Introduction
Currently, vaccination is considered the most effective method of preventing infectious diseases. Global immunization of the population throughout the world has made it possible to eliminate the incidence of smallpox and reduce the prevalence and frequency of complications of infectious diseases such as diphtheria, tetanus, and polio.
Prevention of infectious diseases is one of the pressing health problems around the world. Thus, the Regional Office for Europe of the World Health Organization published the “European Vaccine Action Plan 2015–2020”, which includes six main goals.
- Maintaining the region's status as a polio-free territory.
- Elimination of measles and rubella.
- Controlling the spread of hepatitis B.
- Achievement of regional vaccination targets at all administrative levels.
- Making evidence-based decisions about the introduction of new vaccines.
- Achieving financial sustainability of national immunization programs.
Vaccination is a method of active specific prevention that allows a vaccinated person to develop specific immunity against the causative agent of an infectious disease. With mass vaccination over a long period of time, a layer of the population is formed that is immune to a certain infection, which reduces the possibility of circulation and spread of an infectious agent in the population, and consequently, the incidence of disease even among unvaccinated individuals. In addition, the introduction of vaccines against some viruses can prevent not only the development of an infectious disease, but also its complications and consequences (for example, cervical cancer - with human papillomavirus infection).
Basic legislative documents and regulations on vaccination. National calendar of preventive vaccinations
The main legislative documents on vaccination prevention in Russia are the Federal Law of September 17, 1998 No. 157-FZ (as amended on December 31, 2014, as amended on April 6, 2015) “On Immunoprophylaxis of Infectious Diseases” and the Federal Law of March 30, 1999 No. 52- Federal Law (as amended on November 28, 2015) “On the sanitary and epidemiological welfare of the population.”
The national calendar of preventive vaccinations currently in force in our country (Table 1) was determined by order of the Ministry of Health of Russia dated March 21, 2014 No. 125n “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”
The procedure for carrying out preventive vaccinations is presented in guidelines No. 3.3.1889-04, approved by the Chief State Sanitary Doctor of the Russian Federation on March 4, 2004.
Guidelines No. 3.3.1.1095-02 dated January 9, 2002 contain medical contraindications for preventive vaccinations, recommendations for vaccination in the presence of relative contraindications.
Depending on the epidemiological situation, changes are made to the national vaccination calendar. In addition, regulations may be issued regulating additional immunization for epidemiological indications, vaccination of certain groups of the population, etc.
Thus, in 2011, vaccination against Haemophilus influenzae (for children at risk) was included in the national vaccination calendar in Russia, and in 2014 - vaccination against pneumococcal infection. In addition, some changes have been made to the list of indications for influenza vaccination.
In some regions of Russia, additional vaccines have been introduced into the vaccination calendar. Thus, in Moscow, the regional calendar of preventive vaccinations, approved by order of the Moscow Department of Health dated July 4, 2014 No. 614, includes vaccination of children at 12 months. against chickenpox, children 3–6 years old against hepatitis A (before entering children's preschool educational organizations) and vaccination of girls at 12–13 years old against the human papillomavirus.
Vaccinations that are not included in the national vaccination calendar and the vaccination calendar for epidemiological indications can be carried out at the request of patients with vaccines registered in Russia, taking into account indications and contraindications.
Table 1
National calendar of preventive vaccinations
(Appendix No. 1 to the order of the Ministry of Health of Russia dated March 21, 2014 No. 125n)
Name of preventive vaccination |
|
Newborns in the first 24 hours of life | First vaccination against viral hepatitis B (note 1) |
Newborns on the 3rd–7th day of life | Vaccination against tuberculosis (note 2) |
Children, 1 month | Second vaccination against viral hepatitis B (note 1) |
Children, 2 months | Third vaccination against hepatitis B (risk groups) (note 3) |
First vaccination against pneumococcal infection |
|
Children, 3 months | First vaccination against diphtheria, whooping cough, tetanus |
First vaccination against polio (note 4) |
|
First vaccination against Haemophilus influenzae (risk group) (note 5) |
|
Children, 4.5 months | Second vaccination against diphtheria, whooping cough, tetanus |
Second polio vaccination (note 4) |
|
Second vaccination against Haemophilus influenzae infection (risk group) (note 5) |
|
Second vaccination against pneumococcal infection |
|
Children, 6 months | Third vaccination against diphtheria, whooping cough, tetanus |
Third vaccination against viral hepatitis B (note 1) |
|
Third vaccination against polio (note 6) |
|
Third vaccination against Haemophilus influenzae infection (risk group) (note 5) |
|
Children, 12 months | Vaccination against measles, rubella, mumps |
Fourth vaccination against viral hepatitis B (risk groups) (note 1) |
|
Children, 15 months | Revaccination against pneumococcal infection |
Children, 18 months | First revaccination against diphtheria, whooping cough, tetanus |
First revaccination against polio (note 6) |
|
Revaccination against Haemophilus influenzae infection (risk group) (note 5) |
|
Children, 20 months | Second revaccination against polio (note 6) |
Children, 6 years old | Revaccination against measles, rubella, mumps |
Children 6–7 years old | Second revaccination against diphtheria, tetanus (note 7) |
Revaccination against tuberculosis (note 8) |
|
Children, 14 years old | Third revaccination against diphtheria, tetanus (note 7) |
Third revaccination against polio (note 6) |
|
Adults, 18 years old | Revaccination against diphtheria, tetanus - every 10 years from the date of the last revaccination |
Children from 1 year to 18 years old, adults from 18 to 55 years old, not previously vaccinated | Vaccination against viral hepatitis B (note 9) |
Children from 1 year to 18 years, women from 18 to 25 years (inclusive), not sick, not vaccinated, vaccinated once against rubella, who have no information about vaccinations against rubella | Vaccination against rubella |
Children from 1 year to 18 years inclusive and adults up to 35 years of age inclusive, who have not been sick, not vaccinated, vaccinated once, and have no information about vaccinations against measles | Vaccination against measles (note 10) |
Children from 6 months; students in grades 1–11; students studying in professional educational organizations and educational organizations of higher education; adults working in certain professions and positions (employees of medical and educational organizations, transport, public utilities); pregnant women; adults over 60 years of age; persons subject to conscription for military service; people with chronic diseases, including lung disease, cardiovascular disease, metabolic disorders and obesity | Flu vaccination |
Notes:
1. The first, second and third vaccinations are carried out according to the 0–1–6 scheme (1st dose - at the start of vaccination, 2nd dose - 1 month after the 1st vaccination, 3rd dose - 6 months after start of vaccination), with the exception of children belonging to risk groups, whose vaccination against viral hepatitis B is carried out according to the scheme 0-1-2-12 (1st dose -
at the start of vaccination, 2nd dose - 1 month after the 1st vaccination, 3rd dose - 2 months from the start of vaccination, 4th dose - 12 months from the start of vaccination).
2. Vaccination is carried out with a vaccine for the prevention of tuberculosis for gentle primary vaccination (BCG-M); in constituent entities of the Russian Federation with incidence rates exceeding 80 per 100 thousand population, as well as in the presence of tuberculosis patients around the newborn - the vaccine for the prevention of tuberculosis (BCG).
3. Vaccination is carried out for children belonging to risk groups (born from mothers who are carriers of HBsAg, patients with viral hepatitis B or who have had viral hepatitis in the third trimester of pregnancy, who do not have test results for markers of hepatitis B, who use narcotic drugs or psychotropic substances, from families in which there is a carrier of HBsAg or a patient with viral hepatitis B and chronic viral hepatitis).
4. The first and second vaccinations are carried out with a vaccine for the prevention of polio (inactivated).
5. Vaccination is carried out for children belonging to risk groups (with immunodeficiency conditions or anatomical defects leading to a sharply increased risk of hemophilus influenzae infection; with oncohematological diseases and/or long-term immunosuppressive therapy; children born from mothers with HIV infection; children with HIV infection; children in orphanages).
