Why did one of the richest people on the planet create the largest charitable foundation that supports the development and production of vaccines? Bill Gates has allocated almost $6 billion for vaccination: to fight polio, malaria, measles, hepatitis B, rotavirus and AIDS. This is part of the largest philanthropic project in human history. In his appeals to business, Bill Gates uses the concept of "capitalist charity" - long-term investments in the social sphere (health, education), when the state, science and business implement transparent and systematic programs. World health, he says, needs the private sector, but points out that medical efficiency and income are not mutually exclusive. By building the technologies of the future at Microsoft today, this man understands that vaccines are the same technologies that today lay the foundation for a healthy future for generations to come. Vaccination is recognized as one of the most effective inventions of world medicine in recent centuries. We do not know about many diseases that claimed the lives of millions of people, thanks to vaccination (smallpox, rabies, poliomyelitis and others have been defeated). The average life expectancy of the population in the world has increased by 20-30 years.
Treat and be treated more expensive
Vaccination is an economically effective preventive measure. According to the Global Alliance for Vaccines and Immunization (GAVI), for every dollar invested in vaccine prevention, the return on investment is $18. According to the Center for Infectious Disease Control (Atlanta, USA), every dollar invested in measles vaccination yields a profit of $11.9. Profit from immunization against polio is $10.3, from vaccination against rubella - $7.7, against mumps - $6.7. Immunoprophylaxis of whooping cough and Haemophilus influenzae infection brings a profit of $2.1–3.1 and $3.8, respectively.
$313 million was spent on the eradication of smallpox, the amount of damage prevented annually is $1-2 billion. No other branch of the national economy gives such an impressive return. All the costs of activities carried out under the auspices of WHO for the eradication of smallpox paid off within one month after the proclamation of its eradication.
Speaking about Russia, the annual economic damage due to rotavirus infection is more than 6.8 billion rubles, and due to the human papillomavirus (HPV) - more than 20 billion rubles. These are the first results of a study of the economic burden of diseases and the economic impact of vaccination programs, conducted by experts from the Effective Healthcare platform and presented at the Gaidar Forum in 2018.
In 2017, Effective Health experts began to develop a model for evaluating the effectiveness of vaccination. The model is based on algorithms for calculating direct economic damage (medical care costs), indirect (disability), socio-demographic (caused cases of disability, death, loss of reproductive ability), quality of life (years of quality life, life expectancy).
Using this approach, the economic burden of rotavirus and HPV was calculated.
To assess the direct damage, the experts used compulsory medical insurance rates, the actual cost of one case in health facilities, clinical recommendations, prices for medicines and medical services. When calculating the indirect damage, economic indicators were taken, for example, GDP, the level of employment of the population, the duration of the sick leave.
According to experts, most of the costs could have been avoided through vaccination and prevented more than 5,000 deaths caused by HPV-associated cancers. Moreover, preventing reproductive diseases in young women could give birth to 1,350 children a year.
According to research by the Global Alliance for Vaccines and Immunization, about 100 million people are on the verge of poverty due to healthcare costs, while timely vaccination from 2016 to 2020 will save 24 million people from poverty in 41 countries of the alliance.
High technologies against infections
The production of vaccines is a complex multi-step process that takes an average of 4 to 36 months, while the production of a solid dosage form (tablet) can take about three weeks. At the same time, the bulk of this time (up to 70%) is occupied by quality control, which includes several hundred different tests, and this is normal, because healthy newborns are vaccinated with vaccines. Therefore, in general, the costs of production and release of the vaccine into circulation are much higher compared to the solid dosage form. Even the transfer of technology to a production site in Russia can take up to three to five years. Not to mention the development of vaccines from scratch is billions of dollars, 10-15 years before entering the market. Thus, the production of vaccines is a process with a delayed business outcome, and immunization is an investment in the prevention of infectious diseases with a delayed effectiveness for the health system.
Realizing the high demand and clear benefits of using vaccines, the industry continues to evolve, offering health care technological and scientific solutions in the fight against the spread of life-threatening infections, for which there are no geographical boundaries. Each local manufacturer keeps the defense in his country, preventing viruses from spreading. World leaders solve the problem on a global scale. Be that as it may, vaccination has been and will be one of the most profitable types of investments in healthcare, because it can significantly reduce the costs of the state and the citizens themselves for the treatment of infectious diseases, and also solves the problem of reducing the incidence and mortality from infections, and hence increasing life expectancy of the country's population.
Introduction
Currently, vaccination is considered the most effective method of preventing infectious diseases. Global immunization of the population throughout the world has made it possible to eliminate the incidence of smallpox, to reduce the prevalence and frequency of complications of such infectious diseases as diphtheria, tetanus, and poliomyelitis.
Prevention of infectious diseases is one of the urgent tasks of public health throughout the world. For example, the World Health Organization Regional Office for Europe published the European Vaccine Action Plan 2015–2020, which includes six main goals.
- Maintaining the region's polio-free status.
- Elimination of measles and rubella.
- control of the spread of hepatitis B.
- Achievement of regional vaccination targets at all administrative levels.
- Make evidence-based decisions about introducing new vaccines.
- Achieve financial sustainability of national immunization programs .
Vaccination is a method of active specific prophylaxis that allows the vaccinated person to develop specific immunity against the causative agent of an infectious disease. With mass vaccination for a long time, a layer of the population is formed that is immune to a certain infection, which reduces the possibility of circulation and spread of an infectious agent in the population, and, consequently, the incidence even among unvaccinated individuals. In addition, the introduction of vaccines against certain viruses can prevent not only the development of an infectious disease, but also its complications and consequences (for example, cervical cancer - with human papillomavirus infection).
