Starting this year, children in Belarus will receive fewer vaccinations. More precisely, not the vaccinations themselves, but their repetitions (re-vaccinations). Thus, tuberculosis will now only be vaccinated at birth. Until now, BCG vaccination was also given at 7 years of age (in risk groups). Vaccination against polio will now be carried out at 3, 4, 5 months and 7 years (and it was also done at one and a half and 2 years). What are the reasons for these changes?

Revaccination of children at the age of seven did not affect the incidence of tuberculosis

The BCG vaccine, which is used today all over the world, does not prevent the incidence of tuberculosis, but protects against its generalized forms (for example, tuberculous meningitis, which affects the brain and meninges) precisely in childhood, when immunity has not yet been formed, he explained. Andrey Astrovko, Deputy Director for organizational and methodological work of the Republican Scientific and Practical Center for Pulmonology and Phthisiology. - The revaccination of children at risk at the age of seven, which we carried out, did not change the morbidity picture in any way. Therefore, it was cancelled, as recommended by WHO for countries with a low incidence of tuberculosis among children.

In the diagnosis of tuberculosis, according to the specialist, nothing will change: children from the risk group under 7 years old are given the Mantoux test, and from 8 years old to adolescence - Diaskintest for everyone.

Due to the fact that tuberculosis began to be detected in adolescents at earlier stages, the incidence in this age segment increased, but decreased at the age of 19 - 21 years. In general, the incidence of tuberculosis in Belarus is decreasing,” said Andrei Astrovko.

There are quantitative and qualitative changes in polio vaccination. It will take place in four stages, and the vaccine will be administered only intramuscularly and only inactivated. There will no longer be a live vaccine in drops that drop directly into the mouth.

The use of oral polio vaccine does not exclude the circulation of vaccine poliovirus. It can cause polio in children with immune deficiency. We haven’t had such cases for many years, but in order to completely eliminate them, we are switching to four-time immunization with an inactivated vaccine,” she explained Inna Karaban, Deputy Head of the Department of Hygiene, Epidemiology and Prevention of the Ministry of Health.

Adults should be vaccinated against diphtheria and tetanus every 10 years.

Why are vaccinations done several times? And for how long do they provide immunity?

A full course of preventive vaccinations against viral hepatitis B, measles, rubella, and mumps creates long-term immunity against these infections for 20 years or more, she said Natalia Shmeleva, Head of the Department of Immunoprophylaxis, State Institution “Republican Center for Hygiene, Epidemiology and Public Health”. - Preventive vaccinations against diphtheria and tetanus provide protection for up to 10 years. Therefore, vaccination must be repeated after 16 years every 10 years. If this is not done, protection against infection disappears. And diphtheria and tetanus are diseases that are very difficult for our body to cope with on its own. They are extremely severe, and tetanus is usually fatal.

- Why do preventive vaccinations begin for children under one year of age?

As a rule, the first vaccinations coincide with the time when the maternal antibodies that he received through the placenta disappear from the child’s blood. These antibodies last, as a rule, 3 - 6 months, and against measles, rubella, mumps - 10 months. Children are vaccinated against infections that are most dangerous in childhood, according to a schedule that allows them to form the most stable immunity.

- What serious contraindications to vaccination can there be?

Modern vaccines are safe, and the list of contraindications is quite limited. For vaccines against measles, rubella, mumps, and influenza, this is an allergy to chicken egg whites; for vaccines against whooping cough, diphtheria and tetanus - progressive neurological diseases (for example, epilepsy), anaphylactic shock, Quincke's edema, urticaria that occurred after the first dose of the vaccine (one case per 10 million vaccinations is recorded).

Often in the practice of Belarusian doctors there are false contraindications when the doctor, playing it safe, establishes contraindications for vaccination in children with bronchial asthma or chronic pyelonephritis in remission, when there are no objective reasons to postpone vaccination. As a rule, such children first of all need protection from infections. After all, they have to visit medical institutions much more often than healthy children, and their risk of contracting one of the vaccine-preventable diseases is higher. If a child with bronchial asthma is infected with diphtheria, the outcome of the disease will be unpredictable. But vaccination for such children is very easy.

- Can parents refuse vaccinations for their child?

Yes. In our country, the provision of medical care (including preventive vaccinations) is carried out with the consent of the patient. From the age of 14, a child can independently decide on vaccination. In accordance with Article 45 of the Law of the Republic of Belarus “On Health Care”, parents can refuse medical intervention. The refusal is documented in the medical documentation and signed by the child’s parents. But by refusing to vaccinate their children, they are putting their health at unnecessary risk.

STAY IN THE KNOW!

Free vaccinations for children included in the National Vaccination Calendar of Belarus:

from diphtheria, tetanus, whooping cough, polio, measles, rubella, mumps, tuberculosis, viral hepatitis B, Haemophilus influenzae and pneumococcal infections (at risk), influenza.

Vaccinations against pneumococcal and hemophilus influenzae infections are given free of charge to those who have one of the indications: chronic hepatitis, liver cirrhosis, chronic kidney, heart and lung diseases, immunodeficiency conditions, cystic fibrosis.

Vaccinations on a paid basis:

against influenza (vaccines that are purchased for the provision of paid services), papillomavirus infection, chickenpox, pneumococcal and hemophilic infections (for children who are not vaccinated free of charge), as well as vaccination with complex vaccines containing components against diphtheria and whooping cough in one dose , tetanus, polio, hepatitis.

Vaccinations that can be done free of charge for epidemic reasons:

against rabies, brucellosis, chickenpox, viral hepatitis A, viral hepatitis B, diphtheria, yellow fever, tick-borne encephalitis, whooping cough, measles, rubella, leptospirosis, polio, anthrax, tularemia, plague, mumps.

National calendar of preventive vaccinations

Although vaccination at the level of an idea was born in China back in the 8th century. AD, it is considered the main medical breakthrough of the 19th century. After all, at first, the approach to immunization against the then scourge of humanity, smallpox, was quite barbaric - they simply transferred smallpox pus through an incision to a healthy person. And only the French chemist Louis Pasteur proposed a new method that was both gentler and more progressive, which was brilliantly proven in 1885. Then Pasteur vaccinated against rabies the shepherd Joseph Meister, who had been bitten by a rabid dog, and he remained alive. Since then, new vaccines against dangerous diseases began to appear regularly: 1913 - the debut of vaccination against diphtheria, 1921 - against tuberculosis, 1936 - against tetanus, 1939 - against tick-borne encephalitis, etc. Today, medicine is already firmly in control of infections, is practicing vaccinations even against cervical cancer, and is considering how to deal with its current enemies, say, diabetes and Alzheimer's disease, using the same proven approach.

Vaccination calendar in Belarus

Today it is enshrined in law and includes vaccination against 9 infections: hepatitis B, tuberculosis, whooping cough, diphtheria, tetanus, polio, measles, mumps and rubella. In most regions, since 2008, routine immunization has been carried out against viral hepatitis A. In Minsk, they also vaccinate against Hib (hemophilus influenzae) infection, and from this year - against chickenpox. In addition to the calendar, there is a list of preventive vaccinations - it contains 19 items. They are carried out according to epidemic indications. It must be said that our country is not at all a leader in vaccinations. The national calendars of some countries also include vaccinations against pneumococcal and meningococcal infections.

What vaccinations should I get?

Doctors insist: everything is from the national calendar! Unless, of course, there are contraindications and medical exemptions. After all, each country forms its own calendar for a reason, but taking into account infections that can spread massively in it and be especially difficult, even leading to death. The fact is that a fully vaccinated mother transfers specific antibodies to her baby through the placenta, which will provide protection only in the first months of life. But already from three to five months those that protect against diphtheria, tetanus begin to fade, and by the year - against measles... Therefore, it is so important to help the still delicate body take up an all-round defense.

As for adults, in addition to revaccinations according to the schedule (for example, diphtheria and tetanus are vaccinated once every 10 years), you should definitely think about vaccination against...

• Yellow fever if you are traveling to areas of Africa and Latin America that are 20 degrees above and below the equator. Let's say, to Brazil and Kenya. Everyone who travels there must have an international medical certificate of appropriate vaccination, which is valid for 10 years. In Belarus, it can be done at the 19th Minsk clinic, and at least 10 days before the trip. Vaccines have also been invented for other quarantine infections - plague and cholera, but they are rarely used.
• Hepatitis A. This is if your plans include Egypt, Turkey, Crimea, Bulgaria, Israel or Algeria, where the chance of getting “jaundice” is much higher. This vaccination is done 7 - 14 days before travel, then it provides protection for 1 - 1.5 years. If the vaccination is repeated after 6 - 12 months, then immunity will develop 10 - 20 years in advance.
• Hepatitis B - if you travel for more than a month to Thailand, China and other countries in Southeast Asia, where there is a high probability of becoming infected in medical institutions. There is a “fast” vaccine that will form immunity in a month.
• Tick-borne encephalitis. Such vaccination is highly desirable for fans of extreme rafting on the rivers of the Far East and is not always necessary if you are simply planning to go on a tour of urban Europe. As a rule, they are vaccinated in the fall, in two stages, with an interval of 5 - 7 months. There is a “faster” vaccination, when you can travel within a month. And finally, the “emergency option” is the administration of immunoglobulin 3 to 4 days before the trip. But if the vaccine provides protection for a year, then immunoglobulin provides protection for only a month.

In addition, employees of forest management organizations in the Belovezhskaya Pushcha National Park, Berezinsky Biosphere Reserve and other potentially dangerous places in terms of the spread of infection are vaccinated against tick-borne encephalitis. From rabies - workers who catch and keep stray animals, as well as slaughterhouses, veterinarians, hunters, foresters, taxidermists, etc.

Vaccinations for children in Belarus

Calendars of preventive vaccinations may differ slightly across the country, so we present the one that is valid in Minsk. It includes vaccinations for both children under one year old and those older.

Newborns in the first 12 hours of life- VGV-1

Newborns on days 3-5 of life - BCG (BCG-M)

1 month- VGV-2

3 months - DPT-1 (AaKDS), IPV-1, Hib-1

4 months - DPT-2 (AaKDS), IPV-2, Khib-2

5 months - DPT-3 (AaDPT), IPV-3, VGV-3, Hib-3

12 months - trivaccine (or LCV, ZHPV, rubella vaccine)

18 months- DPT-4 (AaKDS), OPV-4, VGA-1, Khib-4

2 years- OPV-5, VGA-2

6 years - ADS, trivaccine (or LCV, JPV, rubella vaccine)

Before entering school- VGA 1-2*

7 years- OPV-6, BCG

11 years old- AD-M

13 years old- HBV 1-3*

14 years old- BCG**

16 years and every 10 years until age 66 inclusive- ADS-M, (AD-M, AS)

* not previously vaccinated against this infection.

** persons from risk groups.

HBV- vaccine against viral hepatitis B.

HAA- vaccine against viral hepatitis A.

BCG- vaccine against tuberculosis.

BCG-M- vaccine against tuberculosis with reduced antigen content.

DPT- adsorbed pertussis-diphtheria-tetanus vaccine.

AAKDS- acellular adsorbed pertussis-diphtheria-tetanus vaccine.

ADS- adsorbed diphtheria-tetanus toxoid.

AD-M- adsorbed diphtheria toxoid with reduced antigen content.

ADS-M- adsorbed diphtheria-tetanus toxoid with reduced antigen content.

AC- tetanus toxoid.

OPV- oral live polio vaccine.

IPV- inactivated polio vaccine.

ZhKV- live measles vaccine.

ZhPV- live mumps vaccine.

Trivaccine- complex vaccine against measles, rubella, mumps.

Hib- vaccine against Haemophilus influenzae infection (Hib infection).

Vaccination at 3 months

There are three of them - a “three in one” vaccine, simultaneously against whooping cough, diphtheria and tetanus, against polio and against Haemophilus influenzae. If we compare it with the general schedule, it turns out that vaccination at 3 months is not at all “super shock”, as many young parents believe, but it is certainly necessary in order to consistently form the immunity the child needs. However, the opinion that our vaccination is “too early” is also unfounded. For example, vaccination against hepatitis B is done in the first 12 hours from the moment of birth, and this is not our know-how, but the experience of the USA and Europe.

Vaccination against chickenpox and DTP

They started vaccinating against chickenpox this year, free of charge and in all children's clinics. In just three months, more than 3 thousand children received the vaccine, which significantly reduced the risk of spreading the infection, the rise of which was noted last year. In general, this virus is easily transmitted by airborne droplets and is extremely contagious: out of 100 people in contact with a patient with chickenpox, 85-99 will get sick. Moreover, in 5-6 percent of cases complications arise, including pneumonia, acute otitis media and even sometimes meningoencephalitis. Children under one year of age are especially at risk, but even at the age of 15 years and older, chickenpox is often difficult to tolerate. The figure speaks for itself: every month in Minsk, an average of 10 people are hospitalized due to chickenpox. Peak season is from December to May.

As for the chickenpox vaccine itself, it has been used in the world for more than 30 years. Somewhere – in risk groups, somewhere (in Canada, Germany, Australia, etc.) it is included in the national calendar. Until recently, two vaccines against chickenpox were registered in Belarus, Belgian and Japanese. Children from one year to 13 years of age are immunized once, over 13 years old - twice with an interval of 6-10 weeks. The duration of protection is at least 20 years, the guarantee that you will not get sick is up to 94 percent.

The DTP vaccine has two versions - whole cell and cell-free. The second one is practiced in Minsk. The name itself is an abbreviation of the initial letters of the diseases from which protection is given: whooping cough, diphtheria, tetanus. Don't think that these are threats from days gone by. There was a surge in diphtheria in the country in the 1990s, precisely because too many people refused to be immunized. And doctors record the lethal consequences of tetanus almost every year. No one is immune from this, because the pathogen lives in the soil.