6. The third vaccination and subsequent revaccinations against polio are given to children with a live vaccine to prevent polio; children born to mothers with HIV infection, children with HIV infection, children in orphanages - an inactivated vaccine for the prevention of polio.
7. The second revaccination is carried out with toxoids with a reduced content of antigens.
8. Revaccination is carried out with a vaccine to prevent tuberculosis (BCG).
9. Vaccination is carried out for children and adults who have not previously been vaccinated against viral hepatitis B, according to the 0-1-6 scheme (1st dose -
at the start of vaccination, 2nd dose - 1 month after the 1st vaccination, 3rd dose - 6 months from the start of vaccination).
10. The interval between the first and second vaccinations should be at least 3 months.
All citizens of the Russian Federation have the right to free preventive vaccinations included in the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications in medical organizations of the state and municipal healthcare systems.
Financing of vaccinations not included in the National Calendar of Preventive Vaccinations is carried out from regional budgets, funds from citizens and from other sources not prohibited by the legislation of the Russian Federation.
Types of drugs for vaccine prophylaxis
Vaccines are preparations that are obtained from microorganisms or their metabolic products. The active principle of vaccines is specific antigens, which, when introduced into the human body, cause the development of immunological reactions (active immune response), which further ensure immune resistance to pathogenic microorganisms.
Thus, statements by opponents of vaccination that vaccination suppresses one’s own immunity can be called unfounded.
All vaccines are usually evaluated according to three parameters:
- safety, that is, the absence of pathogenicity (the ability to cause vaccine-associated diseases) for humans;
- reactogenicity, or the ability to cause adverse post-vaccination reactions;
- immunogenicity- the ability to induce a pronounced protective immune response.
Vaccines must be safe, have minimal reactogenicity, and at the same time maintain high immunogenicity.
In accordance with the method of production and the type of specific antigen, all vaccines can be divided into several types.
Live vaccines(for example, measles, rubella, oral poliomyelitis) contain weakened living microorganisms that have lost their virulence, but retain their immunogenic properties. The advantages of such vaccines include their ability to stimulate long-term and lasting immunity, and therefore this type of drug can be administered once or with rare revaccinations (once every 5–10 years). The disadvantages of live vaccines include heat lability, photosensitivity, and the impossibility of strict dosing. In addition, live vaccines can cause vaccine-associated diseases in immunocompromised individuals.
Inactivated (killed) vaccines contain pathogenic microorganisms inactivated (killed) by high temperature, ultraviolet radiation, alcohol, etc. (for example, whole-cell pertussis vaccine, inactivated polio vaccine) or subcellular structures (acellular pertussis vaccine, pneumococcal vaccine). The advantages of inactivated vaccines are heat stability and the possibility of strict dosing. At the same time, they create only humoral immunity, which is less stable than after the introduction of live vaccines, which requires repeated administration. Inactivated vaccines also have disadvantages such as instability to freezing and high reactogenicity. At the same time, whole-cell vaccines containing whole killed microorganisms are more reactogenic. Drugs that contain subunit (subcellular) structures are much less likely to cause adverse reactions.
Anatoxins(diphtheria, tetanus) - chemically neutralized (inactivated) exotoxins of microorganisms that have retained their antigenic structure. The general properties of these immunopreparations are similar to inactivated vaccines, including their requirement for repeated administration. Toxoids create only antitoxic immunity in the absence of antimicrobial immunity. If infected, patients vaccinated with toxoids develop non-toxic forms of the infectious disease (for example, diphtheria) or carriage, which avoids serious complications.
Recombinant vaccines obtained using genetic engineering methods. This type of immunotherapy includes vaccines against the hepatitis B virus (contains the surface antigen of the virus - HBsAg, which causes an immune response), human papillomavirus, and rotavirus. The advantages of such vaccines are the ability to form fairly stable long-term immunity and low reactogenicity.
Basic vaccinations of the national calendar
The national calendar of preventive vaccinations was developed taking into account international recommendations and the epidemiological situation in Russia.
Thus, the need for vaccination against tuberculosis is due to the continuing high incidence rate in Russia (according to Rospotrebnadzor for 2014 - 54.5 per 100 thousand population).
The importance of vaccination against diphtheria, tetanus, whooping cough, and polio is dictated by their severe course and high mortality rates for these diseases.
Despite the decrease in the incidence of viral hepatitis B, immunization of the population is still relevant, especially in risk groups, which is due to the severe course of hepatitis B, frequent transition to chronic forms and a high level of disability.
Vaccination against rubella is aimed not only at preventing the development of severe forms of this disease, especially in adolescents and adults, but primarily at preventing this disease in pregnant women, since it is dangerous for the development of congenital rubella syndrome.
Vaccinal prevention of measles and mumps is also aimed at preventing the development of severe forms and serious complications of these diseases.
The high risk of life-threatening complications from influenza dictates the need for vaccine prevention of this infection, especially in risk groups, including children and the elderly.
Vaccination against Haemophilus influenzae is aimed at reducing the incidence of diseases caused by this pathogen. Haemophilus influenzae b is a common cause of purulent otitis media, pneumonia, meningitis, and epiglottitis in children. Children aged 4 months and older are most often affected. up to 5 years. This infection is associated with about 200 thousand deaths of children under 5 years of age (mainly from meningitis and pneumonia) per year. After meningitis caused by Haemophilus influenzae infection, 15–35% of patients retain persistent impairments leading to disability. About 5% of children with meningitis caused by Haemophilus influenzae infection die.
The introduction of vaccination against pneumococcal infection into the national vaccination calendar is associated with both the high frequency of pneumococcal pneumonia, otitis, meningitis, and the increasing resistance of pneumococci to antibiotics.
Vaccination against hepatitis B
In accordance with the national calendar of preventive vaccinations, vaccination against viral hepatitis B is carried out to all newborn children in the first 24 hours of life. The need for early introduction of the vaccine is dictated by the continuing high levels of incidence of viral hepatitis B and virus carriage, especially in the age group from 15 to 29 years, as well as the high risk of infection of the child during childbirth or during breastfeeding. If a child was not vaccinated at birth for any reason (relative contraindications, parental refusal, etc.), it can be done at any age by drawing up an individual vaccination schedule.
The national vaccination calendar also provides for vaccination against viral hepatitis B for unvaccinated children from 1 to 18 years of age and adults from 18 to 55 years of age.
To prevent viral hepatitis B, recombinant (genetically engineered) vaccines are used.
Vaccination against viral hepatitis B is carried out according to two main schemes - 0–1–6 and
0–1–2–12.
The 0–1–6 schedule, when the first vaccination is carried out in the first 24 hours of a newborn’s life (0), the second vaccination at 1 month (1), and the third at 6 months, is recommended for children who are not at risk.
The 0–1–2–12 vaccination schedule (after the first vaccination, the second is carried out 1 month later, the third – 2 months after the first, and the fourth – 12 months after the first) is used in children from risk groups, which include children born:
1) from mothers who are carriers of HBsAg, sick with viral hepatitis B or who have had viral hepatitis in the third trimester of pregnancy, who do not have test results for hepatitis B markers;
2) from mothers who use narcotic drugs or psychotropic substances;
3) in families where there is a carrier of HBsAg, a patient with acute viral hepatitis B and chronic viral hepatitis.
Also, the 0-1-2-12 regimen is used in adults at risk of infection with the hepatitis B virus (for example, in patients on hemodialysis).
Vaccination against viral hepatitis B in children who are not at risk and who have not received vaccinations before the age of 1 year, as well as adolescents and adults who have not been vaccinated previously, is carried out according to the 0-1-6 scheme (the first dose is on the day of vaccination, the second dose - after 1 month, third dose - after 6 months from the start of immunization).
