Recommendations for immunization of people living with HIV infection. Flu - all about vaccination for people with HIV Is it possible to get the HIV flu vaccine

Can people living with HIV be vaccinated?

Vaccination or immunization is a modern and effective remedy prevention of many diseases. In response to the introduction of a vaccine containing weakened or “killed” microorganisms, the body’s immune system produces antibodies to them. When pathogenic microbes subsequently enter the body, the body already has the skill to successfully fight them.

Most vaccines are designed to prevent infections. However, there are also those that help the body fight infection that has already entered the body. They are called “therapeutic” vaccines, as opposed to the “preventative” vaccines described above.

“Live” vaccines contain a weakened living microorganism. They are able to multiply in the body and cause an immune response, forming immunity to this disease. At the same time, the disease can occur in mild form, but then the immune system studies the vaccine and begins to produce special substances to destroy it.

“Inactivated” vaccines contain either a killed whole microorganism or components cell wall or other parts of the pathogen. That is, a person does not get sick, but the body develops immunity to this species diseases.

Because HIV gradually destroys the immune system, the vaccine may not be as effective or may take longer to produce an immune response. Vaccination may also cause more side effects in people with HIV. Vaccines can even cause the disease they are designed to protect against.

Vaccination may increase your viral load for a period of time. On the other hand, getting the flu, hepatitis or other preventable diseases is much worse. It is not recommended to take a viral load test within 4 weeks after vaccination.

Influenza vaccination for people living with HIV is the best studied. It has been proven to be effective and safe. However, people with HIV are not recommended to use the nasal vaccine because it contains a live virus.

If you have a very low immune status, the vaccine may not work. If possible, strengthen your immune system by taking antiretroviral therapy before vaccination.

Try to avoid contact with people who have been vaccinated against these diseases for 2-3 weeks.

Vaccination and HIV

Many diseases can be avoided by getting vaccinated. In this regard, many people living with HIV are interested in the question of how vaccination affects the body, as well as which vaccines can be given and which ones it is better to abstain from. You can find answers to these questions in this article.

What is vaccination?

Vaccination, or immunization, is a modern and effective means of preventing many diseases. In response to the introduction of a vaccine containing weakened or killed microorganisms, the body's immune system produces antibodies to them. When pathogenic microbes subsequently enter the body, the body already has the skill to successfully fight them.

Most vaccines are designed to prevent infections. However, there are also those that help the body fight infection that is already present in the body. They are called therapeutic vaccines.

Live vaccines contain a weakened live microorganism. They are able to multiply in the body and cause an immune response, forming immunity to this disease. In this case, the disease may occur in a mild form, but then the immune system studies the vaccine and begins to produce special substances to destroy it.

Inactivated vaccines contain either a killed whole microorganism or components of the cell wall or other parts of the pathogen. That is, a person does not get sick, but the body develops immunity to this type of disease.

There may be some side effects with vaccination. When a live vaccine is administered, the disease may be mild. Even when you receive an inactivated vaccine, your immune system reacts to it. As a result, reactions such as pain and redness at the injection site, weakness, fatigue or nausea may occur for about a day.

How is vaccination different for people with HIV?

Because HIV gradually destroys the immune system, the vaccine may not work as effectively or may take longer to produce an immune response. Vaccination may also cause more side effects in people with HIV. Vaccines can even cause the disease they are designed to protect against.

Not much research has been done on the effects of vaccination on people with HIV, especially since the advent of antiretroviral therapy. However, we can offer some basic recommendations for people with HIV:

Vaccination may increase your viral load for a period of time. On the other hand, getting the flu, hepatitis or other preventable diseases is much worse. It is not recommended to take a viral load test within 4 weeks after vaccination.
Influenza vaccination for people living with HIV is the best studied. It has been proven to be effective and safe. However, people with HIV are not recommended to use the nasal vaccine because it contains live virus.
If you have a very low immune status, the vaccine may not work. If possible, strengthen your immune system by taking antiretroviral therapy, before vaccination.
Many live vaccines, including the smallpox vaccine, are not recommended for people with HIV. It is not recommended to get the smallpox vaccine unless your doctor agrees that it is safe for you. Try to avoid contact with people who have been vaccinated against smallpox for 2-3 weeks. Measles, mumps and rubella vaccines have been shown to be safe for people with HIV if the immune status is above 200 cells/ml.