Basic legislative documents and normative acts on vaccination. National calendar of preventive vaccinations
The main legislative documents on vaccination in Russia are Federal Law No. 157-FZ of September 17, 1998 (as amended on December 31, 2014, as amended on April 6, 2015) “On Immunoprophylaxis of Infectious Diseases” and Federal Law No. 52-FZ of March 30, 1999 Federal Law (as amended on November 28, 2015) “On the sanitary and epidemiological welfare of the population”.
The national calendar of preventive vaccinations currently in force in our country (Table 1) is determined by the order of the Ministry of Health of Russia dated March 21, 2014 No. 125n “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications”.
The procedure for conducting preventive vaccinations is presented in the guidelines No. 3.3.1889-04, approved by the Chief State Sanitary Doctor of the Russian Federation on 03/04/2004.
Guidelines No. 3.3.1.1095-02 dated January 9, 2002 contain medical contraindications for preventive vaccinations, recommendations for vaccination in the presence of relative contraindications.
Depending on the epidemiological situation, changes are made to the national vaccination schedule. In addition, regulations may be issued that regulate additional immunization according to epidemiological indications, vaccination of certain groups of the population, etc.
Thus, in 2011, vaccination against hemophilic infection (for children at risk) was included in the national vaccination schedule in Russia, and in 2014, vaccination against pneumococcal infection was included. In addition, some changes were made to the list of indications for influenza vaccination.
In some regions of Russia, additional vaccines have been introduced into the vaccination calendar. So, in Moscow, the regional calendar of preventive vaccinations, approved by order of the Moscow Department of Health dated July 4, 2014 No. 614, includes vaccination of children at 12 months of age. against chickenpox, children aged 3–6 years against hepatitis A (before entering preschool educational organizations) and vaccination of girls at 12–13 years old against the human papillomavirus.
Vaccinations that are not included in the national vaccination calendar and the vaccination calendar according to epidemiological indications can be carried out at the request of patients with vaccines registered in Russia, taking into account indications and contraindications.
Table 1
National calendar of preventive vaccinations
(Appendix No. 1 to the order of the Ministry of Health of Russia dated March 21, 2014 No. 125n)
Name of preventive vaccination |
|
Newborns in the first 24 hours of life | First vaccination against viral hepatitis B (note 1) |
Newborns on the 3rd–7th day of life | Tuberculosis vaccination (note 2) |
Children, 1 month | Second vaccination against viral hepatitis B (note 1) |
Children, 2 months | Third vaccination against hepatitis B (risk groups) (note 3) |
First vaccination against pneumococcal infection |
|
Children, 3 months | First vaccination against diphtheria, whooping cough, tetanus |
First vaccination against polio (note 4) |
|
First vaccination against Haemophilus influenzae (risk groups) (note 5) |
|
Children, 4.5 months | Second vaccination against diphtheria, whooping cough, tetanus |
Second vaccination against polio (note 4) |
|
Second vaccination against Haemophilus influenzae (risk groups) (Note 5) |
|
Second pneumococcal vaccination |
|
Children, 6 months | Third vaccination against diphtheria, whooping cough, tetanus |
Third vaccination against viral hepatitis B (note 1) |
|
Third polio vaccination (note 6) |
|
Third vaccination against Haemophilus influenzae (risk groups) (note 5) |
|
Children, 12 months | Vaccination against measles, rubella, mumps |
Fourth vaccination against viral hepatitis B (risk groups) (note 1) |
|
Children, 15 months | Revaccination against pneumococcal infection |
Children, 18 months | First revaccination against diphtheria, whooping cough, tetanus |
First revaccination against polio (note 6) |
|
Revaccination against Haemophilus influenzae (risk groups) (Note 5) |
|
Children, 20 months | Second revaccination against polio (note 6) |
Children, 6 years old | Revaccination against measles, rubella, mumps |
Children 6–7 years old | Second revaccination against diphtheria, tetanus (note 7) |
Revaccination against tuberculosis (note 8) |
|
Children, 14 years old | Third revaccination against diphtheria, tetanus (note 7) |
Third revaccination against polio (note 6) |
|
Adults, 18 years old | Revaccination against diphtheria, tetanus - every 10 years from the last revaccination |
Children from 1 to 18 years old, adults from 18 to 55 years old, not previously vaccinated | Vaccination against viral hepatitis B (note 9) |
Children from 1 to 18 years of age, women from 18 to 25 years of age (inclusive), not ill, not vaccinated, vaccinated once against rubella, who do not have information about vaccinations against rubella | Rubella vaccination |
Children from 1 to 18 years of age inclusive and adults under the age of 35 inclusive, not ill, not vaccinated, vaccinated once, who do not have information about vaccinations against measles | Measles vaccination (note 10) |
Children from 6 months; students in grades 1–11; students in professional educational organizations and educational institutions of higher education; adults working in certain professions and positions (employees of medical and educational organizations, transport, public utilities); pregnant women; adults over 60; persons subject to conscription for military service; people with chronic diseases, including lung disease, cardiovascular disease, metabolic disorders and obesity | Influenza vaccination |
Notes:
1. The first, second and third vaccinations are carried out according to the scheme 0-1-6 (1st dose - at the time of the start of vaccination, 2nd dose - 1 month after the 1st vaccination, 3rd dose - 6 months after start of vaccination), with the exception of children at risk, whose vaccination against viral hepatitis B is carried out according to the scheme 0-1-2-12 (1st dose -
at the start of vaccination, 2nd dose - 1 month after the 1st vaccination, 3rd dose - 2 months after the start of vaccination, 4th dose - 12 months after the start of vaccination).