Vaccination against tuberculosis
Vaccination against tuberculosis is given to newborns in the first 3–7 days of life. To prevent tuberculosis, the BCG vaccine (BCG - Bacillus Calmette - Guerin), containing live attenuated mycobacteria of the vaccine strain (Micobacterium bovis), and BCG-M, in which the content of mycobacteria is lower than in BCG, is used. In regions where the incidence of tuberculosis exceeds 80 per 100 thousand population, it is recommended to use BCG for vaccination of newborns. The same vaccine is used to immunize newborns who are surrounded by tuberculosis patients. In other cases, children are vaccinated with a vaccine to prevent tuberculosis for a gentle primary vaccination with BCG-M.
Revaccination is carried out at 7 years of age for uninfected children who have a negative Mantoux reaction with the BCG vaccine.
Vaccination against pneumococcal infection
To prevent pneumococcal infection, two types of vaccines are used: conjugate and polysaccharide.
Pneumococcal conjugate vaccines (PCV) contain pneumococcal polysaccharides conjugated to a carrier protein. The composition of PCV10 (Synflorix) includes polysaccharides of 10 serotypes of pneumococcus, conjugated with the D-protein of capsular H. influenzae, tetanus and diphtheria toxoids. PCV13 (Prevenar) contains polysaccharides from 13 pneumococcal serotypes conjugated to the carrier protein CRM197 (diphtheria toxoid). Conjugate vaccines do not contain a preservative. Pneumococcal conjugate vaccines are used in children in the first 5 years of life, and PCV13 is also used in people over 50 years of age.
Pneumococcal polysaccharide vaccine (PPV) contains purified capsular polysaccharides from 23 pneumococcal serotypes (Pneumo 23).
PPV is used for vaccination of children over 2 years of age and adults over 65 years of age, as well as from risk groups.
Vaccination against pneumococcal infection in accordance with the national vaccination calendar includes two administrations of a conjugate vaccine in the first year of a child’s life (at 2 and 4.5 months) and revaccination at 15 months.
Risk groups for developing severe pneumococcal infection include:
- patients with chronic diseases of the lungs, cardiovascular system, liver, kidneys, and diabetes mellitus;
- persons with immunodeficiency conditions (HIV, cancer, receiving immunosuppressive therapy);
- persons with anatomical/functional asplenia;
- premature babies;
- persons in organized institutions (orphanages, boarding schools, army collectives);
- patients after cochlear implantation;
- patients with liquorrhea;
- long-term and frequently ill children;
- patients infected with Mycobacterium tuberculosis.
Vaccination against diphtheria and tetanus
For vaccine prevention of diphtheria and tetanus, diphtheria and tetanus toxoids are used, which are part of combination drugs (DTP, ADS, ADS-M, Infanrix-Hexa, Pentaxim, etc.).
Vaccination against diphtheria and tetanus is carried out three times starting from 3 months with an interval between administrations of 45 days (1.5 months). Revaccination is carried out at 18 months (or 1 year after the last vaccination), at 7 years and at 14 years. For adults, revaccination is carried out every 10 years after the last vaccine administration.
It should be remembered that the administration of toxoids allows the formation of only antitoxic immunity, so vaccinated patients may suffer from, for example, diphtheria, but the disease will occur in the form of bacterial carriage or in a non-toxic form, without the development of severe complications (with correct immunization and an adequate immune response).
Vaccination against polio
For vaccine prevention of polio, live oral polio vaccine (OPV) and inactivated polio vaccine (IPV) are used. In this case, IPV can be either a stand-alone drug (Imovax-Polio) or a component of a combination vaccine.
Vaccination against polio is carried out three times (simultaneously with the introduction of DPT) starting from 3 months with an interval between vaccine administrations of 45 days (1.5 months). Revaccination is carried out at 18 months
(also with DPT) and at 20 months. At the age of 14, the last booster vaccination against polio is given.
In accordance with the vaccination calendar, the first and second vaccinations of children (at 3 and 4.5 months) are carried out with IPV, and the third vaccination and all subsequent revaccinations are carried out with OPV (in the absence of contraindications). However, it is possible to carry out a full series of vaccination and revaccination with inactivated polio vaccine. Children who have contraindications to OPV (immunodeficiency conditions, malignant neoplasms) are administered IPV.
Vaccination against whooping cough
Prevention of whooping cough is most important in children in the first year of life, since this disease is especially severe at an early age.
For immunoprophylaxis of whooping cough, combined vaccines containing killed whole-cell pertussis microbes, diphtheria and tetanus toxoids (DTP, Bubo-Kok) are used. Acellular vaccines (Infanrix-Hexa, Pentaxim) are also used, which do not contain the whole pertussis component, which ensures the low reactogenicity of these vaccines compared to whole-cell ones.
The course of vaccination against whooping cough consists of three injections of the vaccine with an interval of 45 days with revaccination after 1 year. In accordance with the vaccination calendar, children are vaccinated at 3, 4.5 and 6 months, revaccination is carried out at 18 months. In case of violation of the vaccination schedule, vaccination against whooping cough must be completed before the child reaches the age of 4 years. After this age, vaccination against whooping cough is not carried out, and for immunoprophylaxis of diphtheria and tetanus, drugs that do not contain a pertussis component are used. In many European countries and the United States, the vaccination schedule includes additional revaccination of children aged 4–6 years with acellular (acellular) pertussis vaccine. In Russia, such revaccination is included in the regional vaccination calendar of the Sverdlovsk region.
Vaccination against Haemophilus influenzae
Vaccination against hemophilus influenzae is carried out for children from risk groups three times at 3, 4.5 and 6 months, revaccination - once at 18 months. (12 months after the third vaccination). If for some reason vaccination begins after 6 months, a double dose of the vaccine with an interval of 1–2 months is sufficient. Risk groups include children with immunodeficiency conditions or anatomical defects that increase the risk of hemophilus influenzae infection, children with oncohematological diseases and/or long-term immunosuppressive therapy, children from mothers with HIV infection, children with HIV infection, children in orphanages .
Vaccination against measles
Vaccination against co r and is carried out with live measles vaccine or combined divaccines (measles-mumps) or trivaccines (measles-mumps-rubella). The use of di- and tri-vaccines is preferable to mono-vaccines, as it reduces the number of injections.
Vaccination against measles is carried out once at 12 months, revaccination - at 6 years. In addition, children from 1 to 18 years of age and adults up to 35 years of age (inclusive), who have not been sick, not vaccinated, vaccinated once, and who do not have information about preventive vaccinations against measles, are subject to immunization against measles.
Vaccination against mumps
Vaccination against mumps is carried out with a live mumps vaccine, as well as di- or tri-vaccines (measles-mumps, measles-mumps-rubella) once at 12 months, revaccination - at 6 years.
Vaccination against rubella
Vaccination against rubella is carried out with a live rubella vaccine or trivaccine (measles-rubella-mumps) once at 12 months, revaccination - at 6 years. In addition, the vaccination calendar regulates the vaccination of children from 1 to 18 years of age, women from 18 to 25 years of age (inclusive), who have not been sick, have not been vaccinated, have been vaccinated once, and have no information about vaccinations against rubella.
Flu vaccination
Influenza vaccination has been included in the list of mandatory vaccinations on the national calendar since 2006. In accordance with the vaccination calendar, children from 6 months are subject to vaccination; students in grades 1–11; students studying in professional educational organizations and educational organizations of higher education; adults working in certain professions and positions (employees of medical and educational organizations, transport, public utilities); pregnant women; adults over 60 years of age; persons subject to conscription for military service; persons with chronic diseases.
Influenza vaccines contain antigens of influenza viruses A/H1N1, A/H3N2 and B. The antigenic composition of vaccines is updated annually depending on the predicted epidemic situation.
The live intranasal vaccine contains attenuated strains of the influenza virus and is used in children over 3 years of age and adults.
Subunit and split vaccines are used in children from 6 months. and adults.
