On conducting seromonitoring to study the state of population immunity to polio. How to test for polio antibodies Serological monitoring of herd immunity

On conducting seromonitoring to study the state of population immunity to polio

Accepted Ministry of Health of the Orenburg Region,
Office of Rospotrebnadzor for the Orenburg region

1. Serological studies to study the state of specific immunity in indicator groups of the population are a mandatory element of epidemiological surveillance of polio and are carried out to control the organization and implementation of vaccine prevention of this disease.
2. In connection with the continued circulation of polioviruses in a number of countries in Africa and Asia and the continuing real threat of the introduction of a wild strain of this pathogen into the region, it is extremely important to obtain objective data on the state of the population’s immunity to polio.
3. In pursuance of the sanitary and epidemiological rules SP 3.1.1.2343-08 "Prevention of polio in the post-certification period" and the Action Plan for 2006 - 2008. to maintain the polio-free status of the Orenburg region

4. We order:

5. 1. To the chief doctors of the Buzuluk Central City Hospital and the Buguruslan Central City Hospital, the Gayskaya Central District Hospital, and the Novoorskaya Central District Hospital:
6. 1.1. Organize blood sampling for serological testing for poliomyelitis in indicator groups of the population in accordance with Appendix No. 1: in the cities. Buzuluk and Buguruslan in May 2008, in Gaisky and Novoorsky districts - in September 2008.
7. 1.2. Ensure compliance with the rules for the collection, transportation and storage of blood serum in accordance with Appendix No. 2.
8. 1.3. Ensure the delivery of blood serum to the virology laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" from the cities. Buguruslan and Buzuluk until May 23, 2008, Gaisky and Novoorsky districts - until September 21, 2008.
9. 1.4. Ensure that the results of serological tests for polio are included in the appropriate medical records.
10. 2. The heads of the Eastern, North-Eastern, Western, North-Western territorial departments must ensure control over the correct formation of population groups subject to serological examination for polio, the organization and conduct of blood sampling and compliance with the deadlines for delivery of the material to the virological laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" region".
11. 3. To the chief physician of the Federal State Health Institution "Center for Hygiene and Epidemiology in the Orenburg Region" N.N. Vereshchagin. ensure the examination of blood sera within 7 - 10 days from the moment of their receipt with the submission of research results to the Office of Rospotrebnadzor for the Orenburg Region and the State Institution "Orenburg Regional Center for the Prevention and Control of AIDS and Infectious Diseases".
12. 4. Control over the execution of this order shall be assigned to the First Deputy Minister V.N. Averyanov. and Deputy Head of the Rospotrebnadzor Office for the Region Yakovlev A.G.
13. Minister of Health
14. Orenburg region
15. N.N. KOMAROV
16. Supervisor
17. Management
18. Rospotrebnadzor
19. in the Orenburg region
20. N.E.VYALTSINA

The procedure for selecting children for serological examination to determine the state of immunity to polio viruses

1. Serological monitoring of the state of collective immunity to polio should be carried out in the following indicator groups of the population:
2. - Group I - children aged 3-4 years who have received a full range of vaccinations in accordance with age (vaccination and two revaccinations).
3. - Group II - children aged 14 years who have received a set of vaccinations in accordance with their age.
4. Poliomyelitis survivors cannot be included in indicator groups; children who lack information about vaccinations; not vaccinated against polio; who have suffered any disease 1 - 1.5 months before the examination, since some diseases can lead to a temporary decrease in the titer of specific antibodies.
5. Each indicator group must represent a homogeneous statistical population, which requires selection of individuals with the same number of vaccinations and the period since the last vaccination. In this case, this period must be at least 3 months. The number of each indicator group must be at least 100 people.
6. Optimally, 4 groups of the same age group should be selected for the examination (2 groups from two medical institutions), at least 25 people in each group. In the case of a smaller number of indicator group children in children's groups, achieving representativeness of the research is achieved by increasing the number of preschool institutions where these studies will be conducted.
7. In children's groups, before a serological examination, medical workers must carry out explanatory work with parents about the need to prevent polio and determine post-vaccination immunity to it.
8. The period during which sera are collected and delivered to the virology laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" should not exceed 7 days.

