Rules for vaccinating children. The procedure for vaccinations
CARRYING OUT PREVENTIVE VACATIONS
Second vaccination against viral hepatitis B
First vaccination against diphtheria, whooping cough, tetanus, polio
Revaccination against measles, rubella, mumps
Second revaccination against diphtheria, tetanus
Rubella vaccination (girls).
Vaccination against viral hepatitis B (previously unvaccinated)
The third revaccination against diphtheria, tetanus.
Revaccination against tuberculosis.
Third revaccination against polio
adults
Revaccination against diphtheria, tetanus - every 10 years from the last revaccination
In case of violations of the timing of the start of vaccinations, the latter are carried out according to the schemes provided for by this calendar and instructions for the use of drugs.
8.2. Whooping cough immunization
8.2.1. The goal of whooping cough vaccination, according to WHO recommendations, should be to reduce the incidence by 2010 or earlier to a level of less than 1 per 100,000 population. This can be achieved by ensuring at least 95% coverage with three vaccinations of children at the age of 12 months. and the first revaccination of children at the age of 24 months.
8.2.2. Vaccination against pertussis is subject to children from 3 months of age to 3 years 11 months 29 days. Vaccinations are carried out with DTP vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.
8.2.3. The vaccination course consists of 3 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.
8.2.4. The first vaccination is carried out at the age of 3 months, the second - at 4.5 months, the third vaccination - at the age of 6 months.
8.2.5. Revaccination with DTP vaccine is carried out once every 12 months. after completed vaccination.
8.2.6. DTP vaccinations can be given at the same time as other vaccinations in the vaccination schedule, with the vaccines being administered with different syringes to different parts of the body.
8.3. Immunization against diphtheria
Vaccinations are carried out with the DPT vaccine, ADS toxoids, ADS-M, AD-M.
8.3.1. The goal of vaccination against diphtheria, as recommended by WHO, is to achieve by 2005 an incidence rate of 0.1 or less per 100,000 population. This will be possible by ensuring at least 95% coverage of completed vaccination of children at the age of 12 months, the first revaccination of children at the age of 24 months. and at least 90% vaccination coverage of the adult population.
8.3.2. Vaccination against diphtheria is subject to children from 3 months of age, as well as adolescents and adults who have not previously been vaccinated against this infection. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.
8.3.3. The first vaccination is carried out at the age of 3 months, the second vaccination - at the age of 4.5 months, the third vaccination - at the age of 6 months. The first revaccination is carried out after 12 months. after completed vaccination. Children from 3 months of age to 3 years 11 months 29 days are subject to vaccination with DTP vaccine.
Vaccination is carried out 3 times with an interval of 45 days. Shortening intervals is not allowed. With a forced increase in the interval, the next vaccination is carried out as soon as possible, determined by the state of health of the child. Skipping one vaccination does not entail repeating the entire vaccination cycle.
8.3.4. ADS-anatoxin is used to prevent diphtheria in children under 6 years of age:
Whooping cough;
Over 4 years old, not previously vaccinated against diphtheria and tetanus.
8.3.4.1. The course of vaccination consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.
8.3.4.2. The first revaccination with ADS-anatoxin is carried out once every 9-12 months. after completed vaccination.
8.3.5. DS-M-anatoxin is used:
For revaccination of children 7 years old, 14 years old and adults without age limit every 10 years;
For vaccination against diphtheria and tetanus in children from 6 years of age who have not previously been vaccinated against diphtheria.
8.3.5.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. If it is necessary to increase the interval, the next vaccination should be carried out as soon as possible.
8.3.5.2. The first revaccination is carried out with an interval of 6-9 months. after completed vaccination once. Subsequent revaccinations are carried out in accordance with the national calendar.
8.3.5.3. Vaccinations with ADS-M-anatoxin can be carried out simultaneously with other vaccinations of the calendar. Vaccinations are carried out with different syringes in different parts of the body.
8.4. Immunization against tetanus
8.4.1. In the Russian Federation, neonatal tetanus has not been recorded in recent years, and sporadic incidence of tetanus is recorded annually among other age groups of the population.
8.4.2. The goal of tetanus immunization is to prevent tetanus in the population.
8.4.3. This can be achieved by ensuring at least 95% coverage of children with three vaccinations by 12 months. life and subsequent age-related revaccinations by 24 months. life, at 7 years and at 14 years.
8.4.4. Vaccinations are carried out with the DPT vaccine, ADS toxoids, ADS-M.
8.4.5. Children from 3 months of age are subject to vaccination against tetanus: the first vaccination is carried out at the age of 3 months, the second - at 4.5 months, the third vaccination - at the age of 6 months.
8.4.6. Vaccinations are carried out with DTP vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterolateral thigh at a dose of 0.5 ml.
8.4.7. The course of vaccination consists of 3 vaccinations with an interval of 45 days. Shortening intervals is not allowed. With a forced increase in the interval, the next vaccination is carried out as soon as possible, determined by the state of health of the child. Skipping one vaccination does not entail repeating the entire vaccination cycle.
8.4.8. Revaccination against tetanus is carried out with DTP vaccine once every 12 months. after completed vaccination.
8.4.9. Inoculations with DTP vaccine can be carried out simultaneously with other vaccinations of the vaccination schedule, while the vaccines are administered with different syringes in different parts of the body.
8.4.10. ADS-anatoxin is used to prevent tetanus in children under 6 years of age:
Whooping cough;
Having contraindications to the introduction of the DTP vaccine;
Over 4 years old, not previously vaccinated against tetanus.
8.4.10.1. The course of vaccination consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. In the event of an increase in the interval between vaccinations, the next vaccination is carried out as soon as possible, determined by the state of health of the child.
8.4.10.2. The first revaccination with ADS-anatoxin is carried out once every 9-12 months. after completed vaccination.
8.4.11. ADS-M-anatoxin is used:
For revaccination of children against tetanus at 7 years, 14 years and adults without age limit every 10 years;
For tetanus vaccination of children from 6 years of age who have not previously been vaccinated against tetanus.
8.4.11.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Shortening intervals is not allowed. If it is necessary to increase the interval, the next vaccination should be carried out as soon as possible.
8.4.11.2. The first revaccination is carried out with an interval of 6-9 months. after completed vaccination once. Subsequent revaccinations are carried out in accordance with the national calendar.
8.4.11.3. Vaccinations with ADS-M-anatoxin can be carried out simultaneously with other vaccinations of the calendar. Vaccinations are carried out with different syringes in different parts of the body.
8.5. Immunization against measles, rubella, mumps
8.5.1. The WHO program provides:
Global elimination of measles by 2007;
Prevention of cases of congenital rubella, the elimination of which, according to the WHO goal, is expected in 2005;
Reducing the incidence of mumps to 1.0 or less per 100,000 population by 2010
This will be possible when reaching at least 95% vaccination coverage of children by 24 months. of life and revaccination against measles, rubella and mumps in children aged 6 years.
8.5.2. Vaccinations against measles, rubella and mumps are subject to children over the age of 12 months who have not had these infections.
8.5.3. Revaccination is subject to children from 6 years of age.
8.5.4. Rubella vaccination is for girls aged 13 years who have not previously been vaccinated or who have received one vaccination.
8.5.5. Vaccination and revaccination against measles, rubella, mumps is carried out with monovaccines and combined vaccines (measles, rubella, mumps).
