home Drugs Flu reminder. Vaccine prevention of influenza. Vaccine prevention against influenza Viral complications of influenza

Flu reminder. Vaccine prevention of influenza. Vaccine prevention against influenza Viral complications of influenza

As one famous saying goes, time is divided into pre-war, war and post-war. So now we live in pre-war times. Anticipating your next question, let me clarify the situation. Very soon, we will all have to confront a dangerous enemy: the influenza virus. And a flu epidemic is the same war in which no prisoners are taken, but the wounded are piled up. Therefore, it is necessary to properly prepare for large-scale military operations, where the main preparatory stage is knowledge of the principles of preventing infection caused by the influenza virus. I will make a reservation that in this article I will touch upon issues of purely flu prevention. You can read about what the flu is, its symptoms and treatment on our website.

Flu prevention May be specific, using vaccines, and nonspecific carried out through a general impact on the immune system with the help of appropriate medications.

In fact, vaccination is the only scientifically sound method of preventing influenza. In terms of the final result (and this should be considered the absence of influenza incidence), it is twice as superior to nonspecific methods of prevention, and from a material point of view, which is also important, vaccination is ahead. See for yourself: one or two vaccinations as an alternative to a course of immunomodulatory and antiviral drugs will obviously cost less.

Influenza vaccines are divided into:

alive, including a specially reconstituted live influenza virus. An example is the domestic Ultravac vaccine;
inactivated, which may contain either a killed influenza virus or antigens - its individual parts.

Inactivated vaccines in turn, are classified depending on the integrity of the virus included in their composition into:

whole virion(I think everything is clear here). Examples are Russian Grippovac and IGV;
split vaccines, including the outer and inner parts of the split virus. Examples - Fluarix (Belgium), Vaxigrip (France), Fluvaxin (China);
subunit vaccines, the components of which are only the outer parts of the vaccine virus. This is a series of Russian vaccines Grippol (Grippol-neo, Grippol-plus) and the Dutch Influvac.

In order not to get confused in this “vaccine gallery”, I’ll point out main differences between them:

route of administration. Live vaccines are sprayed into the nasal cavity using a dispenser, and inactivated ones are injected;
permissible age for vaccination. For live and whole-virion inactivated vaccines, it is three years and older, for subunit and split vaccines - six months from birth;
frequency of adverse reactions (fever, local reactions). Here priority goes to subunit and split vaccines, the use of which is fraught with a lower risk of adverse reactions;
list of indications and contraindications. As in the previous case, the use of subunit and split vaccines seems more justified. So, these vaccines are safe for expectant and existing (nursing) mothers, as well as six-month-old babies.

The period of development of immunity after vaccination is 2-3 weeks, protection lasts on average from 6 months to a year. The next time you vaccinate, it is not at all necessary to change the vaccine that worked perfectly last time. You can vaccinate her again.

Unfortunately, one cannot say that “one tablet is enough,” i.e. One injection - and the flu will pass by with a guarantee. Much depends on age, general health, and individual characteristics. However, the effectiveness is quite high, and if we translate it into percentages, then on average it will be 70-95% of those who are not sick of the total number of vaccinated individuals. The remaining 5-30% will have a milder form of the flu.

Nonspecific prevention of influenza

This type of prevention involves the use of a wide range of medications and special methods that help increase general immunity and the formation of nonspecific resistance to infectious agents. Used as immunocorrective agents interferon inducers(Cycloferon, Kagocel, Amiksin, Neovir, Tiloron), synthetic analogues of thymus preparations(Timalin, Imunofan, Timogen, Timactid, Timoptin), plant adaptogens(tinctures of aralia, ginseng, lemongrass, extracts of Eleutherococcus, Leuzea, Rhodiola), vitamins B, A, C, antiviral agents(Arbidol, Remantadine), oxolinic ointment.

Despite the seeming old-fashionedness, there are a great variety of means and methods: from gargling with cold water (within reasonable limits, of course) to contrast showers and swimming pools.

