Problems of vaccination of children with allergic diseases. The problem of vaccination is based on real conflicting facts

Globally, 12 million children die every year from infections potentially controlled by immunoprophylaxis. The number of disabled children, as well as the costs of treatment, cannot be determined. At the same time, 7.5 million children die due to diseases for which there are currently no effective vaccines, and more than 4 million die from diseases that are completely preventable with the help of immunoprophylaxis.

The history of modern vaccine prophylaxis began in 1796, when English doctor E. Jenner (1749-1823) vaccinated the first inhabitant of the Earth against smallpox. Currently, the world community considers vaccination as the most economical and affordable way the fight against infections and as a means of achieving active longevity for all social strata of the population of developed and developing countries. The accumulated data convincingly indicate that the risk of adverse reactions to the introduction of modern vaccines is disproportionately lower than when the corresponding infection occurs. The triumph of vaccination was the eradication of smallpox worldwide. .

Immunization is the main and leading method of prevention, this is due to the peculiarities of the mechanism of transmission of the infectious agent and the persistent nature of post-infectious immunity. First of all, this concerns respiratory tract infections, however, in many diseases with a different mechanism of transmission, vaccination of the population is a decisive direction in their prevention. For example, poliomyelitis and neonatal tetanus became manageable only after receiving and wide application relevant vaccines. Their effectiveness has now made it possible to set the task of their complete elimination. Routine immunization has become a decisive and effective measure in the fight against such infections as diphtheria, whooping cough, measles. With the introduction of National Immunization Schedules, significant progress has been made in the control of vaccine-preventable diseases in many countries. . Basically, success in this direction was achieved in Europe, the USA, Canada and some others, where the incidence of diphtheria and tetanus decreased so much that by the beginning of the 1970s these infections were no longer a public health problem. Currently, in such countries, the incidence of these infections has practically been reduced to zero, and very impressive success has been achieved in the fight against other diseases that cause significant socio-economic damage (rubella, hemophilic and meningococcal infection and etc.) .

The problem of incomplete vaccination coverage of children is acute in African countries,. More than 6 million children in sub-Saharan Africa are not receiving the full three-dose series of diphtheria, tetanus and whooping cough vaccine. A study was conducted that examined 27,094 children aged 12-23 months from 24 sub-Saharan countries. A study of the main drivers of vaccination refusal showed that vaccination refusal in these countries is influenced by the lack of formal education of the mother (OR 1.35, 95% CI 1.18 to 1.53) and father (OR 1.13, 95% CI 1.12 up to 1.40), low material wealth of the family, mothers' access to the media increases the level of refusal to vaccinate.

Also important factors vaccine refusals are living in urban areas (OR 1.12, 95% CI 1.01 to 1.23), high illiteracy rates (OR 1.13, 95% CI 1.05 to 1.23), and living in a country with a high birth rate (OR 4.43 , 95% CI 1.04 to 18.92).

Modern medicine considers vaccination as the most effective and most cost-effective way to prevent infectious diseases. However, at all stages - from the production of vaccines to the consequences of a vaccination given to a particular child - there are many real problems. Problems, the solution of which will make vaccination even more effective, safe, and convenient.

We have already talked about some problems - the relationship between the fundamental possibility of vaccination in general and the use of specific vaccines in particular with financial well-being countries, the presence of additional substances in vaccines, in addition to the immunogen, difficulties with the transportation and storage of drugs, the risk of technical errors during vaccination, etc. It is clear that the list of difficulties is not limited to this list, and therefore I would like to draw readers' attention to some more problems . So what's the problem modern vaccination?

Modern vaccination - problems

Impossibility of practical prediction of vaccination complications

We have already written that complications, unlike vaccination reactions, are not so much a manifestation of the reactogenicity of the drug, but an individual feature of the immune system of a particular child. The dream of practicing doctors remains some kind of mass test examination, according to the results of which one can say: this child cannot be vaccinated against measles, for example, but this one can.