Rules for collecting, transporting and storing blood serum

1. 1. Technique for collecting and primary blood treatment
2. When conducting serological studies, only one blood sample is required from each person included in the observed group. The minimum amount of blood serum required for the study is at least 0.2 ml; it is better to use 1 ml. Therefore, the minimum blood sample volume should be at least 0.5 ml; optimally 2 ml. It is better to take blood from a vein, since this method is the least traumatic and allows you to obtain the required volumes with a minimum level of hemolysis.
3. Blood from a vein in an amount of 5 ml is taken with a disposable sterile syringe into a sterile tube under aseptic conditions.
4. If taking blood from a vein cannot be carried out for some reason, the blood is taken by pricking a finger. In this way, it is possible to obtain a sufficient amount of blood for serological studies. Blood in a volume of 1.0 - 1.5 ml is collected directly through the edge of a sterile disposable centrifuge tube with a stopper (or into special microtubes for collecting capillary blood). Before drawing blood, the patient's hand is warmed with hot water, then wiped dry with a clean towel. The finger is treated with a sterile cotton ball soaked in 70% alcohol and pierced with a sterile disposable scarifier. The puncture is made slightly away from the midline, closer to the lateral surface of the finger (the place where large vessels pass). Drops of blood protruding at the puncture site are collected with the edge of a dry, sterile measuring centrifuge tube so that the drops flow down the wall to the bottom. To obtain a large amount of blood, it is recommended to lightly massage the sides of the phalanx. In very young children, a blood sample can be obtained by pricking the heel.
5. After taking blood, the injection site is lubricated with a sterile cotton ball moistened with a 5% iodine solution.
6. The tube with blood is closed with a sterile rubber stopper, a strip of adhesive tape is glued to the tube, on which the number of the person being examined is written, corresponding to the serial number in the accompanying document, the surname and initials, and the date of collection. Before being sent to the laboratory, blood can be stored at a temperature of +4 - +8 degrees. With no more than 24 hours.
7. In the laboratory, to obtain serum, a test tube with blood is left in an inclined (at an angle of 10 - 20 degrees) position at room temperature for 30 minutes. to form a clot; after which the test tube with blood is shaken to separate the clot from the wall of the tube and left overnight in the refrigerator at a temperature of +4 - 8 degrees. WITH.
8. After removing the serum from the clot (the tubes are circled along the inner surface with a Pasteur pipette), it is centrifuged at 1000 - 1200 rpm. for 15 - 20 minutes. Then the serum is carefully poured or aspirated with a pipette with a bulb into sterile centrifuge (plastic) tubes or Eppendorf tubes with the obligatory transfer of the label from the corresponding tube to them.
9. If the laboratory does not have a centrifuge, then whole blood should be left in the refrigerator until complete clot retraction (separation of the red blood cell clot from the serum) occurs. Carefully, carefully, avoiding damage to red blood cells, transfer the serum to another sterile tube equipped with a label. The serum should be transparent, light yellow in color, without significant hemolysis.
10. Serum arriving at the laboratory (without a clot) can be stored until examination in household refrigerators at a temperature of 4 degrees. C within 7 days. For longer storage, the whey can be frozen at -20 degrees. WITH.
11. 2. Transportation of serum (blood) samples
12. Before transporting the collected material, it is very important to take precautions: check the availability of the collected information, tightly cap the tubes, arrange the samples according to their numbers, place the sera in a plastic bag.
13. To transport blood (serum), thermal containers (cooler bags, thermos) should be used. If refrigeration elements are used (they must be frozen), you need to place them on the bottom and sides of the container, and then place a plastic bag with serum samples inside, and put the frozen elements back on top. Place the accompanying documents, indicating the date and time of departure, in a plastic bag and place it under the lid of the thermal container.
14. When carrying out seromonitoring, blood (serum) samples are accompanied by a carefully completed accompanying document - “List of persons subject to serological examination for the presence of specific antibodies to poliovirus” (attached).
15. When preparations for shipment are completed, inform the recipient about the time and method of transportation, the number of samples, etc.
16. Samples are delivered to the virology laboratory of the Federal State Institution "Center for Hygiene and Epidemiology in the Orenburg Region" (Orenburg, 60 Let Oktyabrya St., 2/1, tel. 33-22-07).
17. At the place of collection of blood serum samples, duplicate lists of examined persons and the results of serum testing should be stored for at least 1 year.
18. The results are also entered into accounting forms (history of the child’s development, outpatient card of the patient).
19. List of persons
20. subject to serological examination for the presence
21. specific antibodies to poliovirus (seromonitoring)
22. (pre) In _____________ in _______ year city, district Name of health care facility __________________________ Name of institution ___________________ N Preschool (group), school (class), etc. (/pre)

MU 3.1.2943-11

METHODOLOGICAL INSTRUCTIONS

3.1. PREVENTION OF INFECTIOUS DISEASES

Organization and conduct of serological monitoring of the state of collective immunity to infections controlled by means of specific prevention (diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio, hepatitis B)