In conclusion, I will “chew” a little on the main behavioral recommendations for the period of widespread spread of the influenza virus:

avoid contact with clearly unhealthy people;
reduce your stay in crowded places to a minimum;
touch your nose and mouth less with your hands;
wash your hands (often and regularly!) with soap, or better yet, with an antiseptic;
if there is a sick person in the family, then it is very advisable to put on gauze bandages (for both the sick and healthy);
Regularly ventilate your “apartments”.

When using the material, a hyperactive link to www..

Modern tactics of influenza vaccine prevention

A.V. Loginov.
Representative office of "Pasteur Merier Connaught" in the CIS

Currently, there are two approaches to preventing influenza in the world: immunoprophylaxis with an inactivated vaccine and chemoprophylaxis with antiviral drugs (such as amantadine or rimantadine).

Annual vaccination of persons at high risk of influenza complications is the most effective preventive measure. International experience shows that when using inactivated vaccines, it is not necessary to take a break from influenza vaccination every three years. The vaccine is most cost-effective when vaccinating people who are susceptible to complications or who are at increased risk of transmitting the virus. It is obvious that it would be advisable to get vaccinated during hospitalization or one of your routine doctor's visits before the onset of influenza season.
Inactivated influenza vaccines contain three strains of the virus (usually two type A and one type B) that are likely to circulate around the world during the next flu season. So, for the 1998-1999 season. they contain influenza virus H1N1, H3N2 and B (strains: A/Beijing/262/95-like, A/Sydney/5/97-like and B/Beijing/184/93-like). Instead of B/Beijing/184/93, manufacturers use an antigenically identical strain - B/Harbin/07/94 due to better technological characteristics. Since the composition of the vaccines for the 1998-1999 season. differs from the composition of the vaccines of the 1997-1998 season, the vaccine stocks of the 1997-1998 season. should not be used to prevent influenza during the 1998-1999 season.

Groups to be vaccinated
Dosage recommendations vary by age group (see table). Two doses of the vaccine, given at least one month apart, are required to achieve a significant antibody response in children under 9 years of age who have not been previously vaccinated.

Table. Dosage of influenza vaccines depending on age.

Groups at high risk of developing influenza complications

Adults and children with chronic pathologies of the respiratory and cardiovascular systems, including children with bronchial asthma.
Adults and children who required regular medical observation or hospitalization for a year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathy, or immunosuppression (including drug-induced immunosuppression).
People of any age who have a chronic condition and are in long-term care facilities.
Children and adolescents (ages 6 months to 18 years) who are receiving long-term aspirin therapy due to the risk of developing Reye's syndrome with influenza.
Women who are in the 2nd or 3rd trimester of pregnancy during a seasonal epidemic rise in incidence.
Persons over 65 years of age.

Groups of people at increased risk of influenza virus transmission
People with influenza can spread the disease to those in high-risk groups they care for or live with. In this regard, the following should be vaccinated:

Doctors, nurses and other staff in both hospitals and other health care settings
Employees of special institutions for the care of patients with chronic pathologies who are in contact with the contingent of these institutions.
Family members of patients at risk

Vaccination of other population groups
Breastfeeding mothers can get vaccinated because the influenza vaccine does not affect the safety of breastfeeding for mothers and children. Lactation does not affect the immune response and is not a contraindication to vaccination.

Vaccine prevention of influenza can be carried out for people who want to reduce the risk of the disease (the vaccine can be prescribed to children from 6 months of age). Persons whose activities are particularly important should be considered candidates for vaccination to minimize the risk of interruption of socially important activities during epidemics.

Concomitant use with other vaccines
The flu vaccine can be given at the same time as other routine vaccinations.

Flu vaccination time
The optimal time for a vaccination campaign for high-risk individuals is usually between October and mid-November. For children under 9 years of age, the second dose should be given before December if possible. Vaccination with inactivated vaccines to prevent influenza is not contraindicated during the annual epidemic rise in incidence.