1. For pneumonia

People living with HIV have a higher risk of developing pneumococcal pneumonia. Effective vaccine becomes in 2-3 weeks. The protective effect of the vaccine lasts about 5 years.

2. For hepatitis

There are several types viral hepatitis. Vaccines are available for hepatitis A and B. Hepatitis A is not a serious threat, but can be quite problematic for people with weakened livers. The same applies to people with hepatitis B and C. Two hepatitis A vaccines can protect you for 20 years. Three vaccinations against hepatitis B can provide protection against it for 10 years.

3. For the flu

You must be vaccinated against influenza every year. Flu vaccinations are recommended for all people living with HIV. For better protection It is recommended to get vaccinated sometime in November before flu season. In some cases, the flu can develop into pneumonia. Some vaccines may cause allergic reaction in people who are allergic to eggs.

4. For tetanus and diphtheria

Tetanus is a serious disease that is caused by a common bacterium. Tetanus infection can be transmitted through skin wounds. It is not transmitted from one person to another. Injecting drug users are at high risk of tetanus infection. Diphtheria is also bacterial infection. It can be transmitted from one person to another, and is often found in homeless people. The diphtheria vaccine is always given with a tetanus shot. Diphtheria and tetanus are usually vaccinated in childhood. People with HIV are not recommended to be vaccinated more than once every 10 years.

5. For measles, mumps and rubella

Measles, mumps and rubella are viral infections. They can be transmitted by airborne droplets. Typically, one vaccination protects for a lifetime. However, since this live vaccine, it is not recommended for people with an immune status below 200 cells/ml.

If you are planning a trip

Before traveling, you need to make sure that you have been vaccinated against hepatitis A and B. Each country has its own requirements for vaccination upon entry. In general, inactivated vaccines should not be a problem for people with HIV traveling. However, live vaccines, including typhoid vaccine, should be avoided. yellow fever and cowpox. If a polio vaccine is required, it must be inactivated, but not live. In this case, you need to get a letter from your doctor saying that medical indications You should not be vaccinated with a live vaccine. This practice is accepted in most countries.
Don't be afraid, you haven't been infected with anything

HIV-infected people are more likely to get sick and die from infectious diseases, the development of which can be prevented by vaccines. On the other hand, HIV-infected people are more likely to develop side effects from the administration of vaccines, and there is also a higher likelihood of vaccination failure - the lack of formation of a protective antibody titer (post-vaccination immunity).

In this regard, the indications and timing of vaccine administration are determined individually for each patient - the better the immune status, the higher the likelihood of a sufficient immune response to the vaccine.

In patients with severe immunodeficiency, vaccinations are usually ineffective and even there may be contraindicated.

In some cases, passive immunoprophylaxis (immunoglobulin) may be indicated. Once the CD4 count has stabilized after an initial rise on ART, vaccinations or booster vaccinations with individual vaccines should be reconsidered.

Depending on immune status, HIV-infected individuals should expect an insufficient immune response to previously administered vaccines and a rapid decline in protective antibody titre over time. Until recently, the basic rule for use in clinical practice was:

• with CD4 lymphocyte count<300 мкл –1 иммунный ответ на введение вакцины снижен;
• with CD4 lymphocyte count<100 мкл –1 ответ на вакцинацию не ожидается.

However, recent data have cast doubt on the validity of this concept. It has been established that in patients with a suppressed viral load, the formation of an immune response to the administration of some vaccines (for example, influenza vaccines does not depend on the number of CD4 lymphocytes. However, after increasing the number of CD4 lymphocytes to a level of >200 μl -1, the possibility of revaccination should be considered.

