Rules for the vaccination of children. Routes of administration of vaccines. National calendar of preventive vaccinations

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Today vaccinations have already firmly entered our lives as a highly effective means of preventing dangerous infectious diseases, which has negative consequences in the form of complications, or even death. In modern medical practice, they are made either to form immunity to dangerous infections, or to treat an infected person at an early stage. Accordingly, all vaccinations are usually divided into preventive and therapeutic. Basically, a person is faced with preventive vaccinations that are given in childhood, and then re-immunized if necessary. An example of a curative vaccination is the introduction of tetanus toxoid, etc.

What are preventive vaccinations?

Preventive vaccinations are a method of immunizing a person against certain infectious diseases, during which various particles are introduced into the body that can lead to the development of a stable immunity to pathology. All preventive vaccinations involve the introduction of a vaccine, which is an immunobiological preparation.

The vaccine is a weakened whole microbes - pathogens, parts of the membranes or genetic material of pathogenic microorganisms, or their toxins. These components of the vaccine cause a specific immune response, during which antibodies are produced against the causative agent of an infectious disease. Subsequently, it is these antibodies that provide protection against infection.

To date, all preventive vaccinations are classified into:
1. Planned.
2. Conducted according to epidemiological indications.

Scheduled vaccinations are given to children and adults at a specific time and at a specific age, regardless of whether an epidemic focus of infection has been identified in a given region or not. And vaccination according to epidemiological indications is done to people who are in a region in which there is a danger of an outbreak of a dangerous infectious disease (for example, anthrax, plague, cholera, etc.).

Among the planned vaccinations, there are mandatory for everyone - they are included in the national calendar (BCG, MMR, DTP, against polio), and there is a category of vaccines that are administered only to people at risk of contracting infections due to the specifics of their work (for example, against typhoid, tularemia , brucellosis, rabies, plague, etc.). All scheduled vaccinations are carefully worked out, the timing of their setting, age and time are set. There are developed schemes for the introduction of vaccine preparations, the possibility of combining and the sequence of immunization, which is reflected in the regulations and guidelines, as well as in the vaccination schedules.

Preventive vaccination of children

For children, preventive vaccinations are necessary to protect vulnerable babies from dangerous infectious diseases that can be fatal even when treated with modern high-quality drugs. The entire list of preventive vaccinations for children is developed and approved by the Ministry of Health of Russia, and then, for ease of use, is drawn up in the form of a national calendar.

In addition to those indicated in the national calendar, there are a number of preventive vaccines that are recommended for children. The recommendation to vaccinate is given by the child's attending physician on the basis of an analysis of the state of health. In some regions, they also introduce their own vaccinations, which are necessary, since the epidemiological situation for these infections is unfavorable, and there is a risk of an outbreak.

Preventive vaccinations for children - video

The value of preventive vaccinations

Despite the different structure of possible components for a particular vaccine, any vaccine is able to form immunity to infection, reduce the incidence and prevalence of pathology, which is its main purpose. The active components of the drugs, in response to the introduction into the body of any person, cause a reaction from his immune system. This reaction is in all respects similar to that which develops when infected with an infectious disease, but much weaker. The meaning of such a weak reaction of the immune system in response to the administration of the drug is that special cells are formed, which are called memory cells, which provide further immunity to infection.

Memory cells can be stored in the human body for a different period of time - from several months to many years. Memory cells that live only a few months are short-lived, but vaccination is necessary to form a different type of memory cell - long-lived. Each such cell is formed only in response to a specific pathogen, that is, a cell formed against rubella will not be able to provide immunity to tetanus.

For the formation of any memory cell - long or short-lived, a certain period of time is required - from several hours to a whole week. When the causative agent of the disease enters the human body for the first time, then all manifestations of the infection are due precisely to the activity of this microbe. During this period, the cells of the immune system "get acquainted" with the pathogenic microbe, after which the activation of B-lymphocytes occurs, which begin to produce antibodies that have the ability to kill the pathogen. Each microbe needs its own specific antibodies.

Recovery and relief of the symptoms of infection begins only from the moment when antibodies are produced and the destruction of the pathogenic microorganism begins. After the destruction of the microbe, some of the antibodies are destroyed, and some become short-lived memory cells. B-lymphocytes, which produced antibodies, go into the tissues and become the same memory cells. Subsequently, when the same pathogenic microbe enters the body, the memory cells against it are immediately mobilized, producing antibodies that quickly and effectively destroy the infectious agent. Since the pathogen is quickly destroyed, an infectious disease does not develop.

Against infections that the human body is able to cope with, it makes no sense to be vaccinated. But if the infection is dangerous, the mortality of sick people is very high - it is necessary to vaccinate. Vaccinations are simply a carrier of the antigen of the microbe - the pathogen, on which memory cells are produced. There are two possible outcomes when contracting a dangerous infection - recovery with the formation of immunity, or death. Vaccination also ensures the formation of this immunity without a mortal risk and the need to endure a severe course of infection with extremely painful symptoms.

Quite naturally, in response to vaccination, the process of formation of memory cells during the activation of the immune system is accompanied by a number of reactions. The most common reactions are at the injection site, and some are common (for example, fever for several days, weakness, malaise, etc.).

List of preventive vaccinations

So, today in Russia the list of preventive vaccinations includes the following vaccines, which are given to children and adults:

against hepatitis B;
against tuberculosis - only for children;
... tetanus;
... Haemophilus influenzae;
... poliomyelitis;
... rubella;
... mumps (mumps);
... meningococcal infection;
... tularemia;
... tetanus;
... plague;
... brucellosis;
... anthrax;
... rabies;
... tick-borne encephalitis;
... Q fever;
... yellow fever;
... cholera;
... typhus;
... hepatitis A;
... shigellosis.

This list includes mandatory vaccinations that are given to all people, and those performed according to epidemiological indications. Epidemiological indications can be different - for example, living or temporarily staying in the focus of an outbreak of a dangerous infection, leaving for regions with an unfavorable situation, or working with dangerous microbes - pathogens or with livestock, which is a carrier of a number of pathologies.

National calendar of preventive vaccinations (2013, 2012, 2011)

The vaccination schedule is compiled and approved based on the significance of the infections against which vaccination is carried out, as well as the availability of drugs. The calendar may be revised if any circumstances change - for example, the emergence of new vaccines that have different rules for use, or the risk of an outbreak that requires urgent and urgent immunization.