1. DEVELOPED by the Federal Service for Supervision of Consumer Rights Protection and Population Welfare (E.B. Ezhlova, A.A. Melnikova, G.F. Lazikova, N.A. Koshkina); FBUZ "Federal Center for Hygiene and Epidemiology" of Rospotrebnadzor (N.Ya. Zhilina, O.P. Chernyavskaya); Federal State Budgetary Institution "Moscow Research Institute of Epidemiology and Microbiology named after G.N. Gabrichevsky" of Rospotrebnadzor (N.M. Maksimova, S.S. Markina, T.N. Yakimova, N.T. Tikhonova, A.G. Gerasimova, O.V. Tsvirkun, N.V. Turaeva, N.S. Kushch); Federal State Budgetary Institution "Central Research Institute of Epidemiology" of Rospotrebnadzor (V.P. Chulanov, N.N. Pimenov, T.S. Selezneva, A.I. Zargaryants, I.V. Mikheeva); State Institution "Institute of Poliomyelitis and Viral Encephalitis named after M.P. Chumakov" RAMS (V.B. Seybil, O.E. Ivanova), State Institution "Moscow Research Institute of Vaccines and Serums named after I.I. Mechnikov RAMS (N .V. Yuminova, R.G. Desyatskova); Omsk State Medical Academy (V.V. Dalmatov); Office of Rospotrebnadzor for the Novosibirsk region (N.I. Shulgina); Office of Rospotrebnadzor for Moscow (I.N. Lytkina, V.S.Petina, N.I.Shulakova).

2. DEVELOPED to replace the guidelines MU 3.1.1760-03 “Organization and conduct of serological monitoring of the state of collective immunity against vaccine-preventable infections (diphtheria, tetanus, measles, rubella, mumps, polio).”

3. APPROVED on July 15, 2011 and put into effect by the Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko.

1 area of ​​use

1 area of ​​use

1.1. The guidelines outline the basic principles of organizing and implementing serological monitoring of the state of collective immunity to infections controlled by means of specific prevention (diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio, hepatitis B).

1.2. These guidelines are intended for specialists from bodies carrying out state sanitary and epidemiological supervision, and specialists from medical and preventive organizations.

2. General provisions

2.1. Conducting serological monitoring allows for a continuous process of objective assessment of the state of specific post-vaccination immunity to infectious agents controlled by means of specific prevention in “indicator” population groups and risk groups and is a mandatory element of epidemiological surveillance of diphtheria, tetanus, whooping cough, measles, rubella, mumps , polio and hepatitis B, since epidemiological well-being in relation to these infections is determined by the state of post-vaccination immunity.

2.2. The purpose of serological monitoring is to assess the level of actual protection from infections of individuals, groups and the population as a whole, as well as to assess the quality of vaccination work in a specific territory and in a specific healthcare organization.

2.3. Serological monitoring includes:

selection of “indicator” population groups, the state of specific immunity of which allows us to extrapolate the results obtained to the population of the surveyed territory as a whole;

organizing and conducting serological studies of blood sera of vaccinated people (in “indicator” population groups);

assessment of the effectiveness of immunization.

The procedure for collecting, transporting and storing blood sera for research is carried out in accordance with Appendix 1.

2.4. "Indicator" populations include individuals with a documented vaccination history. In this case, the period from the last vaccination to the examination for the presence of diphtheria and tetanus antibodies, pertussis agglutinins, antibodies to measles, rubella, mumps, polio, and hepatitis B viruses must be at least 3 months.

The introduction of “indicator” groups makes it possible to unify the forms and methods of analyzing grafting work.

2.5. The organization and conduct of serological monitoring of the state of collective immunity of the population is carried out by health care organizations and bodies carrying out state sanitary and epidemiological supervision.

2.6. Carrying out serological monitoring of the state of collective immunity is formalized by a resolution of the Chief State Sanitary Doctor for the constituent entity of the Russian Federation, in which, in agreement with the health authorities, the territories, time (schedule), contingents and number of population groups to be examined are determined, microbiological laboratories for conducting research are determined, and as well as persons responsible for organizing and carrying out this work.

In furtherance of the resolution of the Chief State Sanitary Doctor for the constituent entity of the Russian Federation, an order is issued by the health care management body of the constituent entity of the Russian Federation.

Conducting serological monitoring is annually included in the work plans of territorial bodies of Rospotrebnadzor and healthcare organizations.

3. Materials and methods

3.1. The material for the study is blood serum, the identified antibodies in which are a source of information about the level of immunity to infectious agents controlled by means of specific prevention.

3.2. The methods used for testing serums must be harmless, specific, sensitive, standard and accessible for mass examinations.

3.3. To conduct serological studies of blood serum in the Russian Federation, the following are used:

passive hemagglutination reaction (RPHA) - to detect antibodies to measles virus, diphtheria and tetanus toxoids;

agglutination reaction (RA) - to detect agglutinins of the pertussis microbe;

enzyme-linked immunosorbent assay (ELISA) - to detect antibodies to measles, rubella, mumps, hepatitis B viruses, as well as the causative agent of whooping cough;

reaction to neutralize the cytopathic effect of the virus in tissue cell culture (macro- and micromethod) - to detect antibodies to polio viruses.

