Approximate criteria for pathological reactions to vaccination. The value of preventive vaccinations

The Society of Orthodox Doctors has published a brochure on vaccination in children. The authors of the brochure in an understandable and accessible form talk about vaccination, about attitudes towards vaccinations Orthodox Church in the person of her holy ascetics - St. Luke of Simferopol (doctor V. F. Voyno-Yasenetsky) and St. Innokenty (Veniaminov) of Moscow.

The Russian calendar includes vaccination against the 10 most relevant infections at the present time, each of which will be considered separately (see Appendix 1). In addition, regional calendars have been approved in certain constituent entities of the Russian Federation preventive vaccinations which, as a rule, include vaccination against several more infections. In Russia, there is also a calendar of preventive vaccinations according to epidemic indications, according to which vaccination is carried out to the population of certain territories (where any infection is common) or to persons performing certain work (dangerous in terms of contracting any infection).

Vaccination is carried out in state, municipal, departmental and commercial medical institutions, preschool institutions, schools and enterprises, in exceptional cases - at the place of residence. Also, vaccination can be carried out by a private practitioner with a license. Vaccinations included in the national calendar and the calendar according to epidemic indications are carried out free of charge in state and municipal institutions. The health worker is obliged to provide complete and objective information about the need for vaccinations, the consequences of refusing them, and possible post-vaccination reactions or adverse events. Vaccinations are carried out only with the consent of citizens, parents or legal representatives minors and incapacitated citizens. Before vaccination, the doctor (in countryside, possibly a paramedic) must necessarily interview the parents and examine the patient, during which possible contraindications to vaccination are analyzed, body temperature is measured.

In patients with chronic diseases, laboratory and instrumental examinations can be performed as prescribed by a doctor. An immunological examination is necessary only for patients with immunodeficiency or suspected of it, before using a live vaccine, the indication for such a study is determined by a doctor (usually an immunologist).

The vaccine should be transported in a thermal container and stored in a refrigerator at certain temperature. It is forbidden to use the drug with an expired shelf life, in case of violation of the rules of transportation or storage, if there are signs of damage to the inner packaging or a change in the appearance of the vaccine. Vaccination should be carried out in strict accordance with the instructions for the vaccine preparation and in compliance with the necessary asepsis rules.

After vaccination, the patient is under the supervision of medical professionals for at least 30 minutes. Parents of a vaccinated child should be warned about possible reactions to the vaccine and about actions in the event of adverse events. The vaccinated is also monitored by a patronage nurse: after the introduction of an inactivated vaccine - in the first 3 days, after the introduction of a live vaccine - additionally on the 5th and 10th day. In the first days after vaccination, it is important to protect the child from unnecessary physical activity, control the cleanliness of the skin at the vaccination site, do not include new foods in the diet.

Vaccination against certain infections

Viral hepatitis B- an infectious disease characterized by severe damage to the liver. The virus is transmitted sexually through contact with blood and other biological fluids infected person, and can also be transmitted from an infected mother to her child during pregnancy, childbirth or breastfeeding. Transmission is also possible with close long-term household contact (primarily in families where there is a carrier of the virus). Acute viral hepatitis B can progress to chronic form: in newborns in 90%, in infants in 50%, and in adults in 10% of cases. In children of the first years of life, mortality from hepatitis is approximately 10 times higher than in adults. Chronic hepatitis B can be latent for a long time and not manifest in any way. It is not uncommon for carriers of the virus to develop cirrhosis and/or liver cancer after several decades. There are currently about 5 million carriers of the hepatitis B virus in Russia.

Hepatitis B vaccinations are included in the calendars of almost all countries of the world. In most cases, the vaccination course begins on the first day of life - in this way, infection of newborns from mothers who carry the virus can be prevented (testing during pregnancy does not always reveal the virus in a woman).

Since 1996, vaccination of children from mothers with the virus, as well as children and adults from risk groups, has been started in Russia, and since 2002 mass vaccination has been carried out. As a result, from 2001 to 2007, the incidence in the country decreased by 8 times.

Currently, recombinant vaccines are used for vaccination, which contain the surface antigen of the virus ("Australian antigen", HBsAg). Combination vaccines are also available that include a hepatitis B component together with pertussis-diphtheria-tetanus vaccine, diphtheria-tetanus toxoid, or hepatitis A vaccine. Hepatitis B vaccines different manufacturers have no fundamental differences and are interchangeable.

Tuberculosis- an infectious disease caused by Mycobacterium tuberculosis and characterized by various phases of the course. The risk of contracting tuberculosis is great and threatens almost anyone. Most often, this disease affects the lungs, but almost all organs can be affected. The treatment of tuberculosis is very complex and takes many months and sometimes years.

Tuberculosis vaccinations are massively carried out in 64 countries of the world, and in people from risk groups in another 118. Vaccination protects, first of all, from severe forms of tuberculosis infection - meningitis, widespread lung damage, bone damage, which are the most difficult to cure. The development of the disease is also possible in vaccinated children, but in them it usually proceeds in a mild form.

Taking into account the continuing high incidence of tuberculosis, in Russia vaccination is carried out for newborns in the maternity hospital on the 3rd–7th day of life.

For vaccination, Russian-made vaccines are currently used, which contain live attenuated bovine-type mycobacteria (in most regions of the country, a preparation with a reduced number of mycobacteria - BCG-M) is used. Annual tuberculin diagnostics (mantoux test) allows timely detection of infection of the child with mycobacterium tuberculosis. With a negative Mantoux test, revaccination is carried out at the age of 7 and 14.

Whooping cough- acutely contagious bacterial infection respiratory tract. The pathogen is transmitted by airborne droplets. Whooping cough can develop serious complications- pneumonia, brain damage (convulsions, encephalopathy) and others. Whooping cough is very dangerous for children of the first year of life, since it is difficult at this age and often leads to respiratory arrest. Prior to the introduction of pertussis vaccination, mainly children under the age of 5 suffered from pertussis. About 300 thousand deaths from whooping cough in children are registered annually in the world, mainly in developing countries where vaccination is not readily available.

Whooping Cough Vaccinations included in the calendars of all countries of the world, with the start of the vaccination course, no later than 3 months of age. For 10 years after the introduction of pertussis vaccination in the USSR (in 1959), the incidence decreased by approximately 23 times, and mortality by 260 times.

For vaccination use combined vaccines against whooping cough, diphtheria and tetanus. There are 2 types of vaccines: DTP (adsorbed pertussis-diphtheria-tetanus vaccine) - whole-cell, which contains inactivated (killed) pertussis bacilli and AaDTP - acellular (cell-free), which contains 2-4 separate components (antigens) of pertussis bacillus. The Russian vaccination calendar allows the use of both types of vaccines. By efficiency different types vaccines differ little, but the cell-free vaccine (AaDTP) is much less likely to cause post-vaccination reactions than the whole cell vaccine (DPT).

Diphtheria- acute bacterial infection. The causative agent of diphtheria produces a toxin that causes cell death with the formation of fibrinous films (more often in the upper respiratory tract - the oropharynx, larynx, nose), and also disrupts the function of the nervous and cardiovascular systems, adrenal glands, and kidneys. The pathogen is transmitted by airborne droplets. With diphtheria, serious complications often develop: damage to the heart muscle (myocarditis), nerve damage with the development of paralysis, kidney damage (nephrosis), asphyxia (suffocation when closing the lumen of the larynx with films), toxic shock, pneumonia and others. Mortality from diphtheria currently averages about 3%, but in children early age and the elderly, it exceeds 8%.

Vaccinations against diphtheria included in the calendars of all countries of the world. Mass vaccination against diphtheria in our country was started in 1958, after which, within 5 years, the incidence decreased by 15 times, and then to single cases. From 1990 to 1999 against the backdrop of a sharp decline in vaccination coverage in Russia and in countries former USSR there was an epidemic of diphtheria, during which more than 4 thousand people died. Unfortunately, it is practically impossible to eliminate this infection completely, due to such a phenomenon as the carriage of corynobacteria, which occurs without clinical manifestations.

For vaccination, diphtheria toxoid is used, which is used separately or as part of combined vaccines: DTP, AaDTP, ADS, ADS-M and a number of others. In case of contact of unvaccinated (or vaccinated in violation of the calendar) with the patient, emergency vaccination is necessary.

Tetanus- an acute bacterial infection, which is characterized by a very severe lesion nervous system. The causative agent of tetanus produces the strongest toxin that causes generalized skeletal muscle spasms. The source of infection are animals and humans, in which the bacterium lives in the intestines and enters the soil with feces, where it persists for a long time in the form of spores. Infection develops when the pathogen enters the wound. The patient is not contagious to others.

Even with timely highly qualified treatment, mortality from tetanus is more than 25%, and without medical care it exceeds 80%. Mortality of more than 95% is observed in newborns who become infected through the umbilical wound in the absence of maternal antibodies (if the mother was not vaccinated).

Every year, about 200 thousand deaths from tetanus in children are recorded in the world, mainly among newborns.

Tetanus shots included in the calendars of all countries of the world. In countries where mass vaccination against tetanus is carried out, the incidence of the disease is 100 times less than in developing countries, where vaccination is not widely available. Thanks to mass vaccination, only isolated cases of tetanus are currently registered in Russia.

For vaccination, tetanus toxoid is used, which is used separately or as part of combined vaccines: DPT, AaDTP, ADS, ADS-M and a number of others. In case of injuries in unvaccinated or in case of violation of the vaccination calendar, emergency tetanus prophylaxis is necessary, which includes not only the introduction of toxoid, but also the use of tetanus toxoid serum or tetanus immunoglobulin according to indications.

Polio- an acute viral infection, which is characterized by damage to the digestive system, upper respiratory tract and nervous system with the development of paralysis, mainly in the lower extremities.

The disease develops when poliovirus enters the gastrointestinal tract, usually through dirty hands or food. In most cases, poliomyelitis occurs in the form of respiratory or intestinal infection. Paralysis develops in only 1-5% of cases of infection, however, these changes are almost always irreversible.

Polio mostly affects children under 5 years of age.

