Immunobiological preparations. Combined five-component vaccine Pentaxim

1. By the nature of the antigen.

Bacterial vaccines

Viral vaccines

2. According to the methods of preparation.

Live vaccines

Inactivated vaccines (killed, non-live)

Molecular (anatoxins)

genetic engineering

Chemical

3. By the presence of a complete or incomplete set of antigens.

Corpuscular

Component

4. According to the ability to develop immunity to one or more pathogens.

Monovaccines

associated vaccines.

Live vaccines- preparations in which the following are used as the active principle:

Attenuated, i.e. weakened (lost their pathogenicity) strains of microorganisms;

The so-called divergent strains of non-pathogenic microorganisms having related antigens with antigens of pathogenic microorganisms;

Recombinant strains of microorganisms obtained by genetic engineering (vector vaccines).

Immunization with a live vaccine leads to the development of the vaccinal process, which occurs in the majority of those vaccinated without visible clinical manifestations. The main advantage of this type of vaccine- a completely preserved set of pathogen antigens, which ensures the development of long-term immunity even after a single immunization. However, there are also a number of disadvantages. The main one is the risk of developing a manifest infection as a result of a decrease in the attenuation of the vaccine strain (for example, live polio vaccine can rarely cause poliomyelitis up to the development of spinal cord injury and paralysis).

Attenuated vaccines are made from microorganisms with reduced pathogenicity, but pronounced immunogenicity. Their introduction into the body mimics infectious process.

Divergent vaccines- Microorganisms that are closely related to pathogens of infectious diseases are used as vaccine strains. The antigens of such microorganisms induce an immune response that is cross-directed against the antigens of the pathogen.

Recombinant (vector) vaccines- are created on the basis of the use of non-pathogenic microorganisms with the genes of specific antigens of pathogenic microorganisms built into them. As a result, a living non-pathogenic recombinant strain introduced into the body produces an antigen of a pathogenic microorganism, which ensures the formation of specific immunity. That. the recombinant strain acts as a vector (conductor) of a specific antigen. As vectors, for example, a DNA-containing vaccinia virus, non-pathogenic Salmonella, into the genome of which the HBs genes, the hepatitis B antigen, virus antigens, are used. tick-borne encephalitis and etc.

Note: Att. – attenuated, Div. - divergent.

Inactivated vaccines- prepared from killed microbial bodies or metabolites, as well as individual antigens obtained by biosynthetic or chemically. These vaccines show less (compared to live) immunogenicity, which leads to the need for multiple immunizations, but they are devoid of ballast substances, which reduces the frequency side effects.

Corpuscular (whole cell, whole virion) vaccines- contain full set antigens prepared from killed virulent microorganisms (bacteria or viruses) by heat treatment or exposure to chemical agents (formalin, acetone). For example, anti-plague (bacterial), anti-rabies (viral).

Component (subunit) vaccines- consist of individual antigenic components that can ensure the development of an immune response. To isolate such immunogenic components, various physicochemical methods are used, therefore they are also called chemical vaccines. For example, subunit vaccines against pneumococci (based on capsule polysaccharides), typhoid fever(based on O-, H-, Vi - antigens), anthrax(polysaccharides and polypeptides of capsules), influenza (viral neuraminidase and hemagglutinin). To give these vaccines a higher immunogenicity, they are combined with adjuvants (sorbed on aluminum hydroxide).

Genetically engineered vaccines contain antigens of pathogens obtained using methods genetic engineering, and include only highly immunogenic components that contribute to the formation of an immune response.

Ways to create genetically engineered vaccines:

1. Introduction of virulence genes into avirulent or weakly virulent microorganisms (see vector vaccines).

2. Introduction of virulence genes into unrelated microorganisms, followed by isolation of antigens and their use as an immunogen. For example, for the immunoprophylaxis of hepatitis B, a vaccine has been proposed, which is the HBsAg of the virus. It is obtained from yeast cells into which a viral gene (in the form of a plasmid) encoding the synthesis of HBsAg has been introduced. The drug is purified from yeast proteins and used for immunization.

3. Artificial removal of virulence genes and the use of modified organisms in the form of corpuscular vaccines. Selective removal of virulence genes opens up broad prospects for obtaining stubbornly attenuated strains of Shigella, toxigenic Escherichia coli, causative agents of typhoid fever, cholera, and other bacteria. There is an opportunity to create polyvalent vaccines for the prevention of intestinal infections.