3.4. To conduct serological studies, diagnostic kits and test systems registered in the Russian Federation must be used.

4. Methodological approaches to selecting population groups

4.1. When forming “indicator” population groups subject to serological survey, the following principles should be adhered to.

4.1.1. Uniformity of the place where vaccinations were received (health care organization, preschool institution, school and other organizations where vaccinations were carried out).

This principle of forming groups makes it possible to identify organizations with low quality vaccination work, and with a subsequent thorough investigation, identify its specific shortcomings (violation of the rules of storage and transportation of vaccines, falsification of vaccinations, their inconsistency with the timing and schemes of the existing calendar of preventive vaccinations, technical errors, etc.).

4.1.2. Unity of vaccination history.

The population under study must be homogeneous, which requires selection of individuals with the same number of vaccinations and the period since the last vaccination.

4.1.3. Similarity of the epidemiological situation under which the study groups are formed.

To implement the requirements of this principle, groups are formed from groups in which no cases of diphtheria, whooping cough, measles, rubella, mumps, or hepatitis B have been recorded for one year or more.

4.2. The selection of contingents for the survey begins with the identification of territories.

The boundaries of the territory are determined by the scope of service of a particular health care organization. This can be a separate organized group of children and adults, a medical district, a settlement assigned to a paramedic-midwife station, or the service area of ​​one clinic.

4.3. It is advisable to carry out serological monitoring primarily in large administrative territories of the constituent entities of the Russian Federation (in cities, regional centers) - annually. Every year, different districts and clinics of the city (district center) should be included in the survey. The frequency of their examination should be 6-7 years (according to schedule).

4.4. To form an “indicator” group, you should select 4 groups of subjects of the same age (2 groups from 2 health care organizations), at least 25 people in each group, that is, each “indicator” group should have at least 100 people.

4.5. Before conducting a serological examination of persons selected for the “indicator” group (children and adults), medical workers must carry out explanatory work, including with the parents of the children being examined, about the purpose of checking their strength of post-vaccination immunity to infections controlled by means of specific prevention.

4.6. Blood serum of adults for research can be taken at blood transfusion stations.

The procedure for collecting, transporting and storing blood serum is defined in Appendix 1.

5. “Indicator” population groups subject to serological examination for the presence of specific antibodies

5.1. Serological monitoring of the state of collective immunity provides for a multi-purpose serological survey in each territory of “indicator” population groups.

Multipurpose serological studies involve determining in one blood serum sample maximum spectrum of antibodies to the pathogens of the studied infections.

5.2. The "indicator" groups do not include:

those who have had whooping cough, diphtheria, tetanus, measles, rubella, mumps, polio and acute hepatitis B, as well as patients with chronic hepatitis B and carriers of the hepatitis B virus;

children who lack information about vaccinations;

not vaccinated against these infections;

who have suffered any disease 1-1.5 months before the examination, since certain diseases can lead to a temporary decrease in the titer of specific antibodies.

5.3. The state of collective immunity to diphtheria, tetanus, mumps, polio, and hepatitis B in adults is determined without taking into account vaccination data. The state of immunity to measles and rubella - without taking into account vaccination data - is determined in adults only in the age group of 40 years and older.

5.4. Diphtheria and tetanus.

Based on the results of a serological examination of children aged 3-4 years, the formation of basic immunity is assessed; at the age of 16-17 years, the quality of vaccinations carried out at school and secondary educational institutions is assessed.

The results of serological surveys of adults aged 18 years and older (by age group) without taking into account their vaccination status make it possible to assess the actual level of protection from diphtheria and tetanus in adults in each age group and to identify risk groups in terms of incidence and severity of the disease.

5.5. Whooping cough.

Based on the results of a serological examination of children aged 3-4 years, the formation of basic immunity is assessed.

5.6. Measles, mumps, rubella.

Based on the results of a serological examination of children aged 3-4 years and 9-10 years, the level of anti-measles, anti-mumps and anti-rubella immunity is assessed after vaccination and revaccination.

Serological examination of children aged 16-17 years allows us to evaluate the effectiveness of revaccination in the long term, as well as the level of the immune layer to these infections in newly formed groups of secondary and higher educational institutions.

The results of a survey of adults aged 25-29 and 30-35 years, vaccinated against measles, rubella and mumps, characterize the state of specific immunity among the young adult population, including rubella - women of childbearing age.

Based on the results of a survey of adults aged 40 years and older (donors, excluding vaccination history), an assessment is made of the actual protection of the adult population from measles, rubella and mumps.

5.7. Polio.

Based on the results of a serological examination of children aged 1-2 years, 3-4 years and 16-17 years, the level of immunity to poliomyelitis in the immediate period after vaccination and revaccination with polio vaccine is assessed; in adults, the actual state of immunity to poliomyelitis in the age groups 20- 29 years old, 30 years old and older.

