Conditions and procedure for vaccinations. Preventive vaccinations - vaccination form, schedule, national calendar. Historical milestones in the development of vaccination

Carrying out prophylactic vaccinations for FAP

General principles of preventive vaccinations

The concept of vaccination and immunization

Protective vaccinations(immunization, vaccination) creation of immunity to infectious diseases by introducing vaccines, toxoids, immunoglobulins, immune sera into the body. Preventive vaccinations are also carried out in order to create active immunity or short-term specific protection against the pathogen or its toxins (creation of passive immunity).

Actively acquired immunity results from the transfer of an infectious disease or the introduction of a vaccine into the body. It is formed 1-2 weeks after the introduction of the antigen and persists for years and tens of years (with measles for life). Passively acquired immunity occurs when antibodies are transferred from the mother to the fetus through the placenta, ensuring that newborns are immune to certain infectious diseases (for example, measles) for several months.

The same immunity is created artificially when immune sera containing antibodies against the corresponding microbes or toxins produced by bacteria are introduced into the body.

The high effectiveness of immunoprophylaxis, primarily for a number of infectious diseases with an airborne mechanism of pathogen transmission, not only led to a sharp decrease in the incidence rate, but also ensured the elimination of some common dangerous infectious diseases (for example, smallpox).

Immunization with vaccines (vaccine prophylaxis) and toxoids as a routine preventive measure is more effective than immunization with serum preparations (seroprophylaxis), as it provides protection for a longer period.

Serum immunization is carried out primarily to persons who have not been previously vaccinated due to contraindications, as well as to patients who are in serious condition. Immunization with sera is carried out as soon as possible after contact with the source of infection in the epidemic focus. To create passive immunity, immunoglobulins (vaccination preparations containing ready-made protective antibodies) are also introduced. Immunoglobulins are administered in cases where it is necessary to quickly increase the protective functions of the body, create temporary immunity to a particular infectious disease, or ease the severity of the onset of the disease.

To create active immunity, vaccines or toxoids are introduced into the human body. Vaccines contain killed or live, but weakened, disease-causing pathogens, in response to the introduction of which specific protective substances are produced, called antibodies. Toxoids are obtained by neutralizing microbial toxins (poisons) with formalin. In this case, the toxin loses its toxicity, but retains the ability to induce immunity.

Vaccines can be administered intradermally (tuberculosis vaccine), subcutaneously (typhoid and many others), intramuscularly (diphtheria-tetanus, measles, mumps, etc.); through the mouth (polio), intranasally (influenza).

For each vaccine, the most effective scheme has been established: the frequency of administration (once, twice or three times); intervals between injections, the dose of the drug. Anatoxins are administered subcutaneously or intramuscularly. To achieve a constant high intensity of immunity, in some cases, repeated vaccinations (revaccination) are carried out at various times after vaccination.

Given the ability of the human body to develop immunity to several contagious diseases at the same time, complex vaccination preparations are widely used, which are a mixture of several vaccines and toxoids (for example, pertussis-diphtheria-tetanus vaccine, trivaccine - rubella, measles, mumps).

Vaccinations in order to obtain active immunity are carried out in a planned manner and according to epidemic indications. Routine vaccinations carried out by the preventive vaccination calendar established by the Ministry of Health, regardless of the epidemiological situation, include vaccinations against childhood infections (measles, whooping cough, poliomyelitis, mumps, diphtheria, rubella, etc.).

Scheduled vaccinations in some cases are also carried out for the population in the territory of natural foci of zoonotic infections (gularemia, tick-borne encephalitis). Unscheduled (emergency) immunoprophylaxis is carried out by decision of the territorial health authorities and the state epidemiological surveillance service.

Organization and conduct of preventive vaccinations

Carrying out preventive vaccinationsrequires strict adherence to asepsis rules to prevent purulent-inflammatory diseases. Only healthy health workers who do not have even minor injuries on their hands, purulent lesions of the skin and mucous membranes, regardless of their location, are allowed to be vaccinated. After 30 injections, you must wash your hands with soap and then wipe them with alcohol. The health worker conducting the vaccination puts on a sterile clean gown, ironed with a hot iron, and a cap (scarf) on his head.

Preventive vaccinations are carried out only in medical institutions (polyclinic, FAP).

Each vaccination room (point) should have: a refrigerator, a cabinet for instruments and medicines, bixes with sterile material, a changing table and (or) a medical couch, tables for preparing preparations for use, a table for storing documentation, a container with a disinfectant solution. The office should have instructions for the use of all preparations for vaccination, as well as a tonometer, thermometers, disposable syringes, and ethyl alcohol. In case of an unusual reaction or anaphylactic shock, the vaccination room should have anti-shock therapy: 0.1% tavegil solution, 2.4% eufillin, 0.9% sodium chloride solution, cardiac glycosides (strophanthin, corglicon) , cordiamine, caffeine, hormonal drugs (prednisolone, hydrocortisone).

Vaccinations against tuberculosis and tuberculin diagnostics should be carried out in separate rooms or on specially allocated days. In the absence of a separate office, they are carried out on a specially dedicated table. A separate cabinet is used to accommodate syringes and needles allocated for BCG vaccine and tuberculin.

The use for other purposes of instruments intended for vaccination against tuberculosis is prohibited. On the day of BCG vaccination, all other manipulations are not carried out.
For preventive vaccinations on the territory of the Russian Federation, vaccines are used that are registered in the Russian Federation and have a certificate from the National Authority for Control of Medical Immunobiological Preparations - GISK them. L. A. Tarasevich.

Transportation, storage and use of vaccines is carried out in compliance with the requirements of the "cold chain".

Preventive vaccinations are carried out medical workers trained in the rules of organization, storage and technique of vaccination, as well as the methods of necessary assistance in case of development of post-vaccination reactions and complications.

Seminars on the theory of immunization and the technique of preventive vaccinations with mandatory certification must be attended at least once a year.

Responsible for organizing and preventive vaccinations is the head of a medical institution (at the FAP - a paramedic). The procedure for planning and conducting preventive vaccinations is established by order of the head of the medical institution with a clear definition of the responsible and functional duties of medical workers involved in planning and conducting vaccinations.

The organization of primary work is based on:

Full and reliable accounting of the entire population (separately the child population) living in each territory;
availability of medical documentation (forms No. 063 / y, forms No. 026 / y, forms No. 112 / y, etc.);
planning preventive vaccinations of all those to be vaccinated, taking into account the calendar and existing contraindications;
providing the medical institution with all the necessary and high-quality vaccine preparations, subject to the rules of transportation and storage;
strict accounting of persons who received vaccinations and sera, as well as newcomers who do not have preventive vaccinations in accordance with the calendar;
carrying out reporting of the immune layer of the population (separately the child population) - monthly, quarterly, annual. A reliable population count is a prerequisite
not only for the planning of preventive vaccinations, but also for the organization of all preventive work at the FAP.

It is desirable to conduct a population census 2 times a year (spring-autumn); additionally, the lists of arrivals are amended to include arrivals and departures, as well as newborn children.

Upon completion of the population census, the lists are checked against the presence of existing registration forms, in the absence of the latter they are drawn up. For all residents, the doctor starts a vaccination card file according to the registration form No. 063 / y. It is advisable to arrange the card index alphabetically, by year and by the groups they attend. The vaccination card file is stored in a separate office or cabinet; the paramedic at the FAP is responsible for the completeness and correctness of maintaining documents.

Immunization planning for the next year is carried out by the FAP paramedic or a medical worker responsible for immunoprophylaxis, while taking into account the entire population of the district, individual children who are subject to preventive vaccinations according to the plan according to the "Vaccination Calendar" by age, and not vaccinated on time for various reasons.

Upon completion of planning, the total number of those vaccinated in the next year is calculated, a consolidated plan is drawn up, which is sent to the territorial bodies of sanitary and epidemiological supervision.

On the basis of the quantitative information contained in the plans about the persons to be vaccinated, an application for vaccinal and serum preparations is drawn up.

Vaccination tactics. Ways of administering vaccines
The selection of adults and children for vaccination is carried out by a paramedic at FAPs. Vaccinations are carried out by trained medical personnel.

Before vaccination, it is necessary to carefully check the quality of the drug, its labeling, the integrity of the ampoule (vial).

Vaccines should not be used:

With inappropriate physical properties;
with violation of the integrity of the ampoules;
with unclear or missing markings on the ampoule (vial);
adsorbed vaccines (in particular DPT, ADS, ADS-M) stored or transported in violation of the temperature regime, especially those subjected to freezing;
live (measles, mumps, rubella) exposed to temperatures above 8 °C; BCG - more than 4 gr. Celsius. The opening of ampoules, the dissolution of lyophilized vaccines (measles, mumps), the vaccination procedure is carried out in accordance with the instructions, with strict observance of asepsis rules.

The drug in the opened ampoule (bottle) is not subject to storage!
Vaccination tools (syringes, needles, scarifiers) must be disposable and rendered unusable in the presence of the person who was vaccinated or his parent.

When carrying out the vaccination procedure, it is necessary to strictly adhere to the relevant provisions of the "Instructions for the use of the drug".
Vaccination should be given in a lying or sitting position to avoid falling when fainting, which occurs during the procedure in adolescents and adults.

When carrying out immunoprophylaxis, the following methods of drug administration are used: cutaneous, intradermal, subcutaneous, intramuscular, enteral, intranasal.

