Conducting vaccinations. Organizing and conducting preventive vaccinations

The Law of the Russian Federation “On the Sanitary and Epidemiological Well-Being of the Population” in 1991 (Art. 24) established for the first time the obligatory vaccination of children against 6 infections: tuberculosis, polio, whooping cough, diphtheria, tetanus and measles.

In order to increase the effectiveness of vaccine prophylactics, a schedule of preventive vaccinations has been developed.

It takes into account the following circumstances:

1) the age-related immunological ability of children to develop a sufficiently intense immunity;

2) the epidemiological state of the country;

3) the effectiveness of vaccines used, the duration of post-vaccination immunity;

4) the possibility of simultaneous immunization with several vaccines, depending on the established synergism and antagonism, as well as depending on the reaction of the child’s body to various associated drugs;

5) the dangers of post-vaccination complications.

The vaccination calendar is not stable, it is constantly changing and being updated depending on changes in the epidemiological situation in the country, new data on theoretical and applied immunology, development of new, including associated, vaccines, etc. (Table 12).

Vaccination against tuberculosis. Vaccination and revaccination against tuberculosis is carried out on newborn and uninfected tuberculosis to school-age children with BCG vaccine.

Characteristics of the drug.The vaccine is a live bacteria of the BCG vaccine strain, dried in a 1.5% solution of sodium glutaminate. Available in ampoules containing 0.5 mg of BCG, which is 20 doses of 0.025 mg of the drug. Before use, the vaccine is diluted in sterile isotonic sodium chloride solution, the ampoules with which, together with the instruction on the use of the drug, are attached to the vaccine.

Dates of vaccination BCG.The child is vaccinated on the 4-5th day of life. Revaccination is carried out at the age of 7, 12 and 17 years of age to clinically healthy children in whom a pre-set Mantoux test with 2 TE of purified tuberculin at a standard dilution (PPD-L) gave a negative result.

Vaccination dose -0.025 mg of BCG vaccine in 0.1 ml of isotonic sodium chloride solution for all ages.

Method of administration.The BCG vaccine is administered strictly intracritically on the border of the upper and middle third of the outer surface of the left shoulder.

With the correct vaccine administration technique, a white papule is formed, usually disappearing in 15-20 minutes. After 4-6 weeks, a specific vaccine reaction in the form of a papule develops at the site of intracutaneous administration of the BCG vaccine, followed by pustularization, the formation of a crust and a small scar of 2-10 mm in size. The reverse development of the local reaction lasts 2-3 months, sometimes longer. A scar at the site of vaccination is formed in 90-95% of vaccinated children.

The main indicator of acquired immunity and its intensity is the development of a positive tuberculin test (post-vaccination allergy) in 94-100% of vaccinated children. A direct correlation was established between the frequency of occurrence and the intensity of post-vaccination allergy and the presence of a scar at the site of vaccination and its magnitude.

Complications.The BCG vaccine is not very potent. Complications are usually local in nature and rarely occur (about 0.003-0.02%). Complications are: 1) subcutaneous cold abscesses, which can occur when a vaccine enters subcutaneously if a violation of the vaccination technique, their size is 10 mm or more in diameter; 2) post-vaccination lymphadenitis, which can appear both in the presence of a normal local vaccination reaction, and in combination with a cold subcutaneous abscess. In some cases, there may be a softening of the lymph nodes, the formation of fistulas (abscess lymphadenitis). Calcium lymph nodes, detected radiologically, often in the left axillary cavity 0.5 mm in size - 1 cm or more; 3) keloid scars appear more often in revaccinated BCG girls at pre-pubertal and pubertal age, as well as in cases of highly conducted vaccinations (in the area of ​​the shoulder joint); 4) osteitis - a local lesion of the tubular bones, are extremely rare; 5) Generalization of BCG infection. It is very rare (in newborns 4 cases per 1,000,000 vaccinated, at an older age - 3.5 per 1,000,000 vaccinated). According to many authors, this severe complication occurs mainly in children with immunodeficiency (septic granulomatous disease). The complication proceeds according to the type of a severe general disease with affection of various organs and various clinical symptoms. At the autopsy, billions of tubercles and foci of necrosis are found, from which it is possible to isolate the acid-resistant bacillus BCG mycobacteria, which are not virulent for guinea pigs.

Table 12

Vaccination schedule (routine vaccination)

Treatment.Anti-TB drugs: ftivazid (30-40 mg / kg per day), tubazid (10-20 mg / kg per day), PASK (15-20 mg / kg per day), streptomycin (15-20 mg / kg in day intramuscularly). The course of treatment is 3-6 months. It is prescribed for generalized BCG infection, abscess lymphadenitis, sometimes with calcification of the lymph nodes. Local treatment is prescribed for the softening of infiltrates and lymph nodes, with caseous abscess lymphadenitis and caseous abscesses. The caseous masses are sucked off with a syringe and a 5% solution of salyuzid or streptomycin is injected (5-6 punctures every 3-7 days). As a local treatment for ulcers and fistulas, 10 are used. % ftivazidnuyu ointment or 20% ointment PASK or powder ftivazidom, PASK.

In the absence of effect, surgical treatment is performed — an abscess cavity is scraped out, granulations are removed and capsules are destroyed or the entire lymph node or abscess is removed.

Keloid scars are not recommended. For large and growing keloids, they are cut around 0.5. % solution of hydrocortisone emulsion with 0.5% solution of novocaine 1 time per week. The cleavage of keloid with hydrocortisone can be combined with calcination with lidaza (32-64 U).

Contraindications for vaccination of newborns:1) acute diseases (including intrauterine infections, birth injuries, hemolytic disease);

2) prematurity (birth weight less than 2000 g) and immaturity of newborns. Children not vaccinated during the neonatal period ™ receive the BCG vaccine 1-6 months after recovery.

Contraindications to revaccination:1) acute infectious and non-infectious diseases, exacerbation of chronic diseases. In this case, vaccination is carried out no earlier than one month after recovery (remission); 2) immunodeficiency states; malignant blood diseases and neoplasms, the appointment of immunosuppressants and radiation therapy. In these cases, vaccination is carried out 12 months after the end of treatment; 3) patients with tuberculosis and persons who have undergone tuberculosis; 4) positive and dubious Mantoux reaction with 2 Tu PPD-L; 5) complicated reactions to the previous administration of BCG vaccine (keloid scars, lymphadenitis, etc.).

Vaccination against polio.For the prevention of poliomyelitis, polio live oral vaccine from Sabin strains (EAV) is used.

Characteristics of the drug.The vaccine consists of attenuated (weakened) strains of poliomyelitis viruses of three immunological types - I, II, III. Available in liquid form, red-orange color, without sediment, without impurities in vials. The drug contains in 1 vaccination dose the following number of infectious units: type I not less than 1 000 000; Type II at least 100,000; Type III at least 300,000.

Dates of vaccination.Since the age of three months, vaccinations are carried out three times in the first year with an interval of 1.5 months; revaccination is carried out during the second and third years twice with an interval of 1.5 months; at the age of 7-8 years and 15-16 years - once.

Vaccination dosedepends on the concentration (titer) of the vaccine: 2 drops each (when the vaccine is poured in 5 ml containing 50 doses, i.e. 1 dose of the vaccine is 0.1 ml) or 4 drops (when the vaccine is poured in 5 ml = 25 doses or 2 ml = 10 doses, i.e., 1 dose of vaccine - 0.2 ml) per reception.

Method of administration.Vaccination vaccine dose is instilled into the mouth with a sterile pipette, dropper or syringe one hour before meals. Wash down the vaccine with water, as well as eat and drink for an hour after the vaccination is not allowed.

The nature of the vaccination reaction.Poliomyelitis vaccine, as a rule, does not cause either a general or local reaction.

Complications.There are extremely rare. In those vaccinated, predisposed to allergic reactions, allergic complications such as rash, urticaria or angioedema, etc. can be extremely rarely observed. Vaccine-associated poliomyelitis (VAL) in vaccinated people from the 1st to the 30th day after vaccination and in persons exposed to the vaccinated, within 60 days after contact; the incidence of complications 1-3 cases per 3 000 000 vaccinated In recent years, much attention has been paid to the role of immunodeficiency states in the pathogenesis of vaccine-associated polio.

Treatment.Symptomatic.

1) acute illness with fever (37.5 WITHand higher or systemic disorders. Lighter diseases, such as SARS or diarrhea with fever up to 37.5 "C, are not contraindicated; 2) immunodeficiency states, malignant blood diseases, neoplasms, prescription of immunosuppressants or radiation therapy. In these cases, vaccination is carried out after 12 months after the end of treatment, 3) neurological disorders resulting from previous vaccination.

Vaccination against whooping cough, diphtheria andtetanus. For the prevention of pertussis, diphtheria and tetanus, an associated drug is used - adsorbed pertussis-diphtheria-tetanus vaccine (DTP), for the 2nd and 3rd revaccinations - ADS-M-antoxin.

Characteristics of the drug.The vaccine consists of a mixture of pertussis vaccine, purified concentrated diphtheria and tetanus toxoids adsorbed on alumina hydrate. Available in ampoules of 1 ml of the drug containing 20 billion pertussis microbial cells, 30 flocculating units (LF) of diphtheria and 10 antitoxin-binding units (EC) of tetanus toxoids, as well as a preservative - 0.01% merthiolate.

Dates of vaccination.Vaccination begins) from 3 months of age, spend three times at intervals of 45 days. The first revaccination is carried out once through 1-1.5 years after the end of the course; vaccination. The second revaccination is carried out only against diphtheria and tetanus with the vaccine ADS-M at the age of 9 and 15-16 years.

Vaccination dose.One vaccination dose is 0.5 ml and contains 10 billion pertussis microbes, 15 units of diphtheria toxoid and 5 units of tetanus toxoid.

Method of administration.The vaccine is administered intramuscularly (ADS-M-intramuscularly and subcutaneously) in the upper outer quadrant of the buttock or the anterior outer part of the thigh.

The nature of the vaccination reaction.Most children who received DTP vaccine have neither a general nor a local reaction. Some children may have general reactions in the first two days after administration of the vaccine (increase in body temperature to 37.5-38 "C) and local reactions in the form of rapidly absorbable infiltrates.

Complications.In rare cases, excessively strong general reactions in the form of hyperthermia (39–40 ° C) and intoxication phenomena may occur: lethargy, anxiety, disturbed sleep and appetite, as well as severe; local reactions, often to re-introduction of the vaccine (revaccination) - dense infiltrates more than 2 cm in diameter. Children with allergic reactivity to the vaccine may experience allergic reactions.

polymorphic rash (papular, urticar, etc.), sometimes simultaneously with angioedema; exacerbation of exudative diathesis. Very rare, but the most dangerous complication of an allergic nature is anaphylactic shock, which occurs more often after repeated administration of the vaccine in individuals with high body sensitization. Anaphylactic shock develops immediately or 5-6 hours after vaccine administration. In children of the first year of life, similar to the picture of anaphylactic shock in older children, there is a collaptoid state that appears in the first 5-6 hours after vaccination, characterized by severe blanching, cyanosis, lethargy, adynamia, falling blood pressure, cold sweat, and sometimes loss of consciousness. The local allergic reaction is characterized by a sharp hyperemia of the skin with swelling of soft tissues.