Some vaccines may cause a short-term increase in viral load. The peak increase in viral load is recorded 1–3 weeks after vaccination. Therefore, viral load should not be measured as part of routine clinical surveillance for four weeks after vaccination. Many studies show that such increases in viral load (“spikes”) do not lead to significant consequences. However, this may increase the risk of developing ART resistance. Additionally, increased viral replication could (theoretically) increase the risk of mother-to-child transmission of HIV.

When using inactivated (killed) vaccines, the incidence of side effects in HIV-infected people is no different from the incidence of side effects in the general population. However, when using live vaccines in HIV-infected people, there is a higher risk of complications associated with the development of infection with the vaccine strain. Severe and even fatal complications have been reported following vaccination against smallpox, tuberculosis, yellow fever, and measles. However, HIV infection is not an absolute contraindication to vaccination with live vaccines.

Vaccination of contact persons

Since HIV-infected people are extremely susceptible to infections for which vaccines are available, special care must be taken to vaccinate people who are in close contact with HIV-infected people, since once they develop a protective antibody titer, they will not be able to infect an HIV-infected family member with this infection.

However, it should be remembered that after the administration of some live vaccines (for example, oral polio vaccine), the vaccinated person releases the vaccine strain of virus into the external environment for some time and is able to infect an HIV-infected family member who develops an infection with the vaccine strain. Therefore, oral polio vaccine (OPV) and smallpox vaccine are not used to vaccinate people in the immediate environment of an HIV-infected person.

Of the live vaccines, the MMR vaccine (measles vaccine, mumps and rubella). Vaccination against the varicella virus (chicken pox) is also carried out; If a vaccinated person develops chickenpox caused by a vaccine strain, an HIV-infected person in contact with it can be given prophylaxis with acyclovir.

Vaccination of HIV-infected children

With a few exceptions, HIV-infected children should be vaccinated according to the national schedule preventive vaccinations. HIV-infected not recommended administer the BCG vaccine. Children with severe immunodeficiency (percentage of CD4 lymphocytes<15%) противопоказана MMR (вакцина против кори, эпидемического паротита и краснухи) и вакцина против вируса varicella.

If the CD4 count is >15%, the MMR vaccine is given twice, 1 month apart. According to the latest US guidelines, this vaccine can also be given to children aged 1–8 years with a CD4 cell count >15% and to children >8 years of age with a CD4 cell count >200 μL–1.

Due to lack of data, the quadruple MMRV vaccine (measles, mumps, rubella and varicella virus vaccine) should not be used.

If there are contraindications to the administration of one of these four live vaccines, susceptible family members (especially siblings) should be vaccinated.

If an HIV-infected child does not have protective antibodies after diphtheria and tetanus vaccination, there is little benefit from live vaccines such as MMR and varicella virus vaccine, even if the CD4 cell count is above the above thresholds. In these cases, passive immunoglobulin prophylaxis may be useful.

HIV-infected children should receive the standard course of vaccination with the seven-valent pneumococcal conjugate vaccine (PCV) starting in the second month of life, and additionally with the 23-valent pneumococcal polysaccharide vaccine (PPSV) after the age of 2 years (must be ≥2 months after the last dose of PCV ). Revaccination with PPSV is carried out every 5–6 years.

The American magazine POZ published a reminder for people with HIV that it is recommended to get a flu shot during September or October of each year. Not long ago Russian study showed that influenza increases the risk of heart attack, even in HIV-negative people without problems with the immune system. If a person already has heart disease, as many people with HIV do, the flu can be deadly for them. People with HIV are usually recommended to get a flu shot once a year and a pneumococcal pneumonia shot every five years.

The flu vaccine for people with HIV may include the following:

If the CD4 count is below 200 cells/ml, vaccination may not be effective. People with such a low immune status are advised to consult their doctor before getting the vaccine.