Parenteral administration of drugs (cutaneous, intradermal, subcutaneous and intramuscular) can be carried out using scarifiers, syringes and needleless injectors. Needle-free injectors provide the introduction of vaccines, serum preparations with a warm jet through the skin under high pressure. The latter method is painless, they can be vaccinated up to 1500 people in 1 hour.

Before parenteral administration of an inactivated vaccine, the skin of the person being grafted in the injection area is wiped with alcohol or ether, and after vaccination, it is lubricated with 70% alcohol or 5% alcohol solution of iodine.

Intradermal vaccines are injected strictly into the skin of the inner side of the forearm or the outer side of the shoulder, injecting the needle with a cut downward at an angle of 10-15 ° C. An indicator of the correctness of the introduction is the formation on the skin at the injection site of a small, whitish, clearly defined and dense formation that looks like a lemon peel. When the vaccine is administered subcutaneously, the needle is injected at an angle of 45-50 ° C into the subcutaneous tissue of the subscapular region or the outer side of the shoulder (thigh), or into the lateral parts of the abdomen. Intramuscular injection of the vaccine is carried out in the upper outer quadrant of the buttock.

Before inoculation of live vaccines applied on the skin, the place where it is supposed to scarify the skin is treated with alcohol, then with ether. Then apply a few drops of the drug at such a distance from each other, as indicated in the instructions for this drug. After that, with the tip of a special scarifier (pen) through the applied drops, shallow skin incisions are made to the papillary layer (drops should appear - blood dewdrops). Then the vaccine should be wiped with the plane of the scarifier, allowed to dry for 5-10 minutes, and the area of ​​the incisions should be covered with a sterile napkin for 45-60 minutes.

When immunized with enteral vaccines that are administered through the mouth, liquid and tablet preparations are distributed with a spoon or tweezers, respectively, grafted, the polio vaccine is administered through the mouth with a special pipette.

Oral preparations are administered to the vaccinated only in the presence of a medical worker.

During intranasal immunization using a special nebulizer, before the introduction of the vaccine, each grafted nebulizer tip is wiped with 70% alcohol and injected to a depth of 0.5 cm into the nasal passages, previously cleared of mucus.

Violations of the technique or volume of the administered drug can lead to various complications and reactions in the vaccinated.

Observation of the vaccinated is carried out in accordance with the instructions for the use of drugs in the first 30 minutes after administration, since at this time it is theoretically possible to develop immediate reactions, including anaphylactic shock. Further, according to the appropriate preventive vaccination schedule, the vaccinated children are observed after 24 hours, 48 ​​and 72 hours, after the introduction of live vaccines - at 5-6 and 10-11 days, the child is vaccinated with BCG, the observation is carried out up to 9 months of age with a description of the general and local manifestations. If the frequency and intensity of general local reactions or the occurrence of unusual reactions exceed the permissible instructions for the use of this vaccine, the vaccination of this series of drugs is stopped and the territorial sanitary and epidemiological supervision authorities are informed about this.

According to the Law of the Russian Federation on the sanitary and epidemiological well-being of the population, vaccinations against tuberculosis, poliomyelitis, diphtheria, tetanus, whooping cough, measles, mumps are mandatory. Vaccinations are also obligatory for some occupational groups in case of an increased risk of infection for an employee in contact with its source, as well as in case of a risk of mass spread of infection by an employee (for example, a food unit).

A number of vaccinations are mandatory for citizens traveling abroad, especially to countries with a hot climate or an epidemiologically disadvantaged state.

Legal approach to immunoprophylaxis

The legal approach to immunoprophylaxis provides for a combination of rights, duties and responsibilities of the individual and the state; these principles, to some extent reflected in the legislation of many countries, provide for the following:

All citizens are provided by the state with the opportunity to receive all necessary vaccinations free of charge, as well as to receive information about the nature of the vaccination, its effectiveness, possible situations, etc. Vaccinations are carried out only with the consent of the vaccinated person or his parents (guardians), and the state guarantees free medical care, which may be needed if a reaction or complication develops;

Every citizen has the right to refuse vaccination for himself or his child (with the exception of vaccination against especially dangerous infections carried out according to epidemiological indications), which he must record in writing; if he refuses to sign, at least 2 health workers do it;

If an unvaccinated person (or his child) falls ill with the corresponding infection, he is not paid days of incapacity for work. Unvaccinated children are not allowed in children's institutions, health camps and educational institutions, as they can be sources of epidemic outbreaks. The manufacturer's liability is
with drug quality. Vaccinating medical workers are responsible for the correct determination of indications and contraindications, for achieving the necessary vaccinations, as well as for the correct storage of drugs, as well as for the technique of administering the vaccine and monitoring the vaccinated children according to the instructions.

Before vaccination, all vaccinated are examined by a paramedic in order to identify persons for whom it is contraindicated. Before the examination, thermometry is obligatory, and if necessary, preliminary laboratory tests and consultations of specialists. Mass-use vaccines have a minimum of contraindications and can be used without a special examination.

Vaccinations are a way to prevent infectious diseases that have serious consequences. A vaccine triggers a response that builds immunity against a specific disease.

Vaccination is planned or according to epidemiological indications. The latter is carried out in cases of outbreaks of dangerous diseases in a certain region. But most often people are faced with the planned conduct of preventive vaccinations. They are carried out according to a specific schedule.

Some vaccinations are mandatory for everyone. These include BCG, COC, DPT. Others are carried out exclusively for those who have an increased risk of contracting a disease, for example, at work. It could be typhus, plague.

The vaccination schedule is designed taking into account many factors. Specialists have provided different schemes for the administration of drugs, the possibility of their combination. The national calendar is valid throughout the country. It may be revised in the light of any new data.

In Russia, the national calendar includes all necessary vaccinations for all ages.

There are also regional calendars. For example, residents of Western Siberia are additionally injected because this infection is common there.

On the territory of Ukraine, the vaccination schedule is somewhat different.

The procedure for conducting preventive vaccinations

In order to administer a vaccine to a child or adult, a number of conditions must be met. The organization and conduct of preventive vaccinations is regulated by regulatory documents. The procedure can be carried out exclusively in polyclinics or specialized private medical institutions. In an institution for such manipulations, a separate vaccination room should be allocated, which must also meet certain requirements:

• it should contain: a refrigerator, sterile instruments, a changing table, a table, a medicine cabinet, a disinfectant solution;
• all used material and tools should be placed in a container with a disinfectant solution;
• availability of drugs for antishock therapy is mandatory;
• it is necessary to keep instructions for all drugs;
• The office should be cleaned twice a day.

It is also important that vaccination against tuberculosis (BCG) should be carried out either in a separate room, or only on certain days.

Before manipulation, the patient must pass the necessary tests and undergo an examination by a doctor. During the appointment, the doctor is interested in the state of health at the moment, clarifies the presence of reactions to previous vaccinations. Based on this information, the doctor issues a permit for the procedure.

The patient can be manipulated if contraindications to preventive vaccinations are identified. They can be permanent or temporary.

The former are not common and are most often a strong reaction to previous vaccinations.

Childhood vaccinations are a relevant topic for parents, perhaps, until the child grows up. Doctors are convinced that vaccination saves babies and teenagers from many health problems, but restless moms and dads are often wary of this type of prevention. How to avoid the side effects of vaccinations, but at the same time build strong immunity in a child? Let's talk about this in more detail in this article.

Types of vaccinations and vaccination rates in Russia

Vaccination involves the targeted enrichment of the immune system with information about dangerous microorganisms that it has not encountered before. Almost all infections leave a kind of trace in the body: the immune system continues to remember the enemy "by sight", so a new encounter with an infection no longer turns into a malaise. But many diseases - especially in childhood - are fraught not only with unpleasant symptoms, but also with health complications that can leave an imprint on a person's entire future life. And it is much more reasonable, instead of getting such experience in "combat conditions", to make life easier for the child using a vaccine.

A vaccine is a pharmaceutical preparation containing killed or weakened particles of bacteria and viruses, which allows the body to develop immunity without serious loss to health.

The use of vaccines is justified both for the prevention of the disease and for its treatment (with a protracted course of the disease, when it is necessary to stimulate the immune system). Preventive vaccinations are used in young and adult patients, their combination and sequence of administration are prescribed in a special document - the National Calendar of Preventive Immunizations. These are the recommendations of experts to achieve the best result with minimal negative consequences.

There are vaccines that are not used under normal conditions, but are extremely useful in the event of an outbreak of a particular disease, as well as when traveling to an area known for a difficult epidemic situation for a specific infection (for example, cholera, rabies, typhoid fever, etc.). .). You can find out which preventive vaccinations will be useful for children according to epidemic indications from a pediatrician, immunologist or infectious disease specialist.

When deciding on vaccination, it is important to keep in mind the legal norms adopted in the territory of the Russian Federation:

• Vaccination is a voluntary choice of parents. There is no punishment for refusing it, but it is worth considering what such a decision is fraught with for the well-being of both your child and other babies who may one day become infected with an infectious disease from him;
• any vaccination is carried out in medical organizations that have access to this type of procedure (we are talking not only about public clinics, but also about private centers);
• the vaccination must be given by a physician who has access to vaccination (doctor, paramedic or nurse);
• vaccination is permissible only with drugs officially registered in our country;
• before starting the procedure, the doctor or nurse must explain to the child's parents the positive and negative properties of the vaccine, possible side effects and the consequences of refusing to vaccinate;
• before the introduction of the vaccine, the child must be examined by a doctor or paramedic;
• if on the same day vaccination is carried out in several directions at once, then the vaccinations are given in different parts of the body, each time with a new syringe;
• except in the situation described above, the period between two vaccinations against different infections must be at least 30 days.