After the introduction of DPT vaccine, sometimes there is asthma syndrome, croup syndrome (in these cases it is necessary to eliminate ARVI), hemorrhagic syndrome.

The most serious complications are CNS disorders. These include a stubborn shrill cry or screech that lasts for several hours after vaccination; encephalic reaction, which is most often manifested by convulsions with loss of consciousness with or without hyperthermia, in the form of “nods”, “pecks”, gaze, sekussov, absences, etc .; extremely rarely develops encephalitis, characterized by repeated or continuous convulsions, prolonged loss of consciousness, hyperthermia, vomiting, hyperkinesis, automatic movements, limb paresis, focal symptoms. The course is severe, often with gross residual effects.

When repeatedly vaccinating the DPT vaccine, it is possible that various intercurrent diseases, such as SARS, enterovirus, intestinal, meningococcal infections and other diseases that are common in children during the first years of life, can be layered on the vaccination process.

If unusual reactions and complications appear, no further vaccination is carried out. It is believed that the development of the described complications is associated with the pertussis component of the vaccine. Based on this, as well as taking into account the nature of the complication and its severity, the vaccination can be continued with ADS-toxoid. If a child has previously received a single DTP vaccine vaccine, he is given ADS-toxoid once, if two vaccinations, he is vaccinated with ADS-toxoid after 1-1.5 years.

Treatment.In most cases, due to the short duration (from several hours to 1-2 days) and the ease of post-vaccination reactions and complications, no active therapeutic measures are required.

In case of hyperthermia (39.5-40 ° C and above) antipyretic agents are used: paracetamol - 0.01 g / kg orally, analgin - 0.008-0.015 g / kg, acetyl salicylic acid (aspirin) - 0.015 g / kg. With persistent hyperthermia, intramuscular injection of 50% solution of dipyrone - 0.015 ml / kg simultaneously with antihistamines (1% solution of dimedrol, 2% solution of suprastin, 2.5% solution of pipolfen, etc.). Apply physical methods of cooling, frequent and fractional drinking.

Single and short-term seizures, as a rule, do not require active therapy. With repeated and incessant convulsions, one should not hesitate with lumbar puncture. Apply a 0.5% solution of Seduxen - 0.05 mg / kg intramuscularly or intravenously with a 10% glucose solution; phenobarbital: children up to 1 year old - 1 mg / kg, over 1 year old - 10 mg for one year of life; 25% solution of magnesium sulfate -0.2 ml / kg intramuscularly; sodium o-sibutyrate solution - 50-100 mg / kg with 20-30 ml of 5% glucose solution intravenously. Dehydration preparations: 15-20% solution of mannitol at the rate of 1.0-1.5 g of dry matter per 1 kg of body weight of the child; lasix (furosemide) - 1-3 mg / kg 2-3 times intramuscularly or intravenously, diacarb (0.125-0.25 g), hypothiazide (0.0125-0.025 g), etc. Symptomatic therapy. Rehabilitation therapy for severe neurological complications.

Contraindications to vaccination:1) acute infectious and non-infectious diseases. In these cases, vaccination is carried out no earlier than 1 month after recovery; 2) exacerbation of chronic diseases. Vaccination is carried out individually after 1-3 months from the beginning of remission; 3) long-term and severe diseases (viral hepatitis, tuberculosis, meningitis, myocarditis, hemorrhagic vasculitis, etc.). Vaccination is carried out individually in 6-12 months after recovery; 4) unusual reactions and complications of previous administration of DTP vaccine: severe forms of allergic reactions (shock, angioedema, polymorphic exudative erythema, etc.); convulsions, episodes of shrill cry, disorder of consciousness; severe general reactions (body temperature above 39.5 WITH,symptoms of intoxication). Note: small local reactions, temperature reactions up to 39.5 ° C are not contraindications to further vaccination DTP vaccine. Children with unusual reactions and complications continue to be vaccinated with ADS-M-toxoid; 5) diseases nervous system, convulsive syndrome, general or focal neurological symptoms. Note: children with chromosomal diseases (Down's disease, etc.), hereditary metabolic diseases (phenylketonuria, etc.), with perinatal CNS lesions without residual effects are subject to vaccinations over 6 months of age; 6) prematurity (birth weight less than 2500 g). Vaccination is carried out at the age of 6 months under the condition of normal psychomotor and physical development; 7) severe forms allergic diseases: serum sickness syndrome, recurrent angioedema, generalized eczema, severe forms of bronchial asthma. Note: children with recurrent obstructive bronchitis, local forms of atopic dermatitis receive AXD vaccine 3 months after exacerbation; family history of allergy, mild manifestations of food allergy, exudative diathesis are not contraindications for DTP vaccination; 8) immunodeficiency states, malignant blood diseases and neoplasms, the appointment of immunosuppressants and radiation therapy.

Vaccination against measles In order to prevent measles, live measles vaccine (JCV) is used.

Characteristics of the drug.The live measles vaccine is prepared from a vaccine strain L-16 grown on cell cultures of Japanese quail embryos. The vaccine is available in dry form in ampoules or vials with a content of 1-5 vaccination doses. Immediately before administration, the vaccine is diluted with a solvent attached to each vial or vial. Dissolved vaccine has the form of a clear or slightly opalescent pink or colorless liquid.

Dates of vaccination.Live measles vaccine vaccinates measles-free children between the ages of 12 months and 14 years. Revaccination is carried out before entering the school for seronegative children.

Children older than 12 months and adults who have not had measles and have not previously been vaccinated, who have been in contact with measles patients, are subject to measles vaccine in the absence of contraindications no later than 72 hours from the moment of contact with the patient.

Method of administration.The vaccine is injected subcutaneously in a volume of 0.5 ml under the scapula or in the shoulder area (on the border of the upper and middle third of the shoulder from the outside). Perhaps intradermal administration of the vaccine using a needleless injector in a volume of 0.1 ml. The shelf life of the diluted vaccine should not exceed 20 minutes.

The nature of the vaccination reaction.In most children, measles vaccination is not accompanied by any clinical manifestations. In some children, from the 5th-6th to the 18th day, the body temperature may rise to 37.5-38.5 ° С, catarrhal phenomena appear in the form of cough, slight conjunctivitis, rhinitis; sometimes there is a small pale pink co-reparate rash. The vaccination reaction lasts more than 2-3 days; during this period, the child is infectious to others.

Complications.While the vaccine is not very effective, complications in vaccinated people are very rare. In children with allergic reactivity, both during the first days of vaccination and during the height of the vaccination reaction, an allergic rash of a polymorphic, sometimes urticarial nature, angioedema, lymphadenopathy, arthralgia, rarely - serum sickness syndrome, asthastatic syndrome or croupy syndrome, hemorrhagic hemorrhagic vasculitis syndrome.

With pronounced general reactions to vaccination, the child's body temperature rises to 39-40 * C, symptoms of intoxication appear, and sometimes neurological symptoms. When hyperthermia can develop an encephalic reaction, which is characterized by a convulsive syndrome lasting 1–2 minutes (single or repeated). The prognosis is favorable, residual effects are extremely rare.

Often, the vaccination process may be stratified SARS, which may be complicated by pneumonia, tonsillitis.

In recent years, in our country measles vaccination in the vast majority of children does not cause serious complications.

Treatment.Symptomatic.

Contraindications to vaccination:1) acute infectious and non-infectious diseases; exacerbation of chronic diseases. In these cases, vaccination is carried out no earlier than 1 month after recovery (remission). Note: in case of contact with infectious patients in a family, children's institution, etc., the vaccination is carried out after quarantine is over; in mild afebrile forms of respiratory diseases (rhinitis, mild hyperemia of the mucous membrane of the pharynx, etc.), vaccination can be carried out in 2 weeks; according to epidemiological indications, vaccination of convalescents after non-severe respiratory diseases is allowed; with a history of febrile convulsions, an increase in body temperature in the post-vaccination period is an indication for antipyretics; 2) immunodeficiency states: malignant blood diseases and neoplasms; the appointment of immunosuppressants and radiation therapy. Vaccination is carried out 12 months after the end of treatment; 3) severe forms of allergic reactions to aminoglycosides (monomitsin, kanamycin, etc.) and quail eggs.

Vaccination against measles can be performed no earlier than 3 months after or 2 weeks before the administration of immunoglobulin or preparations containing antibodies.

Vaccination against mumps. For the prevention of mumps used live mumps vaccine.

Characteristics of the drug.A live parotitis vaccine is prepared from an attenuated strain of the parotitis virus L-3 grown on cell cultures of embryos of Japanese quails or quails of the “Pharaoh” line. The vaccine is available in dry form in ampoules (vials). Each vaccination dose contains at least 10,000 GADA of so attenuated parotitis virus, monomitsin or kanamycin monosulphate up to 25 U. Dissolved vaccine has the form of a clear or slightly opalescent pink or colorless liquid. Ampoule contains from 1 to 5 doses.

Dates of vaccination.Vaccination is given to children from 18 months to 7 years old, who had not previously had parotitis.

Method of administration.The vaccine is administered once in a volume of 0.5 ml subcutaneously under the scapula or in the outer shoulder area.

The nature of the vaccination reaction.In most children, the vaccination process is asymptomatic. Some of the vaccinated from the 4th to the 12th day after the introduction of the vaccine may experience a temperature reaction and catarrhal phenomena lasting 1-2 days. In rare cases, a brief (2-3 days) slight increase in the parotid glands occurs at the same time. Local reactions, as a rule, are absent.

Complications.Complications are extremely rare. These include high body temperature, abdominal pain, vomiting, febrile seizures; allergic reactions in the form of rashes in children with allergic changes in reactivity.

Extremely rarely, vaccinated can develop benign serous meningitis. Each case of serous meningitis must be differentiated from serous meningitis of a different etiology.

Treatment.Symptomatic.

Contraindications to vaccination:1) acute infectious and non-infectious diseases. In these cases, the vaccination is done no earlier than 1 month after recovery; 2) exacerbation of chronic diseases. Vaccination is carried out individually after 1-3 months from the beginning of remission; 3) long-term current and severe diseases (viral hepatitis, tuberculosis, diffuse diseases of the connective tissue, diseases of the nervous system, pancreatitis, etc.). Vaccination is carried out individually in 6-12 months after recovery; 4) immunodeficiency states; malignant blood diseases, neoplasms, radiation therapy. Vaccination is carried out 12 months after the end of treatment; 5) severe allergic general and local reactions to the administration of measles vaccine; severe allergic reactions to amino glycosides and quail eggs.

It is forbidden to carry out vaccination against parotitis during the rise of the incidence of serous meningitis of enteroviral etiology.

