Monitoring children after preventive vaccinations. Vaccination rules
When carrying out preventive vaccinations, the following methods of introducing immunizing drugs into the body are used: subcutaneous, intradermal and intramuscular injections, cutaneous vaccine applications, oral and intranasal vaccination methods. For recent years During mass vaccinations, the so-called needle-free jet vaccination method began to be used using special devices - needle-free jet injectors that emit under high pressure a very thin jet of vaccine in a precisely dosed volume, piercing the skin.
The subcutaneous method of preventive vaccination is used to administer all killed and some live vaccines. The most convenient and less painful place for subcutaneous injections is the subcutaneous fatty tissue under the lower angle of the shoulder blades, which has a poorly developed network of nerve fibers and blood vessels. Subcutaneous injections can also be made into other areas of the body rich in subcutaneous fat, such as the side walls of the abdomen, the outer part of the shoulder, and the outer part of the thigh.
At the injection site, the skin is disinfected with alcohol or ether, grabbed along with the subcutaneous fatty tissue with the thumb and forefinger of the left hand and pulled back to form a vertical fold. The needle is inserted into the upper half of the fold at its base at an angle of about 45°, and the syringe should be turned with the needle down in order to prevent air from entering the subcutaneous tissue from the syringe if it is not carefully removed before injection. If air bubbles remain unnoticed in the syringe or in the lumen of the needle, then when the syringe is positioned with the needle down, they will float up under the piston and will not penetrate the subcutaneous tissue.
Before injecting, it is very important to make sure that the needle has entered the subcutaneous tissue and not into the skin or deep under the fascia; If the needle is inserted too superficially or deeply, the injection is very painful and can lead to superficial skin necrosis, the development of vaccine abscesses and severe general reactions. When inserted correctly, the needle moves freely when changing the inclination of the syringe, does not pull the skin and does not get stuck in the fascia or muscle.
After removing the needle, the injection site is lightly massaged with a sterile cotton ball and lubricated with iodine tincture.
The intradermal injection method is used for drugs administered in small volumes (0.1 - 0.2 ml), in particular for preventive vaccinations against tuberculosis with the BCG vaccine and for diagnostic allergy tests (tularemia, brucellosis, tuberculosis, anthrax, etc.) . For intradermal administration of drugs, one-gram tuberculin syringes with fine graduations (0.01 ml) and a thin needle (No. 0415) with a short bevel are used, carefully checked for leaks: when pressing on the piston, the syringe should not allow liquid to pass through the needle site and through the piston. There must be a separate syringe for each drug, and syringes used for immunization with the BCG vaccine must not be used for immunization with other vaccines.
The most convenient place for intradermal injections is the middle part of the palmar surface of the skin of the forearm, which is disinfected with alcohol or ether before injection. The syringe needle is inserted into the skin stretched by the fingers of the left hand, cut upward, holding the syringe almost parallel to the surface of the skin. The cut of the needle should completely enter the skin and move 2-3 mm beyond the inlet in order to prevent fluid from flowing back through the inlet. When strictly correct intradermal injection needle, a dense whitish papule with a diameter of 5 to 8 mm appears at the injection site, having the appearance of a lemon peel, which resolves after 15-25 minutes. The absence of a papule indicates incorrect needle insertion.
The intramuscular method of administering biological drugs is used for active immunization with DPT vaccine, DPT toxoid and for passive immunization with serum drugs (normal anti-measles immunoglobulin, anti-anthrax globulin, anti-smallpox immunoglobulin, etc.).
Drugs in the dosages indicated in the instructions are injected into the gluteal muscles in the area of the left or right upper outer quadrant of the buttock or into the muscles of the outer thigh. When injecting into the gluteal muscles, the person being vaccinated should lie on their stomach or stand with the corresponding leg slightly bent at the knee to relax gluteal muscles. The skin at the injection site is disinfected with alcohol or ether. The needle is inserted perpendicular to the surface of the skin to a depth of 3-8 cm, depending on the degree of development of subcutaneous fatty tissue. After removing the needle, the injection site is lubricated with iodine.