General contraindications
Inactivated influenza vaccines should not be administered to persons with hypersensitivity to egg white or other components of influenza vaccines without first consulting a physician. However, individuals with hypersensitivity who are at risk may be vaccinated with appropriate assessment of the degree of allergy and desensitization.
Persons with acute febrile illness should not usually be vaccinated until symptoms resolve. Mild illness with or without fever should not be a contraindication to the use of influenza vaccines.

Bibliography

Prevention and control of influenza. Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR, CDC, V.46, No. RR-9.
1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics, 1997, pp. 307-315.
Order of the Ministry of Health of the Russian Federation No. 25 of January 27, 1998 “On strengthening measures to prevent influenza and other acute respiratory viral infections”

Influenza is the most common cause of temporary disability among the population, especially in the autumn-winter period. Despite the achievements of modern medicine, this infectious disease continues to be among the most severe, as it leads to frequent hospitalization and even death. Influenza vaccine prevention is one of the most effective measures to reduce the number of complications and mortality from this infection.

Influenza is caused by a virus of the same name and ranks first in prevalence among all infectious diseases in the world. During annual epidemics, according to statistics, influenza affects 10 to 20% of the adult working population. Among children, elderly people, as well as weakened patients with concomitant somatic pathologies, this figure reaches 40-60%. The most dangerous complications of influenza are:

Viral bronchitis and pneumonia.
Damage to the central and peripheral nervous system.
Pathologies of the cardiovascular system (viral myocarditis, endocarditis, pericarditis).
Myositis.
Attachment of secondary bacterial infections (sinusitis, otitis, inflammation of the respiratory tract).

Vaccination is especially important for people with weakened immune systems, patients with severe chronic pathologies, young children, pensioners and pregnant women.

Influenza vaccination is mandatory for people working with people (teachers, employees of preschool institutions, volunteers) and medical workers.

Vaccination against influenza reduces the risk of developing the disease, and if the disease does occur, it prevents the occurrence of serious complications.

General information

The causative agent of a dangerous disease belongs to the orthomyxovirus family and includes influenza viruses of types A, B and C. These microbial particles differ from each other in their antigenic structure, in addition, the influenza A virus often mutates, which causes the high prevalence of the disease and frequent epidemics .

In this regard, trivalent influenza vaccines containing viral particles of two types A and B have become widespread. Since the causative agent of influenza type C does not cause epidemics, but only sporadic cases, it is not included in vaccine preparations. For vaccination of children and adults the following are used:

Live and whole virion drugs are highly effective drugs, accompanied by frequent side effects (allergic reactions, pain in the limb, fever and chills), and therefore their use is limited.
Split vaccines (split vaccines) are second-generation drugs characterized by less reactogenicity and, as a consequence, a lower frequency of adverse reactions.
Subunit vaccines - contain only envelope antigens and are completely devoid of the internal component of influenza viruses. Thanks to this, they are safe, well tolerated and approved for use by infants, debilitated people and pensioners.

The composition of vaccinations changes every year, depending on the recommendations of the WHO and the Global Influenza Surveillance System. Each season, one or more vaccine components for the Northern or Southern Hemisphere may be replaced by another based on analyzes of circulating samples of the pathogen.

Types of vaccines

Injectable preparations are the most common among all flu vaccinations; vaccines for intranasal administration are less common. Among them are:

A live vaccine containing weakened and non-infectious viruses (Microgen, Russia).
Inactivated liquid whole cell influenza vaccine (“Microgen”).
Split-vakitsny - Grippol (Microgen Russia), Fluarix (Belgium), Begrivak (Germany), Vaxigrip (France).
Subunit drugs - Grippol plus (Petrovax Pharm Russia), Influvac (Netherlands), Agrippal (Italy).

All vaccinations are interchangeable, however, the use of live and whole-cell influenza vaccines, despite good results in the formation of immunity, is limited among people with immunodeficiency, children under 18 years of age, pregnant women and people with a tendency to allergic reactions, due to the high incidence of side effects.