Flu vaccination in Minsk

The campaign has already ended. In total, doctors have set themselves the goal of vaccinating 35 percent of Minsk residents (673 thousand people). A year ago there were 505 thousand, and at some enterprises over 40 percent of the workforce was vaccinated against the flu. By the way, it also analyzed how effective and economically feasible it was. It turned out that, for example, an increase in flu vaccinations at the Belarusfilm National Film Studio to 35 percent resulted in a reduction in the incidence of more than 10 percent. Experts have already even calculated the overall figure: for every dollar invested in the vaccination campaign, there is a $11.2 effect. Last year, in this way, more than 49 thousand cases of influenza and more than 60 thousand ARVI diseases were prevented in Minsk.

Chinese or French flu vaccine?

Natalya Gribkova, head of the laboratory of influenza and influenza-like diseases of the Republican Scientific and Practical Center for Epidemiology and Microbiology, does not consider this issue to be fundamental: “They are of the same level, they are not at all different in quality. The Chinese one is, yes, somewhat cheaper, but if the production does not comply with WHO requirements, the country will simply be deprived of the right to produce the vaccine.” Another question is that WHO experts changed the composition of the vaccine for Belarusians. Typically, we have three influenza viruses circulating: two viruses of group A and one of group B, and last year microbiologists identified another one of group B. So the current vaccine already has 4 components. For free vaccination, the vaccine “Fluvaxin” (China) is used, for paid vaccination “Vaxigrip” (France), “Grippol Plus” (Russia), “Influvac” (Netherlands). The cost of the procedure is from 70 to 127 thousand rubles, depending on the type.

Flu shots for children

Kindergarten pupils and schoolchildren are classified as a so-called risk group, therefore their flu vaccination is very desirable. After all, a children's group, where millions of microbes rotate, is fertile ground for an epidemic. Everyone is vaccinated for free, on the spot. However, with the consent of the parents (written or oral - this is at the discretion of the administration of the educational institution). Children under three years old are given half the dose, older ones - the full dose. If a five-year-old child is brought in who has never had the flu before and has not been vaccinated, he is given two full vaccinations at intervals of a month.

Vaccinations: pros and cons

Galina Chervonskaya, with her bestseller “Ruthless Immunization,” which denounces vaccinations as almost the worst enemies of civilization, of course, has a group of supporters. At one time there were so many of them that Moscow admitted that we were losing the fight against anti-vaxxers! Then they began to figure it out, fact by fact. As a result, our doctors came to the conclusion that Chervonskaya’s monograph does not contain scientific information, only chaotically drawn facts and the negativity that exists in any case. Yes, the facts that opponents of vaccinations rely on once existed, but now there are different vaccines, different approaches. And it’s practically an axiom: vaccinology is the most life-saving science. To no other medical discipline does humanity owe the salvation of so many lives, millions and millions. Let’s say that over the past 50 years, more than 2 million cases of measles have been prevented in Belarus using a single tool - vaccination. Meanwhile, hundreds of thousands of people continue to die from measles around the world. The experience of countries that tried to refuse vaccination is sad. As soon as Japan canceled the vaccine against whooping cough, there was a surge, and even deaths occurred. The same thing happened with vaccination against mumps - serous meningitis began.

What fuels the panic of anti-vaxxers is the fact that an entire generation has grown up that does not know what a serious infectious disease, say, polio, is. Medicine has partly become a hostage to its own successes. Add to this the darkness of the Internet and the psychology of modern parents, who are ready to argue with a doctor until they are hoarse and then do not want to be held accountable for their decisions. Here is an explanation for why there are still disputes between “amateurs” and “professionals”. To be fair, it should be noted that the number of vaccine refusals in Minsk is decreasing; several vaccine prevention centers have already opened, where specialists have taken on the task of working with the most hesitant parents and their children.

Should I get a flu shot?

In developed countries this issue has not been raised for a long time. Of course, do it! By the way, this is indirectly confirmed by the story of the “swine” flu. Our doctors specifically analyzed the situation after the fact: of those who died in that epidemic, not a single one was vaccinated... According to the most conservative estimates, influenza and respiratory diseases in total account for 10 to 53 percent of complications. After all, then a person is overtaken by bronchitis, pneumonia and even strokes with heart attacks. In America, up to 30 thousand people a year used to die from the flu. What does “from the flu” mean? From its consequences.

There is no doubt, there are isolated cases when people get sick even after vaccination, but it still does not provide 100% protection. But then the disease progresses much easier. And yet it is a fact: vaccination alone cannot solve the problem of influenza. Half of the people who often suffer from it and acute respiratory diseases have certain abnormalities in the immune system. Therefore, they additionally need vitamins and immunostimulating drugs, such as eleutherococcus extract or aralia tincture.

First of all, you need a flu shot:

• people over 65 years old;
• patients with chronic diseases of the pulmonary, cardiovascular, endocrine systems, kidneys;
• workers in education, trade services and food, transport and medicine;
• children over 6 months.

Should my child be vaccinated?

To decide this, you need to clearly understand several supporting points.

1. There are constant contraindications to all vaccines. This:

• a complication following the administration of a previous dose of the drug (anaphylactic shock that developed within 24 hours after vaccination, immediate allergic reactions, encephalitis or encephalopathy, afebrile convulsions);
• primary immunodeficiency state, immunosuppression, malignant neoplasms.

2. You have every right to refuse. Previously, vaccinations were given to everyone, but now the following procedure applies: parents must give their consent to vaccination, and the child must be carefully examined by a doctor (not a paramedic!) and give an opinion on the absence of contraindications. By the way, if places are available, kindergartens are required to admit children without vaccinations. It’s another matter if parents are planning to send their child to kindergarten at a time when the group is quarantined, for example, due to rubella. If a child is not vaccinated against it, he will not be accepted immediately - primarily because he is the one at risk of getting sick.

Refusal of preventive vaccination is recorded in the patient’s medical documents and signed by him or his legal representative, as well as a medical professional. If you do not sign, the health worker will certify this fact on your card.

3. Any vaccine can cause some reactions. The general reaction is determined by temperature: up to 38° is a weak reaction, from 38° to 39.5° is moderate, above 39.5° is already severe. According to local reactions, compactions: up to 5 cm in diameter - weak reaction, from 5 to 8 cm - moderate and more than 8 cm - severe. Most often it gives DTP reactions: a rise in temperature, compaction, the child may become too restless. But a moderate and severe reaction is more of a casuistry for us.

4. You need to prepare for vaccination.

• Many doctors advise, for example, before the first vaccination with the DPT vaccine, to do a general blood and urine test, and also to obtain permission from a neurologist for vaccination. And if the child has allergic disorders (atopic dermatitis, etc.), discuss a plan for preventing exacerbations with the doctor in advance. This usually means taking antihistamines for 2 days before the vaccination and 2 days after.
• On the day of vaccination, you should not introduce new complementary foods or new types of food. If the child is old enough, never, even as a joke, scare him with vaccination. If he asks, tell me honestly: yes, there may be discomfort, but it’s only for a few seconds!
• Check with your doctor that your child does not have a fever at the time of vaccination. At the time of the injection, do not worry - your anxiety will be passed on to the child. You can distract him with some game or song.
• Do not rush to leave the clinic or medical center. Sit for 20-30 minutes near the office. Firstly, this will help you calm down, and secondly, it will allow you to quickly provide help in case of an unexpected reaction to the vaccine.
• Monitor the situation by first consulting with your doctor what to do in a particular case. But under no circumstances use aspirin. It is contraindicated for children under 16 years of age! And don’t panic: if any reaction occurs, but the vaccination was not done with a live vaccine, then vaccination with a 99% probability has nothing to do with it.

Consequences of the flu shot

When using a good vaccine, out of 100 vaccinated children, only 4–8 may develop local reactions in the form of redness, thickening or pain at the injection site, and 1–8 may develop general reactions such as a short-term increase in temperature (up to 37.5 ° C), malaise . However, this is a temporary situation.

Temperature after vaccination

Fever does occur after vaccination in 15-20 percent of children. If this temperature is up to 38.5, then there is no need to bring it down at all. 39-40? Paracetamol, for example. It is not worth giving it in advance because it reduces the immune response. Of course, if you have a high temperature, you need to see a doctor. After all, most often a febrile state is associated with pneumonia or some other disease. This must be ruled out by doing a blood test, urine test, etc. Previously, doctors hospitalized children with pathology after vaccination - and in 6 cases out of 10 it turned out that vaccination was not to blame. The guideline, as a rule, is when exactly the temperature increased. After DTP, the thermometer may rise in the first two days. Later - that means it’s not because of DPT. And vice versa, if after vaccination against measles the fever breaks out on the first, second, third, fourth day, then do not blame the vaccination. It can only be suspected if the temperature rises on the fifth or sixth day.

Larisa KRYMOVA.

What does the national vaccination calendar look like in Belarus?

More detailed information about this can be found in Resolution of the Ministry of Health of Belarus No. 42 of May 17, 2018.

In particular, since last year, vaccinations have been provided free of charge against 12 diseases, and vaccinations are carried out at certain stages of life:

Disease	When is the vaccine given?
viral hepatitis B	in the first 12 hours of life, as well as in children aged 2, 3 and 4 months
tuberculosis	on the 3-5th day of life
pneumococcal infection	children aged 2, 4 and 12 months, but only with immunodeficiency conditions, recurrent acute purulent otitis, pneumonia, diabetes mellitus
diphtheria, tetanus, whooping cough, hemophilus influenzae	children aged 2, 3, 4 months
hemophilus influenzae infection	Children who have not previously received such a vaccination are given it before they reach 5 years of age. Moreover, the vaccine is not administered to everyone, but only to children at risk - with chronic diseases, immunodeficiency, etc.
diphtheria, tetanus, whooping cough	children under 18 months - if not previously vaccinated
polio	children aged 2, 3, 4 months and 7 years
measles, mumps (mumps), rubella	children aged 12 months and 6 years
diphtheria and tetanus (repeated)	at ages 6, 16, 26 and every subsequent 10 years until age 66
flu (annual)	children aged 6 months to 3 years, children over 3 years old and adults with chronic diseases, adults over 65 years old, pregnant women, healthcare workers, pharmacists and some other categories of people

How to prepare for vaccination

Proper preparation for vaccination, especially in the first months of life, will help you endure the injection, if not painlessly, then at least with the least possible health consequences.

• Before vaccinations, you must undergo an examination by a pediatrician and obtain permission for vaccination. Without it, they have no right to give an injection
• If a child is allergic to vaccine components, it is necessary to inform the doctor about this - he can give a medical advice or prescribe additional tests, consultations with specialists
• A couple of days before vaccination, you should not introduce new foods into your baby’s diet - this is especially true for breastfed children. High likelihood of allergic reactions
• If allergic reactions have occurred in the past, it makes sense to give the child antihistamines before the vaccine is administered, but only after consulting a doctor

What to do after vaccination

Immediately after the injection, which most children perceive as painful, you need to calm the baby, try to rock him to sleep and monitor his reaction.

Within 30-40 minutes after the vaccine is administered, you should not leave the clinic - in rare cases, the child experiences an acute allergic reaction, which will need to be eliminated immediately, and you just need to calm down.

After vaccination, the temperature may rise slightly, the injection site may swell slightly - parents do not need to worry in this case. You can take a child's antipyretic, put your child to bed early, even with you next to you - sometimes this helps overcome stress better than medicine.

What not to do:

• Do not wet the injection site for 24 hours
• It’s better to do without evening bathing, just wipe the baby’s skin with napkins
• No need to go on a visit or meet new people
• The injection site does not need to be lubricated with anything or a tight bandage applied.
• You should not introduce new foods into your diet for 3-4 days after vaccination.

What to do:

• Walk outdoors, especially in good weather. As a last resort, go out onto the balcony
• Wear loose clothing that does not chafe the skin
• Monitor the injection site for a few more days and in case of sudden changes or fever, call your doctor.

What reactions to vaccination are considered normal:

• high fever (occurs in every 10 children)
• redness, swelling, swelling of the injection site
• After vaccination against measles and rubella, it is not uncommon to experience a cough, sore throat and even a runny nose. This is how the body reacts to the introduction of a vaccine - taking an antipyretic usually relieves all symptoms

But if the child is unwell for several days, the temperature does not go down, weakness is observed and the condition only worsens - it is better to consult a doctor.

When you can't vaccinate

A certain percentage of parents are afraid of vaccinations and try, if not to avoid them, then at least to postpone them for a while. But there are not many absolute contraindications for vaccination.

Vaccinations are usually not given to people with infectious diseases or those who have just had an illness. Children with exacerbation of chronic diseases are also temporarily exempt from vaccination. Such a disease in itself is not a reason for medical withdrawal - in any case, consultation with a pediatrician and a specialist who is caring for the child is necessary.

If a child has a serious allergy to components of the vaccine, the doctor may prescribe antihistamines or postpone the vaccination.

Then, when the baby recovers, all vaccinations can be done individually.

4 questions about vaccinations from worried parents

1.When will vaccinations against meningococcal infection begin in Belarus?

The Ministry of Health also noted: “Due to the extremely low incidence of meningococcal infection in the Republic of Belarus, vaccination against it is not provided for in the National Calendar of Preventive Vaccinations and the List of Preventive Vaccinations for Epidemic Indications”.

Therefore, vaccination will be done on a paid basis.