Unfortunately, many parents are convinced that such tests exist, moreover, this conviction is often supported by anti-vaccination literature - they say that doctors are to blame for the complications, because "they didn't even bother to prescribe at least some tests." The paradox of the situation is further aggravated by the fact that, firstly, no one can say what tests are needed, and secondly, many commercial laboratories are ready to satisfy the demand for examinations, offering numerous, but unreliable “vaccination tests” or "prevaccination tests".

There is one more nuance regarding the examination before vaccination - the development of vaccine-associated infections in children with severe congenital immunodeficiency not detected before vaccination. By the way, this is one of the arguments of those who believe that it is necessary to be vaccinated later. Now, if we didn't BCG vaccination on the third day after birth, and instead the child was observed and plus an examination of his immunological status was carried out - so we would have detected immunodeficiency in time, and the child would not have a generalized BCG infection.

We have to admit with sadness that the formal correctness of this statement has no practical output. Firstly, even economically developed countries cannot afford a mass examination of the immunological status, and secondly, and this is perhaps the main thing, modern medicine does not have effective methods for treating severe congenital immunodeficiencies. The screening will help to avoid a fatal vaccination, but will not protect against fatal staphylococcus aureus or the inevitable rotavirus.

"Children's" diseases in adults - the problem of vaccination

Under the conditions of mass vaccination, there is a clear trend towards the fact that adults are more likely to get sick with common childhood infections. And measles, rubella, mumps and chickenpox in adults are much more serious and severe in comparison with children. Nevertheless, the solution to this very real problem is quite possible and possible in two ways: firstly, by timely revaccination of adults and, secondly, by mass vaccination of children.

The paradox of the situation lies precisely in the fact that the "maturing" of childhood infections occurs only when less than 80-90% of children are vaccinated (for different diseases in different ways). The more refusals to vaccinate than more contraindications to vaccinations, the more often adults will get sick. The described state of affairs perfectly illustrates the position of WHO regarding vaccination against chickenpox: if the state cannot afford to vaccinate more than 90% of children, it is not necessary to include this vaccination in the vaccination calendar.

Difficulties in obtaining information - the problem of vaccination

The lack of adequate information regarding vaccinations is very actual problem. Acute deficiency understandable campaign materials, the absence of persons able and willing to explain and explain. Parents often cannot get basic information about which vaccine preparation will be vaccinated.

Organization of vaccinations - the problem of vaccination

The problems of modern vaccination are familiar to everyone who has visited a polyclinic with a child. Employment of doctors and amateur nurses, queues and contact with sick children in the corridor of the clinic, impossibility public control compliance with the rules for storing vaccine preparations, violation of vaccination techniques, lack of conditions for qualified emergency care in case of complications, and much more.

The complexities of statistics

The presence of impoverished health care in general and impoverished doctors in particular causes the likelihood of an absolutely criminal situation, when vaccinations are not given, but a document is bought on their implementation. In some territories, the number of paper-vaccinated children reaches 10%, which subsequently gives reason to talk about the ineffectiveness of vaccinations and that no herd immunity does not exist - indeed, where did the measles outbreak come from if 90% of children are vaccinated (supposedly vaccinated!). Another statistical nonsense is the untimely informing or failure to inform the regulatory authorities about the occurrence of deviations in health associated or possibly associated with vaccination.

Help with complications - the problem of vaccination

Often there is an immoral situation when a society that encourages vaccination, in the event of complications, simply strikes out the victim from its members: a person who has become disabled due to vaccination cannot survive on compensation payments provided by the state.

Anti-vaccination - the problem of vaccination

Unique problem. Actually there is great amount smart, intelligent, conscientious people who are able to create a powerful social movement aimed at solving the real problems of vaccination described above. But a dozen extremists appear who manage to lead this spontaneous movement, using false, unproven and unverified information, distortion of facts, emotional slogans that have no scientific basis. As a result, there is a real problem: instead of constructive optimization of the most effective way to prevent infections, we have a deliberately destructive social movement.