In Russia, a vaccination calendar for children and adults has been approved, which is valid throughout the country. This calendar has not changed in recent years, so for 2011, 2012 and 2013 it is the same. Vaccinations included in this calendar are performed for all people. Vaccines from the national calendar are shown in the table:

Vaccine	Age at which vaccination is given
Against hepatitis B	The first day after birth, at 1 month, at 2 months, at half a year, at a year, then every 5-7 years
Against tuberculosis (BCG)	Children on 3 - 7 days after birth, at 7 years old, at 14 years old
Against diphtheria, whooping cough and tetanus (DPT)	At 3 months, at 4 - 5 months, at six months, at one and a half years, at 6 - 7 years, at 14 years, at 18 years
Against Haemophilus influenzae	At 3 months, at 4-5 months, at six months, at one and a half years
Against polio	At 3 months, at 4-5 months, at six months, at one and a half years, at 20 months, at 14 years
Against measles, rubella and mumps	At 1 year old, at 6 years old
Rubella	From 11 years old every five years until the age of 18 for boys and up to 25 years for girls
against measles	At 15-17 years old, then every five years until age 35
Against the flu	Children from the age of 6 months, vaccinated every year

These vaccinations are given to all children at the specified time. If vaccination has not been carried out, then the dates are postponed taking into account the condition of the child, but the scheme of procedures remains the same.

Regional calendar of preventive vaccinations

The regional calendar of preventive vaccinations is developed and approved by the local authorities of the Ministry of Health, taking into account specific circumstances and the epidemiological situation. All vaccines from the national one must be included in the regional calendar of preventive vaccinations, and the necessary ones are added.

An individual program of preventive vaccinations for a child is developed and reflected in the following medical records:
1. Preventive vaccination card - form 063 / y.
2. The history of the development of the child - form 112 / y.
3. Medical card of the child - form 026 / y.
4. An insert for an outpatient medical record - form 025 / y (for adolescents).

These documents are created for each child living in the area, attending a kindergarten, school, college or college.

The preventive vaccination program is compiled separately for adults. This work is carried out by specialists - physicians from polyclinics. Preventive vaccinations for adults cover everyone who is eligible for vaccination, regardless of whether the person is working. Adults are included in the immunization plan based on the data on the vaccinations performed and their statute of limitations.

Carrying out preventive vaccinations

Preventive vaccinations can be carried out in a state medical institution (polyclinic), or in specialized centers for immunization of the population, or in private clinics licensed to carry out this type of medical manipulation. Preventive vaccinations are directly administered in the vaccination room, which must meet certain requirements and standards.

In institutions where the BCG vaccine is administered, it is necessary to have two vaccination rooms. One of them is designed exclusively to work with the BCG vaccine, and the other is for all other vaccinations.

The vaccination room must have:

sterile instruments and materials;
disposable syringes and needles for intradermal and intramuscular injections;
forceps (tweezers);
containers in which used tools and garbage are collected.

Also, there should be a sufficient number of tables in the office, each of which is intended for setting only one type of vaccine. The table must be marked, syringes, needles and sterile materials are prepared on it.

Any sterile material must be taken with sterile forceps, which are stored in containers with chloramine or chlorhexidine. The solution is changed daily, and the forceps and containers themselves are sterilized every day.

All used syringes, needles, ampoules, drug residues, cotton wool or swabs are thrown into a container with a disinfectant solution.

Organization and procedure for vaccination

The organization of preventive vaccinations and the procedure for their implementation was developed and prescribed in the Guidelines MU 3.3.1889-04, which were approved by the Chief State Sanitary Doctor of the Russian Federation on March 4, 2004. These rules are still valid today.

What kind of preventive vaccinations are given is prescribed in the national and regional calendars. For vaccination, all institutions use only registered domestic or imported drugs that are approved for use.

All preventive vaccinations are organized and carried out in accordance with the following requirements and instructions:

Any vaccination is carried out only in a specialized institution accredited to perform immunizations (vaccination rooms in polyclinics, kindergartens, schools, colleges, schools, health centers, FAPs).
If necessary, special teams are formed, and procedures are carried out at home.
Prophylactic vaccines are given only as prescribed by a doctor or paramedic.
Immediately before the planned vaccination, the data on the condition of the child or adult are carefully ascertained, on the basis of which permission is given for manipulation.
Before the planned immunization, the child or adult is examined by a doctor, the presence of contraindications, allergies or strong reactions to previously administered drugs is found out.
Before injection measure the temperature.
Before the planned vaccination, the necessary tests are given.
Vaccine injection is performed only with disposable syringes and needles.
Vaccinations can only be done by a specialist - a physician who owns injection techniques, as well as emergency care skills.
In the vaccination room, there is a mandatory kit for emergency care.
All vaccines must be stored according to the rules and regulations.
All documentation must be in the vaccination room.
In no case should vaccination be carried out in a treatment room or dressing room.
The vaccination room is cleaned twice a day, using disinfectant solutions.

Technique for preventive vaccinations

Preventive vaccinations must be carried out following a certain technique. General rules and methods for the introduction of prophylactic vaccines are determined by regulatory documents. So, the sequence of actions of a medical worker when administering a vaccine should correspond to the following plan:

1. The ampoule with the vaccine preparation is taken out of the refrigerator and its appearance is examined. It is necessary to fix the integrity of the ampoule, the labeling on the vial, as well as the quality of the liquid inside. Vaccine preparations must not contain flakes, lumps, turbidity, etc.
2. Ampoules are opened with sterile gloves in the cold.
3. The vaccine is administered exclusively with a disposable syringe and needle.
4. If several vaccines are administered at a time, it is necessary to inject each drug into different places, and collect the vaccine in a separate syringe.
5. The injection site is wiped with alcohol or other antiseptics.
6. The injection site of the BCG vaccine or Mantoux test is treated with ether.
7. The vaccine is administered to the patient in a sitting or lying position.
8. After the administration of the drug, the patient remains under observation for half an hour.

Journal of preventive vaccination

All vaccinations made by a medical worker must be entered in a special register. In case of loss of an individual card or moving to another place, all data can be restored by contacting the medical institution where the vaccination was performed, where they will make an extract from such logs stored in the archives. Also, based on the entries in the journal, preventive immunization plans are drawn up, in which the names of the people to be vaccinated are entered.

The preventive vaccination journal is a standard form of medical documentation 064 / y, which reflects the following data:

surname, name and patronymic of the person being vaccinated;
the patient's address;
year of birth;
place of study or work;
name of the vaccine preparation;
primary vaccination or revaccination;
method of vaccine administration (subcutaneously, intramuscularly, by mouth, etc.).

In addition, vaccination information is recorded for each patient, which takes into account the following data:
1. Date of administration, series of drug and dose.
2. All reactions that were observed after vaccination.
3. Any atypical manifestations or questionable points.

The register of preventive vaccinations is stitched, the pages are numbered. The form of the magazine is usually ordered from a printing house, which prints them according to a model approved by the Ministry of Health.

Immunization card, form 063

The vaccination card, form 063 / y, is a medical document that contains information about all vaccinations and biological tests performed. This document is often referred to simply as a "vaccination sheet". The document must record the date of vaccination, numbers and series of the drug.

The vaccination card is filled out by medical specialists in the clinic, FAP, school or kindergarten. Moreover, when conducting immunization at a school or kindergarten, other documentation can be used, from which information about vaccinations is transferred to the vaccination card in the form 063 / y. Vaccination sheet form 063 / y can be issued to the parents of the child if it is necessary to provide information about the availability of vaccinations for the baby to any authorities (for example, the visa department, hospitals, etc.). One copy of the vaccination list is stored in the archives of the medical institution for 5 years.

