Rules for vaccination. What vaccinations are required for children?

The selection of children for vaccinations is carried out monthly using preventive vaccination cards (form No. 063/u) by a district nurse, nurse or paramedic of a preschool or school.

The preventive vaccination plan is drawn up in accordance with the vaccination calendar.

The plan indicates the type of vaccination and the date of implementation.

If it is necessary to increase the intervals, the next vaccination should be carried out as soon as possible, determined by the state of health of the child.

Reducing intervals is not allowed!

Contraindications are taken into account.

If a medical exemption from vaccination is necessary, a note is made in the child’s developmental history, in the medical record, in the professional’s chart. vaccinations, in the monthly vaccination plan (indicate the end date of the medical allotment and diagnosis).

Children temporarily exempt from vaccinations must be monitored and registered and vaccinated in a timely manner.

Vaccination cannot be done within a month before entering a children's group and a month after the start of visiting a kindergarten.

At the end of each month, information about vaccinations given in kindergartens and schools is entered into the development history of organized children (form No. 112/u).

If parents refuse vaccination in the child's developmental history, a written statement is issued.

Preparation for vaccinations.

1) Children are vaccinated after obtaining parental consent.

A nurse or paramedic verbally or in writing invites parents and their child to be vaccinated on a certain day.

The preschool or school warns parents in advance about vaccinations for their children.

At 2.5 months (before the first DTP vaccination), children undergo a general blood test and a general urine test.

On the day of vaccination, in order to identify contraindications, a pediatrician (paramedic at the FAP) conducts a survey of parents and examines the child with mandatory thermometry, which is recorded in the history of the child’s development or the child’s medical record (form No. 026/u).

The nurse or paramedic is required to warn the mother about possible post-vaccination reactions and the necessary actions.

a) DTP - do not bathe on the day of vaccination, put a heating pad on the injection site

b) Polio – do not give water or food for one hour.

To limit the circulation of the vaccine virus among those around the vaccinated child, parents should be explained the need to observe the rules of personal hygiene of the child after vaccination (separate bed, potty, bedding, clothes separate from other children, etc.)

c) Measles, mumps - do not bathe on the day of vaccination.

Carrying out vaccinations.

Vaccinations are best done in the morning.

BCG vaccinations are carried out in a special separate room (cannot be carried out in the same room with other vaccinations) by a nurse with special training.

Vaccinations against other infections are carried out in vaccination rooms of children's clinics, medical offices of kindergartens, schools and first-aid posts (cannot be done in the treatment room where antibiotic injections and other manipulations are performed).

Cabinets must be equipped with anti-shock therapy equipment.

Vaccinations are carried out by a nurse or paramedic who has permission to perform vaccination work.

Before vaccination, it is necessary to check the correctness of its appointment and registration.

Immunobiological preparations and solvents for them are stored in the refrigerator at the temperature specified in the annotation for the preparation.

Having taken the drug, you need to check the presence of labeling, expiration date, integrity of the ampoule, and the quality of the drug.

The drug should not be used if there is no or incorrect

labeling, if the expiration date has expired, if there are cracks on the ampoule, if the physical properties of the drug change, if the storage temperature conditions are violated.

Injections of immunobiological preparations are made only with disposable syringes in compliance with the rules of asepsis and antisepsis.

10) Register the name of the vaccination, date of administration, series number, dose of the drug in the following documents:

Vaccination log (by type of vaccination);

History of child development (form No. 112/u);

Child’s medical record (form No. 026/u);

Card of preventive vaccinations (form No. 063/u);

Certificate of preventive vaccinations (form No. 156/u-93);

Monthly vaccination plan.

Monitoring the vaccination reaction.

Due to the possibility of developing an immediate allergic reaction, the child is observed for 30 minutes after vaccination.

The reaction to the administration of the drug is checked by a nurse in the pediatric area (carrying out patronage of the child), a nurse (paramedic) of a kindergarten or school within the prescribed time frame.

The general condition of the child, temperature, behavior, sleep, appetite, condition of the skin and mucous membranes, as well as the presence of a local reaction if the drug was administered by injection are assessed.

A record of the presence of a reaction to the vaccine is made in the child’s developmental history and in the medical record (for organized children).

If it is impossible to carry out patronage, parents are given a “Vaccination Reaction Observation Sheet”, where they record all changes in the child’s condition. The sheet is pasted into the history of the child’s development.

Responsibility The doctor or paramedic is responsible for administering the vaccination,

who gave permission for the vaccination, and the nurse or paramedic who performed it.

AFTER A CAREFUL STUDY OF THE “IMMUNOPREVENTION” SECTION, CHECK YOUR LEVEL OF COMPREHENSION OF THE MATERIAL BY ANSWERING THE TEST CONTROL TASKS. COMPARE YOUR ANSWERS WITH THE STANDARD AT THE END OF THE GUIDE.

DUE TO THE LARGE VOLUME AND COMPLEXITY OF THE MATERIAL ON IMMUNOPROPHYLAXIS, PROCEED TO WORK ON THE NEXT STAGE OF THE MANUAL ONLY AFTER YOU ARE SUFFICIENT THAT YOUR KNOWLEDGE IS SUFFICIENT.