Molecular vaccines- these are preparations in which the antigen is represented by metabolites of pathogenic microorganisms, most often molecular bacterial exotoxins - toxoids.

Anatoxins- toxins neutralized with formaldehyde (0.4%) at 37-40 ºС for 4 weeks, completely lost their toxicity, but retained the antigenicity and immunogenicity of toxins and are used to prevent toxin infections (diphtheria, tetanus, botulism, gas gangrene, staphylococcal infections and etc.). The usual source of toxins is industrially cultivated natural strains-producers. I release toxoids in the form of mono- (diphtheria, tetanus, staphylococcal) and associated (diphtheria-tetanus, botulinum trianatoxin) preparations.

Conjugate vaccines are complexes of bacterial polysaccharides and toxins (eg, a combination of Haemophilus influenzae antigens and diphtheria toxoid). Attempts are being made to create mixed cell-free vaccines, including toxoids and some other pathogenicity factors, eg, adhesins (eg, acellular pertussis-diphtheria-tetanus vaccine).

Monovaccines - vaccines used to create immunity to one pathogen (monovalent drugs).

Associated drugs - for the simultaneous creation of multiple immunity, antigens of several microorganisms (usually killed) are combined in these preparations. The most commonly used are: adsorbed pertussis-diphtheria-tetanus vaccine (DTP vaccine), tetravaccine (vaccination against typhoid, paratyphoid A and B, tetanus toxoid), ADS-vaccine (diphtheria-tetanus toxoid).

Vaccine administration methods.

Vaccine preparations are administered orally, subcutaneously, intradermally, parenterally, intranasally and by inhalation. The route of administration determines the properties of the drug. Live vaccines can be administered skin-to-skin (scarification), intranasal, or oral; toxoids are administered subcutaneously, and non-live corpuscular vaccines - parenterally.

Intramuscular injected (after thorough mixing) sorbed vaccines (DPT, ADS, ADS-M, HBV, IPV). The upper outer quadrant of the gluteal muscle should not be used, since in 5% of children the nerve trunk passes there, and the buttocks of the baby are poor in muscles, so that the vaccine can get into fatty tissue (risk of slowly dissolving granuloma). The injection site is the anterolateral region of the thigh (the lateral part of the quadriceps muscle) or, in children older than 5-7 years, the deltoid muscle. The needle is inserted vertically (at an angle of 90°). After the injection, the plunger of the syringe should be pulled back and the vaccine should be administered only if there is no blood, otherwise the injection should be repeated. Before injection, the muscle is folded with two fingers, increasing the distance to the periosteum. On the thigh, the thickness of the subcutaneous layer in a child up to the age of 18 months is 8 mm (max. 12 mm), and the thickness of the muscle is 9 mm (max. 12 mm), so a needle 22-25 mm long is sufficient. Another method- in children with a thick fatty layer - stretch the skin over the injection site, reducing the thickness of the subcutaneous layer; while the depth of needle insertion is less (up to 16 mm). On the arm, the thickness of the fat layer is only 5-7 mm, and the thickness of the muscle is 6-7 mm. In patients hemophilia intramuscular injection is carried out in the muscles of the forearm, subcutaneous - in the rear of the hand or foot, where it is easy to press the injection channel. subcutaneously unsorbed - live and polysaccharide - vaccines are administered: into the subscapular region, into the outer surface of the shoulder (on the border of the upper and middle thirds) or into the anterolateral region of the thigh. Intradermal the introduction (BCG) is carried out into the outer surface of the shoulder, the Mantoux reaction - into the flexor surface of the forearm. OPV is injected into the mouth, if a child spit up a dose of the vaccine, he is given a second dose, if he spit it up, the vaccination is postponed.

Surveillance of the vaccinated lasts 30 minutes, when an anaphylactic reaction is theoretically possible. Parents should be informed about possible reactions requiring medical attention. The child is observed by a patronage nurse first 3 days after the introduction of an inactivated vaccine, on the 5-6th and 10-11th day - after the introduction of live vaccines. Information about the vaccination carried out is recorded in the registration forms, vaccination journals and in the Certificate of preventive vaccinations.