Immunization schedule for children under 3 years old

Most of the vaccinations from the National Calendar for Children fall on the first year and a half of life. At this age, the child is most susceptible to infections, so the task of parents and doctors is to make sure that diseases bypass your baby.

Of course, it is difficult for a kid to explain how important vaccination is and why pain must be endured. However, experts advise to approach the process delicately: try to distract the baby from medical manipulation, be sure to praise him for good behavior and carefully monitor his well-being in the first three days after the procedure.

As with any other drug use, vaccination has contraindications. They are individual for each vaccination, but it is important to exclude the introduction of the vaccine against the background of an existing infection and if the child is allergic to a particular product. If you have reason to doubt the safety of the officially approved vaccination schedule, it is worth discussing alternative vaccination schedules and other disease prevention measures with your doctor.

Immunization schedule for children from 3 to 7 years old

At preschool age, children need to be vaccinated much less frequently. However, it is important not to forget to check with the Calendar of preventive vaccinations, so as not to accidentally forget to visit the pediatrician on time.

Calendar of preventive vaccinations for schoolchildren

In school years, the timing of vaccination of children is usually monitored by an employee of the first-aid post - all students are often vaccinated centrally, on the same day. If your child has health conditions that require a separate vaccination scheme, do not forget to discuss this with representatives of the school administration.

To vaccinate or not to vaccinate children?

The question of the advisability of vaccinating children in recent decades has been acute: in Russia and around the world, the so-called anti-vaccination movement remains popular, whose supporters consider vaccination a harmful procedure implanted by pharmacological corporations in order to enrich themselves.

This point of view is based on isolated cases of complications or death in children who were vaccinated against any infections. In most cases, it is not possible to establish the objective cause of such a tragedy, however, opponents of vaccination do not consider it necessary to rely on statistics and facts, they only appeal to the natural feeling of fear of parents for their children.

The danger of such beliefs is that without universal vaccination it is impossible to exclude the persistence of foci of infection, the carriers of which are unvaccinated children. By coming into contact with other babies who have not been vaccinated due to contraindications, they contribute to the spread of the disease. And the more convinced "anti-vaxxers" there are among parents, the more often children suffer from measles, meningitis, rubella and other infections.

Another reason that often keeps parents from getting vaccinated is the uncomfortable conditions in the vaccination room at the children's polyclinic at the place of registration. However, proper time planning, an experienced doctor who will clarify all questions, and your positive attitude, which will also affect the child, will certainly help you survive the vaccination without tears and disappointments.

MU 3.3.1889-04

METHODOLOGICAL INSTRUCTIONS

3.3. IMMUNOPROPHYLAXIS OF INFECTIOUS DISEASES

The procedure for conducting preventive vaccinations

Date of introduction: from the moment of approval

1. DEVELOPED by the Department of State Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia (G.F. Lazikova); Federal Center for State Sanitary and Epidemiological Surveillance of the Ministry of Health of Russia (E.N. Belyaev, A.A. Yasinsky, V.N. Sadovnikova, L.N. Kostina. E.A. Kotova).

2. APPROVED by the Chief State Sanitary Doctor of the Russian Federation - First Deputy Minister of Health of the Russian Federation G.G. Onishchenko 04.03.04.

3. INTRODUCED FOR THE FIRST TIME.

1 area of ​​use

1 area of ​​use

1.1. These guidelines contain requirements for preventive vaccinations against infectious diseases.

1.2. The requirements set out in the guidelines are aimed at ensuring the effectiveness and safety of vaccination, as well as ensuring the reliability of accounting for preventive vaccinations.

1.3. The guidelines are intended for specialists of bodies and institutions of the state sanitary and epidemiological service and healthcare organizations, regardless of the legal forms and forms of ownership, carrying out activities in the field of immunoprophylaxis in the prescribed manner.

2. Basic provisions

Federal Law N 157-FZ of September 17, 1998 "On Immunoprophylaxis of Infectious Diseases" provides for preventive vaccinations against tuberculosis, poliomyelitis, measles, mumps, viral hepatitis B, rubella, diphtheria, whooping cough, tetanus, included in the national preventive calendar vaccinations, and preventive vaccinations according to epidemic indications.

Immunization within the framework of the national calendar of preventive vaccinations is carried out with vaccines of domestic and foreign production, registered and approved for use in the prescribed manner in accordance with the instructions for their use.

When carrying out routine vaccination of the population, it is necessary to follow the procedure for administering vaccines in a certain sequence at a specified time. The combination of these factors makes up the national calendar of preventive vaccinations.

The national calendar is built taking into account the socio-economic significance of infections controlled by means of vaccine prevention, domestic and international experience in the prevention of infectious diseases, as well as the availability of effective, safe, affordable vaccines in the country.

The next revision of the national calendar may be caused by the emergence of new generation drugs, the use of which reduces the number of drug injections, changes the way the vaccine is administered, as well as the cancellation of the next or the introduction of additional vaccination to optimize the management of the epidemic process of infection.

3. General requirements for the organization and conduct of preventive vaccinations

3.1. Preventive vaccinations for citizens are carried out in healthcare organizations, regardless of organizational and legal forms and forms of ownership, as well as by persons engaged in private medical practice, with a license for this type of activity in the field of immunoprophylaxis.

3.2. The work on carrying out preventive vaccinations is financed from the federal budget, the budgets of the constituent entities of the Russian Federation, compulsory medical insurance funds and other sources of funding in accordance with the legislation of the Russian Federation and the legislation of the constituent entities of the Russian Federation.

3.3. Financing of the supply of medical immunobiological preparations (MIBP) for preventive vaccinations within the framework of the national calendar is carried out at the expense of the federal budget in accordance with the legislation of the Russian Federation, and the supply of MIBP for preventive vaccinations according to epidemic indications - at the expense of the budgets of the constituent entities of the Russian Federation and non-budgetary funding sources in accordance with the Federal Law "On the supply of products for federal state needs" and the legislation of the constituent entities of the Russian Federation.

3.4. The organization and conduct of preventive vaccinations is provided by the head of a medical and preventive organization that has a license for this type of activity in the field of immunoprophylaxis.

3.5. Preventive vaccinations are carried out for citizens who do not have medical contraindications, with the consent of citizens, parents or other legal representatives of minors and citizens recognized as incompetent in the manner established by the legislation of the Russian Federation.

3.6. Preventive vaccinations are carried out in strict accordance with the instructions for the use of drugs.

3.7. To carry out preventive vaccinations, medical personnel trained in the rules of vaccination technique, emergency procedures in case of development of post-vaccination reactions and complications are allowed. Immunization against tuberculosis is allowed for medical personnel who have undergone appropriate training and have a special certificate of admission, annually updated.

3.8. Medical workers involved in the vaccination of infectious diseases should undergo annual training on the organization and conduct of preventive vaccinations.

4. The procedure for conducting preventive vaccinations

4.1. Preventive vaccinations are carried out in the vaccination rooms of medical and preventive organizations, children's preschool educational institutions, medical offices of general educational institutions (special educational institutions), health centers of organizations in strict compliance with the requirements established by regulatory and methodological documents.

4.2. If necessary, the territorial executive authorities in the field of healthcare, in agreement with the centers of state sanitary and epidemiological surveillance, may decide to conduct preventive vaccinations at home or at the place of work by vaccination teams.

4.3. Preventive vaccinations are carried out as prescribed by a doctor (paramedic).

4.4. Before vaccination, anamnestic data are collected by examining medical documents, and a survey is also conducted of the person to be immunized and / or his parents or guardians.

4.5. Persons who are to be immunized are subjected to a preliminary examination by a doctor (paramedic) taking into account anamnestic data (previous diseases, tolerance to previous vaccinations, the presence of allergic reactions to drugs, products, etc.).

4.6. If necessary, a medical examination is carried out before vaccination.

4.7. Immediately before vaccination, thermometry is carried out.

4.8. All preventive vaccinations are carried out with disposable syringes and disposable needles.

4.9. Preventive vaccinations are carried out by medical workers trained in the rules of organization and technique of vaccination, as well as emergency care in case of post-vaccination complications.

4.10. Premises where prophylactic vaccinations are carried out must be provided with emergency and anti-shock therapy kits with instructions for their use.

4.11. Storage and use of vaccines and other immunobiological preparations is carried out in strict compliance with the requirements of regulatory and methodological documents.

4.12. Preventive vaccinations are carried out in accordance with the approved plan for preventive vaccinations.

4.13. The room for preventive vaccinations is provided with the necessary equipment and equipment.

4.14. In the office where preventive vaccinations are carried out, there must be the necessary documents.

4.15. Vaccinations against tuberculosis and tuberculin diagnostics are carried out in separate rooms, and in their absence - on a specially allocated table, with separate tools that are used only for these purposes. For BCG vaccination and bioassays, a certain day or hours are allocated.

4.16. It is not allowed to carry out preventive vaccinations in dressing rooms and treatment rooms.

4.17. The vaccination room is cleaned 2 times a day using disinfectants. Once a week, a general cleaning of the vaccination room is carried out.