Polio vaccinations included in the calendars of all countries of the world. For 10 years after the start of mass vaccination against poliomyelitis in the USSR (in 1959-1960), the incidence decreased by approximately 135 times and amounted to less than 100 cases per year. In 1995 in Chechnya and Ingushetia against the background significant reduction vaccination coverage, there was an outbreak of poliomyelitis. Since 1996, no cases of paralytic poliomyelitis caused by the "wild" strain of the virus have been registered in our country. Since 2002, the European Region, including Russia, has been declared polio-free. However, since the beginning of 2010, there has been an outbreak of poliomyelitis in Tajikistan and the registration of diseases in children who arrived from this country in Russia. Thus, the circulation of the virus requires the continuation of mass vaccination.

Two types of vaccines are used for vaccination: oral polio vaccine (OPV), which contains live attenuated polioviruses, and inactivated polio vaccine (IPV), which contains killed polioviruses. In very rare cases, in people with impaired immunity, the viruses included in OPV can cause vaccine-associated paralytic poliomyelitis - both in vaccinated people and in people who have been in contact with them. Therefore, since 2008, only IPV has been administered to infants, and OPV has been used for revaccination. After switching to immunization with an inactivated vaccine since 2009, not a single case of vaccine-associated paralytic poliomyelitis has been registered in Russia (over the previous 10 years, an average of 11 cases per year was registered).

Measles- acute viral infection. The virus is transmitted by airborne droplets, the contagiousness of measles is close to 100%, that is, almost everyone who has been in contact with the patient gets sick. With measles, serious complications can develop - pneumonia, brain damage (encephalitis), eye damage, hearing loss, and others. Measles mainly affects children from 1 to 7 years of age. Infants get sick rarely and usually not severely due to passive immunity received from the mother, which can last up to 6 months after birth. More than 500,000 deaths from measles are recorded annually in the world, mainly in children in developing countries where vaccination coverage is insufficient.

Measles vaccinations included in the calendars of most countries in the world. In the USSR, mass vaccination began in 1968, and a year later the incidence decreased by approximately 4 times. After the introduction of revaccination in 1986,

measles is very rare in our country (only 27 cases were registered in 2008). Many countries with high vaccination coverage do not currently report measles.

For vaccination use a live measles vaccine (ZHKV) containing a weakened virus. The vaccine is also part of a divaccine (together with the mumps vaccine) and a trivaccine (together with the mumps and rubella vaccine).

Parotitis(mumps) is an acutely contagious viral infection. When epidparotitis develops inflammation of the salivary glands, as well as other glands (pancreas, testicles, ovaries, prostate, breast, lacrimal, thyroid). The virus is transmitted by airborne droplets. Mortality in mumps is extremely low, but serious complications can develop - diabetes(with damage to the pancreas), meningitis or meningoencephalitis, deafness and others. The most significant complication is male infertility, the most common cause of which is inflammation of the testicles (orchitis) in case of mumps. The frequency of orchitis increases significantly with age: it is rare in boys of preschool age, but develops in most affected adolescents and adult men.

Epidparotitis mainly affects children of school age.

Vaccinations against mumps included in the calendars of most countries in the world. For 10 years after the introduction of vaccination against mumps in the USSR (in 1981), the incidence decreased by approximately 12 times.

For vaccination, a live mumps vaccine (ZHPV) containing a weakened virus is used. Divaccine and trivaccine may also be used (see Measles).

Rubella- acute viral infection. Rubella mainly affects children from 2 to 9 years old. At this age, the disease is often asymptomatic and may be unrecognized. Rubella is usually more severe in adolescents and adults. Highly serious danger presents rubella for a pregnant woman, especially in the first trimester. In most cases, infection of the fetus occurs, which leads to miscarriage, stillbirth, or the development of congenital rubella syndrome, which manifests itself in the form of severe malformations of the eyes, hearing, heart, brain, and other organs.

Rubella vaccinations included in the calendars of most countries in the world. For 5 years after the introduction of rubella vaccination in Russia (in 2002), the incidence decreased by more than 15 times. In the United States, the introduction of rubella vaccination has led to a decrease in cases congenital disease from several tens of thousands per year to single ones.

For vaccination, a live rubella vaccine containing a weakened virus is used. A trivaccine may also be used (see Measles).

Flu is a highly contagious acute respiratory viral infection with outbreaks occurring every year. Influenza can occur in a fulminant form with rapid development viral pneumonia and high probability lethal outcome. Influenza may develop bacterial pneumonia, inflammation of the brain (encephalitis), inflammation of the heart muscle (myocarditis), damage to the kidneys and other organs. At risk severe course influenza includes infants, pregnant women, the elderly, "lying" patients, people with chronic heart and lung diseases. Between 250,000 and 500,000 people die from the flu every year in the world.

In each season, the properties of the virus that cause the disease change. The peculiarity of the causative agent is very frequent change external antigens - neurominidase (N) and hemagglutinin (H), which determine the subtype (strain) of the virus. Therefore, it is recommended to vaccinate against seasonal influenza annually with a vaccine that contains the antigens of the three most relevant strains in a given year. The effectiveness of vaccination is from 60 to 90% under the condition of mass immunization. It has been established that mass vaccination reduces the incidence among the unvaccinated. Long-term analysis shows that in Russia the rise in the incidence of influenza usually begins in January, reaches a maximum in March and ends in May. Therefore, it is most advisable to vaccinate from September to December. According to epidemic indications, it is possible to vaccinate against individual strains of the virus with specially developed vaccines.

Currently, mainly 2 types of seasonal influenza vaccines are used - inactivated subunit and split (split) vaccines. Subunit vaccines contain external antigens of the virus. Split vaccines also contain internal antigens that do not change and thus also provide some protection against strains not included in the vaccine.

Contraindications to vaccination

Currently, less than 1% of children have permanent contraindications to vaccination. Contraindications do not concern all vaccines at once, but only certain ones: they are presented in the table.

Temporary contraindications to vaccination are much more common. There are temporary contraindications for acute diseases and exacerbations of chronic diseases. In such cases, some time after recovery or achievement of remission of a chronic disease, vaccinations can be carried out. A temporary contraindication for the use of live vaccines is pregnancy, as well as transfusion of blood, its components or preparations (immunoglobulins), since the vaccination in this case will be ineffective.

With the accumulation of scientific data in immunology and vaccinology, as well as with the improvement of the quality of vaccine preparations, the number of contraindications to vaccination is decreasing. In this regard, many diseases and conditions for which medical exemptions from vaccinations were widely given in previous years are not currently considered as permanent contraindications. Such states include perinatal lesion central nervous system (perinatal encephalopathy) and stable neurological conditions (eg cerebral palsy), birth defects development, increase thymus, mild anemia, intestinal dysbacteriosis. A history of serious illness is also not a contraindication to vaccination. For some diseases, vaccination is not contraindicated, but can be carried out only if certain conditions. For example, in patients with allergic diseases, vaccination in some cases should be carried out against the background of taking medicines to prevent exacerbation.

The presence of any serious diseases in relatives cannot serve as a contraindication to vaccination, but if there is a patient with immunodeficiency in the family, then a newborn child should be examined before the introduction of the BCG vaccine and caution in the future when using live vaccines.

Adverse events associated with vaccination

Conducted long-term studies show that in most cases adverse events that occur after vaccination are not associated with vaccination. According to the national calendar, the main part of vaccinations is carried out in the first 2 years of life.

Children, especially in the first years of life, are prone to frequent infectious diseases due to the characteristics of the immune system. Also, it is in the first years of life that various allergic reactions often develop.

Naturally, the onset of a disease often coincides with the vaccination and can be mistakenly regarded as a reaction to the vaccination.

It is necessary to carefully monitor the child after vaccination and protect him from contact with infectious patients.

Among the adverse events associated with vaccination, it is necessary to distinguish between vaccination reactions and post-vaccination complications.

Vaccination reactions- these are short-term local and general changes in the process of immunity formation. Local reactions include induration, redness (hyperemia) and soreness at the injection site, general reactions include fever, malaise, sleep disturbance and appetite. These reactions develop in the first two days after vaccination and usually disappear within a few days. After the use of live vaccines from the 5th to the 14th day, a reaction may be noted in the form of the appearance of mild symptoms of the disease against which the vaccine was made. In the vast majority of cases, vaccination reactions are a variant of the body's normal response to vaccination and do not require treatment.

In isolated cases, severe reactions are noted in children: fever over 40 ° C, febrile convulsions (against the background of high temperature), hyperemia and edema of more than 8 cm in diameter at the injection site, prolonged shrill cry of the child. In such cases, you should immediately consult a doctor.

Post-vaccination complications (PVO)- severe and / or persistent health disorders that have developed as a result of vaccinations develop extremely rarely - less than 1 case per 10 thousand vaccinations.

Complications may be associated with an individual unusual response of the body to the vaccine in the form of changes in the nervous system (convulsions, encephalitis), allergic reactions (anaphylactic shock, Quincke's edema) and other disorders. PVO includes diseases caused by vaccine microorganisms that usually occur in people with a previously unrecognized immunodeficiency state: bones (osteitis) or generalized infection with vaccination against tuberculosis, paralytic poliomyelitis with oral polio vaccine, and some others. Also, complications include pronounced local lesions during vaccination against tuberculosis: inflammation of the lymph node (lymphadenitis), cold abscess, subcutaneous infiltrate, ulcer, keloid scar. In a number of cases, the development of PVO is associated with vaccination without taking into account the condition of the child, a violation of the technique for administering the vaccine, transporting and storing vaccines.

Scientific evidence undeniably shows that the risk severe consequences and death from vaccine-preventable infections are ten times higher than when vaccinated against them. So, for example, serious damage to the nervous system with whooping cough is noted approximately 1000 times more often than when vaccinated against this disease with a whole cell vaccine. The use of a modern cell-free (acellular) pertussis vaccine reduces the likelihood of damage to the nervous system by a factor of ten. Nevertheless, vaccinations are a serious medical procedure that requires constant attention to their implementation, both from medical professionals and from parents.

According to the law, in the event of air defense, citizens have the right to receive free medical care and social support.