According to the degree of need, allocate: scheduled (mandatory) vaccination, which is carried out in accordance with the vaccination schedule, and vaccination according to epidemiological indications, which is carried out to urgently create immunity in persons at risk of developing an infection.

IMMUNICATION CALENDAR IN UKRAINE

(Order of the Ministry of Health of Ukraine No. 48 dated 03.02.2006)

Vaccinations by age

Vaccinations for the prevention of tuberculosis are not carried out on the same day as other vaccinations. It is unacceptable to combine vaccinations for the prevention of tuberculosis with other parenteral manipulations on the same day. Revaccination against tuberculosis is subject to children aged 7 and 14 years with a negative result of the Mantoux test. Revaccination is carried out with the BCG vaccine.

All newborns are subject to vaccination for the prevention of hepatitis B, vaccination is carried out with a monovalent vaccine (Engerix B). If the mother of the newborn is HBsAg "-" (negative), which is documented, the child can be vaccinated during the first months of life or combined with pertussis, diphtheria, tetanus, polio (Infanrix IPV, Infanrix penta). In the case of a combination of immunization with vaccinations against whooping cough, diphtheria, tetanus and poliomyelitis, schemes are recommended: 3-4-5-18 months of life or 3-4-9 months. life. If the mother of the newborn is HBsAg "+" (positive), the child is vaccinated according to the scheme (first day of life) - 1-6 months. The first dose is administered in the first 12 hours of a child's life, regardless of body weight. Together with vaccination, but no later than the 1st week of life, it is necessary to introduce specific immunoglobulin against hepatitis B into another part of the body at the rate of 40 IU/kg of body weight, but not less than 100 IU. If the mother of a newborn with HBsAg has an undetermined HBsAg status, the child must be vaccinated in the first 12 hours of life with a simultaneous study of the mother's HBsAg status. In the case of a positive result in the mother, hepatitis B prophylaxis is carried out in the same way as in the case of vaccinating a newborn child against HBsAg "+" of the mother.

Interval between first and second, second and third DTP vaccination vaccine is 30 days. The interval between the third and fourth vaccination should be at least 12 months. The first revaccination at 18 months is carried out with a vaccine with an acellular pertussis component (hereinafter referred to as AaDTP) (Infanrix). AaDPT is used for further vaccination of children who had post-vaccination complications from previous DTP vaccinations, as well as for all vaccinations for children with a high risk of post-vaccination complications based on the results of a vaccine commission or a pediatric immunologist. Combined vaccines (with different options combinations of antigens) that are registered in Ukraine (Infanrix hexa).

Inactivated polio vaccine (hereinafter referred to as IPV) is used for the first two vaccinations, and in case of contraindications to the introduction of oral polio vaccine(hereinafter referred to as OPV) - for all subsequent vaccinations according to the vaccination calendar (Polyorix, Infanrix IPV, Infanrix penta, Infanrix hexa). After OPV vaccination, it is proposed to limit injections, parenteral interventions, planned operations within 40 days, avoid contact with sick and HIV-infected people.

Vaccination for the prevention of Hib infection can be carried out with monovaccines and combined vaccines that contain a Hib component (Hiberix). When using Hib vaccine and DPT from different manufacturers, the vaccines are given in different parts of the body. It is advisable to use combination vaccines with a Hib component for primary vaccination (Infanrix hexa).

Vaccination to prevent measles, mumps and rubella is carried out with a combined vaccine (hereinafter referred to as MMR) at the age of 12 months (Priorix). Re-vaccination for the prevention of measles, mumps and rubella is carried out for children at the age of 6 years. Children who have not been vaccinated against measles, mumps and rubella at 12 months and 6 years of age can be vaccinated at any age up to 18 years of age. In this case, the child should receive 2 doses with a minimum interval. Children aged 15 years who have received 1 or 2 measles vaccinations but have not been vaccinated against mumps and rubella and have not had these infections are given routine vaccination against mumps (boys) or against rubella (girls). Persons over 18 years of age who have not previously been vaccinated against these infections can be vaccinated with a single dose according to epidemic indications at any age up to 30 years. A history of measles, mumps or rubella is not a contraindication to trivaccination.

The Pentaxim vaccine is gaining more and more popularity. Many parents and their children have already appreciated the convenience of this invention, because now the baby does not have to endure several injections, each for a specific disease, and wait for a reaction to them. This five-component vaccination allows you to pass this unpleasant procedure shortcut way. What this vaccine is and how safe it is for children, we have to figure it out.

