What is Hib vaccination. Hemophilus influenzae vaccination for children. Adverse reactions to Hib vaccine

Hib infection

Hib infection (hemophilic infection) is a group of diseases caused by the most dangerous Haemophilus influenzae type b. The causative agent of this infection is the cause of severe

• purulent meningitis (inflammation brain),
• epiglottitis (inflammation of the epiglottis),
• sepsis ( blood poisoning),
• pneumonia ( pneumonia),
• otitis ( ear infection),
• arthritis (inflammation of the joints)
• acute respiratory diseases (ARI), etc.

Most forms of infection are very severe, causing various complications leading to disability: mental and motor retardation, hearing loss (up to complete deafness), impaired motor activity and others. Hemophilus infection is difficult to treat, as the pathogen is resistant to some antibiotics. Some cases of hemophilic infection are fatal.

How can you get Hib infection?

The pathogen is transmitted from a sick person or a carrier of the infection when talking, coughing, sneezing, with saliva, through toys and household items.

Who is at risk of getting sick?

Haemophilus influenzae has a special protective capsule that makes this microorganism "invisible" to some cells of the immune system of children under the age of 5 years. For this reason, they do not form a full-fledged defense against this infection. Therefore, children can carry this disease repeatedly.

Most high risk development severe forms Hib infection is present in

• Often and long-term ill children.
• Children with chronic inflammatory diseases respiratory tract.
• HIV-infected children.

For such children, vaccination is prescribed not only for preventive purposes, but also for therapeutic purposes.
The risk of developing Haemophilus influenzae is higher in

• Children under the age of 5 who are in closed groups (orphanages).
• Children aged 6-12 months who are on artificial feeding.
• Children attending or preparing to attend pre-school institutions.

How to effectively prevent Hib infection?

It is impossible to protect a child from meeting with Haemophilus influenzae. So it is necessary to "prepare" him for this meeting. Only effective way to prevent the development of Hib infection in a child is the introduction of a vaccine.

What vaccines are used to prevent Hib infection in modern medical practice?

To prevent Hib infection, highly effective vaccines are used, created using modern technologies. Their efficiency approaches 100%.
The introduction of such vaccines is well tolerated. Local reactions on injection (redness, induration at the injection site) are observed in 4-5 children out of 100 vaccinated. Temperature reactions are recorded in isolated cases. In case of occurrence, these reactions do not affect the usual way of life of the child.
Hib vaccines do not contain live pathogens, so you cannot get an infection from the vaccine.

What are the schedules for administering the vaccine?

It is advisable to start vaccination of children from the age of 3 months according to the classical scheme. In this case, basic immunity will be provided by vaccination, consisting of three vaccinations with an interval of 1 month. At the age of 18 months it is necessary to carry out a single revaccination (supportive vaccination).

How older child, the higher the ability of his immune system to form protection against Hib infection. Therefore, if a child is immunized according to an individual schedule, vaccination can begin at the age of 6 to 12 months and consist of two vaccinations with an interval of 1-1.5 months, followed by a revaccination at 18 months. In the case of the start of immunization at the age of over 12 months, one vaccination is enough to form a complete protection against Hib infection (without subsequent revaccination).

Haemophilus influenzae vaccine can be administered simultaneously with vaccines against whooping cough, diphtheria and tetanus, poliomyelitis, viral hepatitis B and other infections. Simultaneous administration of vaccines against several (5-6) infections does not overload the immune system, which is capable of simultaneously processing tens of thousands of antigens.

What are the contraindications to the introduction of the vaccine against Haemophilus influenzae?

The vaccine is not administered in the presence of an allergy to the components of the vaccine (tetanus or diphtheria components, etc.). Vaccination is delayed until the symptoms of an acute or exacerbation of a chronic disease disappear.

Before vaccinating the child, the doctor will definitely examine and give an opinion on the possibility of administering the vaccine to him.

Prepared by:
Head of the Immunoprophylaxis Department of the Minsk City Center for Hygiene and Epidemiology Glinskaya I.N.,
Epidemiologist of the Immunoprophylaxis Department of the Minsk City Center for Hygiene and Epidemiology Volosar L. A.

Haemophilus influenzae is one of the most serious and underestimated threats to young children, which can lead to the most dire consequences, up to lethal outcome. effective protection from this insidious bacterium today is vaccination, which we will discuss below.

What is a hemophilic infection?

