home Audience 3 Preventive vaccinations: meaning, vaccination calendar. The importance of vaccination in the prevention of infectious diseases The practical importance of vaccinations

Preventive vaccinations: meaning, vaccination calendar. The importance of vaccination in the prevention of infectious diseases The practical importance of vaccinations

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Today vaccinations have already firmly entered our lives as a highly effective means of preventing dangerous infectious diseases, which have negative consequences in the form of complications, or even death. In modern medical practice, they are done either with the aim of creating immunity to dangerous infections, or to treat an infected person at an early stage. Accordingly, all vaccinations are usually divided into preventive and therapeutic. Basically, a person is faced with preventive vaccinations, which are given in childhood, and then re-immunization is carried out if necessary. An example of a therapeutic vaccinations is the administration of antitetanus serum, etc.

What are preventive vaccinations?

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

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

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

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

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

Preventive vaccination of children

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

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

Preventive vaccinations for children - video

The importance of preventive vaccinations

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

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

The formation of any memory cell, whether long-lived or short-lived, requires a certain period of time - from several hours to a whole week. When the causative agent of a disease enters the human body for the first time, all manifestations of the infection are caused precisely by the activity of this 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 pathogenic microorganism. Each microbe requires its own special antibodies.

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

It makes no sense to vaccinate against infections that the human body can cope with. But if the infection is dangerous, the mortality rate of sick people is very high, it is necessary to vaccinate. Vaccinations are simply a carrier of the antigen of a microbe - a pathogen, for which memory cells are produced. When contracting a dangerous infection, there are two possible outcomes - recovery with the formation of immunity, or death. Vaccination ensures the formation of this immunity without mortal risk and the need to endure a severe infection with extremely painful symptoms.

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

List of preventive vaccinations

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

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

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

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

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

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

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

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

Regional calendar of preventive vaccinations

The regional calendar of preventive vaccinations is developed and approved by local authorities of the Ministry of Health, taking into account specific circumstances and the epidemiological situation. The regional calendar of preventive vaccinations must include all vaccines from the national one, and add the necessary ones.

An individual program of preventive vaccinations for a child is developed and reflected in the following medical documentation:
1. Card of preventive vaccinations - form 063/у.
2. Child development history - form 112/у.
3. Child’s medical record – form 026/у.
4. Insert for an outpatient medical record - form 025/u (for adolescents).

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

The preventive vaccination program is separately drawn up for adults. This work is carried out by specialists - doctors from clinics. Preventive vaccinations for adults cover everyone who is eligible for vaccination, regardless of whether the person works. Adults are included in the immunization plan based on data on vaccinations performed and their expiration date.

Carrying out preventive vaccinations

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

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

The vaccination room must have:

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

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

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

All used syringes, needles, ampoules, drug residues, cotton wool or tampons are disposed of in a container with a disinfectant solution.

Organization and procedure for vaccination

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

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

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

Any vaccination is carried out only in a specialized institution accredited to perform immunizations (vaccination rooms in clinics, kindergartens, schools, colleges, colleges, health centers, first aid stations).
If necessary, special teams are formed and procedures are carried out at home.
Preventive vaccines are given exclusively as prescribed by a doctor or paramedic.
Immediately before the planned vaccination, data on the condition of the child or adult are carefully clarified, on the basis of which permission for manipulation is given.
Before planned immunization, a child or adult is examined by a doctor to determine the presence of contraindications, allergies or strong reactions to previously administered drugs.
Before the injection, the temperature is measured.
Before the planned vaccination, the necessary tests are taken.
The vaccine is injected only with disposable syringes and needles.
Vaccinations can only be given by a medical specialist who is proficient in injection techniques, as well as emergency care skills.
The vaccination room must have an emergency kit.
All vaccines must be stored according to rules and regulations.
The vaccination office must have all the documentation.
Under no circumstances should vaccination be carried out in a treatment room or dressing room.
The vaccination room is cleaned twice a day using disinfectant solutions.

Technique of preventive vaccinations

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

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

Journal of Preventive Vaccination

The medical worker must enter all vaccinations performed in a special logbook. If you lose your individual card or move to another place, all data can be restored by contacting the medical institution where the vaccination was carried out, where they will make an extract from such logs stored in the archives. Also, based on the entries in the journal, preventive immunization plans are drawn up, in which the names of the people to be vaccinated are entered.