2. After the vaccine is administered, will the child definitely not get sick?

Unfortunately, no one can give an absolute guarantee - however, after mass vaccination, the percentage of cases decreases significantly. Thus, since 2002, the World Health Organization (WHO) has recognized Belarus as a polio-free country. And since 2011, not a single case of diphtheria has been reported in the country.

3.What are the consequences after refusing vaccinations?

None. Parents have the right to refuse scheduled vaccinations - there are no fines or legal consequences for this in Belarus. In other countries, they are actively fighting anti-vaxxers. Thus, in the USA, unvaccinated children are educated at home, in Italy such children are not allowed into kindergartens, and in France there are large fines for refusing vaccination.

4. Is it true that after vaccination you can become autistic?

This question can only be asked by ignorant people: autism spectrum disorders, cerebral palsy and organic lesions of the central nervous system are in no way related to vaccination. Sometimes genetic mutations are to blame for this, or it can also be the consequences of birth injuries - but not a vaccine.

If you want to consult a doctor about vaccination or get vaccinated on a paid basis, please refer to our directory of medical centers.

From user log Yulia

CALENDAR of preventive vaccinations in Belarus

*Abbreviations:

HBV - against viral hepatitis B,

BCG - against tuberculosis (http://www.happydoctor.ru/info/96),

BCG-M is a vaccine against tuberculosis with a reduced antigen content,

DTP - adsorbed (whole cell) pertussis-diphtheria-tetanus vaccine,

AaDPT - adsorbed (acellular) pertussis-diphtheria-tetanus vaccine,

ADS - adsorbed diphtheria-tetanus toxoid,

ADS-M - adsorbed diphtheria-tetanus toxoid with reduced antigen content,

IPV - inactivated polio vaccine,

OPV - oral (live) polio vaccine,

MMR - combined vaccine against measles, mumps, rubella (trivaccine),

AS - tetanus toxoid.

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Calendar of preventive vaccinations in Belarus

Available: For everyone

Currently in Belarus, vaccination is carried out against 12 infections: hepatitis B, tuberculosis, diphtheria, tetanus, whooping cough, polio, measles, mumps, rubella, pneumococcal and Haemophilus influenza infections and influenza. The National Vaccination Calendar indicates the minimum intervals between vaccinations. These intervals cannot be shortened, but can be increased if necessary. Calendar of preventive vaccinations in Minsk and the Republic of Belarus

1. HBV - vaccine against viral hepatitis B
2. HAV - vaccine against viral hepatitis A
3. BCG - vaccine against tuberculosis
4. BCG-M - tuberculosis vaccine with reduced antigen content
5. DTP - adsorbed pertussis-diphtheria-tetanus vaccine
6. AaDTP - acellular adsorbed pertussis-diphtheria-tetanus vaccine
7. ADS - adsorbed diphtheria-tetanus toxoid
8. AD-M - adsorbed diphtheria toxoid with reduced antigen content
9. ADS-M - adsorbed diphtheria-tetanus toxoid with reduced antigen content
10. IPV - inactivated polio vaccine
11. LCV - live measles vaccine
12. LPV - live mumps vaccine
13. Trivaccine - a complex vaccine against measles, rubella, mumps
14. Hib - vaccine against Haemophilus influenzae infection (Hib infection)

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Schedule of preventive vaccinations for children

Preventive vaccinations allow you to avoid many diseases, sometimes quite dangerous. For example, with the help of vaccination it was possible to completely defeat smallpox and significantly reduce the incidence of polio, tetanus and other dangerous infections.

To make it more convenient for parents, vaccinations for young children are carried out according to a schedule. Vaccines against some diseases are combined, which allows you to be vaccinated against several diseases at once in one vaccination.

Parents and the local pediatrician must monitor compliance with the vaccination schedule. It is their close cooperation that will allow the child to grow up healthy.

The importance and necessity of vaccination

The importance of vaccination, both for an individual and for the population as a whole, is difficult to overestimate. Thanks to vaccinations, most people do not experience or suffer from mild forms of whooping cough, measles and diphtheria, which can lead to death, and more dangerous “adult” infections - smallpox, polio, tetanus, plague.

The effectiveness of vaccination is based on the fact that components of the pathogen or the pathogen itself are introduced into the body in a form in which it cannot cause disease.

The body’s immune system produces antibodies to the pathogen and, when confronted with a non-vaccinating (“wild”) microorganism, responds with a full-fledged immune response.

The importance of vaccination for the population is even greater. When conditions are created in which the majority of people are vaccinated against a particular disease, each single case of disease does not become the cause of an epidemic.

Epidemiologists call the number of unvaccinated people in the population the “fire percentage.” If it is low, then the likelihood of contact between two unvaccinated people and infection of one from the other is low, so cases of the disease remain isolated. If the fire rate increases, then the risk of an epidemic, and sometimes a pandemic, also increases with it.

Features and conditions of vaccination

Vaccination requires adherence to a certain order. Firstly, vaccinations are given only in medical institutions, and only by medical workers who have the appropriate certificates that they have the right to work with vaccinations in pediatrics.

Drugs used for vaccination must be certified and approved for use in Russia, and parents have the right to demand all the required documents.

Secondly, vaccinations must be carried out strictly according to the schedule; you can deviate from it only after consulting a doctor. If vaccination involves revaccination, then it is necessary to observe the interval between the first and subsequent injections of the vaccine.

It is possible to reschedule vaccinations only if there are relative indications for vaccinations - for example, an acute illness. The fact that a child cannot receive a vaccine on time is noted in his developmental history.

It is also important to remember that vaccinations are given only to healthy children. If the child is sick, vaccination is postponed; if there are absolute contraindications, a corresponding note is made about this in the development history. Before giving a referral for vaccination, the local pediatrician will prescribe blood and urine tests, and immediately before the vaccination, the doctor will measure the child’s temperature.

The entire vaccination process is carefully documented - the development history indicates permission or contraindications for vaccination, absolute contraindications with the conclusion of the immunological commission, the date of vaccination, the drug used, the name of the medical worker who performed the vaccination.

Treatment of colds during pregnancy
- you can read about this in our publication on the website.

You can read about how to determine the gender of your unborn child in this article.

From here you will learn how to properly introduce complementary foods into your baby's diet.

Schedule of preventive vaccinations for children under one year old

At this age, the child receives the most important vaccinations in his life against most dangerous infections. Some of them cause lasting immunity for life, some will have to be given again in adulthood, and others, such as the flu shot, are given every year. At this age, it is very important to follow the calendar to the day.

• first day (in the maternity hospital) - hepatitis B;
• 3-5 days (in the maternity hospital) – tuberculosis;
• 1 month – hepatitis B (second vaccination);
• 2 months – pneumococcal infection;
• 3 months – DPT (whooping cough, diphtheria, tetanus), polio, hemophilus influenzae infection;
• 4.5 months – pneumococcus, DPT, polio, hemophilus influenzae (all – revaccination);
• 6 months – hepatitis B, DTP, polio, hemophilus influenzae infection (re-vaccination);
• 12 months – measles, rubella, mumps.

The flu vaccine is not on the list of mandatory ones, but it can be given to a child starting from the age of six months. Immunity lasts for a year.

Immunity against hepatitis B after vaccination is maintained for about 20 years, so it must be repeated for adults. Other vaccinations, which are given up to a year, provide lifelong immunity, with rare exceptions.

According to epidemic indications, from 1.5 months they are vaccinated against rotavirus infection, from 9 months - meningococcus, from 12 months - hepatitis A. These vaccinations are also not included in the national calendar.

What vaccinations do children need to get from 1 to 3 years of age?

Between one and three years is another important period in a child’s vaccination. But the administration of many vaccinations at this time is very dependent on the previous one, which is why strict adherence to the schedule is so important in the first year. During these two years the following vaccinations are given:

• 15 months – pneumococcus (booster vaccination);
• 18 months – DPT, polio, hemophilus influenzae infection (re-vaccination);
• 20 months – polio.

Additional vaccination against pneumococcus is carried out after 2 years.

Among those vaccinations that are not included in the national calendar, but can be given according to epidemic indications are influenza, hepatitis A and B, meningococcal infection, tick-borne encephalitis, chicken pox. All of them are allowed from 12 months or earlier.

After three years, the number of vaccinations decreases significantly. From three to six years there is a kind of break in vaccination. During this period, you can get vaccinated against influenza, hepatitis A and B, meningococcal infection and tick-borne encephalitis, as well as chickenpox, if the child has not had it before.

At 6 years of age, repeated vaccinations against measles and mumps are given, along with a vaccination against rubella. From 6 to 7 years of age, the child must receive repeated vaccinations against tuberculosis, diphtheria and tetanus.

The last mandatory vaccination for a schoolchild is at the age of 14, a second vaccination against tetanus, diphtheria and polio. The remaining vaccinations can be done at any age from which they are allowed, if the child for some reason did not receive this vaccination on time, or there are epidemic indications for re-vaccination.

Schedule for children in Belarus

In Belarus, the vaccination schedule is very similar to the Russian one, but has its own characteristics. For example, the hepatitis B vaccine is administered in the first 12 hours of life, and not just on the first day, the DPT vaccine is administered at 3, 4, 5 and 18 months, and the interval between its first administrations is not 1.5 months, but one. The same applies to polio and Haemophilus influenzae.

In Belarus, adherence to the vaccination schedule is more strict than in Russia, and the reason for refusing vaccination can only be a medical exemption, and extremely rarely, the desire of the parents. This allows us to maintain a favorable epidemiological situation, which has not changed for many years.

Ukraine, unlike Belarus, strives to take into account the wishes of parents, so refusal to vaccinate is considered a good reason not to carry out prevention.

The epidemiological situation remains quite favorable; according to experts, this situation will last for at least another 15 years. However, the vaccination calendar in Ukraine is also accepted and observed quite strictly.

In the first month of life, the vaccination schedule coincides with the Russian or Belarusian one, but the first DPT vaccination is at 2 months, then at 4, 6 and 18. The difference in the interval at which the first three injections should occur is caused by the high reactogenicity of the DPT vaccine, but for it effectiveness, it is necessary to maintain a strictly defined concentration of the drug in the blood.

Possible body reactions and causes of complications

The most common reaction to vaccination is an allergy. It can have varying severity, from mild discomfort to anaphylactic shock. It occurs because the vaccine interferes with the functioning of the immune system.

The frequency of allergic manifestations depends on the drug, but occurs in one case per 100,000 vaccinated people or less. This is much lower than the likelihood of death or disability for many of the diseases that vaccines protect against.

Parents have the right to refuse vaccination of their child in writing, even in the absence of medical contraindications. In many children's institutions, this entails a negative reaction from teachers, which in many ways has good reasons.

The epidemiological danger directly depends on the number of people susceptible to infection in the population, and the likelihood that one of them will become infected from another. Vaccination reduces this chance to the minimum possible.

If there are many unvaccinated people in the population, then if one of them gets sick, there is a high probability that one unvaccinated person will infect another. In addition, unvaccinated people get sick much more severely and with a risk of complications.

Additional information about vaccinations from Dr. Komarovsky is in the next video.

Classmates

nektarin.su

Should you be afraid of vaccinations? 10 popular myths about vaccination

For many years, there has been controversy regarding vaccination. The amount of negative information is off the charts, parents are confused, intimidated, and no matter how much experts try to dot the i’s by explaining the need to get vaccinated, there are still skeptics trying to convince us otherwise.

sunny7.ua

We asked pediatrician, director of the Good Doctor company, Alexander Dechko, to sort out the most popular myths on the topic of vaccination.

Vaccinations cause various diseases: autism, cerebral palsy, cancer

For a long time there was a misconception, unsubstantiated rumors that people who have undergone vaccination are more likely to suffer from autism and cancer. Autism was primarily attributed to vaccines. Today, there is such a direction as evidence-based medicine, which has clearly proven that there is no statistically proven relationship between the use of vaccines and the development of autism, cerebral palsy or cancer.

Some diseases almost never occur anymore, so you don’t need to be vaccinated against them.

Today in the National Vaccination Calendar of the Republic of Belarus there is not a single vaccination that is useless or superfluous. All the diseases against which our children are vaccinated exist; the causative agents of these diseases circulate in nature. We must remember that the number of diseases is small precisely because the human population uses vaccines. As soon as we stop vaccinating, an increase in the incidence rate is immediately felt. An example is the situation in Ukraine, where last year, due to military operations, the vaccination campaign was practically failed, and as a result, cases of polio and other so-called vaccine-preventable diseases were recorded. One can recall cases of measles imported from Europe - as soon as attention to vaccination was relaxed, there was an immediate increase in incidence.

The vaccine itself can cause disease

This myth is due to the fact that so-called live vaccines were previously used. The live virus they contain, when it enters the body, actually causes a mild form of illness, immunity is formed, and the person no longer gets sick.

Today, vaccines with live viruses are practically not used, and we can say with confidence that the use of modern vaccines is not accompanied by the occurrence of diseases for which we are vaccinated.

For example, from this year in the Republic of Belarus, even the polio vaccine will be used only inactivated and only in the form of injections.

It's better to get sick than to get vaccinated

The diseases against which we vaccinate children are so serious that it is simply incorrect to compare possible post-vaccination reactions and possible complications from the disease. Well, how can you say that it is better to get over diphtheria, when the mortality rate from it before the vaccine was introduced was 50%? Disability from polio ranged from 70 to 90%! Why take the risk?

An exception to this issue is vaccination against chickenpox (it is not included in the National Vaccination Calendar). Chickenpox leaves behind lifelong immunity; immunity after vaccination, according to various sources, lasts 20-25 years.

But the chickenpox vaccine is not intended for everyone. It is used in weakened children, in people who have had certain diseases, in cancer patients, etc.

