﻟﻤﺴﺘﺄﺼﻠﻴﻥ ﻟﻠﻁﺤﺎل‪ ،‬ﻭﻓﻲ ﺤﺎﻻﺕ ﺍﻷﻭﺒﺌﺔ‪ .‬ﻭﺠﺭﻋﺘﻪ ‪ 0.5‬ﻤﻴﻠﻠﺘﺭ‪ ،‬ﺘُﻌﻁﻰ ﺘﺤﺕ ﺍﻟﺠﻠﺩ ﻟﻸﻁﻔﺎل‬
‫ﻓﻭﻕ ﻋﻤﺭ ﺴﻨﺘﻴﻥ‪.‬‬

‫‪ .7‬اﻟﻠﻘﺎح ﺿد اﻟﻛوﻟﯾ ار ‪Cholera Vaccine‬‬

‫ﻭﻫﻭ ﻟﻘﺎﺡ ﻤﺤﻀﺭ ﻤﻥ ﺍﻟﻤﻴﻜﺭﻭﺒﺎﺕ ﺍﻟﻤﺴﺒﺒﺔ ﻟﻤﺭﺽ ﺍﻟﻜﻭﻟﻴﺭﺍ‪ ،‬ﻤﻴﺘﺔ ﺒﻭﺍﺴﻁﺔ ﺍﻟﻔﻴﻨﻭل ﺍﻟﺴﺎﺨﻥ‪ .‬ﻭﻴﻌﻁﻰ‬
‫ﻓﻲ ﺤﺎﻻﺕ ﺍﻷﻭﺒﺌﺔ‪ ،‬ﻭﻓﻌﺎﻟﻴﺘﻪ ﻻ ﺘﺯﻴﺩ ﻋﻥ ‪ ،%50‬ﻭﻤﺩﺘﻪ ‪ 6-3‬ﺸﻬﻭﺭ‪ .‬ﻭﻻ ﻴﻌﻁﻰ ﻟﻤﻥ ﺘﻘل ﺃﻋﻤﺎﺭﻫﻡ ﻋﻥ‬
‫ﻭﻴﻜﺭﺭ ﻜل ‪ 6‬ﺸـﻬﻭﺭ‪ .‬ﻭﺍﻟﺠﺭﻋﺔ ﺍﻟﻤﻨﺎﺴﺒﺔ ﻫﻲ‪:‬‬
‫‪ 6‬ﺸﻬﻭﺭ‪ .‬ﻭﻴﺘﻜﻭﻥ ﻤﻥ ﺠﺭﻋﺘﻴﻥ ﺒﻴﻨﻬﻤﺎ ﺃﺴﺒﻭﻉ‪ُ ،‬‬

‫ﺃ‪ 6 .‬ﺸﻬﻭﺭ ـ ‪ 4‬ﺴﻨﻭﺍﺕ‪ 0.2 :‬ﻤﻠﻠﻴﻠﻴﺘﺭ‪.‬‬

‫ﺏ‪ 5 .‬ﺴﻨﻭﺍﺕ ـ ‪ 10‬ﺴﻨﻭﺍﺕ‪ 0.3 :‬ﻤﻠﻠﻴﻠﻴﺘﺭ‪.‬‬

‫ﺝ‪ .‬ﺃﻜﺜﺭ ﻤﻥ ﻋﺸﺭ ﺴﻨﻭﺍﺕ‪ 0.5 :‬ﻤﻠﻠﻴﻠﻴﺘﺭ‪.‬‬

‫‪ .8‬اﻟﻠﻘﺎح ﺿد اﻟﺣﻣﻰ اﻟﺻﻔراء ‪Yellow Lever Vaccine‬‬

‫ﻟﻘﺎﺡ ﻤﻬﻡ ﻟﻜل ﺍﻟﻤﺴﺎﻓﺭﻴﻥ ﺇﻟﻰ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻤﻭﺒﻭءﺓ‪ .‬ﻭﻻ ﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﻟﻤﻥ ﺘﻘل ﺃﻋﻤﺎﺭﻫﻡ ﻋﻥ ‪ 9‬ﺃﺸﻬﺭ‪،‬‬
‫ﻭﺠﺭﻋﺘﻪ ‪ 0.5‬ﻤﻠﻠﻴﻠﻴﺘﺭ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻭﻴُﻌﺩ ﺼﺎﻟﺤﴼ ﺒﻌﺩ ﻋﺸﺭﺓ ﺃﻴﺎﻡ ﻤﻥ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﻭﻟﻤﺩﺓ ﻋﺸﺭ ﺴﻨﻭﺍﺕ‪.‬‬