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

last name, first name and patronymic of the person being vaccinated;
patient's address;
year of birth;
place of study or work;
name of the vaccine product;
primary vaccination or revaccination;
method of vaccine administration (subcutaneous, intramuscular, oral, etc.).

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

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

Vaccination card, form 063

The preventive vaccination card, form 063/u, is a medical document that contains information about all vaccinations and biological tests performed. Often this document is simply called a “vaccination sheet”. The document must record the date of vaccination, numbers and series of the drug.

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

The vaccination card is printed and filled out individually for each child.

Certificate

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

A certificate of preventive vaccinations is issued to a person in a maternity hospital, clinic, medical unit or health center. Each vaccination performed is included in the vaccination certificate, which displays the date, the name of the clinic, the signature of the medical worker who performed the manipulation, and the seal of the health care institution. The vaccination certificate must not contain any blots or corrections. Any corrections or blank fields will result in the certificate being invalidated. The document does not include contraindications or reasons for lack of vaccination.

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

Refusal of preventive vaccinations, sample form

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

Refusal from vaccinations must be submitted in writing to the head of the treatment and prevention, preschool child care institution or school. An approximate form of refusal of vaccinations, which can be used as a form and sample, is presented below:

Head physician of clinic no./ or
To the director of school no./ or
To the head of kindergarten No.
_______district, __________city (village, hamlet)
From __________name of the applicant_____________________

Statement
I, ____________full name, passport details______________, refuse to do all preventive vaccinations (or indicate which specific vaccinations you refuse to do) to my child _______full name of the child, date of birth_________, registered at clinic No. (or attending kindergarten No., or school No.). The legal basis is the legislation of the Russian Federation, namely “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” dated July 22, 1993 No. 5487-1, articles 32, 33 and 34 and “On the immunoprophylaxis of infectious diseases” dated September 17, 1998 No. 57 - Federal Law, Articles 5 and 11.
Number
Signature with transcript

What does the lack of preventive vaccination entail?

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

As can be seen from the law, a child or an adult may not be allowed to visit a child care facility, and an employee may not be allowed to enter 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 the transition to quarantine, unvaccinated children and adults are not allowed into groups. During the rest of the year, children and adults can work, study and attend kindergartens without restrictions.

Order on preventive vaccinations

Today, on the territory of Russia, Order No. 51n of January 31, 2011 “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications” is in force. It is in accordance with this order that the current national vaccination calendar was approved.

Preventive vaccination in kindergarten

For children, preventive vaccination can be carried out individually or in an organized manner. In an organized manner, vaccinations are given to children attending kindergartens and schools, where immunization specialists come with ready-made drugs. In this case, the medical workers of the child care institution draw up vaccination plans that include those children who require them. All information about the manipulations performed in kindergarten is recorded on a special vaccination sheet (form 063/y) or in a medical record (form 026/y - 2000).

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

Before use, you should consult a specialist.

Vaccination (inoculation) is the most acceptable method of mass prevention of infectious diseases. Today, it is with the help of vaccinations that it is possible to protect the human body from harmful infections, which have a very negative impact not only on the general condition of a person, but also cause significant harm to his internal organs.

Viral (measles, rubella, mumps, polio, hepatitis B, etc.), bacterial (tuberculosis, diphtheria, whooping cough, tetanus, etc.) infections are effectively prevented thanks to timely vaccination.

The essence of vaccination is as follows: vaccines are introduced into the human body, which are weakened or killed pathogens of various infections. Also, artificially synthesized proteins that are similar to the proteins of the pathogen can be used for vaccination. When pathogens enter the body, the human immune system recognizes foreign cells and begins to actively produce so-called antibodies that block the actions of harmful bacteria.

It is safe to say that the purpose of human vaccination is to help strengthen immunity to a variety of microbes and viruses, so the infection will be destroyed by the immune system even before symptoms of the disease appear.

It is noteworthy that most vaccinations can be done at the same time. For this purpose, scientists have developed special preparations that contain a mixture of several vaccines. For example, the DTP vaccine has been developed for whooping cough, diphtheria and tetanus. It is worth emphasizing that these types of vaccines are as effective as single vaccinations directed against one disease.

Creation of immunity occurs in different ways. Some vaccines need to be given once, but there are a number of vaccines that are given repeatedly. In medicine, there is the term revaccination - this is a procedure aimed at maintaining the immunity already developed by previous vaccinations. As a rule, revaccination is carried out several years after the introduction of the first vaccine.