8.5.6. The drugs are administered once subcutaneously at a dose of 0.5 ml under the shoulder blade or in the shoulder area. Simultaneous administration of vaccines with different syringes to different parts of the body is allowed.
8.6. Immunization against polio
8.6.1. WHO's global goal is to eradicate poliomyelitis by 2005. Achievement of this goal is possible with coverage of three vaccinations of children 12 months old. life and revaccinations of children 24 months. life of at least 95%.
8.6.2. Vaccinations against polio are carried out with a live oral polio vaccine.
8.6.3. Vaccinations are subject to children from 3 months of age. Vaccination is carried out 3 times with an interval of 45 days. Shortening intervals is not allowed. When prolonging the intervals, vaccinations should be carried out as soon as possible.
8.6.4. The first revaccination is carried out at the age of 18 months, the second revaccination - at the age of 20 months, the third revaccination - at 14 years.
8.6.5. Polio vaccinations can be combined with other routine vaccinations.
8.7. Immunization against viral hepatitis B
8.7.1. The first vaccination is given to newborns in the first 12 hours of life.
8.7.2. The second vaccination is given to children at the age of 1 month.
8.7.3. The third vaccination is given to children at the age of 6 months.
8.7.4. Children born to mothers carrying the hepatitis B virus or suffering from hepatitis B in the third trimester of pregnancy are vaccinated against hepatitis B according to the scheme 0 - 1 - 2 - 12 months.
8.7.5. Vaccination against hepatitis B in children at the age of 13 is carried out previously not vaccinated according to the scheme 0 - 1 - 6 months.
8.7.7. The vaccine is administered intramuscularly to newborns and young children in the anterolateral part of the thigh, to older children and adolescents - in the deltoid muscle.
8.7.8. The dosage of the vaccine for vaccination of persons of different ages is carried out in strict accordance with the instructions for its use.
8.8. Immunization against tuberculosis
8.8.1. All newborns in the maternity hospital on the 3rd - 7th day of life are subject to vaccination against tuberculosis.
8.8.2. Revaccination against tuberculosis is carried out in tuberculin-negative children not infected with Mycobacterium tuberculosis.
8.8.3. The first revaccination is carried out for children at the age of 7 years.
8.8.4. The second revaccination against tuberculosis at the age of 14 is carried out for tuberculin-negative children not infected with Mycobacterium tuberculosis, who have not received the vaccination at the age of 7.
8.8.5. Vaccination and revaccination is carried out with a live anti-tuberculosis vaccine (BCG and BCG-M).
8.8.6. The vaccine is injected strictly intradermally at the border of the upper and middle thirds of the outer surface of the left shoulder. The inoculation dose contains 0.05 mg BCG and 0.02 mg BCG-M in 0.1 ml of solvent. Vaccination and revaccination is carried out with one gram or tuberculin disposable syringes with fine needles (N 0415) with a short cut.
9. The procedure for conducting preventive vaccinations
according to epidemic indications
In the event of a threat of the emergence of infectious diseases, prophylactic vaccinations according to epidemic indications are carried out for the entire population or certain professional groups, contingents living or arriving in territories that are endemic or enzootic for plague, brucellosis, tularemia, anthrax, leptospirosis, tick-borne spring-summer encephalitis. The list of works, the performance of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations, was approved by Decree of the Government of the Russian Federation of July 17, 1999 N 825.
Immunization according to epidemic indications is carried out by decision of the centers of state sanitary and epidemiological supervision in the constituent entities of the Russian Federation and in agreement with the health authorities.
Endemic territory (with respect to human diseases) and enzootic (with respect to diseases common to humans and animals) are considered to be a territory or group of territories with a constant confinement of an infectious disease due to specific, local, natural and geographical conditions necessary for the constant circulation of the pathogen.
The list of enzootic territories is approved by the Ministry of Health of Russia on the proposal of the centers of state sanitary and epidemiological supervision in the constituent entities of the Russian Federation.
Emergency immunoprophylaxis is carried out by decision of the bodies and institutions of the state sanitary and epidemiological service and local health authorities in the constituent entities of the Russian Federation.
9.1. Plague Immunoprophylaxis
9.1.1. Preventive measures aimed at preventing infection of people in natural foci of plague are provided by anti-plague institutions in cooperation with territorial institutions of the state sanitary and epidemiological service.
9.1.2. Vaccination against plague is carried out on the basis of the presence of an epizootic of plague among rodents, the identification of plague-stricken domestic animals, the possibility of importing an infection by a sick person, and an epidemiological analysis conducted by an anti-plague institution. The decision on immunization is made by the Chief State Sanitary Doctor for the subject of the Russian Federation in agreement with the health authorities.
9.1.3. Immunization is carried out in a strictly limited area for the entire population from the age of 2 or selectively threatened contingents (livestock breeders, agronomists, employees of geological parties, farmers, hunters, purveyors, etc.).
9.1.4. Vaccinations are carried out by medical workers of the district network or specially organized vaccination teams with instructive and methodological assistance from anti-plague institutions.
9.1.5. The plague vaccine provides immunity to those vaccinated for up to 1 year. Vaccination is carried out once, revaccination - after 12 months. after the last vaccination.
9.1.6. Measures to prevent the importation of plague from abroad are regulated by the sanitary and epidemiological rules SP 3.4.1328-03 "Sanitary protection of the territory of the Russian Federation".
9.1.7. Preventive vaccinations are controlled by anti-plague institutions.
9.2. Immunoprophylaxis of tularemia
9.2.1. Vaccinations against tularemia are carried out on the basis of the decision of the territorial centers of the state sanitary and epidemiological supervision in agreement with the local health authorities.
9.2.2. Planning and selection of contingents to be vaccinated is carried out differentially, taking into account the degree of activity of natural foci.
9.2.3. Distinguish between scheduled and unscheduled vaccination against tularemia.
9.2.4. Scheduled vaccination from the age of 7 is carried out for the population living in the territory with the presence of active natural foci of the steppe, floodplain-marsh (and its variants), foothill-stream types.
In foci of the meadow field type, vaccinations are carried out for the population from the age of 14, with the exception of pensioners, the disabled, people who are not engaged in agricultural work and who do not have livestock for personal use.
9.2.4.1. On the territory of natural foci of tundra, forest types, vaccinations are carried out only in risk groups:
Hunters, fishermen (and members of their families), reindeer herders, shepherds, field farmers, meliorators;
Persons sent for temporary work (geologists, prospectors, etc.).
9.2.4.2. In cities directly adjacent to active foci of tularemia, as well as in areas with low-active natural foci of tularemia, vaccinations are carried out only for workers:
Grain and vegetable stores;
Sugar and alcohol factories;
Hemp and flax plants;
feed shops;
Livestock and poultry farms working with grain, fodder, etc.;
Hunters (members of their families);
Procurers of skins of game animals;
Employees of fur factories engaged in the primary processing of skins;
Employees of departments of especially dangerous infections of the centers of state sanitary and epidemiological supervision, anti-plague institutions;
Employees of deratization and disinfection services;
9.2.4.3. Revaccination is carried out after 5 years for contingents subject to routine immunization.
9.2.4.4. Cancellation of scheduled vaccinations is allowed only on the basis of materials indicating the absence of circulation of the causative agent of tularemia in the biocenosis for 10-12 years.