The preventive vaccination card is printed in a typographical way, and is filled out individually for each child.

Certificate

The certificate of preventive vaccinations is entered into the register of state documents, and has the form 156 / y - 93. Today, the vaccination certificate is a medical document that is maintained throughout a person's life. A certificate of preventive vaccinations is required for people traveling abroad, working in hazardous conditions or the food industry, as well as athletes, and for the implementation of scheduled medical examinations. Today in Russia there is no common federal database of vaccinations, so it is almost impossible to restore a lost certificate.

A certificate of preventive vaccinations is issued to a person in a maternity hospital, clinic, medical unit or health center. Each vaccination carried out is entered into the vaccination certificate, which displays the date, the name of the clinic, the signature of the medical worker who carried out the manipulation, and the seal of the healthcare institution is affixed. The vaccination certificate should not contain any blots or corrections. Any corrections or blank fields will invalidate the certificate. The document does not include contraindications or reasons for not vaccinating.

A vaccination certificate is required for admission to kindergarten, school, work, the army, when visiting a doctor, when undergoing treatment in a hospital. The certificate of preventive vaccinations must be kept by the owner until death.

Refusal of preventive vaccinations, sample form

To date, every adult, or guardian - a representative of a minor, has the right to refuse vaccination. The basis for this is provided by the Law of the Ministry of Health of the Russian Federation No. 157 F3 of September 17, 1998, Article 5. Regarding vaccinations for children, a parent can refuse them on the basis of the same law, only Article 11, which states that the child is vaccinated only with the consent of his legal representatives, that is, parents, guardians, etc.

Refusal of vaccinations must be submitted in writing to the head of the medical and preventive, preschool children's institution or school. A sample waiver form that can be used as a form and template is provided below:

Statement
I, ____________ full name, passport data ______________ refuse to do all preventive vaccinations (or indicate which specific vaccinations you refuse to do) to my child _______ full name of the child, date of birth _________, registered at polyclinic No. (or attending kindergarten No., or school No.). The legal basis is the legislation of the Russian Federation, namely "Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens" dated July 22, 1993 No. 5487-1, articles 32, 33 and 34 and "On the immunoprophylaxis of infectious diseases" dated September 17, 1998 No. 57 - Federal Law, articles 5 and 11.
Number
Signature with decryption

What does the lack of preventive vaccination entail?

The absence of preventive vaccinations entails the following consequences, according to the law of the Ministry of Health of the Russian Federation No. 157 F3 of September 17, 1998, article 5:
1. Prohibition for citizens to travel to countries where stay, in accordance with international health regulations or international treaties of the Russian Federation, requires specific preventive vaccinations.
2. Temporary refusal to admit citizens to educational and health institutions in case of mass infectious diseases, or in case of the threat of epidemics.
3. Refusal to hire citizens for work or removal of citizens from work, the performance of which is associated with a high risk of contracting infectious diseases. The list of works, the performance of which is associated with a high risk of contracting infectious diseases, requires mandatory preventive vaccinations, is established by the federal executive body authorized by the Government of the Russian Federation.

As can be seen from the law, a child or an adult may not be allowed to visit a children's institution, and an employee - to the workplace, if there are no vaccinations, and the epidemiological situation is unfavorable. In other words, when Rospotrebnadzor announces the danger of an epidemic, or the transition to quarantine, then unvaccinated children and adults are not allowed into groups. During the rest of the year, children and adults can work, study and attend kindergartens without restrictions.

Order on preventive vaccinations

Today, in Russia, there is an order No. 51n dated January 31, 2011 "On the approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications." It is according to this order that the current national vaccination calendar was approved.

Preventive vaccination in kindergarten

Children can be vaccinated individually or organized. Vaccinations are organized in an organized manner for children attending kindergartens and schools, where immunization specialists come with ready-made preparations. In this case, the health workers of the children's institution draw up vaccination plans, which include those children who need them. All information about the manipulations performed in kindergarten is recorded in a special vaccination sheet (form 063 / y) or in a medical record (form 026 / y - 2000).

Vaccinations in kindergarten are carried out only with the consent of the parents or other legal representatives of the child. If you wish to refuse vaccinations for your child, you must register your refusal in writing with the office of the institution, and notify the nurse.

Before use, you should consult with a specialist.

1. Preventive vaccinations are carried out in medical institutions of the state, municipal, private healthcare systems.

2. Responsible for organizing and conducting preventive vaccinations are the head of a medical institution and persons involved in private medical practice who conduct vaccinations. 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.

3. 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. Tarasovich.

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

5. To ensure the timely conduct of preventive vaccinations, the nurse, orally or in writing, invites persons to be vaccinated (parents of children or persons replacing them) to the medical institution on the day determined for vaccination: in a children's institution - informs the parents of children in advance, subject to preventive vaccination.

6. Before the prophylactic vaccination, a medical examination is carried out to exclude an acute disease, mandatory thermometry. In the medical documentation, a corresponding record of the doctor (paramedic) about the vaccination is made.

7. Preventive vaccinations are carried out in strict accordance with the indications and contraindications for their implementation in accordance with the instructions attached to the vaccine preparation.

8. Preventive vaccinations should be carried out in the vaccination rooms of polyclinics, children's preschool educational institutions, medical rooms of general education educational institutions (special educational institutions), health centers of enterprises with strict observance of sanitary and hygienic requirements. In certain situations, health authorities may decide to administer vaccinations at home or at the place of work.

9. The room where preventive vaccinations are carried out should include: a refrigerator, a cabinet for tools 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 drugs that are used for vaccinations.

11. Each grafted injection is carried out with a separate syringe and a separate needle (disposable syringes).

12. Vaccinations against tuberculosis and tuberculin diagnostics should be carried out in separate rooms, and in their absence - on a specially allocated table. A separate cabinet is used to accommodate syringes and needles used 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 to the child are not carried out.

13. Preventive vaccinations are carried out by medical workers who are trained in the rules for organizing and administering vaccinations, as well as emergency procedures in case of post-vaccination reactions and complications.

14. Seminars for doctors and paramedical workers on the theory of immunization and the technique of preventive vaccinations with mandatory certification should be held by the territorial health authorities at least once a year.

15. After the prophylactic vaccination, medical supervision must be provided for the period specified in the Instructions for the use of the corresponding vaccine preparation.

16. A record of the vaccination carried out is made in the work log of the vaccination room, the history of the development of the child (f. 112-y), the card of preventive vaccinations (f. 063-y), the medical record of a child attending a preschool educational institution, a general educational institution (f. 026-y), in the certificate of preventive vaccinations (f. 156/y-93). In this case, the necessary information is indicated: type of drug, dose, series, control number. In the case of using an imported drug, the original name of the drug in Russian is entered. The data entered in the certificate is certified by the signature of a doctor and the seal of a medical institution or a person engaged in private medical practice.