From my point of view, the use of the chickenpox vaccine is justified in relation to children starting from puberty. Everyone knows that young children, as a rule, generally tolerate chickenpox quite easily, but the older the child becomes, the more severe the disease. My opinion is this: if a child has not had chickenpox before the age of 10-11, then it makes sense to be vaccinated against it. It is also advisable to vaccinate parents who did not have chickenpox in childhood, but were in contact with sick children. In such a situation, it makes sense to get vaccinated within 72 hours.

Vaccination weakens the body and “spoils” the immune system

Vaccination leads to the formation of immunity against the microorganism against which the vaccine is developed. The vaccine does not have any other effects on immunity. The vaccine leads to a strengthening, and in no case to a weakening of immunity.

Likar.info

Side effects from vaccinations are more dangerous than the disease itself

Any vaccine can have both so-called post-vaccination reactions and complications. Complications occur in approximately one thousandth of one percent of all vaccinated children.

As for post-vaccination reactions (fever, redness and thickening at the injection site), they are completely harmless, do not harm the body, have no consequences and usually disappear within 72 hours.

If the child is healthy, the vaccine is of high quality and the vaccination was carried out technically correctly, then the number of complications tends to zero.

Flu is not a serious illness at all. Why get vaccinated?

You can give some figures: in Europe, about three thousand people die from influenza every year. Each person can decide for himself how serious the disease is, which leads to such serious mortality in Western European countries with a high level of quality of life and prosperity.

An annual flu vaccination is the only preventative measure that really helps.

Today, the effectiveness of flu vaccination is very high - it is more than 90%.

The vaccination campaign in our republic has already begun, vaccines are available, which means there is no need to delay visiting a medical facility. The incidence of influenza usually rises at the end of January - beginning of February; you should get vaccinated before the end of December.

The vaccine begins to “work” within two to three weeks after vaccination, its effect lasts for a year. Some people believe that you don't need to get vaccinated against the flu every year. This is wrong! The virus mutates, revaccination is required.

Everyone is recommended to get vaccinated against the flu. As for the risk group, it traditionally includes infants; elderly people; people with chronic diseases, as well as people who have a large number of contacts due to their professional employment (teachers, doctors, etc.)

The following factors are contraindications to the flu vaccine: the child’s age is less than six months; any disease in the acute period; the presence of an allergic reaction to the components of the vaccine (the influenza virus is cultivated on a chicken egg embryo, therefore, an allergy to chicken egg proteins is a contraindication to vaccination); as well as a history of allergic reactions to this vaccine.

The child may not encounter an infection, but complications after the vaccine will certainly arise.

We return to mathematics again: complications occur with a frequency of no more than one thousandth of a percent. Therefore, the likelihood of complications occurring is extremely low.

	Groups of individuals and timing of preventive vaccinations
Viral hepatitis B	Newborns in the first 12 hours of life, children aged 1 and 5 months
Tuberculosis	Newborns on the 3rd-5th day of life, children aged 7 years who are at increased risk of tuberculosis
Pneumococcal infection	Children aged 2, 4 and 12 months
Diphtheria, tetanus, whooping cough
Polio	Children aged 3, 4, 5, 18 months, 2 and 7 years
Haemophilus influenzae infection	Children aged 3, 4, 5, 18 months
Measles, mumps, rubella	Children aged 12 months and 6 years
Diphtheria and tetanus	Children age 6, age 16, adults age 26, and every 10 years thereafter until age 66
Diphtheria	Children aged 11 years
	Children from 6 months and adults

Preventive vaccinations in accordance with the National Calendar of Preventive Vaccinations are carried out at certain periods of a person’s life, regardless of the epidemiological situation, to create specific immunity of the human body to the relevant infectious diseases;

Conversation about the need for vaccinations

Preparing a child for vaccination

• Before the first vaccination with DTP vaccine, it is necessary to do a general blood and urine test, and also obtain permission from a neurologist for vaccination.
• If your child has allergic disorders (diathesis, etc.), discuss the regimen with your doctor in advance prevention of exacerbation of allergies. Usually it consists of taking antihistamines (suprastin, fenistil) for 2 days before vaccination and 2 days after.
• Before vaccination, it is recommended to put a Viburkol suppository one day at night, in the morning on the day of vaccination, in the evening on the day of vaccination, and so on for 3-5 days.
• If you haven't done so yet, buy children's antipyretics with paracetamol. Better buy candles, since flavorings in syrups themselves can cause adverse reactions. Buy analgin.

On the day of vaccination

• Do not introduce new foods or new types of food. If your child is breastfed, do not introduce new foods into your diet.
• Don't forget to take antihistamines and other medications prescribed by your doctor.
• Make sure that you have analgin at home (especially in the case of DPT vaccines) and baby suppositories with paracetamol (Efferalgan, Panadol). Do not rely solely on homeopathic medicines - they can be used, but they will not help if you have severe reactions to vaccinations.
• If the child is old enough - never, even as a joke don't scare your child with vaccinations.
• If your child asks about the injection, be honest and say that it may be a little painful, but it’s only for a few seconds.

Before leaving home

• If you have a card that records your vaccinations, take it with you.
• Be sure to take it with you favorite toy or baby's diaper.

At the time of vaccination

Just before the vaccination

• Make sure with your doctor that your child does not have a fever at the time of vaccination. This is the only universal contraindication to vaccination.
• Ask your doctor from what and with what kind of vaccine The child will be vaccinated today.
• Don't hesitate to ask your doctor if you have any doubts about the vaccine.

At the moment of injection

• Don't worry. Your excitement and anxiety are transferred to the child. Be calm and confident - and the child will tolerate the vaccination much easier.
• Don't worry about the fact that you are still worried, just turn your anxiety into a constructive direction.
• To distract the child(and yourself) - communicate with him, play, sing songs, look at interior items, play with a toy taken from home.
• Smile and be kind to the child.
• The child must be with you during the injection. in my arms- this way it will be more comfortable for him and you.
• Let your child cry after the injection. Don't force your child to "be brave" or tell him that crying is a shame.
• If a child says that he is in pain, “blow out” the pain. Take a deep breath and slowly “blow out” the pain. Repeat this exercise several times.

After vaccination

In the first 30 minutes after vaccination

• Don't forget and be shy ask your questions to the doctor. Be sure to ask about what and when reactions to the vaccine may occur and in what cases to seek medical help.
• Take your time leave the clinic or medical center. Sit for 20-30 minutes near the office. Firstly, this will help you calm down, and secondly, it will allow you to quickly provide help in case of immediate allergic reactions to the vaccine.
• If the child is breastfed - give him a breast, this will help him calm down.
• If the child is old enough, please him with some pleasant surprise, reward him with something, praise. Tell him it's okay.

Upon returning home after vaccination

• In case of vaccination with DTP vaccine: unless otherwise prescribed by the doctor, give the child a dose (suppository or syrup) of an antipyretic. This will avoid unpleasant reactions that occur in the first hours after vaccination.
• If the child does not have a temperature - you can swim, as usual. The presence of reactions at the injection site is not a contraindication to swimming, and even vice versa.

First night after vaccination

• Most often, temperature reactions to inactivated vaccines (DPT and others) occur on the first day after vaccination.
• In the case of DTP vaccines: prophylactically, always at night give your child an antipyretic, even if the temperature is currently normal. Keep analgin on hand.
• If strong temperature reactions occur (38.5°C or higher), give once child one quarter of 0.5 g of analgin tablet. In children over 2 years of age, the dose can be increased to one third of the same tablet.
• In case of temperature reactions, do not neglect wiping your child with warm water. Do not use vodka for rubbing - it irritates and dries baby's skin.
• Don't forget that the daily allowance paracetamol dosage is not unlimited. In case of overdose, serious complications are possible. Carefully read the instructions for the drug you are using (Panadol, Efferalgan, Tylenol).
• No way don't use aspirin. Its use in young children is fraught with serious complications.

The first two days after vaccination

(inactivated vaccines - DPT, DPT, hepatitis B, Hib vaccine, IPV)

• Take the medications prescribed by your doctor to prevent allergic disorders.
• Continue taking antipyretics according to the instructions for the medications if the temperature remains elevated.
• DTP vaccines. Monitor your child's body temperature. Try not to let it rise above 38.5°C (under the arm). In some children, against the background of an increase in temperature, the so-called so-called febrile seizures. Take antipyretics without waiting for the temperature to rise.
• You can and should walk with your child, you can and should bathe him. The exception is when the child has a fever due to or regardless of vaccination.
• If a Mantoux test was performed, when swimming, try not to let water get into the place where the test was taken. Don't forget that sweat is also a liquid, so make sure your baby's hand doesn't sweat.
• Don't introduce new products into the child’s diet (and your own if the child is breastfed). This can be done on the 3rd day after vaccination and later.
• In the case of DPT, ADS, hepatitis B and ADS-M vaccines. When strong reactions at the injection site(swelling, thickening, redness) apply a warm compress or simply periodically apply a cloth moistened with water. If you are not already taking anti-inflammatory medications, start taking them.

5-12 days after vaccination

• In the case of vaccination with live vaccines (drops of polio vaccine OPV, measles, mumps, rubella), adverse reactions usually occur 5-12 days after vaccination.
• If any reaction occurs, but the vaccination was not done with a live vaccine, then vaccination with 99% probability has nothing to do with it. The most common cause of temperature and some other reactions in young children is teething, and in older children - colds.

Preventive vaccinations for epidemic indications are carried out:

• persons who are in contact with a patient suffering from
• infectious disease, which is also subject to
• preventive vaccinations;
• persons who, while carrying out professional activities, have a risk of becoming infected with infectious agents
• diseases against which preventive vaccinations are carried out;
• persons who, in conditions of an unfavorable sanitary and epidemiological situation in the Republic of Belarus or on the territory of its individual administrative-territorial units, are at risk
• infection with pathogens of infectious diseases against which preventive vaccinations are carried out;
• persons with possible introduction of infectious diseases
• to the territory of the Republic of Belarus the risk of infection by pathogens
• data on infectious diseases against which preventive vaccinations are carried out;
• persons infected with pathogens of infectious diseases against which preventive vaccinations are carried out,
• may lead to a complicated course of these diseases or death;

Preventive vaccinations are carried out in healthcare organizations that have a special permit (license) to carry out medical activities, issued in the manner established by the legislation of the Republic of Belarus on licensing.

• Information about preventive vaccination is entered into the patient’s medical documents by the medical professional who directly performed it;
• If the patient (in cases provided for by the legislation of the Republic of Belarus, his legal representative) refuses to undergo preventive vaccination, the medical worker must explain in an understandable form the possible consequences of refusing preventive vaccination.
• Refusal from preventive vaccination is recorded in the patient’s medical documents and signed by the patient (his legal representative) and the medical professional. If the patient (his legal representative) refuses to sign, this fact is certified by a medical professional in the patient’s medical documents;
• Preventive vaccinations are carried out taking into account the indications and contraindications for their implementation, in strict accordance with the instructions attached to the immunobiological medicinal product
• means;
• Before carrying out preventive vaccination, the doctor conducts a medical examination of the person and records its results in medical documents;

The medical worker of the healthcare organization who administered the preventive vaccination to the person monitors him for 30 minutes;

In accordance with the National Calendar of Preventive Vaccinations of the Republic of Belarus:

Preventive vaccinations against tuberculosis Children aged 7 years with a negative intradermal Mantoux test result and belonging to a group at increased risk of tuberculosis are assessed in the following categories:

• children from the focus of tuberculosis infection;
• children who do not have a vaccination scar after vaccination against tuberculosis;
• children in a socially dangerous situation, as well as from families living in a hostel, refugees, migrants;
• children from preschool education institutions, general secondary education institutions, special education institutions, social and pedagogical institutions, special educational institutions
• institutions, special medical and educational institutions;
• disabled children;
• children for whom dispensary observation has been established in connection with chronic and recurrent diseases of the respiratory system (except bronchial asthma), genitourinary system, connective tissue disease, diabetes mellitus and other diseases;

Preventive vaccinations against pneumococcal and haemophilus influenzae infections are carried out for children in accordance with age and having one of the following diseases or conditions:

• chronic hepatitis;
• cirrhosis;
• chronic diseases of the kidneys, heart and lungs;
• immunodeficiency states;
• cystic fibrosis;

Preventive flu vaccinations are carried out to the following groups of the population of the Republic of Belarus:

• children aged 6 months to 3 years;
• children aged 3 years and older and adults with chronic diseases;
• persons with immunosuppression;
• persons over 65 years of age;
• pregnant women;
• medical workers;
• children and adults in institutions with 24-hour stay;
• employees of government bodies ensuring the security of the state and the livelihoods of the population.