Myths about vaccination Simultaneously with the beginning of vaccine prevention, an anti-vaccination movement also appeared. The arguments given by the opponents of vaccination, as a rule, are unfounded and, in general, are of a pseudoscientific nature. Here are the most common ones.

Myth 1.The effectiveness of vaccination has no evidence base.

Global population studies in various countries of the world indicate that the introduction of vaccine prevention has led to rapid decline relatively stable in previous years, the incidence - dozens, and sometimes hundreds of times. For vaccines (introduced in recent years), comparative studies have been carried out, which have shown that in the group of vaccinated children the incidence is significantly lower than in the control group.

Myth 2.Vaccination adversely affects the immune system.

Numerous studies have shown that the main effect of vaccines is the formation of specific immunity against a specific infection. Clinical studies have found that some vaccines activate non-specific immune mechanisms, which leads to a decrease in the incidence of infectious diseases in the vaccinated in general. Just as after infectious diseases, after vaccination, there may be some weakening of the body's immunological defense, which is short-term and reversible. During this period, it is desirable to protect the child from contact with infectious patients and factors that provoke the development of infections.

Myth 3.Vaccines contain toxic components.

Indeed, vaccine preparations may contain additional substances that are used as preservatives, stabilizers, immune response enhancers. Conducted studies and many years of practice indicate that the meager concentrations of these substances contained in vaccines are quickly excreted from the human body and do not have any adverse effect. However, medical science is constantly working to improve the safety of vaccines, as a result of which these substances are absent in many modern vaccines.

Myth 4.The development of a number of chronic diseases is associated with vaccination.

There are a number of publications in the scientific literature on the possible relationship of certain diseases (autism, diabetes, bronchial asthma, rheumatoid arthritis, leukemia, and others) with vaccinations. Scientific studies of recent years refute or cast doubt on the causal relationship of these diseases with vaccination. In particular, dozens of studies have found that the frequency of autism does not depend on vaccination coverage.

Observation and analysis of the clinical situation shows that in some children there is indeed a temporary connection between the development or exacerbation of a chronic disease and vaccination. However, as a rule, these examples did not take into account the condition of the child before vaccination and / or the vaccination was done against the background of an infectious disease. For example, bronchial asthma is currently not a contraindication to vaccination, but vaccinations should be carried out in remission and against the background of adequate basic therapy for the disease. Otherwise, an exacerbation of the underlying disease may develop.

Myth 5.Mass vaccination is beneficial only to drug manufacturers.

Of course, the pharmaceutical business (like any other) benefits from the development and production of vaccines. But this cannot be an argument against the use of vaccinations. The practice of mass vaccination was widely used in the Soviet Union in those years when there was unconditional state regulation of the economy and there was virtually no financial benefit from the production of vaccines.

Myth 6.Health authorities do not inform about the complications of vaccinations.

In Russia, there is a state system for monitoring post-vaccination complications (PVO). Complications are registered in our country every year, each of which is investigated. official statistics Air defense in Russia is regularly published on the website of Rospotrebnadzor. The instructions that come with each vaccine product and drug formularies provide detailed information about possible complications during vaccination.

Department for Church Charity and Social Service of the Russian Orthodox Church in 2008

A round table was held on the topic: "Vaccinal prophylaxis in children: problems and ways to solve them." In the Final Document of the Round Table, in particular, it is said: “Recently, false information about the dangers of preventive vaccinations against infectious diseases (vaccination) has been intensively disseminated in the media and popular publications by a small group of people. Distorting the facts, the distributors of this propaganda suggest to the population that the harm from vaccinations many times exceeds their benefits, they present the vaccination as an attempt to exterminate the people of Russia.

It should be noted that medical data, including official information, provided by health authorities, competent specialists, refute these fabrications. Orthodox doctors have also repeatedly spoken out in print and other media against “anti-vaccination propaganda”. Vaccination is powerful tool prevention of infectious diseases, including those extremely dangerous for humans. In some cases, vaccinations do cause complications, which is most often associated with a violation of the rules of vaccination, its use in weakened children. The prevention of these complications is purely medical problem… The participants of the Round Table call for paying close attention to the inadmissibility of the distribution of “anti-vaccination” literature, audio and video products in the monasteries and churches of the Russian Orthodox Church.”

At present, when information about vaccinations can be obtained from the media and on the Internet, parents often lack objective material that provides answers to their questions. Often when discussing potential negative consequences preventive vaccinations, the merits of vaccination in the disappearance and establishment of control over the spread of a number of dangerous infectious diseases, reducing the number of complications of infections and infant mortality are completely forgotten.

You can ask questions, as well as express wishes and suggestions to the authors of the brochure on the websiteSociety of Orthodox Doctors of Russia by the address:www.opvr.ru/contacts.htm__

National calendar of preventive vaccinations

Annex 1. National calendar of preventive vaccinations in Russia

1 Vaccination against viral hepatitis B is given to all newborns in the first 24 hours of a child's life, including children born to healthy mothers and children at risk, which include newborns born to mothers who carry HBsAg, have viral hepatitis B, or have experienced viral hepatitis B in the third trimester pregnancies that do not have test results for hepatitis B markers, as well as those classified as risk groups: drug addicts, in families that have an HbsAg carrier or a patient with acute viral hepatitis B and chronic viral hepatitis (hereinafter referred to as risk groups).

2 Vaccination of newborns against tuberculosis is carried out with the BCG-M vaccine; vaccination of newborns against tuberculosis is carried out with the BCG vaccine in the constituent entities of the Russian Federation with incidence rates exceeding 80 per 100 thousand of the population, as well as in the presence of tuberculosis patients in the environment of the newborn.

Revaccination against tuberculosis is carried out in tuberculin-negative children not infected with mycobacterium tuberculosis at the age of 7 and 14 years.

In the constituent entities of the Russian Federation with tuberculosis incidence rates not exceeding 40 per 100,000 of the population, revaccination against tuberculosis at the age of 14 is carried out for tuberculin-negative children who have not been vaccinated at the age of 7.

3 Vaccination against viral hepatitis B is carried out according to the scheme 0-1-2-12 (the first dose - in the first 24 hours of life, the second dose - at the age of 1 month, the third dose - at the age of 2 months, the fourth dose - at the age of 12 months) newborns and children at risk.

4 Vaccination against viral hepatitis B is carried out according to the scheme 0-3-6 (1 dose - at the time of the start of vaccination, 2 dose - 3 months after 1 vaccination, 3 dose - 6 months after the start of immunization) to newborns and all children who are not related to risk groups.

5 Vaccination against poliomyelitis is carried out with inactivated polio vaccine (IPV) three times for all children of the first year of life.

Notes:

1. Immunization within the framework of the National Immunization Schedule is carried out with vaccines of domestic and foreign production, registered and approved for use in the Russian Federation in the prescribed manner in accordance with the instructions for their use.

2. For immunization against hepatitis B in children of the first year of life, as well as against influenza of children attending preschool institutions, students in grades 1-11, it is recommended to use vaccines that do not contain a preservative (thiomersal).

3. Vaccination against viral hepatitis B is carried out according to the scheme 0-1-6 (1 dose - at the time of the start of vaccination, 2 dose - one month after 1 vaccination, 3 dose - 6 months after the start of immunization) for children who have not received vaccinations at the age of up to 1 year and not related to risk groups, as well as adolescents and adults who have not been vaccinated before.

4. Vaccines used within the framework of the National Immunization Schedule (except BCG, BCG-M) can be administered at intervals of 1 month or simultaneously with different syringes in different parts of the body.

5. In case of violation of the deadline for the start of vaccinations, they are carried out according to the schemes provided for by the National Calendar of Preventive Immunizations, and in accordance with the instructions for the use of drugs.

6. Immunization of children born to HIV-infected mothers is carried out within the framework of the National Immunization Schedule (according to an individual vaccination schedule) and in accordance with the instructions for the use of vaccines and toxoids.

7. Immunization of children born from HIV-infected mothers is carried out taking into account the following factors: the type of vaccine (live, inactivated), the presence of immunodeficiency, taking into account the age of the child, concomitant diseases.

8. All inactivated vaccines (toxoids), recombinant vaccines are administered to children born to HIV-infected mothers, including HIV-infected children, regardless of the stage of the disease and the number of CD4+ lymphocytes.

9. Live vaccines are administered to children diagnosed with HIV infection after an immunological examination to rule out an immunodeficiency state. In the absence of immunodeficiency, live vaccines are administered in accordance with the National Immunization Schedule. In the presence of immunodeficiency, the introduction of live vaccines is contraindicated.

10. 6 months after the initial administration of live vaccines against measles, mumps, rubella, HIV-infected people are assessed for the level of specific antibodies and, in their absence, a second dose of the vaccine is administered with a preliminary laboratory control of the immune status.

Annex 2. VACCINES FOR THE NATIONAL IMMUNICATION SCHEDULE

* The vaccine against Haemophilus influenzae type B (HIB) infection is in a separate vial and is mixed (if necessary) with the vaccine containing the remaining components. Vaccination against HiB is not included in the National calendar, but is recommended by the Ministry of Health and Social Development for all children.

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SOCIETY OF ORTHODOX DOCTORS OF RUSSIA

named after St. Luke of Simferopol (Voyno-Yasenetsky)

Vaccination in children

(brochure for parents)

Moscow - 2010

Edited by the Head of the Department of Children's Diseases, Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, member of the Executive Committee of the OPVR (Moscow) and Professor of the Department of Children's Diseases, Doctor of Medical Sciences. (Moscow)

– pediatrician (St. Petersburg)

– pediatrician, neonatologist (St. Petersburg)

Dear parents!

The purpose of this booklet is to provide, in an accessible form, the objective scientific information you need to make an informed decision about your child's vaccinations.

The brochure highlights the main issues related to vaccination in children: its potential for disease prevention, contraindications, reactions and complications. In addition, information is provided on the infectious diseases themselves, which is certainly necessary for understanding the significance of vaccinations.