Modern vaccination - tasks

Vaccination is a method of creating immunity against a certain infectious disease by administering the appropriate vaccine. Sometimes the term "immunization" is used as a synonym for the word "vaccination", which is not entirely true. Immunization combines all methods of creating immunity - not only vaccinations (when the body produces protective antibodies on its own), but also the introduction of sera, immunoglobulins, blood, plasma for therapeutic or prophylactic purposes (when the body receives ready-made protective antibodies).

What are the objectives of modern vaccination?

The main task of modern vaccination is to achieve the production of specific antibodies in an amount sufficient to prevent a specific disease. A single injection of an immunogen into the body (as in vaccination, for example, against measles or rubella) is far from always enough to ensure the proper level of immune protection. Sometimes two or even three such injections are required (if we talk about diphtheria, whooping cough and tetanus).

The starting (protective, created through vaccination) level of antibodies gradually decreases, and repeated injections vaccine preparation to maintain them (antibodies) the right amount. These repeated injections of the vaccine are revaccination. Nevertheless, many mothers and fathers are mistaken and mistakenly believe that the first administration of a vaccine is vaccination, and all subsequent ones are revaccination. So let's repeat:

vaccination - the introduction of a vaccine to create immune protection;

revaccination - the introduction of a vaccine to maintain immune protection.

Unfortunately, situations are possible when the introduction of a vaccine does not solve the main task of vaccination described above. In other words, vaccinations are done "as expected", but some of those vaccinated are not able to develop enough antibodies to prevent a particular disease.

What is the effectiveness of vaccination?

The effectiveness of vaccination is actually the percentage of those vaccinated who responded to vaccination with the formation of specific immunity. Thus, if the effectiveness of a certain vaccine is 95%, then this means that out of 100 vaccinated, 95 are reliably protected, and 5 are still at risk of the disease. The effectiveness of vaccination is determined by three groups of factors.

Factors depending on the vaccine preparation:

the properties of the vaccine itself, which determine its immunogenicity (live, inactivated, corpuscular, subunit, the amount of immunogen and adjuvants, etc.);
the quality of the vaccine product, i.e. the immunogenicity has not been lost due to the expiration date of the vaccine or due to the fact that it was not stored or transported correctly.

Factors depending on the vaccinated:

genetic factors, which determine the fundamental possibility (or impossibility) of developing specific immunity;
age, because the immune response is most closely determined by the degree of maturity of the immune system;
health status "in general" (growth, development and malformations, nutrition, acute or chronic diseases, etc.);
the background state of the immune system - primarily the presence of congenital or acquired immunodeficiencies.

Compliance with the rules and techniques of vaccination

For each vaccine preparation, the rules for use are defined, providing for the optimal age at the time of vaccination and revaccination, the choice of dose and the interval between doses, the frequency and method of introducing the vaccine into the body. Violation of the rules reduces the effectiveness of vaccination; in the process of vaccination, technical errors are possible, when the drug is dosed incorrectly, in the wrong place, injected, not completely dissolved, not stirred enough, diluted in the wrong way, etc.

We considered the concept of “vaccination effectiveness” rather narrowly, analyzing the factors that can influence the formation of specific immunity in a particular child. At the same time, the effectiveness of vaccination has another meaning, since it refers to immune protection all children, the entire population. The essence of this protection is herd immunity.

Any infectious disease as a phenomenon, as a fait accompli, provides for the existence of three mandatory conditions, three links of the infectious process:

source of infection;
ways of transmission of infection;
people susceptible to this infection.

If even one link is eliminated (which is what vaccination does by eliminating link number three), infectious process stop. The more people are vaccinated, the less intensive the infectious process is. If the number of vaccinated exceeds 90-95%, the infectious process, as a rule, stops.

This is the essence of herd immunity: 90-95% of those vaccinated provide 100% vaccination efficiency, since 5-10% who do not have specific antibodies are reliably protected by herd immunity. Herd immunity does not occur once and for all. He must be watched, he must be supported. A decrease in the number of vaccinated inevitably leads to the loss of collective protection and, as a result, to the emergence of diseases.