List of preventive vaccinations for epidemic indications

List of infections against which preventive vaccinations are carried out	Groups of individuals subject to preventive vaccinations
Rabies	Persons performing work on catching and keeping stray animals; veterinarians, hunters, foresters, slaughterhouse workers, taxidermists; persons working with wild rabies virus; persons with medical indications for immunization due to contact with animals
Brucellosis	Workers of livestock complexes (farms) - until the complete elimination of animals infected with Brucella of the goat-sheep species on farms; employees of procurement organizations, storage, processing of raw materials and livestock products - until the complete elimination of infected animals in farms from which livestock, raw materials and livestock products will come; workers of bacteriological laboratories working with live cultures of Brucella; employees of organizations for the slaughter of livestock suffering from brucellosis, procurement and processing of livestock products obtained from it; veterinary workers, livestock specialists in farms enzootic for brucellosis
Chicken pox	Children who are planning to undergo a transplantation of human organs and (or) tissues, in the absence of antibodies or 2 years after the end of immunosuppressive therapy after such a transplantation
Viral hepatitis A	Persons in contact with a patient suffering from viral hepatitis A
Viral hepatitis B	Children and adults receiving medical care using blood and (or) its components, as well as those on hemodialysis, with oncohematological diseases; persons who have had contact with material contaminated with the hepatitis B virus; medical workers who have contact with human blood and other biological fluids; persons involved in the production of immunobiological medicines from donor and placental blood; students studying in educational institutions in the field of education “Healthcare”
Diphtheria	Contact persons in foci of infection: persons not vaccinated against diphtheria; children who are due for their next preventive vaccination; adults for whom, according to medical documents, 5 or more years have passed since the last preventive vaccination against diphtheria; persons in whom, during a serological examination, anti-diphtheria antibodies were detected in a titer of less than 1:40 (0.01 IU/ml)
Yellow fever	Persons traveling abroad to yellow fever-endemic countries
Tick-borne encephalitis	Employees of forest management organizations performing work in the territories of the Belovezhskaya Pushcha National Park, Berezinsky Biosphere Reserve and other enzootic territories
	Persons who have been in contact with a patient diagnosed with whooping cough in foci of whooping cough infection, who have not had whooping cough and do not have documented information about vaccination against whooping cough or laboratory confirmed results of the presence of protective immunity against whooping cough
	Persons who have been in contact with a patient diagnosed with measles between the ages of 9 months and 40 years, who have not had measles and do not have documented measles vaccinations or laboratory-confirmed results of protective immunity against measles
Rubella	Persons who have been in contact with a patient diagnosed with rubella in foci of rubella infection, who have not had rubella and do not have documented information about vaccinations against rubella or laboratory confirmed results of the presence of protective immunity against rubella
Leptospirosis	Persons performing work on the procurement, storage, processing of raw materials and livestock products obtained from farms unaffected by leptospirosis; persons working with live cultures of the causative agent of leptospirosis
Polio	Persons who have been in contact with a patient diagnosed with poliomyelitis, who do not have documented information about vaccinations against poliomyelitis or laboratory confirmed results of the presence of protective immunity against poliomyelitis, in the focus of poliomyelitis infection; persons who have not been vaccinated against polio, who have arrived from polio-affected countries or are traveling to a polio-affected country
Anthrax	Persons performing the following work in anthrax-prone areas: for slaughter of livestock, procurement and processing of meat and meat products obtained from it; on procurement, storage and processing of agricultural products; persons working with live cultures of the anthrax pathogen
Tularemia	Persons living in territories enzootic for tularemia, as well as those arriving in these territories and performing the following work: agricultural, drainage, construction, other work on excavation and movement of soil, procurement, fishing, geological, survey, forwarding, deratization and disinfection; for logging, clearing and landscaping of forests; persons working with live cultures of the causative agent of tularemia
	Persons traveling to areas enzootic for plague
Mumps	Persons who have been in contact with a patient diagnosed with mumps (minors) in areas of mumps who have not previously had mumps, do not have documented information about vaccination against mumps or laboratory-confirmed results of protective immunity against mumps

List of healthcare institutions of the Republic of Belarus where children are vaccinated on a paid basis

City	Name of institution	Address	Telephone
Brest region
Brest	Medical and advisory clinic	pl. Svobody, 3	23-86-17
	Brest City Children's Clinic No. 1	st. Khalturina, 12	20-98-24
	Brest City Children's Clinic No. 2	st. Soviet Constitution	42-04-17
	MC "LODE"	st. Pionerskaya, 50	42-45-50
Pinsk	Pinsk central city clinic	Irkutskaya Pinskaya Division street, 48	35-56-37
Vitebsk region
Vitebsk	Vitebsk City Central Children's Clinic	st. Chkalova, 14v	22-24-71
Novopolotsk	UZ "Novopolotsk Central District Hospital", children's clinic	st. Blokhina, 27	53-50-22, 53-23-80
Orsha	UZ "Orsha Central Clinic", children's clinic No. 1	st. Pionerskaya, 15	21-18-83
	UZ "Orsha Central Clinic", children's clinic No. 2	st. Innovatorov, 3a	23-11-74
Polotsk	Healthcare institution "Polotsk Central District Hospital", children's clinic	st. Efrosinya Polotskaya, 18	46-17-70
Gomel region
Gomel	Healthcare Institution "City Children's Clinic No. 1"	st. Landysheva, 22	57-87-64
	Branch No. 1 of the Gomel City Children's Clinic	st. Sosnovaya, 22	42-03-43
	Branch No. 2 of the Gomel City Children's Clinic	st. International, 6	36-22-08
	Branch No. 3 of the Gomel City Children's Clinic	st. Bykhovskaya, 108	47-88-21
	Branch No. 4 of the Gomel City Children's Clinic	st. Bogdanova, 12, building 3	54-75-50
	Branch No. 6 of the Gomel City Children's Clinic	st. Krestyanskaya, 15	74 -91-87
Mozyr	City Children's Clinic	st. International, 125	15-21-57
Grodno region
Grodno	Branch of the Healthcare Institution "Grodno Central City Clinic", children's clinic No. 1, city vaccination room	st. Dovatorov, 23	41-47-46
Lida	Healthcare Institution "Lida Central District Hospital", district children's clinic	st. Chernyakhovskogo, 6a	2-24-56
Shchuchin	Healthcare institution "Shchuchinskaya Central District Hospital" - children's consultation	st. Michurina, 22	2-97-93
Minsk and Minsk region
Minsk	City Vaccine Prevention Center based at the City Children's Infectious Diseases Hospital	st. Yakubovsky, 53	258-76-12
	Healthcare institution "3rd city children's clinical clinic"	st. Mogilevskaya, 2/3	216-25-04, 216-22-95
	Healthcare Institution "City Clinic No. 4", pediatric department	Pobediteley Ave., 93	228-53-25, 228-54-47
	Healthcare Institution "Children's Clinic No. 7"	st. Plekhanova, 127	247-71-61
	Healthcare Institution "Children's Clinic No. 8"	st. Yesenina, 66	273-02-86
	Healthcare Institution "Children's Clinic No. 10"	st. Shishkina, 24	341-19-70, 341-87-39
	Healthcare Institution "Children's Clinic No. 13"	st. Kizhevatova, 60	278-15-58
	Healthcare Institution "Children's Clinic No. 15"	st. Golubeva, 27	271-78-07
	Healthcare Institution "Children's Clinic No. 16"	st. Odoevskogo, 45	205-04-51, 251-30-53
	Healthcare institution "17th city children's clinical clinic"	st. Koltsova, 53 k.1	261-20-21, 261-19-83
	Healthcare institution "20th city children's clinic"	st. Olshevskogo, 29, building 2	204-61-07
	Healthcare Institution "Children's Clinic No. 23"	st. Angarskaya, 60	299-81-94
	Healthcare institution "26th city clinic" (pediatric department)	st. Kuntsevshchina, 8	313-25-76
	State Healthcare Institution “Central Polyclinic of the Belarusian Railways at the station. Minsk", children's clinic	st. Voronyanskogo, 50 k.2	225-09-28
	Nordin	st. Surganova, 47B	159
	MC "Ecomedservice"	st. Tolstoy, 4	160, 207-74-74
	village Borovlyany	Minsk RTMO Healthcare Institution "Central District Clinic"	st. Frunzenskaya, 1	505-15-16, 505-27-36
Vileika	Vileyskoye TMO	-	15-40-82
Soligorsk	Healthcare Institution "Soligorsk Central District Hospital", children's clinic	st. Parkovaya, 1	23-13-75
Slutsk	Slutsk Central District Hospital, children's clinic	st. Lenina, 149	5-59-22
Mogilev region
Mogilev	Mogilev Regional Children's Hospital, advisory clinic, office of alternative vaccine prophylaxis	st. Belynitskogo-Biruli, 9	28-07-28
	UZ "Mogilev Children's Clinic"	st. Lazarenko, 68	28-30-20
	Healthcare Institution "Children's Clinic No. 1"	Mira Ave., 12	25-72-91
	Healthcare Institution "Children's Clinic No. 2"	Vitebsky Ave., 8	42-26-06
	Healthcare Institution "Children's Clinic No. 4"	st. Simonova, 55 B	48-40-76
	Healthcare Institution "Children's Clinic No. 10"	st. Krupskaya, 176	31-67-20
Bobruisk	Branch "Bobruisk City Children's Regiment No. 2"	st. Sovetskaya, 116	49-23-29
	UZ "Bobruisk city regiment No. 7"	Stroiteley Ave., 37	55-99-80

INSTRUCTIONSABOUT THE ORGANIZATION OF PREVENTIVE VACCINATIONS

Chapter 1. GENERAL PROVISIONS

1.1. The instructions are intended for medical workers of healthcare organizations operating in the field of immunoprophylaxis.

1.2. For immunization, medical immunobiological preparations (hereinafter referred to as MIBPs) are used, registered and approved for use by the Ministry of Health of the Republic of Belarus.

1.3. By order of the head of the treatment and prophylactic organization, medical workers (back-ups in case of illness or vacation) are appointed who are responsible for planning and performing preventive vaccinations, as well as for transporting, storing, using and recording MIBP.

1.4. Responsibility for organizing vaccinations lies with the head of the treatment and preventive organization. Responsibility for the validity of admission to preventive vaccinations and their timely implementation lies with the general practitioner or pediatrician who prescribed the vaccination; for the technique of performing preventive vaccinations - the medical worker who directly performs them.

1.5. If a patient (for minor children - parents or guardians) refuses vaccinations, the possible consequences of refusing vaccination must be explained to him in an accessible form by a medical professional. Refusal of preventive vaccination is recorded in the medical documentation (form N 025/u or form N 063/u) and signed by the patient (parents or guardian), as well as a medical professional. If the patient or parents (guardians) refuse to sign, a record of this is made in the medical documentation signed by two medical workers.

1.6. Preventive vaccinations are carried out by medical workers trained in vaccination techniques, as well as in providing first aid in the event of post-vaccination complications and reactions, in specially equipped vaccination rooms in clinics, hospitals, rural district hospitals, and rural outpatient clinics. If there is a general practitioner (pediatrician), preventive vaccinations can be carried out in agreement with the territorial center of hygiene and epidemiology in specially equipped rooms at the place of work, study, education of the vaccinated, paramedic and obstetric centers (hereinafter - FAP), if it is possible to comply with them in full rules of asepsis. If it is not possible to allocate a separate vaccination room, it is allowed to combine it with a treatment room.

1.7. Carrying out preventive vaccinations at feldsher-midwife stations and health centers by paramedical personnel without a medical examination is prohibited.

1.8. In a healthcare organization that carries out immunization on the road, vaccination teams are formed with an annual review of their composition, an annual work plan for the teams is drawn up and approved by the chief physician.

1.9. Training seminars on immunization with a mandatory test are conducted by specialists from territorial centers of hygiene and epidemiology together with specialists from healthcare organizations at least once a year.

1.10. Responsibility for the correct maintenance of vaccination documentation lies with the medical staff of the vaccination room.

1.11. Vaccinations against tuberculosis and tuberculin diagnostics are carried out by specially trained nursing personnel who have a certificate of admission from the anti-tuberculosis dispensary to carry out immunization using BCG (BCG-M) and performing the Mantoux test.

Chapter 2. PLANNING VACCINATIONS

2.1. In order to plan preventive vaccinations, healthcare organizations carry out registration of children under 18 years of age for each year of birth, 2 times a year (in June and December), taking into account the migration of the child population and registration of newborns, as well as newly arrived and departed children. The adult population is counted once a year (in December). Registration data for children and adults is recorded in the “Children’s Population Register” or “Adult Population Register” of the health care organization. The dates of the censuses and the number of children are indicated at the end of the page reserved for recording the population of each year of birth.

2.2. A long-term plan for preventive vaccinations for the year (Appendix 1) is drawn up by local pediatricians (therapists) once a year (in December) according to the age composition of the population and preventive vaccination cards (Form N 063-u) in accordance with the current calendar of preventive vaccinations and is submitted to the district (city) centers of hygiene and epidemiology (hereinafter - CGE) until January 5. The Center for Hygiene and Epidemiology submits a plan for preventive vaccinations to the regional centers of hygiene, epidemiology and public health (hereinafter referred to as the Regional Center for Hygiene, Epidemiology and Public Health) and the Minsk City Center for Hygiene and Epidemiology (hereinafter referred to as the Minsk City Center for Hygiene and Epidemiology) until January 10, which, in turn, submit the plan to the State Institution "Republican Center for Hygiene" , Epidemiology and Public Health" (hereinafter - GU RCGEiOZ) until January 15 annually.

2.3. The preventive vaccination plan during the year is adjusted taking into account children born on July 1 of the current year and January 1 of the next year and taking into account the number of children and adolescents arriving at schools and other educational institutions as of September 1 of the current year, and is submitted to higher organizations within 15 days.

2.4. A long-term plan for preventive vaccinations is the basis for drawing up an annual application for MIBP, which is formed from the corresponding applications of lower territorial health care organizations. The calculation of MIBP needs is carried out taking into account the number of contingents subject to vaccination, drug consumption standards for 1 vaccination, MIBP reserve for the 1st quarter of the next year (25% of the annual requirement).

2.5. The justification for the application for MIBP is certified by the head of the healthcare organization. The annual application for MIBP is formed in accordance with Appendix 2 and submitted within the time limits established by the current regulatory documents of the Ministry of Health.