5. Methodology for preventive vaccinations

5.1. Before conducting preventive vaccinations, the medical worker responsible for its implementation visually checks the integrity of the ampoule or vial, the quality of the administered drug and its labeling.

5.2. The opening of ampoules, the dissolution of lyophilized vaccines is carried out in accordance with the instructions, with strict observance of the rules of asepsis and the cold chain.

5.3. Parenteral administration of immunobiological preparations is carried out with a disposable syringe and a disposable needle, subject to the rules of asepsis. In the case of simultaneous administration of several vaccinations (except for BCG), each vaccine is administered with a separate disposable syringe and a disposable needle to different parts of the body.

5.4. The place of administration of the vaccine is treated with 70% alcohol, unless otherwise indicated in the instructions for its use (ether - when setting up the Mantoux river or administering BCG) and other means approved for use in the prescribed manner for these purposes.

5.5. The vaccine is administered at a dose strictly corresponding to the instructions for use of the drug, with the patient lying down or sitting in order to avoid falling during fainting.

5.6. A patient who has received a prophylactic vaccination is placed under medical supervision for a period specified in the instructions for use of the drug (at least 30 minutes).

6. Disposal of vaccine residues, used syringes, needles and scarifiers

6.1. The remains of vaccines in ampoules or vials, used disposable needles, syringes, scarifiers, cotton swabs, napkins, gloves after injection are thrown into containers with a disinfectant solution prepared in accordance with the instructions for its use.

6.2. After disinfection treatment, medical waste is disposed of in accordance with the sanitary rules and norms of SanPiN 3.1.7.728-99 * "Rules for the collection, storage and disposal of waste from medical institutions."
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*Probably an original error. You should read SanPiN 2.1.7.728-99. - Note "CODE".

7. Storage and use of vaccines

7.1. The storage and use of vaccines in healthcare organizations, regardless of the organizational and legal forms and forms of ownership, where preventive vaccinations are carried out, is carried out in accordance with the established requirements of SP 3.3.2.1120-02 "Sanitary and epidemiological requirements for the conditions of transportation, storage and distribution of medical immunobiological drugs used for immunoprophylaxis by pharmacies and health care institutions.

7.2. The maximum shelf life of vaccines in medical and preventive organizations where preventive vaccinations are carried out is 1 month. The maximum storage times are based on the safe storage of vaccines at each level of the cold chain.

7.3. When using vaccines, the principle should be followed: vaccines received earlier should be used first. In practice, basic stocks of vaccines should be used up before the maximum allowable shelf life.

7.4. In medical and preventive organizations where preventive vaccinations are carried out, it is necessary to have a stock of thermal containers and ice packs in case of departure of vaccination teams, as well as emergencies associated with the failure of refrigeration equipment or power outages.

8. The procedure for conducting preventive vaccinations according to the national calendar of preventive vaccinations

8.1. National calendar of preventive vaccinations

In case of violations of the timing of the start of vaccinations, the latter are carried out according to the schemes provided for by this calendar and instructions for the use of drugs.

8.2. Whooping cough immunization

8.2.1. The goal of whooping cough vaccination, according to WHO recommendations, should be to reduce the incidence by 2010 or earlier to a level of less than 1 per 100,000 population. This can be achieved by ensuring at least 95% coverage with three vaccinations of children at the age of 12 months. and the first revaccination of children at the age of 24 months.

8.2.2. Vaccination against pertussis is subject to children from 3 months of age to 3 years 11 months 29 days. Vaccinations are carried out with DTP vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.

8.2.3. The vaccination course consists of 3 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.

8.2.4. The first vaccination is carried out at the age of 3 months, the second - at 4.5 months, the third vaccination - at the age of 6 months.

8.2.5. Revaccination with DTP vaccine is carried out once every 12 months. after completed vaccination.

8.2.6. DTP vaccinations can be given at the same time as other vaccinations in the vaccination schedule, with the vaccines being administered with different syringes to different parts of the body.
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3.3 . IMMUNOPROPHYLAXIS
INFECTIOUS DISEASES

ORDER OF CONDUCT
PREVENTIVE VACATIONS

METHODOLOGICAL INSTRUCTIONS
MU 3.3.1889-04

3.3. IMMUNOPROPHYLAXIS OF INFECTIOUS DISEASES

1.3. The guidelines are intended for specialists of bodies and institutions of the state sanitary and epidemiological service and healthcare organizations, regardless of the legal forms and forms of ownership, carrying out activities in the field of immunoprophylaxis in the prescribed manner.

2 . Key points

Federal Law No. 157-FZ of September 17, 1998 “On Immunoprophylaxis of Infectious Diseases” provides for preventive vaccinations against tuberculosis, poliomyelitis, measles, mumps, viral hepatitis B, rubella, diphtheria, whooping cough, tetanus, included in the national preventive calendar vaccinations, and preventive vaccinations according to epidemic indications.

Immunization within the framework of the national calendar of preventive vaccinations is carried out with vaccines of domestic and foreign production, registered and approved for use in the prescribed manner in accordance with the instructions for their use.

When carrying out routine vaccination of the population, it is necessary to follow the procedure for administering vaccines in a certain sequence at a specified time. The combination of these factors makes up the national calendar of preventive vaccinations.

The national calendar is built taking into account the socio-economic significance of infections controlled by means of vaccine prevention, domestic and international experience in the prevention of infectious diseases, as well as the availability of effective, safe, affordable vaccines in the country.

The next revision of the national calendar may be caused by the emergence of new generation drugs, the use of which reduces the number of drug injections, changes the way the vaccine is administered, as well as the cancellation of the next or the introduction of additional vaccination to optimize the management of the epidemic process of infection.

3 . General requirements for the organization and conduct of preventive vaccinations

3.1. Preventive vaccinations for citizens are carried out in healthcare organizations, regardless of organizational and legal forms and forms of ownership, as well as by persons engaged in private medical practice, with a license for this type of activity in the field of immunoprophylaxis.

3.2. The work on carrying out preventive vaccinations is financed from the federal budget, the budgets of the constituent entities of the Russian Federation, compulsory medical insurance funds and other sources of funding in accordance with the legislation of the Russian Federation and the legislation of the constituent entities of the Russian Federation.

3.3. Financing of the supply of medical immunobiological preparations (MIBP) for preventive vaccinations within the framework of the national calendar is carried out at the expense of the federal budget in accordance with the Federal Law "On the supply of products for federal state needs" and the legislation of the Russian Federation, and the supply of MIBP for preventive vaccinations for epidemic indications - at the expense of the budgets of the constituent entities of the Russian Federation and extrabudgetary sources of funding in accordance with the Federal Law "On the supply of products for federal state needs" and the legislation of the constituent entities of the Russian Federation.

3.4. The organization and conduct of preventive vaccinations is provided by the head of a medical and preventive organization that has a license for this type of activity in the field of immunoprophylaxis.

3.5. Preventive vaccinations are carried out for citizens who do not have medical contraindications, with the consent of citizens, parents or other legal representatives of minors and citizens recognized as incompetent in the manner established by the legislation of the Russian Federation.

3.6. Preventive vaccinations are carried out in strict accordance with the instructions for the use of drugs.

3.7. To carry out preventive vaccinations, medical personnel trained in the rules of vaccination technique, emergency procedures in case of development of post-vaccination reactions and complications are allowed. Immunization against tuberculosis is allowed for medical personnel who have undergone appropriate training and have a special certificate of admission, annually updated.

3.8. Medical workers involved in the vaccination of infectious diseases should undergo annual training on the organization and conduct of preventive vaccinations.

4 . The procedure for conducting preventive vaccinations

4.1. Preventive vaccinations are carried out in the vaccination rooms of medical and preventive organizations, children's preschool educational institutions, medical offices of general educational institutions (special educational institutions), health centers of organizations in strict compliance with the requirements established by regulatory and methodological documents.

4.2. If necessary, the territorial executive authorities in the field of healthcare, in agreement with the centers of state sanitary and epidemiological surveillance, may decide to conduct preventive vaccinations at home or at the place of work by vaccination teams.

4.3. Preventive vaccinations are carried out as prescribed by a doctor (paramedic).

4.4. Before vaccination, anamnestic data are collected by examining medical documents, and a survey is also conducted of the person to be immunized and / or his parents or guardians.

4.5. Persons who are to be immunized are subjected to a preliminary examination by a doctor (paramedic) taking into account anamnestic data (previous diseases, tolerance to previous vaccinations, the presence of allergic reactions to drugs, products, etc.).

4.6. If necessary, a medical examination is carried out before vaccination.

4.7. Immediately before vaccination, thermometry is carried out.

4.8. All preventive vaccinations are carried out with disposable syringes and disposable needles.

4.9. Preventive vaccinations are carried out by medical workers trained in the rules of organization and technique of vaccination, as well as emergency care in case of post-vaccination complications.

4.10. Premises where prophylactic vaccinations are carried out must be provided with emergency and anti-shock therapy kits with instructions for their use.

4.11. Storage and use of vaccines and other immunobiological preparations is carried out in strict compliance with the requirements of regulatory and methodological documents.