Haemophilus influenzae (HIB) infection is whole complex serious diseases, the causative agent of which is Haemophilus influenzae, or, as it is also called, Pfeiffer's wand. This microorganism is easily transmitted when a patient coughs or sneezes, through common household items (for example, toys, dishes, etc.), and in addition, it is present on the mucous membrane of the nasopharynx in about 10% of people.

The most common form of Hib infections is acute respiratory infections, however, in addition to this, there are quite a few big risk development the following diseases and states:

• Haemophilus pneumonia;
• Inflammation of the subcutaneous adipose tissue (purulent cellulitis);
• Inflammation of the epiglottis (epiglotitis), which is often accompanied by respiratory problems;
• Purulent meningitis;
• Infectious diseases of bones, blood, heart;
• Arthritis and sepsis (rarely encountered).

The main danger of HIB infections is that children under the age of five are most affected especially those that do not receive the necessary antibodies from mother's milk, visit children's institutions, etc. In addition, due to their structure, 80% of strains of hemophilic infection are resistant to traditional antibiotics, which makes the treatment of these diseases quite difficult.

As for the frequency serious complications after the transferred forms of the disease, it is approximately 40%. For example, meningitis, which was provoked by Haemophilus influenzae, is much more difficult than meningococcal, and the prognosis in this case is rather disappointing - in about 10-30% of cases given form disease leads to death.

Learn more about Haemophilus influenzae

Vaccination against Haemophilus influenzae (HIB) infection

Until 2010, vaccination against hemophilic infection in the Russian Federation was not mandatory, but only a recommended measure, but at the end of 2010 it was included in the vaccination calendar at the legislative level. It should be noted that this is a normal practice for most developed countries, in which this preventive measure has been practiced for many years.

If parents for some reason refuse routine vaccinations, hemophilic vaccination is recommended for children who are at risk:

• Infants on artificial feeding;
• premature babies;
• Patients suffering from various immunodeficiencies;
• Children who often catch colds and have acute respiratory infections;
• Children with serious chronic diseases, whose body is not able to fight Hib infections at full strength;
• Those who attend or plan to attend preschools.

Mechanism of action of Hib vaccines

Hemophilus vaccine (or Hib vaccine) is a drug created on the basis of an inferior antigen (polysaccharide of the capsule of hemophilic bacteria), which has been combined (conjugated) with tetanus toxoid protein molecules. It was the conjugation of the HIB antigen with the protein that made it possible to solve several problems at once: firstly, to turn it into a full-fledged antigen that can form a stable immunity to the disease, and, secondly, to reduce the reactogenicity of vaccines and make them as safe as possible for the health of babies.

In addition, the vaccine against hemophilic infection has a so-called booster effect: that is, when it is repeatedly administered, the concentration of antibodies in the body not only increases, but grows exponentially.

Features of Hib vaccines

In total, there are three hemophilic vaccinations in Russia that can protect the body from hemophilic infection: the Hiberix and Akt-HIB monovaccines, which contain only Haemophilus influenzae antigens, as well as combination drug Pentaxim, which includes several vaccines at once, including hemophilic. Due to the ease of use, it is Pentaxim in recent times recommended for use in public maternity hospitals and clinics.

• Vaccine "Act-HIB". Manufacturer - Sanofi Pasteur Corporation, France. it oldest drug against Haemophilus influenzae in the world, which has already proven its effectiveness in reducing the incidence of Hib infections in many countries. The main advantage of Act-HIB is that it is able to form strong immunity in babies from 6 to 12 months, when Haemophilus influenzae poses a particular danger to the body.
• Vaccine "Hiberix". Manufacturer - GlaxoSmithKline, Belgium. "Hiberix" is an analogue of "Act-HIB", and has a similar mechanism of action. True, the experience of using this drug on the territory of the Russian Federation is relatively small, so it is rather difficult to talk about its disadvantages and advantages.
• Vaccine "Pentaxim". Manufacturer - Sanofi Pasteur Corporation, France. A multicomponent vaccine that protects the body from five infections at once: DTP + hemophilic infection. Nowadays, it is widely used in both public and private medical institutions, however, due to the presence of the pertussis component, this vaccine is considered quite reactogenic, that is, it can cause some side effects.

How and where is the hemophilus vaccine administered?

Infants under two years of age are vaccinated against hemophilic infection in the front of the thigh, and older babies - in the shoulder, and more precisely in the deltoid region. Hib vaccines can be combined with other vaccines: for example, they are often given on the same day as DTP vaccination. Such a complex introduction allows minimizing the number of adverse reactions from the immune system.