Indications and method of administration

The optimal time for preventive vaccination against influenza is the period from October to November, i.e., the time before the start of the epidemic season. However, many experts consider vaccine prevention to be relevant during the entire period of increasing incidence of influenza and ARVI. This is due to the fact that the synthesis of specific antibodies sufficient to protect the body requires an average of 14 days, and the flu epidemic lasts many times longer.

The vaccine preparation is administered according to the following scheme:

Children over 3 years of age and adults are prescribed a dosage of 0.5 ml once.
Infants aged 6 months and older. up to 3 years – two doses of the vaccine (0.25 ml) are required at an interval of two weeks.
Children under 6 months who are breastfed do not require administration of the drug.

For adults, the injection is performed in the deltoid muscle area, for infants - in the anterolateral part of the thigh.

The flu shot can be combined with other vaccine preparations, provided they are administered to different parts of the body.

Undesirable effects

The flu vaccine has a number of side effects due to the effect of the drug itself. Normally, they do not cause significant discomfort to the patient and all symptoms go away on their own after a few days. These include:

Runny nose, sneezing, itching sensation in the nasal cavity.
Pain, sore throat.
Dry cough.
Muscle pain, soreness.
Slight compaction in the area where the drug was administered.
Nausea, vomiting.
Increased body temperature with chills.

In rare cases, patients develop symptoms of allergic reactions - skin rash, itching, urticaria, Quincke's edema and anaphylactic shock.

Complications from the vaccine include lymphadenitis, neuralgia, convulsions and spasms of the limbs, systemic vasculitis and thrombocytopenia. With any such symptom, it is important to consult a doctor as soon as possible in order to diagnose, determine the cause of the condition and select treatment.

Each case of a post-vaccination complication must be registered by the manufacturer of the drug.

Contraindications for use

Nurse draws medicine into a syringe

Before administering the influenza vaccine, it is important to undergo a comprehensive examination to identify contraindications. These include:

History of allergic reactions to vaccinations.
Chicken protein intolerance.
Atopic bronchial asthma, allergic dermatitis in the acute phase.
Diseases of the nervous system, history of seizures.
Severe pathologies of the endocrine and cardiovascular systems.
Diseases of the immune and hematopoietic systems.
Respiratory diseases.

The vaccine should only be administered to healthy people. That is why, before routine immunization, an in-person examination by a pediatrician or therapist is necessary in order to assess the patient’s condition and identify temporary contraindications, which include symptoms of acute respiratory viral infections and inflammatory diseases of the ENT organs.

Influenza vaccination is the best way to protect against the disease and the development of serious complications.

For quotation: Markova T.P., Yarilina L.G., Kim M.N. Vaccine prevention of influenza. New domestic vaccine Ultrix® // Breast Cancer. 2014. No. 25. S. 1862

The urgency of the problem of respiratory infections, including influenza, is beyond doubt. The problem is complicated by the variety of infectious agents that cause respiratory infections (about 200 viruses, Chlamydia and Mycoplasma pneumoniae, bacterial pathogens (Streptococcus pneumoniae, Haemophilus influenzae, etc.)), as well as mutations of the influenza virus. Comparative characteristics of influenza viruses are presented in Table 1.

Influenza A viruses are the most contagious and virulent; they contain 2 types of neuraminidase (Na1, NA2) and 3 types of hemagglutinin (HA1, HA2, HA3). The influenza B virus contains 1 type of neuraminidase and 1 type of hemagglutinin. Virus C does not contain neuraminidase, but contains hemagglutinin, has a receptor-degrading enzyme - neuraminate-0-acetylesterase and does not have variability. A change in NA or HA is called an antigenic shift. Intermediate hosts and natural reservoirs of influenza A virus can be birds (bird flu). Virus variability may be associated with point mutations in the genome and changes in NA or HA (antigenic drift). It is possible to completely replace HA and NA through the mechanism of reassortment/recombination (antigenic shift), which occurs once every 10-12 years and can lead to the development of a pandemic. Influenza pandemics include: Spanish flu (H1N1) in 1918, Asian flu (H2N2) in 1957, Hong Kong flu (H3N2) in 1968. With antigenic drift, about 10% of the population gets sick, with antigenic shift - 40- 60%, because there is no immunity to the new type of virus.
According to WHO, an adult can get respiratory infections 3-4 times a year, children attending school - 4-5 times, preschoolers - up to 6 times, children in the first year of life can get sick 2-12 times a year.
The last influenza epidemic was observed in 2009, it was caused by the influenza A (H1N1) pdm 09 virus. Around the world, 220 thousand people fell ill, of which 1,900 people died. During the epidemic season of 2012-2013. influenza A (H1N1) pdm 09 virus was already circulating as a seasonal virus, along with other influenza A (H3N2) and B viruses.