9.2.4.5. Vaccination according to epidemic indications is carried out:
In settlements located in territories previously considered free from tularemia, when people fall ill (when registering even isolated cases) or when tularemia cultures are isolated from any objects;
In settlements located on the territories of active natural foci of tularemia, when a low immune layer is detected (less than 70% in meadow-field foci and less than 90% in floodplain-marsh foci);
In cities directly adjacent to active natural foci of tularemia, contingents at risk of infection - members of horticultural cooperatives, owners (and members of their families) of personal vehicles and water transport, water transport workers, etc.;
In the territories of active natural foci of tularemia - to persons who come to carry out permanent or temporary work - hunters, foresters, meliorators, surveyors, peat miners, fur skins (water rats, hares, muskrats), geologists, members of scientific expeditions; persons sent for agricultural, construction, survey or other work, tourists, etc.
Vaccination of the above contingents is carried out by healthcare organizations in the places of their formation.
9.2.5. In special cases, persons at risk of contracting tularemia must undergo emergency antibiotic prophylaxis, after which, but not earlier than 2 days after it, they are vaccinated with a tularemia vaccine.
9.2.6. Simultaneous skin vaccination of adults against tularemia and brucellosis, tularemia and plague on different parts of the outer surface of a third of the shoulder is allowed.
9.2.7. The tularemia vaccine provides, 20 to 30 days after vaccination, the development of immunity lasting 5 years.
9.2.8. Monitoring the timeliness and quality of vaccination against tularemia, as well as the state of immunity, is carried out by the territorial centers of the state sanitary and epidemiological surveillance by sampling the adult working population using a tularin test or serological methods at least 1 time in 5 years.
9.3. Immunoprophylaxis of brucellosis
9.3.1. Vaccinations against brucellosis are carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Surveillance in coordination with local health authorities. An indication for vaccination of people is the threat of infection with a goat-sheep species pathogen, as well as the migration of Brucella of this species to cattle or other animal species.
9.3.2. Vaccinations are carried out from the age of 18:
For permanent and temporary livestock workers - until the complete elimination of animals infected with goat-sheep species brucella in farms;
Personnel of organizations for the procurement, storage, processing of raw materials and livestock products - until the complete elimination of such animals in farms from where livestock, raw materials and livestock products come from;
Employees of bacteriological laboratories working with live cultures of Brucella;
Employees of organizations for the slaughter of livestock with brucellosis, the procurement and processing of livestock products received from it, veterinary workers, livestock specialists in farms enzootic for brucellosis.
9.3.3. Persons with clear negative serological and allergic reactions to brucellosis are subject to vaccination and revaccination.
9.3.4. When determining the timing of vaccinations, workers in livestock farms must be strictly guided by the data on the time of lambing (early lambing, scheduled, unscheduled).
9.3.5. Brucellosis vaccine provides the highest intensity of immunity for 5-6 months.
9.3.6. Revaccination is carried out after 10-12 months. after vaccination.
9.3.7. Control over the planning and implementation of immunization is carried out by the territorial centers of the State Sanitary and Epidemiological Surveillance.
9.4. Immunoprophylaxis of anthrax
9.4.1. Immunization of people against anthrax is carried out on the basis of the decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities, taking into account epizootological and epidemiological indications.
9.4.2. Vaccinations are subject to persons from the age of 14 who perform the following works in the territories enzootic for anthrax:
Agricultural, irrigation and drainage, surveying, forwarding, construction, excavation and movement of soil, procurement, commercial;
Slaughtering livestock with anthrax, harvesting and processing meat and meat products obtained from it;
With live cultures of the anthrax pathogen or with material suspected of being contaminated by the pathogen.
9.4.3. Vaccination is not recommended for persons who had contact with animals with anthrax, raw materials and other products infected with the anthrax pathogen against the background of an epidemic outbreak. They are given emergency prophylaxis with antibiotics or anthrax immunoglobulin.
9.4.4. Revaccination with anthrax vaccine is carried out after 12 months. after the last vaccination.
9.4.5. Control over the timeliness and completeness of the coverage of contingents with immunization against anthrax is carried out by the territorial centers of the state sanitary and epidemiological supervision.
9.5. Immunoprophylaxis of tick-borne encephalitis
9.5.1. Vaccinations against tick-borne encephalitis are carried out on the basis of the decision of the territorial centers of the State Sanitary and Epidemiological Surveillance in coordination with local health authorities, taking into account the activity of the natural focus and epidemiological indications.
9.5.2. Proper planning and careful selection of populations at high risk of infection ensure the epidemiological effectiveness of vaccination.
9.5.3. Vaccinations against tick-borne encephalitis are subject to:
Population from the age of 4 living in enzootic areas for tick-borne encephalitis;
Persons arriving in the territory, enzootic for tick-borne encephalitis, and performing the following work - agricultural, hydro-reclamation, construction, geological, exploration, forwarding; excavation and movement of soil; procurement, trade; deratization and disinsection; on logging, clearing and landscaping of forests, zones of improvement and recreation of the population; with live cultures of the causative agent of tick-borne encephalitis.
9.5.4. The maximum age of the vaccinated is not regulated, it is determined in each case based on the appropriateness of vaccination and the state of health of the vaccinated.
9.5.5. In case of violation of the vaccination course (lack of a documented full-fledged course), the vaccination is carried out according to the primary vaccination scheme.
9.5.6. Revaccination is carried out after 12 months, then every 3 years.
9.5.7. Control over the planning and implementation of immunization against tick-borne encephalitis is carried out by the territorial centers of the State Sanitary and Epidemiological Surveillance.
9.6. Immunoprophylaxis of leptospirosis
9.6.1. Vaccinations against leptospirosis are carried out on the basis of the decision of the territorial centers of the state sanitary and epidemiological supervision in coordination with the local health authorities, taking into account the epidemiological situation and the epizootic situation. Preventive vaccination of the population is carried out from the age of 7 according to epidemiological indications. The contingents of risk and the timing of immunization are determined by the territorial centers of the state sanitary and epidemiological supervision.
9.6.2. Persons with an increased risk of infection who perform the following work are subject to immunization:
For the procurement, storage, processing of raw materials and livestock products obtained from farms located in areas enzootic for leptospirosis;
Slaughtering of cattle suffering from leptospirosis, procurement and processing of meat and meat products obtained from it;
Capturing and keeping neglected animals;
With live cultures of the causative agent of leptospirosis;
Sent for construction and agricultural work in places of active natural and anthropurgic foci of leptospirosis (but not later than 1 month before the start of work in them).
9.6.4. Revaccination against leptospirosis is carried out after 12 months. after the last vaccination.
9.6.5. Control over immunization against leptospirosis of contingents at risk of infection and the population as a whole is carried out by territorial centers of state sanitary and epidemiological supervision.
9.7. Immunoprophylaxis of yellow fever
9.7.1. A number of countries with yellow fever enzootic territories require international yellow fever vaccination or revaccination certificates from persons traveling to these territories.
9.7.2. Vaccinations are subject to adults and children, starting from the age of 9 months, traveling abroad to areas enzootic for yellow fever.
9.7.3. Vaccination is carried out no later than 10 days before departure to the enzootic area.
9.7.4. Persons working with live cultures of the causative agent of yellow fever are subject to vaccination.
9.7.5. For persons over 15 years of age, yellow fever vaccination can be combined with cholera vaccination, provided that the drugs are injected into different parts of the body with different syringes, otherwise the interval should be at least one month.