Subunit vaccines (Influvac, Agrippal S1) contain 15 μg of antigens of each strain. The subunit vaccine Grippol® plus includes the immunoadjuvant polyoxidonium, which allows reducing the content of antigens of each strain to 5 μg.
Split vaccines (split) - Begrivak, Vaxigrip, Fluarix, Fluvaxin - contain 15 mcg of antigens of each influenza virus strain.
The listed subunit and split vaccines are produced without a preservative.
The virosomal vaccine Inflexal V, which contains virosomes of highly purified surface antigens of influenza A (H1N1 and H3N2) and B viruses (15 μg for each strain), has also been registered in Russia. Inflexal V does not contain preservatives, formaldehyde, or antibiotics.
Despite the fact that modern inactivated vaccines do not contain stabilizing drugs and antibiotics, it must be borne in mind that chicken embryos are used to produce most of these vaccines. In this regard, the presence of up to 0.05 mcg of ovalbumin in one dose is allowed, which may provoke undesirable local or systemic reactions in persons with chicken protein intolerance.
Vaccination according to epidemic indications
The calendar of preventive vaccinations for epidemic indications is presented in table. 2. The vaccines listed in it are administered when there is an increased risk of contracting a particular infectious disease associated with profession, place of residence, location in the outbreak of the disease, etc.
For example, vaccination against rabies and leptospirosis is carried out for persons who, due to their occupation, encounter stray animals, and therefore have a high risk of infection with the causative agents of these diseases. Contact with a patient with diphtheria is an indication for vaccination in persons who have not previously been vaccinated against this disease.
In recent years, the vaccination schedule for epidemiological indications in our country has also been expanded. In particular, it included vaccination against chickenpox and rotavirus infection.
Table 2
Calendar of preventive vaccinations for epidemic indications
(Appendix No. 2 to the order of the Ministry of Health of Russia dated March 21, 2014 No. 125n)
Name of vaccination | |||
Against tularemia | Persons living in territories enzootic for tularemia, as well as those arriving in these territories – agricultural, drainage, construction, other work on excavation and movement of soil, procurement, fishing, geological, survey, expedition, deratization and disinfestation; – for logging, clearing and landscaping of forests, health and recreation areas for the population. *) Persons working with live cultures of the causative agent of tularemia |
||
Against the plague | Persons living in areas enzootic for plague. Persons working with live cultures of the plague pathogen |
||
Against brucellosis | In foci of goat-sheep type brucellosis, persons performing the following work: – on the procurement, storage, processing of raw materials and livestock products obtained from farms where livestock diseases with brucellosis are registered; – for the slaughter of livestock suffering from brucellosis, the procurement and processing of meat and meat products obtained from it. Livestock breeders, veterinarians, livestock specialists in farms enzootic for brucellosis. Persons working with live cultures of the causative agent of brucellosis |
||
Against anthrax | Persons performing the following work: – livestock workers and other persons professionally engaged in pre-slaughter livestock maintenance, as well as slaughter, skinning and cutting of carcasses; – collection, storage, transportation and primary processing of raw materials of animal origin; – agricultural, drainage, construction, excavation and movement of soil, procurement, fishing, geological, survey, expedition in anthrax-enzootic territories. Persons working with material suspected of being infected with anthrax |
||
Against rabies | For preventive purposes, people at high risk of contracting rabies are vaccinated: – persons working with the “street” rabies virus; – veterinary workers; huntsmen, hunters, foresters; persons performing work on catching and keeping animals |
||
Against leptospirosis | Persons performing the following work: – on the procurement, storage, processing of raw materials and livestock products obtained from farms located in areas enzootic for leptospirosis; – for the slaughter of livestock with leptospirosis, the procurement and processing of meat and meat products obtained from animals with leptospirosis; – on catching and keeping stray animals. Persons working with live cultures of the causative agent of leptospirosis |
||
Against tick-borne viral encephalitis | Persons living in areas endemic for tick-borne viral encephalitis, as well as persons arriving in these territories performing the following work: agricultural, drainage, construction, excavation and movement of soil, procurement, fishing, geological, survey, expedition, deratization and disinfestation; for logging, clearing and landscaping of forests, health and recreation areas for the population. Persons working with live cultures of tick-borne encephalitis |
||
Against Q fever | Persons performing work on the procurement, storage, processing of raw materials and livestock products obtained from farms where diseases of Q fever are registered in livestock. Persons performing work on the procurement, storage and processing of agricultural products in enzootic areas for Q fever. Persons working with live cultures of Q fever pathogens |
||
Against yellow fever | Persons traveling outside the Russian Federation to yellow fever-enzootic countries (regions). Persons handling live cultures of yellow fever pathogen |
||
Against cholera | Persons traveling to cholera-prone countries (regions). Population of the constituent entities of the Russian Federation in the event of complications of the sanitary and epidemiological situation regarding cholera in neighboring countries, as well as on the territory of the Russian Federation |
||
Against typhoid fever | Persons engaged in the field of municipal improvement (workers servicing sewer networks, structures and equipment, as well as organizations carrying out sanitary cleaning of populated areas, collection, transportation and disposal of household waste). Persons working with live cultures of typhoid pathogens. Population living in areas with chronic water epidemics of typhoid fever. Persons traveling to hyperendemic countries (regions) for typhoid fever. Contact persons in areas of typhoid fever according to epidemiological indications. According to epidemic indications, vaccinations are carried out when there is a threat of an epidemic or outbreak (natural disasters, major accidents on the water supply and sewerage networks), as well as in pe Irina Evgenievna MoiseevaNorth-Western State Medical University named after I.I. Mechnikov
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Partnership Programs |
Aptekarskiy per, d. 3, lit. A, office 1H, 191186 Saint-Petersburg, Russia |
37. Vaccine prevention and vaccine therapy.
Vaccinal prevention– administration of drugs to prevent the development of infectious diseases.
Vaccine therapy– administration of drugs for therapeutic purposes.
Vaccine preparations are administered orally, subcutaneously, intradermally, parenterally, intranasally and inhalation. The method of administration is determined by the properties of the drug. Depending on the degree of need, routine vaccination and vaccination for epidemiological indications are distinguished. The first is carried out in accordance with the regulated calendar of immunoprophylaxis of the most common or dangerous infections. Vaccination according to epidemiological indications is carried out to urgently create immunity in persons at risk of developing infection, for example, among staff of infectious diseases hospitals, during an outbreak of an infectious disease in a populated area or a proposed trip to endemic areas (yellow fever, hepatitis A)
38. Live vaccine: production, requirements for vaccine strains, advantages and disadvantages.
Receipt:
Obtained by using two basic principles:
Jenner's principle– the use of strains of pathogens of infectious animal diseases that are genetically closely related to similar human diseases. Based on this principle, vaccinia vaccine and BCG vaccine were obtained. The protective agents (immunogens) of these microbes turned out to be almost identical.
Pasteur's principle– obtaining vaccines from artificially weakened (attenuated) virulent strains of human infectious agents. The method is based on the selection of strains with altered hereditary characteristics. These strains differ from the original ones in that they have lost their virulence, but have retained their immunogenic properties. This is how Pasteur obtained a vaccine against rabies, and later a vaccine against anthrax, plague, and tularemia.
The following methods are used to obtain attenuated strains of pathogenic microbes:
Changing the virulence of a pathogen by exposing it to unfavorable environmental factors followed by selection
Selection of avirulent strains from existing microbial collections.
Requirements for vaccine strains:
selection of spotted mutants with reduced virulence and preserved immunogenic properties by cultivating them under certain conditions or passage through the body of animals resistant to benthic infection.
Advantages– a completely preserved set of pathogen Ags, which ensures the development of long-term immunity even after a single immunization.
Flaws– the risk of developing a manifest infection as a result of reduced attenuation of the vaccine strain.