In Russia during the 2013-2014 epidemic season. 138 deaths from laboratory-confirmed influenza were registered. Influenza A (H1N1) pdm 09 virus was isolated from 135 deceased people, influenza A (H3N2) virus was isolated from 1 person, and influenza B virus was isolated from 1 person. Endocrine pathology was diagnosed in 40.8% of the deceased, obesity in 24.8% and obesity in 37 .6% - diseases of the cardiovascular system.

Specific influenza vaccine prevention is quite effective. Table 2 lists the most commonly used vaccines.
The vaccines have similar immunogenicity and their composition changes every year, according to WHO forecast. The domestic influenza vaccine is a trivalent polymer-subunit vaccine, it contains polyoxidonium, a high-molecular adjuvant associated with influenza virus A (H1N1, H3N2) and B antigens - neuraminidase and hemagglutinin. Polyoxidonium enhances the formation of protective immunity, despite the reduced content of influenza virus antigens in the vaccine. Ultraviolet light is used to inactivate the virus, which increases the safety of the vaccine. Influenza is approved for use from 6 months, is included in the national vaccination calendar, is a low-reactogenic and highly purified vaccine, its safety is controlled at the level of the State Institute of Standardization and Control under Rospotrebnadzor of the Russian Federation. Numerous studies show that after vaccination, the incidence of influenza is reduced by 3-4 times compared to the control group, and due to polyoxidonium, resistance to other respiratory infections increases. For the creation of the vaccine, the team of authors was awarded the State Prize of the Russian Federation in 2002.

In risk groups (children, people over 50 years of age, patients with concomitant diseases, immunodeficiencies, allergic diseases, in which more severe infections, complications and deaths are observed), according to WHO recommendations, vaccination is carried out with subunit vaccines. Older adults are at high risk of serious complications, including secondary bacterial pneumonia, exacerbation of underlying chronic diseases, leading to hospitalization and increased mortality. Inactivated influenza vaccines have been used for more than 50 years, they are safe, tested on millions of people. Vaccination reduces the number of deaths, development and severity of complications. The Influvac vaccine has been shown to be effective in children with allergic diseases. To prevent epidemics, it is necessary to vaccinate the largest number of people. Given the large number of viruses that can cause acute respiratory infections, the incidence of influenza after vaccination should be confirmed serologically.
In a randomized controlled trial (Netherlands), after vaccination of 1838 people over 60 years of age, serologically confirmed influenza cases accounted for 58% of acute respiratory infections. The results of a meta-analysis show that vaccination against influenza among older people in various countries can reduce the number of hospitalizations by an average of 33%, including those associated with pneumonia and influenza by 27-38%, and overall mortality by 50%.

Despite advances in prevention, vaccination coverage remains limited. In the United States in 1997, less than 30% of those vaccinated under the age of 65 were vaccinated; now, according to WHO, the number of vaccinated people is increasing. The structure of the vaccine is not always fully consistent with the circulating strains; accordingly, the protective effect of the vaccine is 70-90%; in risk groups, in the elderly, and in patients with immunodeficiency, the effectiveness decreases to 30-40%.