Haemophilus influenzae vaccination schedules

Haemophilus influenzae vaccination is desirable to be carried out as early as possible, and there are several vaccination schemes for this. Standard scheme as follows:

• I dose of the vaccine - 3 months;
• II dose - 4.5 months;
• III dose - 6 months;
• Revaccination - upon reaching one year old(usually at 18 months).

In addition, there are alternative schedules that depend on the age at which the first dose of the vaccine is given to the child. Up to 6 months, children are given 3 injections with a break of 1-2 months, and revaccination is carried out a year later.

If the first vaccination is given in the period from six months to a year, then 2 injections are given with a 30-day break, and after a year - 1 injection. Finally, children after five years of age are not vaccinated with Hib drugs - it is believed that they already have a fairly strong immunity.

Complications and side effects from vaccination

Usually hemophilic vaccines are quite easily tolerated by vaccinated people of all ages, however, in some cases, complications may develop after hemophilic vaccination of local and general. These include:

• Redness, swelling, swelling and discomfort at the injection site (about 9% of those vaccinated);
• Fever, tearfulness, general malaise(1% vaccinated);
• Enlarged lymph nodes;
• Digestive disorder.

It is impossible to get sick with one of the forms of hemophilic infection after immunization, since it does not contain living microorganisms and bacteria.

There is evidence that after the injection, the child may experience different reactions allergic nature(vomiting, urticaria, convulsions, temperature above 40 o), however similar situations rarely occur. It should be noted that side effects and complications are caused not by the bacterial antigen itself contained in hemophilic vaccines, but by tetanus toxoid, which is also part of them. That is, people who are allergic to tetanus vaccine may experience allergic reactions and hemophilic vaccines.

In any case, parents should carefully monitor the condition of the baby after vaccination, and if any non-specific symptoms show it to the doctor immediately. Also, within half an hour after the procedure, the child should be under the supervision of qualified specialists.

It is very important to remember that if immunization is carried out complex vaccine"Pentaxim", then the list of side effects and contraindications can be somewhat expanded, since in addition to the Hib component, this drug contains four more different antigens.

About actions after vaccination aimed at reducing the risk occurrence of complications,

Efficacy of Hib vaccines

The effectiveness of modern Hib vaccines is quite high: for example, in developed countries, where routine immunization of the population against this infection has been carried out for a long time, the number of cases has decreased by 85-95%. In addition, this preventive measure can reduce the level of carriage of this bacterium from 40 to 3%.

Immune response to haemophilus influenzae vaccination

An adequate immune response to hemophilic vaccination is present in almost 100% of those vaccinated, and only in isolated cases (for example, when taking immunosuppressive drugs) the body's response may be insufficient.

How long does post-vaccination immunity last?

Strong immunity to the disease is formed within two weeks after the introduction of the Hib vaccine (on average, 10-15 days). In 95% of those vaccinated, it persists for 5 years, therefore, after a double injection of the drug, the child is already quite well protected from hemophilic infection.

Preparing for the Hib Vaccine

Preparation for vaccination against Haemophilus influenzae is no different from preparation for other similar preventive measures: the vaccinated person must be examined by a neonatologist or pediatrician, and, if necessary, by other specialists, in particular, by a neurologist. The point is that it is in children with neurological disorders most often complications on various vaccines are noted.

About general rules vaccination training

Contraindications for Haemophilus influenzae vaccination

There are relatively few contraindications for hemophilic vaccination; in particular, The permanent list includes the following:

• Severe allergic reactions to the administration of the hemophilic vaccine in history;
• Individual intolerance to tetanus toxoid and other components of the drug.

Relative contraindications (when vaccination is recommended to be postponed) are acute infectious diseases, as well as exacerbation of any chronic ailments. In this case, the injection should be done when the child's condition is completely stabilized.

Video - “Hemophilus infection, meningitis. Dr. Komarovsky"

Have you and your child had a positive or negative experience with the Haemophilus influenzae vaccination? Share in the comments below.

Haemophilus influenzae (aka Hib-) infection - diseases (pneumonia, acute respiratory infections, bronchitis, meningitis, sepis, etc.) that are caused by Haemophilus influenzae - haemophilus influenzae type of b or HIB.

The bacterium is ubiquitous. Its carriers are up to 40% of children under the age of 5 years and about 5% of adults.

Hib has a special protective capsule that makes this bacterium "invisible" to immune cells, which prevents the formation of effective and long-term immunity to it.