Vaccination of children with altered reactivity.When vaccinating children with allergic changes in reactivity, the following tactics should be followed: clarification of the allergological history of the child and the choice of the optimal time, i.e. the period of the least allergic activity of the disease; Mandatory observance of hypo-or allergen-free diet for the period of vaccination, avoid the introduction of new types of food; the appointment of antihistamines for 2-3 days before vaccination and within 5-10 days after vaccination, vaccination of children against the background of taking zaditen, and children with respiratory allergies - aminophylline.

Vaccination of children with a burdened neurological history is the most responsible and requires a purely individual approach. Most of them are not vaccinated with DTP vaccine, but only with ADS-M-ana-toxin and all other vaccines. Often they are vaccinated while taking sedatives or anticonvulsants. In the presence of a history of febrile seizures with increased body temperature after vaccination, antipyretic agents (paracetamol) are prescribed, physical methods of cooling.

It is recommended to vaccinate children who often suffer from acute respiratory diseases and other infections in the warm season, in the period of the lowest incidence of ARVI, in the absence of contact. Depending on the frequency, severity and nature of repeated diseases in the history before vaccination, such children are tested for blood, urine, and other instrumental (echography, radiography, etc.) and immunological studies.

When vaccinating children with unusual reactions to previous vaccinations, the nature of the reaction and the type of vaccine followed by side effects should be considered. Depending on the nature of the reaction, the question of further vaccination is decided. It is very important not to transfer the diversions from the introduction of any one vaccine to all other types of vaccines. In severe reactions to DTP vaccine, immunization is usually continued with ADS-M-toxoid. These children are not contraindicated in vaccinations against polio, measles and parotitis.

Emergency specific prophylaxistetanus. Emergency prevention of tetanus is carried out by the active-passive method in the following cases:

in case of injuries with violation of the integrity of the skin and mucous membranes;

frostbite and burns of II, III and IV degrees;

abortions and childbirth outside of medical institutions;

with gangrene or necrosis of any type of tissue, abscesses;

animal bites;

with penetrating injuries of the gastrointestinal tract.

For emergency prevention of tetanus used AC-toxoid (you can use and ADS-M-toxoid), tetanus to human immunoglobulin (PCCH); in the absence of PSCH use anti-tetanus serum, horse, purified, concentrated, liquid (PSS).

AC-toxoid injected subcutaneously in the subscapularis area. PSCH is administered in a dose of 250 ME intramuscularly in the upper outer quadrant of the buttock. PSS is administered subcutaneously at a dose of 3000 ME. Before the introduction of the PSS, an intracutaneous test with serum diluted at a ratio of 1: 100, which is in the box with the preparation (the ampoule is marked in red), is mandatory to determine the sensitivity to the foreign protein, in accordance with the attached instruction.

The scheme of choice of prophylactic agents for emergency prevention of tetanus.If the child, according to the available documents, has received a full course of routine immunization, then, regardless of the time of the last vaccination, the previously mentioned drugs are not used.

If revaccination was not performed, regardless of the timing, 0.5 ml of AC-toxoid is injected.

With two vaccinations, if not more than 5 years have passed, 0.5 ml of AU-toxoid is injected; if more than 5 years, 1 ml of AU-toxoid, 250 IU of PSCI and 3,000 IU of PSS are injected.

With one vaccination, if not more than 2 years have passed, 0.5 ml of AU-toxoid is injected, if more than 2 years, 1 ml of AU-toxoid, 250 IU of PSCI and 3000 IU of PSS are injected.

Unvaccinated children under the age of 5 months receive 250 ME PSCI and 3000 ME PSS.

Children older than 5 months receive 1 ml of AC-toxoid, 250 IU of PSCI and 3000 ME of PSS.

In the absence of a child's documents confirming the conduct of vaccinations, as well as contraindications to vaccinations in history, he is administered 0.5 ml of AC-toxoid and only when infected wounds - PSCI and PSS.

Reactions to the introduction of drugs.The introduction of AC-toxoid and ADS-toxoid can cause local (redness, swelling) and general (fever, malaise) reaction. All these phenomena pass in 1-3 days.

On the introduction of tetanus serum possible allergic reactions: immediate, immediately after the introduction or after a few hours; the earliest - on the 2-6th day after the administration and the distant - on the 2nd week and later.

These reactions are manifested by a serum sickness symptom complex (fever, various rashes, itching, pain in the joints, swelling of lymph nodes, enlargement of the liver and spleen, etc.) on the skin, and in rare cases - anaphylactic shock.

Given the possibility of anaphylactic shock, each vaccine should be monitored for 1 hour. If the first signs of complications appear, adequate medical care should be provided (see Anaphylactic shock. Serum sickness).

Emergency preventionrabies. Emergency rabies prophylaxis is carried out by an anti-rabies culture inactivated dry vaccine (rabivak). In addition to the vaccine for moderate and severe injuries, anti-rabies immunoglobulin is used - heterogeneous, derived from hyperimmune horse serum.

Treatment-and-prophylactic immunization is carried out to persons infected (possibly infected) with the rabies virus for bites, wounds, depletion, caused by animals, according to a specially designed scheme depending on the severity of the damage and the state of health of the animals (or lack of data about it).

The full course of immunization is as follows: a pre-dissolved vaccine is injected under the skin of the abdomen in 3 ml for 12 days. Revaccination is carried out on the 10th, 20th and 35th day after the end of the main course. In severe cases (severe injuries and illness or death of the animal), 24 hours before the vaccine is administered, the anti-rabies immunoglobulin is injected intramuscularly (administered as a serum, with protein sensitivity).

In areas free from rabies for 2 years or more, for bites inflicted by pets with an unspecified diagnosis, the immunoglobulin is not injected, but is vaccinated with 3 ml for 12 days.

For bites inflicted by wild animals in rabid-safe areas, a rabies vaccine is given in 3 ml for 12 days and boosted on the 10th, 20th and 25th day after the end of the main course.

Reactions to the introduction of rabies vaccine and immunoglobulin.A local reaction may occur to the administration of the vaccine and immunoglobulin: redness, swelling and general - an increase in body temperature. Perhaps the development of allergic reactions: various rashes, angioedema, serum sickness syndrome.

Treatment.Symptomatic.

Children living in endemic and enzootic territories, as well as on epidemiological indications, are given additional immunization (Table 13).

Table 13

Immunization according to epidemiological indications and living in endemic and endeotic areas

Vaccination in the clinic is organized and carried out in accordance with the order, which approved a schedule of preventive vaccinations, instructions on the tactics of immunization, the basic provisions on the organization and conduct of preventive vaccinations, a list of medical contraindications to immunization, the procedure for registering information about complications from vaccinations.

Prophylactic vaccinations should be carried out in the terms established by the calendar. In case of their violation, simultaneous administration of several vaccines is allowed, but in different parts of the body, and with separate syringes.

In the case of separate vaccinations, the minimum interval should be at least one month. If the hepatitis B vaccine is not administered on the same day as other vaccines, the interval between their administration is not regulated.

Prophylactic vaccinations are carried out in polyclinics or in other premises, respectively, equipped with vaccination rooms, with strict observance of sanitary and hygienic requirements.

Vaccination clinic  should consist of premises for vaccinations and storage of a vaccination card file and have a refrigerator for storing vaccine preparations, a cabinet for instruments and a set of medicines for emergency and anti-shock therapy, boxes with sterile material, a changing table or a medical couch, a table for preparing vaccinations, a table for storage of medical records. The cabinet must have instructions for the use of vaccine preparations and an emergency help booklet.

In order to avoid contamination, it is prohibited to combine vaccinations against tuberculosis with vaccinations against other infections. It is prohibited to conduct vaccinations against tuberculosis and to make a Mantoux test at home.

Prophylactic vaccinations are carried out by medical staff who are trained in the rules of vaccination techniques and emergency care.

Medical workers are obliged to notify parents of the day of preventive vaccinations. All persons to be vaccinated should be examined by a doctor or medical assistant, and the history should be taken into account (prior diseases, allergic reactions to vaccinations, drugs, food).

Immediately prior to vaccination, the child is examined and measured for body temperature. acute illness. A record of the vaccination performed is made in the work register of the vaccination room, the child’s development history, the vaccination preventive map, the medical card of the child attending the institution, the register of preventive vaccinations. After vaccination and revaccination against tuberculosis after 1, 3, 6, 12 months, the nature of the papule, scar, and the state of the regional lymph nodes are recorded.

Basic Vaccines

First vaccination  carried out within 24 hours after the birth of the child. This is an immunization against hepatitis B.

The vaccine is injected intramuscularly in the region of the deltoid muscle of older children or in the anterolateral region of the thigh - in newborns and younger children.

As an exception, the vaccine may be administered subcutaneously in patients with thrombocytopenia and other diseases of the blood coagulation system.

Second vaccination  held at the age of 1 month, the third - at 5 months, simultaneously with DTP and OPV. Premature babies weighing less than 2 kg are vaccinated from two months with similar intervals between vaccinations.

Primary vaccination against tuberculosis is carried out on newborns on the 3-4th day of life. The BCG vaccine is a living dried bacteria of the BCG vaccine strain No. 1. One vaccination dose, 0.05 mg of BCG, dissolves in 0.1 ml of the solvent and is injected intradermally at the border of the upper and middle third of the outer surface of the left shoulder.

Premature babies weighing less than 2 kg, as well as children not vaccinated in the maternity hospital for medical contraindications, are vaccinated in the clinic with a BCG vaccine. Children older than two months, not vaccinated in the neonatal period, are vaccinated in the clinic after tuberculin test with a negative result.

At the age of 7 years, children who have a negative reaction to the Mantoux test are subject to revaccination. The interval between the Mantoux test and revaccination must be at least 3 days and at most 2 weeks.

Vaccination against poliomyelitis is carried out by live polio oral vaccine containing attenuated strains of human poliomyelitis virus of three immunological types (I, II, III). The vaccine comes in the form of a solution and candy.

Vaccination is carried out from three months three times with the interval between vaccinations a month, revaccination - in 18 months, 24 months and 7 years once.

Vaccinations against diphtheria, whooping cough, tetanus are carried out with the DPT vaccine (adsorbed pertussis-diphtheria-tetanus vaccine), which consists of a mixture of first-stage pertussis microbes killed by formalin or mertiolite, purified and concentrated diphtheria and tetanus toxoids adsorbed on aluminum hydroxide.

Vaccination with the DPT vaccine is carried out simultaneously with immunization against polio. Revaccination is carried out once in 18 months. Vaccinations against whooping cough are done from 3 months to 4 years. Children with contraindications to DTP are vaccinated with ADS-toxoid according to the following scheme: vaccination - at 3 and 4 months, revaccination after 9-12 months.

The second revaccination (6 years) is performed with ADS-antitoxin once, the third (11 years) with ADS-M-toxoid once. Children older than 6 years, not previously vaccinated, are vaccinated with ADS-M-toxoid: 2 vaccinations with an interval of one month, revaccination is carried out after 9-12 months once.

