Vaccination is carried out for prevention. Organization and implementation of preventive vaccinations

03.03.2020 -

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Today vaccinations have already firmly entered our lives as a highly effective means of preventing dangerous infectious diseases, which has Negative consequences in the form of complications, or even death. In modern medical practice, they are done either with the aim of creating immunity to dangerous infections, or to treat an infected person at an early stage. Accordingly, all vaccinations are usually divided into preventive and therapeutic. Basically, a person is faced with preventive vaccinations, which are given in childhood, and then re-immunization is carried out if necessary. An example of a therapeutic vaccinations is the administration of antitetanus serum, etc.

What are preventive vaccinations?

The vaccine is a weakened whole microbe - pathogens, parts of the shells or genetic material of pathogenic microorganisms, or their toxins. These components of the vaccine cause a specific immune reaction, during which antibodies are produced against the causative agent of the infectious disease. Subsequently, it is these antibodies that provide protection against infection.

Today, all preventive vaccinations are classified into:
1. Planned.
2. Conducted according to epidemiological indications.

Among the scheduled vaccinations, there are those that are mandatory for everyone - they are included in the national calendar (BCG, MMR, DPT, against polio), and there is a category of vaccines that are administered only to people at risk of contracting infections due to the specifics of their work (for example, against typhus, tularemia , brucellosis, rabies, plague, etc.). All scheduled vaccinations are carefully worked out, the timing of their administration, age and time are established. There are developed schemes for the administration of vaccine preparations, combination possibilities and the sequence of immunization, which is reflected in regulations and guidelines, as well as in vaccination calendars.

Preventive vaccination of children

For children, preventive vaccinations are necessary to protect vulnerable children from dangerous infectious diseases that may result in fatal even when treated with modern high-quality drugs. Full list preventive vaccinations for children is developed and approved by the Ministry of Health of Russia, and then for ease of use is drawn up in the form of a national calendar.

In addition to those indicated in the national calendar, there are a number of preventive vaccines that are recommended for administration to children. The recommendation for vaccination is given by the child's attending physician based on an analysis of the child's health status. Some regions also introduce their own vaccinations, which are necessary because the epidemiological situation for these infections is unfavorable and there is a risk of an outbreak.

Preventive vaccinations for children - video

The importance of preventive vaccinations

Memory cells can remain in the human body for varying periods of time - from several months to many years. Memory cells that live only a few months are short-lived, but vaccination is necessary to form a different type of memory cell - long-lived. Each such cell is formed only in response to a specific pathogenic microorganism, that is, a cell formed against rubella will not be able to provide immunity to tetanus.

For the formation of any memory cell - long- or short-lived - a certain period of time is required - from several hours to whole week. When the causative agent of a disease enters the human body for the first time, all manifestations of the infection are caused precisely by the activity of this microbe. During this period, the cells of the immune system “get acquainted” with the pathogenic microbe, after which B lymphocytes are activated, which begin to produce antibodies that have the ability to kill the pathogenic microorganism. Each microbe requires its own special antibodies.

Recovery and relief of the symptoms of infection begins only from the moment when antibodies are developed and the destruction of the pathogenic microorganism begins. After the microbe is destroyed, some of the antibodies are destroyed, and some become short-lived memory cells. B lymphocytes that produced antibodies go into the tissue and become those very memory cells. Subsequently, when the same pathogenic microbe enters the body, the memory cells available against it are immediately mobilized, producing antibodies that quickly and effectively destroy the infectious agent. Since the pathogen is quickly destroyed, an infectious disease does not develop.

It makes no sense to vaccinate against infections that the human body can cope with. But if the infection is dangerous, the mortality rate of sick people is very high, it is necessary to vaccinate. Vaccinations are simply a carrier of the antigen of a microbe - a pathogen, for which memory cells are produced. When contracting a dangerous infection, there are two possible outcomes - recovery with the formation of immunity, or death. Vaccination ensures the formation of this immunity without mortal risk and the need to endure severe course infections with extremely painful symptoms.

It is quite natural that in response to vaccination, the process of formation of memory cells during activation of the immune system is accompanied by a number of reactions. The most common reactions are at the injection site, and some are general (for example, fever for several days, weakness, malaise, etc.).

List of preventive vaccinations

So, today in Russia the list of preventive vaccinations includes the following vaccines, which are given to children and adults:

against hepatitis B;
against tuberculosis - only for children;
... tetanus;
... Haemophilus influenzae;
...poliomyelitis;
... rubella;
...mumps (mumps);
... meningococcal infection;
... tularemia;
... tetanus;
... plague;
... brucellosis;
... anthrax;
...rabies;
... tick-borne encephalitis;
... Q fever;
... yellow fever;
... cholera;
... typhus;
... hepatitis A;
... shigellosis.

This list includes mandatory vaccinations that are given to all people, and those performed for epidemiological reasons. Epidemiological indications can be different - for example, living or temporarily staying in a hotbed of an outbreak of a dangerous infection, traveling to regions with an unfavorable situation, or working with dangerous microbes - pathogens or with livestock that are carriers of a number of pathologies.

National calendar of preventive vaccinations (2013, 2012, 2011)

The calendar of preventive vaccinations is compiled and approved based on the significance of the infections against which vaccination is carried out, as well as the availability of drugs. The calendar may be revised if any circumstances change - for example, the emergence of new vaccines that have different rules for use, or the risk of an outbreak of infection, which requires urgent and urgent immunization.