‫‪ .9‬اﻟﻠﻘﺎح ﺿد اﻟﺑﻛﺗﯾرﯾﺎ اﻟﺳﺑﺣﯾﺔ اﻟرﺋوﯾﺔ ‪Pneumococcal Vaccine‬‬

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‫ﻭﻫﻭ ﻟﻘﺎﺡ ﻴﺤﻀﺭ ﻤﻥ ‪ 23‬ﻨﻭﻋﴼ ﻤﻥ ﻤﻭﻟﺩﺍﺕ ﺍﻟﻤﻀﺎﺩﺍﺕ ‪ ،Antigens‬ﻤﻥ ﺍﻟﺴﻜﺭﻴﺎﺕ ﺍﻟﻤﺘﻌﺩﺩﺓ ﺍﻟﻘﺸﺭﺓ‬
‫ﺍﻟﻨﻘﻴﺔ ﻟﻠﺒﻜﺘﻴﺭﻴﺎ ﺍﻟﺴﺒﺤﻴﺔ ﺍﻟﺭﺌﻭﻴﺔ‪.‬ﻭﻫﻭ ﻴﻘﻲ ﻤﻥ ﺤﻭﺍﻟﻲ ‪ %88‬ﻤﻥ ﻤﺴﺒﺒﺎﺕ ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺭﺌﻭﻱ‪ .‬ﻭﺠﺭﻋﺘﻪ ‪0.5‬‬
‫ﻤﻴﻠﻠﺘﺭ ﺘﺤﺕ ﺍﻟﺠﻠﺩ‪ ،‬ﻭﻻ ﻴﻌﻁﻰ ﻟﻸﻁﻔﺎل ﺃﻗل ﻤﻥ ﺴﻨﺘﻴﻥ‪ .‬ﺃﻤﺎ ﺩﻭﺍﻋﻲ ﺍﻻﺴﺘﻌﻤﺎل ﻓﻬﻲ‪:‬‬

‫ﺃ‪ .‬ﺒﻌﺩ ﺃﺴﺒﻭﻋﻴﻥ ﻋﻠﻰ ﺍﻷﻗل ﻤﻥ ﺍﺴﺘﺌﺼﺎل ﺍﻟﻁﺤﺎل‪.‬‬

‫ﺏ‪ .‬ﻟﻸﻁﻔﺎل ﺍﻟﺫﻴﻥ ﻴﻌﺎﻨﻭﻥ ﻤﻥ ﺍﺴﺘﺌﺼﺎل ﺘﺸﺭﻴﺤﻲ‪ ،‬ﺃﻭ ﻭﻅﻴﻔﻲ‪ ،‬ﻟﻠﻁﺤﺎل ﻤﺘﻀﻤﻨﻴﻥ ﺍﻷﻨﻴﻤﻴﺎ ﺍﻟﻤﻨﺠﻠﻴﺔ‪،‬‬
‫ﻭﻤﺭﺽ ﻫﻭﺩﺠﻜﻥ‪.‬‬

‫ﺝ‪ .‬ﻤﺘﻼﺯﻤﺔ ﺫﺍﺕ ﺍﻟﻜﻠﻰ ‪.Nephrotic syndrome‬‬

‫ﺩ‪ .‬ﺃﻤﺭﺍﺽ ﻨﻘﺹ ﺍﻟﻤﻨﺎﻋﺔ‪.‬‬

‫‪ .10‬اﻟﻠﻘﺎح ﺿد اﻟطﺎﻋون ‪Plague Vaccine‬‬

‫ﻭﻫﻭ ﻟﻘﺎﺡ ﻤﺤﻀﺭ ﻤﻥ ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺍﻟﻤﻘﺘﻭﻟﺔ‪ ،‬ﻭﻴﻌﻁﻰ ﻋﻠﻰ ﺜﻼﺙ ﺠﺭﻋﺎﺕ‪ :‬ﻋﻨﺩ ﺒﺩء ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﺜﻡ ﺒﻌﺩ ﺸﻬﺭ‪،‬‬
‫ﻭ‪ 6‬ﺸﻬﻭﺭ ﻤﻥ ﺒﺩﺍﻴﺔ ﺍﻟﺘﻠﻘﻴﺢ‪ ،‬ﻭﺫﻟﻙ ﻟﻤﻥ ﻴﻌﻤﻠﻭﻥ ﻓﻲ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻤﻭﺒﻭءﺓ‪ ،‬ﻭﻴﺘﻌﺎﻤﻠﻭﻥ ﻓﻲ ﻤﺠﺎل ﺍﻟﻘﻭﺍﺭﺽ‪.‬‬