2. Vaccination is carried out with a vaccine for the prevention of tuberculosis for sparing primary vaccination (BCG-M); in the subjects of the Russian Federation with incidence rates exceeding 80 per 100 thousand of the population, as well as in the presence of tuberculosis patients in the environment of a newborn - a vaccine for the prevention of tuberculosis (BCG).
3. Vaccination is carried out for children at risk (born from mothers - carriers of HBsAg, patients with viral hepatitis B or who had viral hepatitis in the third trimester of pregnancy, who do not have the results of an examination for hepatitis B markers, who use narcotic drugs or psychotropic substances, from families in which there is a carrier of HBsAg or a patient with viral hepatitis B and chronic viral hepatitis).
4. The first and second vaccinations are carried out with a vaccine for the prevention of polio (inactivated).
5. Vaccination is carried out for children belonging to risk groups (with immunodeficiency conditions or anatomical defects leading to a sharply increased risk of hemophilic infection; with oncohematological diseases and / or receiving long-term immunosuppressive therapy; children born from mothers with HIV infection; children with HIV infection; children in orphanages).
6. The third vaccination and subsequent revaccinations against poliomyelitis are given to children with a live vaccine for the prevention of poliomyelitis; children born to mothers with HIV infection, children with HIV infection, children in orphanages - with an inactivated vaccine to prevent poliomyelitis.
7. The second revaccination is carried out with toxoids with a reduced content of antigens.
8. Revaccination is carried out with a vaccine for the prevention of tuberculosis (BCG).
9. Vaccination is carried out for children and adults who have not previously been vaccinated against viral hepatitis B, according to the 0–1–6 scheme (1st dose -
at the start of vaccination, the 2nd dose - 1 month after the 1st vaccination, the 3rd dose - 6 months after the start of vaccination).
10. The interval between the first and second vaccinations must be at least 3 months.
All citizens of the Russian Federation have the right to free preventive vaccinations included in the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications in medical organizations of the state and municipal health systems.
Financing of vaccinations that are not included in the National Immunization Calendar is carried out at the expense of regional budgets, citizens' funds and from other sources not prohibited by the legislation of the Russian Federation.
Types of drugs for vaccination
Vaccines are drugs that are obtained from microorganisms or their metabolic products. The active principle of vaccines is specific antigens, which, when introduced into the human body, cause the development of immunological reactions (an active immune response), which subsequently provide immune resistance to pathogenic microorganisms.
Thus, the statements of opponents of vaccination that vaccination depresses one's own immunity can be called unfounded.
All vaccine preparations are usually evaluated according to three parameters:
- security, that is, the absence of pathogenicity (the ability to cause vaccine-associated diseases) for humans;
- reactogenicity, or the property to cause adverse post-vaccination reactions;
- immunogenicity- the ability to induce a pronounced protective immune response.
Vaccines should be safe, have minimal reactogenicity and at the same time retain high immunogenicity.
In accordance with the method of obtaining and the type of specific antigen, all vaccines can be divided into several types.
Live vaccines(e.g. measles, rubella, oral poliomyelitis) contain attenuated live microorganisms that have lost their virulence but retained their immunogenic properties. The advantages of such vaccines include their ability to stimulate long-term and lasting immunity, and therefore this type of drugs can be administered once or with rare revaccinations (once every 5–10 years). The disadvantages of live vaccines include thermolability, photosensitivity, the impossibility of strict dosing. In addition, live vaccines can cause vaccine-associated diseases in immunocompromised individuals.
Inactivated (killed) vaccines contain inactivated (killed) by heat, ultraviolet radiation, alcohol, etc. pathogenic microorganisms (for example, whole cell pertussis vaccine, inactivated polio vaccine) or subcellular structures (acellular pertussis vaccine, pneumococcal vaccine). The advantages of inactivated vaccines are thermal stability and the possibility of strict dosing. At the same time, they create only humoral immunity, which is less stable than after the introduction of live vaccines, which requires repeated administration. Also, inactivated vaccines have disadvantages such as instability to freezing and high reactogenicity. At the same time, whole-cell vaccines containing whole killed microorganisms are more reactogenic. Drugs containing subunit (subcellular) structures are much less likely to cause adverse reactions.
Anatoxins(diphtheria, tetanus) - chemically neutralized (inactivated) exotoxins of microorganisms that have retained their antigenic structure. In general properties, these immunopreparations are similar to inactivated vaccines, including that they require repeated administration. Anatoxins create only antitoxic immunity in the absence of antimicrobial. In the case of infection, patients vaccinated with toxoids develop non-toxic forms of an infectious disease (for example, diphtheria) or carriage, which avoids serious complications.
Recombinant vaccines obtained by genetic engineering. This type of immunopreparations includes vaccines against the hepatitis B virus (contains the surface antigen of the virus - HBsAg, which causes an immune response), human papillomavirus, rotavirus. The advantages of such vaccines are the ability to form a sufficiently stable long-term immunity and low reactogenicity.
The main vaccinations of the national calendar
The national vaccination calendar was developed taking into account international recommendations and the epidemiological situation in Russia.
Thus, the need for vaccination against tuberculosis is due to the continuing high incidence in Russia (according to Rospotrebnadzor data for 2014 - 54.5 per 100,000 people).
The importance of vaccination against diphtheria, tetanus, whooping cough, poliomyelitis is dictated by their severe course and high mortality rates in these diseases.
Despite the decrease in the incidence of viral hepatitis B, immunization of the population is still relevant, especially in risk groups, due to the severe course of hepatitis B, frequent transition to chronic forms and a high level of disability.
Rubella vaccination is aimed not only at preventing the development of severe forms of this disease, especially in adolescents and adults, but first of all at preventing this disease in pregnant women, since it is dangerous for the development of congenital rubella syndrome.