17. In medical documents, it is necessary to note the nature and timing of general and local reactions, if any.

18. With the development of an unusual reaction or complication to the introduction of the vaccine, it is necessary to immediately notify the head of the medical institution or a person engaged in private practice, and send an emergency notice (f-58) to the territorial center of the State Sanitary and Epidemiological Supervision.

19. The fact of refusal of vaccinations, with a note that the medical worker has given explanations about the consequences of such a refusal, is documented in the mentioned medical documents and signed by both the citizen and the medical worker.

Immunization calendar

Starting dates for vaccinations	Name of the vaccine
4-7 days	BCG or BCG-M
3 months
4 months	DPT, oral polio vaccine (OPV)
5 months	DPT, oral polio vaccine (OPV)
12-15 months	Vaccine against measles, mumps
18 months	DPT, oral polio vaccine - single dose
24 months	Oral polio vaccine - once
6 years	ADS-M, oral polio vaccine, measles, mumps, rubella* vaccine
7 years	BCG**
11 years	AD-M
14 years	BCG***
16-17 years old	ADS-M
adults once every 10 years	ADS-M (AD-M)

*Vaccination against measles, mumps and rubella is carried out with myovaccines or trivaccines (measles, rubella and mumps), subject to the production of domestic drugs or the purchase of foreign vaccines registered in the prescribed manner.
** Revaccination is carried out for children not infected with tuberculosis.
*** Revaccination is carried out for children who are not infected with tuberculosis and who have not received Irivovka at 7 years of age.
Preventive vaccinations must be carried out strictly within the time limits established by the Calendar of preventive vaccinations, combining the vaccines indicated for each age. If it is violated, other vaccinations can be carried out simultaneously with separate syringes in different parts of the body; for subsequent vaccinations, the minimum interval is four weeks.
To avoid contamination, it is unacceptable to combine on the same day vaccination against tuberculosis with other parenteral manipulations.
The introduction of gamma globulins is carried out in accordance with the instructions for their use.

False contraindications to preventive vaccinations

List of medical contraindications for preventive vaccinations

Vaccine	Contraindications
All vaccines	Severe reaction or complication to previous dose*
All live vaccines	Immunodeficiency state (primary), immunosuppression, malignancy, pregnancy
BCG vaccine	Child weighs less than 2000 g, colloidal scar after previous dose
OPV (oral polio vaccine)
DTP	Progressive disease of the nervous system, history of afebrile convulsions (instead of DTP, DTP is administered)
ADS, ADS-M	There are no absolute contraindications
ZHKV (live measles vaccine)	Severe reactions to aminoglycosides
ZhPV (live mumps vaccine)	Anaphylactic reactions to egg white
Rubella vaccine or trivaccine (measles, mumps, rubella)

Note. Scheduled vaccination is postponed until the end of acute manifestations of the disease and exacerbation of chronic diseases. In case of non-severe SARS, acute intestinal diseases, etc., vaccinations are carried out immediately after the temperature returns to normal.
* A strong reaction is the presence of a temperature above 40 ° C, at the injection site - edema, hyperemia > 8 cm in diameter, an anaphylactic shock reaction.

Vaccination centers where you can get vaccinated against viral hepatitis B

Polyclinic No. 119 for children
(m. "Yugo-Zapadnaya") Vernadsky Ave., 101, building 4, office. eight; 23; 24
Opening hours: 9-18.
Tel.: 433-42-16, 434-56-66

Polyclinic No. 103 for children
(m. "Yasenevo") st. Golubinskaya, 21, building 2
Tel.: 422-66-00

Medical center "Mayby" City Clinical Hospital No. 31
(m. "Prospect Vernadsky") st. Lobachevsky, 42
Opening hours: 9-17
Tel.: 431-27-95, 431-17-05

Det. polyclinic No. 118
"Northern Butovo"; "Kondivaks" (m. "South") st. Kulikovskaya, 1-b
Tel.: 711-51-81, 711-79-18

Diavax LLC
(m. "Shabolovskaya", "Dobryninskaya") st. Lesteva, 5/7 (kennel No. 108)
Opening hours: 9-18
Tel.: 917-24-16, 917-46-09

Vaccination Center at the Institute of Immunology
(m. "Kashirskaya") Kashirskoe sh., 24/2
Opening hours: 9-17
Tel.: 111-83-28, 111-83-11

Scientific Medical Center "Medincourt"
Prospect Mira, 105
Tel.: 282-41-07

Institute of Pediatrics, Scientific Center for Children's Health, Russian Academy of Medical Sciences
(m. "Universitet") Lomonosovsky pr-t, 2/62
Opening hours: 10-16
Tel.: 134-20-92

"Medincenter"
(m. "Dobryninskaya"), 4th Dobryninsky per., 4
Tel.: 237-83-83, 237-83-38

Athens Medical Center
Michurinsky Ave, 6
Opening hours: 9-18
Tel.: 143-23-87, 147-91-21

JSC "Medicine"
(m. "Mayakovskaya") 2nd Tverskoy-Yamskoy per. ten
Opening hours: 8-20
Tel.: 250-02-78 (children), 251-79-82 (adults)

MONIKI
(m. "Prospect Mira") st. Shchepkina, 01/2, bldg. 54, 506 cab.
Opening hours: 10-15
Tel.: 284-58-83

"Mediclub" Canadian clinic
Michurinsky Ave, 56
Tel.: 921-98-65

Polyclinic No. 220
(m. "Krasnopresnenskaya") st. Zamorenova, 27, room. 411
Tel.: 255-09-77

Hematology Research Center
(m. "Dynamo") Novozykovsky pr., 4
Opening hours: 9-18
Tel.: 213-24-94, 212-80-92

Honey. Center "In Kolomenskoye"
(m. "Kolomenskaya") st. High, 19
Opening hours: 9-18
Tel.: 112-01-65, 112-91-62

Honey. Center "Healthy Generation"
(m. "Shabolovskaya") st. Lesteva, 20
Opening hours: 9-18
Tel.: 954-00-64

Honey. center of the Administration of the President of the Russian Federation
(metro station "Arbatskaya") Staropansky per., 3, building 2
Opening hours: 9-20
Tel.: 206-12-78 (vaccination of children only)

"Medep"
(m. "Universitet") Lomonosovsky pr-t, 43
Opening hours: 9-18
Tel.: 143-17-98, 143-63-43

Institute of Pediatrics and Pediatric Surgery, Ministry of Health of the Russian Federation
(m. "Petrovsko-Razumovskaya") st. Taldomskaya, 2 (vaccination at home is possible)
Opening hours: Tue, Fri. 10-13
Tel.: 487-10-51, 487-42-79

Modern medical practice is difficult to imagine without measures aimed at preventing diseases. The most well-known and effective measure of disease prevention is vaccination, which makes it possible to protect your body from infection of pathogens - the causative agents of a huge number of infectious pathologies. Vaccinations allow you to build resistance to infections from childhood, protect yourself from complications, and also eliminate the likelihood of death from the disease. The active substances of the drug, in response to an injection into the body of the vaccine, causes a reaction from its immune system. This reaction is similar to that which develops during infection, but much weaker. The meaning of this reaction is that the immune system, in response to the introduction of the vaccine, forms special cells called memory cells, they create resistance to infection.