The purpose of preventive vaccinations is to prevent the occurrence and spread of infectious diseases. Immunization is the process of forming the body's immunity to a particular infectious disease by administering a vaccine, thanks to which a person acquires immunity.

In the Republic of Belarus, vaccination of the population is carried out as part of the provision of medical care to citizens and is carried out free of charge (fully funded by the state) on the basis of the National Calendar of Preventive Vaccinations and the List of Preventive Vaccinations for Epidemic Indications.

Routine vaccination according to the National Preventive Vaccination Calendar is carried out at certain periods of a person’s life and includes vaccination against 12 infectious diseases:

viral hepatitis B;

tuberculosis;

diphtheria;

tetanus;

• polio;

  measles, mumps, rubella;

  pneumococcal infection;

  Haemophilus influenzae infection type b (Hib infection);

In addition to routine preventive vaccinations, immunization is carried out according to epidemic indications against 18 infections: rabies, brucellosis, chickenpox, viral hepatitis A, viral hepatitis B, diphtheria, yellow fever, tick-borne encephalitis, whooping cough, measles, rubella, leptospirosis, polio, anthrax, tetanus, tularemia, plague, mumps.

In the Republic of Belarus, preventive vaccinations for epidemic indications are carried out: to persons in contact with a patient suffering from an infectious disease; persons at risk of infection while carrying out professional activities; persons whose infection with pathogens of infectious diseases can lead to a complicated course of these diseases or death.

The date of preventive vaccination is determined by the local pediatrician (general practitioner, general practitioner, neonatologist).

To carry out preventive vaccinations in a timely manner, the medical worker orally or in writing invites persons who should be vaccinated to the territorial health care organization.

For reference. Carrying out preventive vaccinations outside healthcare organizations or by visiting teams (for example, at the place of work, study) is possible in premises that meet sanitary and epidemiological requirements.

All information about vaccination is entered into the patient’s medical documentation (for example, “Preventive Vaccination Card”, “Outpatient Medical Card”, “Child Development History”, etc.).

Prophylactic vaccination is a simple medical intervention. Therefore, the medical professional will definitely clarify your consent before the vaccination. Consent for simple medical intervention is given verbally by the patient, and the medical professional makes a note of consent in medical documents.

Persons who have reached the age of majority, as well as minors aged fourteen to eighteen years, have the right to independently consent to simple medical intervention. In all other cases, consent is given by parents or legal representatives.

However, in accordance with current legislation, the patient or his legal representative has the right to refuse vaccination. In this case, the attending physician explains in an accessible form the possible consequences of the refusal; the refusal is recorded in the medical documentation and signed by the patient and the attending physician.

The doctor must explain to the patient (parents, guardians, other legal representatives) the need for vaccination, and also inform:

about the infection against which preventive vaccination is carried out,

about the name of the vaccine,

about the presence of contraindications and possible adverse reactions.

Before vaccination, the doctor must examine the patient, measure the temperature, respiratory rate, pulse, and ask whether he has any complaints about his health. This takes into account previous reactions to vaccinations, allergies to medications, foods, and existing chronic diseases.

If there are no contraindications to vaccination, the specialist will give written permission, which is recorded in the medical card and is a prerequisite for preventive vaccination.

After vaccination, you should not leave the medical facility for the first 30 minutes; sit near the office. This time will be enough for the child to calm down after the injection, and in case of an unexpected reaction to the vaccine, parents will be able to immediately receive medical help.

Preventive vaccinations are given to individuals only during the absence of an acute or exacerbation of a chronic disease. Therefore, for the period until recovery, disappearance of symptoms, normalization of condition and recovery from the illness, the doctor will establish a temporary (long-term) contraindication for immunization. Its duration may vary, but is usually limited to one to three months.

A permanent contraindication to all vaccines is a complication following the administration of a previous dose of the drug. In particular, severe immediate allergic reactions that develop within 24 hours after vaccination, encephalitis (encephalopathy), seizures that occur in children with elevated body temperature.

The conclusion on the establishment, cancellation or extension of a permanent and long-term contraindication is made by the immunological commission, which will also determine the further tactics of vaccination for the patient.

Children who are not vaccinated on time due to medical contraindications are vaccinated according to an individual schedule, taking into account the recommendations of a pediatrician or other specialists.

The introduction of any vaccine is naturally accompanied by changes in the body: immunity begins to form, protective antibodies are formed in the blood. Sometimes these processes are accompanied by certain symptoms, so-called adverse (post-vaccination) reactions. In any case, these reactions do not last long (from several hours to several days) and do not leave consequences for the body. They can be divided into two groups:

local - may manifest as redness, thickening, pain at the site of vaccine administration;

are common - may manifest as increased body temperature, weakness, lethargy, or vice versa, tearfulness.

There is also a group of serious adverse reactions - these are changes in the body associated with vaccination and occurring as part of pathological changes. Such reactions occur extremely rarely - 1 case per several thousand or millions of vaccinations given.

If any symptoms occur during the period after vaccination, you must inform your pediatrician, who will assess the severity of their manifestations and, if necessary, give individual recommendations. Medical assistance provided in the event of serious adverse reactions helps to avoid consequences for the body.