The problem of childhood vaccinations is complex and ambiguous. Before putting the child on the vaccine, parents should familiarize themselves with the information about the benefits of the vaccine and the possible consequences of its introduction, and find out whether the baby has contraindications to immunization.

Mandatory universal preventive vaccination of children has in the past decades made it possible to drastically reduce the incidence of serious infectious diseases.

After entering a weakened pathogen, the child's body produces antibodies and retains the memory of the transferred "disease". However, parents often have questions: Is the injected vaccine safe? When should and can be vaccinated child? What body reactions are allowed in the post-vaccination period? Is it possible to do without vaccination?

Indications for vaccination and vaccination of children

Immunizations should be given for each child. Mandatory vaccination against tuberculosis, polio, measles, whooping cough, tetanus, rubella, diphtheria, mumps, hepatitis B.

Before each vaccination a blood test is taken, the child must be examined by a pediatrician and determines his state of health. If the doctor has no comments, then after signing the parental agreement on vaccination, you can go to the vaccination office.

IMPORTANT: The indication for additional vaccination of children is a recorded outbreak of an infectious disease and the resulting threat of its spread.

Excess influenza epidemic threshold may be an indication for vaccine prevention of this disease.

Vaccinations and vaccination of children: pros and cons. The benefits of vaccinations and vaccination of children

In recent years, so-called "anti-vaccination" campaigns have been actively gaining momentum. According to their supporters, to preserve children's health and to avoid possible negative effects of vaccinations is possible only by refusing all preventive vaccinations. They explain their position by:

The danger of vaccine diseases is somewhat exaggerated.
   serious post-vaccination complications often occur in children
   for a small child too many mandatory vaccinations
   the mechanisms of formation of the child’s immunity are not well understood, therefore it should not be interfered with in any way
   immunization "undermines" the health of the child and becomes the impetus for the development of diseases

On the other hand, those who give all their vaccinations to their children are absolutely sure that they protect babies from dangerous infectious diseases and their consequences. Among the reasons for which children need to be vaccinated, parents note the following:

The immunity of the child is very vulnerable, especially for infectious diseases, so preventive vaccination of children is the duty of sensible parents.
   modern vaccine is effective and can not harm the body healthy babyas it is free from hazardous components
   possible effects of vaccination, such as fever and redness at the injection site are standard

IMPORTANT: The likelihood of the consequences for the child’s health and life from an infectious disease is several dozen times higher than the probability of any serious reaction to vaccination.

Parents must decide for themselves whether they are ready to deprive their child of the right to health, depriving him of mandatory preventive vaccinations or is it still better to protect the baby from dangerous infections with the help of vaccination.

Do I need the consent of the parents for vaccinations and vaccination of the child?

Before the child is vaccinated, the pediatrician asks parents to fill out a standard medical document - consent to immunization. To do this, parents will have to decide in advance whether they will carry out the prevention of infectious diseases for their child or not.

IMPORTANT: Parents have the right to receive any information about the vaccine to immunize a child. The pediatrician is obliged to answer in detail all their questions regarding the upcoming vaccination.

Parents confirm their consent to vaccination by signing on the form - the questionnaire. This document is pasted into an outpatient card and stored up to the age of 18 years. Such a form must be filled before each new vaccination of the child.

IMPORTANT: Parents who previously refused vaccinations, but changed their opinion, can sign a consent and begin immunization of the child at any time.

A sample of consent (refusal) for vaccination was approved by the Order of the Ministry of Health and Social Development of Russia dated January 26, 2009.

Is it possible for parents to refuse vaccinations and vaccination of the child?

• A prerequisite for vaccinating a child under 15 is the written consent of the parents. If parents do not wish to vaccinate their child, they sign a waiver.
• Such action is provided by law: "Citizens of the Russian Federation in the implementation of immunoprophylaxis have the right to refuse vaccinations." Every parent can exercise this right.
• If parents refuse to be vaccinated, the pediatrician is obliged to inform them of the possible consequences and make the appropriate notes in the child’s medical records.

Is there a law on vaccination of children in Russia?

Provisions for prophylactic vaccination of children are indicated in Federal Law “On Immunoprophylaxis of Infectious Diseases”adopted by the State Duma on July 17, 1998.

• The Law gives clear medical concepts used in immunization issues, defines the state policy, the rights and obligations of citizens during vaccination, the responsibility for refusing vaccinations and the consequences of such actions
• The provisions of the national vaccination calendar, the requirements for immunobiological vaccines, social protection of citizens in case of post-vaccination complications are also indicated.
• Issues of immunization of the population are also specified in the “Fundamentals of the Russian Federation Law on the Protection of Citizens' Health” and the Federal Law “On the Sanitary and Epidemiological Welfare of the Population”

Schedule of vaccination of children in Russia. Vaccination schedule and vaccination of children

For prophylactic immunization of children use the National schedule (schedule) of vaccinations, approved by the Ministry of Health of the Russian Federation. It indicates the required vaccinations, their multiplicity and the age of the child, in which vaccination is recommended.

What is the mandatory vaccination of children? What is routine vaccination of children?

Mandatory (planned) vaccination is a measure of preventive vaccinations according to the vaccination schedule for children who have no contraindications. It can occur in both public and private medical institutions licensed to carry out immunization.

IMPORTANT: For routine vaccination, written consent of the parents and a preliminary examination of the child by a doctor are required.

What is an additional vaccination of children?

Additional vaccination of children is carried out out of the approved schedule. An indication for additional vaccination may be an outbreak of an infectious disease or the parents' desire to protect their child from diseases not covered by the calendar.

In the first case, vaccinations are mandatory for all children in a disadvantaged area in order to stop the circulation of the virus. Vaccination is carried out at the expense of the state.

In the second case, vaccination is not mandatory. The most popular childhood vaccinations "optional":
   from chickenpox ( Okavaks or Varilriks)
   pneumococcal vaccination ( Pneumo 23 or Prevenar 13) - protects against otitis, pneumonia, bronchitis and sinusitis
   from rotovirus ( Rotarix or rotatec)
   for flu ( Grippol, Influvac, Waxigripp)
   from hepatitis A ( Avaksim 80 and Khavriks 720)
   from tick-borne encephalitis (FSME-IMMUN Junior, Encepur)
  These vaccines are usually purchased by parents on their own, and immunization of the child is carried out in consultation with the district pediatrician.

What is prophylactic vaccination of children?

Prophylactic vaccination  - the introduction into the body of a child of immunobiological agents capable of creating immunity to an infectious disease.

However, vaccinations do not protect the child by 100%. After vaccination, the child may become infected with the disease from which it was previously vaccinated. But the disease will flow much easier, and unwanted complications can be avoided.

IMPORTANT: Subject to the vaccination of 90% of children, the occurrence of epidemics of infectious diseases is unlikely.

Preparing a child for vaccinations and vaccinations

In order for a child to be vaccinated normally and not cause unwanted reactions, several simple rules  preparation for vaccination:

Pass urine and blood tests, wait for their results
   a few days before vaccination, it is desirable to refuse to visit crowded places
   Do not give your child a new meal that may cause allergies.
   measure the child's body temperature
   report the signs of a child’s ill health if they manifest themselves in the last 5-7 days
if a child takes medicine, be sure to tell the doctor what and how much
   note when and how the child was allergic
   report on the features of the child's body, how he endured previous vaccinations
  If the doctor concludes that the child is healthy - you can vaccinate.

What tests need to pass a child before vaccination?

Before vaccination, two tests are taken from a child:
   clinical blood test
   general urine analysis
  To obtain reliable test results, the child should not eat or drink anything before donating blood. Even breastfeeding and drinking juices is unacceptable. The minimum time from the last feeding to the trip to the laboratory is 4 hours.

A urine test is taken in a clean and preferably in a sterile container. The day before the collection of tests can not feed the child beets and carrots, as they can stain the urine. The analysis is collected in the morning, from the first urination. The child is pre-washed, paying particular attention to the hygiene of the urinary organs.

IMPORTANT: For infants use a special cellophane urinal, which can be bought at any pharmacy.

Vaccinations and vaccination of newborns

During the neonatal period, the child is given two vaccinations: from hepatitis B and from tuberculosis.

Hepatitis B vaccine (the first of three) is given after 12 hours of life. For this, a vaccine of both domestic and foreign production can be used. These are inactivated vaccines containing a small portion of the dead virus — the hepatitis B protein — which are not capable of causing the development of the disease.

IMPORTANT: Contraindications to vaccination of a newborn for hepatitis B in the first days of life may be a small child's weight (less than 1500g), asphyxia, and revealed violations of organs and systems. Vaccination is carried out after stabilization of the child.

On the 3rd - 7th day of the child's life, they are vaccinated against tuberculosis BCG. Vaccine is used for vaccination. BCG  or BCG-M.  BCG  allowed to use for healthy babies weighing 2500g. BCG-M  is a lightweight version BCG  and is used for infants and infants with CNS damage.

IMPORTANT: Contraindications to vaccination of BCG and BCG-M are the presence of HIV infection in the infant, complications after vaccination of the child’s close relatives, infection with tuberculosis and a doubtful Mantoux test.

Vaccinations and vaccination of the child in 3 months

• According to the vaccination schedule, children who have reached the age of three months are given the first vaccination against diphtheria, whooping cough, tetanus, polio, and the second against hepatitis B
• The vaccine for diphtheria, tetanus and whooping cough complex, known as DTP. Conducted in three steps. Its components form a child's resistant immunity to these diseases for a period of up to 10 years. Then revaccination is necessary.

IMPORTANT: Most children have a reddening and slight swelling at the injection site after DTP vaccination, which is a normal variant. It is also possible to increase body temperature to 38.3 - 38.5 ° C.

• For vaccination against poliomyelitis for the first time use a vaccine containing a dead virus of the disease ( IPV). Injected, unlike OPV  - oral vaccine containing a live virus. Quickly forms a strong immunity. IPV  is part of such complex vaccinations as Infanrix  and Pentax

IMPORTANT: When OPV is vaccinated, severe complications may develop with a probability of 1: 2500000. There are no complications with the use of IPV.

• Also at 3 months, the child is given a second hepatitis B vaccine.

Vaccinations and vaccination of the child after the year

• In the year the child is given a comprehensive vaccination against measles, rubella and parotitis. Recently used complex vaccines ( Priorix, MMR II)but it is possible to use monovaccines containing live viruses
• You can apply a comprehensive vaccine for the purpose of emergency prevention of measles no later than 72 hours after contact with a sick child.

IMPORTANT: Vaccination is contraindicated in children with allergies to chicken and quail eggs, immunodeficiency, during exacerbations. chronic diseases.

• Reactions after vaccination may appear on the 5th - 15th day in the form of fever and rash, which is normal.
• AT 1.6 years  revaccination against pertussis, diphtheria, tetanus and polio vaccination
• AT 20 months  conduct revaccination against poliomyelitis

Vaccinations and vaccination of children 6 years

When a child reaches six years of age, they will be vaccinated against measles, rubella, mumps and polio.