What is a prophylactic vaccination?

Prophylactic vaccination is the most common method of immunization, based on the introduction of a vaccine into the body, which consists of various particles that can form a stable immune response against the disease. Vaccination is nothing more than a special solution, which contains live or killed microorganisms, their fragments, toxins. Acting as antigens, these components of drugs, after entering the bloodstream, trigger a chain of reactions aimed at the production of antibodies and, accordingly, stimulate the development of immunity to a specific disease.

All preventive vaccinations are conditionally divided into two large groups:

the introduction of the vaccine to children and adults, which is carried out at a specific time and regardless of the epidemiological situation in certain areas;
vaccination for epidemiological indications, when it is given to people living in a region with a registered outbreak of an infectious disease or an increased risk of its occurrence.

The vaccine helps to avoid infection of the body with complex forms of dangerous pathologies. According to studies, in a society where 95% of citizens are vaccinated, there is no favorable environment for the development of infections, and therefore their complete disappearance is observed. It was through mass vaccination of the population that mankind managed to withstand the plague and, and, by several hundred times, reduce the number of episodes of childhood diseases, poliomyelitis,.

Childhood infectious diseases are one of the most common phenomena in pediatric practice. Every year, an outbreak of a disease is recorded in our country, which can not only cause temporary disability of the population, but also increase mortality in the region. The most suitable environment for the spread and habitat of pathogens of such diseases is the children's team. That is why doctors strongly recommend that parents of babies get preventive vaccinations on time, which will protect the child from contagious infections and prevent their epidemics.

As you know, the list of mandatory vaccinations is formed by employees of the Ministry of Health and forms the basis for creating a national vaccination calendar. In addition to the national immunization plan, there is also a regional list of annual vaccinations, which may vary depending on the epidemiology of the designated area.

Prophylactic administration of vaccination in children is carried out in specially designated places. An instruction to vaccinate a child is given by a doctor after testing. Any fact of the introduction of vaccination is recorded in documentary forms that are stored in the institution and, if necessary, issued to the owner in the form of extracts or copies. It is important for parents to remember that without vaccinations, their child may be denied temporary access to educational institutions, sports clubs, or permanent residence in another country where vaccinations are a compulsory measure against diseases.

Vaccine video

Why is it necessary to vaccinate the population?

Vaccination is simply necessary in cases where an infectious disease is a danger, that is, it threatens his life and can provoke the development of irreparable complications. Vaccination allows you to create immunity to a number of diseases with a pronounced risk of mortality and eliminate complications. After all, it is precisely the complex variants of the course of disease processes that lead to the formation of persistent and detrimental consequences of diseases, the development of their deadly complications, and the transformation of the disease into a chronic form.

The introduction of a vaccine provides the body with the opportunity to form an immune system against most of the infections known today. After the vaccine, special cells (antibodies) begin to be synthesized in the body, which subsequently are able to protect the vaccinated organism from the penetration of dangerous microorganisms into it. Immunity is maintained over a certain time period. It could be months, years, decades. Naturally, the protection acquired in the usual way (after an illness) is stronger and more effective, but vaccinations can also reliably protect a person from microorganisms and their toxins.

What vaccinations are made in Russia?

The list of preventive vaccinations includes:

mandatory vaccine injections;
the recommended introduction of the vaccine, which is done according to individual indications.

living in a region with an unfavorable epidemiological situation;
work in enterprises where there is a risk of infection (livestock farms, slaughterhouses).

National calendar: concept and features

The preventive vaccination calendar is compiled by the Ministry of Health. When creating it, several points are taken into account, in particular, the significance of infections and the availability of a vaccine in the public domain. The calendar is valid throughout the country. According to it, it is necessary for every citizen living in Russia to be vaccinated, regardless of age and provided that he has no contraindications. In recent years, the plan has remained unchanged and has the following form:

*Vaccine against*	*Age of the patient at the time of vaccination*
*Tuberculosis*	Child 3-7 days after birth, children 7 and 14 years old
	Child on the first day of life, 1st month, 2nd month, 6th month, 1 year, every 5 years
*DTP*	Baby at 3 months, 4 months, half a year, 18 months
	7, 14, 18 years old
*Polio*	Child at 18-20 months and at 14 years
*, rubella,*	Child at 12 months and 6 years old
	A child from 11 years old every five years up to 18 (boys) and 25 (girls) years
*measles infection*	At age 15, every 5 years until age 35
*flu*	Child from six months of age each year

Regional calendar

The vaccination program for residents of a certain area is developed by local doctors working in outpatient medical institutions, kindergartens, and schools. This plan is being worked out taking into account registered citizens and fixing born children, people who left or arrived. The disease prevention scheme should cover all adult citizens and children who need a planned introduction of a vaccine or revaccination.

Each child has its own documentation, in particular, a card of preventive vaccinations, a medical card and a history of the development of the child. It is stored in the medical unit and, if necessary, can be handed out.

Vaccination

Preventive vaccinations should be carried out in special vaccination rooms, which are located in polyclinics, private clinics, and vaccination centers. For setting BCG, a separate room is required. There should be enough space in the treatment room. Here you should install tables for sterile instruments and disposable syringes, as well as containers for collecting garbage.

The vaccination room must comply with certain rules and sanitary standards. Any material that is used in the vaccination process is taken with a sterile forceps. Before this, it must be immersed in a solution of chlorhexidine, which should be changed daily. Used disposable instruments, as well as cotton wool, bandages and swabs, should be disposed of in a waste container with a disinfectant. The floor in such rooms is washed several times a day and using disinfectants.

The procedure for staging preventive vaccinations is regulated at the legislative level. Vaccination is carried out only by introducing certified preparations of domestic or foreign production.

Infectious diseases are vaccinated in the following order:

vaccination is done in special institutions accredited for the introduction of vaccinations;
if necessary, teams are formed to vaccinate the population at home;
before vaccination, the patient excludes contraindications to injections and assesses the general state of health;
before vaccination, body temperature should be measured and tested;
injections are carried out using disposable instruments;
vaccination can only be done by a specialist with the necessary education;
there must be a kit for emergency medical care in the office;
drugs are stored in accordance with the rules prescribed in the instructions;
the introduction of the vaccine is not carried out in the dressing room or manipulation room;
all documentation must be kept in the vaccination room;
the room is cleaned twice a day with antiseptics.

Features of the holding technique

The technique of vaccinating patients against diseases is determined by regulatory documents and complies with the following plan:

the ampoule with the drug is taken out of the refrigerator;
the integrity of the vial, the appearance of the solution, its expiration dates are evaluated;
the package is opened only with sterile gloves;
the vaccine is drawn up and administered using disposable needles and syringes;
the injection site must be wiped with an alcohol solution (for - ether);
if it is necessary to administer several drugs, a separate toolkit is used for each of them;
during the injection, the patient is forced to sit or lie down;
after the injection, the doctor observes the patient for another 30 minutes.