It is also necessary to talk about coincidences - changes in the body that arose during the period after a particular vaccination and were not related to vaccination.

It is very important to correctly distinguish between a post-vaccination reaction and any disease that coincided with the vaccination. Medical care in case of development of a post-vaccination reaction and any disease will be different.

For information. For example, a child received a vaccination using a vaccine against viral hepatitis B. At the same time, he “caught” some kind of respiratory virus, which caused his body temperature to rise to 39˚C, weakness, lethargy, redness and “soreness” in the throat , runny nose. This set of symptoms allows us to say that the symptoms that arose after vaccination are not associated with the administration of the vaccine (since they are not characteristic of a post-vaccination reaction to the administration of a vaccine against viral hepatitis B), but are associated with an associated infection.

Every parent should understand that the number of complications as a result of an infection is thousands, and sometimes tens of thousands of times greater than after vaccination.

An individual approach to the appointment and administration of vaccinations ensures that the risk of post-vaccination reactions and complications is minimized.

Before using the vaccine, they undergo the state registration procedure and the incoming laboratory quality control procedure in accordance with the current legislation of the Republic of Belarus. Monitoring of compliance with the “cold chain” (optimal temperature conditions for storing immunobiological medicines) during transportation, storage and use of vaccines is carried out. In the Republic of Belarus, monitoring of adverse reactions, including serious ones, is carried out. They are extremely rare: in the entire history of vaccination in our country, only isolated cases have been recorded.

Immunoprophylaxis of infectious diseases in children is one of the most important tasks of modern pediatrics. Where vaccination rules are followed, morbidity statistics are much lower. Almost all countries of the world have developed a special vaccination schedule, which strictly regulates the timing and norms of immunological measures against tuberculosis, meningitis, polio, staphylococcal, rotavirus and Haemophilus influenzae infections, as well as against hepatitis and diphtheria.

Citizens have the right to receive complete information about vaccinations from medical workers. Parents should also be aware of a rare but possible side effect of vaccines - post-vaccination complications.

You will learn about what vaccinations children are given in Russia in the material below.

Federal law on vaccination of children in Russia

Federal Law of September 17, 1998 No. 157-FZ “On the Immunoprophylaxis of Infectious Diseases” for the first time established in our country the legal framework in the field of immunoprevention of infections, which is carried out in order to protect the health and ensure the sanitary and epidemiological well-being of citizens. The law on childhood vaccination in Russia stipulates that vaccination is voluntary, i.e. vaccinations are carried out only with the consent of the child’s parents or his legal representatives. The refusal must be confirmed in writing.

There are no restrictions on an unvaccinated child visiting child care facilities outside of an epidemic situation due to the relevant infection. The same law on vaccination in Russia provides for the right of citizens to social protection in the event of post-vaccination complications.

A medical worker (nurse, paramedic, doctor) is obliged to explain to parents in an accessible form the need for a particular vaccination. Also, medical workers are required to inform parents in advance about the timing of specific vaccinations, what infection the vaccination is against, the dangers of the disease for unvaccinated people, the need to monitor the child after vaccination and consult a doctor in cases where the child’s well-being is impaired.

The document regulating the procedure for vaccination of children in Russia is the order of the Ministry of Health and Social Development of Russia dated January 31, 2011 No. 51n “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications.”

Basic rules for vaccinating children

Preventive vaccinations are carried out for children as planned in specially equipped vaccination rooms at children's clinics in compliance with sanitary and hygienic requirements by qualified medical personnel.

According to the basic rules of childhood vaccination, before a preventive vaccination, a medical examination of the child by a doctor and thermometry is carried out.

Parents are interviewed by a doctor to identify previous diseases, the presence of reactions or complications to previous vaccinations, allergic reactions to medications, products, individual characteristics of the body, contact with infectious patients.

If a child has chronic diseases, allergic conditions and others, the necessary laboratory and instrumental tests and consultations with specialist doctors (neurologist, immunologist-allergist and others) are first carried out.

Data from the survey and examination, as well as permission to vaccinate, are recorded in the child’s developmental history.

After immunoprophylaxis, children are under medical supervision for 30 minutes, when it is theoretically possible for immediate anaphylactic reactions to develop. Parents are informed about possible reactions and symptoms that require contacting a doctor. Next, the vaccinated child should be observed by a nurse for the first 3 days after the administration of inactivated vaccines and on days 5-6 and 10-11 after the administration of live vaccines.

Information about the vaccination performed is entered into registration forms (No. 112, -63 and 26), vaccination logs and a Certificate of Preventive Vaccinations.

Vaccination against tuberculosis: when children are vaccinated

- the most important problem in the world, every day 24,000 people fall ill with it and 7,000 people die. Vaccination of children against tuberculosis is included in the WHO Expanded Program on Immunization; it is carried out in more than 200 countries, and over 150 countries carry it out in the first days after birth.