Haemophilus influenzae has a record resistance to antibiotics, which makes the treatment of Hib infection extremely difficult, even with the use of the most modern and expensive drugs. Treatment is also hampered by the fact that in Russia there are no available test systems for diagnosing and determining sensitivity to antibiotics.

The infection is transmitted to children from carriers with saliva through toys and household items, by airborne droplets- with sneezing, coughing. In some cases, parents and older children are the source of infection. school age.

All this is the reason why Hib infection in Russia takes the leading position in childhood morbidity and mortality, causing not less than a third of cases of acute respiratory infections, up to 25% of cases of pneumonia, up to 55% of meningitis and about 20% of otitis in children under the age of 5 years.
The only way to reliably protect yourself from HiB infection is to get vaccinated.

Why is Hib infection dangerous specifically for children under the age of 5?

The Hib bacterium is covered with a protective capsule made of a special polysaccharide, the molecule of which is too simple for T-lymphocytes to react to it. For this reason, the formation of immunity occurs "half-heartedly", without the participation of T-cells, which leads to the development of insufficient antibody concentrations to protect children under the age of 5 years. In 6-year-old children and adults, antibody-producing cells are already able to form adequate immunity on their own, without the help of T-lymphocytes.

In addition, in children 6-12 months of age who are bottle-fed and do not receive small additional amounts of maternal antibodies with breast milk, the risk of the most severe forms of Hib infection, pneumonia and meningitis, is especially high. For this reason, artificial feeding is an additional indication for vaccination against Hib infection, starting at 3 months of age.

Features of Hib infection in Russia

Unlike Western countries, where the main form of Hib infection is meningitis, in Russia, as well as in other countries that do not routine vaccinations against Hib, the most common form is acute respiratory diseases, including the actual acute respiratory infections, pneumonia (pneumonia) and bronchitis.

In Russian studies in children's groups with a high frequency of colds, high percent carriers of HIB. Vaccination in such groups made it possible to significantly reduce the frequency of acute respiratory infections among frequently ill children.

As a matter of fact, high level Carriage of HIB explains the fact of frequent colds in children who begin to attend children's groups. This is why the Hib vaccine is essential for all children before starting nursery or kindergarten.

Groups and risk factors

Factors on the basis of which risk groups for Hib infection are distinguished, and, accordingly, groups for priority vaccination, are:

• Artificial feeding - among such children, an increased incidence is recorded, which is associated with the absence of mother's milk substitutes additional factors protection against haemophilus influenzae.
• Visiting children's preschool institutions(nurseries, kindergartens, etc.). Vaccination is required for all children attending or planning to attend nurseries and kindergartens.
• The presence of school-age children in the family - children over 5 years old can be carriers and sources of CIB for their younger brothers and sisters, however, they are less susceptible to infection due to more full development immune system.
• The presence of chronic diseases (immunodeficiencies and immunodeficiency states, frequent acute respiratory infections, heart and lung diseases, blood diseases, diabetes etc.) — the immune system of even completely healthy children is not able to adequately fight the hemophilic infection, and the less ready to resist CIB are children with compromised immunity.

Hib vaccine is also indicated for some categories of children over 5 years of age and adults. Thus, in particular, in the United States it is recommended to vaccinate previously unvaccinated patients with sickle cell anemia, asplenia, patients with immunodeficiencies (in particular, caused by AIDS, IgG2 deficiency), patients with immunosuppression after chemotherapy.

A Brief History of Hib Vaccines

The first pure Hib capsule polysaccharide (PRP) vaccine appeared in 1985. It allowed to partially protect children only from the age of 18 months. and, since her main antigen remained defective, i.e., T-lymphocytes were not involved, revaccination with this vaccine did not lead to an increase in immunity.

Then it was first applied new way creating vaccines based on defective antigens — chemical compound(conjugation) of such substances with proteins, which made them full-fledged antigens. The first such vaccine based on PRP and diphtheria toxoid (PRP-D) appeared in 1987. However, it did not provide adequate protection in children under the age of 1.5 years. Other combinations were created - based on a modified diphtheria toxoid, one of the proteins of meningococcus, but they all had drawbacks.

Optimum results have been achieved with a combination of PRP and tetanus toxoid (PRP-T) developed by researchers at the French company Sanofi Pasteur (formerly Aventis Pasteur). It was the PRP-T-vaccine (Act-HIB) that made it possible to create reliable immunity by the age of 6-12 months, when the highest frequency of HiB-meningitis is noted.