The cutaneous method of preventive vaccinations is used for immunization with some live vaccines (tularemia, brucellosis, Q fever, anthrax, plague, smallpox), as well as for diagnostic allergy tests. This least reactogenic method of preventive vaccinations cannot be used for immunization with killed vaccines, since only living microbial bodies are able to penetrate scarified skin, multiply in the body and form active specific immunity.
For cutaneous preventive vaccinations, vaccines containing live microbial bodies in high concentrations are produced.
Before applying (applying to the skin) live vaccines, you should never disinfect the skin with iodine, which destroys living microbial bodies; Pre-treatment of the skin at the vaccination site is carried out only with alcohol or ether, which must completely evaporate before applying the vaccine.
Vaccinations are carried out on outer surface shoulder or on the palmar surface of the forearm. After disinfection, drops of diluted dry vaccine are applied to the dried skin surface with a sterile eye pipette or syringe. The number of drops, their location and the distance between them are indicated in the instructions for use of this vaccine. Through each drop of the vaccine, linear, parallel or cross-shaped cuts (notches) are made with a special sterile scarifier or smallpox vaccination pen. The number of cuts, their length and location, the distance between them are indicated in the relevant instructions.
It is important that the incisions are superficial, do not penetrate deeper than the papillary layer of skin and do not cause bleeding. Only small dewdrops of blood and lymph should appear at the site of the incisions. If the incisions are too superficial, the vaccine is not completely absorbed; if the incisions are too deep, the vaccine is washed off with blood; in both cases, the effectiveness of vaccinations is reduced or lost.
After making the incisions, the vaccine is rubbed into them with the back of a scarifier or smallpox vaccination pen and allowed to dry, leaving the vaccination site open for 5-10 minutes.
The oral method is used to administer Sabin's live polio vaccine (LIV vaccine), live oral influenza vaccine and various bacteriophages (typhoid, dysentery, salmonella, etc.). Preparations for oral use are available in both liquid and dry forms (tablets, capsules, dragees).
Instructions for the use of orally administered drugs provide for the timing of administration of some drugs in connection with the timing of meals. All oral medications are taken in the presence of medical personnel.
The intranasal vaccination method is used for preventive vaccinations against influenza with a live intranasal vaccine for adults, a live intranasal vaccine for children aged 3 to 16 years, and for the administration of human leukocyte interferon to prevent influenza and other viral infections. respiratory diseases. Available in dry form in glass ampoules; immediately before use, the vaccine is dissolved in boiled water cooled to room temperature, interferon is dissolved in sterile distilled water, ampoules of which are included in the box with the drug. Methods of dilution of drugs, doses, intervals and timing of administration are indicated in the relevant instructions.
The live influenza vaccine is administered into the nasal cavity using a special nebulizer of liquid preparations, interferon - by inhalation, spraying or instillation into the nasal passages. Sprayers are sterilized by boiling for 10-15 minutes, the heads of the sprayers are wiped with alcohol and burned after each injection.
Before administering drugs, the nasal passages must be cleared of mucus and crusts for better absorption of the drug. After administering the drug, the vaccinee should take a deep breath and remain sitting for 2-3 minutes with his head thrown back, after which he should not clear his nose for 30 minutes.
No-needle (jet) method found practical application in recent years and has been officially approved for preventive vaccinations against smallpox, cholera, anthrax, tularemia, plague, yellow fever. The possibility of using it for other bacterial preparations is being studied.
This method of administering vaccines has a significant advantage over all others. In 1 hour, using one needle-free injection machine, you can vaccinate more than 1000 people. This achieves high labor productivity.
The immunization technique is simple; it does not require syringes, needles, their sterilization, or changing them for each person vaccinated. In addition, vaccines are used in minimally strict dosages. All this taken together also provides an economic effect.