Pentaxim is a vaccine that gives protection to the body against five infections at once, such as tetanus, diphtheria, polio, whooping cough, as well as Haemophilus influenzae type b, which causes pneumonia, meningitis and others. serious illness. And this drug belongs to the class of highly immunogenic vaccines, that is, giving high immunity from the above diseases.

Pentaxim belongs to a new generation of acellular (acellular) vaccines that have replaced cellular, that is, cellular vaccines. The new, acellular vaccine is less reactogenic and does not contain bacterial membrane lipopolysaccharides, which can cause complications after vaccination. But still, its main advantage is its multicomponent nature, because separate vaccination requires 12 injections, while with Pentaxim vaccination, only 4 are enough. The course consists of 3 injections and 1 revaccination.

Many parents are very apprehensive about vaccinations for fear of adverse reactions. child's body. In this case, you should find out which kids are suitable for Pentax? The instructions for use of the drug say that this vaccine is suitable for healthy children from the age of three months. Recommend the vaccine for children who have negative reactions to the introduction of whole-cell vaccines, such as DTP, babies with HIV infections, immunodeficiency, chronic diseases nervous system, stable neurological symptoms, allergic diseases and febrile seizures.

In addition, many parents do not vaccinate due to frequent illnesses anemic child, atopic dermatitis, dysbacteriosis, perinatal encephalopathy, dysbacteriosis. Pentaxim, in this case, is also recommended for use. The safety of the drug is confirmed by studies conducted by Russian scientists.

It is worth paying attention to the consequences that this vaccine can cause. It must be said that Pentaxim is absolutely well tolerated by children. In rare cases, vaccinated children may experience adverse reactions requiring immediate medical attention. It is thanks to the cell-free pertussis component that the drug is well tolerated. In addition, the introduction of intramuscular polio vaccine, which is part of Pentaxim, reduces the risk of vaccine-associated poliomyelitis.

The described vaccine has no age limit for vaccination, due to the presence of a cell-free pertussis component, and therefore even adults can be vaccinated. Doctors' recommendations regarding DTP boil down to the fact that revaccination at 6-7 years of age involves its vaccines containing a low number of antigens (ADS or ADSM). That is why Pentaxim is ideal for vaccinating children under 6 years of age. In addition, the vaccine can be done without the HIB component, which comes in a separate vial.

In rare cases, the introduction of the Pentaxim vaccine causes an increase in temperature. During this period, doctors do not recommend the use of antipyretic drugs, because such actions can significantly reduce the body's immune response to the vaccine. Sometimes the injection site may hurt a little. The drug can be administered simultaneously with other vaccinations, for example, the vaccine against measles, mumps, rubella or hepatitis B.

But even despite the excellent performance of Pentaxima with clinical trials Before using it, you need to consult a pediatrician, because this vaccine has a number of contraindications. In addition, if there is backlash organism for this vaccination, it is impossible to establish which component of the drug it was. All this should also be taken into account when agreeing to vaccinate a child. Take care of your kids!

Over the centuries, humanity has experienced more than one epidemic that claimed the lives of many millions of people. Thanks to modern medicine succeeded in developing drugs to avoid many fatal diseases. These drugs are called "vaccine" and are divided into several types, which we will describe in this article.

What is a vaccine and how does it work?

The vaccine is medical preparation containing killed or weakened pathogens various diseases or synthesized proteins of pathogenic microorganisms. They are introduced into the human body to create immunity to a particular disease.

The introduction of vaccines in human body is called vaccination. The vaccine, entering the body, induces immune system a person to produce special substances to destroy the pathogen, thereby forming his selective memory for the disease. Subsequently, if a person becomes infected with this disease, his immune system will quickly counteract the pathogen and the person will not get sick at all or will suffer light form illness.

Methods of vaccination

Immunobiological agents may be administered different ways according to the instructions for vaccines, depending on the type of drug. There are the following ways vaccination.

• The introduction of the vaccine intramuscularly. The vaccination site for children under one year old is the upper surface of the middle of the thigh, and for children from 2 years old and adults it is preferable to inject the drug into the deltoid muscle, which is located in the upper part of the shoulder. The method is applicable when an inactivated vaccine is needed: DTP, DTP, against viral hepatitis B and influenza vaccine.