5.8. Hepatitis B.

Based on the results of a serological examination of children aged 3-4 years and 16-17 years, as well as adults and medical workers aged 20-29 years, 30-39 years and 40-49 years, the level of immunity to hepatitis B is assessed.

5.9. At the discretion of specialists carrying out state sanitary and epidemiological surveillance, serological examination for the infections in question can be carried out in other age and professional groups.

Recommended "indicator" groups for serological monitoring of the state of collective immunity to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B are presented in Appendix 2 (Tables 1, 2).

6. Assessment of the effectiveness and quality of vaccinations performed

6.1. Assessment of the state of specific immunity of the population to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B is carried out based on the results of a serological survey of “indicator” population groups.

6.2. To assess the actual vaccination and protection of children and adults from diphtheria and tetanus, blood serum is examined in parallel with diphtheria and tetanus antigen diagnostic kits. Protected from these infections are persons in whose blood serum antitoxic antibodies are detected in a titer of 1:20 or higher.

6.3. When assessing the level of post-vaccination anti-pertussis immunity, those protected from whooping cough are those whose blood serum contains agglutinins at a titer of 1:160 or higher.

6.4. Seropositive to measles, rubella and mumps viruses are persons in whose blood serum specific antibodies are determined at the level specified in the relevant instructions for the test systems.

6.5. When assessing the level of post-vaccination immunity to the hepatitis B virus, protected persons are those whose blood serum contains antibodies to HBsAg at a concentration of 10 IU/l or more.

6.6. The strength of collective immunity to polio and the quality of vaccination can be judged based on three indicators:

proportion of persons seropositive for polio viruses types 1, 2 and 3(sera in which the antibody titer is equal to or higher than 1:8 are considered seropositive; the proportion of seropositive results is calculated for the entire group of examined sera);

proportion of persons seronegative for polio viruses types 1, 2 and 3(sera are considered seronegative if they do not contain antibodies to one of the types of poliovirus in a 1:8 dilution; the proportion of seronegative results is calculated for the entire group of examined sera);

proportion of seronegative individuals(absence of antibodies to all three types of the virus) are considered persons whose sera do not have antibodies to all three types of polio virus.

An indicator of the intensity of collective immunity to polio is geometric mean antibody titer, which is calculated only for a group of sera that have antibodies to the corresponding poliovirus serotype in a titer of 1:8 or higher (Appendix 3).

6.7. The results of a serological survey of contingents are recorded in laboratory workbooks, indicating the locality, organization, surname, initials, age of the subject and antibody titer. The results are also entered into accounting forms (history of the child’s development (form N 112/u), patient’s outpatient card (form N 025/u), preventive vaccination card (form N 063/u), vaccination certificate and other accounting forms.

6.8. The detection in each group of children and adolescents of no more than 5% of persons with a titer of diphtheria and tetanus antibodies less than 1:20 and no more than 10% of persons with the absence of protective titers of diphtheria and tetanus antibodies in the group of adults serves as an indicator of sufficient protection from diphtheria and tetanus.

6.9. The criterion for epidemiological well-being in case of whooping cough should be considered to be the identification of no more than 10% of individuals in the examined group of children with an antibody level of less than 1:160.

6.10. The criteria for epidemiological well-being for measles and rubella are considered to be the identification of no more than 7% of seronegative individuals in each “indicator” group.

6.11. Among those vaccinated against mumps, the proportion of those who are seronegative should not exceed 10%.

6.12. The detection in each study group of no more than 10% seronegative for each of the three serotypes of the polio virus serves as an indicator of sufficient protection from polio.

6.13. Among those vaccinated against hepatitis B, the percentage of people with antibody concentrations less than 10 IU/l should not exceed 10%.

6.14. If below the specified indicators are detected in any “indicator” group:

more than 5% of individuals among children and adolescents and more than 10% of individuals among adults with diphtheria and tetanus antibody titers below the protective level;

more than 10% of individuals with pertussis antibody titers below the protective level;

more than 7% of people seronegative for measles and rubella virus;

more than 10% are seronegative among those vaccinated against mumps;

more than 10% of individuals seronegative for each of the three serotypes of the polio virus;

more than 10% of people seronegative for the hepatitis B virus, with a concentration of antibodies to HBsAg less than 10 IU/l

necessary:

conduct an analysis of vaccination documentation for identified seronegative individuals to establish the fact of vaccination - compare information about vaccinations in all registration forms (preventive vaccination card (form N 063/u), child development history (form N 112/u), outpatient card of the patient (form N 025/u), work logs and others);

assess the conditions of storage and transportation of vaccines, the procedure for immunization;

additionally check the state of immunity to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B in persons of the same age in the amount of at least 100 people, but in 2 other teams of the same health care organization, where a high proportion of seronegative persons;

vaccinate identified seronegative individuals in accordance with current regulations.