The needle-free method ensures complete sterility when administering the drug, since the ampoule or bottle containing the vaccine is separated from the external environment and the possibility of foreign microflora entering it is excluded. Thanks to the design of the device, the possibility of parenteral transmission of hepatitis is also excluded. Since injections usually do not cause any painful sensations For the majority of those vaccinated, the needle-free method is more effective from a psychological point of view.
The principle of the method is the ability of a thin stream of liquid (drug), which is under high pressure when exiting the device, to pierce the skin and penetrate into the underlying tissue to a certain depth, i.e. the drug can be administered intradermally, subcutaneously and intramuscularly, and at the same time exactly dosed volume.
There are various types devices for needle-free (jet) administration of drugs - injectors. Common to all is the presence of a working cylinder, where the liquid for injection is placed, a drive with a piston to create the necessary liquid pressure in front of the nozzle, and the nozzle itself, where the jet is formed. The necessary pressure is created by a piston, which is driven by spring, pneumatic, hydraulic and other devices.
Injectors, depending on the design, can be intended for administering drugs by all methods (intradermal, subcutaneous, intramuscular) or only one of them.
The needle-free method is increasingly used for mass immunization carried out in a short time.
The rules for handling injectors are described in detail in special instructions supplied with devices of various designs.
It is important to note that in order to ensure sufficient operational efficiency, personnel must first undergo special training.
Before vaccinating, parents should know vaccination rules And basic legal acts regulating this far from safe procedure.
Basic documents
1.Federal Law “On Immunoprophylaxis of Infectious Diseases”, which came into force in October 1998,
Art. 5 “Rights and responsibilities of citizens during immunoprophylaxis”, paragraph 1 states: “A citizen has the right to refuse preventive vaccinations.” 2. “Fundamentals of legislation Russian Federation on the protection of citizens’ health”, which contains 30 and 33 articles.
Article 30. “Consent to medical intervention. A necessary condition for medical intervention is informed voluntary consent citizen. In the case when a citizen’s condition does not allow him to express his will, and medical intervention is urgent, the issue of its implementation is decided by a council, and if it is impossible to assemble a council, the attending (duty) doctor directly decides.
Article 33. “Refusal of medical intervention. A citizen or his legal representative has the right to refuse medical intervention or demand its termination, with the exception of cases when anti-epidemic measures are carried out in relation to persons who have committed socially dangerous acts, as well as persons suffering from severe mental disorders.”
2."Convention on the Rights of the Child", which came into force in 1990.
Vaccination rules
In addition to these legal documents, there are certain rules for vaccination, regulated by common sense, research and instructions from the Ministry of Health.
Here are these rules:
Vaccinations must be done strictly according to indications if parents want to carry them out.
Carrying out vaccinations strictly according to indications is indeed extremely important, since in terms of the strength of its effect on the body, vaccination is equivalent to complex heart surgery.
In order for vaccinations to be prescribed, it is necessary to do an immunological blood test to determine the composition of antibodies and obtain a conclusion about which antibodies the child does not have.
Thus, the child should receive exactly those vaccinations that allow him to develop the missing antibodies.
Vaccination against a disease to which immunity has already been formed leads to the destruction of this immunity and the child will remain unprotected.
Infant does not require vaccinations. The infant constantly receives immune protection from the mother in the form of passive immunity and does not require additional immunization. Even if a baby is put to the breast once, the mother’s passive immunity will circulate in his blood for another 6 months and protect him from infections.
Therefore, in order to find out what the child’s own immunity is, an immunological blood test should be carried out no earlier than six months after the end of breastfeeding. And after this study, begin vaccinations.
In addition, all vaccinations given to a child under 1 year of age have a destructive effect on the thymus gland, main body immune system. Since in a children's clinic, vaccinations begin from the age of 3 months, in order to protect yourself from unnecessary intrusiveness of health workers, you should give a written refusal from vaccinations.
Based on the federal law “On Immunoprophylaxis of Infectious Diseases”, Article 5, Clause 3, “When carrying out immunoprophylaxis, citizens are obliged to: follow the instructions of medical workers; confirm in writing the refusal of preventive vaccinations.”