Feedback from parents suggests that children infancy better tolerate vaccination upper part hips than in the buttocks. The same opinion is shared by physicians, conditioned by the fact that in the gluteal region there may be an abnormal placement of nerves, which occurs in 5% of children under one year old. In addition, children of this age have a significant fat layer in the gluteal region, which increases the likelihood of the vaccine getting into the subcutaneous layer, which reduces the effectiveness of the drug.

• Subcutaneous injections are administered with a thin needle under the skin in the area of ​​the deltoid muscle or forearm. An example is BCG, the smallpox vaccine.

• The intranasal method is applicable for vaccines in the form of an ointment, cream or spray (measles, rubella).
• The oral route is when the vaccine is placed in the form of drops in the patient's mouth (polio).

Types of vaccines

Today in the hands medical workers against dozens infectious diseases there are more than a hundred vaccines that have avoided entire epidemics and greatly improved the quality of medicine. It is conventionally accepted to distinguish 4 types of immunobiological preparations:

1. Live vaccine (against polio, rubella, measles, mumps, influenza, tuberculosis, plague, anthrax).
2. Inactivated vaccine (against whooping cough, encephalitis, cholera, meningococcal infection, rabies, typhoid fever, hepatitis A).
3. Toxoids (vaccines against tetanus and diphtheria).
4. Molecular or biosynthetic vaccines (for hepatitis B).

Types of Vaccines

Vaccines can also be grouped according to the composition and method of their preparation:

1. Corpuscular, that is, consisting of whole microorganisms of the pathogen.
2. Component or acellular consist of parts of the pathogen, the so-called antigen.
3. Recombinant: This group of vaccines includes the antigens of a pathogenic microorganism introduced using genetic engineering methods into the cells of another microorganism. A representative of this group is the flu vaccine. More a prime example- a vaccine against viral hepatitis B, which is obtained by introducing an antigen (HBsAg) into yeast cells.

Another criterion by which a vaccine is classified is the number of diseases or pathogens it prevents:

1. Monovalent vaccines are used to prevent only one disease (for example, BCG vaccine against tuberculosis).
2. Polyvalent or associated - for vaccination against several diseases (for example, DPT against diphtheria, tetanus and whooping cough).

live vaccine

live vaccine is an indispensable drug for the prevention of many infectious diseases, which is found only in corpuscular form. characteristic feature This type of vaccine is considered to be that its main component is weakened strains of the infectious agent that can reproduce, but are genetically devoid of virulence (the ability to infect the body). They contribute to the body's production of antibodies and immune memory.

The advantage of live vaccines is that still alive, but weakened pathogens induce the human body to develop long-term immunity (immunity) to a given pathogenic agent even with a single vaccination. There are several ways to administer the vaccine: intramuscularly, under the skin, nasal drops.

The disadvantage is that a gene mutation of pathogenic agents is possible, which will lead to the disease of the vaccinated. In this regard, it is contraindicated for patients with especially weakened immunity, namely for people with immunodeficiency and cancer patients. Requires special conditions transportation and storage of the drug in order to ensure the safety of living microorganisms in it.

Inactivated vaccines

Use of vaccines with inactivated (dead) pathogenic agents widely used for prevention viral diseases. The principle of action is based on the introduction of artificially cultivated and viable viral pathogens into the human body.

“Killed” vaccines in composition can be either whole-microbial (whole-viral), subunit (component) and genetically engineered (recombinant).

An important advantage of "killed" vaccines is their absolute safety, that is, the absence of the likelihood of infection of the vaccinated and the development of infection.

The disadvantage is a lower duration of immune memory compared to "live" vaccinations, also in inactivated vaccines risk of developing autoimmune and toxic complications, and for the formation of a full-fledged immunization, several vaccination procedures are required with maintaining the required interval between them.

Anatoxins

Toxoids are vaccines created on the basis of decontaminated toxins released during the life of some pathogens of infectious diseases. The peculiarity of this vaccination is that it provokes the formation of not microbial immunity, but antitoxic immunity. Thus, toxoids are successfully used for the prevention of those diseases in which clinical symptoms are associated with a toxic effect (intoxication) resulting from the biological activity of a pathogenic agent.

The release form is a clear liquid with a sediment in glass ampoules. Shake contents before use to uniform distribution toxoids.