6.15. If, after an additional examination, the number of people unprotected to these infections exceeds the given criteria, it is necessary to check the availability of vaccinations in people of the same age groups with a high proportion of seronegative, whose medical care is provided by this health care organization in order to establish falsification of vaccinations. Identified unvaccinated persons should be vaccinated in accordance with current regulations.

6.16. Materials of serological monitoring of the state of collective immunity are summarized for organizations of various types, clinics, districts, cities (district centers) and the constituent entity of the Russian Federation as a whole (Appendix 2, Tables 3, 4, 5, 6). Next, for each infection, the results of the serological survey are compared with morbidity rates and the level of vaccination coverage, which will confirm official data on immunization of the population or identify discrepancies in vaccination coverage with the level of collective immunity.

6.17. Dynamic monitoring of the state of the population's immunity to infections controlled by means of specific prevention allows for timely identification of signs of epidemiological troubles. The forecast of the epidemiological situation for each of the observed infections is considered unsatisfactory if there is a tendency towards an increase in the proportion of seronegative ones.

6.18. When the first prognostic signs are identified in any territory, indicating an approaching worsening of the epidemiological situation for any of the infections under consideration, management decisions are made aimed at increasing the level of the immune layer among the population.

Appendix 1. Procedure for collecting, transporting and storing blood serum

Annex 1

1. Technique for collecting and primary blood treatment

Capillary blood is taken from a finger under aseptic conditions. Before drawing blood, the patient's hand is warmed with hot water, then wiped dry with a clean towel. The finger, having been wiped with 70° alcohol, is pierced with a sterile disposable scarifier. Blood in a volume of 1.0-1.5 ml is collected directly through the edge of a sterile disposable centrifuge tube with a stopper (or into special microtubes for collecting capillary blood). After taking blood, the injection site is lubricated with a 5% iodine solution.

The tube should be numbered and a label should be attached to it indicating the registration number, surname, initials, and date of blood collection.

To obtain serums, a test tube with blood is placed in the room where the blood was drawn, in an inclined (at an angle of 10-20°) position at room temperature for 20-30 minutes to form a clot, after which the test tube with blood is shaken to separate the clot from the wall of the tube .

A list of examined persons is compiled, which indicates the city (district), number of the preschool institution, group, school, class, number of the secondary specialized institution, group, name of the university, faculty, group, registration number, surname, first name of the patient, date of birth, date vaccinations against diphtheria, tetanus, measles, rubella, mumps, polio and hepatitis B, date of blood draw, signature of the responsible person.

The test tubes along with the lists are sent to the clinical diagnostic laboratory of the hospital, where the test tubes with blood are left overnight in the refrigerator at a temperature of 4-8 °C.

After separating the serum from the clot (the tubes are circled along the inner surface with a sterile Pasteur pipette), it is centrifuged at 1000-1200 rpm for 15-20 minutes. Then the serum is carefully poured or aspirated with a pipette with a bulb into sterile centrifuge (plastic) tubes or Eppendorf tubes with the obligatory transfer of the label from the corresponding tube to them.

In the laboratory, serum (without clot) can be stored in refrigerators at a temperature of (5 ± 3) ° C for 7 days before testing. For longer storage, the whey should be frozen at -20 °C. Re-freezing of thawed whey is not allowed. Having collected the required amount of sera, they are sent to the laboratory of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology" of Rospotrebnadzor in a constituent entity of the Russian Federation for research.

2. Transportation of serum (blood) samples

Before transporting the collected material from the survey area, it is very important to take precautions: check the availability of the collected information, tightly cap the tubes, arrange the samples according to their numbers, etc. Lists of surveyed persons should be kept at the collection site. Thermal containers (refrigerator bags) are used to transport blood serum. When transporting and storing blood in the winter, it is necessary to create conditions under which it does not freeze.

When sending samples by rail or air, the laboratory must be notified (by telephone, telegram) of the train (flight) number, date and time of departure and arrival, number of samples, etc.

Appendix 2. Tables

Appendix 2

Table 1

"Indicator" groups for serological monitoring of the state of collective immunity to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B

"Indicator" groups	Diphtheria	Tetanus		Rubella	Epidemi- chelic mumps	Polio- myelitis	Hepatitis B
1-2 years

A blood test for the strength of immunity is one of the effective indicators in diagnosing diseases associated with impaired immunity. A condition where the immune system is significantly weakened is called immunodeficiency. This condition can be primary, that is, congenital, or secondary. Primary immunodeficiency occurs due to the presence of a genetic defect in the development of the immune system. In most cases, it is determined fairly quickly. Children with weak immune systems from birth usually do not live longer than 6 years.

Secondary immunodeficiency is a consequence of negative changes in the immune system that is normal from birth. The reason for weakened immunity may be poor nutrition; if a person does not consume foods that are important for the normal functioning of the body, immunoglobulin will have nothing to form from. This cause is most often found in vegetarians and children.