The vaccine cannot be given if the child is sick or weakened. In cases where a child is sick, is teething, has perinatal problems (PEP, increased intracranial pressure, hypertonicity, distance, etc.), vaccinations cannot be given. They can be done a month after the end of the disease or unfavorable physiological condition.
Vaccinations are also not given if the child has diathesis, since vaccinations can significantly strengthen it. Parents' decision to vaccinate their child should be informed. If a mother was going to get vaccinated, she has the right to know the “List of Contraindications” and “List of Post-Vaccination Complications” for vaccination, and the mother is not required to take the information by ear. The health facility where she is going to get vaccinated should provide her with these lists in writing so that she can read them in detail and make an informed decision.
It should be remembered that each list contains at least 7 points, one of which may be a complication such as death.
Post-vaccination complications:
a.Vaccinations, according to various sources, lead to diathesis in children in 60-80% of cases;
b.Children practically do not get sick with free form polio; the majority of cases of polio are caused by vaccination;
c. DPT and ADSM vaccinations cause post-vaccination complications such as convulsive syndrome, sudden death, anaphylactic shock, etc.;
d. Vaccination against measles gives the following complications: neurological, convulsive syndrome, nephrological, damage to the lungs and tonsils, etc.
Safety guarantee.
Every mother should know that by agreeing to a vaccination, she has the right to familiarize herself with the certificate and instructions for the vaccine that her child will be vaccinated with. Having received assurances about the safety of the vaccine, she has the right to ask the head of the children's department of the clinic for a letter of guarantee that her child will not suffer any post-vaccination complications over the next 10 years, i.e. during the period of validity of the vaccine.
The quality of Russian vaccines.
All Russian vaccines are produced in violation of technology and most of them are poisoned with mercury salts (merthiolate). In addition, you should know that when they talk about the safety of the Russian vaccine, this means that 50-70% of the experimental animals died.
Quality of imported vaccines.
All vaccines that have passed customs control are outdated or have expired. Low quality imported vaccines provided to us is due to the fact that developed countries According to their legislation, they do not have the right to supply strategic goods to 3rd world countries, and vaccines are classified as strategic goods.
You cannot give more than one vaccination in one session. This is the instruction of the Ministry of Health for clinics. However, in reality, a child can receive up to 4 vaccinations in one session, arguing for such malicious sabotage on the grounds of the mother’s convenience. “So that you don’t have to come to us twice, we’ll do everything at once!” - the nurse says cheerfully and cheerfully. However, this action leads to serious suffering of the immune system and significantly impairs the body's resistance. It is this situation that is the most dangerous, since when several vaccines are administered simultaneously, severe post-vaccination complications most often occur.
You cannot vaccinate with a live vaccine. Since vaccination with a live vaccine is not a vaccination, but a deliberate infection with a disease that a child in free form might not have contracted. Boys should not be vaccinated against mumps (mumps). The result of such vaccination can be impotence and male infertility.
Having vaccinations does not guarantee protection against the disease. For example, after vaccination against mumps, children suffer from this disease twice, and after vaccination against diphtheria, children suffer from diphtheria without fever and end up in intensive care with an attack of suffocation, when it is almost impossible to save the child.
A child without vaccinations is less dangerous than a child with vaccinations. Therefore, there is no reason to refuse admission to a child who does not have vaccinations. kindergarten or school. In addition, on the basis of the federal law “On Immunoprophylaxis of Infectious Diseases,” child care institutions cannot refuse parents to admit a child on the grounds that he/she has not completed preventive vaccinations.
Article 5 “Rights and responsibilities of citizens in the implementation of immunoprophylaxis”, paragraph 2 “The absence of preventive vaccinations entails: temporary refusal to admit citizens to educational and health institutions in the event of mass outbreaks infectious diseases or when there is a threat of epidemics.”