GENERAL ISSUES

Immunity - the body's immunity to foreign agents with antigenic properties, primarily to infectious agents. The formation of immunity is carried out by the immune system - the most complex structure that unites the organs, tissues and cells of the body and consists of two interconnected parts: nonspecific and specific. To non-specific mechanisms immune protection include the natural barriers of the body - the skin, mucous membranes, and others, as well as various cells (phagocytes) and substances that destroy or neutralize foreign agents. The specific mechanisms of immune defense include antibodies (immunoglobulins) and cells of the immune system - lymphocytes. In an infectious disease, natural specific immunity is formed, aimed at destroying a specific infectious agent and preventing the development of the disease during re-infection. But the disease itself poses a serious threat to human health, since complications often develop and adverse effects. To form artificial specific immunity to diseases in a safe way, vaccination is used - the introduction into the body of drugs (vaccines) containing certain fragments of infectious agents (antigens). The purpose of vaccination is to prevent the development of an infectious disease or reduce its manifestations.

Vaccines are divided into live, inactivated (killed) and recombinant. Live vaccines contain weakened (so-called, attenuated) causative agents of an infectious disease - bacteria or viruses , which have lost their main pathogenic properties, but retained the ability to cause the formation of immunity. After vaccination with such a vaccine, some mild symptoms of infection may occur for a short time. Inactivated vaccines are divided into whole-cell (corpuscular) and fragmented. Corpuscular vaccines contain viruses or bacteria that have been chemically or physically inactivated and are therefore unable to cause symptoms of the disease. Fragment vaccines contain only individual parts of the pathogen (proteins or polysaccharides) that are immunogenic - the ability to induce immunity. A special group of fragmentary vaccines are conjugated preparations, in which polysaccharides with weak immunogenicity are connected (conjugated) with a special protein that enhances the immune response. Toxoids are also classified as fragmentary vaccines (protein nature) - they are obtained by disinfecting bacterial toxins, which are the main factors in the development of a number of diseases. Recombinant vaccines also contain separate antigens, but they are obtained by genetic engineering: genetic code The infectious agent is introduced into yeast cells that produce the desired antigen (without genetic modification).

Vaccines may also include additional components: preservatives and stabilizers (ensure the safety of the antigenic material in the preparation), adjuvants (enhance the immunogenicity of vaccine antigens - that is, increase the production of antibodies against an infectious agent). These substances are present in vaccines in microdoses that are safe for the body. Also, vaccines may contain ballast substances (components of nutrient media for obtaining vaccine microorganisms; chemical agents used to inactivate a pathogen or toxin; antibiotics) that enter the preparation during the manufacturing process. Modern methods of vaccine production make it possible to completely purify vaccines of such substances or reduce their content to a safe minimum.

Most vaccines are given into the body by intramuscular or subcutaneous injection. It is also possible to administer vaccines by mouth, by intradermal injection, skin application, nasal instillation or inhalation. Directly in bloodstream(intravenous) vaccines are never given.

Preparations can be in the form of monovaccines and combined vaccines. Monovaccines contain antigens of one type of causative agent of one infection. Combined contain antigens of pathogens various infections or different types of pathogens of the same infection. The use of combined vaccines has the following advantages: it reduces the number of injections, reduces the likelihood of adverse events, reduces the need to visit a medical institution, and optimizes the implementation of the vaccination schedule. Scientific studies have shown that the use of combined vaccines does not cause an "overload" of the immune system and does not increase the likelihood of allergies.

HISTORY OF VACCINATION

Infectious diseases have accompanied mankind throughout history. Terrible epidemics often devastated entire countries.

Everyone knows the descriptions of plague epidemics. But that was not the worst. Smallpox was more afraid. The very sight of the patient was terrible: the whole body was covered with bubbles-pustules, which left behind, if a person was destined to survive, disfiguring scars. Her victims were Queen of England Mary II, Emperor Joseph I of Austria, the young Emperor of Russia Peter II, the elderly King of France Louis XV, Elector of Bavaria Maximilian III. The Queen of England Elizabeth I, the French politician Count O. Mirabeau, the Austrian composer W. Mozart, the Russian poet and translator N. Gnedich were ill with smallpox and preserved its traces for the rest of their lives.

Highly dangerous disease was measles. In 1874, a measles epidemic in London killed more lives than the smallpox epidemic that preceded it. In the Kingdom of Denmark in 1846, almost the entire population of the Faroe Islands died of measles. Epidemics of diphtheria sometimes took on enormous proportions. During the epidemic of 1 years in some districts of southern and central Russia, up to 2/3 of all children died from it. rural population. Until very recently, tens of thousands of people were killed and maimed by polio every year, chained to wheelchair US President F. Roosevelt.

Tuberculosis was mainly a disease of the young. Among those whom he killed are the wonderful actress V. Asenkova, the poets A. Koltsov, S. Nadson, I. Takuboku, D. Kitts, the artists M. Bashkirtseva, F. Vasiliev. They got sick famous politicians(Napoleon II, S. Bolivar, E. Jackson) and great people of art (J. Moliere, O. Balzac, K. Aksakov, A. Chekhov, F. Chopin) ...

Such a deplorable situation made one extremely appreciate those few reliable known facts, which in any way allowed to protect a person from dangerous disease. It has been observed that a person who has had smallpox does not get it again. It was believed that it was impossible to avoid the disease, so the idea arose of artificial infection human lung a form of smallpox to protect him from deadly disease further. This idea was realized a thousand years before the birth of Christ: in ancient China doctors blew powdered, dried smallpox crusts into a man's nose. Similar approaches have been used in ancient india, Iran, Africa, the Caucasus and other regions. These techniques are called "variolation", from the word "variola" (smallpox) or "inoculation", from the word "inoculation" (vaccination).

Variolation became the property of science thanks to Mary Montague, the wife of the English envoy in Constantinople. Having become acquainted in 1717 with the method of carrying out variolation in Turkey, she made “inoculations” for her children, and later organized them at the English royal court. In Russia, the first "vaccination" was made in 1786 to Empress Catherine II, after which variolation became widespread in our country, primarily among the nobility. However, this method was quite dangerous: after such a “vaccination”, a severe form of smallpox could develop.

The next step in the development of immunoprophylaxis was made by a rural surgeon from England, Edward Jenner. For twenty years, he collected information on cases of infection with the so-called "cowpox" and found that those who had been ill with it did not get sick. smallpox. In 1796, Jenner first vaccinated an eight-year-old boy with the contents of a pustule taken from a cowpox milkmaid. The boy easily tolerated the vaccination and the subsequent infection with smallpox did not lead to the disease. After 2 years, Jenner published the results of his observations, which attracted a lot of attention from doctors. After Jenner's technique has repeatedly confirmed its effectiveness and safety, it has received universal recognition. The proposed method was called "vaccination" - from the word "wakka" (cow).

In Russia, the first vaccination was carried out at the request of the Empress Maria Feodorovna in 1801 by the famous Moscow doctor E. Mukhin. The boy, who was vaccinated, received the nobility and a new surname - Vaccines. A feature of the organization of vaccination in Russia was the active participation of the clergy. Understanding the high authority of the Orthodox Church and the role that it can play in preserving the health of the people, the Holy Synod in 1804, by its decree, invited all bishops and priests to explain the benefits of vaccination [Priest Sergiy Filimonov, 2007]. Smallpox inoculation was part of the training program for future clergy. In the life of St. Innokenty (Veniaminov), Metropolitan of Moscow and Kolomna, the apostle of America and Siberia, it is told how, thanks to smallpox vaccination, an opportunity was opened for the spread Christian faith on the outskirts Russian Empire- Alaska. In 1811, the "Pastoral exhortation on the inoculation of protective cowpox" was published, written by Bishop of Vologda Evgeny (Bolkhovitinov), a remarkable scientist, a member of many scientific societies. The great Russian surgeon Yasenetsky, later Archbishop of Simferopol and Crimean Luka, when he worked as a zemstvo doctor, personally carried out smallpox vaccination and was indignant at the actions of opponents of vaccination.

The success of vaccination against smallpox contributed to the fact that scientists in many countries began to work on the creation of vaccines against other dangerous infections. In the middle of the 19th century, the French scientist Louis Pasteur discovered a method of "attenuation" (weakening) of pathogens by repeatedly infecting (passaging) animals that are insensitive to infection. In 1885, under his leadership, a vaccine against rabies was created. Our compatriot in late XIX century created vaccines against cholera and plague. In 1914, A. Calmette and C. Guerin developed a vaccine against tuberculosis (BCG). In 1923, the French scientist G. Ramon developed a method for obtaining toxoids (neutralized bacterial toxins), which made it possible to create vaccinations against diphtheria, tetanus and other diseases.

In the 20th century, our country was not able to fully realize its scientific potential in the field of vaccine prevention - revolutionary upheavals and brutal repressions slowed down the development of domestic science. Many microbiologists and immunologists were repressed, some of them died. Nevertheless, Russian scientists have made a great contribution to the development of immunoprophylaxis. The names of our great compatriots who worked in the field of vaccination in Russia will forever remain in history: he developed a system of measures to combat smallpox, which made it possible to eradicate it, organized the introduction BCG vaccinations and created the first vaccine quality control laboratory, created vaccines against diphtheria and scarlet fever, organized the first mass vaccinations, created a vaccine against polio - vaccines against a number of viral diseases.

Thanks to advances in medicine, including immunoprophylaxis, infant mortality has been significantly reduced and life expectancy has increased. Vaccination made it possible to eliminate the once formidable smallpox, put poliomyelitis on the brink of elimination, and reduce the incidence of measles to a minimum. Severe forms of whooping cough and diphtheria have become rare. Vaccination has played an important role in reducing child mortality from tuberculosis. Currently, scientists are facing important tasks: improving the safety of existing vaccines, in particular, the creation of drugs without the use of preservatives, the creation of combined vaccines that allow vaccination against several infections at the same time, the creation of vaccines against HIV infection, viral hepatitis C, streptococcal infection and other diseases. Let's hope that modern scientists will be worthy of their great predecessors.