Vaccination of measles and mumps is also focused on preventing the development of severe forms and serious complications of these diseases.
The high risk of life-threatening complications from influenza dictates the need for vaccination against this infection, especially in risk groups, including children and the elderly.
Vaccination against Haemophilus influenzae is aimed at reducing the incidence of diseases caused by this pathogen. Haemophilus influenzae b is a common cause of purulent otitis media, pneumonia, meningitis, and epiglottitis in children. Children aged from 4 months get sick most often. up to 5 years. About 200 thousand deaths of children under 5 years old (mainly from meningitis and pneumonia) per year are associated with this infection. After meningitis caused by hemophilic infection, 15-35% of patients have persistent disorders leading to disability. About 5% of children with meningitis caused by Haemophilus influenzae die.
The introduction of vaccination against pneumococcal infection into the national vaccination schedule is associated with both a high incidence of pneumococcal pneumonia, otitis, meningitis, and with the increasing resistance of pneumococci to antibiotics.
Hepatitis B vaccination
In accordance with the national calendar of preventive vaccinations, vaccination against viral hepatitis B is carried out for all newborns in the first 24 hours of life. The need for early vaccine administration is dictated by the continuing high incidence of viral hepatitis B and virus carriers, especially in the age group from 15 to 29 years, as well as the high risk of infection of the child during childbirth or during breastfeeding. If the child was not vaccinated at birth for any reason (presence of relative contraindications, parents' refusal, etc.), it can be carried out at any age by drawing up an individual vaccination schedule.
The National Immunization Schedule also provides vaccination against viral hepatitis B for unvaccinated children from 1 to 18 years of age and adults from 18 to 55 years of age.
For the prevention of viral hepatitis B, recombinant (genetically engineered) vaccines are used.
Vaccination against viral hepatitis B is carried out according to two main schemes - 0-1-6 and
0–1–2–12.
Scheme 0-1-6, when the first vaccination is given in the first 24 hours of a newborn's life (0), the second vaccination at 1 month (1), and the third at 6 months, is recommended for children who are not at risk.
The 0–1–2–12 vaccination schedule (after the first vaccination, the second one is given 1 month later, the third one 2 months after the first, and the fourth one 12 months after the first) is used in children from risk groups, which include children born:
1) from mothers - carriers of HBsAg, patients with viral hepatitis B or who had viral hepatitis in the third trimester of pregnancy, who do not have the results of an examination for hepatitis B markers;
2) from mothers who use narcotic drugs or psychotropic substances;
3) in families where there is an HBsAg carrier, a patient with acute viral hepatitis B and chronic viral hepatitis.
Also, the 0-1-2-12 regimen is used in adults at risk for infection with the hepatitis B virus (for example, in patients on hemodialysis).
Vaccination against viral hepatitis B in children who are not at risk, who have not received vaccinations before the age of 1 year, as well as adolescents and adults who have not been vaccinated before, is carried out according to the 0-1-6 scheme (the first dose is on the day the vaccination starts, the second dose - after 1 month, the third dose - after 6 months from the start of immunization).
Tuberculosis vaccination
Vaccination against tuberculosis is carried out for newborns in the first 3-7 days of life. For the prevention of tuberculosis, the BCG vaccine (BCG - Bacillus Calmette - Guerin), containing live attenuated mycobacteria of the vaccine strain (Micobacterium bovis), and BCG-M, in which the content of mycobacteria is less than in BCG, is used. In regions where the incidence of tuberculosis exceeds 80 per 100 thousand of the population, it is recommended to use BCG for vaccination of newborns. The same vaccine is used to immunize newborns around whom there are patients with tuberculosis. In other cases, children are vaccinated with a vaccine for the prevention of tuberculosis for a sparing primary vaccination with BCG-M.
Revaccination is carried out at 7 years of age for uninfected children with a negative Mantoux reaction with the BCG vaccine.
Vaccination against pneumococcal infection
Two types of vaccines are used to prevent pneumococcal infections: conjugated and polysaccharide.
Pneumococcal conjugate vaccines (PCV) contain pneumococcal polysaccharides conjugated to a carrier protein. The composition of PCV10 (Synflorix) includes polysaccharides of 10 pneumococcal serotypes, conjugated with the D-protein of acapsular H. influenzae, tetanus and diphtheria toxoids. PCV13 (Prevenar) contains polysaccharides from 13 pneumococcal serotypes conjugated to the CRM197 carrier protein (diphtheria toxoid). Conjugate vaccines do not contain a preservative. Pneumococcal conjugate vaccines are used in children of the first 5 years of life, and PCV13 also in people over 50 years of age.
The pneumococcal polysaccharide vaccine (PPV) contains purified capsular polysaccharides from 23 pneumococcal serotypes (Pneumo 23).
PPV is used to vaccinate children over 2 years of age and adults over 65 years of age, as well as from risk groups.
Vaccination against pneumococcal infection in accordance with the national vaccination schedule includes two injections of a conjugate vaccine in the first year of a child's life (at 2 and 4.5 months) and revaccination at 15 months.
Risk groups for developing severe pneumococcal infection include:
- patients with chronic diseases of the lungs, cardiovascular system, liver, kidneys, with diabetes mellitus;
- persons with immunodeficiency states (HIV, oncological diseases receiving immunosuppressive therapy);
- persons with anatomical/functional asplenia;
- premature babies;
- persons staying in organized institutions (orphanages, boarding schools, army collectives);
- patients after cochlear implantation;
- patients with liquorrhea;
- long-term and frequently ill children;
- patients infected with Mycobacterium tuberculosis.