‫‪ .11‬اﻟﻠﻘﺎح ﺿد اﻟﺟﻣرة اﻟﺧﺑﯾﺛﺔ ‪Anthrax Vaccine‬‬

‫ﻫﻭ ﻟﻘﺎﺡ ﻤﺘﺎﺡ ﻟﻠﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺍﻷﺼﻭﺍﻑ ﺍﻟﻤﺴﺘﻭﺭﺩﺓ ﻤﻥ ﺍﻷﻤﺎﻜﻥ ﺍﻟﻤﻭﺒﻭءﺓ‪ ،‬ﺃﻭ ﺍﻟﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺩﺒﺎﻏﺔ ﺍﻟﺠﻠﻭﺩ‪.‬‬

‫‪ .12‬اﻟﻠﻘﺎح ﺿد داء اﻟﻛﻠب ‪Rabies Vaccine‬‬

‫ﻫﻭ ﻟﻘﺎﺡ ﺒﺸﺭﻱ ﺜﻨﺎﺌﻲ ﺫﻭ ﺘﺄﺜﻴﺭ ﻗﻭﻱ‪ ،‬ﻋﻨﺩ ﺍﺴﺘﺨﺩﺍﻤﻪ ﻤﺒﺎﺸﺭﺓ ﺒﻌﺩ ﺍﻟﻌﻀﺔ‪ ،‬ﻭﻟﻜﻥ ﻻ ﺒﺩ ﻤﻥ ﺍﺴﺘﻌﻤﺎل‬
‫ﻤﺼل ﺩﺍء ﺍﻟﻜﻠﺏ ﺍﻟﺒﺸﺭﻱ‪ ،‬ﻓﻲ ﺍﻟﻭﻗﺕ ﻨﻔﺴﻪ‪ ،‬ﺇﺫﺍ ﻜﺎﻥ ﻫﻨﺎﻙ ﺸﻙ ﻓﻲ ﺍﺤﺘﻤﺎل ﻋﺩﻭﻯ‪ .‬ﻭﻴﻤﻜﻥ ﺃﻥ ﻴُﻌﻁﻰ‬
‫ﻟﻠﻤﻌﺭﻀﻴﻥ ﻟﻠﻌﺩﻭﻯ‪ ،‬ﻗﺒل ﺍﻟﺴﻔﺭ ﺨﺎﺼﺔ ﺇﻟﻰ ﺍﻷﻤﺎﻜﻥ ﺍﻟﻨﺎﺌﻴﺔ‪ .‬ﻭﻴﻌﻁﻰ ﺍﻟﻠﻘﺎﺡ ﺩﺍﺨل ﺍﻟﺠﻠﺩ‪.‬‬

‫‪ .13‬اﻟﻠﻘﺎح ﺿد ﻓﯾروس روﺗﺎ ‪Rota Virus Vaccine‬‬

‫ﻭﻴﻌﻁﻲ ﻤﻨﺎﻋﺔ ﻀﺩ ﺭﻭﺘﺎ ﻓﻴﺭﻭﺱ‪ ،‬ﺃﻜﺒﺭ ﻤﺴﺒﺏ ﻟﻺﺴﻬﺎل ﻓﻲ ﺍﻟﻌﺎﻟﻡ‪.‬‬

‫ﻫﻭ ﻟﻘﺎﺡ ﺠﺩﻴﺩ ﺘﺤﺕ ﺍﻟﺒﺤﺙ‪ُ ،‬‬

‫اﻟﻠﻘﺎﺣﺎت اﻟﺧﺎﺻﺔ ﺑﺎﻟﻣﺳﺎﻓرﯾن‬

‫ﺍﻟﻤﺴﺎﻓﺭﻭﻥ ﺇﻟﻰ ﺍﻟﻤﻨﺎﻁﻕ ﺍﻟﻤﻭﺒﻭءﺓ‪ُ ،‬ﻴﺠﺭﻱ ﺘﺤﺼﻴﻨﻬﻡ ﻀﺩ ﻜل ﺃﻭ ﺒﻌﺽ ﺍﻷﻤﺭﺍﺽ ﺍﻵﺘﻴﺔ‪:‬‬

‫‪ .1‬ﺍﻟﻤﻼﺭﻴﺎ ‪Malaria Vaccine‬‬

‫‪ .2‬ﺍﻟﺘﻴﻔﻭﺌﻴﺩ ‪Typhoid Vaccine‬‬

‫‪ .3‬ﺍﻟﺤﻤﻰ ﺍﻟﺼﻔﺭﺍء ‪Yellow Fever Vaccine‬‬

‫‪ .4‬ﺍﻟﻜﻭﻟﻴﺭﺍ ‪Cholera‬‬

‫‪ .5‬ﺍﻟﺠﻤﺭﺓ ﺍﻟﺨﺒﻴﺜﺔ ‪Anthrax‬‬

‫‪ .6‬ﺍﻟﻜﺒﺩﻱ ﺍﻟﻭﺒﺎﺌﻲ "ﺏ" ‪Hepatities B‬‬

‫‪ .7‬ﺍﻟﺜﻨﺎﺌﻲ ﺍﻟﺒﻜﺘﻴﺭﻱ ‪D.T. Vaccine‬‬

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‫‪ .8‬ﺸﻠل ﺍﻷﻁﻔﺎل ‪Poliomyelitis‬‬