ORGANIZATION OF VACCINATION

Vaccination as a measure to prevent infections is used throughout the world. However, in different countries different needs in vaccination (which is determined by the epidemic situation in the region) and different possibilities for its implementation. Therefore, in each country there is a National Immunization Calendar, which provides a schedule of routine vaccination at a specific age against certain infections for all citizens. Vaccination in Russia is regulated by a number of regulations, among which the main one is the Federal Law "On Immunoprophylaxis of Infectious Diseases" dated January 1, 2001 (the text of the law with all the changes can be found on the Internet at: www. *****/documents/zakon/457). The Russian calendar includes vaccination against the 10 most relevant infections at the present time, each of which will be considered separately (see Appendix 1). In addition, in some constituent entities of the Russian Federation, regional vaccination schedules have been approved, which, as a rule, include vaccination against several more infections. Also in Russia there is a calendar of preventive vaccinations according to epidemic indications, according to which vaccination is carried out for the population of certain territories (where any infection is common) or for persons performing certain work (dangerous in terms of contracting any infection).

Vaccination is carried out in state, municipal, departmental and commercial medical institutions, preschool institutions, schools and enterprises, in exceptional cases - at the place of residence. Also, vaccination can be carried out by a private practitioner with a license. Vaccinations included in the national calendar and the calendar according to epidemic indications are provided free of charge in state and municipal institutions. The health worker is obliged to provide complete and objective information about the need for vaccinations, the consequences of refusing them, and possible post-vaccination reactions or adverse events. Vaccinations are carried out with the consent of citizens, parents or legal representatives of minors and incapacitated citizens. Before vaccination, a doctor (in rural areas, possibly a paramedic) must necessarily conduct an interview and examination of the patient, during which possible contraindications to vaccination are analyzed, and body temperature should be measured. In patients with chronic diseases, laboratory and instrumental examinations can be performed as prescribed by a doctor. An immunological examination is necessary in patients with immunodeficiency (or suspected of it) before using a live vaccine, the indication for such a study is determined by a doctor (usually an immunologist).

The vaccine product must be transported and stored in a thermal container. It is forbidden to use the vaccine: expired, in violation of the rules of transportation or storage, if there are signs of damage to the packaging or contamination of the vaccine. Vaccination should be carried out in strict accordance with the instructions for the vaccine preparation and in compliance with the necessary asepsis rules. After vaccination, the patient is under the supervision of medical professionals for at least 30 minutes. Parents of a vaccinated child should be warned about possible reactions to the vaccine and about actions in the event of adverse events. The vaccinated is also monitored by a patronage nurse: after the introduction of an inactivated vaccine - in the first 3 days, after the introduction of a live vaccine - additionally on the 5th and 10th day. In the first days after vaccination, it is important to protect the child from excessive physical exertion; new ones should not be included in the diet. food products, control the cleanliness of the vaccination site.

VACCINATION AGAINST SELECTED INFECTIONS

Viral hepatitis B - an infectious disease characterized by severe damage to the liver. The virus is transmitted sexually, through contact with the blood and other body fluids of an infected person, and can also be transmitted from mother to child during pregnancy, childbirth, or breastfeeding. Transmission is also possible with close long-term household contact (primarily in families where there is a carrier of the virus). Acute viral hepatitis B can become chronic: in newborns in 90%, in infants in 50%, and in adults in 10% of cases. In children of the first years of life, mortality from hepatitis is approximately 10 times higher than in adults. Chronic hepatitis B can be latent for a long time and not manifest in any way. It is not uncommon for carriers of the virus to develop cirrhosis and/or liver cancer after several decades. There are currently about 5 million carriers of the hepatitis B virus in Russia.

Vaccinations against hepatitis B are included in the calendars of almost all countries of the world. In most cases, the vaccination course begins on the first day of life - in this way, infection of newborns from mothers who carry the virus can be prevented (testing during pregnancy does not always reveal the virus in a woman). In Russia since 1996 vaccination of children from mothers who are carriers of the virus, as well as children and adults from risk groups, has begun, and since 2002 mass vaccination of children has been carried out. Dynamic since 2001 by 2007, the incidence of viral hepatitis B decreased by 8 times.

Currently, genetically engineered vaccines are used for vaccination, which contain the surface antigen of the virus (“Australian antigen”, HBsAg). There are also combined vaccines that include a component (antigen) against hepatitis B together with pertussis-diphtheria-tetanus, diphtheria-tetanus toxoid or hepatitis A vaccine. Hepatitis B vaccines from different manufacturers do not have fundamental differences and are interchangeable.

Tuberculosis - a chronic infectious disease caused by Mycobacterium tuberculosis and characterized by different phases of the course. The risk of contracting tuberculosis is great and threatens almost anyone. Most often, this disease affects the lungs, but almost all organs can be affected. The treatment of tuberculosis is very complex and takes many months and sometimes years.

Vaccinations against tuberculosis are carried out massively in 64 countries of the world and in risk groups in another 118. Vaccination protects, first of all, from severe forms of tuberculosis infection - meningitis, widespread lung damage, bone damage, which are the most difficult to cure. Infection is also possible in vaccinated children, but in them the disease usually occurs in mild forms. Given the continuing high incidence of tuberculosis, in Russia, vaccination is carried out for newborns in the maternity hospital on the 3rd-7th day of life.

For vaccination, a Russian-made vaccine is currently used, which contains live attenuated bovine mycobacteria with a reduced amount: BCG-M. Annual tuberculin diagnostics (Mantoux test) allows timely detection of infection of the child with Mycobacterium tuberculosis. With a negative Mantoux test, revaccination is carried out at the age of 7 and 14.

Whooping cough - acutely contagious bacterial infection of the respiratory tract. The pathogen is transmitted by airborne droplets. With whooping cough, serious complications can develop - pneumonia, brain damage (convulsions, encephalopathy) and others. Whooping cough is very dangerous for children of the first year of life, since it is difficult at this age and often leads to respiratory arrest. Prior to the introduction of pertussis vaccination, mainly children under the age of 5 suffered from pertussis. About 300,000 deaths from whooping cough in children are recorded annually in the world, mainly in developing countries where vaccination is not readily available.

Vaccinations against whooping cough are included in the calendars of all countries of the world at the beginning of the vaccination course, no later than 3 months of life. For 10 years after the introduction of pertussis vaccination in the USSR (in 1959), the incidence decreased by approximately 23 times, and mortality by 260 times.

For vaccination, combined vaccines against whooping cough, diphtheria and tetanus are used. There are 2 types of vaccines: DTP (adsorbed pertussis-diphtheria-tetanus vaccine) - whole-cell, which contains inactivated (killed) pertussis bacilli and AaDTP - acellular (cell-free), which contains 2-4 separate components (antigens) of pertussis. The Russian vaccination calendar allows the use of both types of vaccines. The effectiveness of different types of vaccines differs little, but the cell-free vaccine (AaDTP) is much less likely to cause post-vaccination reactions than the whole cell vaccine (DPT).

Diphtheria - acute bacterial infection. The causative agent of diphtheria (corinobacteria) produces a toxin that causes cell death with the formation of fibrinous films (more often in the upper respiratory tract - the oropharynx, larynx, nose), and also disrupts the function of the nervous and of cardio-vascular system, adrenal glands, kidneys. The pathogen is transmitted by airborne droplets. With diphtheria, serious complications can develop, such as damage to the heart muscle (myocarditis), nerve damage with the development of paresis and paralysis, kidney damage (nephrosis), asphyxia (suffocation when closing the lumen of the larynx with films), toxic shock, pneumonia and others. Mortality from diphtheria currently averages about 3%, but in young children and the elderly it exceeds 8%.

Vaccinations against diphtheria are included in the calendars of all countries of the world. Mass vaccination against diphtheria in our country was started in 1958, after which, within 5 years, the incidence decreased by 15 times, and then – to isolated cases. From 1990 to 1999 Against the backdrop of a sharp decline in vaccination coverage in Russia and the countries of the former USSR, an epidemic of diphtheria was observed, during which more than 4 thousand people died. Unfortunately, it is completely impossible to eliminate this infection, due to such a phenomenon as the carriage of corynobacteria, which occurs without clinical manifestations.

For vaccination, diphtheria toxoid is used, which is used separately or as part of combined vaccines: DTP, AaDTP, ADS, ADS-M and a number of others. In case of contact with a patient in unvaccinated or in case of violation of the vaccination calendar, emergency vaccination is carried out.

Tetanus - an acute bacterial infection, which is characterized by a very severe damage to the nervous system. The causative agent of tetanus produces the strongest toxin that causes generalized skeletal muscle spasms. The source of infection are animals and humans, in which the bacterium lives in the intestines and enters the soil with feces, where it persists for a long time in the form of spores. Infection develops when the pathogen enters the wound. The patient is not contagious to others. Even with timely highly qualified treatment, mortality from tetanus is more than 25%, and without medical care it exceeds 80%. Mortality of more than 95% is observed in newborns who become infected through the umbilical wound in the absence of maternal antibodies (if the mother was not vaccinated). Every year, about 200 thousand deaths from tetanus in children are recorded in the world, mainly among newborns.

Tetanus vaccinations are included in the calendars of all countries in the world. In countries where mass vaccination against tetanus is carried out, the incidence of the disease is 100 times less than in developing countries, where vaccination is not widely available. Thanks to mass vaccination, only isolated cases of tetanus are currently registered in Russia.

For vaccination, tetanus toxoid is used, which is used separately or as part of combined vaccines: DTP, AaDTP, DTP, ATP-M and a number of others. In case of injuries in unvaccinated or in case of violation of the vaccination schedule, emergency tetanus prophylaxis is carried out, which includes not only the introduction of toxoid, but also the use of tetanus toxoid serum or tetanus immunoglobulin according to indications.

Polio - an acute viral infection, which is characterized by damage to the digestive system, upper respiratory tract and nervous system with the development of paralysis, mainly in the lower extremities. The disease develops when poliovirus enters the gastrointestinal tract, usually through dirty hands or food. In most cases, poliomyelitis occurs as a respiratory or intestinal infection. The development of paralysis is noted only in 1-5% of cases of infection, however, these changes are irreversible. Polio mostly affects children under 5 years of age.