Each state forms its own vaccination policy. This policy provides for a list of diseases for which vaccination is considered appropriate or mandatory, as well as a set of rules governing the vaccination process itself: the choice of drugs, indications, contraindications, conditions, doses, methods, timing and intervals of vaccinations and revaccinations.

PEDIATRIC NEUROLOGIST ABOUT VACCINATIONS Emelyanova Nadezhda Borisovna, pediatric neurologist, Moscow I worked as a pediatrician in a kindergarten and vaccinated children. At the institute, they literally explained to us how it works the immune system, and now I wonder why I was satisfied with these "explainers". If professors of immunology are perplexed about the complexity of immunity, discovering more and more new mechanisms in its functioning, admitting that they know very little about immunity, that vaccines are dangerous, then why did everything seem clear and simple to me?! For example, here is what a doctor of medical sciences, professor, leading researcher at the laboratory of biotechnology at the Institute of Immunology of the State Scientific Center of the Ministry of Health of the Russian Federation writes. Ignatieva G.A.: “Vaccination is theoretically the best method of immunotherapy and immunoprophylaxis. But there are problems, the most difficult of which we will outline. The biggest of the difficult problems is the biohazard of the vaccine preparations themselves, regardless of the target antigen. The fact is that all modern vaccinating drugs are obtained by biotechnology using animal sera and cells. Animals, as it becomes known to us the further, the more, there are extremely dangerous infections for humans such as prion and retroviral. It is fundamentally impossible to purify the vaccine from impurities potentially containing these infections (without losing the actual vaccinating antigen). Such a serious concomitant phenomenon forces us to admit that, by vaccinating the population, medicine unknowingly violates the basic principle - "do no harm." And now, when I hear from pediatricians that vaccines “train” the immune system, that they protect against infectious diseases that vaccines are safe makes me sad and anxious, because the price of such poor "explanatory" is children's health and children's lives. When the reverse side of vaccination was revealed to me, which is not advertised and not presented at the institute, I became scared and ashamed. Scary, because I finally realized what I did with my own child, I understood where the “legs” of his sores grow from and what such “care” for his health is fraught with. And it's a shame - because I, being a doctor, bearing responsibility for the health of the children entrusted to me, treated vaccination so thoughtlessly and lightly, and after all, according to Mr. Onishchenko (the country's chief sanitary doctor), it is a "serious immunobiological operation." Here my pediatrician colleagues can reproach me: “It is clear that vaccination is not a game of spillikins, it is necessary individual approach!“ It's all about the DEGREE of understanding the depth of the problem. After all, I also very strictly selected children for vaccination - mandatory inspection, thermometry, anamnesis (and so that no one in the family gets sick, does not sneeze!), When necessary - tests, in a word, everything that can be done in a polyclinic ... But we must admit that these minimum data (and in a polyclinic they are - maximum), they say NOTHING about the state of immunity and health in general in a particular child. And do not be deceived and deceive parents - even a detailed immunogram and consultation with an immunologist will not protect the child from the side effects of vaccines, will not guarantee that the vaccine will not provoke a serious autoimmune disease, that it will not disrupt the subtle mechanisms of self-regulation and the child will not develop diabetes, bronchial asthma , blood cancer or other incurable disease. If parents really understood what kind of roulette they are playing, then many would think ... I understood and thought. Now it is almost impossible to make a diagnosis “Post-vaccination complication”. The doctor who did this signs his own sentence, so no one makes such diagnoses in order to avoid trouble. Therefore, WE DO NOT KNOW how many children actually affected by vaccination, and we think that very few (one in a million) will “carry over” this time too ... I saw a child, six months old, who on the third day after vaccination had a clinical death . He was revived, but he will be an idiot because the cerebral cortex is dead. NONE of the doctors “remembered” that three days before clinical death they made him DTP vaccination. We have a lot of talk about the so-called concept informed consent for medical interventions, in particular vaccinations. In fact, this is an empty sound. A parent, wishing to vaccinate their child, must know that: 1. According to Russian law, HE HAS THE RIGHT to refuse vaccination (for any reasons, including religious ones) and this refusal will not entail ANY consequences in the form of non-admission to Kindergarten, school, institute. And those citizens who obstruct such parents should deal with the prosecutor's office. 