9.7.6. Revaccination is carried out 10 years after the first vaccination.
9.7.7. Vaccinations against yellow fever are carried out only in vaccination stations at polyclinics under the supervision of a doctor with the obligatory issuance of an international certificate of vaccination and revaccination against yellow fever.
9.7.8. The presence of an international certificate of vaccination against yellow fever is checked by officials of sanitary and quarantine points when crossing the state border in case of departure to countries that are unfavorable in terms of the incidence of yellow fever.
9.8. Q fever immunoprophylaxis
9.8.1. Vaccinations against Q fever are carried out by decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities, taking into account the epidemiological and epizootic situation.
9.8.2. Vaccinations are carried out for persons aged 14 years in areas unfavorable for Q fever, as well as for professional groups performing work:
For the procurement, storage, processing of raw materials and livestock products obtained from farms where Q fever diseases of small and large cattle are recorded;
For harvesting, storage, processing of agricultural products in enzootic territories for Q fever;
For the care of sick animals (persons who have recovered from Q fever or who have a positive complement fixation test (CFR) in a dilution of at least 1:10 and (or) a positive indirect immunofluorescence test (RNIF) in a titer of at least 1 are allowed to care for sick animals :40);
Working with live cultures of Q fever pathogens.
9.8.3. Vaccination against Q fever can be carried out simultaneously with vaccination with live brucellosis vaccine with different syringes in different hands.
9.8.4. Revaccination against Q fever is carried out after 12 months.
9.8.5. Control over the immunization against Q fever of the subject contingents is carried out by the territorial centers of the State Sanitary and Epidemiological Surveillance.
9.9. Immunoprophylaxis of rabies
9.9.1. Vaccinations against rabies are carried out by decision of the territorial centers of the State Sanitary and Epidemiological Surveillance in coordination with local health authorities.
9.9.2. Vaccinations against rabies from the age of 16 are subject to:
Persons performing work on catching and keeping neglected animals;
Working with "street" rabies virus;
Veterinarians, hunters, foresters, slaughterhouse workers, taxidermists.
9.9.3. Revaccination is carried out after 12 months. after vaccination, then every 3 years.
9.9.4. Persons at risk of infection with the rabies virus undergo a course of therapeutic and prophylactic immunization in accordance with the regulatory and methodological documents for the prevention of rabies.
9.9.5. Control over the immunization of eligible contingents and persons at risk of infection with the rabies virus is carried out by territorial centers of state sanitary and epidemiological supervision.
9.10. Immunoprophylaxis of typhoid fever
Preventive vaccinations against typhoid fever are carried out from the age of 3 to the population living in areas with a high incidence of typhoid fever, revaccination is carried out after 3 years.
9.11. Influenza Immunoprophylaxis
9.11.1. Influenza immunoprophylaxis can significantly reduce the risk of the disease, prevent negative consequences and effects on public health.
9.11.2. Influenza vaccination is carried out for persons at increased risk of infection (over 60 years of age, suffering from chronic somatic diseases, often ill with acute respiratory infections, preschool children, schoolchildren, medical workers, workers in the service sector, transport, educational institutions).
9.11.3. Any citizen of the country can receive a flu shot at will, if he has no medical contraindications.
9.11.4. Influenza vaccinations are carried out annually in the fall (October-November) during the pre-epidemic influenza period by decision of the territorial centers of the State Sanitary and Epidemiological Supervision.
9.12. Immunoprophylaxis of viral hepatitis A
9.12.1. Vaccinations against hepatitis A are subject to:
Children from 3 years of age living in areas with a high incidence of hepatitis A;
Medical workers, educators and staff of preschool institutions;
Public service workers, primarily employed in public catering organizations;
Workers for the maintenance of water and sewer facilities, equipment and networks;
Persons traveling to hepatitis A hyperendemic regions of Russia and the country;
Persons in contact with the patient (patients) in the foci of hepatitis A.
9.12.2. The need for immunization against hepatitis A is determined by the territorial centers of the State Sanitary and Epidemiological Surveillance.
9.12.3. Control over immunization against hepatitis A is carried out by the territorial centers of the State Sanitary and Epidemiological Surveillance.
9.13. Immunoprophylaxis of viral hepatitis B
9.13.1. Vaccinations against hepatitis B are carried out:
Children and adults who have not been previously vaccinated, in whose families there is a carrier of HbsAg or a patient with chronic hepatitis;
Children of orphanages, orphanages and boarding schools;
Children and adults who regularly receive blood and its preparations, as well as those on hemodialysis, and oncohematological patients;
Persons who have had contact with material infected with the hepatitis B virus;
Medical workers who have contact with the blood of patients;
Persons involved in the production of immunobiological preparations from donor and placental blood;
Students of medical institutes and students of secondary medical schools (primarily graduates);
People who inject drugs.
9.13.2. The need for immunoprophylaxis is determined by the territorial centers of the State Sanitary and Epidemiological Surveillance, exercising subsequent control over immunization.
9.14. Immunoprophylaxis of meningococcal infection
9.14.1. Vaccinations against meningococcal infection are carried out:
Children over 2 years old, adolescents, adults in the foci of meningococcal infection caused by meningococcus serogroup A or C;
Persons at increased risk of infection - children from preschool institutions, students in grades 1-2 of schools, teenagers in organized groups united by living in hostels; children from family dormitories located in unfavorable sanitary and hygienic conditions, with a 2-fold increase in the incidence compared to the previous year.
9.14.2. The need for immunization against meningococcal infection is determined by the territorial centers of state sanitary and epidemiological surveillance.
9.14.3. Control over the implementation of immunoprophylaxis is carried out by the territorial centers of the State Sanitary and Epidemiological Supervision.
9.15. Immunoprophylaxis of mumps
9.15.1. Vaccinations against mumps are carried out in contact with the patient (sick) in the foci of mumps to persons aged 12 months. up to 35 years old, previously not vaccinated or once vaccinated and not sick with this infection.
Vaccinations are a way to prevent infectious diseases that have serious consequences. A vaccine triggers a response that builds immunity against a specific disease.
Vaccination schedulesVaccination is planned or according to epidemiological indications. The latter is carried out in cases of outbreaks of dangerous diseases in a certain region. But most often people are faced with the planned conduct of preventive vaccinations. They are carried out according to a specific schedule.
Some vaccinations are mandatory for everyone. These include BCG, COC, DPT. Others are carried out exclusively for those who have an increased risk of contracting a disease, for example, at work. It could be typhus, plague.
The vaccination schedule has been designed with many factors in mind. Specialists have provided different schemes for the administration of drugs, the possibility of their combination. The national calendar is valid throughout the country. It may be revised in the light of any new data.
In Russia, the national calendar includes all necessary vaccinations for all ages.
There are also regional calendars. For example, residents of Western Siberia are additionally injected because this infection is common there.
On the territory of Ukraine, the vaccination schedule is somewhat different.
The procedure for conducting preventive vaccinations
In order to administer a vaccine to a child or adult, a number of conditions must be met. The organization and conduct of preventive vaccinations is regulated by regulatory documents. The procedure can be carried out exclusively in polyclinics or specialized private medical institutions. In an institution for such manipulations, a separate vaccination room should be allocated, which must also meet certain requirements:
- it should contain: a refrigerator, sterile instruments, a changing table, a table, a medicine cabinet, a disinfectant solution;
- all used material and tools should be placed in a container with a disinfectant solution;
- availability of drugs for antishock therapy is mandatory;
- it is necessary to keep instructions for all drugs;
- The office should be cleaned twice a day.