Vaccination against diphtheria and tetanus
For the vaccination of diphtheria and tetanus, diphtheria and tetanus toxoids are used, which are part of the combined preparations (DPT, ADS, ADS-M, Infanrix-Geksa, Pentaxim, etc.).
Vaccination against diphtheria and tetanus is carried out three times starting from 3 months with an interval between injections of 45 days (1.5 months). Revaccination is carried out at 18 months (or 1 year after the last vaccination), at 7 years and at 14 years. For adults, revaccination is carried out every 10 years after the last injection of the vaccine.
It should be remembered that the introduction of toxoids allows the formation of only antitoxic immunity, therefore, vaccinated patients may suffer from, for example, diphtheria, but the disease will proceed in the form of a bacteriocarrier or in a non-toxic form, without the development of severe complications (with properly performed immunization and an adequate immune response).
Polio vaccination
For polio vaccination, live oral polio vaccine (OPV) and inactivated polio vaccine (IPV) are used. In this case, IPV can be either an independent drug (Imovax-Polio) or a component of a combined vaccine.
Vaccination against poliomyelitis is carried out three times (simultaneously with the introduction of DPT) starting from 3 months with an interval between vaccine injections of 45 days (1.5 months). Revaccination is carried out at 18 months
(also with DTP) and at 20 months. At the age of 14, the last revaccination against polio is carried out.
In accordance with the vaccination schedule, the first and second vaccinations of children (at 3 and 4.5 months) are carried out with IPV, and the third vaccination and all subsequent revaccinations are carried out with OPV (if there are no contraindications). However, it is possible to carry out a complete series of vaccinations and revaccination with inactivated polio vaccine. Children who have contraindications to OPV (immunodeficiency conditions, malignant neoplasms) are administered IPV.
Whooping cough vaccination
Prevention of whooping cough is most important in children of the first year of life, since this disease is especially severe at an early age.
For the immunoprophylaxis of whooping cough, combined vaccines containing killed whole-cell pertussis microbes, diphtheria and tetanus toxoids (DPT, Bubo-Kok) are used. Cell-free vaccines (Infanrix-Gexa, Pentaxim) are also used, which do not contain a whole pertussis component, which ensures low reactogenicity of these vaccines compared to whole-cell vaccines.
The course of vaccination against whooping cough consists of three injections of the vaccine with an interval of 45 days with revaccination after 1 year. In accordance with the vaccination schedule, vaccination is carried out for children at 3, 4.5 and 6 months, revaccination - at 18 months. In case of violation of the vaccination schedule, pertussis vaccination must be completed before the child reaches the age of 4 years. After this age, vaccination against whooping cough is not carried out, and for the immunoprophylaxis of diphtheria and tetanus, drugs that do not contain a pertussis component are used. In many European countries and in the USA, additional revaccination of children at 4-6 years of age with acellular (acellular) pertussis vaccine is included in the vaccination schedule. In Russia, such revaccination is included in the regional vaccination schedule of the Sverdlovsk region.
Vaccination against Haemophilus influenzae
Vaccination against hemophilic infection is carried out for children from risk groups three times in 3, 4.5 and 6 months, revaccination - once in 18 months. (12 months after the third vaccination). If for some reason vaccination is started after 6 months, it is sufficient to administer the vaccine twice with an interval of 1-2 months. Risk groups include children with immunodeficiency conditions or anatomical defects that increase the risk of hemophilic infection, children with hematological malignancies and / or long-term immunosuppressive therapy, children from mothers with HIV infection, children with HIV infection, children in orphanages .
Measles vaccination
Vaccination against R and carried out with a live measles vaccine or combined divaccines (measles-mumps) or trivaccines (measles-mumps-rubeus). The use of di- and trivaccines is preferable to monovaccines, as it allows to reduce the number of injections.
Vaccination against measles is carried out at 12 months once, revaccination - at 6 years. In addition, children from 1 to 18 years of age and adults under the age of 35 years (inclusive) who have not been ill, not vaccinated, vaccinated once, who do not have information about prophylactic vaccinations against measles, are subject to immunization against measles.
Vaccination against mumps
Vaccination against mumps is carried out with a live mumps vaccine, as well as di- or trivaccines (measles-mumps, measles-mumps-rubeella) at 12 months once, revaccination - at 6 years.
Rubella vaccination
Vaccination against rubella is carried out with a live rubella vaccine or trivaccine (measles-rubella-mumps) at 12 months once, revaccination at 6 years. In addition, the vaccination schedule regulates the vaccination of children from 1 to 18 years old, women from 18 to 25 years old (inclusive), who have not been ill, not vaccinated, vaccinated once, who do not have information about rubella vaccinations.
Influenza vaccination
Influenza vaccination has been included in the list of mandatory vaccinations of the national calendar since 2006. In accordance with the vaccination calendar, children from 6 months old are subject to vaccination; students in grades 1–11; students in professional educational organizations and educational institutions of higher education; adults working in certain professions and positions (employees of medical and educational organizations, transport, public utilities); pregnant women; adults over 60; persons subject to conscription for military service; persons with chronic diseases.
Influenza vaccines contain antigens of influenza A/H1N1, A/H3N2 and B viruses. The antigenic composition of vaccines is updated annually depending on the predicted epidemic situation.
The live intranasal vaccine contains attenuated influenza virus strains and is used in children from 3 years of age and adults.
Subunit and split vaccines are used in children from 6 months. and adults.
Subunit vaccines (Influvac, Agrippal S1) contain 15 μg of antigens of each strain. The composition of the Grippol® plus subunit vaccine includes the polyoxidonium immunoadjuvant, which makes it possible to reduce the content of antigens of each strain to 5 μg.