Types of vaccines

Conventionally, all vaccines can be classified as follows:

Live vaccines. Such vaccinations involve the introduction of weakened living microorganisms into the human body. Measles, rubella, tuberculosis, mumps - these diseases can be prevented with live vaccines.
Inactivated vaccines. This type of vaccination involves the introduction into the body of a killed whole microorganism (whooping cough, rabies, viral hepatitis A) or a component of the cell wall or another part of the pathogen (whooping cough, meningococcal infection).
Anatoxins. A vaccine that contains an inactivated toxin produced by a harmful bacterium. For example, diphtheria and tetanus can be prevented with this type of vaccination.
Biosynthetic vaccines. Such vaccines are created only using genetic engineering methods. Viral hepatitis B is a disease that can only be prevented with this vaccine.

Methods of administering vaccines

Vaccination is carried out in different ways. The procedure for vaccination depends on the type and mechanism of action of the vaccine. Traditionally, vaccines are administered intramuscularly. However, quite often vaccinations are given intradermally, cutaneously or subcutaneously. Certain vaccines are given through the mouth or nose.

In each individual case, the procedure for vaccination is determined by the specifics of the drug.

Contraindications for vaccination

Experts have identified a number of reasons why vaccinations are not recommended. Here are the main ones:

the presence of an allergic reaction to the previous administration of this drug;
on vaccine components;
presence of high body temperature;
hypertension, rheumatism.

VACCINE PREVENTION OF INFECTIOUS

DISEASES IN CHILDREN

Epidemiological well-being in modern conditions is associated with the widespread use of vaccine prevention. This term refers to the artificial reproduction of the immune response by introducing a vaccine (i.e., a specific antigen) in order to create immunity to infection.

Vaccines are biological preparations obtained from weakened, killed microorganisms, their metabolic products, or created using genetic engineering technology and used for active immunization for the purpose of specific prevention of infections.

4.1. General characteristics of vaccines

All vaccines are divided into live and inactivated.

Live vaccines. Live vaccines include BCG, measles, rubella, mumps, and polio myelitis (Sabin vaccine). They are created on the basis of living weakened microorganisms with a persistent decrease in virulence. Vaccine strains used in the production of live vaccines are obtained by isolating attenuated (weakened) strains from patients or from the external environment through selection of vaccine clones and long-term passivation in the body of experimental animals, as well as on cells of chicken or human embryos. Chicken embryo cells are used, for example, to produce a vaccine against yellow fever, and human cells against rubella. The post-vaccination immunity formed as a result of immunization is close in intensity to post-infectious immunity. Live vaccines are thermolabile, and therefore they must be stored and transported at a temperature of 4 -8 ° C, observing the so-called “cold chain”.

Inactivated vaccines. Such vaccines are divided into whole cell (particular), split (split), subunit, recombinant and toxoid.

Whole cell vaccines. Whole cell vaccines include vaccines against polio (Salk vaccine), whooping cough (adsorbent

pertussis-diphtheria-tetanus (DPT)), influenza, hepatitis A, rabies. These vaccines contain inactivated, purified, undestructed microorganisms, which are obtained by neutralizing them through chemical or physical action. Whole cell vaccines create unstable humoral immunity, and therefore, to achieve a protective level of specific antibodies, they must be administered repeatedly. Whole cell vaccines are highly reactogenic.

Split vaccines(splits). These include vaccines against influenza (Vaxigrip, Fluarix). Digestive vaccines contain all fragmented purified microorganism particles separated by detergents.

Subunit vaccines(chemical). Subunit vaccines include vaccines against meningococcus, pneumococcus, Haemophilus influenzae, typhoid fever, hepatitis B, and influenza (Influvax, Grippol). They contain only surface antigenic fractions of inactivated microorganisms, which makes it possible to reduce the protein content in the vaccine and reactogenicity.

Recombinant vaccines. The hepatitis B vaccine (Engerix B) is produced using recombinant technology. The microorganism gene region encoding the synthesis of a protective antigen is inserted into the DNA of producer cells (yeast, Escherichia coli), which, when multiplying, produce this antigen. The protective protein is isolated from the producing cells and subjected to purification. Recombinant vaccines are weakly reactogenic. The immunity that develops after vaccination is relatively short-lived.