The creation of conjugated Hib vaccines made it possible to combine them with the main DTP vaccines for the vaccination schedule, which are also administered fractionally, using the revaccination effect. Combined vaccines based on a combination of DTP and Hib appeared and firmly entered the vaccination schedules of Western countries. The first such multicomponent vaccine "PentAct-HIB" (DPT+IPV+HIB) manufactured by "Aventis Pasteur" in 1992 was awarded the European Galen Prize for his contribution to the development of pharmacology.

A Brief History of Hib Vaccination

Since 1989, with the advent of effective conjugate vaccines, vaccination against HiB has been carried out worldwide. In 1989, mass vaccination began in Finland and Iceland, in 1990 - in the USA, since 1992 - in Great Britain, Denmark and Norway. Studies have shown that with the help of routine vaccination for 3 years, it was possible to reduce the incidence of HiB to single cases, which served to further spread vaccinations against HiB. Currently, vaccination against Hib is introduced into the vaccination schedules of all developed countries of the world.

Hib vaccination is recommended by the World Health Organization. It is expected that in the near future WHO will introduce vaccinations against HiB into the recommended minimum vaccination calendar for developing and even backward countries of the world, where the need for this vaccine will be provided by humanitarian organizations, including UNICEF.

In Russia, vaccination against HiB is allowed and recommended by the Ministry of Health of the Russian Federation since 1997. In a number of regions (Moscow, Moscow region, Krasnoyarsk, Irkutsk, Samara region, etc.) various programs for the prevention of CIB in risk groups are being carried out. AT Tyumen region for the first time in Russia, a program of routine vaccination of all children against Hib was adopted.

How Hib vaccines work

Conjugation of the main CIB antigen with a protein molecule made it possible to use the so-called. booster effect. In other words, Hib vaccines have a revaccination effect, when repeated administration of the vaccine causes not just a linear increase in the concentration of antibodies, but an increase in their concentration exponentially.

The peculiarity of the booster effect is that up to a certain stage with each reintroduction increases and the multiplicity of the increase in the number of antibodies. This explains why the primary vaccination course consists of several vaccinations, and subsequent booster vaccinations are always carried out with just one dose of vaccine. This, in particular, is the basis of the basic scheme for the use of Hib vaccines, when 3 vaccinations are given as part of the primary course, followed by a single revaccination.

Hib vaccines

The only vaccine with experience mass application in Russia is Act-HIB manufactured by sanofi pasteur (France). It should be noted that Akt-HIB is the original PRP-T vaccine, which made it possible to achieve major successes in the eradication of HiB infection in the developed countries of the world.

In Russia, the Belgian Hib vaccine Hiberix, which is common in European countries, is also registered, but so far it does not have such a large-scale Russian experience of use. In the process of development and registration is also domestic vaccine against HiB infection.

Hib vaccination schedules

There are three schedules for Hib vaccine, depending on the age at which the vaccination course begins.

Classic scheme
At the start of vaccination against Haemophilus influenzae at 3 months, the vaccination schedule consists of four injections at the same ages when vaccinations with DTP vaccine are given - primary vaccination at 3 months, 4.5 months, 6 months plus revaccination at 18 months.

If a child is vaccinated according to an individual scheme or there are slight deviations from the calendar dates, then it should be remembered that primary course Hib vaccine consists of 3 vaccinations with a minimum interval of 1 month. Protective concentrations of antibodies when using this scheme are guaranteed to be achieved 2 weeks after the 3rd vaccination.

advantage classical scheme is that it allows you to develop antibodies before the onset of the most dangerous in terms of Hib meningitis (in addition to other forms of infection) age - 6-12 months.

Alternative schemes
The older the child, the higher the ability of his immune system to independently form immunity to Hib infection.

At the beginning of vaccination at 6 months, the vaccination course consists of two injections with an interval of 1-2 months. and the third introduction of the vaccine, revaccination at the age of 18 months, and if vaccination begins at the age of 1-5 years, then the vaccination course consists of a single vaccination.

Alternative vaccination schedules are convenient in terms of preparing for admission to a nursery or Kindergarten However, their common drawback is the inability to protect the child up to the most dangerous in terms of severe forms of infection (meningitis, pneumonia) at the age of 6-12 months.

Features of the use of Hib vaccines

The convenience of vaccines against hemophilic infection lies not only in the coincidence of the main scheme of their use with the scheme of administration of DTP vaccines. In addition, Hib vaccines can be combined in the same syringe with DTP vaccines, which reduces the number of injections and visits to the doctor while increasing the protection components.