The introduction of active immunization into the practice of children's health care has led to a significant reduction in the incidence of children infectious diseases. Currently, vaccinations are carried out against tuberculosis, diphtheria, tetanus, whooping cough, polio, measles, mumps, hepatitis B, rubella and other vaccinations for epidemiological indications. Active immunization agents against acute respiratory diseases (ribomunil, polyoxidonium) are used. The first clinical trials preventive vaccinations against chickenpox.
1. Organization and implementation of preventive vaccinations
Currently, vaccination work in the clinic is organized and carried out in accordance with the order, which approves the calendar of preventive vaccinations, instructions on immunization tactics, basic provisions on the organization and conduct of preventive vaccinations, a list of medical contraindications to immunization, and the procedure for registering information about complications from vaccinations .
Preventive vaccinations must be carried out within the time limits established by the calendar. In case of violation, simultaneous administration of several vaccines is allowed, but in different parts of the body and with separate syringes.
When vaccinations are carried out separately, the minimum interval should be at least a month. If vaccination against hepatitis B is not carried out on the same day as other vaccinations, then the interval between their administration is not regulated.
In the event of acute diseases, including ARVI and acute intestinal infections, or exacerbation of chronic routine immunization is postponed until the symptoms of the disease disappear.
Preventive vaccinations are carried out in appropriately equipped vaccination rooms of clinics or other premises in strict compliance with sanitary and hygienic requirements.
By decision of the health authorities, preventive vaccinations can be carried out at the place of work (study) of the vaccinated person or at home.
The vaccination office of the clinic should consist of premises for vaccinations and storage of vaccination records and have a refrigerator for storing vaccination preparations, a cabinet for instruments and a set of medications for emergency and anti-shock therapy, bins with sterile material, a changing table or medical couch, a table for preparing vaccination preparations , table for storing medical records. The office should have instructions on the use of vaccinations and instructions on providing emergency care.
Vaccinations against tuberculosis and Mantoux testing should be carried out in a separate room, and in its absence, on a special table, on designated days and hours.
To avoid contamination, combining vaccinations against tuberculosis with vaccinations against other infections is prohibited. Vaccinations against tuberculosis and performing the Mantoux test at home are prohibited.
Supervisor medical institution bears responsibility for organizing vaccination work, appoints medical workers responsible for planning and performing preventive vaccinations with a clear definition of their functional responsibilities.
Preventive vaccinations are carried out by medical workers trained in the rules of vaccination techniques and emergency care techniques.
Medical workers are required to notify parents in advance about the day of preventive vaccinations. All persons subject to vaccination must be examined by a doctor or paramedic, and anamnesis should be taken into account (previous diseases, allergic reactions for vaccinations, medicines, food products).
Immediately before vaccination, the child is examined and body temperature is measured to exclude acute illness.
After vaccination, medical supervision must be provided.
Vaccinations and tuberculin diagnostics are carried out with syringes and needles for disposable use only. For immunization, vaccines approved for use in Russia are used.
The medical staff of the vaccination room is responsible for the completeness and accuracy of the vaccination documentation.
A record of the completed vaccination is made in the work log of the vaccination office, the history of the child’s development, the preventive vaccination card, the medical record of the child visiting the child care facility, and the preventive vaccination log. After vaccination and revaccination against tuberculosis, the nature of the papule, scar, and the condition of the regional lymph nodes are recorded after 1, 3, 6, 12 months.
The record indicates the name of the drug, country of origin, dose, series, control number, expiration date, information about local and general reactions to the vaccine, complications, and the timing of their development.
If a post-vaccination reaction occurs, you must immediately notify the head of the medical institution; if a complication develops, send an emergency notification to the territorial epidemiology center. The fact of refusal to vaccinate is recorded in medical documents with a note that medical worker explanations are given about the consequences of refusal, signed by the citizen and the medical worker.
Basic vaccines
The first vaccination is carried out within 24 hours after the birth of the child. This is an immunization against hepatitis B. Engerix-B recombinant yeast liquid vaccine is a sterile suspension containing purified genetically engineered hepatitis B core surface antigen (HBS Ag).
The surface antigen gene was isolated from the hepatitis B virus and incorporated into yeast.