39. Killed vaccines. The principle of receiving. Chemical vaccines.
Killed vaccines.
Produced from highly verulent strains of infectious agents that are typical in antigenic structure. Bacterial strains are grown on solid or liquid nutrient media (virus strains are grown in animal bodies or cultured cells).
heating, treatment with farmalin, acetone, and alcohol ensures reliable inactivation of pathogens and minimal damage to Ag.
Production control is carried out for sterility, harmlessness, reactogenicity, immunogenicity. Vaccines are sterilely filled into ampoules and then dried in a vacuum at low temperature.
Drying vaccines ensures high stability of drugs (storage for 2 or more years) and reduces the concentration of some impurities (formalin, phenol).
Vaccines are stored at a temperature of 4-8 degrees. Immunization with killed vaccines leads to the creation of active antimicrobial immunity.
The effectiveness of immunization is assessed in epidemiological experiments by comparing the incidence rate in vaccinated and unvaccinated people, as well as by the level of protective Abs determined in vaccinated people. The effectiveness of these vaccines is generally lower compared to live ones, but upon repeated administration they create fairly stable immunity; the most common route of administration is parenteral.
Chemical vaccines
They consist of Ags obtained from microorganisms by various, mainly chemical, methods. For this purpose, acid hydrolysis and extraction with trichloroacetic acid are also used. However, the most commonly used method is enzymatic digestion according to Raistrick and Topley.
Cooking steps:
Growing a vaccine strain culture in a liquid nutrient medium, followed by destruction of bacteria with pancreatin and supercentrifugation to remove corpuscular elements.
Precipitation of immunogen from the supernatant with alcohol and supercentrifugation to precipitate Ag
Freeze drying of precipitated complete Ag with the addition of a preservative (0.3% phenol solution) and sorbent (aluminum hydroxide).
Chemical vaccines contain an admixture of individual organic compounds consisting of proteins, polysaccharides and lipids. In some cases, ribosomal fractions of microbes are used.
The main principle of obtaining these vaccines is the isolation and purification of protective Ags, which ensure the development of reliable immunity.
A type of chemical vaccines are split and subunit vaccines. Digested vaccines contain the internal and external proteins of the virus broken down into fractions. Subunit vaccines contain only the outer proteins of the virus, the remaining Ags are removed.
Chemical vaccines have weak reactogenicity. They can be administered in large doses and repeatedly. The use of adjuvants, as immune response enhancers, increases the effectiveness of vaccines. Chem. Vaccines, especially dry ones, are resistant to environmental influences, are well standardized and can be used in various associations aimed simultaneously against a number of infections.
In recent years, the situation with infectious diseases has sharply worsened throughout Russia, especially in large cities. High growth is observed in the group of so-called controlled infections. This means that children are more likely to get sick with diphtheria, whooping cough, mumps and other infectious diseases. Scientists attribute this to changes in socio-economic conditions, in other words, to a deterioration in living conditions. But not only! The increase in the incidence of controlled infections is associated with insufficient vaccination coverage of eligible groups of children and adults, and the high frequency of unjustified refusals from vaccinations.
Humanity does not owe the salvation of so many lives to any medical science as vaccinology, which studies the development and use of drugs for the prevention of infectious diseases - vaccine prevention has demonstrated impressive successes and, without a doubt, has proven that it is the most effective means of preventing infectious diseases. One such achievement is the eradication of smallpox in the 20th century. In the near future, the goals of eliminating polio and reducing the incidence of measles, rubella, diphtheria and mumps are set. A wide network of immunization rooms has been created in children's clinics, and vaccination rooms have been opened to immunize children on a paid basis. The legal framework for vaccine prevention has been developed and implemented.
In the coming century, vaccine prevention will play an increasingly important role in protecting the population from infections. It is expected that in the 21st century the calendar of preventive vaccinations will include immunization against 35-40 infections. Today we can say with complete confidence that vaccination is an effective method of preventing a number of infectious diseases.
Vaccination and immunoprophylaxis
Vaccination provides protection for both children and adults from a number of serious infectious diseases. This series includes infections such as tuberculosis, hepatitis, diphtheria, tetanus, whooping cough, polio, measles, rubella, mumps, meningococcal infection, hemophilic infection, influenza and others. According to the World Health Organization (WHO), 4-5 million children worldwide die or become disabled every year from the above infections. The successful development of medicine has made it possible to find an effective method of prevention and protection against these diseases - the method of timely vaccination. Timely vaccination is immunoprophylaxis within the time limits presented in the national vaccination calendar (each country has its own vaccination calendar that meets international requirements).
Immunoprophylaxis is a method of individual or mass protection of the population from infectious diseases by creating or enhancing artificial immunity. Immunity is the ability of the human body to resist unfavorable external factors, such as bacteria, viruses, fungi, poisons of various origins that enter the body with food and air. Conventionally, immunity can be divided into general and specific. The implementation of general immunity involves the central organs of immunity (thymus gland, tonsils, etc.), skin, mucous membranes, blood proteins, etc. Means of specific immunity (antibodies - immunoglobulins G and M) are selective and are formed after an illness or vaccinations. A child with a high level of general immunity reduces not only the risk of post-vaccination complications, but also the likelihood of contracting the infectious disease against which he is vaccinated.
- Immunoprophylaxis is:
- specific (directed against a specific pathogen)
- nonspecific (activation of the body’s immune system as a whole)
- active (production of protective antibodies by the body itself in response to the vaccine)
- passive (introduction of ready-made antibodies into the body) The successful development of medicine has made it possible to find an effective method of prevention and protection against infectious diseases - the method of timely vaccination.
Vaccination is the introduction into the human body of a weakened or killed pathogenic agent (or an artificially synthesized protein that is identical to the agent’s protein) in order to form immunity by producing antibodies to fight the pathogen. Among the microorganisms that are successfully combated with the help of vaccinations, there may be viruses (for example, the causative agents of measles, rubella, mumps, polio, hepatitis A and B, etc.) or bacteria (the causative agents of tuberculosis, diphtheria, whooping cough, tetanus, etc.). The more people are immune to a particular disease, the less likely the rest (non-immune) are to get sick, the less likely an epidemic will occur. The development of specific immunity to a projective (protective) level can be achieved with a single vaccination (measles, mumps, tuberculosis) or with multiple vaccinations (poliomyelitis, DPT).
Vaccination is the most effective and cost-effective means of protection against infectious diseases known to modern medicine.
Vaccines are biological preparations designed to create immunity in people, animals and birds to pathogens of infectious diseases. They are obtained from weakened or killed microorganisms or their metabolic products. The basis of each vaccine is protective antigens, which represent only a small part of a bacterial cell or virus and ensure the development of a specific immune response.
Who needs vaccines and why?
Mass vaccination events are necessary to prepare the body for a quick and effective encounter with a pathogenic microbe. Vaccines containing bacteria, viruses or their antigens in a safe form are administered so that the immune system has time to first “get acquainted” with this pathogen and mobilize its protective resources. Already upon a second encounter with a real “enemy,” the body will be ready to very quickly develop a reaction that is able to eliminate the invading virus or bacteria before they manage to settle in it and begin to reproduce.
Vaccines are administered to the body in different ways.
Methods of administering vaccines
Oral (through the mouth). A classic example of an oral vaccine is OPV - live polio vaccine. Typically, live vaccines that protect against intestinal infections (poliomyelitis, typhoid fever) are administered in this way. This type of vaccination does not require special education or training.
Intradermal and cutaneous. A classic example intended for intradermal administration is BCG. Other intradermal vaccines include live tularemia vaccine and smallpox vaccine. The traditional site for cutaneous injection of vaccines is either the shoulder (above the deltoid muscle) or the forearm - midway between the wrist and elbow.