In Russia, a vaccination calendar for children and adults has been approved, valid throughout the country. This calendar has not changed in recent years, so for 2011, 2012 and 2013 it is the same. The vaccinations included in this calendar are performed for all people. Vaccines from the national calendar are shown in the table:

Vaccine	Age at which vaccination is given
Against hepatitis B	The first day after birth, at 1 month, at 2 months, at six months, at a year, then every 5 to 7 years
Against tuberculosis (BCG)	Children 3–7 days after birth, at 7 years old, at 14 years old
Against diphtheria, whooping cough and tetanus (DPT)	At 3 months, at 4 - 5 months, at six months, at one and a half years, at 6 - 7 years, at 14 years, at 18 years
Against Haemophilus influenzae	At 3 months, at 4 - 5 months, at six months, at one and a half years
Against polio	At 3 months, at 4 - 5 months, at six months, at one and a half years, at 20 months, at 14 years
Against measles, rubella and mumps	At 1 year, at 6 years
Against rubella	From the age of 11 every five years until the age of 18 for boys and until the age of 25 for girls
Against measles	At 15 – 17 years old, then every five years until age 35
Against the flu	Children from the age of 6 months are vaccinated every year

These vaccinations are given to all children within the specified time frame. If vaccination has not been carried out, the dates are postponed taking into account the child’s condition, but the scheme of procedures remains the same.

Regional calendar of preventive vaccinations

The regional calendar of preventive vaccinations is developed and approved by local authorities of the Ministry of Health, taking into account specific circumstances and the epidemiological situation. The regional calendar of preventive vaccinations must include all vaccines from the national one, and add the necessary ones.

An individual program of preventive vaccinations for a child is developed and reflected in the following medical documentation:
1. Card of preventive vaccinations - form 063/у.
2. Child development history - form 112/у.
3. Child's medical record - form 026/у.
4. Insert for an outpatient medical record - form 025/u (for adolescents).

These documents are issued for each child living in the area, attending kindergarten, school, college or college.

The preventive vaccination program is separately drawn up for adults. This work is carried out by specialists - doctors from clinics. Preventive vaccinations for adults cover everyone who is eligible for vaccination, regardless of whether the person works. Adults are included in the immunization plan based on data on vaccinations performed and their expiration date.

Carrying out preventive vaccinations

Preventive vaccinations can be carried out in a state medical institution (polyclinic), or in specialized immunization centers for the population, or in private clinics licensed to carry out this type medical manipulations. Preventive vaccinations are administered directly in the vaccination room, which must meet certain requirements and standards.

In institutions where the BCG vaccine is administered, it is necessary to have two vaccination rooms. One of them is designed exclusively for working with the BCG vaccine, and the other carries out all other vaccinations.

The vaccination room must have:

sterile instruments and materials;
disposable syringes and needles for intradermal and intramuscular injections;
forceps (tweezers);
containers in which used tools and waste are collected.

Also, the office must have a sufficient number of tables, each of which is intended for administering only one type of vaccine. The table must be marked, syringes, needles and sterile materials are prepared on it.

Any sterile material must be taken with sterile forceps, which are stored in containers with chloramine or chlorhexidine. The solution is changed daily, and the forceps and containers themselves are sterilized every day.

All used syringes, needles, ampoules, drug residues, cotton wool or tampons are disposed of in a container with a disinfectant solution.

Organization and procedure for vaccination

The organization of preventive vaccinations and the procedure for their implementation were developed and prescribed in the Methodological Instructions MU 3.3.1889-04, which were approved by the Chief State Sanitary Doctor of the Russian Federation on March 4, 2004. These rules are still in effect today.

What kind of preventive vaccinations are given is prescribed in the national and regional calendars. To carry out vaccination, all institutions use only registered drugs of domestic or imported production, approved for use.

All preventive vaccinations are organized and carried out in accordance with the following requirements and instructions:

Any vaccination is carried out only in a specialized institution accredited to perform immunizations (vaccination rooms in clinics, kindergartens, schools, colleges, colleges, health centers, first aid stations).
If necessary, special teams are formed and procedures are carried out at home.
Preventive vaccines are given exclusively as prescribed by a doctor or paramedic.
Immediately before the planned vaccination, data on the condition of the child or adult are carefully clarified, on the basis of which permission for manipulation is given.
Before planned immunization, a child or adult is examined by a doctor to determine the presence of contraindications, allergies or strong reactions to previously administered drugs.
Before the injection, the temperature is measured.
Before the planned vaccination, the necessary tests are taken.
The vaccine is injected only with disposable syringes and needles.
Vaccinations can only be given by a medical specialist who is proficient in injection techniques, as well as emergency care skills.
The vaccination office must have a kit for providing emergency care.
All vaccines must be stored according to rules and regulations.
The vaccination office must have all the documentation.
Under no circumstances should vaccination be carried out in a treatment room or dressing room.
The vaccination room is cleaned twice a day using disinfectant solutions.