When are children vaccinated against tuberculosis according to WHO recommendations? Vaccination is carried out for practically healthy newborns with the BCG-M vaccine at the age of 3-7 days. Newborns with contraindications are treated in neonatal pathology departments, where they should be vaccinated before discharge. Children who were not vaccinated during the neonatal period should be vaccinated within 1-6 months of life; children older than 2 months are vaccinated if the Mantoux test is negative.

Repeated vaccination (re-vaccination) of children against tuberculosis is carried out for uninfected tuberculin-negative schoolchildren aged 7 and 14 years.

A normal reaction to the vaccine is assessed by a local pediatrician. At the site of intradermal injection of the vaccine, an infiltrate of 5-10 mm in size develops with a nodule in the center and a smallpox-type crust, sometimes a pustule or small necrosis with scanty discharge. In newborns, a reaction to tuberculosis vaccination appears after 4-6 weeks; after revaccination, sometimes already in the 1st week. Reverse development occurs within 2-4 months; in 90-95% of those vaccinated, a scar measuring 3-10 mm remains.

Vaccination schedule for vaccinating children against hepatitis B

About 90% of newborns from HBeAg carrier mothers are infected during childbirth; if the mother carries only HBsAg, the risk of vertical transmission of the virus to the newborn is lower, but all of them have a high risk of infection during breastfeeding and close contact with the mother. In newborns, in 90% of cases it takes a chronic course, when infected in the 1st year - in 50%, in adults - in 5-10%. Therefore, the importance of preventing vertical transmission of hepatitis B by vaccinating children on the 1st day of life is obvious. This is in line with the WHO strategy.

The hepatitis B vaccination schedule for children includes three doses of the hepatitis B vaccine. V1 vaccination is performed in the first 12 hours of the child's life. V2 - at the age of 1 month. Children are vaccinated against hepatitis B V3 in the sixth month of life.

Children of mothers who are carriers of HBsAg (risk group) are vaccinated according to the schedule of 0-1-2-12 months.

Below you will find out when children are vaccinated against diphtheria.

When are children vaccinated against diphtheria?

- anthroponotic bacterial infection with aspiration mechanism of pathogen transmission. The disease is characterized by general intoxication, fibrinous inflammation of the mucous membranes of the oropharynx and respiratory tract, as well as the skin, mucous membranes of the genital organs, and eyes. The causative agent of diphtheria belongs to the genus Corynebacterium. The leading route of transmission of the pathogen is airborne droplets. The main transmission factor is air, but sometimes the pathogen can be transmitted through household contact. The source of infection is often bacteria carriers. A distinctive feature of modern carriage is that the bulk of carriers of toxigenic corynebacteria are concentrated among children aged 6 to 10 years, who, thanks to routine vaccination, have a high level of anti-diphtheria antitoxic immunity.

For the primary vaccination of children against diphtheria, the DTP vaccine is used, starting from 3 months of age three times with an interval of 1.5 months and the first revaccination 12-18 months after the completed three-time vaccination.

If a baby (from 3 months to 6 years) has had whooping cough, then to prevent diphtheria in children, vaccination with the ADS-toxoid vaccine is used. The vaccination course is 2 doses with an interval of 30-45 days. Repeated vaccination against diphtheria is given to children once every 9-12 months.

Vaccinations for children against rotavirus infection

- the main cause of acute gastroenteritis; by the age of five, almost all children suffer from it, usually twice. Epidemics are observed in the winter-spring period.

The source of infection is a sick person or carrier. For children, the source of infection is mainly adults. The pathogen is transmitted through household contact, food and water. The highest incidence is recorded in children 6-12 months old.

The disease is often severe due to the development of dehydration and complications. It begins acutely, the early sign is copious, watery stools, yellow in color, foamy in appearance, with a pungent odor. The child's anxiety increases after eating, and bloating is noted. Vomiting up to 3-4 times on the first day of the disease. Body temperature may be normal or rise briefly in the first 1-3 days. Catarrhal phenomena may appear - hyperemia of the pharynx, cough, difficulty in nasal breathing.

Profuse watery diarrhea, vomiting, and fever lead to dehydration, requiring rehydration, often intravenous, in a hospital setting.

To prevent rotavirus infection, children are vaccinated with Rotarix and RotaTek vaccines from 6 weeks of age with an interval of 4-6 weeks.

Vaccinations for children when vaccinated against pneumococcal and hemophilus influenzae infections

Vaccination against pneumococcal infection.

Currently, according to WHO, diseases of pneumococcal (Streptococcus pneumoniae) etiology are recognized as the leading cause of mortality as a result of vaccine-preventable infections. The highest incidence rates are recorded among children in the first 2 years of life and the elderly. Pneumococcal pneumonia kills more children under 5 years of age than other infectious diseases, including AIDS, malaria and measles combined.

In order to prevent pneumococcal infection, young children are vaccinated; for this, starting from 2-3 months of age, the Prevenar conjugate vaccine is used.

Vaccination against Haemophilus influenzae infection.

Research in recent decades has shown that J. influenzae type b (HIB) is the cause of such serious diseases in children as epiglottitis, osteomyelitis, septic arthritis and septicemia.