4.12. Preventive vaccinations are carried out in accordance with the approved plan for preventive vaccinations.

4.13. The room for preventive vaccinations is provided with the necessary equipment and equipment.

4.14. In the office where preventive vaccinations are carried out, there must be the necessary documents.

4.15. Vaccinations against tuberculosis and tuberculin diagnostics are carried out in separate rooms, and in their absence - on a specially allocated table, with separate tools that are used only for these purposes. For BCG vaccination and bioassays, a certain day or hours are allocated.

4.16. It is not allowed to carry out preventive vaccinations in dressing rooms and treatment rooms.

4.17. The vaccination room is cleaned 2 times a day using disinfectants. Once a week, a general cleaning of the vaccination room is carried out.

5 . The method of carrying out preventive vaccinations

5.1. Before conducting preventive vaccinations, the medical worker responsible for its implementation visually checks the integrity of the ampoule or vial, the quality of the administered drug and its labeling.

5.2. The opening of ampoules, the dissolution of lyophilized vaccines is carried out in accordance with the instructions, with strict observance of the rules of asepsis and the cold chain.

5.3. Parenteral administration of immunobiological preparations is carried out with a disposable syringe and a disposable needle, subject to the rules of asepsis. In the case of simultaneous administration of several vaccinations (except for BCG), each vaccine is administered with a separate disposable syringe and a disposable needle to different parts of the body.

5.4. The place of administration of the vaccine is treated with 70% alcohol, unless otherwise indicated in the instructions for its use (ether - when setting up the Mantoux river or administering BCG) and other means approved for use in the prescribed manner for these purposes.

5.5. The vaccine is administered at a dose strictly corresponding to the instructions for use of the drug, with the patient lying down or sitting in order to avoid falling during fainting.

5.6. A patient who has received a prophylactic vaccination is placed under medical supervision for a period specified in the instructions for use of the drug (at least 30 minutes).

6 . Disposal of vaccine residues, used syringes, needles and scarifiers

6.1. The remains of vaccines in ampoules or vials, used disposable needles, syringes, scarifiers, cotton swabs, napkins, gloves after injection are thrown into containers with a disinfectant solution prepared in accordance with the instructions for its use.

6.2. After disinfection treatment, medical waste is disposed of in accordance with the sanitary rules and norms of SanPiN 3.1.7.728-99 "Rules for the collection, storage and disposal of waste from medical institutions."

7 . Storage and use of vaccines

7.1. The storage and use of vaccines in healthcare organizations, regardless of the organizational and legal forms and forms of ownership, where preventive vaccinations are carried out, is carried out in accordance with the established requirements of SP 3.3.2.1120-02 "Sanitary and epidemiological requirements for the conditions of transportation, storage and distribution of medical drugs used for immunoprophylaxis by pharmacies and health care institutions.

7.2. The maximum shelf life of vaccines in medical and preventive organizations where preventive vaccinations are carried out is 1 month. The maximum storage times are based on the safe storage of vaccines at each level of the cold chain.

7.3. When using vaccines, the principle should be followed: vaccines received earlier should be used first. In practice, basic stocks of vaccines should be used up before the maximum allowable shelf life.

7.4. In medical and preventive organizations where preventive vaccinations are carried out, it is necessary to have a stock of thermal containers and ice packs in case of departure of vaccination teams, as well as emergencies associated with the failure of refrigeration equipment or power outages.

8. The procedure for conducting preventive vaccinations according to the national calendar of preventive vaccinations

8.1. National calendar of preventive vaccinations

In case of violations of the timing of the start of vaccinations, the latter are carried out according to the schemes provided for by this calendar and instructions for the use of drugs.

8.2. Whooping cough immunization

8.2.1. The goal of whooping cough vaccination, according to WHO recommendations, should be to reduce the incidence by 2010 or earlier to a level of less than 1 per 100,000 population. This can be achieved by ensuring at least 95% coverage with three vaccinations of children at the age of 12 months. and the first revaccination of children at the age of 24 months.

8.2.2. Vaccination against pertussis is subject to children from 3 months of age to 3 years 11 months 29 days. Vaccinations are carried out with DTP vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.

8.2.3. The vaccination course consists of 3 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.

8.2.4. The first vaccination is carried out at the age of 3 months, the second - at 4.5 months, the third vaccination - at the age of 6 months.

8.2.5. Revaccination with DTP vaccine is carried out once every 12 months. after completed vaccination.

8.2.6. DTP vaccinations can be given at the same time as other vaccinations in the vaccination schedule, with the vaccines being administered with different syringes to different parts of the body.

8.3. Immunization against diphtheria

Vaccinations are carried out with the DPT vaccine, ADS toxoids, ADS-M, AD-M.

8.3.1. The goal of vaccination against diphtheria, as recommended by WHO, is to achieve by 2005 an incidence rate of 0.1 or less per 100,000 population. This will be possible by ensuring at least 95% coverage of completed vaccination of children at the age of 12 months, the first revaccination of children at the age of 24 months. and at least 90% vaccination coverage of the adult population.

8.3.2. Vaccination against diphtheria is subject to children from 3 months of age, as well as adolescents and adults who have not previously been vaccinated against this infection. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.

8.3.3. The first vaccination is carried out at the age of 3 months, the second vaccination - at the age of 4.5 months, the third vaccination - at the age of 6 months.

The first revaccination is carried out after 12 months. after completed vaccination. Children from 3 months of age to 3 years 11 months 29 days are subject to vaccination with DTP vaccine.

Vaccination is carried out 3 times with an interval of 45 days. Shortening intervals is not allowed. With a forced increase in the interval, the next vaccination is carried out as soon as possible, determined by the state of health of the child. Skipping one vaccination does not entail repeating the entire vaccination cycle.

8.3.4. ADS-anatoxin is used to prevent diphtheria in children under 6 years of age:

those who have recovered from whooping cough;

over 4 years old, not previously vaccinated against diphtheria and tetanus.

8.3.4.1. The course of vaccination consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.

8.3.4.2. The first revaccination with ADS-anatoxin is carried out once every 9-12 months. after completed vaccination.

8.3.5. DS-M-anatoxin is used:

for revaccination of children 7 years old, 14 years old and adults without age limit every 10 years;

for vaccination against diphtheria and tetanus in children from 6 years of age who have not previously been vaccinated against diphtheria.

8.3.5.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. If it is necessary to increase the interval, the next vaccination should be carried out as soon as possible.

8.3.5.2. The first revaccination is carried out with an interval of 6-9 months. after completed vaccination once. Subsequent revaccinations are carried out in accordance with the national calendar.

8.3.5.3. Vaccinations with ADS-M-anatoxin can be carried out simultaneously with other vaccinations of the calendar. Vaccinations are carried out with different syringes in different parts of the body.

8.4. Immunization against tetanus

8.4.1. In the Russian Federation, neonatal tetanus has not been recorded in recent years, and sporadic incidence of tetanus is recorded annually among other age groups of the population.

8.4.2. The goal of tetanus immunization is to prevent tetanus in the population.

8.4.3. This can be achieved by ensuring at least 95% coverage of children with three vaccinations by 12 months. life and subsequent age-related revaccinations by 24 months. life, at 7 years and at 14 years.

8.4.4. Vaccinations are carried out with the DPT vaccine, ADS toxoids, ADS-M.

8.4.5. Children from 3 months of age are subject to vaccination against tetanus: the first vaccination is carried out at the age of 3 months, the second - at 4.5 months, the third vaccination - at the age of 6 months.

8.4.6. Vaccinations are carried out with DTP vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.

8.4.7. The course of vaccination consists of 3 vaccinations with an interval of 45 days. Shortening intervals is not allowed. With a forced increase in the interval, the next vaccination is carried out as soon as possible, determined by the state of health of the child. Skipping one vaccination does not entail repeating the entire vaccination cycle.

8.4.8. Revaccination against tetanus is carried out with DTP vaccine once every 12 months. after completed vaccination.

8.4.9. Inoculations with DTP vaccine can be carried out simultaneously with other vaccinations of the vaccination schedule, while the vaccines are administered with different syringes in different parts of the body.

8.4.10. ADS-anatoxin is used to prevent tetanus in children under 6 years of age:

those who have recovered from whooping cough;

having contraindications to the introduction of DPT-vaccine;

over 4 years old, not previously vaccinated against tetanus.

8.4.10.1. The course of vaccination consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.

8.4.10.2. The first revaccination with ADS-anatoxin is carried out once every 9-12 months. after completed vaccination.

8.4.11. ADS-M toxoid is used:

for revaccination of children against tetanus at 7 years, 14 years and adults without age limit every 10 years;

for tetanus vaccination of children from 6 years of age who have not previously been vaccinated against tetanus.

8.4.11.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. If it is necessary to increase the interval, the next vaccination should be carried out as soon as possible.

8.4.11.2. The first revaccination is carried out with an interval of 6-9 months. after completed vaccination once. Subsequent revaccinations are carried out in accordance with the national calendar.

8.4.11.3. Vaccinations with ADS-M-anatoxin can be carried out simultaneously with other vaccinations of the calendar. Vaccinations are carried out with different syringes in different parts of the body.

8.5. Immunization against measles, rubella, mumps

8.5.1. The WHO program provides:

· global elimination of measles by 2007;

· prevention of cases of congenital rubella, the elimination of which, according to the WHO goal, is expected in 2005;

Reducing the incidence of mumps to a level of 1.0 or less per 100,000 population by 2010.

This will be possible when reaching at least 95% vaccination coverage of children by 24 months. of life and revaccination against measles, rubella and mumps in children aged 6 years.