Technique of preventive vaccinations

Preventive vaccinations must be carried out following a certain technique. General rules and the methodology for administering preventive vaccines are determined by regulatory documents. So, the sequence of actions of a medical worker when administering a vaccine must correspond next plan:

1. The ampoule with the vaccine preparation is taken out of the refrigerator and its appearance is examined. It is necessary to record the integrity of the ampoule, the markings on the bottle, as well as the quality of the liquid inside. Vaccine preparations should not contain flakes, pieces, turbidity, etc.
2. The ampoules are opened using sterile gloves in the cold.
3. The vaccine is administered exclusively with a disposable syringe and needle.
4. If several vaccines are administered at a time, it is necessary to inject each drug into different places and draw the vaccine into a separate syringe.
5. The injection site is wiped with alcohol or other antiseptics.
6. The injection site of the BCG vaccine or Mantoux test is treated with ether.
7. The vaccine is administered to the patient in a sitting or lying position.
8. After administration of the drug, the patient remains under observation for half an hour.

Journal of Preventive Vaccination

The medical worker must enter all vaccinations performed in a special logbook. If you lose your individual card or move to another place, all data can be restored by contacting the medical institution where the vaccination was carried out, where they will make an extract from such logs stored in the archives. Also, based on the entries in the journal, preventive immunization plans are drawn up, in which the names of the people to be vaccinated are entered.

The preventive vaccination log is a standard form of medical documentation 064/u, which reflects the following data:

last name, first name and patronymic of the person being vaccinated;
patient's address;
year of birth;
place of study or work;
name of the vaccine product;
primary vaccination or revaccination;
method of vaccine administration (subcutaneous, intramuscular, oral, etc.).

In addition, information about vaccination is recorded for each patient, which takes into account the following data:
1. Date of administration, drug series and dose.
2. All reactions that were observed after vaccination.
3. Any atypical manifestations or doubtful points.

The preventive vaccination logbook is stitched and the pages are numbered. The magazine form is usually ordered from a printing house, which prints them according to a template approved by the Ministry of Health.

Vaccination card, form 063

The preventive vaccination card, form 063/u, is a medical document that contains information about all vaccinations and biological tests performed. Often this document is simply called a “vaccination sheet”. The document must record the date of vaccination, numbers and series of the drug.

The vaccination card is filled out by medical specialists at the clinic, at the first aid station, at school or kindergarten. Moreover, when carrying out immunization in a school or kindergarten, other documentation can be used, from which information about vaccinations is transferred to the vaccination card in form 063/u. Vaccination certificate form 063/u can be issued to the child’s parents if it is necessary to provide information about the child’s vaccinations to any authorities (for example, visa department, hospitals, etc.). One copy of the vaccination certificate is stored in the archives of the medical institution for 5 years.

The vaccination card is printed and filled out individually for each child.

Certificate

The certificate of preventive vaccinations has been entered into the register of state documents, and has the form 156/u - 93. Today, a vaccination certificate is a medical document that is maintained throughout a person’s life. A certificate of preventive vaccinations is necessary for people traveling abroad, working in hazardous conditions or the food industry, as well as athletes, and for routine medical examinations. Today in Russia there is no common federal vaccination base, so it is almost impossible to restore a lost certificate.

A certificate of preventive vaccinations is issued to a person in maternity hospital, clinic, medical unit or health center. Each vaccination performed is included in the vaccination certificate, which displays the date, the name of the clinic, the signature of the medical worker who performed the manipulation, and the seal of the health care institution. The vaccination certificate must not contain any blots or corrections. Any corrections or blank fields will result in the certificate being invalidated. The document does not include contraindications or reasons for lack of vaccination.

A vaccination certificate is required for admission to kindergarten, school, work, the army, when visiting a doctor, and when undergoing treatment in a hospital. The certificate of preventive vaccinations must be kept by the owner until death.

Refusal of preventive vaccinations, sample form

Today, every adult, or guardian representative of a minor, has the right to refuse vaccination. The basis for this is provided by the Law of the Ministry of Health of the Russian Federation No. 157 F3 of September 17, 1998, Article 5. Regarding vaccinations for children, a parent can refuse them on the basis of the same law, only Article 11, which states that the child is vaccinated only with the consent of his legal representatives, that is, parents, guardians, etc.

Refusal from vaccinations must be submitted in writing to the head of the treatment and prevention, preschool child care institution or school. An approximate form of refusal of vaccinations, which can be used as a form and sample, is presented below:

Head physician of clinic no./ or
To the director of school no./ or
To the head of kindergarten No.
_______district, __________city (village, hamlet)
From __________name of the applicant_____________________

Statement
I, ____________full name, passport details______________, refuse to do all preventive vaccinations (or indicate which specific vaccinations you refuse to do) to my child _______full name of the child, date of birth_________, registered at clinic No. (or attending kindergarten No., or school No.). Legal basis– legislation of the Russian Federation, namely “Fundamentals of the legislation of the Russian Federation on the protection of the health of citizens” dated July 22, 1993 No. 5487-1, articles 32, 33 and 34 and “On immunoprophylaxis of infectious diseases” dated September 17, 1998 No. 57 - Federal Law, Articles 5 and 11.
Number
Signature with transcript

What does the lack of preventive vaccination entail?

The lack of preventive vaccinations entails the following consequences, according to the law of the Ministry of Health of the Russian Federation No. 157 F3 dated September 17, 1998, article 5:
1. A ban for citizens to travel to countries whose stay, in accordance with international health regulations or international treaties of the Russian Federation, requires specific preventive vaccinations.
2. Temporary refusal to admit citizens to educational and health institutions in the event of widespread infectious diseases or the threat of epidemics.
3. Refusal to hire citizens for work or removal of citizens from work, the performance of which is related to high risk diseases of infectious diseases. The list of works, the performance of which is associated with a high risk of contracting infectious diseases, requires mandatory preventive vaccinations, is established by the federal executive body authorized by the Government of the Russian Federation.