Currently, the most effective and, perhaps, the only way to prevent diseases caused by J. influenzae type b is their specific prevention through vaccination. It has been proven that vaccinations for children against Haemophilus influenzae infection (Hib infection) are highly effective, have virtually no serious drawbacks, including no side effects, and therefore can be used in children in the first months of life.

Vaccines against hemophilus influenzae are usually immunized in children in the first year of life, starting at 2-3 months of age. The primary vaccination regimen for children against Haemophilus influenzae involves the administration of three doses of the drug simultaneously with DTP, the polio vaccine.

Tetanus vaccination: when do children get vaccinated?

Tetanus is a typical wound infection related to sapronoses. The causative agent of the disease, Clostridium tetani, produces a strong biological poison, namely tetanus exotoxin, consisting of two components: tetanospasmin (neurotoxin), which affects nervous tissue and causes cramps due to spasmodic muscle contraction, and tetanolysin, which destroys red blood cells.

The incidence of tetanus is recorded everywhere. The tetanus microbe enters the soil together with feces mainly from the intestines of domestic animals and humans. Infection with tetanus occurs when soil, manure, fertilizers and other substances infected with spores enter the human body through damaged skin or mucous membranes, as well as during injections, operations, abortions and childbirth in inappropriate conditions, outside medical institutions.

Since 1961, Russia has had a national program of compulsory vaccinations against tetanus in children, which has made it possible to eliminate the disease in newborns and reduce morbidity and mortality from this infection by 30 times. Currently, in the Russian Federation, instead of 450-500 cases of tetanus per year, there are only about 20. However, the danger of infection always exists, especially in modern conditions associated with increased trauma (man-made and natural disasters, emergency situations). The immune defense of each individual plays a key role in preventing tetanus disease.

Vaccination against tetanus in children and adults includes two areas - routine active immunization and emergency immunization for injuries. The only reliable method of protection so far is active immunization through tetanus vaccinations for children and adults with tetanus toxoid (TS), starting from an early age. For this purpose, according to the current national calendar of preventive vaccinations of the Russian Federation, children starting from 3 months of age receive a full course of immunization with tetanus toxoid as part of associated drugs - DTP, ADS, ADS-M, which also include anti-diphtheria and anti-pertussis components. When are tetanus vaccinations given to children according to WHO recommendations? The full course of immunization includes a primary three-time DPT vaccination (at 3-4.5-6 months) and one revaccination (at 18 months).

Vaccination of children when traveling abroad

When families with children travel abroad, they must be fully vaccinated according to the calendar. What vaccinations do children get when traveling abroad? It is advisable to vaccinate children 1 year of age according to an accelerated schedule: against hepatitis B - 3 vaccinations with an interval of 1 month, DTP - 3 vaccinations with a monthly interval and revaccination after 6 months, - IPV - 3 vaccinations with a monthly interval.

When traveling to a measles-endemic region, the measles vaccine should be administered to a child starting at six months of age (with subsequent vaccination after a year), and a child over 1 year old who has been vaccinated once should be given a double dose of the vaccine.

Split and subunit influenza vaccines can be administered from 6 months of age.

For preventive vaccination of children traveling abroad, if they have not received full vaccinations, all missing vaccines are administered simultaneously.

Contraindications to vaccination: in what cases children are not vaccinated

In recent years, the number of contraindications to vaccination of children has decreased significantly. This is due both to an improvement in the quality of immunobiological preparations and to a significant expansion and deepening of knowledge about the etiopathogenesis of post-vaccination complications.

The wide list of contraindications used for many years in our country was compiled on the basis of existing contraindications to smallpox vaccination. Modern vaccinology does not stand still - the technology of production and purification of vaccines is being improved, the concentration of ballast substances and the antigens themselves is decreasing. After summarizing scientific data and practical results, it was proven that children with various chronic diseases generally develop specific immunity well, and they do not experience complications of the underlying disease. The attitude towards vaccinations for children with immunodeficiency conditions, as well as with diseases caused by immunopathological mechanisms, has been revised.

It is mandatory to vaccinate disabled children with various lesions of the nervous, endocrine systems, musculoskeletal system, etc. Failure to comply with contraindications and unreasonable medical exemptions from vaccinations often lead to the fact that children with somatic pathologies, allergic diseases, and neurological defects are defenseless against infectious diseases , which are particularly difficult. Contraindications to vaccination are regulated by the methodological guidelines “Medical contraindications to preventive vaccinations with drugs from the national vaccination calendar. MU 3.3.1.1095-02", approved. Chief State Sanitary Doctor of the Russian Federation 01/09/2002

Contraindications to vaccinations for children may include:

• true, as a rule, associated with certain components of vaccines and listed in the instructions for vaccines. For example, the pertussis component of DPT is contraindicated in cases of progressive neurological disease;
• false, which have developed due to outdated traditions and prejudices (perinatal encephalopathy, dysbacteriosis, anemia). These are the main unjustified reasons for delays in vaccination;
• absolute, having absolute force. If they are present, vaccination is not carried out under any circumstances;
• relative, the final decision on which is made by the doctor after analyzing various factors, such as the proximity of the epidemic, the likelihood of contact with the source of infection, the degree of risk of the child developing severe complications in case of illness, etc. An example is an allergy to chicken egg whites, which is a contraindication to influenza vaccinations. In a situation where the risk of complications and death due to influenza in a given patient exceeds the risk of an allergy to the components of the vaccine, the contraindication is ignored and the vaccine is given after preliminary preparation;
• temporary, i.e. valid for a certain period of time, after which the contraindication can be lifted. For example, it is not recommended to vaccinate against the background;
• permanent ones that cannot be removed. These include some types of severe primary immunodeficiencies. Permanent contraindications are quite rare - no more than 1% of children.