It is also important that vaccination against tuberculosis (BCG) should be carried out either in a separate room, or only on certain days.
Before manipulation, the patient must pass the necessary tests and undergo an examination by a doctor. During the appointment, the doctor is interested in the state of health at the moment, clarifies the presence of reactions to previous vaccinations. Based on this information, the doctor issues a permit for the procedure.
The patient can be manipulated if contraindications to preventive vaccinations are identified. They can be permanent or temporary.
The former are not common and are most often a strong reaction to previous vaccinations.
In the fight against infectious diseases, methods of specific prevention are becoming increasingly important.
From this article you will learn what is the vaccination of children, what are the basic rules for vaccination and a lot of other useful information about vaccination in Russia.
History of vaccination
Protection against infection through immunization has been known for hundreds of years. So, since ancient times, the Chinese have sucked dried and crushed crusts of smallpox patients into their noses. However, this method, called variolation, was associated with a great risk to life and health. In the 18th century, Edward Jenner first began vaccinating people to protect them from smallpox. He rubbed a drop of pus containing a harmless vaccinia virus into the scarified (incised) skin. E. Jenner called the vaccination method vaccination (lat. vaccinatio; from vacca - cow), and the material taken from cow pox pustules - vaccine.
After 100 years, Louis Pasteur developed the scientific basis for the creation and use of vaccines from live microbes. He showed that during the natural aging of cultures, the cultivation of pathogens of infectious diseases on unusual media, exposure to adverse environmental factors, as well as the passage of microbes through the body of unsusceptible animals, a sharp weakening (attenuation) of virulence is possible without a significant decrease in antigenicity.
A great contribution to the development of vaccination was made by domestic researchers I. I. Mechnikov, P. Erlikh, P. F. Zdrodovsky, A. M. Bezredka, A. A. Smorodintsev and others.
Purpose of vaccination- creation of specific immunity to an infectious disease. Immunization must be harmless and effective.
Active post-vaccination immunity persists for 5-10 years in those vaccinated against measles, diphtheria, tetanus, poliomyelitis, or for several months in those vaccinated against influenza, typhoid fever. However, with timely revaccination, immunity can be maintained throughout life.
In children born prematurely or with low body weight, responses to immunization are expressed to the same extent as in children born at term of the same age.
Immunology of the vaccinal process
Macrophages, T-lymphocytes (effector-cytotoxic, regulatory-helpers, memory T-cells), B-lymphocytes (memory B-cells), antibodies produced by plasma cells (IgM, IgG, IgA), and also cytokines (monokines, lymphokines).
After the introduction of the vaccine, macrophages capture the antigenic material, cleave it intracellularly and present fragments of the antigen on their surface in an immunogenic form (epitopes). T-lymphocytes recognize the antigens presented by the macrophage and activate B-lymphocytes, which turn into plasma cells.
The formation of antibodies in response to the initial introduction of an antigen is characterized by three periods:
The latent period, or "lag phase" is the time interval between the introduction of an antigen (vaccine) into the body and the appearance of antibodies in the blood. Its duration ranges from several days to 2 weeks, depending on the type, dose, method of antigen administration, and the characteristics of the child's immune system.
The growth period is characterized by a rapid increase in antibodies in the blood. The duration of this period can be from 4 days to 4 weeks: approximately 3 weeks in response to tetanus and diphtheria toxoids, 2 weeks to pertussis vaccine. After the introduction of measles and mumps vaccines, specific antibodies increase rapidly, which allows the use of active immunization for emergency prevention of measles and mumps in the foci of infection (in the first 2-3 days from the moment of contact).
The period of decline occurs after reaching the maximum level of antibodies in the blood, and their number decreases rapidly at first, and then slowly over several years.
An essential component of the primary immune response is the production of class M immunoglobulins (IgM), while in the secondary immune response, antibodies are mainly represented by class G immunoglobulins (IgG). Repeated injections of the antigen lead to a faster and more intense immune response: the "lag phase" is absent or becomes shorter, the maximum level of antibodies is reached faster, and the time of persistence of antibodies is lengthened.
The optimal time interval between vaccine injections is 1-2 months. Reducing the intervals contributes to the neutralization of antigens by previous antibodies, lengthening does not cause a decrease in the effectiveness of immunization, but leads to an increase in the non-immune layer of the population.
Children with an unfavorable allergic history may respond to the introduction of immune drugs with the development of allergic reactions. The pertussis component of the DTP vaccine, components of nutrient media and cell cultures on which vaccine strains of viruses are grown, as well as antibiotics that are used in the manufacture of vaccines, have an allergenic effect. However, the introduction of the DTP vaccine, although it can cause a short-term increase in the level of total IgE in the blood, does not, as a rule, lead to its persistent increase. The use of toxoids in children with allergic diseases is usually not accompanied by an increase in specific antibodies of the Ig E class to food, household and pollen allergens.
Types and characteristics of vaccines
Preparations used for immunization
Vaccines are drugs obtained from weakened, killed microorganisms or their metabolic products and used for active immunization with the aim of specific prevention of infections.
Live vaccines are produced on the basis of the use of live attenuated microorganisms with firmly fixed avirulence. Vaccine strains multiply in the human body and induce cellular, humoral and local immunity. Live vaccines create highly intense and long-lasting immunity. The following live vaccines are used: BCG, oral polio Sabin, measles, mumps, rubella; vaccines against plague, tularemia, brucellosis, anthrax, KU fever. Live vaccines are contraindicated to immunize children with immunodeficiencies, patients receiving glucocorticoids, immunosuppressants, radiotherapy, as well as patients with lymphomas and leukemias; they are contraindicated in pregnant women due to the risk of fetal damage.
Inactivated (killed) vaccines are obtained by neutralizing bacteria and viruses using chemical or physical effects. Killed vaccines (pertussis, rabies, leptospirosis, polio Salk, etc.) create unstable humoral immunity; in order to achieve a protective level of specific antibodies, their repeated administration is necessary.
Anatoxins are made from exotoxins of pathogens by treating them with a 0.3-0.4% formalin solution at a temperature of + 38-40 ° C for 3-4 weeks. Anatoxins adsorb on aluminum hydroxide; they are easily dosed and combined with other vaccine preparations. With the introduction of toxoids, antitoxic immunity is produced. Use diphtheria, tetanus, staphylococcal toxoids, as well as toxoids against botulism and gas gangrene.
Chemical (subcellular) vaccines contain antigenic fractions of killed microorganisms. These include: polyvalent polysaccharide pneumococcal vaccine, polysaccharide meningococcal A and A + C vaccines, TABTe (against typhoid, paratyphoid A and B, tetanus).
Recombinant vaccines (against viral hepatitis B, influenza, etc.) are created using the latest genetic engineering technologies. Inactivated vaccines, toxoids, chemical and recombinant vaccines contain an adjuvant (phosphate or aluminum hydroxide) that enhances the immune response.
There are monovaccines (contain one antigen), associated (have several antigens) and polyvalent vaccines (consist of different strains of the same type of microorganisms). An example of an associated (combined) vaccine is an adsorbed pertussis-diphtheria-tetanus vaccine (DPT) containing killed pertussis bacteria, diphtheria and tetanus toxoids; polyvalent - Sabin's oral noliomyelitis vaccine, consisting of attenuated strains of poliovirus types 1, 2, 3.