As a result of the proliferation of yeast cells and purification of the surface antigen, the HBS Ag vaccine was obtained, spontaneously transforming into spherical particles with a diameter of 20 nm, containing non-glycosylated HBS Ag polypeptides and a lipid matrix of phospholipids, which have the properties of natural HBS Ag. Preservative – thiomersal. Three-time administration of Engerix-B leads to the formation of specific antibodies and prevents the development of hepatitis B disease in 95-98% of vaccinated people.
The vaccine is administered intramuscularly into the deltoid muscle area for older children or into the anterolateral thigh area for newborns and young children.
As an exception, the vaccine can be administered subcutaneously to patients with thrombocytopenia and other diseases of the blood coagulation system.
It is not recommended to administer the vaccine intramuscularly into the gluteal region, as well as subcutaneously and intradermally, as this may lead to a low immune response. Intravenous administration of the vaccine is strictly prohibited. A single dose of the drug for newborns and children under 10 years of age is 10 mcg (0.5 ml), for children over 10 years of age – 20 mcg (1 ml).
The second vaccination is carried out at the age of 1 month, the third at 5 months, simultaneously with DPT and OPV. Premature children weighing less than 2 kg are vaccinated from two months with similar intervals between vaccinations.
Primary vaccination against tuberculosis is carried out on newborns on the 3rd-4th day of life. BCG vaccine is live dried bacteria of the BCG vaccine strain No. 1. One vaccination dose - 0.05 mg of BCG - is dissolved in 0.1 ml of solvent, administered 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 according to medical contraindications, are vaccinated at the clinic with the BCG-M vaccine. Children older than two months, who were not vaccinated during the newborn period, are vaccinated in the clinic after a tuberculin test is performed and the result is negative.
Children are vaccinated again if, 2 years after vaccination and a year after revaccination, they have not developed a post-vaccination scar and the Mantoux test is negative.
At the age of 7 years, children who have negative reaction to try Mantoux. The interval between the Mantoux test and revaccination should be at least 3 days and no more than 2 weeks.
Persons with positive and questionable reactions to the Mantoux test, as well as those who had complications from previous administrations of BCG and BCG-M, are not subject to immunization.
Vaccination against polio is carried out with a live oral polio vaccine containing weakened strains of the human polio virus of three immunological types (I, II, III). The vaccine is available in the form of a solution and candy.
Vaccination is carried out three times from three months with a month interval between vaccinations, revaccination is carried out once at 18 months, 24 months and 7 years.
If inactivated polio vaccine is available, the first vaccination in the vaccine cycle at the age of 3 months is IPV, and the next 2 are OPV. Before entering school, a child must receive 5 vaccinations (3 in the first year of life and 2 in the second).
In the case where the child was previously vaccinated according to an individual scheme, the minimum interval between completed vaccination and revaccinations should be at least 6 months. Co-administration of oral polio vaccine with all vaccines is not excluded.
Vaccine-associated paralytic poliomyelitis occurs within a period of 4 to 30 days, in contact persons - from 4 to 75 days, in persons with immunodeficiency these periods may be different.
When communicating with a patient with polio caused by wild poliovirus, all contact children (vaccinated and unvaccinated) should receive OPV.
For those who are fully vaccinated, 1 dose of OPV is administered, for those who are not vaccinated, the administration is carried out according to the full schedule, for those who are partially vaccinated - up to the number of vaccinations established by the calendar.
Vaccinations against diphtheria, whooping cough, and 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 formaldehyde or merthiolyte, purified and concentrated diphtheria and tetanus toxoids adsorbed on aluminum hydroxide.
The DPT vaccination course consists of three intramuscular injections of the drug (0.5 ml each) at monthly intervals. Reducing intervals is not allowed.
If it is necessary to extend the intervals after the 1st or 2nd vaccination over a month, the next vaccination should be carried out as soon as possible, determined by the child’s health condition, but not exceeding 6 months. In exceptional cases, extension of intervals is allowed up to 12 months.