Vaccinations against poliomyelitis are included in the calendars of all countries of the world. For 10 years after the start of mass vaccination against poliomyelitis in the USSR (in the years), the incidence decreased by approximately 135 times and amounted to less than 100 cases per year. In 1995 in Chechnya and Ingushetia, against the background of a significant decrease in vaccination coverage, an outbreak of poliomyelitis was observed. Since 1996 cases of paralytic poliomyelitis caused by the "wild" strain of the virus have not been registered in our country. Since 2002 The European region, including Russia, has been declared polio free. However, since the beginning of 2010 there is an outbreak of poliomyelitis in Tajikistan and the registration of diseases in children who arrived from this country in Russia. Thus, the circulation of the virus requires the continuation of mass vaccination.

Two types of vaccines are used for vaccination: oral polio vaccine (OPV), which contains live attenuated polioviruses, and inactivated polio vaccine (IPV), which contains killed polioviruses. In very rare cases, in people with impaired immunity, the viruses included in OPV can cause vaccine-associated paralytic poliomyelitis - both in vaccinated people and in people who have been in contact with them. Therefore, since 2008, only IPV has been administered to infants, and OPV has been used primarily for revaccination. After switching to immunization with an inactivated vaccine since 2009, not a single case of vaccine-associated paralytic poliomyelitis has been registered in Russia (for the previous 10 years, about 11 cases per year were registered).

Measles - acute viral infection. The virus is transmitted by airborne droplets, the contagiousness of measles is close to 100%, that is, almost everyone who has been in contact with the patient gets sick. With measles, serious complications can develop - pneumonia, brain damage (encephalitis), eye damage, hearing loss, and others. Measles mainly affects children from 1 to 7 years of age. Infants get sick rarely and usually not severely due to passive immunity received from the mother, which can last up to 6 months after birth. More than 500,000 deaths from measles are recorded annually in the world, mainly in children in developing countries where vaccination coverage is insufficient.

Vaccinations against measles are included in the calendars of most countries in the world. In the USSR, mass vaccination began in 1968, and a year later the incidence decreased by approximately 4 times. After the introduction of revaccination in 1986, measles is very rare in our country (in 2008, only 27 cases were registered). In many countries with high vaccination coverage, measles is not currently reported.

For vaccination, a live measles vaccine (LMV) containing a weakened virus is used. The vaccine is also part of a divaccine (together with the mumps vaccine) and a trivaccine (together with the mumps and rubella vaccine).

mumps (mumps) - acute viral infection. With epidparotitis, inflammation of the salivary glands develops, as well as other glands (pancreas, testicles, ovaries, prostate, milk, lacrimal, thyroid). The virus is transmitted by airborne droplets. Mortality in mumps is extremely low, but serious complications can develop - diabetes mellitus (with damage to the pancreas), meningitis or meningoencephalitis, deafness, and others. The most significant complication is male infertility, the most common cause of which is inflammation of the testicles (orchitis) with mumps. The frequency of orchitis increases significantly with age: it is rare in boys of preschool age, but develops in most adolescents and adult men. Epidparotitis mainly affects children of school age.

Vaccinations against mumps are included in the calendars of most countries in the world. For 10 years after the introduction of vaccination against mumps in the USSR (in 1981), the incidence decreased by approximately 12 times.

For vaccination, a live mumps vaccine (LPV) containing a weakened virus is used. Divaccine and trivaccine may also be used (see Measles).

Rubella - acute viral infection. Rubella mainly affects children from 2 to 9 years old. At this age, the disease is often asymptomatic and may be unrecognized. Rubella is usually more severe in adolescents and adults. Rubella is a very serious danger for a pregnant woman, especially in the first trimester. In most cases, infection of the fetus occurs, which leads to miscarriage, stillbirth or the development of congenital rubella syndrome as a result of the formation of severe malformations of the eyes, hearing organ, heart, brain and other organs.

Rubella vaccinations are included in the calendars of most countries in the world. For 5 years after the introduction of rubella vaccination in Russia (in 2002), the incidence decreased by more than 15 times. In the United States, the introduction of rubella vaccination has led to a decrease in cases of congenital disease from several tens of thousands per year to single ones.

For vaccination, a live rubella vaccine containing a weakened virus is used. Trivaccine may also be used (see Measles).

Flu - an extremely contagious acute respiratory viral infection, the increased incidence of which is observed annually. Influenza can occur in a fulminant form with the rapid development of viral pneumonia and a high probability of death. Influenza may cause bacterial pneumonia, inflammation of the brain (encephalitis), inflammation of the heart muscle (myocarditis), damage to the kidneys and other organs. The risk group for severe influenza includes the elderly, infants, pregnant women, bedridden patients, people with chronic heart and lung diseases. Between 250,000 and 500,000 people die from the flu every year in the world.

In each season, the properties of the virus that cause the disease change. A feature of the pathogen is a very frequent change in external antigens - neurominidase (N) and hemagglutinin (H), which determine the subtype (strain) of the virus. Therefore, an annual seasonal influenza vaccination is recommended with a vaccine that contains the antigens of the most relevant strains in a given year. The effectiveness of vaccination is from 60 to 90% under the condition of mass immunization. It has been established that mass vaccination reduces the incidence among the unvaccinated. Long-term analysis shows that in Russia the rise in the incidence of influenza usually begins in January, reaches a maximum in March and ends in May. Therefore, it is most advisable to vaccinate from September to December. According to epidemic indications, vaccination against individual strains of the virus can be carried out with specially developed vaccines.

Currently, mainly 2 types of seasonal influenza vaccines are used - inactivated subunit and split (split) vaccines. Subunit vaccines contain external antigens of the virus. Split vaccines also contain internal antigens that do not change and thus also provide some protection against strains not included in the vaccine.

CONTRAINDICATIONS TO VACCINATION

Currently, less than 1% of children have permanent contraindications to vaccination. Contraindications do not concern all vaccines at once, but only certain ones: they are presented in the table.

Temporary contraindications to vaccination are much more common. Temporary contraindications are available for acute diseases and exacerbations of chronic diseases. In such cases, some time after recovery or achievement of remission of a chronic disease, vaccinations can be carried out. A temporary contraindication for the use of live vaccines is pregnancy, as well as transfusion of blood, its components or preparations (immunoglobulins), since vaccination will not be effective.

With the accumulation of scientific data in immunology and vaccinology, as well as with the improvement of the quality of vaccine preparations, the number of contraindications to vaccination is decreasing. In this regard, many diseases and conditions for which medical exemptions from vaccination were widely given in previous years are not currently considered as permanent contraindications. Such conditions include perinatal damage to the central nervous system (perinatal encephalopathy) and stable neurological conditions (for example, cerebral palsy), congenital malformations, enlarged thymus, mild anemia, intestinal dysbacteriosis. A history of serious illness is also not a contraindication to vaccination. For some diseases, vaccination is not contraindicated, but can be carried out only under certain conditions. For example, in patients with allergic diseases, vaccination in some cases should be carried out while taking medications that prevent exacerbation.

The presence of any serious diseases in relatives cannot serve as a contraindication to vaccination, but if there is a patient with immunodeficiency in the family, then a newborn child should be examined before the introduction of the BCG vaccine and caution in the future when using live vaccines.

Vaccination, or, as it is also called, inoculation, is the process of introducing a vaccine into the body. Vaccines have historically taken their name from Latin word"vacca" - a cow.

VACCINATION: RISK OR BENEFIT? The risk of developing tuberculosis for the unvaccinated is 1: 1200 The probability of complications in the form of a generalized infection with BCG vaccination is 1: The chance of developing paralysis with polio is 1: 100. The probability of paralysis with vaccination with an inactivated vaccine is 0.

WHY IS VACCINATION NEEDED? Many infections for which vaccination is carried out proceed very quickly, and lead either to death or severe disability. Bacterial resistance to antibiotics and other drugs is now rapidly growing, and in cases with resistance, the prognosis for a cure can be very poor.

Vaccines are drugs that contribute to the creation of artificial specific immunity acquired in the process of vaccination and necessary to protect the body from a specific pathogen. Vaccines are made by complex biochemical processes from microorganisms, their metabolic products, or individual components of a microbial cell.

A vaccine preparation containing certain doses of the pathogen, once in the human body, collides with blood cells - lymphocytes, resulting in the formation of antibodies - special protective proteins that are stored in the body certain period time. It could be a year, five years or more. Related to this is the need for repeated vaccinations - revaccination, after which stable long-term immunity is formed. At a subsequent "meeting" with a pathogenic microorganism, antibodies recognize it and neutralize it, and the person does not get sick.

National calendar of preventive vaccinations In Russia, vaccination is carried out in accordance with the National Calendar of Preventive Immunizations and the Federal Law of the Russian Federation dated 157-FZ “On Immunization of Infectious Diseases” The National Calendar of Preventive Immunizations is a regulatory legal act that establishes the timing and procedure for conducting preventive vaccinations for citizens

Obtaining complete and objective information about preventive vaccinations, possible complications and consequences of refusing them Free vaccinations included in the National Calendar and vaccinations according to epidemiological indications in state and municipal health care institutions Free examination and treatment in case of post-vaccination reactions and complications Compensation for harm caused their health as a result of immunization Choice of an organization or individual engaged in private medical practice Obtaining a certificate of preventive vaccinations Refusal of vaccinations The rights of citizens during immunoprophylaxis in accordance with the Federal Law of the Russian Federation of 157-FZ "On Immunoprophylaxis of Infectious Diseases"

Restriction of the rights of citizens in case of refusal of immunization may be allowed solely for the purpose of protecting their own health and may be expressed in: Temporary refusal to accept: for work, children organized groups, educational institutions, etc. during the epidemic of diseases. In a temporary refusal to leave citizens to countries whose stay requires vaccinations in accordance with international rules The rights of citizens during immunoprophylaxis in accordance with the Federal Law of the Russian Federation dated 157-FZ "On Immunoprophylaxis of Infectious Diseases"

Age Name of vaccination Newborns (first 12 hours) Hepatitis B 1 vaccination 3-7 days Tuberculosis (BCG-M or BCG) 1 month Hepatitis B 2 vaccination 2 months Hepatitis B 3 vaccination (children at risk) 3 months Diphtheria, whooping cough, tetanus , poliomyelitis, haemophilus influenzae (first vaccination) 4.5 months Diphtheria, whooping cough, tetanus, polio, haemophilus influenzae (second vaccination) 6 months Hepatitis B 3 vaccination, diphtheria, whooping cough, tetanus, poliomyelitis, haemophilus influenzae (third vaccination) 12 months Hepatitis B 4 vaccination (children at risk) Measles, rubella, mumps 18 months Diphtheria, whooping cough, tetanus, poliomyelitis, Haemophilus influenzae (first revaccination) NATIONAL immunization schedule