‫‪ .9‬ﺍﻟﻁﺎﻋﻭﻥ ‪Plague‬‬

‫‪ .10‬ﺩﺍء ﺍﻟﻜﻠﺏ ‪Rabies‬‬

‫‪ .11‬ﺍﻟﺩﺭﻥ ‪Tuberculosis BCG‬‬

‫اﻟﻠﻘﺎﺣﺎت اﻟﺧﺎﺻﺔ ﺑﺎﻟﻣرﺿﻰ‬

‫ﺒﻌﺽ ﺍﻟﻤﺭﻀﻰ ﻴﺠﺭﻱ ﺘﻠﻘﻴﺤﻬﻡ ﻀﺩ ﻜل‪ ،‬ﺃﻭ ﺒﻌﺽ‪ ،‬ﺍﻷﻤﺭﺍﺽ ﺍﻵﺘﻴﺔ‪:‬‬

‫‪ .1‬ﺍﻟﻬﻴﻤﻭﻓﻴﻠﺱ ﺃﻨﻔﻠﻭﻨﺯﺍ ‪Haemophilus Influenza B‬‬

‫‪ .2‬ﺍﻻﻟﺘﻬﺎﺏ ﺍﻟﺴﺤﺎﺌﻲ ‪Meningitis‬‬

‫‪ .3‬ﺍﻟﺒﻜﺘﻴﺭﻴﺎ ﺍﻟﺭﺌﻭﻴﺔ ‪Pneumococcal‬‬

‫ﻷﻥ ﻫﺅﻻء ﺍﻟﻤﺭﻀﻰ ﻤﻥ ﻨﺎﻗﺼﻲ ﺍﻟﻤﻨﺎﻋﺔ‪ ،‬ﺃﻭ ﻤﻥ ﺠﺭﻯ ﺍﺴﺘﺌﺼﺎل ﺍﻟﻁـﺤﺎل ﻟﻬﻡ‪ ،‬ﻜﻤﺎ ﻴﺤﺩﺙ ﻓﻲ‬
‫ﺒﻌﺽ ﺃﻤﺭﺍﺽ ﺍﻟﺩﻡ‪ ،‬ﻴﻜﻭﻨﻭﻥ ﺃﻜﺜﺭ ﻋﺭﻀﺔ ﻟﻺﺼﺎﺒﺔ ﺒﻬﺫﻩ ﺍﻷﻤﺭﺍﺽ ﺍﻟﻔّﺘﺎﻜﺔ‪.‬‬

‫اﻟﻠﻘﺎﺣﺎت اﻟﺧﺎﺻﺔ ﺑﺑﻌض اﻟﻣﻬن‬

‫‪ .1‬اﻟﺣﻣﻰ اﻟﺻﻔراء ‪ :Yellow Lever‬ﻟﻠﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺍﻟﻤﺠﺎل ﺍﻟﺩﺒﻠﻭﻤﺎﺴﻲ‪ ،‬ﺃﻭ ﺍﻟﺒﻌﺜﺎﺕ ﻓﻲ ﺍﻷﻤﺎﻜﻥ‬

‫ﺍﻟﻤﻭﺒﻭءﺓ‪.‬‬

‫‪ .2‬اﻟﺟﻣرة اﻟﺧﺑﯾﺛﺔ ‪ :Anthrax‬ﻟﻠﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺍﻟﻤﻌﺎﻤل ﺍﻟﻁﺒﻴﺔ‪ ،‬ﻭﺍﻷﺒﺤﺎﺙ ﺍﻟﺒﻴﻁﺭﻴﺔ‪ ،‬ﻭﺩﺒﺎﻏﺔ ﺍﻟﺠﻠﻭﺩ‪.‬‬

‫‪ .3‬اﻟﻛﺑدي اﻟوﺑﺎﺋﻲ ب ‪ :Hepatities B‬ﻟﻠﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺒﻨﻭﻙ ﺍﻟﺩﻡ ﻭﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ‪.‬‬

‫‪ .4‬اﻟطﺎﻋون ‪ Plague‬وداء اﻟﻛﻠب ‪ :Rabies‬ﻟﻠﻌﺎﻤﻠﻴﻥ ﻓﻲ ﺍﻟﻤﺴﺘﺸﻔﻴﺎﺕ ّ‬

‫ﺍﻟﺒﻴﻁﺭﻴﺔ‪ ،‬ﻭﻓﻲ ﻤﺠﺎل ﺃﺒﺤﺎﺙ‬
‫ﺍﻟﺤﻴﻭﺍﻥ‪.‬‬

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