The advantages of toxoids are indispensable for the prevention of those diseases against which live vaccines are powerless, moreover, they are more resistant to temperature fluctuations, do not require special conditions for storage.

Disadvantages of toxoids - they induce only antitoxic immunity, which does not exclude the possibility of the occurrence of localized diseases in the vaccinated, as well as the carriage of pathogens of this disease by him.

Production of live vaccines

Mass production of the vaccine began at the beginning of the 20th century, when biologists learned how to weaken viruses and pathogenic microorganisms. A live vaccine is about half of all preventive drugs used in world medicine.

The production of live vaccines is based on the principle of reseeding the pathogen into an organism that is immune or less susceptible to a given microorganism (virus) or cultivating the pathogen under unfavorable conditions with exposure to physical, chemical and biological factors followed by selection of non-virulent strains. The most common substrates for culturing avirulent strains are chicken embryos, primary cell cultures (chicken or quail embryonic fibroblasts), and transplantable cultures.

Obtaining “killed” vaccines

The production of inactivated vaccines differs from live vaccines in that they are obtained by killing rather than attenuating the pathogen. To do this, only those pathogenic microorganisms and viruses that have the greatest virulence are selected, they must be of the same population with clearly defined characteristics characteristic of it: shape, pigmentation, size, etc.

Inactivation of pathogen colonies is carried out in several ways:

• overheating, that is, the impact on the cultivated microorganism elevated temperature(56-60 degrees) a certain time (from 12 minutes to 2 hours);
• exposure to formalin for 28-30 days with maintenance temperature regime at a level of 40 degrees, a solution of beta-propiolactone, alcohol, acetone, chloroform can also act as an inactivating chemical reagent.

Making toxoids

In order to obtain a toxoid, toxogenic microorganisms are first cultivated in a nutrient medium, most often in a liquid consistency. This is done in order to accumulate as much exotoxin in the culture as possible. The next stage is the separation of the exotoxin from the producer cell and its neutralization using the same chemical reactions that apply to “killed” vaccines: exposure to chemicals and overheating.

To reduce the reactivity and susceptibility, antigens are cleaned of ballast, concentrated and adsorbed with alumina. The process of adsorption of antigens plays important role, since the injected injection with a high concentration of toxoids forms a depot of antigens, as a result, antigens enter and spread throughout the body slowly, thereby providing efficient process immunization.

Destruction of unused vaccine

Regardless of which vaccines were used for vaccination, containers with drug residues must be treated in one of the following ways:

• boiling used containers and tools for an hour;
• disinfection in a solution of 3-5% chloramine for 60 minutes;
• treatment with 6% hydrogen peroxide also for 1 hour.

Expired drugs must be sent to the district sanitary and epidemiological center for disposal.

inactivated vaccines.

Divergent vaccines

Attenuated (attenuated) vaccines

Weakened (attenuated) vaccines are made from microorganisms with reduced pathogenicity, but pronounced immunogenicity. The introduction of a vaccine strain into the body imitates the infectious process: the microorganism multiplies, causing the development of immune responses. The best known vaccines are for the prevention of anthrax, brucellosis, Q fever, and typhoid fever. However most of live vaccines - antiviral. The most well-known vaccine against the causative agent of yellow fever, Sabin's polio vaccine, vaccines against influenza, measles, rubella, mumps and adenovirus infections.

Microorganisms that are closely related to pathogens of infectious diseases are used as vaccine strains. Ag of such microorganisms induce an immune response that is cross-directed to Ag of the pathogen. The best known and longest used vaccine against smallpox(from vaccinia virus) and BCG for the prevention of tuberculosis (from Mycobacterium bovine tuberculosis).

Currently, vaccines made from killed microbial bodies or metabolites, as well as from individual antigens obtained by biosynthetic or chemical means, are also used. Vaccines containing killed microorganisms and their structural components are classified as corpuscular vaccine preparations.

Non-live vaccines usually exhibit less (compared to live vaccines) immunogenicity, which dictates the need for multiple immunizations. At the same time, non-live vaccines are devoid of ballast substances, which significantly reduces the frequency of side effects that often develop after immunization with live vaccines.