2.6. The dates for preventive vaccinations for specific individuals are determined by the local pediatrician (therapist) at the end of each month according to individual preventive vaccination cards (form N 063-u). The names of children (adults) who are subject to the next vaccination are entered in the “Journal of monthly planning and recording of preventive vaccinations” in accordance with the calendar date of vaccination.

Chapter 3. ASSESSMENT OF THE QUALITY AND EFFECTIVENESS OF IMMUNIZATION

3.1. The assessment of the quality and effectiveness of immunization is carried out by the centers of hygiene and epidemiology together with health care organizations; they monitor and analyze individual indicators of the quality of immunization on a monthly basis.

3.2. The quality of immunization is the full implementation of the requirements of instructive and regulatory documents on the organization and conduct of preventive vaccinations.

3.3. Indicators of the quality of immunization are:

3.3.1. vaccination coverage rate;

3.3.2. indicator of timeliness of vaccinations;

3.3.3. frequency of medical contraindications;

3.3.4. average vaccine consumption per vaccination;

3.3.5. immunological effectiveness;

3.3.6. epidemiological effectiveness;

3.3.7. economic efficiency.

3.4. The vaccination coverage rate (CV) is calculated using the formula

3.5. The timeliness of vaccinations carried out (SP) within the time limits established by the calendar of preventive vaccinations is calculated using the formula

Timeliness indicator for HBV-1 - no less than 90%, for BCG-1, DTP-1, Polio-1, HBV-2 - no less than 80%, for DPT-2, Polio-2 - no less than 70%, for DTP -3, Polio-3, HBV-3 - no less than 60%.

The timing of timely preventive vaccinations is established:

For HBV-1 - the first 12 hours after birth;

For BCG-1 - the first 5 days after birth;

For DPT-1, 2, 3, Polio-1, 2, 3 and HBV-2, 3 - within 29 days from the date of setting the date in accordance with the preventive vaccination calendar;

For DPT-4, Polio-4 - until the child reaches 2 years of age;

KPK-1, 2, Polio-5, 6, BCG-2, ADS (6 years), ADS-M (11 years), ADS-M (16 - 66 years), HBV (13 years) - for 11 months 29 days from the date of establishment of the period in accordance with the preventive vaccination calendar.

3.6. The frequency of medical contraindications is determined by the formula:

The number of children under 1 year of age with long-term and permanent contraindications should be no more than 2%, with temporary contraindications - no more than 10%.

3.7. The average vaccine consumption per 1 vaccination is calculated separately for each healthcare organization and for the region as a whole using the formula: number of vaccine doses used / number of vaccinations given.

The standard for vaccine consumption per shot is established in accordance with the current regulatory documents of the Ministry of Health of the Republic of Belarus.

3.8. Immunological effectiveness, i.e. The ability of vaccines to induce the development of immunity in vaccinated individuals in protective titers is determined by the immunological effectiveness coefficient, calculated by the formula

Assessment of immunological effectiveness is carried out in indicator groups (receiving vaccinations in accordance with age), as well as in risk groups (children's boarding schools, orphanages, and others). The timing and scope of necessary studies are determined by the Ministry of Health. Depending on the epidemic situation or the forecast of its development, regional centers of hygiene, epidemiology and public health and the Minsk City Center for Hygiene and Epidemiology can independently determine the need to conduct research to assess the immunological effectiveness of immunization.

3.9. The epidemiological effectiveness of immunization is a reduction in morbidity as a result of preventive vaccinations, determined by the index (K) and coefficient (E) of epidemiological effectiveness.

The immunoprophylaxis effectiveness index (K) shows how many times the incidence of the immunized (A) is lower than the incidence of the non-immunized (B):

An effectiveness index of less than 10 and an effectiveness rate of less than 90% indicate insufficient effectiveness of immunization. The epidemiological effectiveness of immunization is also assessed by the clinical manifestations of the disease (severity), manifestations of the epidemic process (frequency, annual dynamics, age structure of the sick, etc.).

3.10. With optimal organization of vaccination and in order to ensure a high level of collective immunity and maximum efficiency of immunization, the vaccination coverage rate for children should be at least 97% and for adults - at least 95%.

3.11. Cost-effectiveness of immunization.

The initial stage of studying vaccine prevention from an economic perspective is its formalized description in the specific conditions of the nosological form and epidemiological situation. At the same time, general indicators are identified, the set of which may vary for individual nosological forms (Appendix 3). The given indicators can be divided into initial (available to the sanitary and epidemiological service) and derivative (calculated).

3.11.1. Determining the components of economic evaluations of vaccine prevention.

3.11.1.1. Calculation of costs for vaccination.

In general, the cost of vaccination (P) is determined by the formula

3.11.1.3. Costs avoided due to vaccination.

Avoided costs represent the economic losses associated with the spread of diseases among the population that were prevented as a result of vaccine prevention. Avoided costs (f) are defined as the product of the cost of one case of disease (z) and the number of cases prevented (SUMa):

In the presence of carriage of an infectious agent, the economic significance of carriage is determined using formulas similar to (20) and (21), which is added to U. The resulting value constitutes the total economic significance of this disease and characterizes the costs of treating this disease.

3.11.2.2. Calculation of costs for treating patients with vaccination.

The number of cases of illness due to vaccination is the sum of cases of illness among vaccinated and unvaccinated people.

Among the vaccinated, the calculation is carried out according to the formulas

Chapter 4. ORDER OF TRANSPORTATION, STORAGE, USE AND ACCOUNTING OF MEDICAL IMMUNOBIOLOGICAL PREPARATIONS

4.1. Transportation and storage of MIBP is carried out in compliance with the requirements of the “cold chain” at an optimal temperature of +2 to +8 degrees. WITH.

4.2. Long-term storage of live viral vaccines in a frozen state at a temperature of minus 20 degrees. C is permitted at the regional (Minsk) and republican levels.

4.3. In a healthcare organization, MIBP is stored in a specially designated refrigerator, in which storage of other drugs and items is not allowed.

4.4. The duration of storage of the vaccine in a healthcare organization should not exceed 1 month.

4.5. The health worker responsible for storing MIBPs twice a day (before starting and ending work) notes the temperature in the refrigerator at which MIBPs are stored and the time of temperature control in the “Refrigerator Temperature Log” (Appendix 4) and certifies with his signature. The journal must be laced, the sheets numbered and stapled, certified with the seal of the institution and the signature of the head. The storage period for such a journal must be at least 3 years.

4.6. Refrigeration equipment must be defrosted at least once a month. The layer of frost on the walls of freezers and refrigerators/refrigerators should not exceed 5 mm. At least once a year, refrigeration equipment is subject to technical inspection by a qualified specialist with the obligatory drawing up of a report.

4.7. Each refrigerator for storing MIBP is equipped with two alcohol thermometers, which are located on the top and middle shelves of the refrigerator. If there is one thermometer, it is located on the middle shelf. Thermometers are subject to annual metrological verification. It is necessary to provide a thermometer to monitor the temperature during transportation of the MIBP.

4.8. When stored in a refrigerator, MIBPs are arranged in such a way that access to cooled air is provided to each package, and drugs of the same name are stored in series, taking into account the expiration date. MIBP should not be stored on the door panel or bottom of the refrigerator.

4.9. The optimal location of vaccines in the refrigerator: on the top shelf - live viral vaccines (poliomyelitis, measles, BCG, etc.); on the middle shelf - adsorbed vaccines, toxoids, hepatitis B vaccine, Hib infection; on the bottom shelf are solvents for lyophilized vaccines. At the bottom of the refrigerator: 3 - 4 containers with water with a volume of 1 liter, which ensure maintaining a stable temperature, especially during power outages.

4.10. Vaccine diluents must be stored in refrigerators because when diluted, the solvent must be at the same temperature as the vaccine (otherwise, “temperature shock” of the vaccine may develop and its immunogenicity decreases and its reactogenicity increases). Freezing of the solvent is not allowed.

4.11. To transport MIBP, thermal containers (thermal bags) with cold elements and thermometers are used. To transport vaccines from the warehouse and carry out vaccinations on the road, the institution must have at least one thermal container (thermal bag) and two sets of cold elements for each thermal container or thermal bag. Unloading and loading thermal containers should not take more than 10 minutes. While one set of refrigeration elements is in use, the other must be kept frozen in the freezer.

4.13. Each healthcare organization where preventive vaccinations are carried out maintains a “Logbook of registration and use of medical immunobiological preparations”. A separate page is allocated for each type of MIBP. Registration of the receipt and use of solvents for the reconstitution of lyophilized vaccines is carried out in a similar manner in parallel, taking into account the movement of the corresponding vaccines, carefully monitoring the adequacy of the number of doses of solvents to the number of vaccine doses.

4.14. The temperature regime of MIBP transportation and temperature indicator readings are recorded in the “Logbook of Accounting and Use of Medical Immunobiological Preparations”.

4.15. The healthcare professional responsible for MIBPs should ensure that MIBPs that are about to expire are used first.

4.16. The number of doses of MIBP in the refrigerator of a healthcare organization must correspond to the number of planned vaccinations for the current month.

4.17. The head of the institution in which MIBP is stored, regardless of their quantity, must approve an emergency action plan in case of violations in the “cold chain” (Appendix 5). The plan should include measures to prevent and eliminate possible violations in compliance with the “cold chain”, and also identify the persons responsible for execution.

4.18. The following MIBP are subject to write-off and destruction:

Stored under temperature conditions;

Expired;

With unclear or missing markings on the ampoule or bottle;

Violation of the integrity of ampoules or vials;

With changed physical properties (presence of flakes, foreign objects, changes in color and transparency).

4.19. Ampoules (vials) containing inactivated vaccines, live measles, mumps and rubella vaccines, human immunoglobulins and heterologous sera (or their remains) are not subject to disinfection treatment, and the contents of the ampoules are poured into the sewer, the glass is collected in a waste container.

Ampoules (vias) with live vaccines must be disinfected by physical or chemical means.

Physical method for disinfecting vaccines: autoclaving at a pressure of 0.11 MPa and a temperature of 120 degrees. C or 0.20 MPa and a temperature of 132 degrees. C for 15 minutes. Ampoules (vials) are not opened before autoclaving, and afterward they are collected and disposed of in a solid waste landfill.

The chemical method of disinfecting vaccines is the use of disinfectants in concentrations and exposure times specified in the instructions for their use. Before chemical disinfection, ampoules (vials) are opened and completely immersed in the solution. After exposure, the solution is poured into the sewer and the glass is thrown into a garbage container and disposed of in a solid waste landfill.

4.20. After the destruction of the MIBP, a “Report on the write-off of medical immunobiological preparations” is drawn up, approved by the head of the institution (Appendix 6), a copy of which is submitted to the territorial center of hygiene and epidemiology to analyze the volume of written off and destroyed vaccines for individual reasons.

4.21. For preventive vaccinations, only disposable or auto-disable syringes are used, the disinfection and disposal of which are carried out in accordance with current regulatory and instructional documents.

Chapter 5. ORGANIZATION OF THE WORK OF THE VACCINATION OFFICE AND VACCINATIONS

5.1. The vaccination room of a healthcare organization must consist of premises for vaccinations and storage of medical records.

5.2. The vaccination room should have:

A refrigerator specifically designed only for storing MIBP, a thermal container (thermal bag), cold elements;

Cabinet for tools and medicines;

Bixes with sterile material (cotton-gauze balls);

Changing table and medical couch;

Table for preparing vaccination preparations for use;

Cabinet for storing medical records;

Antiseptics, ethyl alcohol;

Container for treating surfaces with a disinfectant solution;

Container for collecting used instruments;

Container for disinfection of used swabs and used vaccines;

Tonometer, thermometers, disposable syringes, medical gloves, transparent millimeter ruler;

A set of emergency medicines: solution of adrenaline 0.1% (3 ampoules), mezaton 1% (3 ampoules) or norepinephrine 0.2% (3 ampoules); prednisolone, dexamethasone or hydrocartisone (5 ampoules); solutions: 2.5% pipolfen (2 ampoules) or 2% suprastin (2 ampoules), 2.4% aminophylline (2 ampoules), 0.9% sodium chloride; cardiac glycosides (2 ampoules); packaging of a dosed aerosol of a beta-antagonist (salbutomol, etc.), an emergency aid instruction;

Germicidal lamp;

Hand washing sink equipped with dispensers for liquid soap and sanitizer;

Instructions for use of the vaccines used;

Documents regulating work on immunoprophylaxis and other regulatory documentation.

5.3. Vaccinations against tuberculosis and tuberculin diagnostics are carried out in a separate specially equipped room, and in its absence - in a vaccination room on a separate medical table on specially designated days.

5.4. Before vaccinations, it is necessary to visually check the quality of the drug, its labeling, and the integrity of the ampoule (vial). It is prohibited to use MIBP:

• - with inappropriate physical properties (changes in the appearance of the vaccine, floating particles, etc.);
• - with violation of the integrity of the ampoules (bottle);
• - with unclear or missing markings on the ampoule (bottle);
• - expired;
• - stored or transported in violation of the temperature regime.

5.5. The dosage and methods of administration of the drug are determined in accordance with the instructions for its use. If the instructions for use of the drug do not specify the injection site, then intramuscular injection of vaccines is carried out in the anterior outer region of the upper thigh - the lateral part of the quadriceps femoris (children under 18 months) and in the deltoid muscle (children over 18 months and adults). For subcutaneous injections of the vaccine, it is necessary to use the subscapular region, the outer surface of the shoulder at the border of the upper and middle third, or the anterolateral part of the thigh. Intradermal injections of vaccines should be carried out in the area of ​​the outer surface of the shoulder or the inner surface of the forearm.