The use of live and non-live vaccines for vaccinations

To correctly assess contraindications to vaccination, it is necessary to know the classification of vaccine preparations, their composition and the effect they have on the body. As you know, vaccines can be divided into two groups - live and inactivated (non-living), which differ significantly in their characteristics.

Live vaccines (poliomyelitis, measles, mumps, chickenpox, etc.) contain avirulent, attenuated or closely related strains of microorganisms that are not pathogenic for humans (vaccine against tuberculosis). Live vaccines are thermolabile (when heated, at room temperature for 30 minutes or more, they lose their immunogenicity), do not include adjuvants, contain a small amount of antibiotics (aminoglycoside series), proteins of the medium on which the microorganism was grown (Japanese quail embryos are used as media , chicken embryos, human diploid cells), in some cases - residual amounts of albumin and gelatin.

Microorganisms inoculated with live vaccines induce specific cellular, humoral and secretory immunity.

Humoral immunity (Th2 type of immune reactions) is associated with the formation of antibodies: antibacterial, virus-neutralizing, or involved in the reaction of complement-dependent cytotoxicity. Secretory specific antibodies create the first barrier of protection against infections by preventing the adhesion of the microorganism to the mucous membranes. Cellular immunity (Thl type), the most important for protection against viral pathogens, is associated with the formation of specific cytotoxic cells capable of recognizing cells infected with the corresponding virus and eliminating them. Attenuated antigens of live vaccines multiply in the body of the vaccinated person, reproduce the infectious process in a weakened form and are capable of causing vaccine-associated diseases when the strain is reverted or in case of immunity defects in the vaccinated person. Therefore, the use of live vaccines is contraindicated in persons with severe immunodeficiency conditions.

The group of non-live vaccines is diverse:

• inactivated whole cell (pertussis) and whole virion (inactivated poliomyelitis, against tick-borne encephalitis, etc.);
• chemical acellular (pertussis acellular) and polysaccharide (meningococcal, pneumococcal);
• recombinant (against hepatitis B, etc.);
• toxoids (diphtheria, tetanus, etc.).

Despite the differences in production methods, reactogenicity, and immunogenicity, they are united by the absence of a living microorganism. As a rule, these vaccines contain stabilizers and an adjuvant that has an immunostimulating effect on specific antibody formation. A common property of non-live vaccines is a decrease in immunogenicity and an increase in reactogenicity when frozen.

Vaccinations with non-live vaccines are designed primarily to form specific antibodies (stimulation of the humoral Th2 type of immune response). They stimulate the formation of a less intense and long-lasting specific immune response than live vaccines, and therefore require repeated administrations. An important property of non-live vaccines is the absence of vaccine-associated diseases and the possibility of use in patients with any immunodeficiency conditions.

There are no absolutely reactogenic vaccines; all vaccine processes have common patterns, depending not only on the properties of the vaccines, but also on the constitutional, genetic characteristics of the body, in particular the HLA system. Quite often, in the post-vaccination period, intercurrent infections accidentally occur, which is often mistakenly interpreted as a post-vaccination complication of vaccination.

Currently, a wide variety of live and non-living vaccines are being developed, produced and used in medical practice around the world. In order to avoid the negative consequences of vaccination, including post-vaccination reactions and complications, and at the same time to achieve the specified level of immune protection caused by it, developers and manufacturers of modern vaccines constantly strive to ensure that their products meet the WHO requirements for an ideal vaccine.

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Organization of vaccination room and vaccinations

Vaccinations are a mass measure; even small deviations from the rules for their implementation are fraught with the development of complications. Vaccination should be carried out in strict compliance with sanitary and hygienic requirements. The worker conducting the vaccination must follow the recommendations for the technique of its administration. The equipment of each vaccination room should include:

Instructions for the use of all vaccines used and other recommendations;

A refrigerator specifically designed for storing vaccines only; vaccines should not be stored for a long time, their quantity should correspond to the number of vaccinations currently planned;

Cabinet for tools and medicines;

Bixes with sterile material;

Changing table and (or) medical couch;

Tables for preparing drugs for use;

Cabinet for storing documentation;

Container with disinfectant solution;

Ammonia, ethyl alcohol, a mixture of ether and alcohol or acetone;

Tonometer, thermometers, disposable syringes, electric suction.

To combat shock, the office should have the following means:

- solutions adrenaline 0, 1 %, mezatona!%, or norepinephrine 0.2%;

— prednisolone, dexamethasone or hydrocortisone in ampoules;

- solutions: 2.5% Pipolfen or 2% Suprastin, 2.4% aminophylline, 0,9% sodium chloride; cardiac glycosides (strophanthin, korglykon);

- packaging of metered-dose aerosol?-agonist (salbutamol and etc.)