Reactions to vaccines
The reaction of the body to the introduction of the vaccine
The introduction of the vaccine into the child's body is accompanied by the development of the vaccination process, which, as a rule, is asymptomatic. Perhaps the appearance of normal (usual) reactions (general and local) after vaccination.
Assessment of the intensity of general reactions
To assess the intensity of general reactions, the following criteria are used:
- weak reaction - an increase in body temperature to 37.5 ° C in the absence of symptoms of intoxication;
- medium strength - body temperature rises within 37.6-38.5 ° C with moderate symptoms of intoxication;
- a strong reaction - an increase in temperature above 38.5 ° C with severe, but short-term symptoms of intoxication.
Assessment of the degree of intensity of local reactions
To assess the degree of intensity of local reactions, the following criteria are used:
- weak reaction - hyperemia at the injection site or hyperemia with an infiltrate up to 2.5 cm in diameter;
- medium strength - infiltrate with a diameter of 2.6-5.0 cm with or without lymphangitis;
- strong reaction - infiltrate 5.0-8.0 cm in diameter; the presence of lymphangitis and lymphadenitis.
The usual general and local reactions after prophylactic vaccinations occur only in a part of the vaccinated. In the instructions for the use of biological preparations, the permissible degree of their reactogenicity is determined. In the event that the frequency of pronounced (strong) reactions among those vaccinated exceeds the percentage allowed by the instruction, further use of this series of vaccine is not allowed. So, for example, vaccinations against measles are stopped if more than 4% of those vaccinated with a pronounced general reaction are among those vaccinated. The DPT vaccine is allowed for use if the number of severe reactions does not exceed 1%.
In some cases, after vaccination, the development of pathological reactions (complications) - general and local - is noted.
Rules for vaccination
Before vaccination, the doctor analyzes the data of the epidemiological history (information about contacts with infectious patients), carefully examines the child and measures the body temperature. Laboratory examination and consultations of specialists are carried out according to indications.
Children who have not been vaccinated due to temporary contraindications are vaccinated according to an individual scheme in accordance with the recommendations of the relevant specialists and the current instructions for the use of drugs.
In the medical documentation, a record is made of a doctor (paramedic) about the permission to carry out vaccination with a specific drug.
How and where are children vaccinated?
All preventive vaccinations are done only with disposable syringes. Vaccinations should be given by health workers who have received appropriate training, as well as trained in emergency care for complications after vaccinations. In the premises where vaccinations are carried out, there must be kits for emergency medical care and anti-shock therapy.
Vaccinations, especially live vaccines, are recommended in the morning in a sitting or lying position (to prevent falling during fainting). Within 0.5-1 hour after vaccination, medical supervision of the child is necessary due to the possible development of immediate allergic reactions. Then within 3 days the child should be observed by a nurse at home (organized team). After vaccination with live vaccines, the child is additionally examined by a nurse on the 5-6th and 10-11th days, since reactions occur during these periods.
It is necessary to warn parents about possible reactions after the introduction of the vaccine, to recommend a hyposensitizing diet and a protective regimen.
Measles. Vaccination - at the age of 12 months. Revaccination - at the age of 6 years. The interval between polio, whooping cough, diphtheria and tetanus vaccine and measles vaccine should be at least two months. Vaccination and revaccination are carried out once.
Mumps. Vaccination - at the age of 12 months. In the absence of a combined vaccine (measles, mumps, rubella), vaccination is carried out together with measles vaccination with different syringes in different parts of the body.
Rubella. Vaccination - at the age of 12 months. Revaccination - at the age of 15-16 years (girls). In the presence of a combined vaccine (measles, mumps, rubella), vaccination is carried out at 12 months. Revaccination is carried out with a monovaccine at the age of 15-16 years, only for girls.
Hepatitis B. Vaccination - at the age of 1,2, 7 months. Newborns are subject to vaccination against viral hepatitis B, primarily children from mothers carrying the hepatitis B virus. Vaccinations are carried out three times with an interval of one month after the first vaccination and 5-6 months after the second. Anti-hepatitis vaccine for newborns, as well as older children, adolescents and persons under the age of 20 years, is prescribed at a dose of 0.5 ml, at the age of over 20 years - at a dose of 1 ml. Vaccination against hepatitis B does not depend on the time of other vaccinations and is carried out both simultaneously and after the introduction of vaccines and toxoids, which are included in the vaccination schedule.
Calendar of preventive vaccinations in Russia
In each country, routine immunization is carried out on time and according to the scheme of the national vaccination schedule.
Calendar of preventive vaccinations in Russia in accordance with the order of the Ministry of Health of the Russian Federation No. 375 of 08.12.97.
Preventive vaccinations must be carried out strictly at the time indicated in the calendar. If the vaccination schedule is violated, it is permissible to simultaneously introduce other vaccines with separate syringes into different parts of the body; for subsequent vaccinations, the minimum interval is 4 weeks.
To avoid contamination, it is unacceptable to combine on the same day vaccination against tuberculosis with other parenteral manipulations.
Since 1997, vaccination against viral hepatitis B has been introduced in Russia.
Contraindications to vaccination
There are situations when a child should not be vaccinated; in these cases, the doctor gives a withdrawal from vaccination. All vaccinations are carried out in strict accordance with the instructions. It is strictly forbidden to vaccinate at home. Parents are informed in advance about the timing of vaccination of children in preschool and school institutions.
Contraindications to the introduction of vaccines
Contraindications to vaccination are divided into permanent (absolute) and temporary (relative).
Absolute contraindications are rare.
Temporary contraindications. Scheduled vaccination is postponed until the end of acute manifestations of the disease and exacerbations of chronic diseases. Usually, vaccination is carried out after 2-4 weeks. after recovery. After mild forms of ARVI, AII, children can be vaccinated immediately after normalization of body temperature.
False contraindications to preventive vaccinations are conditions that are not contraindications to vaccination. History of prematurity, sepsis, hyaline membrane disease, hemolytic disease of the newborn, complications from vaccination in the family, allergies or epilepsy in relatives, as well as conditions such as perinatal encephalopathy, stable neurological conditions, anemia, enlarged thymus shadow, allergies, asthma , eczema, congenital malformations, dysbacteriosis, maintenance drug therapy, topical use of steroids are not a contraindication to vaccination, but are unreasonably used by pediatricians to issue medical exemptions.
Vaccination of children at risk
Children with various aggravating factors in history are classified as "risk groups" for the possibility of developing post-vaccination complications. Before vaccination, the necessary additional examination is carried out, an individual immunization schedule is drawn up. Vaccination is carried out by sparing methods with preliminary preparation. There are four risk groups:
the risk group includes children with suspected damage to the central nervous system or with identified damage to the central nervous system. It has four subgroups:
- children with probable perinatal CNS damage;
- children with established perinatal CNS damage;
- children who have undergone various forms of acute neuroinfections, cerebral palsy, organic diseases of the nervous system;
- children with a history of convulsive seizures of a different nature or paroxysmal conditions (respiratory-affective seizures, fainting, etc.)
risk group - children prone to allergic reactions, with a history of allergic diseases of the skin or respiratory tract (allergic rashes, allergic dermatosis, Quincke's edema, various forms of respiratory allergy).
risk group - children who repeatedly suffer from infections of the upper and lower respiratory tract, otitis media, with chronic diseases (kidney, liver, heart, etc.), who have prolonged subfebrile condition, stop or insufficient weight gain, transient changes in urine.
risk group - children with local and general pathological reactions to vaccinations (history of post-vaccination complications).