As can be seen from the law, a child or an adult may not be allowed to visit a child care facility, and an employee may not be allowed to enter the workplace if there are no vaccinations and the epidemiological situation is unfavorable. In other words, when Rospotrebnadzor announces the danger of any epidemic, or the transition to quarantine, unvaccinated children and adults are not allowed into groups. During the rest of the year, children and adults can work, study and attend kindergartens without restrictions.

Order on preventive vaccinations

Today, on the territory of Russia, Order No. 51n dated January 31, 2011 “On approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations according to epidemic indications"It is in accordance with this order that the current national vaccination calendar was approved.

Preventive vaccination in kindergarten

Vaccinations in kindergarten are carried out only with the consent of the parents or other legal representatives of the child. If you wish to refuse vaccinations for your child, you must register your refusal in writing with the office of the institution and notify the nurse.

Before use, you should consult a specialist.

In the fight against infectious diseases, specific prevention methods are becoming increasingly important.

From this article you will learn what vaccination of children is, what are the basic rules for vaccination and much more. useful information about vaccination in Russia.

History of vaccination

Protection against infection through immunization has been known for hundreds of years. Thus, since ancient times, the Chinese have sucked dried and crushed crusts of smallpox patients into their noses. However, this method, called variolation, was associated with a great risk to life and health. In the 18th century, Edward Jenner first began vaccinating people to protect them from smallpox. He rubbed a drop of pus containing the harmless cowpox virus into the scarified (incised) skin. E. Jenner called the vaccination method vaccination (Latin vaccinatio; from vacca - cow), and the material taken from cow smallpox pustule - vaccine.

100 years later, Louis Pasteur developed the scientific basis for the creation and use of vaccines from living microbes. He showed that during the natural aging of crops, the cultivation of pathogens of infectious diseases in unusual media, and the influence of unfavorable factors on them environment, as well as when microbes are passaged through the body of unsusceptible animals, a sharp weakening (attenuation) of virulence is possible without a significant reduction in antigenicity.

Domestic researchers I. I. Mechnikov, P. Erlikh, P. F. Zdrodovsky, A. M. Bezredka, A. A. Smorodintsev and others made a great contribution to the development of vaccine prevention.

Purpose of vaccination- creation of specific immunity to infectious disease. Immunization must be harmless and effective.

Active post-vaccination immunity lasts for 5-10 years in those vaccinated against measles, diphtheria, tetanus, polio, or for several months in those vaccinated against influenza and typhoid fever. However, with timely revaccination, immunity can last throughout life.

Children born prematurely or with low body weight respond to immunization to the same extent as children born at term of the same age.

Immunology of the vaccine process

The immune response to the vaccine involves macrophages, T-lymphocytes (effector-cytotoxic, regulatory-helper, memory T-cells), B-lymphocytes (memory B-cells), antibodies produced by plasma cells (IgM, IgG, IgA), and also cytokines (monokines, lymphokines).

After vaccine administration, macrophages capture antigenic material, break it down intracellularly, and present antigen fragments on their surface in an immunogenic form (epitopes). T lymphocytes recognize the antigens presented by the macrophage and activate B lymphocytes, which turn into plasma cells.

The formation of antibodies in response to the primary introduction of an antigen is characterized by three periods:

The latent period, or “lag phase,” is the time interval between the introduction of an antigen (vaccine) into the body and the appearance of antibodies in the blood. Its duration ranges from several days to 2 weeks, depending on the type, dose, method of antigen administration, and the characteristics of the child’s immune system.

The growth period is characterized by a rapid increase in antibodies in the blood. The duration of this period can range from 4 days to 4 weeks: approximately 3 weeks in response to tetanus and diphtheria toxoids, 2 weeks in response to pertussis vaccine. After the administration of measles and mumps vaccines, specific antibodies increase quickly, which allows the use of active immunization for emergency prevention of measles and mumps in foci of infection (in the first 2-3 days from the moment of contact).

A period of decline occurs after the maximum level of antibodies in the blood is reached, and their number decreases initially quickly and then slowly over several years.

An essential component of the primary immune response is the production of immunoglobulin class M (IgM), while in the secondary immune response, antibodies are represented mainly by class immunoglobulin G (IgG). Repeated administration of the antigen leads to a faster and more intense immune response: the “lag phase” is absent or becomes shorter, the maximum level of antibodies is reached more quickly, and the persistence of antibodies is prolonged.

The optimal time interval between vaccine administrations is 1-2 months. Reducing the intervals contributes to the neutralization of antigens by preceding antibodies, lengthening them does not cause a decrease in the effectiveness of immunization, but leads to an increase in the non-immune layer of the population.

Children with an unfavorable allergy history may respond to the administration of immune drugs by developing allergic reactions. The pertussis component of the DPT vaccine, components of culture media and cell cultures on which vaccine strains of viruses are grown, as well as antibiotics used in the production of vaccines have an allergenic effect. However, the administration of the DTP vaccine, although it may cause short-term increase the level of total IgE in the blood does not, as a rule, lead to a persistent increase. Use of toxoids in children with allergic diseases usually not accompanied by an increase in specific antibodies of the Ig E class to food, household and pollen allergens.