Vaccinations with DTP vaccine are carried out simultaneously with immunization against polio. Revaccination is carried out once at 18 months. Vaccinations against whooping cough are given from 3 months to 4 years. Children who have contraindications to DTP are vaccinated with DTP toxoid according to the following schedule: vaccination at 3 and 4 months, revaccination after 9-12 months.
If after three or two vaccinations DTP child suffered whooping cough, then the course of DTP vaccination is considered completed. In the first case, revaccination is carried out with ADS at 18 months, in the second - after 9-12 months.
If the child received only one DTP vaccination, he is subject to a second ADS vaccination with revaccination after 9-12 months.
If post-vaccination complications arise after the first DPT vaccination, the second one is given with ADS-toxoid; if for the second, vaccination is considered complete; if for the third, revaccination with DTP is carried out after 12–18 months.
In case of violation of the immunization schedule against diphtheria and tetanus, the intervals between vaccine administrations should be: between vaccination and revaccination - 9-12 months, between the first and second revaccinations - at least 4 years, between the second and third, third and fourth revaccinations - at least 4 years, between subsequent revaccinations - at least 10 years.
For emergency prevention of whooping cough in unvaccinated children, normal human immunoglobulin is used twice with an interval of 24 hours in a single dose of 3 ml to the maximum early dates, vaccine prophylaxis is not carried out. Chemoprophylaxis with erythromycin (40–50 mg/kg/day) for 14 days is effective.
The second revaccination (6 years) is carried out with ADS-antitoxin once, the third (11 years) with ADS-M-antoxin once. Children over 6 years of age who have not previously been vaccinated are vaccinated with ADS-M toxoid: 2 vaccinations at intervals of a month, revaccination is carried out once after 9-12 months. ADS-M toxoid consists of a mixture of concentrated and purified diphtheria and tetanus toxoids with a reduced content of antigens adsorbed on aluminum hydroxide.
Persons who have been in contact with a patient with diphtheria are subject to vaccination with ADS-M (AD-M) - toxoid in a dose of 0.5 ml, if the last vaccination was more than 5 years ago. Persons who are unvaccinated and with an unknown vaccination history are vaccinated twice with an interval of a month.
The Trimovax vaccine for the prevention of measles, mumps and rubella contains live attenuated measles, mumps and rubella viruses, is available in lyophilized form, using water for injection as a solvent. Children are vaccinated at 12 months by subcutaneous or intramuscular injection.
At 6 years of age, revaccination is carried out with a complex vaccine, in cases where the child has not suffered from any of the indicated infections or mono-vaccines according to the calendar, if he has had at least one of them.
Mono-vaccines are administered simultaneously to different parts of the body or at monthly intervals. The Trimovax vaccine can be administered simultaneously with any other vaccine except BCG and BCG-M.
In case of contact with a person with measles who has not been sick and has not been vaccinated, a live measles vaccine is administered in the first 3 days. If there are contraindications to vaccination, normal human immunoglobulin is administered to children under 12 months in a dose of 1.5 ml or 3.0 ml.
In case of contact with a patient with mumps, the JPV vaccination is carried out no later than 72 hours from the moment of contact with a non-sick and unvaccinated person.
Contraindications to preventive vaccinations
A contraindication to all vaccinations is a complication following the administration of the previous dose of the drug - allergic edema that developed within 24 hours after vaccination, immediate anaphylactic reactions, encephalitis, convulsions.
Vaccinations are contraindicated for children with an immunodeficiency state, immunosuppression, or malignant neoplasms.
There are additional contraindications for individual vaccines: BCG is contraindicated in premature infants weighing less than 2 kg, with regional lymphadenitis, regional abscess, keloid scar after a previous vaccination, a history of tuberculous sepsis, generalized BCG infection (developed 1-12 months after immunization), children infected with tuberculosis or with a history of tuberculosis.
There are no absolute contraindications for OPV. Progressive diseases are contraindications for DPT. nervous system, uncontrolled epilepsy, infantile spasms, progressive encephalopathy.