Anatoxins. These are bacterial exotoxins that are neutralized by prolonged exposure to formaldehyde at elevated temperatures. Vaccines against tetanus, diphtheria, whooping cough (infanrix), botulism, and gas gangrene are toxoids. Ana toxins are slightly reactogenic. Thus, when pertussis toxin is administered (as part of the complex vaccine Ifanrix), fever occurs 7 times less often, and pain at the injection site occurs 14 times less often than when administered with whole-cell pertussis vaccine. However, when toxoids are administered, only antitoxic immunity is produced, and therefore they do not prevent bacterial carriage.

Monovaccines and combination vaccines. Depending on the number of antigens included in the vaccines, they are divided into monovaccines and combined (associated) vaccines. Single vaccines contain antigen against one pathogen, while combined vaccines contain antigen against several types of microorganisms.

Monovaccines are divided into monovalent vaccines (contain antigen against one serotype or strain of pathogen

la) and polyvalent (contain antigens against several serotypes or strains of the same microorganism). Polyvalent vaccines include meningo A+ C, pneumo 23, imovax D.T. polio (inactivated trivalent polio vaccine), live trivalent polio vaccine

Examples combination vaccines are DPT vaccine, adsorbed diphtheria-tetanus (DT) and ADS-M (small) toxoids. Among foreign vaccines, Tetrakok 05 (against whooping cough, diphtheria, tetanus and polio), D.T. Vax (against diphtheria and tetanus), MMR-II, Priorix (against measles, rubella, mumps) are widely known.

Composition of vaccines. In addition to antigens that ensure the development of specific immunity, vaccines include stabilizers (introduced into the drug to ensure the stability of its antigenic properties), preservatives (maintaining the sterility of the vaccine) and adjuvants (increasing the immunogenicity of the drug).

Sucrose, lactose, human albumin, and sodium glutamate are used as stabilizers.

The most common preservative both in Russia and abroad is merthiolate (thiomersal) - an organic mercury salt. Merthiolate is contained in the DPT vaccine, anatoxins, hepatitis B vaccine, etc. Its content in these preparations does not exceed 50 mcg per dose. In addition to merthiolate, formaldehyde, phenol, phenoxyethanol and antibiotics (neomycin, kanamycin, polymyxin) are used as preservatives.

Adjuvants include aluminum salts (aluminum hydroxide, aluminum phosphate), polyoxidonium (in the domestic influenza vaccine influenza). The pertussis component in combined vaccines also has adjuvant properties.

In addition, vaccines include substances production technologies(heterologous proteins of the cultivation substrate, components of the nutrient medium, cytokines). Thus, the measles vaccine may contain trace amounts of cattle serum, the mumps vaccine may contain egg whites (quail in domestic vaccines, chicken in foreign vaccines), and the hepatitis B vaccine may contain traces of yeast proteins. According to the WHO vaccine requirements, the content of heterologous serum proteins in the vaccination dose is limited to 1 μg, heterologous DNA - 100 pkg.

Substances that do not determine the immunogenicity of the vaccine may be a source of side effects (toxic, genotoxic, autoimmune, allergic).

4.2. Immunological basis of vaccination

From an immunological point of view, vaccination can be defined as the induction of immunological memory by immunization with a target antigen. During initial and repeated contact with an antigen, there are significant differences in the nature of the immune response (humoral or cellular). In the primary response, IgM antibodies appear on days 3–6, then IgG, and IgA antibodies appear on days 15–21. During the secondary immune response, the rise in IgM levels is unnoticeable; antibody formation begins almost immediately with a sharp increase in the concentration of IgG (Fig. 4.1). These differences in the immune response are explained by the phenomenon of immunological memory.

The phenomenon of immunological memory is manifested in the fact that in the case of a good immune response when the pathogen first enters the body, its repeated entries (secondary immune response) provide sanitation much faster and more effectively. As a result, the pathogen does not have time to cause a pathological infectious process. This is called protective (i.e., protecting against disease) immunity. When vaccinated, the first antigen is the vaccine antigen, which provides protection before contact with the causative agent of an infectious disease.

Despite the fact that the clinical phenomenon of immunological memory has been known since ancient times, its cellular and molecular genetic mechanisms are still unknown. Lymphoid tissue contains 10-100 times more memory T-lymphocytes than mature non-immune T-lymphocytes. These types of T lymphocytes differ in the expression of a number of membrane molecules.