The vaccine cannot cause the flu itself, but people may feel sick for a day after the shot. This is due to the immune system's reaction when it produces antibodies to the vaccine.

The nasal spray vaccine contains live virus and is therefore contraindicated for people with HIV.

The flu vaccine is effective when a large number of people have received it. This is especially important for people whose immune systems are not working well, and therefore are at higher risk of complications from the flu. This primarily applies to older people, as well as people with immunodeficiencies, including HIV infection. Relatives and friends of such people are advised to get vaccinated against influenza, given that the infection may be more dangerous for their loved ones.

Flu or not flu: should you get vaccinated?

As always, every autumn, we are faced with an epidemic that annually kills thousands of our compatriots - the influenza epidemic. Despite official recommendations for all adults to receive an annual influenza vaccination, the public continues to be hesitant about the need for this vaccine. It is especially unclear what to do about flu vaccination for people living with HIV.

What is the flu?
Flu is an infectious disease viral disease, affecting the human respiratory system (nose, throat, lungs). Flu should not be confused with common cold, it's perfect various diseases. The flu usually begins suddenly and is manifested by the following symptoms:
Fever
Headache
Extreme fatigue
Dry cough
Sore throat
Muscle pain

The flu is spread through respiratory droplets, meaning when another person coughs, sneezes or speaks, the virus becomes airborne and other people can inhale the virus. Once in the nose, throat or lungs, the virus begins to multiply and causes characteristic symptoms. Less commonly, the virus is transmitted by touching surfaces that have the virus on it (such as door handles) and then touching your mouth or nose.

The flu can be spread to other people the day before a person becomes sick. Adults can spread the virus for three to seven days after symptoms begin. Flu symptoms appear about four days after the virus enters the body. Some people with influenza are asymptomatic, although they can pass the virus on to others.

In the Northern Hemisphere, the influenza epidemic period usually occurs from November to April. However, at the same time, other respiratory infections with similar symptoms, and it is often difficult to determine whether a person really has the flu or whether it is another infection.

Myths about the flu shot

No one has ever died from the flu
The flu can lead to pneumonia, which results in hospitalization and death for many people each year. Although the flu is mainly dangerous for people over 65 and children under 2 years of age, it remains serious illness for all people.

The vaccine cannot protect against influenza
A flu vaccine is developed for each region annually, taking into account WHO data. If a person gets vaccinated annually, he is maximally protected from the flu. It is true that no vaccine in the world can guarantee 100% protection. Some people, even after vaccination, may develop the flu, although it will likely resolve over a much longer period of time. soft form. In addition, the vaccine may not protect against other “colds” with flu-like symptoms.

Side effects from the vaccine may be worse than the flu itself
Most frequent side effect from vaccination is irritation at the injection site. Also, after vaccination, the temperature may rise slightly. The risk that a person will be allergic to the vaccine is less than the risk of complications resulting from influenza infection. The flu vaccine is contraindicated for people with allergies to chicken eggs(they are used in the production of the vaccine), as well as people who have previously experienced an allergic reaction after a flu shot.

It makes sense to get vaccinated only before December
Vaccination against influenza can be carried out both before the outbreak of an epidemic and during it. Although best time for vaccination - this is September-October, better late than never.

What are the features of vaccination for people with HIV?
HIV is harmful immune system, along with this, the immune system's response to the vaccine may change. It should be noted that so-called “live vaccines” are strictly contraindicated for people with HIV; fortunately, the flu vaccine is not one of them, it contains only particles of the pathogen. In general, vaccination for HIV infection has the following features:

Vaccines temporarily increase the viral load. However, protection against influenza, viral hepatitis and other infections is well worth it. Do not take a viral load test one month after any vaccination.

If you have a low immune status, the vaccine may not work.

Should you even get a flu vaccine if you have HIV?

Influenza causes thousands and millions of deaths every year. However, it is a vaccine-preventable infection. According to most experts, HIV-positive people, as well as their HIV-negative family and friends, need annual vaccination. Although in the vast majority of cases the flu does not lead to severe and irreversible consequences, it is not an experience that one would like to repeat every year. Vaccination is not associated with significant health risks, with the exception of discomfort in the injection area and, rarely, a slight rise in temperature.