Journal of inoculation of the population

The fact of preventive vaccinations is recorded by medical personnel in a special journal. It is always located in the medical institution where the injection was made, and is available for discharge in case the patient loses his individual card. The journal contains such data as last name, first name and patronymic, address of actual residence, age, occupation, name of the administered drug, date of implementation of primary vaccination and revaccination, method of setting. Separately, data on adverse reactions, the series and dose of the prophylactic agent are entered into the document.

The vaccination card has a special form - 063 / y. This is a document that contains information about vaccines administered to a patient. The card is filled in by a doctor in the institution where the vaccination was carried out, that is, in the clinic, at the FAP, preschool institution, etc.

Certificate

This document, which has the form 156 / y-93, is maintained throughout life and may be needed when leaving Russia, to participate in international sports competitions, and to find employment in some enterprises. It must be preserved until death, as it fully reflects his vaccinated immune profile.

It is very difficult to restore a certificate of preventive vaccinations after a loss. It should not contain corrections and blots. Otherwise, the document will most likely be invalidated.

Vaccination waiver form sample

According to the law, people have the right to refuse preventive vaccinations. Refusal is given in writing to the head of the institution where the population is immunized. It should indicate which vaccinations the person refuses to do, where he is registered and what is the reason for such a decision. At the end of the application, there must be a signature and the date of preparation of the form.

Chief Physician of Polyclinic No./or
School Principal No./ or
Kindergarten manager No.
_______ district, __________ cities (villages, villages)
From __________ Full name of the applicant _____________________
Statement
I, ____________ full name, passport data ______________ refuse to do all preventive vaccinations (or indicate which specific vaccinations you refuse to do) to my child _______ full name of the child, date of birth _________, registered at polyclinic No. (or attending kindergarten No., or school No.). The legal basis is the legislation of the Russian Federation, namely “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” dated July 22, 1993 No. 5487-1, articles 32, 33 and 34 and “On the immunoprophylaxis of infectious diseases” dated September 17, 1998 No. 57 - Federal Law, articles 5 and 11.
Number
Signature with decryption

What is the danger of not being vaccinated?

Failure to vaccinate against infectious diseases entails a number of consequences, including:

a ban on traveling abroad to live in another country, where, in accordance with local law, a citizen must have a mandatory vaccine minimum;
temporary refusal for admission to an educational or health institution (this item applies to the period when an epidemic is declared in the region);
refusal to register citizens for work or their removal from the performance of official duties, which is associated with a high risk of their exposure to infectious diseases.

Children without vaccinations may be forcibly dismissed from attending schools and kindergartens, and employees of enterprises may not be allowed to work. Often, unvaccinated individuals do not have the right to be in groups, especially during epidemics.

Vaccination Order

The preventive vaccination plan against infectious diseases is regulated by legal acts, in particular, by order No. 51n dated January 31, 2011 “On approval of the national. immunization calendar.

Prevention in kindergarten

Vaccinations in kindergartens are given only to those children whose parents or legal representatives have agreed to such actions by the medical staff. Activities should be organized and carried out individually. To do this, the medical worker of the institution draws up an immunization schedule with the inclusion of children to be vaccinated in it.

Immunoprophylaxis of infectious diseases in children is one of the most important tasks of modern pediatrics. Where vaccination rules are followed, the incidence rate is much lower. Almost all countries of the world have developed a special vaccination schedule, which strictly regulates the terms and norms of immunological measures against tuberculosis, meningitis, poliomyelitis, staphylococcal, rotavirus and hemophilic infections, as well as against hepatitis and diphtheria.

Citizens have the right to receive full information about vaccinations from medical workers. Also, parents should be aware of a rare but possible side effect of vaccines - post-vaccination complications.

You will learn about what vaccinations are given to children in Russia in the material below.

Federal law on vaccination of children in Russia

Federal Law No. 157-FZ dated September 17, 1998 “On Immunoprophylaxis of Infectious Diseases” for the first time established in our country the legal framework in the field of immunoprophylaxis of infections, which is carried out in order to protect health and ensure the sanitary and epidemiological well-being of citizens. The law on the vaccination of children in Russia determines that vaccination is voluntary, that is, vaccinations are carried out only with the consent of the child's parents or his legal representatives. The refusal must be confirmed in writing.

There are no restrictions on visiting children's institutions by an unvaccinated child outside the epidemic situation for the corresponding infection. The same law on vaccination in Russia provides for the right of citizens to social protection in the event of post-vaccination complications.

A medical worker (nurse, paramedic, doctor) is obliged to explain to parents in an accessible form the need for a particular vaccination. Also, medical workers are required to inform parents in advance about the timing of specific vaccinations, about which infection is being vaccinated against, why the disease is dangerous for the unvaccinated, about the need to monitor the child after vaccination and consult a doctor in cases of a child feeling unwell.

The document regulating the procedure for vaccinating children in Russia is the order of the Ministry of Health and Social Development of Russia dated January 31, 2011 No. 51n “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications”.

Basic rules for vaccinating children

Preventive vaccinations are carried out for children in a planned manner in specially equipped vaccination rooms of children's clinics in compliance with sanitary and hygienic requirements by qualified medical personnel.

According to the basic rules for vaccinating children, a medical examination of the child by a doctor, thermometry is carried out before the preventive vaccination.

Parents are interviewed by a doctor in order to identify previous diseases, the presence of reactions or complications to previous vaccinations, allergic reactions to drugs, products, individual characteristics of the body, contact with infectious patients.

If the child has chronic diseases, allergic conditions, and others, the necessary laboratory and instrumental studies, consultations of specialist doctors (neurologist, immunologist-allergist, and others) are preliminarily carried out.

The data of the interview and examination, as well as the permission to inoculate, are recorded in the child's developmental history.

After immunoprophylaxis, children are under the supervision of a doctor for 30 minutes, when it is theoretically possible to develop immediate reactions of the anaphylactic type. Parents are informed about possible reactions and symptoms requiring medical attention. Further, the vaccinated child should be observed by a nurse for the first 3 days after the introduction of the inactivated one and on days 5-6 and 10-11 after the introduction of live vaccines.

Information about the vaccination carried out is recorded in the registration forms (No. 112, -63 and 26), vaccination journals and the Certificate of preventive vaccinations.

Tuberculosis vaccination: when children are vaccinated

- the most important problem in the world, every day 24,000 fall ill with it, and 7,000 people die. Vaccination of children against tuberculosis is included in the WHO Expanded Program on Immunization, it is carried out in more than 200 countries, more than 150 countries carry it out in the first days after the birth of a child.