So, in particular, abroad and in Russia, it is possible to combine the French vaccines "Tetracoc" and "Act-HIB" in one syringe, this is allowed by the instructions for both vaccines. A similar combination called "PentAct-HIB" is still widely used in France - the only difference is that the vaccine is supplied in a special two-chamber syringe, the components in which (HIB and DTP vaccine) are mixed directly during the administration of the drug.

At present, multicomponent AaDTP vaccines based on a cell-free pertussis component, in particular, Pentaxim and Hexavak, consisting of 5 and 6 components, respectively, are becoming increasingly popular in the West. These vaccines, in addition to DPT, polio and hepatitis B vaccines, also include a vaccine against Haemophilus influenzae.

Contraindications

Specific, that is, characteristic of the Hib vaccine, is only one contraindication - an allergy to tetanus toxoid. In other words, an allergy to the tetanus vaccine, which is a component in particular DTP vaccines, ADS-M, AS and ADS.

This is explained by the fact that the main antigen of the vaccine against hemophilic infection is chemically linked to the tetanus toxoid molecule. Although Hib vaccine does not provide immunity to tetanus, people who are allergic to tetanus vaccine may have allergic reactions to Hib vaccine.

The remaining contraindications are common to all vaccines in nature - the absence of acute diseases or exacerbations of chronic diseases at the time of vaccination; inadequate responses to previous administration of Hib vaccine.

Adverse reactions to Hib vaccine

The Hib vaccine is well tolerated. Reactions at the injection site (redness, induration) are observed in no more than 5-7% of those vaccinated. Temperature reactions are rare and occur in 1% of those vaccinated. These reactions do not affect the usual way of life, do not require treatment and spontaneously disappear within 1-2 days.

Good tolerability makes it possible to combine and combine Hib vaccines with other vaccines of the vaccination schedule and, in particular, with DTP vaccines. Reactions and risks of adverse reactions to less reactogenic vaccines are absorbed by reactions to more “severe” ones, which is confirmed by practice - for example, the frequency of adverse reactions with a separate administration of the Tetracoc vaccine (DTP + IPV) does not actually differ from that when it is combined in one syringe with Akt-HIB vaccine. Moreover, the combination of vaccines on the same day (or in the same syringe, if appropriate) minimizes the number of activations of the immune system, which further reduces the risk of side effects.

Efficacy and effects of vaccination

Modern Hib vaccines are very effective. The incidence of all forms of infection in developed countries where routine immunization is carried out has decreased by 8598%. This can be achieved both due to the individual protection of the vaccinated, and due to the effect of collective protection, which is explained by the interruption of the chain of transmission of the bacterium by the immunity of the vaccinated.

In one of the Russian studies conducted in closed children's groups in the Moscow Region, vaccination for a year made it possible to reduce the level of carriage of Haemophilus influenzae from 41% to 3%, reducing the incidence of all colds (ARI, bronchitis, pneumonia, etc.) several times. Similar effects and efficacy were demonstrated in a study conducted on the results of vaccination in the Krasnoyarsk region.

perspective

main direction further development immunization against Hib is the combination of this vaccine with new generation DTP vaccines. Similar 4-, 5- and 6-component preparations are used in Western countries for several years now.

It is expected that such vaccines will be registered in Russia in the foreseeable future. The first drugs of this class are already used in a number of CIS countries - in Ukraine, Georgia, etc.

Combining Hib vaccines with new conjugate vaccines against pneumococcal and meningococcal infections, which will allow comprehensive prevention diseases caused by these pathogens - acute respiratory infections, meningitis, pneumonia, otitis media, etc.

New recommendations are under evaluation to change the regimen of Hib vaccines, with a reduction in the number of vaccinations as part of their basic regimen. In particular, a transition from a 4-dose to a 3-dose vaccination regimen is being discussed, which would reduce the cost of preventing Hib infection. However, these developments are still at the stage when it would be premature to make a forecast regarding their prospects.

There is reason to believe that in the near future vaccination against Hib will be introduced into the calendars of routine vaccinations in the territory of the CIS countries. Already, this vaccination is recommended by the health authorities of Russia and Ukraine. In some countries, vaccination is carried out through international and foreign humanitarian organizations. According to target program Ministry of Health, scheduled vaccinations against Hib infection may appear in the Russian calendar as early as 2007 or somewhat later, as soon as the domestic vaccine is ready.