Vaccinations and vaccination of children in kindergarten

When a child visits a preschool institution, the responsibility for conducting preventive vaccinations rests with its medical staff.

If the time has come for regular preventive vaccination or additional vaccination is carried out according to epidemiological indications, the parents of the child confirm in writing that they accept it and send it to kindergarten. The doctor examines the child and only after that the child is given a vaccine.

IMPORTANT: Without parental consent, the child will not be vaccinated in kindergarten.

Vaccinations and vaccination of children in schools

Schoolchildren are vaccinated in accordance with the vaccination schedule and only in consultation with the parents or guardians of the child. The school nurse warns about the upcoming vaccination of the class teacher.

The class teacher makes the corresponding records in the children's diaries, asking the parents to confirm in writing the consent or refusal of vaccination. Admission to vaccination is given by a doctor who examines each child immediately before the vaccine is given.

Vaccinations and vaccination of adolescents

Vaccine prophylaxis is necessary not only in childhood. Adolescents to the age of 16 are immunized against diphtheria, tetanus and polio.

All teenage girls are given a rubella vaccine. This helps to avoid the occurrence of fetal abnormalities during pregnancy. Recommended additional vaccination for girls is vaccination against papillomavirus, which will significantly lower the future risk of developing cervical cancer.

Vaccinations and vaccination of premature babies

Vaccination of premature babies, especially lightweight ones, has a number of features:
   permission for vaccination is given by a neonatologist, pediatrician, neuropathologist and immunologist
   vaccination is prohibited for children weighing less than 2000 BCG  in the first days of life
   for children weighing less than 1500g, they cancel vaccination against hepatitis B
   before routine vaccination DTP  need to consult an immunologist
   Flu vaccination recommended in the first year of life

IMPORTANT: If the premature baby has honey. rejection from all vaccinations should be addressed to the immunologist, so that he compiled a personal vaccination calendar for the baby.

Premature babies rarely have negative post-vaccine reactions, so parents should not avoid vaccinations, but rather, try to protect their child as much as possible.

Vaccination and Hepatitis Vaccination

Hepatitis B  - A dangerous disease that provokes severe damage to the liver. The disease develops slowly and asymptomatically, sometimes takes chronic forms.

Every year more than a million people in the world die from the complications of hepatitis B. The disease is transmitted during childbirth from an infected mother to a child, through injections, sexually, through blood transfusion, and through wounds and cuts.

IMPORTANT: Hepatitis B vaccination is mandatory and is carried out in 3 stages: in the first days of life, at 3 months. and at 6 months.

Hepatitis B vaccines can be of both domestic and foreign production. The vaccine is easily tolerated by the child and does not cause negative reactions.

Vaccination against hepatitis A can be carried out additionally, in the event of an epidemic or before the upcoming journey.

Vaccinations and diphtheria vaccination

Diphtheria  - A disease in which severe tonsillitis occurs, the heart, kidneys and nervous system are impaired. The general condition is worsened by intoxication of the body.

In the absence of urgent medical care, suffocation and death of the patient occurs. Infection occurs through airborne droplets. Vaccination against diphtheria complex ( DTP) is done three times, the first time at the age of 3 months.

Vaccinations and tetanus vaccinations

Tetanus  - a disease caused by the stick Clostridium tetam, which enters the body from the ground, dust, water for injuries and traumas. The disease is dangerous damage to the nervous system, the occurrence of severe cramps, strong muscle tension, including respiratory.

This condition in most cases leads to suffocation and cardiac arrest. Vaccination is carried out by a complex vaccine. DTP.

Vaccination and pertussis vaccination

It is dangerous the appearance of intense choking coughing, accompanied by a strong reddening of the skin of the face and the release of large amounts of sputum and saliva.

The attacks are especially intense at night and in the morning. Infection occurs through airborne droplets. The disease is dangerous for unvaccinated children. Vaccination complex - DTP.

Vaccinations and vaccination of children DTP

• DTP  - complex adsorbed pertussis-diphtheria-tetanus preventive vaccine. Used as a domestic drug. DTP, and foreign   Infanrix
• To form a stable immunity in a child, 4 doses of vaccine are administered. The first - in 3 months, the second - in 30 - 45 days after the first, the third - in 6 months
• Last vaccine DTPfixing the result, put at the age of 1.5 years. Further revaccination is performed, which is necessary to maintain the required amount of antibodies. The vaccine is administered intramuscularly in the thigh of a child.

IMPORTANT: To the "cons" of domestic dPT vaccines the occurrence of post-vaccination reactions in the form of fever, weakness, swelling, hardening and redness in the injection area in half of the vaccinated children. Infanrix vaccine is tolerated by children much easier. The reaction to the second vaccination is always somewhat stronger than the first.

• "Lightweight" vaccines ADSthat do not contain the pertussis component, vaccinate children older than 4 years who have not been vaccinated earlier and children who have had a strong reaction to the first injection DTP
• If the second vaccination cannot be performed for any reason, you can postpone the vaccine for a while, but you will need to do it as soon as possible.

General contraindications for vaccination DTP:

• The acute period of any disease
• Allergy to vaccine components
• Immunodeficiency of the body
• After vaccination DTP  the child should be given a dose of any antipyretic and antihistamine if the child is prone to allergies

IMPORTANT: After vaccination, a child may become moody and restless, sleep disturbances, loss of appetite may occur.

The side effects of DPT vaccination include:
   fever
   soreness, swelling, induration, or redness at the injection site
   upset stool

IMPORTANT: Occasionally, children have severe reactions that are manifested by an increase in body temperature above 39 ° C, prolonged crying and reddening of the injection site more than 10 mm.

Vaccine complications DTP can be:
   convulsions without fever
   Quincke swelling, anaphylactic shock
   encephalopathy
  The frequency of such cases 1: 100000

Vaccinations and varicella vaccination for children. Are children vaccinated and vaccinated for chickenpox?

• A common opinion that a child should have been ill chicken pox, erroneously. Transferred chickenpox can greatly and permanently weaken the immune system and cause complications
• You can always protect a child from this disease with the help of a Japanese vaccine. Okavaks  or Belgian - Varilrix. Okavaks  is entered once, Varilrix  twice, protection from the second more. You can vaccinate children older than 12 months

IMPORTANT: Drowsiness, irritability, weakness, malaise, fever, redness at the injection site, rash, headache, nausea, indigestion, can be a reaction to the varicella vaccination.

• Preventive varicella vaccination is not mandatory and is not included in the vaccination schedule. The vaccine is purchased by parents themselves

Vaccinations and vaccination of children measles mumps measles

• Measles - severe infectious disease. It starts with fever, conjunctivitis, cough and rash. Often complicated by pneumonia, sometimes - encephalitis, which can lead to disability. The measles virus is very contagious and volatile. About 97% of children contacting the patient are affected. Vaccination complex or single
• Rubella  - an infection characterized by the appearance of a small rash, a strong increase in lymph nodes and a slight increase in temperature. Children are easily tolerated, but extremely dangerous for pregnant women, as it causes severe pathology of the fetus
• Mumps (mumps)  affects salivary glands, pancreas and testicles in men. For men, mumps transferred in childhood can cause infertility
• To protect against these diseases, a complex live vaccine is used. Priorix  Belgian production, which is easily tolerated by children. Severe post-vaccination reactions are usually not observed. Vaccinations and revaccinations are conducted for children aged 1 year and 6 years, respectively. Additionally, adolescent girls are immunized with this vaccine.

Vaccinations and vaccination of children against tuberculosis

Tuberculosis  - A bacterial disease, which children can become infected by airborne droplets. The children's body is very sensitive to this disease, so tuberculosis easily affects not only the lungs, but also other internal organs and systems.

IMPORTANT: Tuberculosis is the cause of death of every tenth person in the world.

• The first vaccine against tuberculosis is given to a newborn on the 3rd-5th day of life with a vaccine. BCG  or BCG-M. The vaccine is injected subcutaneously, in the shoulder of the left hand. There are no reactions to the vaccine. After some time, a so-called purulent globule is formed at the injection site of the vaccine, which in no case can be removed or processed.
• Revaccination BCG  spend in 7 years, after evaluating the results of the Mantoux test. If revaccination is not performed at the age of 7, then it should be done at 14. If the child has not been vaccinated against tuberculosis for longer than 2 months from birth, the vaccination is done after evaluating the results of the Mantoux test

IMPORTANT: Vaccination helps to prevent the development of severe forms of tuberculosis, such as tuberculous meningitis.

Vaccinations and vaccination against pneumonia and pneumococcal infections in children

Additional vaccination of the child against bronchitis, otitis, pneumonia and other bacterial complications of ARVI is possible with the help of vaccination Prevenar 7,  Prevenar 13, Synlorix  or Pneumatic 23.

This is a very important vaccination, especially for babies up to 4 years old, as they are most seriously at risk of developing a bacterial infection.

Vaccines Prevenar 7  and Prevenar 13  differ in the number of contained pneumococci. The vaccine manufacturer is the UK. It is noteworthy that the vaccination of children Prevenar  included in the vaccination calendars of all developed countries.

Vaccination Scheme Prevenarone of the following:
   if the first injection is given before 6 months, it will take 3 doses, one every month and revaccination at the age of 1-1.5 years
   if the first vaccine is administered from 7 to 11 months, the next one should be done in a month and revaccination in a year.
   from year to year two vaccines are administered in 2 months
   one to five vaccines are sufficient from two to five

Synlorix  - Belgian equivalent Prevenara. Vaccination schedules are completely identical.

Pneumatic 23  - The oldest of these vaccines. In Russia, used since the late 90s. Unlike Prevenara  and Sinflorix  affects only children older than 2 years old, is administered once, acts 3 - 5 years.

Reactions to vaccination against pneumococcal infection are extremely rare, it is easily tolerated and combined with any other vaccine except BCG. The only obvious disadvantage of a vaccine is its high cost.

Vaccination and vaccination of children against influenza

Flu  - one of the most serious infectious diseases due to the high probability of developing complications such as bronchitis and pneumonia. The source of infection is a sick person, the transmission path is airborne.

The disease is acute, with fever up to 40 ° C, pain in the bones and joints, chills, eye soreness, sweating, weakness, headache, a feeling of severe discomfort in the eyebrows and temples, nasal congestion, edema of the throat, cough.

Infants and the elderly are hardest hit by the disease. In winter, the disease often develops into an epidemic.

Vaccination of children against the flu is not mandatory. To protect your child from the flu, one of the following inactivated vaccines is used:
  Influvac  (Netherlands)
Grippol  (Russia)
Grippol plus  (Russia)
Waxigripp  (Russia)
Fluarix  (Belgium)
Agrippal  (Italy)
Begrivak  (Germany)

Children who have not previously been vaccinated against the flu and have not had this disease are given 2 injections with a difference of 1 month.