How are children with pathologies vaccinated?
Children with neurological diseases are vaccinated during the period of disappearance of neurological symptoms or during a period of stable remission. For patients with progressive diseases of the nervous system, a history of afebrile seizures, DTP is administered instead of DPT.
Children with a history of seizures are vaccinated using anticonvulsants (seduxen, relanium, sibazon), which are prescribed 5-7 days before and 5-7 days after the administration of toxoids and from 1 to 14 days after measles and mumps vaccines. The appointment of antipyretics within 1-3 days after vaccination with toxoids and 5-7 days with the use of live vaccines is shown.
Vaccination of children with hypertensive-hydrocephalic syndrome, hydrocephalus is carried out in the absence of disease progression with dehydration therapy (diacarb, glyceryl, etc.).
Vaccination of children with allergic diseases is carried out during the period of stable remission. Children suffering from pollinosis are not vaccinated during the entire flowering period of plants. It is possible to lengthen the intervals between vaccinations, separate administration of vaccines. Strict adherence to a hypoallergenic diet is necessary for 1-2 weeks after vaccination. Antihistamines (claritin, tavegil, suprastin) are prescribed for vaccination of children at risk.
Vaccination of children at risk for prevention
It is advisable to vaccinate children who often suffer from acute respiratory diseases (more than 6 times a year) during the period of the lowest prevalence of SARS. In order to stimulate antibody formation, dibazol, methyluracil, multivitamins are prescribed within 10 days after vaccination. Within 2 weeks before and after vaccination, the appointment of biogenic stimulants (Eleutherococcus extract, tincture of zamanihi, ginseng) is recommended. For the prevention of acute respiratory viral infections in children at risk in the post-vaccination period, intranasal interferon is indicated.
Vaccination work in the clinic is organized and carried out in accordance with the order, which approved the calendar of preventive vaccinations, instructions on the tactics of immunization, the main provisions on the organization and conduct of preventive vaccinations, a list of medical contraindications to immunization, the procedure for registering information about complications from vaccinations.
Preventive vaccinations should be carried out at the time set by the calendar. In case of their violation, the simultaneous administration of several vaccines is allowed, but in different parts of the body and with separate syringes.
With separate vaccinations, the minimum interval should be at least a month. If the vaccination against hepatitis B is not carried out on the same day as other vaccinations, then the interval between their administration is not regulated.
Preventive vaccinations are carried out in appropriately equipped vaccination rooms in polyclinics or other premises with strict observance of sanitary and hygienic requirements.
Vaccination room of the polyclinic should consist of rooms for vaccinations and storage of vaccination files and have a refrigerator for storing vaccination preparations, a cabinet for tools and a set of medicines for emergency and anti-shock therapy, boxes with sterile material, a changing table or a medical couch, a table for preparing vaccination preparations, a table for storage of medical records. The office should have instructions for the use of vaccinations and a reminder for emergency care.
To avoid contamination, it is forbidden to combine vaccinations against tuberculosis with vaccinations against other infections. It is forbidden to carry out vaccinations against tuberculosis and the Mantoux test at home.
Preventive vaccinations are carried out by medical workers trained in the rules of vaccination technique and emergency care.
Health workers are required to notify parents in advance about the day of preventive vaccinations. All persons to be vaccinated should be examined by a doctor or paramedic, taking into account the anamnesis (previous diseases, allergic reactions to vaccinations, drugs, food).
Immediately before vaccination, the child is examined and body temperature is measured to exclude an acute illness. A record of the vaccination performed is made in the working journal of the vaccination room, the history of the development of the child, the card of preventive vaccinations, the medical record of the child attending the children's institution, the register of preventive vaccinations. After vaccination and revaccination against tuberculosis, after 1, 3, 6, 12 months, the nature of the papule, scar, and the state of regional lymph nodes are recorded.
Essential Vaccines
First vaccination carried out within 24 hours after the birth of the child. This is hepatitis B immunization.
The vaccine is administered intramuscularly in the deltoid muscle area of older children or in the anterolateral thigh area in newborns and young children.
As an exception, in patients with thrombocytopenia and other diseases of the blood coagulation system, the vaccine can be administered subcutaneously.
Second vaccination is carried out at the age of 1 month, the third - at 5 months, simultaneously with DPT and OPV. Premature babies weighing less than 2 kg are vaccinated from two months with similar intervals between vaccinations.
Primary vaccination against tuberculosis is carried out for newborns on the 3rd-4th day of life. The BCG vaccine is live dried bacteria of the BCG vaccine strain No. 1. One inoculation dose - 0.05 mg BCG - is dissolved in 0.1 ml of the solvent, injected intradermally at the border of the upper and middle third of the outer surface of the left shoulder.
Premature babies weighing less than 2 kg, as well as children not vaccinated in the maternity hospital for medical contraindications, are vaccinated at the polyclinic with the BCG-M vaccine. Children older than two months, not vaccinated during the neonatal period, are vaccinated in the clinic after a tuberculin test with a negative result.
At the age of 7 years, children who have a negative reaction to the Mantoux test are subject to revaccination. The interval between the Mantoux test and revaccination should be at least 3 days and not more than 2 weeks.
Vaccination against poliomyelitis is carried out with a live polio oral vaccine containing attenuated strains of human poliomyelitis virus of three immunological types (I, II, III). The vaccine is available in the form of a solution and sweets.
Vaccination is carried out from three months three times with an interval between vaccinations of a month, revaccination - at 18 months, 24 months and 7 years once.
Vaccinations against diphtheria, whooping cough, tetanus are carried out with the DTP vaccine (adsorbed pertussis-diphtheria-tetanus vaccine), which consists of a mixture of phase I pertussis microbes killed with formalin or merthiolite, purified and concentrated diphtheria and tetanus toxoids adsorbed on aluminum hydroxide.
Vaccinations with DTP vaccine are carried out simultaneously with immunization against polio. Revaccination is carried out once every 18 months. Vaccinations against whooping cough are done from 3 months to 4 years. Children who have contraindications to DTP are vaccinated with ADS-anatoxin according to the scheme: vaccination - at 3 and 4 months, revaccination after 9-12 months.
The second revaccination (6 years) is carried out with ADS-antitoxin once, the third (11 years) - with ADS-M-anatoxin once. Children over 6 years old, not previously vaccinated, are vaccinated with ADS-M-toxoid: 2 vaccinations with an interval of a month, revaccination is carried out once after 9-12 months.
Children from 1 to 18 years of age (inclusive) and adults up to 35 years of age (inclusive), not ill, not vaccinated, vaccinated once, not having information about measles vaccinations; adults from 36 to 55 years old (inclusive) belonging to risk groups (employees of medical and educational organizations, trade, transport, municipal and social organizations; persons working on a rotational basis and employees of state control bodies at checkpoints across the state border of the Russian Federation) who have not been ill, not vaccinated, vaccinated once, do not have information about vaccinations against measles
Children from 6 months, students in grades 1-11;
students in professional educational organizations and educational institutions of higher education;
adults working in certain professions and positions (employees of medical and educational organizations, transport, public utilities);
pregnant women;
adults over 60;
persons subject to conscription for military service;
people with chronic diseases, including lung disease, cardiovascular disease, metabolic disorders and obesity
*(1) The first, second and third vaccinations are given according to the 0-1-6 schedule (1 dose - at the time of vaccination, 2 dose - one month after vaccination 1, 3 dose - 6 months after the start of vaccination), except for children belonging to risk groups, vaccination against viral hepatitis B which is carried out according to the scheme 0-1-2-12 (1 dose - at the time of the start of vaccination, 2 dose - a month after 1 vaccination, 2 dose - 2 months after the start of vaccination, 3 dose - after 12 months from the start of vaccination).