8.5.2. Vaccinations against measles, rubella and mumps are subject to children over the age of 12 months who have not had these infections.

8.5.3. Revaccination is subject to children from 6 years of age.

8.5.4. Rubella vaccination is for girls aged 13 years who have not previously been vaccinated or who have received one vaccination.

8.5.5. Vaccination and revaccination against measles, rubella, mumps is carried out with monovaccines and combined vaccines (measles, rubella, mumps).

8.5.6. The drugs are administered once subcutaneously at a dose of 0.5 ml under the shoulder blade or in the shoulder area. Simultaneous administration of vaccines with different syringes to different parts of the body is allowed.

8.6. Immunization against polio

8.6.1. WHO's global goal is to eradicate poliomyelitis by 2005. Achievement of this goal is possible with coverage of three vaccinations of children 12 months old. life and revaccinations of children 24 months. life of at least 95%.

8.6.2. Vaccinations against polio are carried out with a live oral polio vaccine.

8.6.3. Vaccinations are subject to children from 3 months of age. Vaccination is carried out 3 times with an interval of 45 days. Shortening intervals is not allowed. When prolonging the intervals, vaccinations should be carried out as soon as possible.

8.6.4. The first revaccination is carried out at the age of 18 months, the second revaccination - at the age of 20 months, the third revaccination - at 14 years.

8.6.5. Polio vaccinations can be combined with other routine vaccinations.

8.7. Immunization against viral hepatitis B

8.7.1. The first vaccination is given to newborns in the first 12 hours of life.

8.7.2. The second vaccination is given to children at the age of 1 month.

8.7.3. The third vaccination is given to children at the age of 6 months.

8.7.4. Children born to mothers who are carriers of the hepatitis B virus or patients with viral hepatitis B in the third trimester of pregnancy are vaccinated against hepatitis B according to the scheme 0 - 1 - 2 - 12 months.

8.7.5. Vaccination against hepatitis B in children at the age of 13 is carried out previously not vaccinated according to the scheme 0 - 1 - 6 months.

8.7.7. The vaccine is administered intramuscularly to newborns and young children in the anterolateral part of the thigh, to older children and adolescents in the deltoid muscle.

8.7.8. The dosage of the vaccine for vaccination of persons of different ages is carried out in strict accordance with the instructions for its use.

8.8. Immunization against tuberculosis

8.8.1. All newborns in the maternity hospital on the 3-7th day of life are subject to vaccination against tuberculosis.

8.8.2. Revaccination against tuberculosis is carried out in tuberculin-negative children not infected with Mycobacterium tuberculosis.

8.8.3. The first revaccination is carried out for children at the age of 7 years.

8.8.4. The second revaccination against tuberculosis at the age of 14 is carried out for tuberculin-negative children not infected with Mycobacterium tuberculosis, who have not received the vaccination at the age of 7.

8.8.5. Vaccination and revaccination is carried out with a live anti-tuberculosis vaccine (BCG and BCG-M).

8.8.6. The vaccine is injected strictly intradermally at the border of the upper and middle thirds of the outer surface of the left shoulder. The inoculation dose contains 0.05 mg BCG and 0.02 mg BCG-M in 0.1 ml of solvent. Vaccination and revaccination is carried out with one gram or tuberculin disposable syringes with fine needles (No. 0415) with a short cut.

9. The procedure for conducting preventive vaccinations according to epidemic indications

In the event of a threat of the emergence of infectious diseases, prophylactic vaccinations according to epidemic indications are carried out for the entire population or certain professional groups, contingents living or arriving in territories that are endemic or enzootic for plague, brucellosis, tularemia, anthrax, leptospirosis, tick-borne spring-summer encephalitis. The list of works, the performance of which is associated with a high risk of infection with infectious diseases and requires mandatory preventive vaccinations, was approved by Decree of the Government of the Russian Federation dated July 17, 1999 No. 825.

Immunization according to epidemic indications is carried out by decision of the centers of the State Sanitary and Epidemiological Surveillance in the constituent entities of the Russian Federation and in agreement with the health authorities.

Endemic territory (with respect to human diseases) and enzootic (with respect to diseases common to humans and animals) are considered to be a territory or group of territories with a constant confinement of an infectious disease due to specific, local, natural and geographical conditions necessary for the constant circulation of the pathogen.

The list of enzootic territories is approved by the Ministry of Health of Russia on the proposal of the centers of the State Sanitary and Epidemiological Surveillance in the constituent entities of the Russian Federation.

Emergency immunoprophylaxis is carried out by decision of the bodies and institutions of the state sanitary and epidemiological service and local health authorities in the constituent entities of the Russian Federation.

9.1. Plague Immunoprophylaxis

9.1.1. Preventive measures aimed at preventing infection of people in natural foci of plague are provided by anti-plague institutions in cooperation with territorial institutions of the state sanitary and epidemiological service.

9.1.2. Vaccination against plague is carried out on the basis of the presence of an epizootic of plague among rodents, the identification of plague-stricken domestic animals, the possibility of importing an infection by a sick person, and an epidemiological analysis conducted by an anti-plague institution. The decision on immunization is made by the Chief State Sanitary Doctor for the subject of the Russian Federation in agreement with the health authorities.

9.1.3. Immunization is carried out in a strictly limited area for the entire population from the age of 2 or selectively threatened contingents (livestock breeders, agronomists, employees of geological parties, farmers, hunters, purveyors, etc.).

9.1.4. Vaccinations are carried out by medical workers of the district network or specially organized vaccination teams with instructive and methodological assistance from anti-plague institutions.

9.1.5. The plague vaccine provides immunity to those vaccinated for up to 1 year. Vaccination is carried out once, revaccination - after 12 months. after the last vaccination.

9.1.6. Measures to prevent the importation of plague from abroad are regulated by the sanitary and epidemiological rules SP 3.4.1328-03 "Sanitary protection of the territory of the Russian Federation".

9.1.7. Preventive vaccinations are controlled by anti-plague institutions.

9.2. Immunoprophylaxis of tularemia

9.2.1. Vaccinations against tularemia are carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Supervision in coordination with local health authorities.

9.2.2. Planning and selection of contingents to be vaccinated is carried out differentially, taking into account the degree of activity of natural foci.

9.2.3. Distinguish between scheduled and unscheduled vaccination against tularemia.

9.2.4. Scheduled vaccination from the age of 7 is carried out for the population living in the territory with the presence of active natural foci of the steppe, name-bog (and its variants), foothill-stream types.

In foci of the meadow-field type, vaccinations are carried out for the population from the age of 14, with the exception of pensioners, the disabled, people who are not engaged in agricultural work and who do not have livestock for personal use.

9.2.4.1. On the territory of natural foci of tundra, forest types, vaccinations are carried out only in risk groups:

hunters, fishermen (and members of their families), reindeer herders, shepherds, field farmers, meliorators;

Persons sent for temporary work (geologists, prospectors, etc.).

9.2.4.2. In cities directly adjacent to active foci of tularemia, as well as in areas with low-active natural foci of tularemia, vaccinations are carried out only for workers:

grain and vegetable stores;

Sugar and alcohol factories;

hemp and flax plants;

feed shops;

· livestock and poultry farms working with grain, fodder, etc.;

hunters (members of their families);

Procurers of skins of game animals;

workers of fur factories engaged in the primary processing of skins;

employees of departments of especially dangerous infections of the centers of the State Sanitary and Epidemiological Surveillance, anti-plague institutions;

employees of deratization and disinfection services;

9.2.4.3. Revaccination is carried out after 5 years for contingents subject to routine immunization.

9.2.4.4. Cancellation of scheduled vaccinations is allowed only on the basis of materials indicating the absence of circulation of the causative agent of tularemia in the biocenosis for 10-12 years.

9.2.4.5. Vaccination according to epidemic indications is carried out:

· in settlements located in territories that were previously considered safe for tularemia, when people fall ill (when registering even single cases) or when tularemia cultures are isolated from any objects;

in settlements located on the territories of active natural foci of tularemia, when a low immune layer is detected (less than 70% in meadow-field foci and less than 90% in swamp foci);

In cities directly adjacent to active natural foci of tularemia, contingents at risk of infection - members of horticultural cooperatives, owners (and members of their families) of personal auto and water transport, water transport workers, etc .;

· in the territories of active natural foci of tularemia - to persons who come for permanent or temporary work, - to hunters, foresters, meliorators, surveyors, peat miners, fur skins (water rats, hares, muskrats), geologists, members of scientific expeditions; persons sent for agricultural, construction, survey or other work, tourists, etc.

Vaccination of the above contingents is carried out by healthcare organizations in the places of their formation.

9.2.5. In special cases, persons at risk of contracting tularemia must undergo emergency antibiotic prophylaxis, after which, but not earlier than 2 days after it, they are vaccinated with a tularemia vaccine.

9.2.6. Simultaneous skin vaccination of adults against tularemia and brucellosis, tularemia and plague on different parts of the outer surface of a third of the shoulder is allowed.

9.2.7. The tularemia vaccine provides, 20 to 30 days after vaccination, the development of immunity lasting 5 years.

9.2.8. Monitoring the timeliness and quality of vaccination against tularemia, as well as the state of immunity, is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision by sampling the adult working population using a tularin test or serological methods at least 1 time in 5 years

9.3. Immunoprophylaxis of brucellosis

9.3.1. Vaccinations against brucellosis are carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Supervision in coordination with local health authorities. An indication for vaccination of people is the threat of infection with a goat-sheep species pathogen, as well as the migration of Brucella of this species to cattle or other animal species.