Measures to prevent a pandemic must be taken in advance, because if it develops, the consumption of medications will increase significantly, the need for initial consultations, the number of visits to the doctor, hospitalizations, and complications will increase. According to WHO forecasts, during a pandemic, in a short period of time the number of visits to clinics will reach 233 million, hospital admissions - 5.2 million, deaths - 7.4 million people.
It is assumed that the most pronounced manifestations of the pandemic will be observed in underdeveloped countries due to insufficiently organized work of the health care system. On the other hand, there will be a shortage of vaccine and staff, which will lead to disruptions in the work of healthcare institutions, public transport, and law enforcement agencies. Without the development of a pandemic in the United States, from 10 thousand to 40 thousand people die annually from influenza, while in the last 60 years there has been no decrease in mortality rates from influenza pneumonia.

In Russia, from 27 million to 41 million patients with acute respiratory infections are registered annually, 95% of which are caused by viruses. In 2002, flu vaccinations in Russia amounted to 10-12%, in the 2013-2014 epidemic season. - 27.8% of the population. According to the order of the Ministry of Health of the Russian Federation No. 125n dated March 21, 2014 “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications,” the risk group includes: children from 6 months; students of grades 1-11 studying in professional educational organizations and educational organizations of higher education; adults working in certain professions and positions (employees of medical and educational organizations, transport, public utilities); pregnant women; adults over 60 years of age; persons subject to conscription for military service; persons with chronic diseases, including lung diseases, cardiovascular diseases, metabolic disorders and obesity.

Until the end of the 1970s. In Russia, vaccination against influenza was carried out with a live attenuated vaccine. Vaccination in risk groups with a live attenuated vaccine is impossible, which is associated with reactogenicity and the possibility of developing influenza in a weakened group of patients. In recent years, IV generation vaccines, virosomal vaccines, into which membrane antigens of the influenza virus are introduced, have been actively introduced into practical healthcare, which makes it possible to increase their immunogenicity and leads to the activation of cellular immunity, increases the titer and increases the duration of circulation of protective antibodies.

The new domestic inactivated split vaccine Ultrix® was obtained by treating influenza viruses with the detergent β-octyl glycoside and contains highly active pseudoviral particles in the form of virosomes, surface and internal antigens of influenza viruses A (H1N1 - 15 μg, H3N2 - 15 μg) and B ( 15 mcg). Administration of the vaccine does not lead to an increase in the level of immunoglobulin (Ig) E, which indicates its safety in allergic diseases. Clinical trials have demonstrated the safety of the vaccine in children over 6 years of age, adults 18-60 years of age, and adults over 60 years of age. The immunogenicity of the vaccine in terms of the level of seroconversion of antibodies to influenza virus A (H1N1) is 94%, A (H3N2) - 86%, B - 90%. The composition of vaccine antigens changes according to WHO recommendations. After 6 months after vaccination, the protective titer of antibodies to the influenza virus A (H1N1) remained in 81.3%, A (H3N2) in 61.5%, B in 47.3% of vaccinated people, while no significant decrease in antibody titer was observed. When vaccinating children, no pronounced reactogenicity was observed; the immunogenicity of the vaccine in terms of the level of seroconversion of antibodies to the influenza virus A (H1N1) was 70%, A (H3N2) - 50%, B - 70%. After vaccination, no pronounced general or local reactions were observed.
The effectiveness of vaccination was assessed in a clinical study in October - November 2013 among 5,743 residents of 7 regions of the Russian Federation, 325 of whom were over 60 years of age. A local reaction was observed in isolated cases, and no therapeutic intervention was required.

The results of vaccination against influenza in 9 schools in Podolsk, Moscow region showed a good effect, the incidence of influenza decreased by 4.7 times, and other acute respiratory viral infections by 1.4 times.
According to V.K. Tatochenko, in whole-virion and split-virion influenza vaccines, the RNA of the virus can be preserved, which can lead to increased interferon synthesis and antiviral protection against other viruses. A study of the possibility of preventing other acute respiratory viral infections after vaccination with the Ultrix® vaccine was carried out among 594 medical workers, 1,389 people from closed organized groups in the Kaluga region, 1,000 residents of Timashevsk, Krasnodar Territory. Among unvaccinated healthcare workers, the incidence of influenza was 2.8 times higher compared to vaccinated workers. In closed groups, the incidence of influenza in those unvaccinated was 47 times higher compared to those vaccinated with the Ultrix® vaccine. The incidence of influenza in vaccinated residents of Timashevsk was 2.4 times lower than in the control group. A complicated course of ARVI in vaccinated people, if the patients became ill, was registered in 9.1% of cases, in the control group - in 36% of cases.