Age Name of vaccination 20 months Polio (second revaccination) 6 years Measles, rubella, mumps (revaccination) 6-7 years Diphtheria, tetanus (second revaccination) 7 years Tuberculosis (BCG) revaccination 14 years Diphtheria, tetanus, polio (third vaccination Tuberculosis (BCG) revaccination Adults Diphtheria, tetanus (every 10 years) revaccination NATIONAL immunization schedule

Children from 1 to 18 years old, adults from 18 to 55 years old, not previously vaccinated Hepatitis B Children from 1 to 18 years old, girls from 18 to 25 years old, not ill, not vaccinated, vaccinated once against rubella Rubella Children, from 6 months, students of grades 1-11, students of higher and secondary vocational schools, adults working in certain types of professions and positions (medical and educational institutions, transport, utilities, etc.), adults over 60 years old Influenza Children under the age of 35 years old and under 35 years old who have not been ill, not vaccinated and not aware of measles vaccinations Measles NATIONAL IMCCINATION CALENDAR

Viral hepatitis B is an infectious disease that manifests itself with jaundice, which is associated with severe liver damage. The main routes of transmission are sexual contact and injection. Sources of infection are chronic carriers and patients. The risk of hepatitis B is 100 times greater than the risk of AIDS. About 10% of sick adults and 90% of children under the age of 1 year become chronic carriers of the hepatitis B virus. Long-term consequences of the disease are cirrhosis of the liver, chronic hepatitis and liver cancer. The only reliable way not to get infected yourself and not to infect your loved ones is to get vaccinated. VIRAL HEPATITIS B

Vaccination against hepatitis B for newborns and all children who are not at risk, carried out according to the scheme patients with viral hepatitis B or who have had viral hepatitis B in the third trimester of pregnancy; not having test results for hepatitis B markers; drug addicts whose families have an HBsAg carrier or a patient with acute viral hepatitis B and chronic viral hepatitis (hereinafter referred to as risk groups) VIRAL HEPATITIS B

Vaccine Regevak Vaccinations in previously unvaccinated persons who have had contact with material infected with the hepatitis B virus are carried out according to the scheme of months. Engerix B vaccine For emergency vaccination of viral hepatitis B accelerated regimen day - 12 months EMERGENCY PREVENTION OF VIRAL HEPATITIS B

Bubo-M. Diphtheria-tetanus-hepatitis B. ZAO Kombiotech, Russia. Bubo Kok. Pertussis-diphtheria-tetanus-hepatitis B. ZAO Kombiotech, Russia. Twinrix. Hepatitis A and B vaccine. GSK, Belgium. VIRAL HEPATITIS B Hepatitis B combination vaccines

Vaccination against tuberculosis At the age of three to seven days, the child is vaccinated against tuberculosis with the BCG vaccine. Tuberculosis is a chronic, widespread and severe infection caused by Mycobacterium tuberculosis (Koch's bacillus). It has been proven that BCG protects 85% of vaccinated children from severe forms of tuberculosis. Therefore, the World Health Organization (WHO) recommends administering this vaccine to newborns in countries where tuberculosis is highly prevalent, including our country. Immunity after vaccination is established after eight weeks. In order not to miss a moment possible infection tuberculosis, the child undergoes a Mantoux test every year. With a negative Mantoux test (i.e., the absence of anti-tuberculosis immunity), revaccination (re-vaccination) of BCG is performed at 7 and / or 14 years. TUBERCULOSIS

VACCINES AGAINST TUBERCULOSIS Vaccine Contents Dosage BCG - live lyophilized tuberculosis vaccine, Microgen, Russia 1 inoculation dose - 0.05 mg in 0.1 ml of solvent (0.5 - 1.5 million viable cells) Ampoules of 0.5 or 1.0 mg (10 or 20 doses), solvent (0.9% sodium chloride solution) 1.0 or 2.0 ml BCG - live lyophilized tuberculosis vaccine, with a reduced number of microbial cells, Microgen, Russia 1 inoculation dose - 0.025 mg in 0.1 ml of solvent (0.5 - 0.75 million viable cells) Ampoules of 0.5 (20 doses), solvent (0.9% sodium chloride solution) of 2.0 ml

DIPHTHERIA Diphtheria is a life-threatening, acute infectious disease characterized by inflammatory process upper respiratory tract or skin in places of cuts, abrasions or inflammation. However, diphtheria is dangerous not so much with local lesions, but with the phenomena of general intoxication and toxic damage. cardiovascular and nervous systems.

DIPHTHERIA The course of the disease in the unvaccinated is especially severe. The widespread use of the vaccine in the post-war years in many countries virtually eliminated cases of diphtheria. However, in the first half of the 1990s, a diphtheria epidemic arose in Russia, the cause of which was insufficient vaccination coverage of children and adults. Thousands of people died from a disease that could have been prevented by vaccination.

ADS - diphtheria-tetanus toxoid, Microgen, Russia. Children from 3 months to 6 years old IM 0.5 ml, who are contraindicated in vaccination with DTP ADS-M - diphtheria-tetanus toxoid, Microgen, Russia. For revaccination of children over 6 years of age, IM 0.5 ml of AD-M - diphtheria toxoid, Microgen, Russia. Enter children older than 6 years / m 0.5 ml. For routine revaccinations in children who received tetanus toxoid for emergency tetanus prophylaxis DIPHTHERIA VACCINES

Despite the high vaccination coverage against whooping cough, this infection has not yet been eradicated. Vaccination immunity fades in 5-7 years, so that schoolchildren, adolescents and adults get whooping cough, albeit atypical - with a cough lasting more than two weeks. It is they who annually infect children of the first half of the year who have not yet developed post-vaccination immunity, and whooping cough is extremely difficult for them. WHOOPING COUGH

Increasing incidence in school and adolescence forced many countries to include revaccination against whooping cough with acellular vaccine in the calendar Belgium, Germany, France, Portugal, the USA, Japan, etc. carry out revaccination at 5-11 years old Austria, Finland, Switzerland also carry out the 3rd revaccination in years 1 revaccination, but at 3 years, in New Zealand - at 4 years, in Denmark - at 5 years For revaccination in all countries except Brazil and Russia, acellular pertussis vaccine is used

VACCINES AGAINST PERTUSSIS Vaccine Content, preservative Bubo-Kok - pertussis-diphtheria-tetanus-hepatitis B, ZAO Kombiotech, Russia B 1 dose (0.5 ml) 10 µg HBsAg, 10 billion pertussis microbes, 15 LF diphtheria and 5 EU tetanus toxoids, preservative - merthiolate 50 mcg Infanrix - diphtheria-tetanus three-component acellular pertussis vaccine, Glaxo SmithKline, England In 1 dose 30 IU of diphtheria, 40 IU of tetanus, 25 mcg of pertussis toxoid. Preservatives - 2-phenoxyethanol, formaldehyde up to 0.1 mg Pentaxim - diphtheria-tetanus acellular pertussis-poliomyelitis and Hib vaccine, Sanofi Pasteur, France In 1 dose 30 IU of diphtheria, 40 IU of tetanus, 25 mcg of pertussis toxoid. Preservatives - 2-phenoxyethanol, formaldehyde up to 0.1 mg

Pentaxim is the only vaccine registered in Russia that simultaneously protects against 5 infections The cell-free pertussis component (2 antigens) included in the Pentaxim vaccine significantly reduces the incidence of adverse reactions characteristic of whole cell pertussis vaccines. Pentaxim allows primary immunization against 5 infections with only 4 injections in 4 visits - instead of 12. Pentaxim has improved safety features, reducing the risk of developing polio, which can develop in vaccinated people, to zero, thanks to the use of inactivated polio vaccine (IPV).

POLIOMYELITIS Poliomyelitis (polio (Greek) - gray, myelos - brain) is an acute viral infection that affects the nervous system (the gray matter of the spinal cord). Characterized by the appearance of flaccid paralysis, mainly lower extremities. In the most severe cases, damage to the spinal cord leads to respiratory arrest. Clinically, poliomyelitis is manifested by fever, headaches and muscle pain followed by the development of paralysis. In the pre-vaccination era, polio was a thunderstorm for all children, causing truly devastating epidemics.

OVP - oral (live) polio vaccine types 1, 2, 3, FGUP PIPVE named after Chumakov RAMS, Russia. 1 dose (4 drops - 0.2 ml) contains 1 million inf. units of type 1, 2, more than 3 million of type 3. Preservative - kanamycin. Administered orally 1 hour before a meal Imovax Polio is an inactivated enhanced polio vaccine type 1, 2, 3 Sanofi Pasteur, France Polio vaccines

Only humans get measles. The infection is transmitted by airborne droplets (in droplets of mucus, the virus retains its properties for several days). It is possible that the virus is transmitted through the placenta from mother to fetus. Previously, measles was considered exclusively a childhood infection, but the trend of recent years shows an increase in the share of adolescents and adults among the diseased. Complications of measles are dangerous: pneumonia, laryngitis, encephalitis, meningoencephalitis, acute meningitis

Mumps is an acute infectious disease that affects the salivary glands, pancreas, seminal glands in men, as well as damage to the nervous system. Children aged 3 to 15 years are most often affected. Parotitis is dangerous for boys with such a complication as infertility PAROTITIS

Rubella - a disease that cripples unborn children If a pregnant woman is not vaccinated against rubella, and has not been ill with this disease, then contact with the patient during pregnancy can lead to malformations in the fetus. Rubella acutely contagious viral disease, manifested by a rapidly spreading rash on the skin, an increase in lymph nodes, usually a slight increase in temperature. RUBELLA

ZHKV - live measles vaccine, Microgen, Russia. ZhPV - live mumps vaccine, Microgen, Russia. Rubella vaccine, Serum Institute, India. ZhPKV - mumps-measles cultural live dry divaccine, Microgen, Russia. Measles, mumps, rubella vaccine, Serum Institute, India. Priorix - combined vaccine for the prevention of measles, rubella, mumps, GSK, Belgium Rouvax - measles, Sanofi Pasteur, France Rudivax - rubella, Sanofi Pasteur, France

Vaccination- one of the main methods of preventing complex diseases of an epidemic nature. Thanks to such prevention, it became possible to avoid many diseases that threaten human life.