Changes in the immune system can be detected by doing a blood test to determine the strength of the immune system. Liver disease is the most common cause of immunodeficiency in adults. It is in the liver that antibodies called “immunoglobulins” are formed. For example, with liver damage due to alcohol consumption or viral hepatitis, this function is impaired.

When should you check your immune system?

Immunodeficiency always manifests itself in some way. If a person very often suffers from acute respiratory viral infections, which often occur with complications, or his herpes gets worse too often, boils form, or the mucous membranes are affected by thrush, it is worth checking the state of the immune system. Venereal diseases that are difficult to treat may also indicate a decrease in immunity. To understand the state of the immune system, you need to contact an immunologist and undergo an examination.

An immunogram is used to study immunity. This is an analysis that reflects the state in which the human immune system is.

Currently, this system of the human body has not been studied enough; it is known that it performs such an important task as eliminating agents that have entered the body (chemicals, bacteria, viruses).

There are two types of immunity that are considered basic:

• humoral, reacting to the penetration of foreign organisms, the destruction of which is carried out by special proteins - immunoglobulins;
• cellular, providing protection to the body with leukocytes.

Before checking the strength of immunity, it is necessary to study the possibilities provided by the immunogram. The indicators obtained as a result of such an analysis make it possible to diagnose both immunities.

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What is an immunogram?

The analysis, which is used to check the strength of the immune system, makes it possible to estimate the number of leukocytes, both total and by subtype (lymphocytes, granulocytes, monocytes). Individual subpopulations of lymphocytes, such as CD cells, are also taken into account.

Immunogram is a method for determining the phagocytic activity of leukocytes.

This activity refers to the ability of protective cells (lymphocytes) to destroy bacteria. The taken biomaterial is examined to obtain information about the number of immunoglobulins and circulating immune complexes.

Blood is taken to test the strength of immunity in certain cases. An immunogram is performed when the following conditions are detected:

• infections that occur with relapses;
• oncology;
• autoimmune diseases;
• allergic diseases;
• diseases that are characterized as protracted and have a chronic form;
• suspected presence of AIDS.

The need for it exists during the study of patients who have undergone organ transplantation and who are undergoing this operation. This procedure is also required to monitor a person’s condition while taking cytostatic drugs, immunomodulators, and immunosuppressants. The process of determining immune status consists of two stages. First, a general blood test and general clinical tests are done, which, when visiting a doctor, are prescribed to everyone, regardless of their problem.

If a sexually transmitted infection is detected, an immunogram is not a mandatory procedure, since these patients usually do not have disturbances in the functioning of the immune system. An absolutely healthy person can become infected with a sexually transmitted infection. But some doctors believe that checking the body’s defenses is the basis for drawing up the correct treatment regimen.

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Who should undergo the study, how is it carried out?

An analysis of the strength of immunity is prescribed to people susceptible to colds in cases where there is a high frequency of their occurrence and a long course. After detecting the level where the violation occurred, competent correction of the condition in which the patient is located is prescribed, aimed at improving health and improving the quality of life.

The material for the study is blood taken from a vein. Her intake includes quitting smoking, avoiding heavy exercise and training the day before the procedure. Before taking the test, you do not eat; it is taken in the morning, provided that more than eight hours have passed since the last meal. It is even forbidden to drink not only tea or coffee, but also ordinary water.

A child’s immunity is checked only if there are appropriate indications for this. We should not forget that the immune system is not formed immediately; its completion occurs at five years.

Patients with chronic diseases undergo more thorough examination, which requires more time. During the test, certain immunity parameters are displayed. Such a study is necessary for frequently recurring pneumonia, sinusitis and bronchitis. Pustular skin diseases and infections caused by fungi are also indications for the procedure.

An immunogram can display indicators that indicate certain abnormalities. In young children, such changes are not considered a pathology. Frequent infections caused by viruses are more the norm for a child than a pathology. After all, the body must first recognize viruses and learn to fight them. And you should not interfere with the functioning of the immune system in such situations, since it can cause harm to health.

The results of the analysis are assessed by a specialist. An immunologist has knowledge that allows him to correctly interpret the data obtained from the material taken for research. He evaluates the digital values ​​taking into account the general health of the patient and the present clinical picture.

A person is considered protected from disease caused by a particular type of poliovirus if that person has developed type-specific neutralizing antibodies. However, the titers of serum neutralizing antibodies that would provide protection against infection have not yet been definitively established. Experiments on animals have shown that passive transfer of antibodies, accompanied by the appearance of antibodies in moderate titers (1:20 and above), provides protection against the disease. However, these results cannot be extrapolated to human populations in which wild or vaccine strains of poliovirus circulate.