Subcutaneous route of vaccine administration. A fairly traditional way of administering vaccines and other immunobiological drugs in the territory of the former USSR, the well-known injection “under the shoulder blade” (this is how gangrenous and staphylococcal toxoids are administered). In general, this route is used for both live and inactivated vaccines. The vaccination site can be either the shoulder (the lateral surface of the middle between the shoulder and elbow joints) or the anterolateral surface of the middle third of the thigh.
Intramuscular route of vaccine administration- the most preferred method of vaccination. It is not recommended for children to be vaccinated in the gluteal region, since at this age the subcutaneous fat layer is well developed, and it is very difficult to get into the gluteal muscle. In addition, any injection into the gluteal region is accompanied by a certain risk of damage to the sciatic nerve in people with anatomical features of its passage through the muscles. Therefore, the most preferable place for intramuscular injection of vaccines in children under 2 years of age is the anterolateral surface of the thigh (in its middle third). In this place, muscle mass is significantly developed, and the subcutaneous fat layer is thinner than in the gluteal region.
In children over 18 months of age and adults, the preferred site for vaccines is the deltoid muscle (the muscle thickening at the top of the upper arm below the head of the humerus). This injection site is not used for vaccination of young children due to insufficient development of muscle mass and greater pain.
Some vaccines (such as live influenza) are administered through the nose using special nebulizers. An aerosol method of administering the vaccine to the mucous membranes of the oral cavity and upper respiratory tract is being developed, as well as in the form of tablets or lozenges for resorption in the mouth.
Revaccination (repeated administration of the vaccine) is aimed at maintaining the immunity developed by previous vaccinations.
- The development of post-vaccination immunity is influenced by the following factors:
- factors related to the vaccine itself
- factors depending on the body:
- state of individual immune reactivity
- age
- presence of immunodeficiency
- state of the body as a whole
- genetic predisposition
- factors related to the external environment:
- quality of human nutrition
- working and living conditions
- climate
- physical and chemical environmental factors
Preventive vaccinations
Vaccines used for preventive vaccinations.
National calendar of preventive vaccinations.
| Age | Name of vaccination |
|---|---|
| In the first 24 hours of life | First vaccination - against hepatitis B |
| Newborns (3-7 days) | Vaccination against tuberculosis (BCG) |
| 3 months | Second vaccination against viral hepatitis B, first vaccination against diphtheria, whooping cough, tetanus, polio |
| 4.5 months | Second vaccination against diphtheria, whooping cough, tetanus, polio |
| 6 months | Third vaccination of viral hepatitis, against diphtheria, whooping cough, tetanus, polio |
| 12 months | Fourth vaccination against viral hepatitis B, measles, mumps, rubella |
| 18 months | First revaccination against diphtheria, whooping cough, tetanus, polio |
| 20 months | Second revaccination against polio |
| 6 years | Revaccination against measles, mumps, rubella |
| 6-7 years | Second revaccination against diphtheria, tetanus |
| 7 years | Revaccination against tuberculosis (BCG) |
| 14 years old | Third revaccination against diphtheria, tetanus, revaccination against tuberculosis, third revaccination against polio |
| Adults over 18 years old | Revaccination against diphtheria, tetanus - every 10 years from the date of the last revaccination |
| Children from 1 year to 17 years old, adults from 18 to 55 years old who have not been vaccinated previously | Vaccination against viral hepatitis B |
General characteristics of vaccines in the vaccination calendar
- About 40 types of vaccines are produced in Russia. Among them:
- Live vaccines (influenza, measles, mumps, polio, anthrax, tuberculosis, Q fever, tularemia, plague, brucellosis)
- Killed (inactivated) vaccines (rabies, typhoid fever, influenza, tick-borne encephalitis, whooping cough, cholera, leptospirosis, typhus, herpes)
- Chemical vaccines (meningococcal infection, cholera, typhoid fever)
- Toxoids (diphtheria, tetanus, botulism)
- Recombinant vaccines (hepatitis B)
Live vaccines are prepared from apathogenic pathogens, i.e. weakened in artificial or natural conditions. Vaccine strains lose their pathogenic properties and lose the ability to cause an infectious disease in humans, but retain the ability to multiply at the injection site, and subsequently in the lymph nodes and internal organs. An infection artificially caused by the introduction of a vaccine continues for a certain time, is not accompanied by a clinical picture of the disease and stimulates the formation of immunity to pathogenic strains of microorganisms. In isolated cases, diseases caused directly by the administration of the vaccine may occur. Sometimes the cause is the weakened immunity of the vaccinated person, sometimes it is the residual virulence of the vaccine strain. Live vaccines create longer-lasting and stronger immunity than inactivated and chemical vaccines. To create such lasting immunity, a single injection of the vaccine is sufficient. Due to the fact that vaccines are made from living microorganisms, a number of requirements are met for the preservation of vaccines.
Inactivated vaccines are prepared from inactivated (by heating, treatment with alcohol, acetone, formaldehyde) virulent strains of bacteria and viruses that have a set of necessary antigens. With the above processing methods, the structure of the antigens is almost not damaged and at the same time, complete inactivation of the vaccines is achieved.
To create long-term protection, repeated administration of inactivated vaccines is required (as their effectiveness is lower than that of live ones).
Chemical vaccines have weak reactogenicity and can be administered repeatedly and in large doses. They are resistant to environmental influences and can be used in various associations, aimed simultaneously against several infections.
Toxoids stimulate the formation of antitoxic immunity, which is inferior to immunity that appears naturally (after suffering from a disease) or after the administration of live vaccines. Antitoxic immunity does not guarantee that a vaccinated person will not become a carrier of bacteria. If the toxoid is not completely inactivated (this may be due to insufficient control during production), symptoms characteristic of this disease may occur.
Recombinant vaccines are a fairly new direction in vaccine production. These are vaccines obtained through genetic engineering. A section of DNA from a pathogenic virus is inserted into the genetic apparatus of a non-pathogenic virus. They have proven in practice their effectiveness, safety, and suitability for use in combination with other vaccines. However, so far, only the recombinant vaccine against hepatitis B has taken its place in the vaccination calendar and in vaccination practice in general.
Combined (complex) vaccines are widely used in world practice. Among them: DTP, live complex vaccine for the prevention of measles, mumps and rubella (produced only abroad), vaccine against measles, mumps and rubella in combination with live vaccines against polio and chickenpox, trivalent polio vaccine (live, inactivated), meningococcal vaccine, flu vaccine, etc.
Contraindications to preventive vaccinations.
Side effects. Complications.
The attitude of doctors towards contraindications to vaccination is constantly changing. There are fewer and fewer reasons for “exemptions,” as the list of diseases exempt from vaccinations becomes shorter. For example, many chronic diseases are not currently a contraindication for vaccination. On the contrary, only timely vaccination of such patients can reduce the number of complications during the next exacerbation. Examples include severe measles in patients with nutritional disorders infected with tuberculosis and HIV, whooping cough in premature infants, rubella in patients with diabetes, influenza in patients with bronchial asthma, pneumococcal infection in patients with blood diseases, viral hepatitis in patients with liver diseases, chickenpox in patients with leukemia. The reduction of contraindications for vaccinations is also associated with the improvement of vaccine production technology.
All contraindications are divided into:
False - contraindications that are not. This list includes diagnoses that indicate an imaginary pathology, for example, dysbiosis in children with normal stool. The question of vaccination is decided by the doctor in each specific case.
Relative (temporal)- there is a contraindication at the moment, but over time it can be removed. A temporary contraindication for routine vaccination is an acute illness or exacerbation of a chronic process. In such cases, vaccinations are given no earlier than 1 month after recovery.