The second kind is inactivated vaccines. They act on the basis of killed microorganisms. These are vaccinations against, and polio.

The third kind is chemical vaccines. They contain only some part of the pathogen. These are vaccinations against, hemophilic infection , whooping cough .

The fourth kind toxoids. Their action is based on a poison produced by bacteria, which has lost its toxic properties, but is capable of inducing immunity. Thus, prevention is carried out and.

Fifth kind - associated vaccines. They are made up of components different kind. Examples might be and MMR II .

An important use case combined vaccines. They reduce the cost of vaccinating the population and increase the coverage of residents with vaccinations. Immunization with such vaccines is simultaneously against, and is carried out for all children.

Rules for vaccination in children

It is a mistake to assume that all vaccinations are carried out in same conditions. On the contrary, the development of immunity to each individual disease requires a special approach. Below we give some rules that relate to the most common vaccinations in our country.

1. Tuberculosis vaccinations carried out on different days with other vaccinations. Revaccination against (BCG vaccine) is given to children aged 7 to 15 years, in whom the result Mantoux test negative.

2. Vaccinations against given to all newborns, it can be given by vaccine Engerix V .

3. The interval between the first three DTP vaccinations is 30 days, and between the third and the next must be at least a year. For the prevention of diseases such as whooping cough, tetanus, poliomyelitis, diphtheria, hepatitis B, combined vaccines are used that have different combinations of antigens.

4. IPV or inactivated vaccine usually used for the first two vaccinations, but in case of contraindications it can be used for subsequent polio vaccinations.

5. Prevention against Hib infection carried out as mono - and often combined vaccines. For primary vaccination, combined vaccines are recommended, which have Hib component .

6. Rubella, measles and mumps are vaccinated combination vaccine(PDA) at 12 months. Re-vaccination is carried out at 6 years. Children who for some reason have not been vaccinated against mumps, measles and rubella at 12 months and at 6 years old are vaccinated until they are 18 years old. 15-year-olds who are not vaccinated against rubella or mumps are vaccinated against mumps (for boys) or rubella (for girls). All unvaccinated children over 18 years of age are vaccinated with a single dose until age 30.

Vaccines for children

The first vaccination that is given to every newborn in the maternity hospital is a vaccination against viral hepatitis B. This vaccination is especially important for those children whose mother is herself a carrier antigen . In this case, the child must receive the first vaccination no more than 12 hours after birth, and then - at 1, 2 and 12 months. Children, whose mothers are not carriers of the virus, are vaccinated with the general scheme listed in the vaccination calendar: on the first day of life, at 1 month and at 6 months. For these children, vaccination against viral hepatitis B is usually combined with vaccinations against other diseases.

The BCG vaccine protects the child from tuberculosis. It is extremely important that babies have such protection from birth.

The DPT vaccine protects children from diphtheria, whooping cough and tetanus. These diseases are very difficult just in newborns. That is why DTP is carried out already starting from 3 months, and then at 4 months and 5 months, and revaccination is carried out at 18 months.

Today there are so-called acellular vaccines. They significantly outperform the whole-cell DTP vaccine. They are less likely to call negative reactions after vaccination and have longer-term immunity.

Vaccination against polio is carried out by two vaccines - IPV and OPV. The inactivated one is more effective because it is administered intramuscularly and this allows for an accurate dosage. It is also safer when it comes to adverse reactions to the vaccine, since the pathogens in it are already dead, but in OPV they are alive.

In many countries, prevention of children from hemophilic infection. The most dangerous type of infectious bacterium is Hib. It can cause serious diseases such as pneumonia, respiratory diseases, septicemia, sepsis. Since the immature body of a child without vaccination cannot adequately resist the disease, it often happens deaths. Hib infection is one of the leading causes of death in young children.

Today, the Hib vaccine is used as part of the immunization schedule in most parts of the world. Thanks to its use, one of the most dangerous forms — purulent meningitis . Vaccination saves approximately 3 million children's lives each year.

Parotitis, measles and rubella often affect children, and these diseases can lead to complications such as loss of hearing and vision, damage to the genitals. Vaccination should be carried out only in rooms specially designated for preventive vaccinations, which should have everything for first aid. Before administering the vaccination, the medical worker should carefully check the conformity of the signature on the packaging of the vaccine for children and on the ampoule, as well as their integrity. If the tightness is broken, there is no marking or information on the label, the storage conditions or expiration date are violated, such a vaccine product should not be used.

Ampoules with a vaccine can be opened only immediately before its use, the contents are used without delay. Unused vaccine residues are destroyed by boiling or soaking in disinfectant solutions .

Preventive vaccinations (vaccination) - the introduction into the human body of microorganisms, their particles or chemical substances to prevent the development of infectious diseases.

The main role of vaccinations is the formation of immunity against certain infectious diseases.

The mechanism of action of preventive vaccinations is the production of antibodies against specific infectious agents by the body. Antibodies are produced against the antigens of microorganisms that enter the body during vaccination, and the entire process of antibody production starts.

If a person has been vaccinated (vaccinated) against certain disease, passed required time for the development of protective substances, the formation of immunity, then in case of contact with the causative agent of this disease, the vaccinated person will not get sick with this infection or will suffer it in a milder form than those people who have not been vaccinated.

The main types of vaccinations and vaccines

Vaccination is mandatory (planned) and carried out according to epidemiological indications.

Mandatory vaccinations are those that are included in the preventive vaccination calendar.

Vaccination according to epidemiological indications is carried out in the presence of an unfavorable epidemic situation in the country for a specific disease, to urgently create immunity in persons at risk of developing an infection, if necessary, travel to another region where dangerous infections are common. An example of an optional but widely available vaccine is the flu vaccine. Another example of vaccination for epidemiological indications is the vaccination of hospital staff during an outbreak of an infectious disease in a community.

Depending on the constituent components of vaccines, they can all be divided into 3 main groups - live, inactivated and artificial.

Live vaccines contain live but weakened microorganisms that are not highly contagious and dangerous. Such microorganisms multiply in the body, cause an asymptomatic infection, and the resulting artificial immunity practically no different from what is formed after an infection. Live vaccines are used to prevent the development of poliomyelitis, tularemia, measles, mumps, and yellow fever. Even a single administration of a live vaccine provides long-term immunity to infection.

Inactivated vaccines are made from killed microorganisms, their individual antigens. Inactivated vaccines are devoid of ballast substances, so the frequency of side effects after their administration is lower than after the administration of live vaccines. At the same time, the immunity that is formed after their administration is not so stable, and there is a need for repeated administration of such vaccines. Inactivated vaccines include anti-plague, anti-rabies, flu, and anthrax vaccines.

Artificial vaccines can be obtained by genetic engineering or completely synthesized. An example of an artificial vaccine is the influenza vaccine Grippol.

There are monovalent and polyvalent (associated) vaccines. Monovalent drugs are used to create immunity to one pathogen (BCG vaccine). Associated vaccines provide the achievement of multiple immunity by single-stage immunization. The most well-known associated vaccine is DPT (adsorbed pertussis-diphtheria-tetanus vaccine).

The main methods of administering vaccine preparations are orally, subcutaneously, intradermally, intranasally (instilled into the nose), inhaled and parenterally (for example, intramuscularly - the drug is injected into the buttock).

Indications and contraindications for the introduction of vaccines

In childhood, each person should be vaccinated against polio, measles, tuberculosis, whooping cough, diphtheria, tetanus, rubella, mumps and hepatitis B. The timing of the introduction of vaccines against these diseases is regulated by the vaccination schedule.

According to epidemiological indications, influenza vaccination can be carried out.

Also, indications for the introduction of vaccines are the emergence or threat of the spread of infectious diseases, the occurrence of outbreaks or epidemics of certain infections.

Contraindications are individual for each vaccine, indicated in the instructions for its use.

General contraindications to the introduction of vaccines - the presence of acute infectious or noncommunicable diseases, chronic diseases of internal organs (liver, pancreas, spleen) during an exacerbation, allergic conditions, severe diseases of the cardiovascular system, diseases of the central nervous system, malignant neoplasms, pronounced immunodeficiencies.

After the introduction of vaccines, body temperature may rise for a short time, appear local reactions in the form of redness, swelling at the injection site. These post-vaccination reactions are not contraindications to the administration of the drug.

Complications after vaccination

All vaccine preparations are subject to General requirements- they must be safe, capable of forming immunity to a specific disease, must not cause allergic reactions, oncological diseases or fetal malformations. In addition, the vaccine should have a long shelf life, its use should be simple and affordable for mass use.

However, if the vaccine manufacturing process is violated, if the above rules are not observed, when vaccinated, if there are contraindications to its implementation, complications may develop in the form of:

• local reactions - abscesses and phlegmon;
• complications from the central nervous system - convulsive syndrome, encephalopathy, post-vaccination encephalitis;
• complications allergic nature- asthmatic syndrome, collaptoid conditions and even anaphylactic shock;
• exacerbation or first manifestations of chronic diseases;
• complications from various organs and systems - kidneys, heart, joints, gastrointestinal tract;
• lethal outcome.

Recently, vaccination has been a topic that generates a lot of controversy and disagreement. Some people are against vaccinations, while others understand the importance of preventive vaccinations. It must be remembered that vaccination is the most effective way to combat many infectious diseases. Of course, there is a risk of side effects after the introduction of the vaccine, however, with proper vaccination, the use of vaccines, for which all the rules and conditions were observed during production, storage and transportation, it is negligible.

To avoid the development of complications due to vaccination, it is necessary to carefully examine the child before vaccination, to inform the doctor about existing chronic diseases, about side effects that occurred after previous vaccinations (if any).