Split vaccines (split) - Begrivac, Vaxigrip, Fluarix, Fluvaxin - contain 15 micrograms of antigens of each influenza virus strain.
The listed subunit and split vaccines are available without a preservative.
In Russia, the virosomal vaccine Inflexal V is also registered, which includes virosomes of highly purified surface antigens of influenza A (H1N1 and H3N2) and B (15 μg for each strain). Inflexal V does not contain preservatives, formaldehyde, antibiotics.
Despite the fact that modern inactivated vaccines do not contain stabilizing drugs and antibiotics, it must be taken into account that chicken embryos are used for the production of most of these vaccines. In this regard, the presence of up to 0.05 μg of ovalbumin in a single dose is allowed, which can provoke undesirable local or systemic reactions in persons with intolerance to chicken protein.
Vaccination according to epidemic indications
The calendar of preventive vaccinations according to epidemic indications is presented in Table. 2. The vaccines listed in it are administered at an increased risk of contracting one or another infectious disease associated with the profession, place of residence, being in the focus of the disease, etc.
For example, vaccination against rabies and leptospirosis is carried out for persons who, by the nature of their activities, encounter stray animals, and therefore have a high risk of infection with pathogens of these diseases. Contact with a patient with diphtheria is an indication for vaccination in persons who have not previously been vaccinated against this disease.
In recent years, the vaccination schedule for epidemiological indications in our country has also been expanded. In particular, it included vaccination against chicken pox and rotavirus infection.
table 2
Preventive vaccination calendar according to epidemic indications
(Appendix No. 2 to the order of the Ministry of Health of Russia dated March 21, 2014 No. 125n)
Name of vaccination | |||
Against tularemia | Persons living in territories enzootic for tularemia, as well as those who arrived in these territories - agricultural, irrigation and drainage, construction, other works on excavation and movement of soil, procurement, commercial, geological, surveying, forwarding, deratization and pest control; – for logging, clearing and landscaping of forests, recreation and recreation areas for the population. *) Persons working with live cultures of the tularemia pathogen |
||
Against the plague | Persons residing in plague-enzootic territories. Persons working with live cultures of the plague agent |
||
Against brucellosis | In the foci of goat-sheep type of brucellosis, persons performing the following work: - for the procurement, storage, processing of raw materials and livestock products obtained from farms where livestock diseases with brucellosis are recorded; - for the slaughter of livestock suffering from brucellosis, the procurement and processing of meat and meat products obtained from it. Animal breeders, veterinarians, livestock specialists in brucellosis enzootic farms. Persons working with live cultures of the causative agent of brucellosis |
||
Against anthrax | Persons performing the following work: – livestock veterinarians and other persons professionally engaged in ante-mortem keeping of livestock, as well as slaughter, skinning and butchering of carcasses; – collection, storage, transportation and primary processing of raw materials of animal origin; - agricultural, irrigation and drainage, construction, excavation and movement of soil, procurement, commercial, geological, prospecting, forwarding in anthrax enzootic territories. Persons working with material suspected of being infected with anthrax |
||
Against rabies | For prophylactic purposes, people who are at high risk of contracting rabies are vaccinated: – persons working with “street” rabies virus; – veterinarians; huntsmen, hunters, foresters; persons performing work on catching and keeping animals |
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Against leptospirosis | Persons performing the following work: - for the procurement, storage, processing of raw materials and livestock products obtained from farms located in areas enzootic for leptospirosis; - for slaughter of cattle suffering from leptospirosis, procurement and processing of meat and meat products obtained from animals suffering from leptospirosis; – on catching and keeping neglected animals. Persons working with live cultures of the causative agent of leptospirosis |
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Against tick-borne viral encephalitis | Persons living in the territories endemic for tick-borne viral encephalitis, as well as persons who arrived in these territories and perform the following works: agricultural, hydro-reclamation, construction, excavation and movement of soil, procurement, commercial, geological, surveying, forwarding, deratization and pest control; for logging, clearing and landscaping of forests, recreation and recreation areas for the population. Persons working with live cultures of the causative agent of tick-borne encephalitis |
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Against Q fever | Persons performing work on the procurement, storage, processing of raw materials and livestock products obtained from farms where Q fever diseases in livestock are recorded. Persons performing work on the preparation, storage and processing of agricultural products in the enzootic territories for Q fever. Persons who work with live cultures of Q fever pathogens |
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against yellow fever | Persons traveling outside the Russian Federation to countries (regions) enzootic for yellow fever. Persons handling live cultures of the yellow fever pathogen |
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against cholera | Persons traveling to cholera-prone countries (regions). The population of the constituent entities of the Russian Federation in case of complication of the sanitary and epidemiological situation for cholera in neighboring countries, as well as on the territory of the Russian Federation |
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Against typhoid fever | Persons employed in the field of communal improvement (employees servicing sewer networks, facilities and equipment, as well as organizations engaged in sanitary cleaning of populated areas, collection, transportation and disposal of household waste). Persons working with live cultures of typhoid pathogens. Population living in areas with chronic waterborne epidemics of typhoid fever. Persons traveling to countries (regions) hyperendemic for typhoid fever. Contact persons in the foci of typhoid fever according to epidemiological indications. According to epidemic indications, vaccinations are carried out when there is a threat of an epidemic or outbreak (natural disasters, major accidents on the water supply and sewerage networks), as well as in Irina Evgenievna MoiseevaNorth-Western State Medical University named after I.I. Mechnikov
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Partnership Programs |
Aptekarskiy per, d. 3, lit. A, office 1H, 191186 Saint-Petersburg, Russia |
The first All-Russian scientific and practical conference with international participation "Modern Immunoprophylaxis: Challenges, Opportunities, Prospects" was held on October 17-18, 2019 in the building of the Government of Moscow (Noviy Arbat St., 36).