However main danger Hib infections are not even s, but acute respiratory infections, including pneumonia and, because it is these forms of it, according to the World Health Organization and the Russian Ministry of Health, that are the most common in countries where there is no routine vaccination against this infection. Unfortunately, Russia is also among these countries. We asked Professor Mikhail Petrovich KOSTINOV, head of the Clinical Center for Immunoprophylaxis of Children's Infections, to answer questions about this infection.

Mikhail Petrovich, what is Hib infection and why is so little known about it?

Haemophilus influenzae (HIB) infection is a group of diseases caused by Haemophilus influenzae type b. It is spread through saliva when sneezing and coughing, as well as through toys and household items that children drag into their mouths. Haemophilus influenzae can cause pneumonia, acute respiratory infections, and other diseases. Unfortunately, on a national scale in Russia, they are just beginning to detect and register this infection and, accordingly, to train doctors. It is for this reason that it is relatively unknown. However, there is no doubt that this problem is very relevant for our country as well.

How common is haemophilus influenzae?

According to Russian studies, in children's groups, the proportion of carriers of Haemophilus influenzae can reach 40%, which explains the frequent colds in children attending or starting to attend kindergartens and nurseries.

How often does Haemophilus influenzae cause disease?

In Russia, HIB is one of the main causes of acute respiratory infections,

For whom this infection poses the greatest threat?

Hib-infection affects all children without exception under the age of 5 years inclusive. First of all, those who attend a nursery or kindergarten. According to WHO, formula-fed children who do not receive antibodies to this infection from their mothers, babies with weakened immune systems are more at risk of getting sick with HiB. chronic diseases heart, lungs, weakening the immune system, also facilitate the penetration of Hib infection into the body.

How easy is Hib to treat?

Hib infection is just very difficult to treat, since this bacillus is record-breaking resistant to antibiotics. For this reason, even timely treatment modern medicines is often unsuccessful. For some common drugs, such as erythromycin, chloramphenicol, tetracycline, the percentage of resistance of Haemophilus influenzae is 80-100%, and these are Russian data. Therefore, treatment should ideally begin with the determination of individual sensitivity to antibiotics.

How to protect a child from a hemophilic infection?

Vaccination is the only, simple and reliable means of preventing Haemophilus influenzae infection. Modern Hib vaccines are actually 100% effective and reliably protect the child during the entire dangerous period.

Abroad, vaccinations against HiB infection have been made since 1989. More than 100 countries around the world are routinely vaccinated against it. In some of them, such as the USA, Great Britain, France, Canada, Finland, vaccinations against this infection are mandatory and are included in national calendars vaccination. By the way, since 2006, Hib vaccination has been included in the calendar mandatory vaccinations Ukraine. We in Russia have been vaccinated against Haemophilus influenzae for more than 10 years. Since there is no Russian vaccine against Hib yet, immunization is carried out by the French, Pasteur, which can rightly be called the "gold standard" - with its advent, in fact, the history of vaccination against HiB all over the world began.

According to our studies, as well as studies conducted almost throughout Russia, it well reduces the level of carriage of Haemophilus influenzae and significantly, by 4-10 times, reduces the incidence of acute respiratory infections. Vaccinated children really begin to get sick less often. While this vaccination can only be done for money, in pay centers vaccination, although some regions have already begun to purchase this vaccine for children from special risk groups.

How easily do children tolerate this vaccine and is it necessary to prepare for it?

The vaccine consists of only one antigen, so it is well tolerated and does not require any preparation. Temperature reactions to it are very rare, not more than 1% of those vaccinated, and mild reactions at the injection site (redness, slight seal) occur in no more than 5% of children.

Children 1 to 5 years of age only need one shot. If possible, then for such babies, ideally, it should be supplemented with a vaccination against pneumococcal infection, and then the child will be protected as much as possible from acute respiratory infections, not worse than children in the same USA.

Akt Hib is a polysaccharide conjugate vaccine against Haemophilus influenzae type b.

Composition, release form and analogues

Akt Hib is available in the form of a lyophilisate for the preparation of a solution for subcutaneous and intramuscular injections along with the solvent. 1 dose of the vaccine contains:

• 10 micrograms of Haemophilus influenzae type b polysaccharide and 18-30 micrograms of conjugated tetanus protein (active ingredients);
• 0.6 mg trometamol, 42.5 mg sucrose (excipients);

0.5 ml of solvent (0.4% sodium chloride solution) contains 2 mg of sodium chloride and up to 0.5 ml of water for injection.

Vaccine Act Hib is a white homogeneous lyophilisate, and the solvent is produced in the form of a colorless clear liquid. One cell pack contains a vial with 1 dose of vaccine and 0.5 ml of diluent in a syringe with a fixed needle. In the case when the needle is not attached to the syringe, 2 separate sterile needles are included in the package.

