1.

Clinical Scenario
A 15-month-old infant was brought for MMR vaccination. The mother inform that her
daughter is very allergic to egg. Knowing that all MMR vaccine contain small amount of egg
protein ovalbumin

2. Dari Clinical Scenario dibuat:

a. Tabel P.I.C.O

P 15 Month-old infant allergic to egg

I MMR vaccination which contains small amount of egg protein ovalbumin

C -

O MMR vaccination for a child who allergic to egg

Answerable Question: Is there any possible to give MMR vaccination which contains
small amount of egg protein ovalbumin to a 15 month old infant who’s very allergic to
egg?

b. Buatlah Search Term/Search/Keyword

“Infant” AND “allergic to egg” AND “MMR vaccine”

c. Lakukan searching
https://www.ncbi.nlm.nih.gov/pubmed/27770112
d. Pastekan abstract artikel yang didapat pada lembar jawaban
Abstract
INTRODUCTION:
Children who develop any hypersensitivity reaction to eggs are routinely referred to hospital
for Measles-Mumps-Rubella (MMR) vaccination as inpatients to prevent anaphylaxis. We
aimed to study the association between hypersensitivity reactions after egg exposure and
similar reactions after MMR immunisation; and examine the necessity of hospital admission
for vaccination.

METHODS:
A prospective observational study was conducted in Paediatric Department in Bukit
Mertajam Hospital, Penang, between March and December 2014. Children referred from
local polyclinics for inpatient MMR vaccination because of a history of egg allergy were
recruited. The children were observed in the ward for post vaccination allergic reactions.
Concurrently, a group of children without egg allergy was recruited from those admitted for
other illnesses but had recent MMR vaccination at polyclinics. Parents of these children were
interviewed and asked if they had observed any reactions post vaccination. In both groups,
sociodemographics, medical history and family history of atopy were collected.
 RESULTS:
Eighty-seven subjects were recruited in this study. Fifty-four infants with egg allergy had
previous mild allergic reactions after exposure to eggs or egg-related products. They were
associated with a family history of egg hypersensitivity, personal history of acute
gastroenteritis and upper respiratory tract infections. Two of them developed cutaneous
rashes post vaccination during observation, but none developed anaphylactic or
anaphylactoid reactions. Two infants among those without egg allergy had post vaccination
fever. There was no association between egg allergy and hypersensitivity reactions to MMR
vaccine (p=0.632).

CONCLUSIONS:
MMR vaccine can be safely administered to children with mild egg allergy, hence admission
for vaccination in the hospital is not warranted. Risk stratification is required to ensure only
infants with severe reactions will be admitted for vaccination.

e. Lakukan Critical appraisal dari artikel dengan criticla appraisal worksheet

CRITICAL APPRAISAL THERAPY STUDY (Randomized Controlled Trial)

VALIDITY:Are the results of the trial valid? (Internal Validity)

Yang dinilai FRISBEC

F: Patient Follow-Up Ya. Tidak ada pasien yang keluar untuk follow-up

 Were all patients who entered the trial

properly accounted for at its
conclusion? Losses to follow-up should
be less than 20% and reasons for drop-
out given.
 Was follow-up long enough? Ya. Follow up dilakukan hanya sehari untuk
melihat reaksi alergi yang muncul dan segera
menghilang dlm beberapa jam.

R: Randomization

 Were the recruited patients Ya

representative of the target
population?
 Was the allocation (assignment) of Pengobatan dilakukan secara acak
patients to treatment randomized and
concealed?

I: Intention to Treat Analysis

 Were patients analyzed in the groups Ya

to which they were randomized?

 Were all randomized patient data

analyzed? If not, was a sensitivity or Ya, seluruh data pasien yang acak dianalisis
 “worst case scenario” analysis done?

S: Similar Baseline Characteristics of Kedua grup sama-sama kelompok usia 1 tahun

dan mempunyai riwayat hipersensitivitas
Patients
terhadap telur
 Were groups similar at the start of the
trial?

B: Blinding - Tidak, mereka mengetahui tentang

vaksin MMR
 Were patients, health workers, and
study personnel “blind” to treatment? -

 If blinding was impossible, were blinded

raters and/or objective outcome measures
used?

E: Equal Treatment Ya

 Aside from the experimental

intervention, were the groups treated

equally?

Conflict of Interest Tidak dijelaskan adanya konflik kepentingan di

penelitian ini

Are the sources of support and other
potential conflicts of interest
acknowledged and addressed?
Summary of Article’s Validity - Tidak ada
-
 Notable study strengths or weaknesses
or concerns?

 How serious are the threats to validity

and in what direction could they bias the

study outcomes?

IMPORTANCY (What were the results?)

Yang dinilai/dihitung

CER

EER 0,074

RR 0,61

RRR (/RBI 0,4

ARI/ABI 0,047
NNT
C.APPLICABILIITY
Will the results help me in caring for my patient? (ExternalValidity/Applicability)
Is my patient so different to those in the study
that the result cannot apply?
Is the treatment feasible in my setting?
Will the potenntial benefits of treatment
outweigh the potential harms of treatment for
my patient?
21,21
Tidak, penelitian ini dapat diaplikasikan untuk
masyarakat umum
Ya
Keuntungan pemberian MMR vaksin lebih
penting walaupun dengan adanya resiko reaksi
alergi/anafilaktik. Tetapi pada penelitian ini
dinyatakan aman untuk memberikan vaksin
MMR untuk anak-anak dengan hipersensitivitas
telur.