Types and characteristics of vaccines

Preparations used for immunization

Vaccines are preparations obtained from weakened, killed microorganisms or their metabolic products and used for active immunization for the purpose of specific prevention of infections.

Live vaccines are produced using live attenuated microorganisms with persistent avirulence. Vaccine strains multiply in the human body and induce cellular, humoral and local immunity. Live vaccines create highly intense and long-lasting immunity. The following live vaccines are used: BCG, oral polio Sabin, measles, mumps, rubella; vaccines against plague, tularemia, brucellosis, anthrax, KU fever. Live vaccines are contraindicated for immunization of children with immunodeficiencies, patients receiving glucocorticoids, immunosuppressants, radiotherapy, as well as patients with lymphomas and leukemia; they are contraindicated in pregnant women due to the risk of fetal damage.

Inactivated (killed) vaccines are obtained by neutralizing bacteria and viruses using chemical or physical action. Killed vaccines (whooping cough, rabies, leptospirosis, Salka polio, etc.) create unstable humoral immunity; to achieve a protective level of specific antibodies, they must be reintroduction.

Anatoxins are made from exotoxins of pathogens by treating them with a 0.3-0.4% formaldehyde solution at a temperature of +38-40 ° C for 3-4 weeks. Toxoids are adsorbed on aluminum hydroxide; they are easily dosed and combined with other vaccine preparations. When toxoids are administered, antitoxic immunity is developed. Diphtheria, tetanus, staphylococcal toxoids, as well as toxoids against botulism and gas gangrene are used.

Chemical (subcellular) vaccines contain antigenic fractions of killed microorganisms. These include: polyvalent polysaccharide pneumococcal vaccine, polysaccharide meningococcal A and A+C vaccines, TABTe (against typhoid fever, paratyphoid A and B, tetanus).

Recombinant vaccines (against viral hepatitis B, influenza, etc.) are created using the latest genetic engineering technologies. Inactivated vaccines, toxoids, chemical and recombinant vaccines contain an adjuvant (phosphate or aluminum hydroxide) that enhances the immune response.

There are mono-vaccines (contain one antigen), associated (have several antigens) and polyvalent vaccines (consist of different strains of the same type of microorganism). An example of an associated (combined) vaccine is the adsorbed pertussis-diphtheria-tetanus vaccine (DTP), containing killed pertussis bacteria, diphtheria and tetanus toxoids; polyvalent - Sabin's oral noliomyelitis vaccine, consisting of attenuated strains of poliovirus types 1, 2, 3.

Reactions to vaccines

The body's response to the vaccine

The introduction of a vaccine into a child’s body is accompanied by the development of the vaccination process, which, as a rule, is asymptomatic. It is possible that normal (usual) reactions (general and local) may occur after vaccination.

Assessment of the intensity of general reactions

To assess the intensity of general reactions, the following criteria are used:

weak reaction - increase in body temperature to 37.5 ° C in the absence of symptoms of intoxication;
medium strength - body temperature rises within 37.6-38.5 ° C with moderate symptoms of intoxication;
a strong reaction - an increase in temperature above 38.5 ° C with pronounced but short-term symptoms of intoxication.

Assessment of the intensity of local reactions

To assess the intensity of local reactions, the following criteria are used:

weak reaction - hyperemia at the injection site or hyperemia with infiltrate up to 2.5 cm in diameter;
medium strength - infiltrate with a diameter of 2.6-5.0 cm with or without lymphangitis;
severe reaction - infiltrate 5.0-8.0 cm in diameter; the presence of lymphangitis and lymphadenitis.

Usual general and local reactions after preventive vaccinations occur only in a portion of those vaccinated. In the instructions for use biological drugs the permissible degree of their reactogenicity has been determined. If the frequency of pronounced (strong) reactions among vaccinated people exceeds the percentage allowed by the instructions, further use of this series of vaccines is not allowed. For example, vaccinations against measles are stopped if among those vaccinated there are more than 4% of people with a pronounced general reaction. The DTP vaccine is allowed for use if the number of strong reactions does not exceed 1%.

In some cases, after vaccination, the development of pathological reactions (complications) - general and local - is noted.

Vaccination rules

Before vaccination, the doctor analyzes the epidemiological history (information about contacts with infectious patients), carefully examines the child and measures body temperature. Laboratory examination and specialist consultations are carried out according to indications.

Children who have not been vaccinated due to temporary contraindications are vaccinated according to an individual schedule in accordance with the recommendations of relevant specialists and current instructions for the use of drugs.

The medical documentation records the doctor (paramedic) authorizing the vaccination with a specific drug.

How and where are children vaccinated?

All preventive vaccinations are done only with disposable syringes. Vaccinations should be given by health care workers who have undergone appropriate training and are also trained in how to provide emergency care for complications after vaccinations. Emergency medical aid and anti-shock therapy kits must be available in the premises where vaccinations are carried out.

Vaccinations, especially live vaccines, are recommended to be carried out in the morning in a sitting or lying position (to prevent falls when fainting states). Within 0.5-1 hour after vaccination, medical supervision of the child is necessary due to the possible development of immediate allergic reactions. Then, for 3 days, the child must be observed by a nurse at home (in an organized group). After vaccination with live vaccines, the child is additionally examined by a nurse on the 5-6th and 10-11th days, since reactions occur during these periods.

