Pemberian Parasetamol Sebelum Vaksinasi Pada Anak-Anak Menurunkan Respon Vaksin

Artikel berjudul "Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials" cukup menarik. Ini berkaitan dengan kebiasaan kita sebagai orang tua maupun sebagai tenaga kesehatan untuk memberikan parasetamol (ACETAMINOPHEN) sebagai profilaksis (pencegahan) sebelum anak kita divaksinasi. Penelitian di atas bertujuan untuk membuktikan efek profilaksis parasetamol terhadap kejadian febril (demam), dan respon antibodi terhadap pemberian vaksin.

Berdasarkan prinsip evidence-based, penelitian di atas termasuk dalam rating I, karena metodenya adalah randomised controlled trial (RCT), gold standard untuk penelitian efikasi dan toksisitas. Kemudian, dari segi publisher, artikel tersebut dimuat di Lancet, jurnal prestisius dengan impact factor pada posisi 3 tertinggi (data 2008, impact factor: 28.64, di bawah NEJM dan Nature). Ini berarti penelitian tersebut bisa dikatakan outstanding research.
Hasilnya:
- Parasetamol menurunkan kejadian demam secara signifikan untuk suhu diatas 38o C, namun tidak menurunkan kejadian demam untuk suhu di atas 39.5o C
- Parasetamol menurunkan respon antibodi
Pada kesimpulan, author menyimpulkan bahwa implikasi klinis dari temuan ini tetap unknown dan butuh penelitian lebih lanjut untuk mengkonfirmasinya. Kemudian, author memberikan pernyataan bahwasannya pemberian parasetamol sebagai profilaksis mestinya tidak menjadi treatment yang direkomendasikan.

Beberapa komentar dari pakar menanggapi hasil penelitian tersebut dimuat dalam editorial Lancet dan medscape sebagai berikut:

- "The amount of protective antibody was a little bit lower for some of these vaccines, so if everybody's levels are a little lower, some people may continue to carry the organism. This might not mean much for an individual, but we don't know whether other people in the population will be getting infected."

- ".... raise an important question regarding the clinical and public health implications of reduced antibody concentrations with the use of acetaminophen. This is particularly important with regard to the extent to which acetaminophen might reduce population protection. This point has implications, especially for Haemophilus influenzae and pneumococcus, for which higher and sustained antibody concentrations are needed to interrupt the carrier state and reduce transmission within the population"

- "...that today's vaccines are safer, with fewer adverse effects, and that recent studies have begun to show that antipyretics do not do as much to reduce fever and alleviate pain and other uncomfortable symptoms associated with infant vaccinations as previously believed.

Lalu, apa yang harus kita lakukan ? mengutip dari salah satu komentar di artikel medscape:

"Because this study showed reduced protective antibodies with...[acetaminophen] and because other studies fail to show that...[acetaminophen] actually helps as much as we thought, I won't recommend that parents give it to their kids. I would say that's out of the books now. If a child does develop a fever and is very uncomfortable, then you can give it. That’s a common sense approach anyway. Why would you give drugs unnecessarily?"

Semoga bermanfaat...

Dipersilahkan untuk membaca teks asli artikel-artikel tersebut di:
- Prymula, R., et al, Effect of prophylactic paracetamol administration at time of vaccination on febrile reactions and antibody responses in children: two open-label, randomised controlled trials, Lancet, Volume 374, Issue 9698, 17 October 2009-23 October 2009, Pages 1305-1306. (ORIGINAL RESEARCH)
- Chen, RT, et al, The yin and yang of paracetamol and paediatric immunisations, Lancet, Volume 374, Issue 9698, 17 October 2009-23 October 2009, Pages 1305-1306. (EDITORIAL)
- Lowry, F., Prophylactic Acetaminophen Before Vaccination in Infants Reduces Vaccine Response, available at: here (MEDSCAPE ARTICLE)
Jika membutuhkan, saya memiliki full text ke-3 artikel di atas.

SALAM...