Studies conducted in the 1950s showed that individuals with low serum neutralizing antibody titers could be reinfected with wild poliovirus. This was confirmed by the observation of 237 people with natural immunity to polio and neutralizing antibody titers of 1:40 or less during familial outbreaks of polio in Louisiana in 1953-1957. Cases of reinfection, proven by a fourfold increase in serum antibody titers, were recorded in 98% of those examined. In contrast, out of 36 people with neutralizing antibody titers of 1:80 above, cases of reinfection were noted in only 33% of those examined.

Recent studies in Japan and the UK have shown that people with low post-vaccination titres of serum neutralizing antibodies may develop reinfection after infection with the vaccine strain of poliovirus. In Japan, when observing 67 children vaccinated with two doses of trivalent PPV for 5 years, 19 children had antibody titers to type 1 poliovirus of 1:8 or lower. After administration of the permissive dose of PPV, 18 of 19 children in this group developed reinfection, as indicated by the release of polio virus in feces. A UK study was conducted in a group of 97 children who were given a new (“resolving”) dose of the same vaccine 8–16 years after three doses of trivalent PPV in early childhood. In 17 children of this group, before the introduction of a new dose of the vaccine, antibody titers to all three serotypes of poliovirus were low (average geometric antibody titers ranged from 1:9 to 1:36). Although the number of children in this group is too small to draw statistically reliable conclusions, it should be noted that of the 8 children without an immune response to the new dose of the vaccine, seven had neutralizing antibody titers of 1:32 or higher. At the same time, in children who responded by seroconverting to the administration of a new dose, antibody titers before vaccination were low.

These data are consistent with previous studies showing that children with low serum antibody titers can be reinfected with the vaccine strain of poliovirus. These studies suggest that people with low but detectable serum antibody titers do not have an increased risk of developing clinical forms of polio. However, they can be reinfected with the polio virus and serve as sources of infection for people who have not been immunized.

The local barrier to polio viruses is provided by secretory IgA antibodies. The level of secretory IgA antibodies that would provide protection against infection remains unknown. Also unknown are the relationships between serum and secretory antibody titers. Children may be resistant to reinfection with poliovirus even in the absence of serum antibodies in cases where they have secretory antibodies in sufficiently high titers.
In 1955, J. Salk formulated his concept of “increased immunological reactivity,” which could prevent deaths from polio even after the use of low-quality vaccines. As this concept evolved, it was proposed that even after neutralizing antibody titers had fallen below minimal detectable levels, immunological memory would persist indefinitely, with the result that repeated immunological stimulation by vaccine or reinfection resulted in a rapid and significant increase in antibody titers. It has been suggested that this secondary immune response to infection develops quickly enough to protect the individual from developing the paralytic form of the disease.

JSalk suggested that lifelong immunity to polio could be induced by a single dose of inactivated polio vaccine (IPV), which should be given to a child between 5 and 7 months of age. However, since this publication, there have been reports of cases of paralytic poliomyelitis in people who received one or more doses of enhanced-potency IPV (uIPV). Moreover, the protective efficacy of a single dose of uIPV (39%) was found to be almost equivalent to the level of neutralizing antibodies induced by a single dose of this vaccine.

note
Consultation with a doctor is the key to your health. Do not neglect your personal safety and always consult a doctor on time.

Poliomyelitis is an acute viral disease that can lead to death or severe damage to the central nervous system. Mass vaccination has made significant progress in the fight against this disease. However, it still remains endemic in several countries in Africa and Asia. Outbreaks of the disease have been recorded in recent years in states bordering Russia.

Immunity to polio

Having immunity to polio reduces the likelihood of getting sick to a minimum. Vaccination allows the body to develop resistance to infection. However, even if all measures have been taken, over time the body’s immune defense may weaken. Persistent immunity is developed in persons who have had the disease or been vaccinated with a live vaccine.

To find out whether a person has antibodies to the polio virus, a serological blood test is performed. This study allows you to determine the risk of infection when exposed to the virus. Typically, an antibody test is performed before traveling to regions where polio cases have been reported.

Where can I get an antibody test?

Testing for antibodies to the polio virus is performed in government and commercial laboratories. The study is not very popular, so it is not carried out in all medical centers. To find out where exactly the test can be done in your city, consult with your local doctor or a specialist at the sanitary-epidemiological station.

In government institutions, the study is performed when indicated. A referral for a free test can be given by an infectious disease specialist at a local clinic. In paid centers, the cost of determining antibodies to polio varies from 1,000 to 3,000 rubles.

How to get tested for polio antibodies

For the qualitative and quantitative determination of antibodies to the polio virus, the enzyme immunoassay method is used. Antibodies are detected in serum or plasma. The result ranges from 0 to 150 U/ml. If the titer is above 12 U/ml, we can talk about the presence of immunity to infection.

It is better to come for the study in the morning before your first meal. In a patient from a vein. It is believed that 0.5-1 ml of blood is sufficient for diagnosis. Paid analysis is completed within 1-2 business days, free analysis within two weeks.