Parents must be warned about possible reactions after administration of the vaccine, recommend a hyposensitizing diet and protective regimen.

Measles. Vaccination - at the age of 12 months. Revaccination - at the age of 6 years. The interval between administration of the polio-pertussis-diphtheria-tetanus vaccine and the measles vaccine should be at least two months. Vaccination and revaccination are carried out once.

Mumps. Vaccination - at the age of 12 months. In the absence of a combined vaccine (measles, mumps, rubella), the vaccination is carried out together with the measles vaccination with different syringes in different parts of the body.

Rubella. Vaccination - at the age of 12 months. Revaccination - at the age of 15-16 years (girls). If a combined vaccine (measles, mumps, rubella) is available, vaccination is carried out at 12 months. Revaccination is carried out with a single vaccine at the age of 15-16 years, only for girls.

Hepatitis B. Vaccination - at the age of 1,2, 7 months. Newborns are subject to vaccination against viral hepatitis B, primarily children from mothers who are carriers of the hepatitis B virus. Vaccinations are carried out three times with an interval of one month after the first vaccination and 5-6 months after the second. The anti-hepatitis vaccine is prescribed in a dose of 0.5 ml for newborns, as well as older children, adolescents and persons under the age of 20 years, and in a dose of 1 ml for those over 20 years of age. Vaccination against hepatitis B does not depend on the timing of other vaccinations and is carried out both simultaneously and after the administration of vaccines and toxoids, which are included in the vaccination calendar.

Calendar of preventive vaccinations in Russia

In each country, routine immunization is carried out on time and according to the national vaccination calendar.

Calendar of preventive vaccinations in Russia in accordance with the order of the Ministry of Health of the Russian Federation No. 375 of 12/08/97.

Preventive vaccinations must be carried out strictly within the time limits indicated in the calendar. If the vaccination schedule is violated, it is permissible to simultaneously administer other vaccines with separate syringes to different parts of the body; for subsequent vaccinations, the minimum interval is 4 weeks.

To avoid contamination, it is unacceptable to combine tuberculosis vaccination with other parenteral procedures on the same day.

Since 1997, vaccination against viral hepatitis B has been introduced in Russia.

Contraindications to vaccination

There are situations when a child should not be vaccinated; in these cases, the doctor gives an exemption from vaccination. All vaccinations are carried out in strict accordance with the instructions. It is strictly forbidden to vaccinate at home. Parents are informed in advance about the timing of vaccinations for children in preschool and school institutions.

Contraindications to the administration of vaccines

Contraindications to vaccination are divided into permanent (absolute) and temporary (relative).

Absolute contraindications are rare.

Temporary contraindications. Routine vaccination is postponed until the end of acute manifestations of the disease and exacerbations of chronic diseases. Usually vaccination is carried out after 2-4 weeks. after recovery. After mild forms of ARVI, AII, children can be vaccinated immediately after body temperature normalizes.

False contraindications for preventive vaccinations - conditions that are not contraindications for vaccination. History of prematurity, sepsis, hyaline membrane disease, hemolytic disease of the newborn, complications after vaccination in the family, allergies or epilepsy in relatives, as well as conditions such as perinatal encephalopathy, stable neurological conditions, anemia, enlarged thymic shadow, allergies, asthma , eczema, birth defects, dysbacteriosis, supportive drug therapy, and local use of steroids are not a contraindication to vaccination, but are unreasonably used by pediatricians to issue medical exemptions.

Vaccination of children at risk

Children with various aggravating factors in their medical history are classified as “risk groups” for the possibility of developing post-vaccination complications. Before vaccination, the necessary additional examination is carried out and an individual immunization schedule is drawn up. Vaccination is carried out using gentle methods with preliminary preparation. There are four risk groups:

The risk group includes children with suspected damage to the central nervous system or with identified damage to the central nervous system. There are four subgroups:

children with probable perinatal damage to the central nervous system;
children with established perinatal damage to the central nervous system;
children who have had various shapes acute neuroinfections, children cerebral paralysis, organic diseases of the nervous system;
children with a history of seizures of various nature or paroxysmal conditions (respiratory-affective seizures, fainting, etc.)

risk group - children prone to allergic reactions, with a history of allergic diseases of the skin or respiratory tract (allergic rashes, allergic dermatoses, Quincke's edema, various forms of respiratory allergosis).

risk group - children who repeatedly suffer from infections of the upper and lower respiratory tract, otitis, with chronic diseases(kidneys, liver, heart, etc.) with prolonged low-grade fever, stopping or insufficient weight gain, transient changes in urine.

risk group - children with local and general pathological reactions to vaccinations (history of post-vaccination complications).

How are children with pathologies vaccinated?

Children with neurological diseases are vaccinated during the period of extinction neurological symptoms or during a period of stable remission. For patients with progressive diseases of the nervous system and a history of afebrile seizures, ADS is administered instead of DPT.

For children with a history of seizures, vaccinations are carried out using anticonvulsants (Seduxen, Relanium, Sibazon), which are prescribed 5-7 days before and 5-7 days after the administration of toxoids and from 1 to 14 days after measles and mumps vaccines. The administration of antipyretics is indicated within 1-3 days after vaccination with toxoids and 5-7 days when using live vaccines.