Flu vaccination is contraindicated in:
   babies up to 6 months
   children with chicken protein intolerance
   children during the acute course of any disease

IMPORTANT: The reaction to the introduction of influenza vaccine can be soreness, swelling, redness at the puncture site, as well as fever, chills. Vaccination can be complicated by otitis media, meningitis and myositis.

Vaccination and vaccination of children against tick-borne encephalitis

Tick-borne encephalitis  - A viral seasonal disease that is transmitted with the bite of an infected tick. Infection is also possible when eating raw cow and goat milk and crushing the tick.

The disease is primarily characterized by severe damage to the central nervous system with pronounced signs of general infectious intoxication of the body - body aches, chills, fever and severe pain in the lumbar region.

Prevention of tick-borne encephalitis in children is possible by vaccination. These vaccinations may be recommended for children older than 1 year old who live or depart in tricky encephalitis areas, but are not required.

IMPORTANT: The effect of vaccination occurs no earlier than two weeks after the introduction of the vaccine. It takes 28 - 45 days from the day of vaccination to form a strong immunity.

For immunization, it is possible to use any domestic or foreign vaccine:
  Encepur Children  (Germany)
FSME - Immun Inzhekt / Junior  (Austria)
Encever  (Russia)
  Their composition coincides with 85%, but foreign vaccines have fewer contraindications. They all form a strong immunity against tick-borne encephalitis virus.

IMPORTANT: The vaccination scheme consists of 3 doses, but every three years it is necessary to carry out a revaccination.

Adverse reactions after vaccination occur in 5% of cases, occurring as a small rash, fever, sleep disturbance, loss of appetite, anxiety, dizziness, and sometimes loss of consciousness.

Vaccination and vaccination of children against poliomyelitis

Polio  - viral infection, affecting in most cases children under 5 years old, causing disruption in the work of the central nervous system. Disease is manifested by the onset of paralysis of the entire musculature of the body, including respiratory, which can lead to disability and even death of the child.

Vaccination against polio is compulsory, is carried out three times during the first year of a child's life, followed by revaccination. May be performed by one of the vaccines:
   inactivated ( IPV) - is administered by injection
   oral live attenuated ( OPV) - is administered in the form of drops, oral

IMPORTANT: When using a live OPV vaccine, there is an insignificant risk of developing a serious disease — the vaccine-associated polio.

Contraindications to vaccination:
allergic reaction to a previous polio vaccine
   allergic reactions to certain antibiotics

In rare cases, a general weakness, loss of appetite, and a slight increase in body temperature are observed in children as a reaction to the vaccine.

Preparations for vaccinations and vaccination of children

• AT article 12 of the Federal Law "On Immunization of Infectious Diseases"  reports on requirements for vaccines and vaccinations
• In accordance with the law, immunobiological preparations can be used domestic or foreign, registered in a specific order for immunoprophylaxis.
• The vaccine can be purchased at a pharmacy by prescription. Conditions for storage and transportation of vaccines must comply with the requirements of sanitary standards. Control of the state of immunoprophylactic drugs is assigned to workers of the sanitary-epidemiological service

Does the child have immunity after vaccination and immunization?

Despite the fact that vaccination does not protect a child 100% of the risk of contracting infectious diseases, in most cases it can form a child’s strong immunity to them.

The meaning of vaccination is that the body of the child in response to the introduction of dead or weakened pathogens produces antibodies.

If the vaccination was successful, then after meeting with the infection from which the prophylactic vaccination was given, the child either will not get sick at all, or will suffer the disease in a very mild form.

Contraindications for vaccination and vaccination in children

For each individual vaccine contraindications are individual and are listed in the instructions for use of the drug.

General contraindications for the introduction of any vaccines to children are:
   pronounced immunodeficiency
   severe diseases of the central nervous system
   cardiovascular pathologies
   presence of malignant neoplasms
   presence of acute infectious or bacterial diseases
   period of exacerbation of chronic diseases
   allergic manifestations

IMPORTANT: Before refusing vaccinations due to the presence of contraindications to the child, parents need to consult a pediatrician.

Are children with allergic diseases vaccinated?

• Children with allergies, due to the frequent occurrence of severe complications after infectious diseases have suffered, need to be vaccinated even more than toddlers who are not familiar with allergies. There are very few vaccines that are contraindicated for use in children with allergic manifestations.
• If the child is prone to allergic reactions, it is likely to manifest on one or more components of the vaccine. However, worry about it is not worth it. It is enough to warn the doctor that the child is allergic to food or drugs.
• A pediatrician will determine the appropriateness of vaccination for such a child. Perhaps to prevent the onset of allergies, he will recommend taking antihistamines for some time after vaccine administration.

Harm vaccinations and vaccinations for the child

Just as for most parents, the benefits of prophylactic vaccination of a child are obvious, for parents of “anti-vaccinations” there is harm from vaccinations. According to their beliefs:
   neonatal vaccination is the leading cause of Sudden Infant Death Syndrome (SIDS)
   most infectious diseases are easily tolerated by children, life-long immunity forms on their own after an illness
   vaccination immunity cannot be transmitted from mother to child, while acquired after illness is transmitted through the placenta
   vaccinated children suffer from acute respiratory diseases much more often than unvaccinated
   vaccination - no more than a business of pharmacists and doctors, which is detrimental to the health of children
   vaccines contain pesticides, mercury, parts of genetically modified viruses, untested antibiotics
   diseases are necessary for the child to train the immune system
   vaccination in infancy can lead to dementia and impaired speech development

IMPORTANT: Taking similar "anti-vaccination" conclusions to heart, parents can refuse to carry out preventive vaccinations to their child, thereby they voluntarily deprive the kid of reliable protection against dangerous diseases.

What complications can be after vaccination in children? Consequences of vaccinations and vaccinations in children

In addition to the appearance of post-vaccination reactions, which are specified in the descriptions of drugs and are a variant of the norm, in rare cases serious post-vaccination complications may occur in children.

Causes of complications after vaccination can be:
   violation of vaccination techniques - the administered dose of the drug is more or less than the recommended dose, the vaccine is administered in the wrong way. It is dangerous to cause allergies, suppuration at the injection site, inflammation of the lymph nodes.
   failure to comply with contraindications - a violation dangerous to the life of the child
the unsatisfactory quality of the vaccine - leads to massive complications of the same type in children vaccinated with the same series of vaccines
   individual sensitivity to vaccine components - manifested by strong allergic and neurological reactions, the outcome of which is very difficult to predict. In rare cases, anaphylactic shock occurs.

IMPORTANT: In case of post-vaccination complications, you should consult a doctor who will conduct an examination and prescribe treatment.

The most severe post-vaccination complications noted earlier include:
   anaphylactic shock (any vaccine except BCG  and OPV)
   Quincke's edema (any, except BCG  and OPV)
   serum sickness (any, except BCG  and OPV)
   encephalitis ( DTP, DTP)
   meningitis ( DTP, DTP, measles and mumps vaccine)
   convulsive states ( DTP, ADS, measles and mumps vaccine)
   poliomyelitis ( OPV)
   arthritis ( rubella vaccine)
   lymphadenitis ( BCG)

IMPORTANT: Complications of vaccinations with otitis media, tonsillitis, sinusitis, bronchitis and pneumonia are observed during vaccination during the incubation period of SARS or influenza.

Can a child's temperature rise after vaccination?

Often in children there is a slight increase in body temperature after administration of the vaccine. This condition is considered normal and usually does not require parental intervention.

But if the values ​​on the thermometer reached high levels, you should give the child an antipyretic agent and notify the district pediatrician of the problems that have arisen.

IMPORTANT: In order to bring down the temperature that a child has as a result of vaccination, it is better to use children's antipyretic suppositories. Dyes and flavoring antipyretic syrups can cause allergic reactions in the body weakened by vaccination.

  Vaccinations and vaccination of children: tips and reviews

For those who doubt the correctness of the decision to make (or not to) vaccinate a child, it is interesting to know the opinions of moms and dads who are experienced in child vaccination.

Below are different parent reviews. Children of some of them preventive vaccination protected from serious diseases, while others convinced the inappropriateness of this event.

Anna:

Hello, I want to tell my story. I was against childhood preventive vaccinations and did not make them to my son until he developed whooping cough at 1.1 years old. The hell we experienced is scary for me to remember. The disease was terrible. My son could not cough, he was choking, attacks did not allow him to breathe. The child, feeling the approach of attack, began to hysteria, panic, tear. Several times he lost consciousness and stopped breathing. It's so scary to watch how your child is on the verge of life and death and understand that this is happening to him because of the short-sightedness and naivety of the parents.

Svetlana:

Vaccination with Priorix vaccine was difficult. Against the background of reduced immunity in a child rose heatwhich is very difficult to shoot down. I worry before each vaccination of my son, but I cannot refuse vaccinations at all - I understand that they need to be given, because they protect against terrible childhood diseases.

Alyona:

I sit and cry. After inoculation of DTP, my daughter had a fever of 39. She is going down hard. In my head all sorts of terrible things are climbing. I am afraid to go to the hospital, antibiotics are prescribed to everyone there indiscriminately.

Natalia:

I am now very afraid of vaccinations. On the eighth day after Priorix vaccination, the baby coughed, the temperature rose to 38.5. The pediatrician said it was a post-vaccination reaction. A few days later, the child's ear ached. All ended with bronchitis, which we treated in the infectious disease ward. Only discharged from the "infectious diseases" and the same caught angina. All our diseases were accompanied by very high fever.

Svetlana:

Daughter 3.7. We do all the necessary vaccinations. Reactions in the form of fever were, but I consider them normal. My husband and I chose to vaccinate a child. Although I worry every time, but I am sure that my daughter is under reliable protection.

• tell the pediatrician in detail about the child’s health in the last week, warn about serious medical interventions, if any
• if the temperature after vaccination has increased more than 39.5 ° C or there are strong seals, redness and swelling at the injection site, consult a doctor
• buy an antipyretic drug before vaccination
• measure baby’s body temperature during the first three days after vaccination

And also the most important advice to all parents: do not trust dubious stories and rumors, but listen to the voice of reason and go towards modern medicine.

Remember that preventive vaccination is mandatory, and the health and life of your child may depend on your decision.

The importance of having a complete and reliable record of all children residing in a given territory, and the availability of documentation for each child, strict records of those who have received the vaccine and who have not been vaccinated in a calendar timeframe. In LPU d. high-quality vaccine products in compliance with the rules of transportation and storage of vaccines, as well as the requirements of the “Cold Chain”. Required and reporting. Accounting for the child population is carried out by the precinct pediatric service 2 times a year (spring-autumn), plus they are added to the lists of arrivals and newborns. Then make reconciliation with existing forms, and if they are lacking, then make out. Vaccination planning impl - cab city child clinic or CRH. The doctor and the nurse at the obstetrician center, the paramedic, are responsible for planning, recording and reporting and conducting vaccinations. Vaccination planning for the next year is carried out by the vaccination staff of the vaccination room (sister-registrars). Take into account all children vaccinated with professional vaccinations and not vaccinated in time for various reasons. Cards prof. Vaccinations f.063u laid out by months of the year in accordance with the timing of the next vaccination, these same forms for children not subject to vaccination stored in a separate cell. Make a free plan for children to be vaccinated next year and send CGSEN (RPN).