To prevent the patient from falling in the event of fainting, vaccinations must be carried out in a lying or sitting position.

5.6. It is necessary to strictly observe the shelf life of vaccines after opening ampoules and taking vaccines from multi-dose vials.

Live (oral) polio vaccine from an opened vial (provided a dropper is used) can be stored for no more than two days at a temperature of +2 - +8 degrees. C. In this case, the bottle should be tightly closed with a dropper. If the vaccine is drawn up each time with a new syringe through a rubber stopper (subject to asepsis), then the period of use is limited by the shelf life of the vaccine.

Open vials of a vaccine containing a preservative (hepatitis B vaccine, etc.) can be used for vaccinations for no more than four weeks, subject to the following conditions:

The vaccine used has not expired;

Vaccines are stored at a temperature of +2 - +8 degrees. WITH;

The vaccine was removed from the vial in a sterile manner;

The indicator on the bottle label (if the bottle is equipped with an appropriate indicator) does not indicate that the vaccine must be destroyed;

Open vials of vaccine taken from health care facilities for use during vaccination activities must be destroyed at the end of the working day.

Open vials of measles, mumps, rubella, BCG (BCG-M) vaccine must be destroyed after 6 hours or at the end of the working day if less than 6 hours have passed.

An open bottle must be destroyed immediately if:

Asepsis rules were not fully followed;

If there are visible signs of contamination (change in the appearance of the vaccine, presence of floating particles).

The bottle label indicates the date and time the bottle was opened.

5.7. The vaccination room is cleaned 2 times a day using detergents. Once a week, the office is thoroughly cleaned with disinfectants registered and approved for use by the Ministry of Health of the Republic of Belarus.

Chapter 6. MEDICAL EXAMINATION BEFORE VACCINATION

6.1. To ensure timely implementation of preventive vaccinations, the medical worker of the pediatric (therapeutic) area orally or in writing invites to the medical institution the persons to be vaccinated (parents of children or persons replacing them), on the day determined for vaccination, in the child care institution - informs in advance and obtains the consent of the parents of children subject to preventive vaccination. Patients (their parents or persons replacing them) are informed about the infectious disease against which the vaccination will be carried out, the properties of the vaccine preparation, possible post-vaccination reactions and actions in case of their occurrence. Parents or persons replacing them give written consent to vaccinations of their children once a year, which is then stored in medical records (Appendix 7).

6.2. Permission for vaccination is given in writing by a pediatrician (therapist). For this purpose and to exclude an acute disease, immediately before vaccination, the doctor conducts a medical examination of the patient, including: thermometry, measurement of respiratory rate, pulse, a survey for complaints, an objective examination of organs and systems (Appendix 8). In this case, anamnestic data should be taken into account (previous diseases, reactions to vaccinations, the presence of allergic reactions to medications, foods).

6.3. In order to prevent post-vaccination reactions and complications in persons with abnormal health conditions, it is necessary to use pre-vaccination drug preparation.

Chapter 7. MONITORING OF VACCINED PEOPLE

7.1. After the vaccination, the treatment and prophylactic organization must provide medical supervision of the vaccinated person for the first 30 minutes (unless the instructions for the drug provide for a different time) in order to provide medical assistance in the event of the development of immediate allergic reactions. Next, the vaccinated person is actively observed by a medical worker in the first three days after the administration of the inactivated vaccine, as well as again on days 5-6 and 10-11 after the administration of live vaccines. At the end of the observation period for long-term post-vaccination reactions, a record of the results of medical observation is made in the medical documentation.

7.2. A record of the completed vaccination is made in the work log of the vaccination office, the history of the child’s development (f. 112-u), the card of preventive vaccinations (f. 063-u), the medical record of the child attending a preschool institution, a comprehensive school, or a secondary specialized educational institution ( f. 026-u), medical record of an outpatient (f. 025-u), in the register of preventive vaccinations (f. 064-u) or other medical documentation. The record indicates: name of the drug, country of manufacture, dose, series, expiration date, as well as information about the presence or absence of post-vaccination reactions or complications (if they occurred, indicate the time of their development, clinical manifestations, duration of storage, treatment provided). The record is certified by the person who vaccinated.

7.3. In the case of vaccination at the place of work or study within 7 days after the end of the observation period for post-vaccination reactions, information about the vaccination must be transferred to the health care organization at the place of registration (residence) for an individual patient or in a list (Appendix 9).

7.4. Information about all vaccinations performed is entered into a doctor's medical certificate (f. 0861-u), which is issued for persons entering educational institutions that provide vocational, secondary specialized and higher education.

Chapter 8. MEDICAL CONTRAINDICATIONS TO VACCINATIONS

8.1. Medical contraindications are divided into three groups: temporary (up to one month), long-term (1 to 3 months) and permanent (1 year or more). The decision to establish or cancel a temporary medical contraindication is made by a pediatrician (therapist). The decision to establish, extend or cancel a long-term and permanent medical contraindication is made by the immunological commission.

8.2. For a qualified collegial decision on the establishment, extension or cancellation of long-term and permanent medical contraindications to preventive vaccinations, an order from the chief physician of a healthcare organization approves the composition of the immunological commission, as well as the procedure for its work. The commission includes: a pediatrician, a neurologist, an otolaryngologist, and, if available, an immunologist and an allergist. If necessary, doctors of other specialties may be involved. In agreement with the chief physician of the territorial center of hygiene and epidemiology, an epidemiologist is involved in the work of the commission.

8.3. If a long-term or permanent medical contraindication is established (Appendices 10, 11), the health worker registers it in the “Record of Permanent and Long-Term Medical Contraindications.”

8.4. Acute infectious and non-infectious diseases, exacerbation of chronic diseases are temporary contraindications for vaccinations. Routine vaccinations are carried out after the disappearance of acute manifestations of the disease and the achievement of complete or maximum possible remission, including during maintenance treatment (except immunosuppressive).

Vaccinations for epidemic indications can be carried out against the background of mild acute respiratory viral infections, acute intestinal infections in the absence of remission against the background of active therapy, according to the decision of a pediatrician (therapist). The basis for making a decision is to compare the risk of an infectious disease and its complications, exacerbation of a chronic disease with the risk of complications after vaccination.

8.5. Children who are not vaccinated on time due to medical contraindications are vaccinated according to an individual schedule according to the recommendations of a pediatrician or other specialists.

8.6. If an infectious disease occurs in an organized group or home, the possibility of immunizing contacts is determined by an epidemiologist together with a pediatrician.

Chapter 9. POST-VACCINAL REACTIONS AND COMPLICATIONS

9.1. The post-vaccination reaction is associated with immunization and is manifested by changes in the functional state that do not go beyond the physiological norm. General post-vaccination reactions are divided into weak (increase in body temperature up to 37.9 degrees C), moderate (38 - 39.9 degrees C) and strong (above 40.0 degrees C). Local reactions are classified according to the diameter of the infiltrate: weak reaction (up to 4.9 cm), medium (5 - 7.9 cm) and strong (8 cm or more or the presence of lymphangitis with lymphadenitis).

9.2. Post-vaccination complication is a clinical manifestation of persistent pathological changes in the body associated with vaccination (Appendix 12).

9.3. Complications, depending on the cause that caused them, may be associated with:

With preventive vaccinations without taking into account medical contraindications;

In violation of vaccination technique;

With the quality of vaccines;

With individual patient reaction.

9.4. If complications develop due to the administration of the vaccine, the doctor must:

Provide medical care to the patient and, if necessary, ensure timely hospitalization;

Send an emergency notification (f. 058-u) to the territorial center of hygiene and epidemiology;

Register this case in the infectious diseases register (form 060);

Immediately inform the head of the healthcare organization.

9.5. The head of a healthcare organization is obliged to immediately send an extraordinary report to the territorial center of hygiene and epidemiology about a post-vaccination complication (Appendix 13).

9.6. The head of the healthcare organization is responsible for the completeness, accuracy and timeliness of recording conditions suspected of post-vaccination complications, as well as for prompt reporting of them.

9.7. The chief doctors of the territorial centers of hygiene and epidemiology, within 6 hours from the moment of receiving information from the health care organization, send an extraordinary report on the post-vaccination complication (Appendix 13) to the regional centers of hygiene, epidemiology and public health and to the State Institution "Minsk City Center of Hygiene and Epidemiology".

9.8. The chief doctors of the regional centers of hygiene, epidemiology and public health and the State Institution "Minsk City Center for Hygiene and Epidemiology" send an extraordinary report on a post-vaccination complication (Appendix 13) to the State Institution "Republican Center for Hygiene, Epidemiology and Public Health", to the health departments of the regional executive committees and the committee for healthcare of the Minsk City Executive Committee within 6 hours from the moment of its receipt.

9.9. The investigation into the causes of post-vaccination complications is carried out by a commission appointed by the health department of the regional executive committee or the health care committee of the Minsk City Executive Committee. Each case of a condition (disease) that developed in the post-vaccination period and is interpreted as a post-vaccination complication requires careful differential diagnosis with both infectious and non-infectious diseases.

9.10. The commission includes various specialists (pediatrician, neurologist, phthisiatrician, allergists, etc.) with the obligatory participation of an epidemiologist. The results of the investigation are documented in an act (Appendix 14) and sent to the Ministry of Health and the State Institution "Republican Center for Hygiene, Epidemiology and Public Health" within 3 days from the moment the complication occurs.

9.11. The results of active monitoring of post-vaccination complications are used to monitor the quality of MIBP and develop individual tactics for safe vaccination.

Chapter 10. TACTICS OF PREVENTIVE VACCINATIONS

10.1. Immunization against viral hepatitis B.

10.1.1. The first vaccination is carried out within 12 hours after the birth of the child, the second - at the age of 1 month. The third vaccination is carried out at 5 months simultaneously with the administration of DTP and IPV (two injections (DTP and IPV) - into the anterolateral surface of the quadriceps femoris muscle, IPV - into the gluteal muscle) or a combined vaccine. When using a combination vaccine, immunization is carried out in the anterolateral surface of the quadriceps femoris muscle.

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

10.1.3. Premature babies born weighing less than 2 kg begin to be vaccinated at the age of 2 months. If the mother is a carrier of HbsAg, the child should be vaccinated from the first day of life.

10.1.4. Vaccination against HBV for children aged 13 years (except for those on hemodialysis) is carried out three times according to the schedule of 0, 1, 6 months.

10.1.5. Vaccination of persons on hemodialysis and regularly receiving blood products is carried out according to the schedule of 0, 1, 2, 12 months in accordance with the instructions for use.

10.2. Immunization against tuberculosis.

10.2.1. Vaccination against tuberculosis is carried out for newborn children in maternity hospitals (departments) on the 3rd - 5th day after birth.

10.2.2. Premature babies weighing less than 2500 g, as well as children who are not vaccinated in maternity hospitals (departments) due to medical contraindications, are vaccinated with BCG-M vaccine (acceptably BCG vaccine) in departments for nursing premature newborns, neonatal departments of children's hospitals before discharge, in clinics.

10.2.3. Children older than 2 months who were not vaccinated during the neonatal period are vaccinated in the clinic after a tuberculin test is performed and the result is negative.

10.2.4. Children are vaccinated again if, 2 years after vaccination and 1 year after revaccination, they have not developed a post-vaccination scar and the Mantoux test is negative. Children who do not develop a scar after vaccination or revaccination twice are not further vaccinated.

10.2.5. Children aged 7 years who have a negative reaction to the Mantoux test are subject to revaccination.

10.2.6. Persons over 14 years of age are subject to revaccination against tuberculosis with a negative Mantoux test if they:

Are registered at the dispensary for any chronic disease;

They are often and long-term sufferers of ARVI and other nonspecific respiratory diseases;

They are contact persons in foci of tuberculosis infection;

From families of refugees, migrants, displaced persons;

From sociopathic families (families of drug addicts, alcoholics, criminals);

From families at medical and social risk (incomplete, poor, raising disabled children, orphans).

10.2.7. The interval between the Mantoux test and revaccination should be at least 3 days and no more than 2 weeks.

10.2.8. If a tuberculin reaction is detected, as well as a hyperergic or intensifying reaction to tuberculin, preventive vaccinations, except BCG, are carried out after completion of the course of chemoprophylaxis.

10.2.9. Revaccination against tuberculosis is allowed to be carried out simultaneously with revaccination with oral polio vaccine (OPV).

10.2.10. Observation of the development of the post-vaccination scar is carried out 1, 3, 6 and 12 months after vaccine administration. The results of observation (presence of a papule, scar, its size, condition of regional lymph nodes) are noted in f. 112-u, 026-u.

10.3. Immunization against polio.

10.3.1. Vaccination is carried out with IPV starting from 3 months three times with an interval between vaccinations of 1 month, revaccination with OPV (IPV) once at 18 months, 24 months and 7 years.

10.3.2. Vaccination tactics for persons without data on polio vaccinations:

Children under 3 years of age should receive a course of primary IPV vaccination (3 vaccinations with an interval of 1 month) and two booster vaccinations. The interval between vaccination and the first revaccination, as well as between revaccinations, can be reduced to one month;

Children aged 3 - 6 years receive a course of IPV vaccination (3 vaccinations with an interval of 1 month). Next, children should receive a revaccination at the age of 7 years, the interval from the last vaccination should not be less than 1 month;

Children 7 - 17 years old receive a course of IPV vaccination;

Persons over 17 years of age are vaccinated (once) with OPV if they come from countries that are epidemically affected by polio.

10.3.3. Adults who have not been vaccinated against polio and who are traveling to a polio-endemic country should be immunized once with OPV 4 weeks before departure.