Corpuscular (whole virion) vaccines

For their preparation, virulent microorganisms kill either heat treatment, or exposure to chemical agents (for example, formalin or acetone). Such vaccines contain a complete set of antigens. The spectrum of pathogens used to prepare non-live vaccines is diverse; most widespread received bacterial (for example, anti-plague) and viral (for example, anti-rabies) vaccines.

Component (subunit) vaccines - a kind of corpuscular non-live vaccines; they consist of separate (main, or major) antigenic components that can ensure the development of immunity. The immunogenic components of the pathogen are used as antigens. Various physicochemical methods are used to isolate them, so preparations derived from them are also known as chemical vaccines. At present, subunit vaccines have been developed against pneumococci (based on capsule polysaccharides), typhoid fever (O-, H- and Vi-Ar), anthrax (capsule polysaccharides and polypeptides), influenza (viral neuraminidase and hemagglutinin). For higher immunogenicity component vaccines often combined with adjuvants (for example, sorbed on aluminum hydroxide).

Is there any point in testing before vaccinations, what are imaginary contraindications and why the first two years of life - the best time to vaccinate a child

Whether the lack of education, or quality control problems medical care lead to the fact that doctors in Russia do not have clear algorithms on how to identify contraindications for vaccination in people, how to advise on vaccination reactions what to do in unusual situations. There are textbooks on the theory of immunoprophylaxis, there are orders for vaccination, but doctors cannot find answers to all their questions there. Therefore, they have to think and make decisions themselves, based only on personal knowledge and experience. Moreover, the answers to most of the questions that concern both doctors and patients can be found in foreign literature. Which is what we did.

Unnecessary Research

Testing before vaccination is an unnecessary measure, it is not spelled out in either Western recommendations or Russian orders on vaccination. Most contraindications are excluded during examination and questioning.

Routine urine and blood tests will not prove the absence of contraindications and will not reveal them, therefore they are meaningless. They are usually appointed either out of fear of missing some acute illness(although in this case changes in blood and urine are not at all necessary), or only in order to make an extra appointment. It is sad that people waste time and money, experience the pain of an unnecessary injection, but it is even worse when, guided by the results of research, doctors draw the wrong conclusions and give a diversion from vaccinations.

At infants tests can often reveal a benign decrease in the level of neutrophils, slight increase ESR in the blood or 1-2 extra white blood cells in the urine. Often in this case, the doctor does not make a diagnosis and does not prescribe treatment, since there is really nothing to treat (decrease in the level of neutrophils without frequent bacterial infections does not speak of immunodeficiency, a slight increase in ESR and leukocytes is not necessarily associated with an infection, etc.), nevertheless, it recommends retaking the analysis in a month or two and gives a challenge. A strange situation: the disease has not been identified, there are no contraindications, and vaccination has been postponed “just in case”.

No reason to withdraw

There are quite clear contraindications to vaccination; a list of special questions (for adults and children) allows you to determine them. Anything else should not be a reason to postpone vaccination. It can be vaccinated for mild infections, anemia and many other diseases. False diagnoses like or perinatal encephalopathy, moreover, they cannot serve as a reason for withdrawal.

People with certain chronic diseases sometimes receive exemptions from vaccinations that they especially need. For example, when bronchial asthma it is necessary to be vaccinated against whooping cough, pneumococcal and hemophilic infections. suffers from them respiratory system, so the probability is higher severe course and complications in case of infection. For a similar reason, people with atopic dermatitis are recommended to be vaccinated against chicken pox: just imagine how a rash with blisters, erosions will proceed in a person whose skin is already inflamed all the time ...

By prescribing meaningless tests, giving false excuses for vaccination, doctors, who in general do not have the goal of dissuading patients from vaccinations, once again sow fear of vaccination.

Vaccination Schedule

Postponing and “breaking up” vaccinations is wrong. Children begin to be vaccinated at the very early age, and this has a special meaning. At about six months, antibodies against infections that have come to the baby in utero cease to protect him, and it takes time to develop vaccination immunity. The probability of getting sick in a child remains even if he communicates only with his parents. Well, by the age when the child begins to communicate more or less often with different people, attend classes with other children, it is necessary to complete the vaccination course. Therefore, the vaccination schedule for children in most countries is designed for the first 20 months of life. In addition, the first 1-2 years, while children have little contact, the child is less likely to catch a cold. Here's another reason not to delay getting vaccinated, because the chances of getting vaccinated will increase as colds become more common.