For ADS, ADS-M, AD and AS there are no absolute contraindications, for JCV, JPV, Trimovax - anaphylactic reaction to aminoglycosides and egg whites, for monovaccine against rubella - anaphylactic reaction to aminoglycosides, for vaccine against hepatitis B - increased sensitivity to yeast and other vaccine components.
A relative contraindication is an acute disease or exacerbation of a chronic one.
In this case, routine vaccination is postponed until symptoms disappear.
The following are not contraindications to vaccinations: perinatal encephalopathy, bronchial asthma, hay fever, drug allergies, eczema, dermatoses, anemia, cerebral palsy, Down syndrome, upper infections respiratory tract and diarrhea at temperatures below 38 °C, chronic diseases of the heart, lungs, liver and kidneys, enlarged thymus gland, birth defects development, treatment with antibiotics or small doses of corticosteroids, dysbacteriosis, variation of the Mantoux tuberculin test without functional manifestations, indications in the anamnesis of prematurity, malnutrition, hemolytic disease newborns, hyaline membrane disease, seizures (including epilepsy, sepsis in family members), allergies in relatives, sudden death in the family, Mantoux tuberculin test and tuberculosis infection in family members.
Post-vaccination reactions and complications
Post-vaccination reactions are changes in the functional state of the body that do not go beyond the physiological norm.
A strong general reaction consists of an increase in body temperature above 40 °C, a strong local reaction is the appearance of an infiltrate at the site of vaccine administration with a diameter of more than 8 cm or an infiltrate in the presence of lymphangitis with lymphadenitis.
Post-vaccination complication – pathological condition organism, developing after vaccination and in its manifestations going beyond the physiological norm.
Complications include:
1) anaphylactic shock due to DTP, ADS, LCV, which occurs within 24 hours after administration of the vaccine;
2) collapsed state on DTP 5–7 days after vaccine administration;
3) encephalopathy (violation brain functions Central nervous system, generalized or focal increase in intracranial pressure, disturbance of consciousness for more than 6 hours, convulsions, slow waves on the EEG) for the administration of DTP, ADS for a period of 3 to 7 days;
4) residual convulsive state(an episode of seizures at a temperature below 39 °C, if they were absent before and repeated after vaccination) on DTP, ADS, AD-M for 3 days;
5) paralytic poliomyelitis on OPV up to 30 days in a vaccinated person, up to 6 months and later in an immunodeficient person, up to 75 days in a contact person;
6) after tuberculosis vaccinations - lymphadenitis, regional abscess, keloid scar and other complications that arose during the year;
7) chronic arthritis on Trimovax, rubella vaccine for 42 days;
8) neuritis of the brachial nerve due to DTP, ADS, AS, ADS-M and other vaccines within a period of 2 to 28 days;
9) thrombocytopenic purpura for LCV, Trivaccine, rubella vaccine for a period of 7 to 30 days. Febrile convulsions, bulging fontanel, piercing
Screaming and prolonged crying can be observed with encephalopathy, but in themselves are not sufficient to diagnose complications from vaccination.
The main principles of treatment of post-vaccination reactions and complications are the fight against hyperthermia, detoxification, the use of desensitizing drugs, anticonvulsant and dehydration therapy, treatment of inter-current infections and aggravated chronic diseases, symptomatic therapy.
For anaphylactic shock medical care must be provided immediately. It consists of stopping the administration of the drug, placing the patient in a horizontal position (on his side), warming him up, administering intramuscular antihistamines, intravenous glucocorticoids, oxygen therapy, symptomatic therapy (administration of cardiac, diuretic, anticonvulsants etc.). After recovery from anaphylactic shock, the child is immediately hospitalized.
If a complication after immunization is detected or suspected, the doctor (paramedic) is obliged to notify the chief physician of the medical institution. The chief physician ensures that the patient is hospitalized in a hospital and sends an emergency notification.
The Territorial Center of Epidemiology registers complications due to vaccination with clarification of the clinical diagnosis, laboratory test material obtained from the patient, sends information to the regional epidemiology center.