Vaccinations against tuberculosis and tuberculin diagnostics should be carried out in separate rooms, and in their absence, on a specially designated table. In the pathology departments of maternity hospitals, it is allowed to introduce BCG in the ward in the presence of a doctor. To accommodate syringes and needles used to administer vaccines BCG and tuberculin, use a separate cabinet. On the day of the event BCG no other manipulations are performed on the child; if necessary, other vaccine injections are given the day before or the day after administration BCG. Vaccination is allowed from the 3rd day of life, discharge - 1 hour after vaccination.

Before vaccinations it is necessary to check the quality of the drug, its labeling, and the integrity of the ampoule (vial). Vaccines cannot be used:

With inappropriate physical properties;

With violation of the integrity of the ampoules;

With unclear or missing markings on the ampoule (bottle);

Vaccines stored or transported under improper temperature conditions, especially:

- adsorbed (DTP, ADS, ADS-M, VGV), frozen;

- alive (measles, mumps, rubella) vaccines exposed to temperatures greater than 8°C; BCG - more than 4°.

Opening of ampoules, dissolution of lyophilized vaccines, parenteral vaccination is carried out in accordance with the instructions with strict adherence to aseptic rules. In order to save vaccines produced in multi-dose packages, WHO has recommended rules for the use of opened vials for subsequent immunization. In accordance with them, a letter from the Center for State Sanitary and Epidemiological Surveillance in Moscow (No. 1-64 dated December 27, 1999) allowed the use of opened bottles with OPV, HBV, DPT, ADS,ADS-M, AS subject to the following conditions:

— all rules of sterility are observed;

- the shelf life of the drug has not expired and

— vaccines are stored in proper conditions at a temperature of 0-8° and opened vials that were taken from a medical institution are destroyed at the end of the working day.

At the end of the working day, opened vaccine vials are destroyed. BCG, LCV, against yellow fever. The vaccine vial is immediately destroyed if:

- sterility rules were violated or

— there is a suspicion of contamination of the opened bottle or

— there are visible signs of contamination, such as changes in the appearance of the vaccine, floating particles, etc.

Tools, used for vaccination (syringes, needles, scarifiers), must be disposable and rendered unusable in the presence of the person being vaccinated or his parent. It is preferable to use auto-disable syringes.

Treatment of the vaccine injection site is carried out, as a rule, with 70% alcohol, unless otherwise indicated (for example, with ether when administering the Mantoux river or administering the vaccine BCG and acetone or a mixture of alcohol and ether for the scarification method of immunization with live vaccines; in the latter case, the diluted vaccine is applied to the skin after the disinfectant liquid has completely evaporated).

When carrying out vaccination, the regulated dose (volume) of the vaccine must be strictly observed. In adsorbed drugs and BCG Poor mixing can change the dose, so the requirement to “shake thoroughly before use” must be taken very conscientiously.

The vaccination is carried out in the position lying down or sitting to avoid falling due to fainting, which occasionally occurs during the procedure in adolescents and adults.

Cleaning the vaccination room carried out 2 times a day using disinfectant solutions. The office is thoroughly cleaned once a week.

Intramuscular vaccination

Regardless of the recommendations contained in the instructions for use of vaccines, intramuscular administration is carried out in anterior outer thigh area(in the lateral part of the quadriceps femoris muscle) or in deltoid muscle. The upper outer quadrant of the gluteal muscle, which until recently was considered the optimal location, should not be used for intramuscular injections due to the risk of nerve damage if it is abnormally located (observed in 5% of children). Moreover, the buttocks of an infant have little muscle tissue and a lot of fatty tissue. The thigh muscle is of sufficient thickness in children of the first year of life; from the age of 5 years, the deltoid muscle also reaches sufficient thickness for intramuscular injections. Vaccination of adults is carried out in the deltoid muscle. The needle is inserted vertically (at an angle of 90°). There are 2 ways to insert a needle into a muscle:

Gather the muscle into a fold with two fingers, increasing the distance to the periosteum;

Stretch the skin over the injection site, reducing the thickness of the subcutaneous layer; this is especially convenient for children with thick fat layers, but the depth of needle insertion should be shallower.

Ultrasound studies showed that the thickness of the subcutaneous layer on the thigh up to the age of 18 months. is 8 mm (maximum 12 mm), and the thickness of the muscle is 9 - mm(maximum 12 mm), so a needle 22-25 mm long is sufficient to inject the vaccine deep into the muscle when taking it into the fold. In children of the first months of life when stretching the skin a needle 16 mm long is sufficient. On the arm, the thickness of the fat layer is less - only 5-7 mm, and the thickness of the muscle - 6-7 mm.

The intramuscular route of administration is the main one for sorbed drugs (DPT, ADS,ADS-M, VGV), since this reduces the risk of developing granulomas (“sterile abscesses”). Subcutaneous administration of these vaccines to adults, which was permitted in the past, has been revised in a number of countries. Intramuscular injection of hepatitis B and rabies vaccines into the deltoid muscle is also practiced because it enhances the immune response.