When are children vaccinated against tuberculosis in accordance with WHO recommendations? Vaccination is carried out in practically healthy newborns with the BCG-M vaccine at the age of 3-7 days. Newborns with contraindications are treated in neonatal pathology departments, where they should be vaccinated before discharge. Children not vaccinated during the neonatal period should be vaccinated within 1-6 months of life, children older than 2 months are vaccinated if the Mantoux test is negative.

Re-vaccination (revaccination) of children against tuberculosis is carried out for non-infected tuberculin-negative schoolchildren aged 7 and 14 years.

The normal reaction to the introduction of the vaccine is assessed by the district pediatrician. At the site of intradermal administration of the vaccine, an infiltrate 5-10 mm in size develops with a nodule in the center and a smallpox-type crust, sometimes a pustule or slight necrosis with scanty discharge. In newborns, a reaction to the tuberculosis vaccine appears after 4-6 weeks; after revaccination, sometimes as early as the 1st week. The reverse development occurs within 2-4 months, in 90-95% of the vaccinated there is a scar 3-10 mm in size.

Vaccination schedule for children vaccinated against hepatitis B

About 90% of newborns from mothers who carry HBeAg become infected during childbirth, in the case of mothers carrying only HBsAg, the risk of vertical transmission of the virus to the newborn is lower, but all of them have a high risk of infection through breastfeeding and close contact with the mother. In newborns, in 90% of cases it takes a chronic course, with infection at the 1st year - in 50%, in adults - in 5-10%. Therefore, the importance of preventing the vertical route of hepatitis B infection by vaccinating children on the 1st day of life is obvious. This is in line with the WHO strategy.

The hepatitis B vaccination schedule for children provides for three hepatitis B vaccines. V1 vaccination is performed in the first 12 hours of a child's life. V2 - at the age of 1 month. V3 children are vaccinated against hepatitis B at the age of six months.

Children of mothers - carriers of HBsAg (risk group) are vaccinated according to the scheme 0-1-2-12 months.

Below you will find out when children are vaccinated against diphtheria.

When children are vaccinated with diphtheria vaccination

- anthroponotic bacterial infection with an aspiration mechanism of pathogen transmission. The disease is characterized by general intoxication, fibrinous inflammation of the mucous membranes of the oropharynx and respiratory tract, as well as the skin, mucous membranes of the genital organs, and eyes. The causative agent of diphtheria belongs to the genus Corynebacterium. The leading route of pathogen transmission is airborne. The main transmission factor is air, but sometimes the pathogen can be transmitted by household means. Bacteriocarriers often become the source of infection. A distinctive feature of modern carriage is that the bulk of carriers of toxigenic corynebacteria are concentrated among children aged 6 to 10 years, who, due to routine vaccination, have a high level of anti-diphtheria antitoxic immunity.

For the primary vaccination of children against diphtheria, DTP vaccine is used, starting from the age of 3 months three times with an interval of 1.5 months and the first revaccination 12-18 months after the completed three-time vaccination.

If a baby (from 3 months to 6 years old) has been ill with whooping cough, then for the prevention of diphtheria in children, vaccination with the ADS-toxoid vaccine is used. The course of vaccination - 2 doses with an interval of 30-45 days. Re-vaccination of children against diphtheria is given to children once every 9-12 months.

Vaccinations for children against rotavirus infection

- the main cause of acute gastroenteritis, by the age of five, almost all children suffer it, usually twice. Epidemics are observed in the winter-spring period.

The source of infection is a sick person or a carrier. For children, the source of infection is mainly adults. The causative agent is transmitted by household contact, food and water. The highest incidence is recorded in children 6-12 months old.

The disease is often severe due to the development of dehydration and complications. It begins acutely, an early sign is copious, watery stools, yellow in color, frothy in appearance, with a pungent odor. The child's anxiety increases after eating, there is bloating. Vomiting up to 3-4 times in the first day of the disease. Body temperature may be normal or rise briefly in the first 1-3 days. Catarrhal phenomena may appear - hyperemia of the pharynx, cough, difficulty in nasal breathing.

Profuse watery diarrhea, vomiting, and fever lead to dehydration requiring rehydration, often intravenously, in a hospital setting.

To prevent rotavirus infection in children, vaccinations with Rotarix and RotaTeq vaccines are performed from the age of 6 weeks with an interval of 4-6 weeks.

Vaccinations for children during vaccination against pneumococcal and hemophilic infections

Vaccination against pneumococcal infection.

Currently, according to the WHO, pneumococcal diseases (Streptococcus pneumoniae) of etiology are recognized as the leading cause of death as a result of preventable infections. The highest incidence rates are recorded among children of the first 2 years of life and the elderly. More children die from pneumococcal pneumonia under the age of 5 than from other infectious diseases, including AIDS, malaria and measles combined.

In order to prevent pneumococcal infection, young children are vaccinated; for this, starting from 2-3 months of age, the Prevenar conjugate vaccine is used.

Vaccination against Haemophilus influenzae.

Studies in recent decades have shown that I. influenzae type b (HIB) is the cause of such serious diseases in children as epiglottitis, osteomyelitis, septic arthritis and septicemia.

Currently, the most effective and, perhaps, the only way to prevent diseases caused by H. influenzae type b is their specific prevention through vaccination. It has been proven that vaccinations for children against hemophilic infection (HIB infection) are highly effective, practically devoid of serious shortcomings, including no side effects, and therefore can be used in children during the first months of life.

As a rule, children of the first year of life are immunized with vaccines against hemophilic infection, starting from 2-3 months of age. The primary scheme for vaccinating children against Haemophilus influenzae involves the administration of three doses of the drug simultaneously with DTP, a polio vaccine.

Tetanus vaccination: When do children get vaccinated?

Tetanus is a typical wound infection related to sapronoses. The causative agent of the disease - Clostridium tetani - produces the strongest biological poison, namely tetanus exotoxin, consisting of two components: tetanospasmin (neurotoxin), which affects the nervous tissue and causes convulsions due to spasmodic muscle contraction, and tetanolysin, which destroys red blood cells.

The incidence of tetanus is recorded everywhere. The tetanus microbe, along with feces, enters the soil mainly from the intestines of domestic animals and humans. Infection with tetanus occurs when soil, manure, fertilizers and other substances infected with spores enter the human body through damaged skin or mucous membranes, as well as during injections, operations, abortions and childbirth in inappropriate conditions, outside medical institutions.

In Russia, since 1961, a nationwide program of mandatory vaccinations against tetanus in children has been operating, which made it possible to eliminate the disease in newborns, reduce the incidence and mortality from this infection by 30 times. Currently, in the Russian Federation, instead of 450-500 cases of tetanus per year, only about 20 cases are noted. However, the risk of infection is constantly present, especially in modern conditions associated with increased traumatism (man-made and natural disasters, emergencies). In the prevention of tetanus disease, the immune defense of each individual plays a key role.