Vaccination of children with hypertensive-hydrocephalic syndrome, hydrocephalus is carried out in the absence of disease progression with dehydration therapy (diacarb, glyceryl, etc.).

Vaccination of children with allergic diseases is carried out during a period of stable remission. Children suffering from hay fever are not vaccinated during the entire flowering period of the plants. It is possible to lengthen the intervals between vaccinations and separate administration of vaccines. Strict adherence to a hypoallergenic diet is necessary for 1-2 weeks after vaccination. For vaccination of children at risk, they are prescribed antihistamines(Claritin, Tavegil, Suprastin).

Vaccination of children at risk for prevention

Children who often suffer from acute respiratory diseases(more than 6 times a year), it is advisable to vaccinate during the period of lowest prevalence of ARVI. In order to stimulate antibody formation, dibazol, methyluracil, and multivitamins are prescribed within 10 days after vaccination. For 2 weeks before and after vaccination, it is recommended to prescribe biogenic stimulants (Eleutherococcus extract, tincture of lure, ginseng). For the prevention of acute respiratory infections viral infections In children at risk in the post-vaccination period, intranasal interferon is indicated.

Today, vaccinations have become firmly established in our lives as a highly effective means of preventing dangerous infectious diseases that have negative consequences in the form of complications or even death. In modern medical practice, vaccination is done either with the aim of creating immunity to dangerous infections, or to treat an infected person at an early stage. Accordingly, all vaccinations are usually divided into preventive and therapeutic. Basically, a person is faced with preventive vaccinations, which are given in childhood, and then re-immunization is carried out if necessary. An example of therapeutic vaccination is the administration of antitetanus serum and the like.

What are preventive vaccinations

Preventive vaccinations are a method of immunizing a person against certain infectious diseases, during which various particles are introduced into the body that can lead to the development of stable immunity to pathology. All preventive vaccinations involve the administration of a vaccine - an immunobiological drug. A vaccine is a weakened whole microbial pathogen, parts of the membranes or genetic material of pathogenic microorganisms or their toxins. These components of the vaccine cause a specific immune reaction, during which antibodies are produced against the causative agent of the infectious disease. Subsequently, it is these antibodies that provide protection against infection.

Today, all preventive vaccinations are divided into:
- planned;
- carried out according to epidemiological indications.

Routine vaccinations are given to children and adults at a certain time and at a specific age, regardless of whether an epidemic focus of infection has been identified in a given region or not. And according to epidemiological indications, vaccination is given to people located in a region in which there is a danger of an outbreak of an infectious disease (for example, anthrax, plague, cholera, etc.). Among the scheduled vaccinations, there are mandatory ones for everyone; they are included in the national calendar (BCG, MMR, DTP, against polio). And there is a category of vaccines that are administered only to people at risk of contracting infections due to the specific nature of their work (for example, against typhoid, tularemia, brucellosis, rabies, plague, etc.).

All scheduled vaccinations are carefully worked out, the timing of their administration, age and time are established. There are schedules for the administration of vaccine preparations, combination possibilities and the sequence of immunization, which is reflected in regulations and guidelines, as well as in vaccination calendars.

Preventive vaccination of children

For children, preventive vaccinations are necessary to protect them from infectious diseases, which can be fatal even when treated with modern high-quality drugs. A list of preventive vaccinations for children is developed and approved by the Russian Ministry of Health, and then, for ease of use, is drawn up in the form of a national calendar. In addition to those indicated in the national calendar, there are a number of preventive vaccines that are recommended for administration to children. A referral for vaccination is given by the child’s attending physician based on an analysis of the child’s health status. Some regions also use their own vaccinations, which are necessary because the epidemiological situation for infections is unfavorable and there is a risk of a pandemic outbreak.

The importance of preventive vaccinations

Despite the different structure of possible components for a specific vaccine, any vaccination is capable of creating immunity to infection, reducing the incidence and prevalence of pathology, which is its main purpose. The active components of the drugs, when introduced into the body of any person, cause a reaction from his immune system. This reaction is in all respects similar to that which develops when infected with an infectious disease, but much weaker. The meaning of such a weak reaction of the immune system to the administration of the drug is that special cells are formed (they are called memory cells), which provide further immunity to infection. Memory cells can remain in the human body for varying periods of time - from several months to many years. Memory cells that last only a few months are short-lived, but vaccination is necessary to form a different type of memory cell—long-lived. Each such cell is formed only in response to a specific pathogenic microorganism, that is, a cell formed against rubella will not be able to provide immunity to tetanus.

The formation of any memory cell, long- or short-lived, requires a certain period of time - from several hours to a whole week. When the causative agent of a disease enters the human body for the first time, all manifestations of the infection are caused precisely by the activity of the microbe. During this period, the cells of the immune system “get acquainted” with the pathogenic microbe, after which B-lymphocytes are activated, which begin to produce antibodies that have the ability to kill the causative microorganism. Each microbe requires its own special antibodies. Recovery and relief of the symptoms of infection begins only from the moment when antibodies are developed and the destruction of the pathogenic microorganism begins. After this, some of the antibodies disappear, and some become short-lived memory cells. B-lymphocytes that produced antibodies go into the tissue and become those same memory cells. Subsequently, when the same pathogenic microbe enters the body, memory cells are immediately mobilized, producing antibodies that quickly and effectively destroy the infectious agent. This means that an infectious disease does not develop.