Has the flu vaccine been studied in people with HIV?

The effect of the influenza vaccine on HIV infection is better known than the effect of any other vaccine. According to the conclusion of scientists from the American Johns Hopkins Institute back in 1996: “the influenza vaccine does not have a significant effect on the level of HIV in patients with an immune status between 200 and 500.” And although scientists still have room for research in this area, so far all the data obtained indicates the safety of the flu vaccine for people living with HIV.

How can vaccination affect viral load?

The flu vaccine, like any other vaccine, may cause a slight increase in viral load. At one time, for this reason, people with HIV were not recommended to get vaccinated against influenza. However, it is now obvious that this increase is temporary, and the viral load soon returns to normal. This increase in viral load lasts no longer than 4-6 weeks. It is important to remember that the attending physician should be aware of all your vaccinations. Also, after getting a flu shot, you will not be able to take a viral load test for at least 2-4 weeks. Otherwise, you may get an overestimated analysis result.

Can you get a flu shot if you are taking therapy?

The only serious side effect of the HIV vaccine is a temporary increase in viral load. However, this does not apply to people who are successfully taking antiretroviral therapy and whose viral load is undetectable. Some scientists even think that such stimulation of HIV reproduction will even help therapy “finish off” the virus more effectively. Theoretically, it can be assumed that if therapy does not work well enough for a person, and his viral load is determined by the test system, then such vaccination can accelerate the development of resistance. However, there is no reliable data on this matter yet. So getting a flu shot while taking therapy is not contraindicated. In any case, if you decide to get vaccinated, be sure to discuss this issue with your doctor.

Is it possible to get a flu shot if you have low fever? immune status?

The lower a person’s immune status, the less likely it is that vaccination, including flu vaccination, will be able to protect him from infection. On the other hand, the likelihood that a person will become infected with influenza increases with a low immune status. Unfortunately, with a low immune status, the risk of side effects from the vaccine also increases - cold symptoms after vaccination and a slight increase in the viral load. But if there are no other contraindications, this is not a reason to skip vaccination.

What to do if you still have the flu?

Influenza is not an opportunistic infection, and in HIV-positive people it occurs in the same way as in everyone else. However, it remains a very serious disease. If you have flu symptoms, it is important to:

Maintain strict bed rest and get as much rest as possible

Drink as much fluid as possible

Avoid drinking alcohol and smoking

Take medications to relieve flu symptoms (preferably prescribed by a doctor)

Flu is viral infection, so no antibiotics will work on her. You should not experiment or use similar drugs, at best they are useless, at worst they can have side effects. Never give children or teenagers with flu symptoms aspirin or products containing it.

Vaccination is critical because HIV-infected children have a higher incidence of infections. Develop more often severe forms, high mortality. Currently, WHO recommends immunization of sick children at all stages of HIV infection with inactivated drugs: DTP, ADS and ADS-M toxoids; vaccines against hepatitis B, polio, influenza, and pneumococcal meningococcal infection. It is believed that HIV-infected children are able to mount both cellular and humoral immune responses, but antibody titers may be low or rapidly decline below protective levels. This indicates the advisability of serological monitoring and the administration of additional doses of the vaccine in case of a poor response to immunization.

WHO also recommends vaccination of HIV-infected people against measles, rubella, and mumps. In the literature, there is data both on the safety and effectiveness of vaccination of HIV-infected people with live vaccines, and information on the possible development of vaccine-associated diseases, a decrease in the level of CD4+ lymphocytes and an increase in viral load in the post-vaccination period. It is also noted that the frequency of specific post-vaccination reactions to measles vaccine in HIV-infected children and HIV-negative children does not differ, however, the percentage of seroconversion and antibody titers are lower in HIV-positive children, mainly due to children with more low level CD4+ lymphocytes. The reduced immune response has led to recommendations to administer a second dose as soon as possible (4 weeks) after the first dose, although, according to some authors, a second dose does not significantly improve vaccination results.