Experts have no evidence to suggest that delaying the introduction of vaccines reduces the risk of vaccine reactions. Or that the introduction of vaccines against several infections at once increases the risk of complications and reduces the already weak immunity. These are just fears and speculations. They are backed by science. Moreover, children emotionally endure vaccinations in infancy much more easily than at an older age: babies are not afraid, cry only because of the injection, and quickly calm down in their arms or at the chest.

National vaccination calendar

There are no “mandatory” and “optional” vaccinations in the vaccination calendars, only those that are really necessary. Vaccination, which is carried out only according to indications, for example against typhoid fever, yellow fever or tick-borne encephalitis, is not included in the national calendar.

The calendars of many developed countries are wider than the Russian one. But this is not at all due to the fact that we and our children are not afraid of hepatitis A, chickenpox, pneumococcal and hemophilic infections, as well as human papillomavirus. The reasons are purely economic: it is no coincidence that the Moscow calendar is wider than the national one.

Drawing up an "individual vaccination schedule" is shown to an extremely limited number of people. Those who have some contraindications for the introduction of part of the vaccines, or who are at risk for diseases not included in the main calendar.

Additional dose

If it is not known what infections you were vaccinated against and what you were ill with, then they are usually vaccinated as if you had not received a single vaccination and did not get sick with anything. There is no evidence that an additional, "excess" dose of the vaccine can harm health or lead to an excessive load on the immune system, the development of autoimmune reactions, although this has been verified in the course of studies.

It is possible to verify the absence of immunity before vaccination only in relation to certain infections (measles, rubella, hepatitis A, diphtheria and tetanus), and this is an optional measure. The exact values ​​​​of a sufficient level of antibodies for other infections are still unknown to medicine, so there is no point in checking them.

domestic or imported

In Russia, there are vaccines of domestic and foreign production. Sometimes imported ones are objectively better: vaccinations with an acellular pertussis component, inactivated poliovirus, without preservatives or antibiotics, in individual syringes, multicomponent, etc. economic reasons in public institutions usually use cheaper vaccines, so they may be somewhat worse than their counterparts. However, the difference is not always fundamental.

Often, the advantage of a multi-component vaccine over a single-component vaccine lies only in the number of injections that a child will have to endure. Sometimes, in multicomponent vaccines, the total dose of preservatives is less, but their effect on the body is greatly exaggerated, so it is difficult to call this a significant advantage. It turns out that, for example, the absence of a combined vaccination against measles, rubella and mumps is not a reason to postpone vaccination. Probability of development side effects after one shot of a multi-component vaccine or after three shots of a single-component vaccine, the same. Just three injections - more painful.

If we imagine that Russia will run out foreign analogues, then despite some shortcomings of some domestic vaccines, it is much safer to introduce them than to completely abandon vaccinations. The risks associated with the introduction of the same whole cell pertussis component are lower than the risks of severe course and complications of the disease.

There are only foreign vaccines against some infections (hemophilic, pneumococcal and others). Then there is no difference where to enter them: in the state or private clinic. Sometimes, during interruptions in supplies or the expiration of the registration period, it happens that some vaccines have run out in private centers, but they are available in public centers (public procurement is larger).

Against some infections (for example, BCG - vaccines against tuberculosis) in Russia there are only domestic vaccines. In Moscow, a license for the introduction of BCG has an extremely limited number of private clinics. Therefore, they go to the district clinic to be vaccinated.

Some foreign vaccines cannot be used due to the lack of a license in Russia.

For money or for free

The approach to administering vaccines may differ between public and private medical institutions. In district clinics, doctors must work strictly on orders (and, probably, this is correct - there is less chance of confusing something in a hurry). But the order is tougher than the actual rules for administering vaccines. The clinic will refuse, even if the vaccination can be done earlier (it may be more convenient for patients if, for example, they plan to leave for the whole summer). A doctor in a private clinic is not obliged to vaccinate by order, he may deviate from the plan, if this does not contradict the instructions for the use of vaccines and world recommendations. The same goes for those who are behind schedule. AT Russian documents there are no minimum intervals between vaccinations, so the doctor of the district clinic must maintain the same intervals as for those who are not lagging behind the schedule. In a private clinic, a doctor may vaccinate patients according to tables that indicate the minimum allowed intervals.