The main analogue of the Act Hib vaccine is Belgian-made Hiberix.

Pharmacological action Akt Hib

Act Hib is not included in the mandatory vaccination calendar, however, experts strongly recommend the introduction of this vaccine due to the high prevalence of infections with the pathogen Haemophilus influenzae type b. It belongs to bacteria of the opportunistic type, which, with a weakened immune system in a child, provoke the following diseases:

• SARS;
• Otitis;
• Meningitis;
• Bronchitis;
• Arthritis;
• Otitis;
• Sepsis;
• Pneumonia;
• Epiglottitis.

The Act Hib vaccine is intended for the prevention of purulent-septic diseases caused by the pathogen Haemophilus influenzae type b. It develops specific resistance to this pathogen and promotes the production of antibodies. As a result, B-lymphocytes are activated by stimulated T-lymphocytes through lymphokines (mediators of immunity). This is the reason for the immunostimulating effect of Act Hib.

It is important to note that in the case of repeated vaccinations, a pronounced booster effect is observed. It is evidence of the formation of immunological memory acquired as a result of the primary injection.

Indications for use Act Hib

Indications for the use of the vaccine, according to the instructions for Act Hib, are various purulent inflammatory processes and diseases caused by Haemophilus influenzae type b. Injections are allowed for children aged 3 months to 5 years.

Contraindications

According to the instructions for Act Hib, this vaccine is contraindicated in case of individual intolerance to its components, in particular to tetanus toxoid. In addition, if a child has acute illness or in cases of exacerbation of existing chronic illness vaccination should be postponed. It is recommended to inject in such situations only after 2 or even 4 weeks after the complete recovery of the child.

Also, the instruction to Act Hib warns that mild forms respiratory infection or intestinal infections are also reasons to delay vaccination. It can be carried out only after the normalization of the body temperature of the baby.

It should be added that Act Hib does not form immunity to meningitis of a different origin and to other types of the pathogen Haemophilus influenzae. Also, the tetanus protein in this vaccine cannot be used as a substitute for childhood tetanus shots.

According to Act Hib reviews, children who are undergoing immunosuppressive therapy or who are immunocompromised have a weak immune response to the vaccine.

How to use Act Hib

According to the instructions for Act Hib, before use, it is necessary to dissolve the lyophilisate with a syringe filled with a solvent and shake thoroughly until the suspension is completely dissolved. The resulting liquid may have a whitish tint or be slightly cloudy. The vaccine is administered subcutaneously or intramuscularly in a single dose of 0.5 ml. Before injection, it is necessary to check whether the needle has penetrated into blood vessel because Act Hib cannot be used intravenously.

The introduction of the vaccine to children under the age of two years is done in the anterolateral region of the thigh (in the middle third), and after two years - in the deltoid muscle.

If vaccination begins to be given to a child up to six months, then 3 injections are carried out with an interval of 1-2 months. Revaccination can be carried out only 1 time a year after the third vaccination.

If vaccination begins to be given to a child from six months to a year, then 2 injections are carried out with an interval of 1 month. Revaccination can be carried out only 1 time at the age of one and a half years.

At the beginning of Act Hib vaccination at the age of one to 5 years, a single injection is performed.

Side effects

According to Act Hib reviews, after the introduction of the vaccine, in some cases, side effects may be observed in the form pain, redness, swelling and induration at the injection site.

In addition, the vaccine can also provoke:

• Edema of the lower extremities;
• Rash;
• transient purpura;
• Febrile or afebrile seizures;
• vomiting;
• Irritability and prolonged crying;
• Urticaria;
• Temperature increase over 39 °C.

Such side effects occur in most cases when Act Hib is administered as part of combination vaccines, for example, against tetanus, diphtheria and whooping cough. They usually go without residual effects alone during the day.

Some reviews of Act Hib indicate that the vaccine may cause an increase in the interval between respiratory movements in premature babies (born at 28 weeks or earlier).

Drug Interactions Act Hib

It is allowed to use Akt Hib simultaneously with other vaccines of the calendar preventive vaccinations subject to two main conditions: the introduction must be carried out in different parts of the body and using different syringes.

About the introduction of any, including over-the-counter, medicinal product or a vaccine coinciding with or recent Act Hib vaccination, you must inform your doctor.

Storage conditions

Akt Hib vaccine should be stored at 2-8°C in the refrigerator. The shelf life is 3 years.