In Russia, there is still no unified methodological approach to immunization of children born to HIV-infected mothers. All children born from HIV-infected mothers after discharge from maternity hospital are observed by a children's clinic at their place of residence and/or the city (regional) Center for the Prevention and Control of AIDS, where they are routinely examined and advised. All medical documents child (including the preventive vaccination card - f. 065/u) are marked with the established code: R.75 (contact), B.23 (HIV infection). Medical workers are required to maintain medical confidentiality about the child’s HIV status.

All children born to HIV-infected mothers are vaccinated with all non-live vaccines before a final diagnosis is made. The issue of administering live vaccines is decided after the child’s diagnosis has been clarified. If HIV infection is excluded and the diagnosis of “Perinatal contact with HIV infection” is canceled, children are considered healthy and vaccinated according to the vaccination schedule. Children with an established diagnosis of HIV infection undergo an immunological study to exclude immunodeficiency before the administration of live vaccines. In the absence of immunodeficiency, live vaccines are administered in accordance with the vaccination schedule. If the child has an immunodeficiency, the administration of live vaccines is contraindicated. For children with stage 3 HIV infection at the end of full course vaccinations, it is advisable to determine the titers of specific antibodies.

Prevention of hepatitis B:

The first vaccination is carried out in the first 12 hours of life in maternity hospital(regardless of the presence of contacts with hepatitis B), with further immunization according to the 0-1-2-12 scheme (4 vaccinations at intervals of 1, 2 and 12 months after the first) If the child’s condition does not allow vaccination in the first 12 hours, then The vaccination is carried out immediately after the child’s condition has stabilized in the maternity hospital or in the hospital where the child has been transferred, or in a clinic at the place of residence. The vaccination schedule is maintained and vaccination is performed in combination with other routine vaccinations.

Prevention against tuberculosis:

Vaccinations are not carried out in the maternity hospital. Subsequent immunization is carried out BCG-M vaccine. The issue of vaccination is decided after the final diagnosis of the child at 18 months. Upon reaching 18 months:

• - Children with a canceled diagnosis of “Perinatal contact” and with a confirmed diagnosis of “HIV infection” without immunodeficiency are vaccinated with the BCG-M vaccine immediately after the diagnosis has been clarified with a preliminary Mantoux test;
• - Children with clinical manifestations HIV infection, administration of the BCG-M vaccine is contraindicated
• - The Mantoux test is performed on vaccinated children on a general basis once a year, on unvaccinated children once every 6 months
• - If a child diagnosed with “Perinatal contact with HIV” is in epidemically unfavorable conditions for tuberculosis (for example, family contact), the question of his immunization with BCG-M vaccine before 18 one month old should be decided individually together with a phthisiatrician, with a mandatory immunological examination before vaccination.

Prevention of polio:

Immunization inactivated vaccine preferred for all HIV-infected children and children with perinatal contact. If it is impossible to use an inactivated vaccine, these children are given a live polio vaccine, but only if they have no contact with an AIDS patient in the family or child's home. Children with clinical manifestations HIV infections Only inactivated polio vaccine (Imovax Polio, Tetracok) is used.

The inactivated vaccine is administered from 3 months according to the following scheme:

• - Tetracok vaccine at 3 months, 4.5 months, 6 months, 18 months with continued revaccination at 6 years and 14 years with the Imovax Polio vaccine;
• - Imovax Polio vaccine - at 3 months, 4.5 months, 6 months, 18 months, 6 and 14 years.