I. Feldblum et al. An open prospective randomized study was conducted including 1008 adults from 18 to 63 years of age, 504 of them were vaccinated with the Ultrix® vaccine, 504 people were not vaccinated (control group). Within 6 months. prospectively monitored the group. The immunogenicity of the vaccine was assessed by the level of seroconversion (the proportion of people whose antiviral antibody titer increased 4 times) and seroprotection (the proportion of people whose antibody titer was more than 1:40). Observation in the post-vaccination period revealed weak local reactions in 0.8% of vaccinated people, weak general reactions in 2.8%, combined reactions in 0.4% of vaccinated people. Follow-up for 6 months. did not reveal significant changes in the biochemical parameters of blood and urine (indicators of bilirubin, creatinine, urea, liver enzymes; in the urine there was no increase in the level of protein and leukocytes). Total IgE at the beginning of the study was 50.14 IU/ml; 180 days after vaccination it remained within the normal range - 88.3 IU/ml (the difference is significant). An increase in IgE levels may be associated with increased environmental and anthropogenic load in a large city (Perm), and the predominance of T-helper type 2 immune response. The immunogenicity of the vaccine in terms of seroconversion of antibodies to influenza virus A (H1N1) was 66.7%, A (H3N2) - 53.5%, B - 46.5%. The seroconversion factor to influenza virus A (H1N1) was 5.18, A (H3N2) - 3.94, B - 3.55. Seroprotection was observed against influenza virus A (H1N1) in 98%, A (H3N2) in 76.8%, and B in 70.7% of those vaccinated. After vaccination, 31 cases of ARVI were diagnosed in vaccinated people, and 32 cases of ARVI were diagnosed in the control group. The incidence rate among vaccinated people was 61.5 per 1 thousand people, in the control group - 85.3 per 1 thousand people (the difference is significant). In the vaccinated group, the diagnosis of influenza was not confirmed; in the control group, it was confirmed in 5 people (the duration of the disease was 7.6 days (moderate form). Thus, the protection coefficient was 100%.