Preventing the spread of infections through immunization is one of mankind's greatest achievements in the field of medicine. During the life of one generation, more than ten severe infections were eliminated or reduced to single cases.
In the world and Russia
According to WHO, the epidemiological situation in the world for a number of infectious diseases remains unstable: measles outbreaks are recorded in Ukraine, Europe and South America, anthrax in Romania, Ukraine and Kazakhstan, Zika fever in the Caribbean and North America . In different countries of the world, cases of meningococcal infection, Dengue and Ebola fevers are noted. All this is a prerequisite for the penetration of infections into Russia and requires constant monitoring of the epidemiological situation in the world and an increase in anti-epidemic preparedness measures.
“Against this background, the unconditional successes of Russia are obvious,” said Anna Popova, Chief State Sanitary Doctor of the Russian Federation, head of the Federal Service for Supervision of Consumer Rights Protection and Human Welfare. – Despite the complication of the measles and rubella epidemiological situation in the countries of the European Region, in Russia it was possible to stabilize it by carrying out additional measures to immunize the population, including children, and achieve the lowest rubella incidence rates in all the years of observation. Today, within the framework of the national calendar of preventive vaccinations, the coverage of the population with vaccinations is approaching 75% and makes it possible to prevent severe and fatal cases of diseases.
Another acute issue facing public health is the immunization of the population as a solution to the problem of biosecurity in modern realities: the concentration of the population in large cities, increasing the permeability of borders, climate change, etc.
- The role of immunoprophylaxis increases significantly in large cities, where a high concentration of the population increases the likelihood of contracting infectious diseases. Public transport, mass cultural and sports events, high migration flows - all these factors create increased risks of epidemiological threats, - says Vasily Akimkin, director of the Central Research Institute of Epidemiology of Rospotrebnadzor.
The importance of immunoprophylactic measures for people traveling to regions and countries endemic for dangerous infectious and natural focal infections is constantly reminded by scientists and epidemiologists. Information about the epidemiological situation in the world (outbreaks of new and old infectious diseases, an increase in seasonal incidence, etc.), as well as the necessary precautions for tourists traveling abroad, is regularly updated on the Rospotrebnadzor website.
2019 has clearly demonstrated the enormous role of vaccination in combating the biological threats associated with climate change. The state was faced with the acute question of the need for a set of preventive sanitary and medical measures in flood zones in the Irkutsk and Amur regions. In all territories that fell into the flood zone, measures were organized to prevent the formation of epidemic foci, and the population was immunized against Sonne dysentery and typhoid fever. All this made it possible to avoid group and outbreak morbidity.
Problem number one
One of the most urgent problems is the incidence of respiratory viral infections, in particular influenza, which remain the most widespread not only in Russia, but also in the world. The rise in incidence occurs in mid-autumn, and influenza vaccination is the main and most effective way to prevent the disease.
According to Rospotrebnadzor, this year it is planned to vaccinate at least 45% of the population. Particular attention will be paid to risk groups, namely: children, pregnant women, people with chronic diseases, people over 60 and healthcare workers.
More vaccinations
The national vaccination calendar is constantly being improved; in recent years, significant changes have taken place in it: vaccinations against hemophilic and pneumococcal infections have been introduced; expanded indications for the use of BCG-M vaccine; the list of persons to be vaccinated against influenza included pregnant women and citizens subject to conscription for military service. But it is too early to stop there, scientists are sure.
- Against Haemophilus influenzae type "B" we vaccinate only children at risk. There is no vaccination against papillomavirus infection, the role of which is very significant in the violation of the reproductive health of the population, - says the chief epidemiologist of the Ministry of Health, Academician of the Russian Academy of Sciences Nikolai Briko. – Russian scientists are actively working today to solve the problem of adult immunization. Today, vaccination is seen as a means of achieving healthy and active longevity.
“We need a special calendar for older people,” Anna Popova is sure. – As a result of scientific research, we came to the conclusion that we need to pay attention to the state of post-vaccination immunity of women who are going to become pregnant.
Another urgent problem in the light of today's requirements is the development and implementation of domestic vaccines. It is necessary to focus on the domestic production of vaccines against chicken pox, whooping cough, rotavirus and papillomavirus infections, which today have to be purchased abroad, scientists are sure.
“The creation of multicomponent vaccines is one of the strategic directions for the development of vaccine prevention, since their use reduces the number of injections, thereby increasing adherence to vaccination and, as a result, contributes to achieving higher vaccination coverage,” says the head of the Scientific and Methodological Center for Immunoprophylaxis of Rospotrebnadzor, working on the basis of laboratories of immunoprophylaxis of the Central Research Institute of Epidemiology of Rospotrebnadzor, Irina Mikheeva. – When creating domestic vaccines, it is necessary to use data on the current antigenic structure of pathogens circulating in the country.
Vaccination of such bacterial infections as pneumococcal, meningococcal, Hib infection and whooping cough is needed not only to reduce the incidence and mortality of the child and adult population, but also to prevent the formation of antibiotic resistance of pathogens of infectious diseases.
Immunoprophylaxis as a way of life
One of the main challenges facing the medical community is to counter the anti-vaccination lobby.
– Vaccination has become the norm for most of our fellow citizens, but not for all. Anti-vaccination sentiment, which is sometimes present and fueled, as a rule, by anonymous sources on the Internet, still exists. Therefore, we carry out daily, consistent work to inform the population about the need for vaccination. Although the numbers speak for themselves: after the start of the vaccination campaign against diphtheria, whooping cough, measles and rubella in the early 60s, the incidence of diphtheria and measles decreased by 6 thousand times, says Anna Popova.