Immunization of the population  - the main effective means of preventing infectious diseases, preventing the development of epidemics. This is the most affordable and economical way to reduce morbidity and mortality from infections. Vaccinal prevention is considered an integral part of medical care, the provision of which to the population, as well as the quality of its implementation, are guaranteed by the state.

The Russian Federation has created and is constantly improving the regulatory framework that regulates all components of the vaccination process: production, testing, registration of domestic and foreign immunobiological preparations, the process of storage, transportation and destruction of vaccines, the procedure for their use in various conditions, and also defines the rights of citizens when conducting this type of medical intervention.

The availability of vaccine prevention is based primarily on the provisions of the Constitution of the Russian Federation. In Art. 41 states that everyone has the right to health care and medical care.

Article 4 of Federal Law No. 157 of 1998 “On Immunoprophylaxis of Infectious Diseases” defines state guarantees of the availability of immunoprophylaxis.

National immunization schedule  - a document approved by the Order of the Ministry of Health of the Russian Federation and defining the terms and types of vaccinations carried out free of charge and on a mass basis in accordance with the compulsory health insurance program.

37. Vaccines from living microbial bodies. Definition Characteristics (vaccines against tuberculosis, poliomyelitis, measles, mumps, tularemia, brucellosis). Indications, contraindications, effectiveness.

Immunization against tuberculosis ( BCG).

For the prevention of tuberculosis used BCG vaccine. It is a live, weakened mycobacterium tuberculosis (type bovis). Vaccination is usually carried out in the maternity hospital.

Introduced intradermally in the upper part of the left shoulder. After the introduction of the vaccine, a small compaction is formed, which can suppurate and gradually, after healing, a scar is formed (as a rule, the whole process lasts from 2-3 months and longer). To assess the acquired immunity, in the future, the child is annually held tuberculin test (Mantoux test).

The results of Russian studies have shown that unvaccinated children develop tuberculosis 15 times more often than those vaccinated in due time and according to all the rules.

Contraindications:

1. primary immunodeficiency

2. new formation

3. intrauterine infections

4. hemolytic disease

Immunization against hepatitis b (Evuks b; Engerix B; Combiotech ).

Hepatitis B vaccine is a recombinant vaccine containing a surface antigen (HBsAg, or Australian antigen) of the hepatitis B virus, produced by yeast cells.

For optimal protection against infection with the hepatitis B virus, it is recommended to prescribe at least 3 injections of the vaccine. The first two injections can be considered as initial doses, while the third or additional injections serve to enhance antibody production in pre-vaccinated patients or seroconversion in a small number of patients who have lowered immune response to the vaccine antigen.

Within certain limits, the time of the appointment of subsequent injections can be selected in accordance with the objectives:

1st injection: selected date 2nd injection: 1 month after 1st injection 3rd injection: 1 month after 2nd injection

Vaccine efficacy: Depends on age, gender and state of health. Up to 19 years old - 100%, 20-39 - 99%, over 40 - 91%. May be lower in men. A small proportion of healthy people do not respond to vaccine administration. For refractory individuals who receive the first injections into the deltoid muscle, a single revaccination is 15–25% effective. After 3 additional doses, the efficiency increases to 30-50%. For refractory individuals who received the first injections into the gluteus muscle, revaccination is 75% effective.

Contraindications:

1. Strong unusual reaction to the introduction of the first dose of the drug.

2. Vaccine should be prescribed with caution if you have an allergy to the yeast.

3. In the case of a severe infectious disease, vaccination is postponed until the condition improves.

Immunization against measles (The vaccine measles cultural live dry; Ruvax; Priorikc).

Vaccination against measles is carried out by measles-free children aged 12-15 months. The second vaccine is administered at the age of 6 years. Using a second dose of vaccine protects children who have not been vaccinated (collective immunity), as well as those who have not developed immunity after the first dose.

The vaccine is injected subcutaneously or intramuscularly under the scapula or in the shoulder area. Due to the fact that vaccine viruses are easily inactivated by ether, alcohol and detergent, it is necessary to prevent the drug from contact with these substances.

Vaccination efficacy:With proper vaccination, immunity is produced in 95% of those vaccinated at the age of 12 months and in 98% of those vaccinated at the age of 15 months on days 21-28 after vaccination. Immunity lasts more than 25 years.

Contraindications:

1. Anaphylactic or anaphylactoid reactions to aminoglycosides.

2. The presence of anaphylactic or anaphylactoid reactions to eggs in history. Protein reaction chicken eggs  is a contraindication for the use of imported vaccines (as they are prepared using chicken embryo), but in this case, you can get a Russian vaccine.

3. Any acute illness or exacerbation of a chronic illness.

Immunization against rubella (Ervevaks; Rudivakc).

Efficiency:95-99%

Duration of action:Lifetime (according to some sources, immunity falls after 3-5 years).

Contraindications:

3. allergy to aminoglycosides and egg white.

Immunization against mumps (Parotitic culture vaccine live dry; MMD 2).

Efficiency:96%

Duration of action: more than 12 years

Contraindications:

1. immunodeficiency states;

2. oncological diseases;

3. allergy to aminoglycosides, eggs.

38. Vaccines from killed microbial bodies and toxoids. Definition Characteristics (DTP vaccine, ADS-M, ADS, AD-M toxoids, vaccines against typhoid fever, cholera, tick-borne encephalitis, influenza, rabies). Indications, contraindications.

Immunization against whooping cough (DTP; Infanrix; Tritanriks).

Vaccine efficacy: According to various sources, the effectiveness of the anti-pertussis vaccine is 70-90%. The vaccination especially well protects against severe forms of whooping cough.

Contraindications:

1. Local reactions over 8 cm to the previous vaccine administration

2.Entsephalopathy within 7 days after the previous dose

3. Temperatures above 40.5 degrees within 48 hours after previous vaccination.

4. Collapse within 48 hours after previous vaccination.

Immunization against diphtheria (DTP; ADS toxoid; ADS-M Anatoxin).

Anatoxins are administered in a single dose of 0.5 ml intramuscularly (upper outer quadrant of the buttocks or anterior-outer thigh area) to children of early and preschool age, older children and adults, they can be administered deeply subcutaneously.

Vaccination efficacy: Vaccination against diphtheria leads to the formation of antitoxic antibodies that prevent the development of clinical manifestations of diphtheria in 95-100% of those vaccinated. In the case of a disease, vaccinated diphtheria proceeds easily - the mortality from diphtheria vaccinated is 10 times less.

The duration of the vaccine:About 10 years

Contraindications:

1. acute infectious diseases (vaccination is done 2-4 weeks after recovery);

2. chronic diseases in the acute phase;

3. Severe reactions to previous vaccine administration.

Immunization against tetanus (Vaccine pertussis-diphtheria-tetanus adsorbed liquid; ADS toxoid; ADS-M Anatoxin).

Vaccine efficacy:Almost 100%

Duration of action:10 years

Contraindications:A history of a neurological or severe allergic reaction (acute respiratory distress or collapse) after a previous dose of tetanus toxoid is contraindicated for repeated administration.

Immunization against poliomyelitis (Polio oral vaccine; Polio Sabin Vero).

Sabin's live attenuated vaccine - oral live vaccine provides the best immunity, this form is usually recommended. However, it carries the risk of paralysis.

Salk inactivated polyvalent vaccine. Individuals vaccinated with this vaccine are less immune against the wild poliovirus strain.

Vaccine efficacy: A single oral polio vaccine gives an effect of 50%. Three-time vaccination causes immunity in 95% of those vaccinated. Reduced efficacy is usually observed in third world countries, especially where it is hot (the vaccine is sensitive to heat).

Duration: Lifetime Immunity

Contraindications:

1. immunodeficiency state (congenital or acquired);

2. oncological diseases;

3. neurological complications of the previous administration of the vaccine.

Emergency prevention tetanus.

Tetanus emergency prophylaxis provides primary surgical treatment of the wound with removal foreign bodies  and necrotic tissue and the creation (if necessary) of specific immunity against tetanus.

In case of emergency prophylaxis, you can use ADS-M (diphtheria-tetanus toxoid) instead of tetanus toxoid.

39. Immune sera and immunoglobulins. Classification. Indications for use (tetanus, anti-diphtheria serum; immunoglobulins: measles, anti-influenza, anti-rabies, etc.), effectiveness.

Immune sera and immunoglobulins obtained from them are biological preparations containing antibodies. They designed to create passive anti-toxic, antibacterial or antiviral immunity  in a person who needs protection against infection or other potentially dangerous substances with antigenic properties.

Immune sera and immunoglobulins are used as a means of seroprophylaxis and serotherapy. In the first case, serum preparations are injected before a possible infection or immediately after it, until there are signs of the disease, and the patient does not have his own antibodies capable of protecting him from infection. In the second case, drugs are introduced for treatment - neutralizing toxins or viruses, enhancing antimicrobial protection. Medicinal preparations are used in cases where there is reason to believe that the body is not able to provide its own protection.

All serum preparations are divided into two groups:

1. heterologous   (derived from animal blood) -heterologous drugs have a number of disadvantages, they quickly disappear from circulation, the immunity created by them lasts no more than 2 weeks. Drugs have strong allergenic properties, before the introduction of drugs it is necessary to put skin tests to identify hypersensitivity to a heterologous protein.

2. homologous   (getting from human blood) -deprived of many side effects  heterologous sera. Homologous sera are used for the prevention and treatment of viral hepatitis, measles, tetanus, botulism, etc.

Anti-tetanus serum   (horse tetanus purified concentrated liquid).

  Indications:Emergency specific prevention of tetanus: injuries with violation of the integrity of the skin and mucous membranes, frostbite and burns II-IV century, community-acquired abortions, childbirth outside of medical institutions, gangrene or necrosis of any type of tissue, abscess, animal bites, penetrating injuries of the digestive tract. Tetanus treatment.

Anti-diphtheria serum   (anti-diphtheria horse purified purified liquid).

Indications:Diphtheria.

Human immunoglobulins are prepared from donor or placental blood., pre-mix the serum obtained from the blood of different individuals, and therefore the concentration of antibodies in them is small. In addition to antibodies, for which preparations of immunoglobulins are prepared, they contain other antibodies that are in human blood. Therefore, measles immunoglobulin is also used to prevent hepatitis, whooping cough, meningitis, and other infectious diseases.

Anti-influenza immunoglobulin

It is a means of passive immunotherapy. It is used in severe toxic forms of influenza, including those with lesions of the respiratory organs. Introduced in the first 1-2 days of the disease for 1-3 doses.

Anti-rabies immunoglobulin

Assign as soon as possible after contact with a rabid, suspicious of rabies or unknown animals.

Tick ​​immunoglobulin

Data on the effectiveness of tick immunoglobulin contradictory. The introduction of immunoglbulin can prevent no more than 60% of cases of tick-borne encephalitis.