2. The parent must know that vaccines are not medicines, they are dangerous and grossly interfere with immunity; should know what they consist of, how they are tested and what complications after vaccination exist. Therefore, the parent must give WRITTEN consent to the vaccination and AFTER he has read and understood that the vaccines contain merthiolate, foreign DNA, that vaccination can provoke diabetes, crayfish, autoimmune diseases, cause death. Therefore, I began to bring to the attention of parents the fact of the existence of the law “On Immunoprophylaxis”, which gives the right to refuse. Many parents were surprised because they did not know that vaccination is voluntary. They told me that they did not want to vaccinate the child (or in general, or with some specific vaccine) or wanted to postpone vaccination, but they were threatened that they would not take them to the garden without vaccinations, they would not give food in the dairy kitchen, and they agreed. I began to ask my parents if they knew about the composition of vaccines, about the methods of their production. After all, before giving a child some kind of medicine, everyone will look at its composition and possible side effects. It turns out that no one has ever seen annotations to vaccines before vaccination. No one has seen the usual annotations in which it is written in black and white what vaccines consist of and official complications for vaccination (for example, death). One day the head physician of a private medical center and asked by what right I give this information to parents. I replied that it was my duty, first of all, to observe the principle of "do no harm", and the parent should know as much as possible in order to make an informed decision to vaccinate - not to vaccinate. The owner of this private center also “took care” and warned me that the center was working under the MINISTRY OF HEALTH program, so I should not give this information to my parents. The fact is that vaccination is also profitable business, a dose of the vaccine can be bought in bulk for a hundred rubles, and “injected” - for a thousand. And what businessman does not like quick profits? They began to follow me, limited access to documentation, citing a “medical secret”, I felt disgusted and left. I came to the children's polyclinic to work as a neurologist, thinking that now I would not be connected with vaccination as I was, working as a pediatrician in the garden and in the center. I immediately warned the head physician that I was wary of vaccination and considered it unacceptable to vaccinate children who were weakened, premature, with obvious neurological problems. The chief doctor agreed with me in many respects, said that he had always been against vaccination, that the famous pediatrician Dombrovskaya (his teacher) sharply criticized vaccinations, but the last diphtheria epidemic shook his confidence. He said that he would gladly take me, but he would re-educate me. The weekdays of a neurologist began. Neurologists are very cautious about vaccination, especially children with problems nervous system. It is known that latent or overt pathology of the nervous system after vaccination can manifest itself in the form of convulsive readiness. That is, vaccination can provoke epilepsy (the described complication of vaccination). In difficult and doubtful cases, I began to give medical exemptions for a month or two from vaccination. Parents asked what to do with the pediatrician, he insists on vaccination. I said YOU DECIDE, the pediatrician can only recommend vaccination. She said that there is a law “On immunoprophylaxis”, on the basis of which it is possible to issue a refusal to vaccinate so that the pediatrician “lags behind”. Head the polyclinic warned: "Step on the throat of your own song." Once, at a consultation, there was a particularly difficult child threatened with cerebral palsy (in fact, already with cerebral palsy, but he will be diagnosed with such a diagnosis after a year), I forbade him to vaccinate, because against her background, cerebral palsy progresses sharply. They did not listen to me, then I told the head physician that I disclaim responsibility for such patients. So what are games really? The neurologist, understanding the severity of the damage to the nervous system and the unfavorable prognosis, gives a medical disqualification, and the pediatrician brushes him off like an annoying fly and vaccinates ... In general, they failed to re-educate me and they fired me. Pediatricians in the clinic spend five to ten minutes for an appointment (in order to earn more on compulsory medical insurance), so the pediatrician is an assembly line worker, he has no time to think. Its main function is to vaccinate children, as other problems will be solved narrow specialists, or he himself with the help of calpols, claritins, flemoxins. Before vaccination, the examination is carried out “by eye”. After vaccination, the child's condition is not monitored, so the pediatrician does not associate the deterioration in the child's health with a recent vaccination. Neurologists are not in best position- the one who thinks about the consequences of vaccination for a particular child gives a medical disqualification, but the issue of vaccination is decided by a pediatrician, from whom “chips are removed for under-coverage” by vaccinations. Therefore, the neurologist receives next appointment an even bigger problem in the child's health, but the decision to next vaccination- back to the pediatrician. Only parents who understand that vaccination is “a complex immunobiological operation” can break this vicious circle and will not give permission to vaccinate their child if they think that they should wait or that vaccinations are harmful and they REFUSE to do them consciously. there are healthy unvaccinated children under supervision - these are COMPLETELY DIFFERENT children ...

