vắc-xin có thể được tiêm bắp nếu, theo ý kiến của một bác sĩ quen thuộc với nguy cơ chảy máu của bệnh nhân, thuốc chủng có thể được quản lý an toàn hợp lý bởi tuyến đường này. Một kim nhỏ (23 đánh giá) nên được sử dụng cho các áp lực tiêm chủng và công ty áp dụng cho trang web | Controversially discussed indications for immunization 91 the vaccine could be administered intramuscularly if in the opinion of a physician familiar with the patient s bleeding risk the vaccine can be administered with reasonable safety by this route. A fine needle s 23 gauge should be used for the immunization and firm pressure applied to the site without rubbing for 2 min. The patient or family should be instructed concerning the risk for hematoma from the injection. Patients with platelet counts of less than 50 X109 L should not receive intramuscular injections. The subcutaneous or intracutaneous route should be considered as an alternative to the intramuscular route in patients with bleeding disorders. Children with inherited coagulopathies should receive factor replacement prior to intramuscular injection 8 17 . Immunization of recent recipients of human immunoglobulin With the exception of yellow fever vaccine the immune response to live viral vaccines may be inhibited by normal human immunoglobulin. Therefore live virus vaccines should be given 3 weeks before or 3 months after a dose of immunoglobulin. If an individual is under medical treatment with high-dose or intravenous immunoglobulin the physician who initiated this treatment should be consulted 8 . Immunization and breast-feeding Breast-fed infants should be immunized according to routinely recommended schedules. Although live vaccines multiply within the mother s body the majority has not been demonstrated to be excreted in human milk. Rubella vaccine virus might be excreted in human milk. However the virus usually does not infect the infant. Where infection has occurred in an infant it has been mild because the virus is attenuated. Inactivated recombinant subunit polysaccharide conjugate vaccines and toxoids pose no risk for mothers who are breast-feeding or for their infants 8 17 . Special recommendations for the immunization of hematopoietic stem cell transplant HSCT recipients and for solid .