10.4. Immunization against whooping cough, diphtheria, tetanus.

10.4.1. Vaccination is carried out from 3 months with DTP vaccine three times with an interval between vaccinations of 1 month, revaccination is carried out once at 18 months. Skipping one vaccination does not entail repeating the entire vaccination cycle.

10.4.2. Vaccinations against whooping cough are given to children aged 3 months to 4 years.

10.4.3. Children who have contraindications to the pertussis component are immunized against diphtheria and tetanus with ADS toxoid (vaccination twice with an interval of 1 month and revaccination after 9 to 12 months) or DTaP vaccine according to a scheme similar to DTP.

10.4.4. If a child who has had whooping cough has previously received 3 or 2 vaccinations with DPT vaccine, the course of vaccination against diphtheria and tetanus is considered completed. In the first case, revaccination is carried out with ADS toxoid at 18 months, in the second - 9 - 12 months after the last administration of the drug.

10.4.5. If a child who has had whooping cough has received only one vaccination with DTP vaccine, he is subject to a second vaccination with DTP toxoid, followed by revaccination after 9 to 12 months.

10.4.6. If a child has a post-vaccination complication (or a strong reaction) to the first vaccination of the DTP vaccine, then the second vaccination is carried out with the DTP toxoid or DTaP vaccine; if it is the second, then the vaccination is considered complete. If a complication develops after the 3rd DTP vaccination, the first revaccination is carried out with DTP toxoid or AADT after 12 to 18 months.

10.4.7. If for some reason 12 months or more have passed after the second vaccination with DPT vaccine, vaccination is considered complete. The first revaccination in children under 4 years of age is carried out with DTP vaccine, in children aged 4 years and older - with DTP toxoid.

10.4.8. In case of violation of the immunization schedule against diphtheria and tetanus in individual children, the interval between vaccine administrations should be:

Between completed vaccination and the first revaccination - at least 9 - 12 months;

Between the first and second revaccinations - at least 4 years;

Between the second and third, third and fourth - at least 5 years;

Between subsequent revaccinations - at least 10 years.

10.4.9. For emergency prevention of whooping cough in unvaccinated children, normal human immunoglobulin is used. The drug is administered to unvaccinated or incompletely vaccinated people twice with an interval of 24 hours in a single dose of 3 ml as early as possible after contact with a patient with whooping cough.

10.4.10. Children who have not received vaccination before contact with a person with whooping cough are not given vaccine prophylaxis. In case of contact with a child with whooping cough with an incomplete vaccine cycle, immunization continues according to the calendar. If a child received the 3rd dose of DTP more than 6 months ago, he should be revaccinated.

10.4.11. Immunization started with the DTaP vaccine can be continued with the DTaP vaccine and vice versa.

10.5. Immunization against diphtheria and tetanus.

10.5.1. The second revaccination is carried out with ADS-toxoid at 6 years, the third with AD-M-toxoid at 11 years, the fourth revaccination is carried out with ADS-M-toxoid at 16 years, subsequent revaccinations with ADS-M-toxoid every 10 years.

10.5.2. ADS toxoid is used to prevent diphtheria and tetanus in children under 6 years of age:

Those who have had whooping cough;

Those who have contraindications to the administration of DTP vaccine;

Over 4 years of age, not previously vaccinated against tetanus.

10.5.3. Children 7 years of age and older, as well as adults who have not previously been vaccinated against diphtheria and tetanus (or do not have information about vaccinations), are vaccinated with ADS-M toxoid twice with an interval of 1 - 1.5 months. The first revaccination is carried out 9-12 months after the completed vaccination once.

10.5.4. AD-M toxoid is used for the third revaccination against diphtheria at the age of 11, as well as for planned revaccinations in persons who have received emergency specific tetanus prophylaxis with tetanus toxoid.

10.5.5. Adults who have not received ADS-M in the last 20 years are vaccinated twice with ADS-M at intervals of 30 to 45 days. If they have received tetanus toxoid during this time, one of the vaccinations may be given AD-M. Persons who have not received any vaccination against diphtheria and tetanus are given a third dose of ADS-M 6 to 9 months after the second vaccination.

10.5.6. Persons over 66 years of age are vaccinated at their request and in the presence of epidemic indications.

10.6. Immunization against measles, mumps, rubella.

10.6.1. Children who have not had these infections are vaccinated at 12 months and revaccinated at 6 years using the combined three-component MMR vaccine.

10.6.2. Vaccination and revaccination of children who have had measles, mumps or rubella can be carried out either using a combination vaccine with three components or using single vaccines.

10.6.3. In case of violation of the immunization schedule, the interval between vaccine administrations should be:

Between vaccination and revaccination using the combined MMR vaccine, as well as vaccination against rubella using the monovaccine and revaccination using the combined vaccine, at least 4 years;

There should be at least 1 year between vaccination against measles and mumps using single vaccines and revaccination using a combined three-component vaccine.

10.6.4. Vaccination against measles can be carried out no earlier than 3 months after or 6 weeks before the administration of immunoglobulin or plasma.

10.6.5. If it is necessary to perform a tuberculin test, it should be carried out before (permitted simultaneously) vaccination with a combined vaccine against measles, mumps and rubella (monovaccines against measles and mumps) or 6 weeks after it.

10.7. The use of several vaccines on one day is allowed, and they are administered with separate syringes to different parts of the body. When sequential vaccinations are carried out with two live vaccines, a monthly interval is established between them.

10.8. Preventive vaccinations for epidemic indications are carried out on the basis of the decision of the Chief State Sanitary Doctor of the Republic of Belarus, the chief state sanitary doctors of the regions, the city of Minsk, cities and districts, taking into account the epidemiological and epizootological situation.

10.9. The procedure and timing of preventive vaccinations for epidemic indications are determined by the regulatory documents of the Ministry of Health of the Republic of Belarus, as well as the Instructions for the use of medical immunobiological preparations.

Appendix 7

FORMS OF CONSENT OF PARENTS (OR PERSONS REPLACED FOR THEM) TO

PREVENTIVE VACCINATIONS FOR ________ YEAR

I, _______________________________________ agree to conduct

(Name of mother or father (guardian))

preventive vaccination against ___________________________________

(name of infectious

diseases)

my son (daughter) _____________________________________________________

(child's full name)

I am familiar with the peculiarities of the period after immunization.

Date ________________ Painting ____________

Appendix 8

to the Instructions "Organization and implementation of preventive vaccinations"

SCHEME OF MEDICAL EXAMINATION BEFORE VACCINATION

• Child's age
• Temperature
• Complaints
• Anamnesis
• Allergy history
• Objective data:
• Lymph nodes
• Musculoskeletal system
• Lungs (percussion, auscultation)
• Heart (percussion, auscultation)
• Stomach
• Liver
• Spleen
• Urination
• Diagnosis:
• Permission for vaccination (specify: vaccination, revaccination (what kind)
• account) against which infection).
• Doctor's signature, personal seal

Appendix 10 to the Instructions "Organization and implementation of preventive vaccinations"

LIST OF LONG-TERM AND PERMANENT MEDICAL CONTRAINDICATIONS TO PREVENTIVE VACCINATIONS

Contraindications (permanent) to all vaccines.

Complication of the previous dose of the drug (anaphylactic shock that developed within 24 hours after vaccination, immediate allergic reactions, encephalitis or encephalopathy, afebrile convulsions).

2. Contraindications to all live vaccines.

2.1. Primary immunodeficiency state.

2.2. Immunosuppression.

2.3. Malignant neoplasms.

2.4. Pregnancy.

3. Contraindications to certain vaccines.

3.1. Tuberculosis vaccine (BCG). Prematurity (child's body weight less than 2500 g), complicated course of the post-vaccination period that developed within 1 year after the initial administration of the BCG or BCG-M vaccine, MBT infection, positive or questionable Mantoux test, history of tuberculosis.

3.2. Oral live polio vaccine (OLV). There are no absolute contraindications.

3.3. Adsorbed pertussis-diphtheria-tetanus vaccine (DTP). Progressive diseases of the nervous system: uncontrolled epilepsy, infaltal spasms, progressive encephalopathy, as well as a history of afebrile seizures, strong post-vaccination reactions to the previous dose of the vaccine.

3.4. Adsorbed diphtheria and diphtheria-tetanus toxoids (ADS, ADS-M, AD, AS). There are no absolute contraindications.

3.5. Live measles vaccine (LMV). Anaphylactic reactions to aminoglycosides, egg whites.

3.6. Live mumps vaccine (LMV). Anaphylactic reactions to aminoglycosides, egg whites.

3.7. Comprehensive vaccine against measles, mumps and rubella. Anaphylactic reactions to aminoglycosides and egg whites.

3.8. Rubella vaccine. Anaphylactic reaction to aminoglycosides.

3.9. Hepatitis B vaccine. Immediate allergic reactions to yeast and other components of the vaccine.

3.10. Inactivated polio vaccine (IPV). Immediate allergic reactions to streptomycin.

Appendix 11

to the Instructions

"Organization and implementation of preventive vaccinations"

DISEASES AND CONDITIONS THAT ARE NOT CONTRAINDICATIONS TO IMMUNIZATION (FALSE CONTRAINDICATIONS)

1. Perinatal encephalopathy.

2. Stable neurological diseases.

3. Anemia.

4. Enlargement of the thymus shadow.

5. Allergies, asthma, eczema.

6. Congenital malformations.

7. Dysbacteriosis.

8. Maintenance therapy.

9. Topical steroids.

10. Indication in the anamnesis of:

10.1. Prematurity.

10.2. Hyaline membrane disease.

10.3. Hemolytic disease of newborns.

10.4. Complications after vaccination in the family (with the exception of generalized BCG infection during immunization against tuberculosis).

10.5. Allergies in relatives.

Appendix 12 to the Instructions "Organization and implementation of preventive vaccinations"

LIST OF MAIN COMPLICATIONS (DISEASES) IN THE POST-VACCINATION PERIOD, SUBJECT TO REGISTRATION AND INVESTIGATION

• Anaphylactic shock
• Severe generalized allergic reactions (recurrent angioedema - Quincke's edema, Steven-Johnson syndrome, Lyell's syndrome, etc.)
• Serum sickness syndrome
• Encephalitis
• Other lesions of the central nervous system with generalized or local manifestations: encephalopathy, serous meningitis, neuritis, polyneuritis
• Residual convulsive conditions: afebrile convulsions (appearing after vaccination at a temperature below 38.5 degrees C and absent before vaccination), repeated within the first 12 months after vaccination
• Vaccine-associated polio in a vaccinated healthy person in contact with a vaccinated person
• Myocarditis, nephritis, thrombocytopenic purpura, agranulocytosis, hypoplastic anemia, collagenosis
• Abscess at the injection site
• Sudden death, other fatalities temporarily related to vaccination
• Lymphadenitis, incl. regional, keloid scar, osteitis and other generalized forms of the disease

Appendix 13 to the Instructions "Organization and implementation of preventive vaccinations"

SCHEME FOR EXTRAORDINARY REPORTING OF POST-VACCINAL COMPLICATIONS

1. Diagnosis: post-vaccination complication

2. Main manifestations: severe allergic, nervous system, other (specify the main symptoms)

3. What drug was administered ____________ Date of administration __________

4. Time and date of appearance of the main clinical symptoms

5. Who carried out the vaccination (position, full name)

6. Vaccine manufacturer

7. Series. Best before date

8. LPO (Location)

9. Date of application to the health care facility.

10. Established diagnosis

11. Date of diagnosis

14. Date of birth

15. Residence address

16. Where does he work (study)

17. Date of hospitalization

18. Diagnosis during hospitalization

19. Additional information

20. Provided information (position, surname, telephone number)

21. Date of notification

Appendix 14 to the Instructions "Organization and implementation of preventive vaccinations"

SCHEME OF INVESTIGATION REPORT FOR COMPLICATIONS AFTER VACCINATION

3. Date of birth

4. Place of work (children's institution)

5. Home address

6. An extraordinary report was sent by telephone or fax. Date

7. Information about the drug

7.1. Name of the drug

7.3. Release date. Best before date

7.4. Manufacturer

7.5. The drug was received in quantity. Date received

7.6. Conditions and temperature conditions of transportation and storage in the region (gorray) TsGE, LPO)

7.7. Violations of the vaccination procedure (method of administration, dosage, storage conditions of the opened ampoule, etc.)

7.8. Number of people vaccinated with this series in the area (city, region)

7.9. Presence of complications and unusual reactions in vaccinated people

8. Information about the health status of the vaccinated person

8.1. Date of vaccination

8.2. Who examined before vaccination

8.3. Temperature before vaccination

8.4. Individual characteristics (prematurity, birth trauma, traumatic brain injury, previous corticosteroid therapy, etc.)

8.5. Past illnesses (for children in the first 3 years of life, indicating the date and duration of the illness), indicate the date and duration of the last illness

8.6. Allergic diseases (including reactions to medications and foods)

8.7. History of seizures in the vaccinated person, his parents, brothers, sisters, with or without high fever, how long ago

8.8. Vaccination history (indicating the date and name of the drug)

8.9. Additional data (contact with an infectious patient, in the family, institution, hypothermia, etc.)

8.10. Clinical course

8.11. Date of illness

8.12. Date of access

8.13. Complaints

8.14. Objectively: symptoms of local and general reaction, diagnosis

8.15. Date and place of hospitalization

8.16. Course of the disease (briefly)

8.17. Final diagnosis: main

8.18. Complication

8.19. Concomitant diseases

8.20. Date of discharge

8.21. Exodus

8.22. Residual effects

8.23. In case of death: date, pathological diagnosis

9. Conclusion of the commission on the causes of the complication

10. Positions and signatures of commission members