Today, the authorities handed under the glass an updated local version of the National Vaccination Calendar, determined by the supplied set of vaccines and epidemiological features.
The second round of supplementary polio immunization is also underway this week.
And, finally, it is from this month that we will be fined for non-compliance with the vaccination plan.
These events prompted the creation of another opus about regional problems.
Problem number one is the lack of drugs.
There has been no measles-mumps vaccine for 5 months now. No, despite recent outbreaks of measles in major Russian cities. No, despite the threat of such an outbreak in our city, given the low vaccination coverage, and especially revaccination. No, despite the seriousness of these diseases in terms of complications. And there will never be both separate measles and mumps vaccines, and measles + mumps + rubella vaccines.
The same 5 months there is no tuberculin. In a city where there are about 50 active bacilli excretors who do not want to be treated. Where there is a practice of unreasonable medical withdrawals from BCG-M in the maternity hospital. Where is the low coverage of fluorographic examination of the adult population.
There have been and are no acellular pertussis vaccines. In a city where both pediatric neurologists are recommending unreasonable medical withdrawals from DTP. Where pertussis revaccination coverage is extremely low. Where whooping cough is detected monthly in both children and adults.
No, and very rarely, and in very small quantities, a vaccine against Haemophilus influenzae type B is supplied. The vaccine is needed, because cases of both meningitis and epiglottitis have occurred.
There is no and never will be a quality flu vaccine.
There is no and never will be a vaccine against tick-borne encephalitis for children up to 3 years old.
Problem number two is vaccination refusals.
They are largely due to ignorance of parents and lack of choice of drugs. Commercial medicine does not solve the latter either, while budget medicine does not solve the former.
No, well, "Infanrix" will be brought, but "Pentaxim" - no way.
And pediatricians, especially those in private practice, take an anti-vaccination position in principle when it comes to immunizing children with health problems.
Problem number three is the local media.
Repeatedly, my immediate supervisor and I tried to invite media representatives to talk about the problems of immunoprophylaxis in our city, but each time they found more interesting topics to post. Prevention does not seem like a hot topic to journalists. Apparently, patients with measles or mumps will be an information bomb.
Problem number four is unreasonable medical excuses.
Neurologists and DTP have already been announced. But the KIK of the polyclinic also sins. Often diseases are interpreted as a contraindication to vaccination in principle, and not as grounds for immunization of sick children according to an individual calendar. I have little idea how whooping cough in a patient with epilepsy or poliomyelitis in a patient with primary immunodeficiency will proceed (and how they are going to treat) those who write such a permanent medical note.
Problem number five is one and a half infectiologists per district.
Well, one isho is working in the hospital, although his intentions to leave our city are getting stronger. The other works in a polyclinic, but is very advanced in age. And if an outbreak of an infectious disease occurs or a separate difficult case"controlled" infection, then the guarantees of a favorable outcome are small. Especially if it turns out to be a vacation period or weekend-holidays.
In the middle of this pentagram are district pediatricians who understand the seriousness of the impending threat so far partially, and ... children who do not know anything about it.
Solutions are not to be found by those in the middle.
But those who are above the situation are not looking for solutions either.
What are the considerations?
What are the problems in your city?