I. Nikonorov et al. A comparative study of the Vaxigrip vaccine and the new virosomal vaccine Ultrix® was conducted during 2007, 2008 and 2010. on the basis of the Institute of Influenza and at the Perm State Medical Academy named after. E.A. Wagner in 2011 in accordance with the national standard. The study included 1,286 people, including 78 children, 40 adults over 60 years of age, and 1,208 adults under 60 years of age. Ultrix® was used in 2 dosages:
1) 35 μg - HA antigens of influenza A viruses (H1N1 - 10 μg, H3N2 - 10 μg) and B (15 μg);
2) 45 μg - HA antigens of influenza A viruses (H1N1 - 15 μg, H3N2 - 15 μg) and B (15 μg).
The composition of the Vaxigrip vaccine is 45 mcg - HA antigens of influenza A viruses (H1N1 - 15 mcg, H3N2 - 15 mcg) and B (15 mcg). The results of observation and examination of patients by a therapist and otolaryngologist were recorded in individual registration cards. When vaccinating 150 clinically healthy volunteers aged 18-60 years, weak systemic reactions were observed in 8% with a dose of Ultrix® vaccine 35 mcg, in 12% with a dose of Ultrix® vaccine 45 mcg and in 8% with vaccination with Vaxigrip at a dose of 45 mcg . The IgE level during the first examination before vaccination exceeded the norm in 28% of cases with a dose of Ultrix® vaccine 35 mcg, in 14% of cases with a dose of Ultrix® vaccine 45 mcg and in 16% of cases before vaccination with Vaxigrip. The volunteers were not diagnosed with allergic diseases. Persons with allergic diseases were not vaccinated due to exclusion criteria.
The immunogenicity of the Ultrix® 35 mcg vaccine in terms of seroconversion of antibodies to influenza virus A (H1N1) was 94%, A (H3N2) - 86%, B - 90%. The seroconversion factor to influenza virus A (H1N1) was 18, A (H3N2) - 8.6, B - 10.4. Seroprotection was observed against influenza virus A (H1N1) in 94%, A (H3N2) in 90%, and B in 78% of vaccinated individuals.
The immunogenicity of the Ultrix® 45 mcg vaccine was similar in terms of the level of seroconversion of antibodies to influenza virus A (H1N1) - 94%, A (H3N2) - 86%, B - 90%. The seroconversion factor to influenza virus A (H1N1) was 19.4, A (H3N2) - 9.4, B - 6.9. Seroprotection was observed against influenza virus A (H1N1) in 86%, A (H3N2) in 90%, and B in 78% of those vaccinated.
The immunogenicity of the Vaxigrip 45 mcg vaccine in terms of seroconversion of antibodies to influenza virus A (H1N1) was 98%, A (H3N2) - 94%, B - 88%. The seroconversion factor to influenza virus A (H1N1) reached 26.7, A (H3N2) - 9.7, B - 14.7. Seroprotection was observed against influenza virus A (H1N1) in 100%, A (H3N2) in 94%, B in 86% of vaccinated individuals.
At the second stage, the possibility of vaccinating 40 people over 60 years of age was studied. Data on the availability of vaccinations for older people remains conflicting. 20 people were vaccinated with the Ultrix® 45 mcg vaccine and 20 people with Vaxigrip 45 mcg. Mild systemic reactions were noted in 15% of patients in each group. After vaccination, the level of total IgE remained within normal limits.
In the elderly, the immunogenicity of the Ultrix® 45 mcg vaccine was similar in terms of the level of seroconversion of antibodies to influenza virus A (H1N1) - 80%, A (H3N2) - 85%, B - 65%. The seroconversion factor for influenza virus A (H1N1) was 9.5, A (H3N2) - 12.1, B - 28.3. Seroprotection was observed against influenza virus A (H1N1) in 70%, A (H3N2) in 90%, and B in 50% of those vaccinated.
The immunogenicity of the Vaxigrip 45 mcg vaccine in the elderly in terms of the level of seroconversion of antibodies to the influenza virus A (H1N1) was 95%, A (H3N2) - 90%, B - 80%. The seroconversion factor to influenza A (H1N1) virus reached 21.9, A (H3N2) - 12.6, B - 7.5. Seroprotection was observed against influenza virus A (H1N1) in 95%, A (H3N2) in 90%, B in 80% of vaccinated individuals.
At the next stage, 36 children aged 12-18 years were vaccinated, and in 2010-2011. 42 children aged 6-12 years were vaccinated. Children were randomly divided into groups receiving Ultrix® 45 mcg and Vaxigrip 45 mcg. No increase in total IgE was observed in children during vaccination. No allergic diseases were reported, but 55% of children aged 6-12 years had elevated IgE levels and decreased during follow-up after vaccination.

The immunogenicity of the Ultrix® 45 mcg vaccine in children 12-18 years old was 70% in terms of seroconversion of antibodies to influenza virus A (H1N1), A (H3N2) - 50%, B - 70%. The seroconversion factor for influenza A (H1N1) virus was 6.5, A (H3N2) - 2.7, B - 4. Seroprotection was observed for influenza A (H1N1) virus in 90%, A (H3N2) - in 80%, B - in 85% of vaccinated people. The results are comparable to the results of vaccination with Vaxigrip 45 mcg.
Thus, studies have shown good safety, immunogenicity and low reactogenicity of the new domestic influenza virosomal vaccine Ultrix® in children over 6 years of age and adults, including people over 60 years of age.

Literature
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