Rice. 4.1. Primary and secondary immune responses, immunological memory response

Why is it important to get vaccinated?
Preventive vaccinations are medical procedures aimed at developing immunity in the body against certain infectious diseases.
Vaccinations not only protect against infection, but are also an essential factor in the anti-epidemic fight against infectious diseases. A sustained reduction in the incidence of tuberculosis, diphtheria, tetanus, whooping cough, and polio depends on the timing of vaccinations. Thanks to vaccinations, smallpox has been completely eradicated.
For successful vaccinations, the appropriate technique for making the grafting material, as well as the correct technique for their implementation, are important. As an anti-epidemic factor, vaccinations are important only if carried out in a timely manner. Depending on the epidemiological situation, the sequence of vaccinations is established, as are the age groups to be vaccinated.
Vaccination material against diseases caused by bacteria or viruses consists of live pathogens with weakened properties (attenuated) or killed pathogens.
Live vaccines induce more stable and long-lasting immunity than killed ones. The duration of development of immunity is taken into account when establishing the timing of re-vaccination - i.e. revaccination. To ensure sufficiently high immunity to protect against infection, vaccinations must be systematically repeated at certain intervals.
Studies conducted in many countries show that 6-8 week old infants “know how” to develop immunity when vaccinated. The level of antibodies formed in the first months of life decreases during the second half of the year, which leads to the need for vaccinations in the second year of a child’s life.

On the 3-4th day of life, the child is vaccinated against tuberculosis (BCG). 0.1 ml of vaccine is injected intradermally into the left shoulder. Within a few minutes, a “lemon peel”-type compaction with a diameter of about 8 mm should appear at the injection site. 2-3 days after vaccination, an infiltrate (i.e., compaction) forms at the injection site, turning into a blister, then suppuration, which heals after 3-6 weeks, sometimes longer.
It leaves a scar, indicating the presence of a post-vaccination tuberculin allergy. In children 11-12 months old, the middle of the scar should be at least 3 mm. When a child comes into contact with a patient with tuberculosis, for diagnostic purposes, in addition to the presence of a scar, it is necessary to conduct a tuberculin test.
In children over 32 months after vaccination, immunity is confirmed by the Mantoux tuberculin test. It is performed intradermally on the inner surface of the forearm. 0.1 ml of diluted tuberculin is administered. The result is determined after 72 hours. The size of the reddened spot is on average 6 mm or more. Revaccination is carried out at the ages of 6-7 years and 14-15 years.
Children who do not have post-vaccination immunity, as well as children with decreased immunity, are given the BCG vaccine again.
Revaccination (re-vaccination) is carried out at certain time intervals, taking into account the time of other vaccinations.
Vaccinations against tetanus, diphtheria, whooping cough, polio and others can be done 3 weeks after the BCG vaccination, BCG vaccination - 2 weeks after other vaccinations.

With the correct technique for vaccination against tuberculosis, complications are rare.
With a deep injection, an ulceration or abscess may form at the injection site, which is accompanied by an enlargement of the inguinal lymph nodes. It is extremely rare that the nodes soften and fistulas form.
The remaining mandatory vaccinations are given in the prescribed manner.