Absolute (constant)- contraindications that should be carefully observed. These contraindications are set out in the instructions for use of the vaccine and an examination by a doctor is required before each vaccination. If there is such a contraindication, this vaccination is not carried out under any circumstances, as the risk of developing post-vaccination complications increases. Among the constant contraindications, there are common to all vaccines. This is an excessively strong reaction or complication to a previous vaccine. There are contraindications for the administration of live vaccines: malignant neoplasms, pregnancy, and some diseases of the immune system. In addition, each vaccine may have its own contraindication, for example, in the case of the hepatitis B vaccine it is an allergic reaction to baker's yeast, for the influenza vaccine it is an allergy to chicken protein.
| State | Vaccine |
|---|---|
| Severe reaction to a previous dose of vaccine | All vaccines |
| Primary immunodeficiency, HIV infection | BCG, OPV, ZhKV, ZhPV |
| Progressive neurological pathology | DPT |
| Convulsions | DPT |
| Severe forms of allergic diseases (anaphylactic shock, recurrent angioedema, polymorphic exudative eczema, serum sickness) | DTP (administered DPT) |
| Malignant blood diseases, neoplasms | All vaccines |
| Allergic reactions to aminoglycosides | All vaccines |
| Anaphylaxis to chicken protein | Imported vaccines |
OPV - attenuated polio vaccine LCV - live measles vaccine LPV - live mumps vaccine
| Nosological forms | Vaccine | Vaccination recommendations | Acute febrile illnesses | All vaccines | In 2 weeks |
|---|---|---|
| Chronic diseases in the acute stage | All vaccines | Upon achieving complete or partial remission (after 24 weeks) | Prematurity (body weight less than 2000 g), intrauterine infections, hemolytic disease of the newborn, etc. | All vaccines | With normal physical and mental development, children who were not vaccinated during the neonatal period receive the vaccine after recovery |
| After administration of gamma globulin, blood plasma preparations and intravenous immunoglobulin | Live vaccines | Vaccination is carried out some time after administration of the drug (depending on the dose) |
False contraindications to vaccination
- stable organic lesions of the nervous system of various origins
- congenital malformations in the compensation stage
- allergic conditions and manifestations in a latent state
- non-progressive perinatal encephalopathy
- rickets
- anemia moderate
- thymus enlargement
- maintenance therapy for chronic diseases
- dysbacteriosis detected by laboratory tests, without clinical manifestations
Vaccination exceptions
Often decisions are made about the impossibility of vaccinating children with poor health. However, according to WHO recommendations, it is weakened children who should be vaccinated first, since they are most seriously ill with infections. Recently, the list of diseases considered contraindications for vaccination has been significantly narrowed.
If there is a risk of contracting whooping cough, diphtheria or tetanus due to an unfavorable epidemiological situation, then the benefits of vaccination may outweigh the risk of complications and in these cases the child should be vaccinated. These conditions include:
- increase in body temperature more than 40°C within 48 hours after vaccination (not caused by other reasons)
- collapse or similar condition (hypotonic episode) within 48 hours after vaccination
- continuous, inconsolable crying for 3 or more hours, occurring in the first two days after vaccination
- convulsions (with or without fever) occurring within 3 days after vaccination
Vaccination of children with known or potential neurological disorders poses a particular challenge. Such children have an increased (compared to other children) risk of manifestation (manifestation) of the underlying disease for the first time 1-3 days after vaccination. In some cases, it is recommended to postpone vaccination with DPT vaccine until the diagnosis is clarified, a course of treatment is prescribed and the child’s condition is stabilized.
Examples of such conditions are: progressive encephalopathy, uncontrolled epilepsy, infantile spasms, a history of seizures, and any neurological impairment that occurs between doses of DPT.
Stable neurological conditions and developmental delays are not contraindications to DTP vaccination. However, it is recommended that such children be given paracetamol at the time of vaccination.
Situations in which the vaccine is prescribed with caution.
Vaccination is postponed if the child has a severe or moderate infectious disease.
Subsequent doses of the DPT vaccine are contraindicated if, after the previous administration, the child experienced anaphylactic shock or encephalopathy (within 7 days and not caused by other reasons).
Vaccination reactions and post-vaccination complications
The vaccine often causes mild vaccination reactions: increased body temperature (usually no higher than 37.5°C), moderate pain, redness and swelling at the injection site, loss of appetite. To reduce the temperature reaction, it is recommended to give paracetamol. If a temperature reaction occurs in a child 24 hours after vaccination or lasts more than a day, then it is considered that it is not related to the vaccination and is caused by another reason. This condition should be examined by a doctor to avoid missing a more serious condition, such as otitis media or meningitis.
Severe vaccine reactions caused by DPT administration are rare. They occur in less than 0.3% of vaccinated people. These include body temperature above 40.5°C, collapse (hypotonic episode), convulsions with or without an increase in temperature.
There are general and local post-vaccination reactions.
General reactions are expressed by a moderate increase in body temperature and mild malaise. When the vaccine is administered subcutaneously, pain appears, and less often, swelling at the injection site (local reaction). Both general and local reactions after vaccinations are easily tolerated and last no more than 3 days.
Severe general intoxication, swelling and suppuration at the site of vaccine administration are regarded as a post-vaccination complication.
Common post-vaccination reactions include: fever, general malaise, headache, joint pain, abdominal pain, vomiting, nausea, sleep disturbance, etc. Temperature is the most objective indicator of the general reaction. It is according to the degree of temperature rise that general reactions are divided into weak (37-37.5 °C), medium (37.6-38.5 °C) and strong (over 38.5 °C). The timing of the onset of a general reaction varies for different vaccines. Thus, a temperature reaction after administration of the DTP vaccine occurs mainly in the first day after vaccination and quickly passes. A temperature reaction to the administration of measles vaccine can occur from the 6th to the 12th day after vaccination. At the same time, hyperemia of the pharynx, runny nose, mild cough, and sometimes conjunctivitis are observed. Less common are general malaise, loss of appetite, nosebleeds, and measles-like rash.
From the 8th to the 16th day after vaccination against mumps, an increase in temperature, hyperemia of the pharynx, rhinitis, and a short-term (1-3 days) increase in the parotid salivary glands are occasionally observed. Prolonged manifestations of catarrhal phenomena or a more pronounced enlargement of the salivary glands are a reason to consult a doctor.
Local reactions develop directly at the site of drug administration. A local reaction to the DPT vaccine is expressed in redness and a small thickening (about 2.5 cm in diameter) at the injection site. A local reaction to the measles vaccine, which appears only occasionally: hyperemia, slight swelling of the tissue at the site of vaccine administration for 1-2 days. A possible local reaction to the rubella vaccine is hyperemia at the site of vaccine administration, and occasionally lymphadenitis.
So, the local reaction manifests itself as local pain, swelling, hyperemia, infiltration, inflammation.
With the aerosol method of vaccine administration, local reactions such as conjunctivitis and catarrhal phenomena of the upper respiratory tract may be observed.
The presence of general and local reactions, as well as the degree of their manifestation, largely depend on the type of vaccine. When live vaccines are administered, symptoms may appear due to the characteristic properties of the strains themselves and the occurrence of a vaccine infectious process.
When introducing killed and chemically adsorbed vaccines, as well as toxoids, local reactions usually develop within a day and, as a rule, disappear after 2-7 days. Fever and other signs of a general reaction last a day or two.
With repeated vaccination, allergic reactions to the vaccine may occur, which are expressed by the appearance of swelling and hyperemia at the site of vaccine administration, as well as complications of general reactions with fever, low blood pressure, rash, etc. Allergic reactions may occur immediately after administration of the drug, but may also appear later , a day or two after vaccination. The fact is that vaccines contain a variety of allergenic substances, some of which cause an immediate allergic reaction, and some cause increased sensitivity, the consequences of which may appear over time. For example, a certain number of children are allergic to egg white, bovine albumin, bovine whey and other heterologous proteins. It has been proven that not all of these children have allergic reactions to a vaccine containing this protein, and that such children, in principle, can be vaccinated with this drug.