Immunoprophylaxis has been and remains one of the most important areas of government policy in the field of public health, epidemiological and biological security of the country. Experts are confident that for the successful implementation of the immunization program, it is necessary to combine the efforts of specialists in various fields in the implementation of a systematic approach to ensuring the quality, effectiveness and safety of vaccine prevention.
Infectious diseases have been integral companions of mankind since its inception. They are caused by pathogenic microorganisms, are rapidly transmitted from person to person, and used to cause mass mortality, especially in childhood.
After the invention of antibiotics, the number of people dying as a result of epidemics decreased, but many diseases caused serious complications and disability in those who suffered them.
Noticeable successes in the treatment and prevention of infectious diseases were achieved after. The method of protection against infections with their help is called - today it is used.
Goals and principles of vaccination and vaccine therapy of infectious diseases
The principles of vaccination are based on immunological memory - the ability of the human body against infectious diseases.
Faced with bacteria and viruses, defense cells not only defeat them, but also “remember” the specific features of foreign agents. If they enter the body a second time, the immune response will be faster and more effective, due to which the activity of pathogenic organisms is suppressed.
In the presence of stable immunity, the disease does not develop at all or proceeds in a mild form and does not cause complications. The effect of immunological memory can be achieved by introducing preparations containing weakened microbes, related microorganisms or their fragments into the body.
Such drugs are called - they are widely used throughout the world for the treatment and prevention of infectious diseases. The introduction of drugs in order to form an immune response to prevent diseases is called vaccine prophylaxis, and their use for treatment is called vaccine therapy.
The main task of vaccination is to reduce morbidity and combat infectious diseases that can cause mass mortality and serious complications.
To date, it is considered the most effective way to protect the population, prevent outbreaks of infections and improve the epidemiological situation.
The full effect of vaccination is possible only with the formation of herd immunity. This is possible only if the number of vaccinated people in the country is at least 90%.
The role of preventive vaccinations
In the Middle Ages, when there were no antimicrobials and other effective medicines, epidemics of infectious diseases covered entire continents. The most famous of them are, Spanish (variety), and.
More than half of the patients died, and the vast majority of the dead were children. With the help of vaccination, humanity managed to defeat these infections, and some of them disappeared altogether, and their pathogens remained only in laboratories.
Other diseases could not be defeated, but vaccination significantly reduced the likelihood of serious complications.
Rules for the introduction of vaccines
The main principle of the use of vaccines is the maximum safety of the vaccinated, therefore, the following rules must be observed when administering drugs:
- (a preliminary medical examination is carried out, and if necessary);
- the doctor must provide complete information about the drug and answer all questions;
- vaccinations are done in public medical institutions or private clinics that are licensed to conduct such events;
- vaccines must be stored and transported under the conditions specified in the instructions;
- prophylactic drugs are administered by qualified nurses.
Before carrying out the procedure, the doctor must obtain the consent of the vaccinated person or his parents on a special form. Patients, for their part, must inform the medical staff about all factors that may become a contraindication to vaccination (SARS symptoms, etc.).
Only vaccinations included in the National Calendar are given free of charge in Russia. Vaccines that are administered at will (for example,) will need to be paid, since they are not purchased at the expense of state budgets.
Features of the vaccination of children with various background conditions
Children with chronic or congenital diseases, especially immunodeficiency states (, AIDS) need vaccination more than healthy ones, but require an individual approach and strict medical supervision.
Vaccinations are done only during periods of remission after a thorough examination of the child.
For the introduction most often used or lightweight versions of drugs that can reduce the risk of complications to a minimum.
Pros and cons of vaccination
The main advantage of vaccination is the formation of a strong immunity that protects the body from infectious diseases and the complications that they may entail. It persists for several years (on average from 5 to 10), and revaccination is carried out no more than 3-5 times in a lifetime.
The disadvantages of vaccines are contraindications and side effects, which in severe cases can lead to serious violations and even.
In addition, vaccinations do not protect the body from disease by 100%, which is why many consider them inappropriate.
Proper preparation and attention to the health of the vaccinated person minimize the risk of side effects.
Shortcomings in the organization and conduct of immunization: topical issues and a modern view of the problem
Over the past 10 years, the number of refusals to vaccinate has increased significantly, and with them outbreaks of serious diseases have returned - diphtheria, measles, poliomyelitis. This is due to a number of negative factors, primarily the lack of public awareness about.
Parents receive information mainly from the Internet, where information is often distorted or unreliable.
In addition, problems in the functioning of the healthcare system (bureaucracy, corruption, etc.) lead to the fact that immunization is carried out with low-quality or expired drugs that cause side effects.
The main task of modern doctors is to convey the correct information to people, control the quality of vaccines and reduce the number of “refuseniks”.
Where is vaccination information kept?
The first vaccinations are given to newborns still in the maternity hospital, the main part - at the age of up to a year, then, if necessary, revaccination is carried out. Information about the vaccinations made is in the patient's medical record, as well as in the archives of medical institutions.
Immunoprophylaxis in the work of a local therapist
The main task of carrying out vaccination among the population falls on the shoulders of district doctors. They should inform patients about the pros and cons of vaccination, conduct outreach work and ensure that the procedures are carried out according to the recommended schedule and rules.
Related videos
About vaccination outside the main part of the National Vaccination Calendar in the video:
Vaccination is the only way to protect the body from infections that can cause serious health consequences or death. It has a number of disadvantages, but the possibility of developing side effects is much lower than the risk of contracting severe infectious diseases.
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