Updated 25.04.2016 25.04.2016

The effectiveness of vaccination is generally recognized throughout the world; there is no other health program that has produced such impressive results. Almost within the lifetime of one generation, more than a dozen severe infections that previously caused heavy damage were eliminated or minimized. Over the past 10 years, significant progress has been made in the development and introduction of new vaccines and the expansion of immunization program coverage. Thanks to immunization, the number of deaths of children 0-5 years old from vaccine-preventable infections (diphtheria, measles, neonatal tetanus, whooping cough, polio) decreases annually.
Paradoxically, the fact that immunization has made many infectious diseases quite rare, and some of them even forgotten, has become the reason why parents and part of the population have formed the opinion that vaccinations are no longer necessary. In fact, refusal to vaccinate leads to a decrease in the immune layer and outbreaks of infectious diseases. Support for immunization programs is needed to prevent the return of highly dangerous infectious diseases that cause disability and death to the region. Immunization saves millions of lives every year. This success should be consolidated and maintained.
National Calendar of Preventive Vaccinations- This is a list of vaccines used. National calendar of preventive vaccinations in Russia, determined Federal Law No. 157-FZ “On Immunoprophylaxis of Infectious Diseases”, includes vaccinations against 12 infections And list of vaccinations for epidemic indications. The number of vaccines designed to prevent infectious diseases is increasing. This makes it possible to expand national vaccination calendars and improve the protection of human health. Combination vaccines are one of the obvious and effective solutions to the problem of reducing the number of injections given to a child during vaccination.
The biological basis for the possibility of creating combination vaccines is the fact that the immune system is able to form a specific immune response to many antigens at once. In this case, the production of antibodies in response to all these antigens occurs in the same way as when they are administered separately. Moreover, some vaccines, when administered simultaneously, can enhance the immune response. If we talk about reactions to the administration of combined vaccines, then numerous studies show that there was no increase in the severity of general and local reactions to the administration of these drugs.
Preventive vaccinations are carried out in the vaccination office of a children's clinic, medical offices of preschool institutions, and schools.
Federal Law No. 157-FZ “On Immunoprophylaxis of Infectious Diseases” provides: free vaccinations, obtaining complete and objective information about vaccinations, the use of vaccines registered in Russia, social protection of citizens in the event of post-vaccination complications, refusal of preventive vaccinations.
Parents' refusal to vaccinate their child violates his right to life and health. Unreasonable medical withdrawal of a child from vaccination may be equated to failure to provide necessary medical care. If citizens refuse preventive vaccinations, the Federal Law provides for certain rights of the state: a ban on traveling to countries where specific vaccinations are required; temporary refusal of admission to educational and health institutions in the event of infectious diseases or the threat of epidemics.
Since 2014 The Ministry of Health of the Russian Federation has approved a new National Calendar of Preventive Vaccinations and a calendar of preventive vaccinations for epidemic indications. Introduced into the Immunoprophylaxis Calendar vaccinations against Haemophilus influenzae and pneumococcal infections for all children .

Haemophilus influenzae infection- a group of acute infectious diseases with primary damage to the respiratory system, central nervous system and the development of purulent foci in various organs. Hemophilus influenzae infection in newborns, infants and young children is the main cause of purulent meningitis, otitis media, various respiratory tract diseases (pneumonia, bronchitis, epiglotitis), conjunctivitis, osteomyelitis, endocarditis, peritonitis, etc. The disease is severe, with high mortality in young children. In this regard, in many countries and in Russia, vaccination against hemophilus influenzae is provided for in the vaccination calendar. Vaccine reactions are rare. They usually manifest themselves as redness or thickening at the injection site; rarely, a rise in temperature to 37.5 degrees is noted. Allergic reactions are unlikely due to the absence of protein impurities in the vaccine. No serious complications have been described. There are several vaccination schedules depending on the age of the child.
Pneumococcal infection- the most common bacterial infection, according to WHO estimates, it causes 1.6 million deaths per year, of which 50% occur in children 0-5 years old. Pneumococcal infections have many different clinical forms: pneumonia (inflammation of the lungs), purulent meningitis (inflammation of the membranes of the brain), bronchitis, otitis (purulent inflammation of the middle ear), sinusitis (inflammation of the sinuses), arthritis (inflammation of the joints), sepsis (blood poisoning ) and etc.
The highest level of pneumococcal infection is recorded after an increase in the incidence of acute respiratory viral infections (ARVI) and influenza. These viral infections lead to the disruption of the “barrier” function of the epithelium of the upper and lower respiratory tract. Therefore, it is most advisable to vaccinate against pneumococcal infection at the same time as or after the administration of the influenza vaccine (September-December).
The most effective way to prevent a child from developing pneumococcal infection is to administer a vaccine. Registered in our country vaccines "Pneumo-23", Prevenar, Synflorix. The vaccine is well tolerated by all vaccinated people. Local vaccination reactions (thickening, redness at the injection site) are recorded in no more than 5 people per 100 vaccinated people. General vaccination reactions (fever, malaise, etc.) are not typical for this vaccine. All reactions after administration of the vaccine go away on their own within 24 hours from the moment they appear.
Preventive vaccinations protect the child from severe forms of infection, from serious complications that arise after infectious diseases (infertility, paralysis and others). Vaccination is the most effective way to protect against infectious diseases.

Olga Anatolyevna Shekhovtsova,
doctor of the vaccination room of the KDP (for children) MC No. 3