Vaccination of travelers
Before traveling abroad, each child must be vaccinated according to age. It is advisable to get the last vaccination no later than 2 weeks before the intended trip. Special exemptions in connection with travel are unacceptable; on the contrary, if necessary, vaccinations can be accelerated, for example, by starting them at the age of 2 months, so that by 4 months the child is fully vaccinated. Children of any age who are not fully vaccinated are given all the missing vaccines at the same time. These recommendations also apply to children adopted by foreigners.
The same applies to adults who must receive vaccinations required for a particular country of residence.
Depending on the region you're traveling to, vaccinations against the following diseases may be recommended.
Diphtheria and tetanus. Vaccination against these diseases should be carried out when traveling to any country.
Polio. Persons traveling to regions where polio still occurs must complete the full course of primary vaccination. For children, if necessary, you can shift the timing and shorten the interval between vaccinations.
Measles and mumps. All persons who have not received at least one dose of the appropriate vaccine and have not been ill must be vaccinated before departure, regardless of the country.
Tuberculosis. Vaccination is recommended for all persons (especially doctors and teachers) traveling for long periods to work among the population of countries with high incidence rates of this infection. Before the trip and after returning, it is advisable to perform a tuberculin test (Mantoux test), which is especially important for people working in the field and children living with them.
Yellow fever. Vaccination against this disease is required for entry into some countries in Africa and South America.
Hepatitis B. Vaccination against hepatitis B is recommended for persons traveling to the countries of Southeast Asia, Africa, and the Middle East.
Typhoid fever. Persons traveling to developing countries (India, North Africa, Central Asia, etc.) for a long period of time (more than 4 weeks) are subject to vaccination.
Meningococcal infection. Vaccination is indicated for persons traveling for a long period of time to countries with a high risk of infection (Sahara region, United Arab Emirates, Saudi Arabia).
Japanese encephalitis. Vaccination is indicated for persons traveling to endemic areas of a number of countries in Southeast Asia and the Far East to work in the field for more than a month in late summer or early autumn.
Cholera. Since vaccination and medications do not provide complete protection of the body and prevent cholera, WHO has not required a certificate for this disease when entering hot countries since 1973.
Plague. The effectiveness of the plague vaccination is approximately 70%, so it is not mandatory for tourists. Only so-called risk groups are vaccinated, that is, people working in areas where the plague may occur.
Rabies. This disease is widespread in countries such as Vietnam, India, China, Thailand, and South American countries. It is advisable to carry out the vaccination course a month before the intended trip.
Tick-borne encephalitis. The likelihood of infection is most relevant in the following countries and regions: Austria, Czech Republic, Karelia, the Urals, Krasnoyarsk, Khabarovsk Territories, Novosibirsk Region and the Volga Region.
Each country has its own vaccination requirements for those arriving or departing. If you are going on a trip abroad and do not know what vaccinations you need to get, you can contact the country's embassy, where they will give you all the necessary information.
Vaccination according to epidemiological indications.
Rabies
Rabies is a viral disease that primarily affects the nervous system. The source of the infectious agent is animals with rabies (dogs, cats, foxes, wolves). Around the world, about 50 thousand people die from rabies every year.
A person becomes infected through a bite, as well as if the saliva of a sick animal gets on damaged skin or mucous membranes, less often through objects contaminated with saliva, when cutting carcasses, etc. The virus can appear in the saliva of an animal no earlier than 10 days before it develops symptoms of rabies, which determines the period of observation after a bite.
Vaccinal prophylaxis is carried out for persons of a number of professions, emergency - for persons who have been in contact with a sick animal.
Why did one of the richest people on the planet create the largest charitable foundation that supports the development and production of vaccines? Bill Gates has allocated almost $6 billion for vaccinations: to fight polio, malaria, measles, hepatitis B, rotavirus and AIDS. This is part of the largest philanthropic project in human history. In his addresses to business, Bill Gates uses the concept of “capitalist charity” - long-term investments in the social sphere (health care, education), when the state, science and business implement transparent and systematic programs. Global health, he says, needs the private sector, but points out that medical efficiency and income are not mutually exclusive. By creating the technologies of the future at Microsoft today, this person understands that vaccine prevention is the same technology that today lays the foundation for a healthy future for several generations to come. Vaccine prevention is recognized as one of the most effective inventions of world medicine in recent centuries. We do not know about many diseases that claimed the lives of millions of people thanks to vaccination (smallpox, rabies, polio and others were defeated). The average life expectancy of the world population has increased by 20-30 years.
Treatment and treatment is more expensive
Vaccination is an economically effective preventive measure. According to the Global Alliance for Vaccines and Immunization (GAVI), for every dollar invested in vaccinations, the return on investment is $18. According to experts from the Center for Infectious Disease Control (Atlanta, USA), every dollar invested in measles vaccination produces a return of $11.9. The profit for immunization against polio is $10.3, for vaccination against rubella - $7.7, against mumps - $6.7. Immunoprophylaxis of whooping cough and infection caused by Haemophilus influenzae brings a profit of $2.1–3.1 and $3.8, respectively.
$313 million was spent on eradicating smallpox, the amount of damage prevented annually is $1–2 billion. No other sector of the national economy provides such an impressive return. All costs of activities carried out under the auspices of WHO to eradicate smallpox were recouped within one month after its eradication was declared.
Speaking of Russia, the annual economic loss due to rotavirus infection is more than 6.8 billion rubles, and due to the human papillomavirus (HPV) - more than 20 billion rubles. These are the first results of a study of the economic burden of disease and the economic effect of vaccination programs, conducted by experts from the Effective Healthcare platform and presented at the Gaidar Forum in 2018.
In 2017, Effective Healthcare experts began developing a model for assessing the effectiveness of vaccination. The model is based on algorithms for calculating direct economic damage (medical costs), indirect (loss of ability to work), socio-demographic (caused cases of disability, death, loss of reproductive ability), quality of life (years of quality life, life expectancy).
Using this approach, the economic burden of rotavirus and HPV was calculated.
To assess direct damage, experts used compulsory medical insurance tariffs, the actual cost of one case in health care facilities, clinical recommendations, prices for medicines and medical services. When calculating indirect damage, economic indicators were taken, for example, GDP, employment rate, and duration of sick leave.
Experts say most of the costs could be avoided through vaccination and more than 5,000 deaths caused by HPV-related cancers could be prevented. Moreover, preventing reproductive diseases in young women could result in the birth of 1,350 children per year.
According to research by the Global Alliance for Vaccines and Immunization, about 100 million people are at risk of poverty due to health care costs, while timely vaccination from 2016 to 2020 will keep 24 million people out of poverty in 41 countries of the alliance.
High technologies against infections
Vaccine production is a complex, multi-step process that takes on average 4 to 36 months, while solid dosage form (tablet) production can take about three weeks. At the same time, the bulk of this time (up to 70%) is occupied by quality control, which includes several hundred different tests, and this is normal, because healthy newborn children are vaccinated with vaccines. Therefore, in general, the costs of producing and releasing the vaccine into circulation are significantly higher compared to the solid dosage form. Even the transfer of technology to a production site in Russia can last up to three to five years. Not to mention developing vaccines from scratch is billions of dollars, 10-15 years before entering the market. Thus, vaccine production is a process with a deferred business result, and immunization is an investment in the prevention of infectious diseases with delayed effectiveness for the healthcare system.
Understanding the high demand and clear benefits of using vaccines, the industry continues to develop, offering healthcare technological and scientific solutions in the fight against the spread of life-threatening infections for which there are no geographical boundaries. Each local manufacturer holds the defense in its own country, preventing viruses from spreading. World leaders are tackling the challenge on a global scale. Be that as it may, vaccination has been and will be one of the most profitable types of investments in healthcare, because it can significantly reduce the costs of the state and citizens themselves for the treatment of infectious diseases, and also solves the problem of reducing the level of morbidity and mortality from infections, and therefore increasing life expectancy of the country's population.