9.3.2. Vaccinations are carried out from the age of 18:

· permanent and temporary livestock workers - until the complete elimination of animals infected with goat-sheep species brucella in farms;

· personnel of organizations for the procurement, storage, processing of raw materials and livestock products - until the complete elimination of such animals in the farms from where livestock, raw materials and livestock products come from;

workers of bacteriological laboratories working with live cultures of brucella;

employees of organizations for the slaughter of livestock affected by brucellosis, the procurement and processing of livestock products obtained from it, veterinary workers, livestock specialists in farms enzootic for brucellosis.

9.3.3. Persons with clear negative serological and allergic reactions to brucellosis are subject to vaccination and revaccination.

9.3.4. When determining the timing of vaccinations, workers in livestock farms must be strictly guided by the data on the time of lambing (early lambing, scheduled, unscheduled).

9.3.5. Brucellosis vaccine provides the highest intensity of immunity for 5-6 months.

9.3.6. Revaccination is carried out after 10-12 months. after vaccination.

9.3.7. Control over the planning and implementation of immunization is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.4. Immunoprophylaxis of anthrax

9.4.1. Immunization of people against anthrax is carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Supervision in coordination with local health authorities, taking into account epizootological and epidemiological indications.

9.4.2. Vaccinations are subject to persons from the age of 14 who perform the following works in the territories enzootic for anthrax:

· agricultural, irrigation and drainage, surveying, forwarding, construction, excavation and movement of soil, procurement, commercial;

· on slaughter of cattle suffering from anthrax, procurement and processing of meat and meat products obtained from it;

with live cultures of the anthrax pathogen or with material suspected of being contaminated by the pathogen.

9.4.3. Vaccination is not recommended for persons who had contact with animals with anthrax, raw materials and other products infected with the anthrax pathogen against the background of an epidemic outbreak. They are given emergency prophylaxis with antibiotics or anthrax immunoglobulin.

9.4.4. Revaccination with anthrax vaccine is carried out after 12 months. after the last vaccination.

9.4.5. Control over the timeliness and completeness of coverage of contingents with immunization against anthrax is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.5. Immunoprophylaxis of tick-borne encephalitis

9.5.1. Vaccinations against tick-borne encephalitis are carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Supervision in coordination with local health authorities, taking into account the activity of the natural focus and epidemiological indications.

9.5.2. Proper planning and careful selection of populations at high risk of infection ensures the epidemiological effectiveness of vaccination.

9.5.3. Vaccinations against tick-borne encephalitis are subject to:

· population from 4 years of age living in enzootic territories for tick-borne encephalitis;

· Persons arriving in the territory, enzootic for tick-borne encephalitis, and performing the following work - agricultural, hydro-reclamation, construction, geological, surveying, forwarding; excavation and movement of soil; procurement, trade; deratization and disinsection; on logging, clearing and landscaping of forests, zones of improvement and recreation of the population; with live cultures of the causative agent of tick-borne encephalitis.

9.5.4. The maximum age of the vaccinated is not regulated, it is determined in each case, based on the appropriateness of vaccination and the state of health of the vaccinated.

9.5.5. In case of violation of the vaccination course (lack of a documented full-fledged course), the vaccination is carried out according to the primary vaccination scheme.

9.5.6. Revaccination is carried out after 12 months, then every 3 years.

9.5.7. Control over the planning and implementation of immunization against tick-borne encephalitis is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.6. Immunoprophylaxis of leptospirosis

9.6.1. Vaccinations against leptospirosis are carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Supervision in coordination with local health authorities, taking into account the epidemiological situation and the epizootic situation. Preventive vaccination of the population is carried out from the age of 7 according to epidemiological indications. The contingents of risk and the timing of immunization are determined by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.6.2. Persons with an increased risk of infection who perform the following work are subject to immunization:

· procurement, storage, processing of raw materials and livestock products obtained from farms located in areas enzootic for leptospirosis;

· on slaughter of cattle suffering from leptospirosis, harvesting and processing of meat and meat products obtained from it;

· on catching and keeping neglected animals;

with live cultures of the causative agent of leptospirosis;

sent for construction and agricultural work to places of active natural and anthropurgic foci of leptospirosis (but not later than 1 month before the start of work in them).

9.6.4. Revaccination against leptospirosis is carried out after 12 months. after the last vaccination.

9.6.5. Control over immunization against leptospirosis of contingents at risk of infection and the population as a whole is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.7. Immunoprophylaxis of yellow fever

9.7.1. A number of countries with yellow fever enzootic territories require international yellow fever vaccination or revaccination certificates from persons traveling to these territories.

9.7.2. Vaccinations are subject to adults and children, starting from the age of 9 months, traveling abroad to areas enzootic for yellow fever.

9.7.3. Vaccination is carried out no later than 10 days before departure to the enzootic area.

9.7.4. Persons working with live cultures of the causative agent of yellow fever are subject to vaccination.

9.7.5. For persons over 15 years of age, yellow fever vaccination can be combined with cholera vaccination, provided that the drugs are injected into different parts of the body with different syringes, otherwise the interval should be at least one month.

9.7.6. Revaccination is carried out 10 years after the first vaccination.

9.7.7. Vaccinations against yellow fever are carried out only in vaccination stations at polyclinics under the supervision of a doctor with the obligatory issuance of an international certificate of vaccination and revaccination against yellow fever.

9.7.8. The presence of an international certificate of vaccination against yellow fever is checked by officials of sanitary and quarantine points when crossing the state border in case of departure to countries that are unfavorable in terms of the incidence of yellow fever.

9.8. Q fever immunoprophylaxis

9.8.1. Vaccinations against Q fever are carried out by decision of the territorial centers of the State Sanitary and Epidemiological Surveillance in coordination with local health authorities, taking into account the epidemiological and epizootic situation.

9.8.2. Vaccinations are carried out for persons aged 14 years in areas unfavorable for Q fever, as well as for professional groups performing work:

· for procurement, storage, processing of raw materials and livestock products obtained from farms where diseases of Q fever in small and large cattle are recorded;

· for procurement, storage and processing of agricultural products in enzootic territories for Q fever;

for the care of sick animals (persons who have recovered from Q fever or who have a positive complement fixation test (CFR) in a dilution of at least 1:10 and (or) a positive indirect immunofluorescence test (RNIF) in a titer of at least 1:40);

working with live cultures of Q fever pathogens.

9.8.3. Vaccination against Q fever can be carried out simultaneously with vaccination with live brucellosis vaccine with different syringes in different hands.

9.8.4. Revaccination against Q fever is carried out after 12 months.

9.8.5. Control over the immunization against Q fever of the subject contingents is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.9. Immunoprophylaxis of rabies

9.9.1. Vaccinations against rabies are carried out by decision of the territorial centers of the State Sanitary and Epidemiological Supervision in coordination with local health authorities.

9.9.2. Vaccinations against rabies from the age of 16 are subject to:

Persons performing work on catching and keeping neglected animals;

working with "street" rabies virus;

· veterinarians, hunters, foresters, slaughterhouse workers, taxidermists.

9.9.3. Revaccination is carried out after 12 months. after vaccination, then every 3 years.

9.9.4. Persons at risk of infection with the rabies virus undergo a course of therapeutic and prophylactic immunization in accordance with the regulatory and methodological documents for the prevention of rabies.

9.9.5. Control over the immunization of eligible contingents and persons at risk of infection with the rabies virus is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.10. Immunoprophylaxis of typhoid fever

Preventive vaccinations against typhoid fever are carried out from the age of 3 to the population living in areas with a high incidence of typhoid fever, revaccination is carried out after 3 years.

9.11. Influenza Immunoprophylaxis

9.11.1. Influenza immunoprophylaxis can significantly reduce the risk of the disease, prevent negative consequences and effects on public health.

9.11.2. Influenza vaccination is carried out for persons at increased risk of infection (over 60 years of age, suffering from chronic somatic diseases, often ill with acute respiratory infections, preschool children, schoolchildren, medical workers, workers in the service sector, transport, educational institutions).

9.11.3. Any citizen of the country can receive a flu shot at will, if he has no medical contraindications.

9.11.4. Influenza vaccinations are carried out annually in the fall (October-November) during the pre-epidemic influenza period by decision of the territorial centers of the State Sanitary and Epidemiological Supervision.

9.12. Immunoprophylaxis of viral hepatitis A

9.12.1. Vaccinations against hepatitis A are subject to:

children from 3 years of age living in areas with a high incidence of hepatitis A;

medical workers, educators and staff of preschool institutions;

workers in the public service sector, primarily employed in public catering organizations;

Workers for the maintenance of water and sewer facilities, equipment and networks;

Persons traveling to hyperendemic regions of Russia and the country for hepatitis A;

Persons who have been in contact with the patient (patients) in the foci of hepatitis A.

9.12.2. The need for immunization against hepatitis A is determined by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.12.3. Control over immunization against hepatitis A is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.13. Immunoprophylaxis of viral hepatitis B

9.13.1. Vaccinations against hepatitis B are carried out:

children and adults who have not been previously vaccinated, in whose families there is a carrier of HbsAg or a patient with chronic hepatitis;

children of orphanages, orphanages and boarding schools;

children and adults who regularly receive blood and its preparations, as well as those on hemodialysis and oncohematological patients;

Persons who have come into contact with material infected with the hepatitis B virus;

healthcare workers who have contact with the blood of patients;

Persons involved in the production of immunobiological preparations from donor and placental blood;

students of medical institutes and students of secondary medical schools (primarily graduates);

Persons who inject drugs.