Prevention of whooping cough, diphtheria, tetanus:

All HIV-infected people, patients with AIDS and children with perinatal contact with HIV infection use the DPT or Tetrakok vaccine, which is administered from 3 months at a time corresponding to the national calendar of preventive vaccinations. The DTP vaccine is used simultaneously with the polio vaccine. For children with AIDS - only with inactivated vaccine (Imovax Polio), in different areas body, in different syringes (or use the Tetracok vaccine). If there are contraindications for use DTP vaccines and Tetrakok administer DPT (DT VAX) or ADS-M (IMOVAX DT ADULT) toxoids according to the administration schedule of these drugs. Children with AIDS with severe cellular immunodeficiency ( total number lymphocytes less than 1000 x 106/l or CD4+ lymphocytes less than 25% of the age norm), it is recommended to monitor the titers of anti-diphtheria antibodies 1-2 months after the completed course of immunization. If antibody titers are below the protective level, additional administration of ADS-M toxoid is carried out, followed by monitoring of antibody titers.

Prevention of measles, mumps and rubella:

Live viral domestic vaccines against measles, mumps, rubella are used, as well as foreign ones, mainly associated (Priorix, MMP II) or single preparations (Ruvax, Rudivax, Ervevax). Vaccination is carried out only after a final diagnosis has been established. Children with perinatal contact and HIV-infected without clinical manifestations are vaccinated in accordance with national calendar vaccinations. For children with clinical manifestations of HIV infection and signs of immunodeficiency, the administration of live vaccines against measles, rubella and mumps is contraindicated. In case of contact with measles, immunoglobulin prophylaxis is carried out.

Additional vaccination:

Children with HIV infection should also be recommended additional immunization against infections: Haemophilus influenzae, pneumococcal, meningococcal, influenza, hepatitis A in accordance with the instructions for use of vaccines. When immunizing children, everything is taken into account concomitant diseases. Selective immunization is indicated for children with perinatal contact, HIV-infected, and AIDS patients.

Flu prevention:

killed, inactivated, split or subunit influenza vaccine, starting from 6 months of life, annually (Grippol, Fluarix, Agrippal, Vaxigripp, Begrivak, Influvac)

Prevention of pneumococcal infection:

Vaccination with a foreign polysaccharide vaccine from 2 years of age according to the schedule provided for in the instructions for the drug (when registering conjugate vaccines in the country from 3 months). Immunization schedule: single vaccination, revaccination no earlier than after 3 years, also once.

Prevention of meningococcal infection:

Vaccinated with polysaccharide vaccines - from one year of age with an epidemic rise in the incidence of meningococci of groups A and C and from 3 months of age to contacts from family or household foci (when outbreaks of meningococci A and/or C are registered) Immunization scheme: single vaccination (children under 2- khlet - twice with an interval of 3 months).

Prevention of hepatitis A:

Vaccinated with a killed vaccine (Havrix - from 1 year, Avaxim, VACTA, HepAinVac - from 2 years) especially for children specialized institutions with 24-hour stay. Unvaccinated children who are exposed to hepatitis A are given immunoglobulin. Vaccination schedule: two injections of the drug with an interval of 6-12 months; persons with immune disorders and those on hemodialysis, the vaccine is administered twice with an interval of 1 month and revaccination 6-12 months after the second dose once.

The data from our study once again confirm that reactions to vaccines should be considered as a natural and completely adequate response to the introduction of a foreign antigen, reflecting the degree of sensitivity of each individual to a specific pathogen.

There is no alternative to vaccines. There is no need to be fooled into thinking that some miracle cure will protect your child better. All possible complications do not exceed the risk to which you expose your child by refusing vaccination.

• 1. An analytical review of literature sources and regulatory documentation on childhood immunization was carried out.
• 2. A questionnaire has been developed to determine parents’ awareness and attitude towards vaccinations.
• 3. A survey was conducted of parents of children applying to the FAP Art. Grigorievskaya, Krasnodar region.
• 4. A selection and systematization of post-vaccination reactions, that is, manifestations of the usual vaccination process, and complications was carried out based on materials from the FAP Art. Grigorievskaya Krasnodar Territory for 2 years
• 5. The results of the parent survey were analyzed and the information aspect of the paramedic’s activities was planned.