Anti-tetanus   andmmunoglobulin

Indications:Emergency prevention of tetanus in adults and children who have not received a full course of immunization with tetanus toxoid or with an unknown vaccination history.

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

What are prophylactic vaccinations

Prophylactic vaccinations are a method of immunizing a person against certain infectious diseases, during which various particles are introduced into the body that can lead to the development of a stable immunity to pathology. All prophylactic vaccinations involve the introduction of a vaccine - an immunobiological preparation. A vaccine is a weakened whole microbial pathogen, parts of the membranes or genetic material of pathogenic microorganisms or their toxins. These components of the vaccine cause a specific immune response, during which antibodies are produced that are directed against the infectious agent. Subsequently, it is these antibodies that provide protection against infection.

To date, all preventive vaccinations are divided into:
   - planned;
   - conducted according to epidemiological indications.

Planned vaccinations are given to children and adults at a certain time and at a specific age, regardless of whether an epidemic center of infection is detected in a given region or not. And vaccination according to epidemiological indications is done to people in the region where there is a danger of an outbreak of an infectious disease (for example, anthrax, plague, cholera, etc.). Among the planned vaccinations are mandatory for all, they are included in the national calendar (BCG, PDA, DTP, against polio). And there is a category of vaccines that are administered only to people at risk of infection due to the specifics of their work (for example, against typhoid, tularemia, brucellosis, rabies, plague, etc.).

All planned vaccinations are carefully worked out, their time limits, age and time are established. There are schemes for the introduction of vaccines, the possibility of a combination and sequence of immunization, which is reflected in the provisions and guidelines, as well as in the vaccination calendars.

Preventive vaccination of children

For children, vaccinations are necessary to protect them from infectious diseases that can be fatal, even when treated with modern high-quality drugs. The list of preventive vaccinations for children is developed and approved by the Ministry of Health of Russia, and then for ease of use is issued in the form of a national calendar. In addition to those indicated in the national calendar, there are a number of prophylactic vaccines that are recommended for administration to children. The referral to the vaccination is given by the attending physician of the child based on the analysis of the state of health. In some regions, they also apply their own vaccinations, which are necessary, since the epidemiological situation of infections is unfavorable and there is a risk of a pandemic outbreak.

The value of preventive vaccinations

Despite the different structure of the possible components for a particular vaccine, any vaccine is capable of forming immunity to infection, reducing the incidence and prevalence of pathology, which is its main purpose. The active components of drugs in response to the introduction into the body of any person cause a reaction from his immune system. This reaction in all respects is similar to that which develops during infection with an infectious disease, but much weaker. The meaning of such a weak reaction of the immune system to the introduction of the drug lies in the fact that special cells are formed (they are called memory cells), providing further immunity to infection. Memory cells can be stored in the human body for a different period of time - from several months to many years. Memory cells that persist for only a few months are short-lived, but vaccination is necessary for the formation of memory cells of a different type — long-lived. Each such cell is formed only in response to a particular pathogen, that is, a cell formed against rubella will not be able to provide immunity to tetanus.

For the formation of any memory cell, long or short living, it takes a certain period of time - from several hours to a whole week. When the causative agent of the disease enters the human body for the first time, all manifestations of infection are caused by the activity of the microbe. During this period, the cells of the immune system "get acquainted" with the pathogenic microbe, after which B-lymphocytes are activated, which begin to produce antibodies that have the ability to kill the pathogen-causing microorganism. Against each microbe requires their own, special antibodies. Recovery and alleviation of the symptoms of an infection begins only from the moment when antibodies are acquired and the destruction of the pathogenic microorganism begins. After that, some antibodies disappear, and some become short-lived memory cells. B-lymphocytes, which produce antibodies, go into the tissue and become the very memory cells. Subsequently, when ingested by the same pathogenic microbe, memory cells immediately are mobilized, producing antibodies, which quickly and effectively destroy the infectious agent. So, the infectious disease does not develop.

Against infections with which the human body is able to cope, it does not make sense to vaccinate. But if the infection is dangerous, the mortality rate of sick people is very high, then vaccination is necessary.

In the case of a dangerous infection, there are two possible outcomes: recovery with immunity or death. Vaccination, on the other hand, ensures the formation of this immunity without a fatal risk and the need to endure a severe course of infection with extremely unpleasant symptoms. It is quite natural that the process of the formation of memory cells during the activation of the immune system is accompanied by a number of reactions. The most common reactions at the injection site and some common (for example, fever for several days, weakness, malaise, etc.).

Vaccination List

Today, the following vaccines for children and adults are included in the list of prophylactic vaccinations: against hepatitis B, against tuberculosis (only for children), diphtheria, whooping cough, tetanus, hemophilus bacilli, polio, measles, rubella, parotitis (mumps), flu meningococcal infection, tularemia, plague, brucellosis, anthrax, rabies, leptospirosis, tick-borne encephalitis, Q fever, yellow fever, cholera, typhoid, hepatitis A, shigellosis.

This list includes mandatory vaccinations that are given to all people, and performed according to epidemiological indications. Epidemiological indications may be different, for example, residence or temporary stay in the outbreak area of ​​a dangerous infection, departure to regions with a dysfunctional situation, or work with dangerous microbes-pathogens or with livestock that carry a number of pathologies.

A national schedule of vaccinations is compiled and approved based on the significance of the infections being vaccinated, as well as the availability of drugs. The calendar may be revised if any circumstances change, for example, when new vaccines appear that have different rules of application, or if there is a risk of an outbreak of infection, which requires urgent and urgent immunization. In Russia, the vaccination schedule for children and adults has been approved, which is valid throughout the country. This calendar has not changed in recent years, for 2011, 2012 and 2013 it is the same. Vaccinations made to this calendar are done to all people.

Preventive Vaccination Plan

A plan or program of preventive vaccinations for children is drawn up by medical specialists working in a clinic, child care center, school, college, college. Any preventive vaccination program is based on a permanent population count, which is carried out twice a year: in April and October. At the same time, retired and arrived citizens, born children, etc., are recorded. The preventive vaccination program covers all people who have not been vaccinated or whose immunization period has passed. Children who have received a medical withdrawal from vaccinations for health reasons should be examined, the results of which will make it clear whether it is possible to put the child in the vaccination plan.

An individual program of preventive vaccinations of the child is developed and reflected in the following medical records:
  - in the vaccination card (form 063 / y);
  - in the history of the child's development (form 112 / y);
   - in the child’s medical record (Form 026 / у);
  - in the insert for an outpatient medical record (form 025 / u) - for adolescents.

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

Conducting preventive vaccinations

Prophylactic vaccinations can be carried out in a public health care facility (clinic), or in specialized immunization centers of the population, or in private clinics licensed to carry out this type of medical manipulation. Immediately put preventive vaccinations in the vaccination room, which must meet certain requirements and standards.

In institutions where the BCG vaccine is being produced, it is necessary to have two vaccination rooms. One of them is designed exclusively for working with the BCG vaccine, and the other is carried out all the other vaccinations.

In the vaccination room should be sterile tools and materials, disposable syringes and needles for intradermal and intramuscular injections, forceps (forceps), containers, which collect the used tools and debris. Also in the office should be a sufficient number of tables, each of which is intended for the formulation of only one type of vaccine. The table must be marked and syringes, needles and sterile materials prepared on it. All used syringes, needles, ampoules, remnants of drugs, cotton wool or tampons are dumped into a container with a disinfectant solution.

Organization and procedure for vaccination

The organization of preventive vaccinations and the procedure for their implementation have been developed and prescribed in the Methodological Guidelines MU 3.3.1889-04, which were approved by the Chief State Sanitary Doctor of the Russian Federation on March 4, 2004. These rules also apply today. What exactly preventive vaccinations are made is prescribed in the national and regional calendars.

For vaccination, all institutions use only registered products of domestic or imported, approved for use. Preventive vaccines are put only on prescription by a doctor or paramedic.

Immediately prior to the planned vaccination, data on the condition of the child or adult are carefully ascertained, on the basis of which permission for manipulation is given. Before the planned immunization, the child is examined by a doctor, it turns out that there are contraindications, allergies or strong reactions to the previously administered drugs. Before injection, measure the temperature. Before the planned vaccination shall be the necessary tests.

Vaccinations can only be done by a medical specialist who is familiar with the injection technique, as well as the skills to provide emergency care. In the vaccination room there is a mandatory emergency kit. All vaccines should be kept according to the rules and instructions.

Prophylactic vaccinations should be carried out in accordance with certain techniques. General rules and methods for the introduction of preventive vaccines are determined by regulatory documents.

All produced vaccinations, the medical professional is obliged to make in a special register. In case of loss of an individual patient's card or when it is moved, all data can be restored by contacting the medical institution where the vaccination was performed, where an extract from such journals stored in the archives will be made. Also, on the basis of journal entries, preventive immunization plans are made in which the names of the people to be vaccinated are entered. The record of preventive vaccinations is a standard form of medical documentation 064 / y. It is stitched, pages are numbered. The magazine is usually ordered from a printing house that prints them according to a sample approved by the Ministry of Health.

Refusal of vaccination

Today, every adult person or guardian, the representative of a minor has the right to refuse vaccination. The reason for this is provided by the Law of the Ministry of Health of the Russian Federation No. 157-F3 of September 17, 1998, article 5. Concerning vaccinations for children: the parent can refuse them on the basis of article 11 of the same law, which states that the child is vaccinated only with his consent legal representatives, that is, parents, guardians, etc. Refusal of vaccinations must be submitted in writing to the head of the treatment-and-prophylactic, pre-school children's institution or school.

What does the lack of prophylactic vaccination entail?

The absence of preventive vaccinations entails the following consequences, according to Article 5 of the Law of the Ministry of Health of the Russian Federation No. 157-F3 of September 17, 1998:
   1) a ban on citizens from traveling to countries whose stay in which, in accordance with the international health regulations or international treaties of the Russian Federation, requires specific preventive vaccinations;
  2) temporary refusal to admit citizens to educational and health institutions in the event of massive infectious diseases or the threat of epidemics;
3) refusal to hire people or to be removed from work that is associated with a high risk of infectious diseases. The list of work, the performance of which is associated with a high risk of infectious diseases, requires mandatory preventive vaccinations, established by the federal executive body authorized by the Government of the Russian Federation.

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

Preventive vaccination in kindergarten

Children preventive vaccination can be carried out individually or in an organized way. Organized vaccinations are given to children attending kindergartens and schools where immunization specialists come with ready-made preparations. In this case, the health workers of the children's institution draw up vaccination plans, which include those children who need vaccination. All information about the conducted manipulations in kindergarten is recorded in a special vaccination sheet (form 063 / y) or in a medical card (form 026 / y-2000). Vaccinations in kindergarten are carried out only with the consent of the parents or other legal representatives of the child. If you wish to refuse vaccinations to a child, you must register your refusal in writing with the office of the institution and notify the nurse.