9.13.2. The need for immunization is determined by the territorial centers of the State Sanitary and Epidemiological Supervision, exercising subsequent control over immunization.

9.14. Immunoprophylaxis of meningococcal infection

9.14.1. Vaccinations against meningococcal infection are carried out:

children over 2 years old, adolescents, adults in the foci of meningococcal infection caused by meningococcus serogroup A or C;

Persons at increased risk of infection - children from preschool institutions, students in grades 1-2 of schools, adolescents in organized groups united by living in hostels; children from family dormitories located in unfavorable sanitary and hygienic conditions with a 2-fold increase in the incidence compared to the previous year.

9.14.2. The need for immunization against meningococcal infection is determined by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.14.3. Control over the implementation of immunoprophylaxis is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.15. Immunoprophylaxis of mumps

9.15.1. Vaccinations against mumps are carried out in contact with the patient (sick) in the foci of mumps to persons aged 12 months. up to 35 years old, previously not vaccinated or once vaccinated and not sick with this infection.

9.15.2. Vaccinations according to epidemic indications in the foci of mumps are carried out no later than the 7th day from the moment the first case of the disease is detected in the outbreak.

9.15.3. Control over the implementation of immunoprophylaxis is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.16. Immunoprophylaxis of measles

9.16.1. Vaccinations against measles are carried out in contact with the patient (sick) in the foci of measles to persons aged 12 months and older. up to 35 years old, previously not vaccinated or once vaccinated and not sick with this infection.

9.16.2. Vaccinations according to epidemic indications in measles foci are carried out no later than 72 hours from the moment the first case of the disease is detected in the foci.

9.16.3. Control over the implementation of immunoprophylaxis is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.17. Immunoprophylaxis of diphtheria

9.17.1. Vaccinations against diphtheria are carried out to persons not previously vaccinated against diphtheria who have been in contact with a source of the infectious agent in the foci of this infection.

9.17.2. Control over the implementation of immunoprophylaxis is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

9.18. Immunoprophylaxis of cholera

9.18.1. Vaccinations against cholera are carried out by decision of the executive authority in the field of sanitary and epidemiological welfare of the population:

· to the population from the age of 2 living in the border regions of Russia in the event of an unfavorable cholera situation in the adjacent territory;

persons traveling to cholera-prone countries.

9.18.2. Revaccination is carried out after 6 months.

9.18.3. Control over the immunization of the population is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.

10. Procedure for registration of preventive vaccinations

10.1. The procedure for registration of preventive vaccinations and registration of refusal to carry out preventive vaccinations is the same and mandatory for all healthcare organizations, regardless of organizational and legal forms and forms of ownership.

10.2. The correctness and reliability of the registration of vaccinations is ensured by the medical worker conducting the vaccinations.

10.3. The results of the examination of the patient before vaccination are entered into the history of the child's development (f. 112 / y), the child's medical record (f. 026 / y) or (depending on the age of the patient) the outpatient medical record (f. 025 / y)

10.4. The following information about the performed prophylactic vaccination is subject to accounting: date of administration of the drug, name of the drug, batch number, dose, control number, expiration date, nature of the reaction to the injection. The following data is entered into the registration forms of medical documents:

for children - a card of preventive vaccinations (f. 063 / y), a history of the development of the child (f. 112 / y), a certificate of preventive vaccinations (f. 156 / e-93), a child's medical card (for schoolchildren) (f. 026 /y);

For adolescents - an insert sheet for a teenager to the outpatient medical record (f. 025-1 / y), a certificate of preventive vaccinations (f. 156 / e-93), a child's medical record (for schoolchildren) (f. 026 / y) ;

In adults - an outpatient card of the patient (f. 025 / y), a register of preventive vaccinations (f. 064 / y), a certificate of preventive vaccinations (f. 156 / e-93).

The information entered in the certificate of preventive vaccinations (f. 156 / e-93) is certified by the signature of a medical worker and the seal of the medical organization.

10.5. All cases of uncomplicated strong local (including edema, hyperemia > 8 cm in diameter) and strong general (including temperature > 40 °, febrile convulsions) reactions to the vaccine, mild manifestations of skin and respiratory allergies are recorded in accounting forms of medical documents specified in clause 10.5.

10.6. A report on the vaccinations carried out by a medical and preventive organization is compiled in accordance with the instructions for filling out Form No. 5 of the Federal State Statistical Observation “Report on preventive vaccinations” (quarterly, annual) and Form No. 6 of the Federal State Statistical Observation “Information on the contingents of children, adolescents and adults vaccinated against infectious diseases as of December 31 of the past year.

11 . Registration of refusal of preventive vaccinations

11.1. In accordance with the Federal Law of September 17, 1998 No. 157-FZ “On Immunoprophylaxis of Infectious Diseases”, citizens have the right to refuse preventive vaccinations, and in case of refusal of preventive vaccinations, citizens are required to confirm it in writing.

11.2. A medical worker of a medical and preventive organization serving the children's population is obliged, in case of refusal of immunization, to warn the child's parents about the possible consequences:

temporary refusal to admit a child to educational and health institutions in case of mass infectious diseases or the threat of epidemics;

11.3. The district therapist or the doctor of the teenage office is obliged to warn the citizen (teenager, adult) about the following consequences of refusing preventive vaccinations:

Refusal to hire or dismissal from work, the performance of which is associated with a high risk of contracting infectious diseases;

· a ban on travel to countries where stay in accordance with international health regulations or international treaties of the Russian Federation requires specific preventive vaccinations.

11.4. Refusal to carry out vaccinations is made in writing. For this purpose, a medical worker of a medical and preventive organization makes an appropriate entry (with a mandatory note of a warning about the consequences) in medical documents - the history of the development of the child (f. 112 / y) or the history of the development of the newborn (f. 097 / y); medical record of the child (f. 026 / y); outpatient medical record (f. 025-87). Citizens, parents or other legal representatives of minors are required to put their signature under the record of refusal from preventive vaccination.

12 . Bibliographic data

1. Federal Law No. 52-FZ of March 30, 1999 "On the sanitary and epidemiological well-being of the population."

2. Federal Law No. 157-FZ of September 17, 1998 "On Immunoprophylaxis of Infectious Diseases".

3. Sanitary and epidemiological rules SP 3.1.958-99 “Prevention of viral hepatitis. General requirements for epidemiological surveillance of viral hepatitis”.

4. Sanitary and epidemiological rules SP 3.1.2.1108-02 "Diphtheria prevention".

5. Sanitary and epidemiological rules SP 3.1.1.1118-02 "Prevention of poliomyelitis".

6. Sanitary and epidemiological rules SP 3.1.2.1176-02 "Prevention of measles, rubella and mumps".

7. Sanitary and epidemiological rules SP 3.3.2.1248-03 "Conditions for the transportation and storage of medical immunobiological preparations".

8. Sanitary and epidemiological rules SP 3.1.1295-03 "Prevention of tuberculosis".

9. Sanitary and epidemiological rules SP 3.1.2.1319-03 "Influenza prevention". Sanitary and epidemiological rules SP 3.1.2.1382-03. Additions and changes to SP 3.1.2.1319-03 "Influenza Prevention".

10. Sanitary and epidemiological rules SP 3.1.2.1320-03 "Prevention of pertussis infection".

11. Sanitary and epidemiological rules SP 3.1.2.1321-03 "Prevention of meningococcal infection".

12. Sanitary and epidemiological rules SP 3.4.1328-03 "Sanitary protection of the territories of the Russian Federation".

14. Sanitary and epidemiological rules SP 3.1.7.13 80-03 "Plague prevention".

15. Sanitary and epidemiological rules SP 3.1.1381-03 "Tetanus prevention".

16. Sanitary rules and norms SanPiN 2.1.7.728-99 "Rules for the collection, storage and disposal of waste from medical institutions."

17. Order of the Ministry of Health of the Russian Federation No. 229 dated June 27, 2001 “On the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications”.

18. Order of the Ministry of Health of the Russian Federation No. 25 dated January 25, 1998 “On strengthening measures to prevent influenza and other acute respiratory viral infections”.

19. Order of the Ministry of Health of the Russian Federation No. 24 dated January 25, 1999 “On strengthening the work on the implementation of the polio eradication program in the Russian Federation by the year 2000”.

20. Order of the Ministry of Health of Russia dated July 29, 1998 No. 230 "On increasing the readiness of bodies and institutions of the State Sanitary and Epidemiological Service of Russia to work in emergency situations."

21. Federal target program "Vaccinal prophylaxis for 1999 - 2000 and for the period up to 2005".

22. Instructions for the preparation of state statistical reporting in the form No. 5 "Report on preventive vaccinations", No. 01-19 / 18-10 dated 02.10.92, "Information on preventive vaccinations", form No. 5, Goskomstat of Russia No. 152 dated 14.09. 95.

23. Instructions for the preparation of state statistical reporting in the form No. 6 "On the contingents of children, adolescents and adults vaccinated against infectious diseases", No. 10-19 / 18-10 dated 09.21.95.