Vaccination against tetanus in children and adults includes two directions - a routine active immunization and emergency immunization for injuries. The only reliable method of protection so far has been active immunization with tetanus vaccinations for children and adults with tetanus toxoid (TT) starting at an early age. To this end, according to the current national calendar of preventive vaccinations of the Russian Federation, children from the age of 3 months receive a full course of immunization with tetanus toxoid as part of the associated preparations - DTP, ATP, ADS-M, which also include antidiphtheria and antipertussis components. When are children vaccinated against tetanus according to WHO recommendations? A full course of immunization includes a primary triple vaccination with DTP (at 3-4.5-6 months) and one revaccination (at 18 months).

Vaccination of children when traveling abroad

When families with children travel abroad, they must be fully vaccinated according to the calendar. What vaccinations are given to children when traveling abroad? It is advisable to vaccinate children of the 1st year of life according to an accelerated scheme: against hepatitis B - 3 vaccinations with an interval of 1 month, DPT - 3 vaccinations with a monthly interval and revaccination after 6 months, - IPV - 3 vaccinations with a monthly interval.

When traveling to a region endemic for measles, the measles vaccine should be administered to a child from the age of six months (with subsequent vaccination after a year), and a child over 1 year old, vaccinated once, should be given a double dose of the vaccine.

Influenza split and subunit vaccines can be administered from 6 months of age.

For preventive vaccination of children traveling abroad, if they have received incomplete vaccinations, all the missing vaccines are administered simultaneously.

Contraindications to vaccination: in what cases children are not vaccinated

In recent years, the number of contraindications to vaccination of children has significantly decreased. This is due both to the improvement in the quality of immunobiological preparations, and to a significant expansion and deepening of knowledge about the etiopathogenesis of post-vaccination complications.

A wide list of contraindications, used for many years in our country, was compiled on the basis of existing contraindications to smallpox vaccination. Modern vaccinology does not stand still - the technology for the production and purification of vaccines is being improved, the concentration of ballast substances and the antigens themselves are decreasing. After summarizing scientific data and practical results, it was proved that children with various chronic diseases generally develop specific immunity well, while they do not have any complications of the course of the underlying disease. The attitude towards vaccination of children with immunodeficiency states, as well as with diseases caused by immunopathological mechanisms, has been revised.

Be sure to vaccinate disabled children with a variety of lesions of the nervous, endocrine systems, musculoskeletal system, etc. Non-compliance with contraindications, unreasonable medical exemptions from vaccinations often lead to the fact that children with somatic pathology, allergic diseases, neurological defects are defenseless against infectious diseases , flowing especially hard. Contraindications to vaccination are regulated by the guidelines “Medical contraindications to prophylactic vaccinations with preparations of the national vaccination schedule. MU 3.3.1.1095-02, approved. Chief State Sanitary Doctor of the Russian Federation 09.01.2002

Contraindications for vaccinating children may include:

true, usually associated with certain components of vaccines and listed in the instructions for vaccines. For example, the pertussis component of DPT is contraindicated in advanced neurological disease;
false, which have developed due to outdated traditions and prejudices (perinatal encephalopathy, dysbacteriosis, anemia). These are the main unjustified reasons for vaccination delays;
absolute, having absolute power. In their presence, vaccination is not carried out under any circumstances;
relative, the final decision on which is made by the doctor after analyzing various factors, such as the proximity of the epidemic, the likelihood of contact with the source of infection, the degree of risk of a child developing a serious complication in case of illness, etc. An example is an allergy to egg protein, which is a contraindication to influenza vaccination. In a situation where the risk of complications and death due to influenza in a given patient exceeds the risk of allergy to vaccine components, the contraindication is neglected and vaccinated after preparation;
temporary, i.e., valid for a certain period of time, after which the contraindication can be removed. For example, it is not recommended to graft on the background;
permanent, which cannot be removed. These include some types of gross primary immunodeficiencies. Permanent contraindications are quite rare - no more than 1% of children.

The use of live and non-live vaccines for vaccinations

For a correct assessment of contraindications to vaccination, it is necessary to know the classification of vaccine preparations, their composition and the effect on the body. As is known, vaccines can be conditionally divided into two groups - live and inactivated (non-living), which differ significantly in their characteristics.

Live vaccines (polio, measles, mumps, varicella, etc.) contain avirulent, attenuated or closely related strains of microorganisms that are not pathogenic for humans (tuberculosis vaccine). Live vaccines are thermolabile (when heated, at room temperature for 30 minutes or more lose their immunogenicity), do not include adjuvants, contain a small amount of antibiotics (aminoglycoside series), proteins of the medium on which the microorganism was grown (Japanese quail embryos are used as media , chicken embryos, human diploid cells), in some cases - the residual amount of albumin and gelatin.

Microorganisms inoculated with live vaccines induce specific cellular, humoral and secretory immunity.

Humoral immunity (Th2 type of immune reactions) is associated with the formation of antibodies: antibacterial, virus-neutralizing or participating in the reaction of complement-dependent cytotoxicity. Secretory specific antibodies create the first barrier of protection against infections by preventing the adhesion of the microorganism to the mucous membranes. Cellular immunity (Thl type), the most important for protection against viral pathogens, is associated with the formation of specific cytotoxic cells capable of recognizing cells infected with the corresponding virus and eliminating them. Attenuated antigens of live vaccines multiply in the body of the vaccinated person, reproduce the infectious process in a weakened form and are capable of causing vaccine-associated diseases in case of strain reversion or immunity defects in the vaccinated person. Therefore, the use of live vaccines is contraindicated in people with severe immunodeficiency.

The group of non-live vaccines is diverse:

inactivated whole-cell (pertussis) and whole-virion (inactivated polio, against tick-borne encephalitis, etc.);
chemical acellular (pertussis acellular) and polysaccharide (meningococcal, pneumococcal);
recombinant (against hepatitis B, etc.);
toxoids (diphtheria, tetanus, etc.).

Despite the differences in methods of preparation, reactogenicity, and immunogenicity, they are united by the absence of a living microorganism. As a rule, these vaccines contain stabilizers and an adjuvant that has an immunostimulatory effect on specific antibody production. A common property of non-live vaccines is a decrease in immunogenicity and an increase in reactogenicity upon freezing.

Inoculations with non-live vaccines are designed mainly for the formation of specific antibodies (stimulation of the humoral Th2 type of immune response). They stimulate the formation of a less intense and prolonged specific immune response than live vaccines, and therefore require repeated injections. An important property of non-live vaccines is the absence of vaccine-associated diseases and the possibility of use in patients in any immunodeficiency state.

There are no absolutely areactogenic vaccines, all vaccination processes have common patterns that depend not only on the properties of vaccines, but also on the constitutional, genetic characteristics of the organism, in particular the HLA system. Quite often, in the post-vaccination period, intercurrent infections accidentally join, which is often mistakenly interpreted as a post-vaccination complication for vaccination.

Currently, the world is developing, producing and using in medical practice a wide variety of live and non-live vaccines. In order to avoid the negative consequences of vaccination, including post-vaccination reactions and complications, and at the same time to achieve the desired level of immune protection caused by it, developers and manufacturers of modern vaccines are constantly striving to ensure that their products meet the WHO requirements for an ideal vaccine.

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