Due to the greater likelihood of vascular damage, intramuscular administration in patients with hemophilia is replaced by subcutaneous administration. It is useful to pull back the syringe plunger after the injection and inject the vaccine only if there is no blood. Otherwise, the entire procedure must be repeated.

Subcutaneous vaccination

This route is usually used when administering unsorbed drugs (measles, rubella, mumps, as well as meningococcal and other polysaccharide vaccines). The injection site is the subscapular region or the area of ​​the outer surface of the shoulder (at the border of the upper and middle third); In the USA, subcutaneous injection into the anterior outer thigh is allowed.

Skin vaccination

Cutaneous (scarification) vaccination is used when inoculating with live vaccines against a number of particularly dangerous infections (plague, tularemia, etc.). In this case, through a drop (drops) of the vaccine applied in an appropriate dilution to the surface of the skin (usually the outer surface of the shoulder at the border of the upper and middle third), a regulated number of superficial non-bleeding (the appearance of “dewdrops” of blood is allowed) incisions is made with a dry smallpox vaccination pen. When making incisions, it is recommended to stretch the skin, as with intradermal injection.

Oral vaccination and intradermal administration

Vaccines against polio, plague and cholera are administered orally, intradermally - BCG, tuberculin at r. Mantoux, horse serum diluted 1:100.

Observation of vaccinated people

Observation is carried out during the first 30 minutes after vaccination directly by a doctor (paramedic), when it is theoretically possible for immediate anaphylactic reactions to develop. The child's parents are informed about possible reactions and symptoms that require contacting a doctor. Next, the vaccinated person is observed by a patronage nurse for the first 3 days after the administration of the inactivated vaccine and on days 5-6 and 10-11 after the administration of live vaccines. Unusual reactions and complications should be carefully reviewed.

Intelligence information about the vaccination performed is recorded in registration forms (N 112, 63 and 26), vaccination logs and a Certificate of Preventive Vaccinations indicating the batch number, expiration date, manufacturer, date of administration, nature of the reaction . When vaccinations are carried out by a private practitioner, a detailed certificate should be issued or information should be entered into the Certificate.

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1. Before vaccinating your child, you need to make sure that he is absolutely healthy: he has no cough, no diarrhea, and clean skin.
2. Blood and urine tests should be in order.
3. Before going for vaccination, be sure to measure your child's temperature.
4. If the child has recently been sick, you need to wait time. After a mild cold, 7-10 days are enough, after - at least 2-3 weeks, and in some cases it is better to postpone vaccination for a month. After pneumonia, sore throat and childhood infections (measles, rubella, chickenpox, scarlet fever, mumps), at least a month should pass. If the child had pyelonephritis - 6 months.
5. If you have any chronic disease (bronchial asthma, chronic pyelonephritis, chronic tonsillitis, etc.) or a neurological disease, you need to wait for a lasting improvement and obtain permission from a specialist: ENT doctor, neurologist, allergist, etc., which the child is being observed.
6. The annotations of some vaccinations contain information that they can be done against the background of a mild ARVI or immediately after recovery. Such recommendations to the author seem very dubious. The fact is that in order to develop high-quality immunity to vaccination, the immune system must be in good condition, and viral infections greatly weaken it. To strain yourself once again after an illness is to put the child’s immune system at risk: it can become strained. In addition, immunity will not be of the quality that we would like.
7. Each subsequent vaccination should be carried out no earlier than 4 weeks after the previous one. The only exceptions are vaccinations against rabies and tetanus for emergency reasons.
8. If the child has been in contact with an infectious patient, the doctor should be informed about this. The doctor should be notified if the child was treated with drugs that suppress the immune system, if he was given blood or plasma transfusions, or if immunoglobulin was administered intramuscularly. And if there were any reactions to the previous vaccination, be sure to tell your doctor about it.
9. Find out in advance what vaccination your child will receive and why. Ask your doctor what complications may arise from vaccination and how to behave if they occur.
10. Vaccinations are administered by health care workers (nurse or doctor). After vaccination, do not rush to go home as soon as possible. The child must be monitored for 30 minutes, because anaphylactic reactions may occur during this period.
11. The child must be monitored for 3-4 days after vaccination. During this period, vaccination complications may occur.
12. After vaccination with live vaccines (BCG, measles, mumps, rubella), the child should not receive antibiotics and sulfa drugs 2 days before vaccination and for 7-10 days after. They reduce the effectiveness of vaccination.
13. On the day of vaccination, you should not overload the child: carry out physiotherapeutic procedures, x-rays, actively engage in sports, etc. It is also not advisable to bathe the child after vaccination.
14. It is necessary to have antipyretic drugs (Panadol, Efferalgan, Nurofen - any) in your home medicine cabinet, since the vaccination may cause the temperature to rise, as well as antiallergic drugs (Suprastin, Fenistil, Diazolin, Claritin, Tavegil - any).
15. Children with allergies should be given antiallergic drugs 2 days before vaccination and for 3 days after (see paragraph 14).
16. If any complication arises after vaccination within 3 days - local redness, fever, convulsions, etc. - be sure to notify your doctor.