*(2) Vaccination is carried out with a vaccine for the prevention of tuberculosis for gentle primary vaccination (BCG-M); in the subjects of the Russian Federation with incidence rates exceeding 80 per 100 thousand population, as well as in the presence of tuberculosis patients in the environment of a newborn - a vaccine for the prevention of tuberculosis (BCG).
*(3) Vaccination is provided to children at risk (born to mothers of HBsAg carriers, patients with viral hepatitis B or who had viral hepatitis B in the third trimester of pregnancy, who do not have test results for hepatitis B markers, who use narcotic drugs or psychotropic substances, from families in which there is a carrier of HBsAg or a patient with acute viral hepatitis B and chronic viral hepatitis).
*(4) The first and second vaccinations are given with the polio vaccine (inactivated).
*(5) Vaccination is carried out for children at risk (with diseases of the nervous system, immunodeficiency states or anatomical defects leading to a sharply increased risk of haemophilus influenzae infection; with anomalies in the development of the intestine; with oncological diseases and / or receiving long-term immunosuppressive therapy; children born to HIV-infected mothers; HIV-infected children; premature and low-birth-weight babies; children in orphanages).
*(6) The third vaccination and subsequent revaccinations against polio are given to children with a vaccine for the prevention of polio (live); children belonging to risk groups (with diseases of the nervous system, immunodeficiency conditions or anatomical defects leading to a sharply increased risk of hemophilic infection; with anomalies in the development of the intestine; with oncological diseases and / or receiving long-term immunosuppressive therapy; children born to mothers with HIV - infection; children with HIV infection; premature and low birth weight children; children in orphanages) - polio vaccine (inactivated).
*(6.1) Vaccination and revaccination of children at risk may be carried out with immunobiological medicinal products for the immunoprophylaxis of infectious diseases, containing combinations of vaccines intended for use in appropriate age periods.
*(7) The second revaccination is carried out with toxoids with a reduced content of antigens.
*(8) Revaccination is carried out with a vaccine for the prevention of tuberculosis (BCG).
*(9) Vaccination is carried out for children and adults who have not previously been vaccinated against viral hepatitis B according to the 0-1-6 scheme (1 dose - at the time of the start of vaccination, 2 dose - one month after 1 vaccination, 3 dose - 6 months after start of vaccination).
*(10) The interval between the first and second vaccinations must be at least 3 months.
The procedure for carrying out preventive vaccinations for citizens within the framework of the national calendar of preventive vaccinations
With changes and additions from:
1. Preventive vaccinations within the framework of the national calendar of preventive vaccinations are carried out for citizens in medical organizations if such organizations have a license that provides for the performance of works (services) for vaccination (carrying out preventive vaccinations).
2. Vaccination is carried out by medical workers who have been trained in the use of immunobiological drugs for the immunoprophylaxis of infectious diseases, the organization of vaccination, vaccination techniques, as well as in the provision of medical care in an emergency or urgent form.
3. Vaccination and revaccination within the framework of the national calendar of preventive vaccinations are carried out with immunobiological medicinal products for the immunoprophylaxis of infectious diseases, registered in accordance with the legislation of the Russian Federation, according to the instructions for their use.
In cases stipulated by the national calendar of preventive vaccinations, vaccination and revaccination with immunobiological medicinal products for the immunoprophylaxis of infectious diseases containing combinations of vaccines are allowed.
4. Before carrying out preventive vaccination, the person to be vaccinated, or his legal representative, is explained the need for immunoprophylaxis of infectious diseases, possible post-vaccination reactions and complications, as well as the consequences of refusing to carry out preventive vaccination, and informed voluntary consent to medical intervention is issued in accordance with the requirements of Article 20 of the Federal Law of November 21, 2011 N 323-FZ "On the basics of protecting the health of citizens in the Russian Federation" .
5. All persons who are to be vaccinated must first be examined by a doctor (paramedic).
6. When changing the timing of vaccination, it is carried out according to the schemes provided for by the national calendar of preventive vaccinations and in accordance with the instructions for the use of immunobiological drugs for the immunoprophylaxis of infectious diseases. It is allowed to administer vaccines (except vaccines for the prevention of tuberculosis) used within the framework of the national immunization calendar, on the same day with different syringes to different parts of the body.
7. Vaccination of children for whom immunoprophylaxis against pneumococcal infection was not started in the first 6 months of life is carried out twice with an interval between vaccinations of at least 2 months.
8. Vaccination of children born to mothers with HIV infection is carried out within the framework of the national calendar of preventive vaccinations in accordance with the instructions for the use of immunobiological drugs for the immunoprophylaxis of infectious diseases. When vaccinating such children, the following are taken into account: the HIV status of the child, the type of vaccine, indicators of the immune status, the age of the child, concomitant diseases.
9. Revaccination of children against tuberculosis, born to mothers with HIV infection and receiving three-stage chemoprophylaxis of HIV transmission from mother to child (during pregnancy, childbirth and in the neonatal period), is carried out in the maternity hospital with vaccines for the prevention of tuberculosis (for sparing primary vaccination). In children with HIV infection, as well as when HIV nucleic acids are detected in children by molecular methods, revaccination against tuberculosis is not carried out.
10. Vaccination with live vaccines within the framework of the national immunization schedule (with the exception of vaccines for the prevention of tuberculosis) is carried out for children with HIV infection with the 1st and 2nd immune categories (lack of immunodeficiency or moderate immunodeficiency).
11. If the diagnosis of HIV infection is excluded, children born to mothers with HIV infection are vaccinated with live vaccines without prior immunological examination.
12. Toxoids, killed and recombinant vaccines are administered to all children born to mothers with HIV infection as part of the national immunization schedule. For children with HIV infection, these immunobiological drugs for the immunoprophylaxis of infectious diseases are administered in the absence of severe and severe immunodeficiency.
13. When vaccinating the population, vaccines containing antigens that are relevant to the Russian Federation are used, which make it possible to ensure the maximum effectiveness of immunization.
14. When vaccinating against hepatitis B in children of the first year of life, against influenza of children from 6 months of age studying in general educational institutions, pregnant women, vaccines that do not contain preservatives are used.
______________________________* Collection of Legislation of the Russian Federation, 2012, N 26, art. 3442; No. 26, Art. 3446; 2013, N 27, art. 3459; No. 27, Art. 3477; No. 30, art. 4038; No. 39, Art. 4883; No. 48, art. 6165; No. 52, Art. 6951.
** Order of the Ministry of Health and Social Development of the Russian Federation of March 23, 2012 N 252n "On approval of the procedure for assigning a paramedic, a midwife to the head of a medical organization when organizing the provision of primary health care and emergency medical care of certain functions of the attending physician for the direct provision of medical assistance to the patient during the period of observation and treatment, including the prescription and use of drugs, including narcotic drugs and psychotropic drugs" (registered by the Ministry of Justice of the Russian Federation on April 28, 2012, registration number N 23971).