It makes no sense to vaccinate against infections that the human body can cope with. But if the infection is dangerous, the mortality rate of sick people is very high, then vaccination is necessary.

When contracting a dangerous infection, there are two possible outcomes: recovery with the formation of immunity or death. Vaccination ensures the formation of this immunity without mortal risk and the need to endure a severe infection with extremely unpleasant symptoms. It is quite natural that the process of formation of memory cells during activation of the immune system is accompanied by a number of reactions. The most common reactions are at the injection site and some general ones (for example, elevated temperature for several days, weakness, malaise, etc.).

List of preventive vaccinations

Today in Russia the list of preventive vaccinations includes the following vaccines for children and adults: against hepatitis B, against tuberculosis (children only), diphtheria, whooping cough, tetanus, Haemophilus influenzae, polio, measles, rubella, mumps, influenza, meningococcal infection, tularemia, plague, brucellosis, anthrax, rabies, leptospirosis, tick-borne encephalitis, Q fever, yellow fever, cholera, typhoid, hepatitis A, shigellosis.

This list includes mandatory vaccinations that are given to all people, and those performed for epidemiological reasons. Epidemiological indications can be different, for example, living or temporarily staying in the area of the outbreak of a dangerous infection, leaving for regions with an unfavorable situation, or working with dangerous pathogenic microbes or with livestock that are carriers of a number of pathologies.

National calendar of preventive vaccinations is compiled and approved based on the significance of the infections against which vaccination is carried out, as well as the availability of drugs. The calendar may be revised if circumstances change, for example if new vaccines become available that have different rules for use, or if there is a risk of an outbreak of infection that requires urgent and urgent immunization. In Russia, a vaccination calendar for children and adults has been approved, valid throughout the country. This calendar has not changed in recent years; it is the same for 2011, 2012 and 2013. The vaccinations included in this calendar are performed for all people.

Preventive vaccination plan

A plan, or program, for preventive vaccinations for children is drawn up by medical specialists working in a clinic, child care facility, school, college, or college. Any preventive vaccination program is based on a constant census of the population, which is carried out twice a year: in April and October. At the same time, departing and arriving citizens, newborn children, etc. are recorded. The preventive vaccination program covers all people who have not been vaccinated or whose immunization deadline has come. Children who have received a medical exemption from vaccinations for health reasons must undergo an examination, the results of which will determine whether the child can be included in the vaccination plan.

An individual program of preventive vaccinations for a child is developed and reflected in the following medical documentation:
— in the preventive vaccination card (form 063/у);
— in the history of the child’s development (form 112/у);
— in the child’s medical record (form 026/у);
- in the insert for an outpatient medical record (form 025/u) - for adolescents.

These documents are issued for each child living in the area and attending kindergarten, school, college or college.

Carrying out preventive vaccinations

Preventive vaccinations can be carried out in a state medical and preventive institution (polyclinic), or in specialized centers for immunization of the population, or in private clinics licensed to carry out this type of medical manipulation. Preventive vaccinations are administered directly in the vaccination room, which must meet certain requirements and standards.

The vaccination room must have sterile instruments and materials, disposable syringes and needles for intradermal and intramuscular injections, forceps (tweezers), containers in which used instruments and debris are collected. Also, the office must have a sufficient number of tables, each of which is intended for administering only one type of vaccine. The table must be marked, syringes, needles and sterile materials are prepared on it. All used syringes, needles, ampoules, drug residues, cotton wool or tampons are disposed of in a container with a disinfectant solution.

Organization and procedure for vaccination

To carry out vaccination, all institutions use only registered drugs of domestic or imported production, approved for use. Preventive vaccines are given exclusively as prescribed by a doctor or paramedic.

Immediately before the planned vaccination, data on the condition of the child or adult are carefully clarified, on the basis of which permission for manipulation is given. Before the planned immunization, the child is examined by a doctor to determine the presence of contraindications, allergies or strong reactions to previously administered drugs. Before the injection, the temperature is measured. Before the planned vaccination, the necessary tests are taken.

Vaccinations can only be given by a specialist - a physician who is proficient in injection techniques, as well as emergency care skills. The vaccination room must have a kit for emergency assistance. All vaccines must be stored according to rules and regulations.

Preventive vaccinations must be carried out following a certain technique. The general rules and methodology for administering preventive vaccines are determined by regulatory documents.

The medical worker must enter all vaccinations performed in a special logbook. If the patient’s individual card is lost or if he moves, all data can be restored by contacting the medical institution where the vaccination was carried out, where they will make an extract from such journals stored in the archives. Also, based on the entries in the journal, preventive immunization plans are drawn up, in which the names of the people to be vaccinated are entered. The preventive vaccination log is a standard form of medical documentation 064/у. It is stitched, the pages are numbered. The magazine is usually ordered from a printing house, which prints them according to a template approved by the Ministry of Health.

Refusal of preventive vaccinations

Today, every adult or guardian or representative of a minor has the right to refuse vaccination. The basis for this is provided by the Law of the Ministry of Health of the Russian Federation No. 157-F3 of September 17, 1998, Article 5. Regarding vaccinations for children: a parent can refuse them on the basis of Article 11 of the same law, which states that vaccination of a child is carried out only with his consent legal representatives, that is, parents, guardians, etc. Refusal from vaccinations must be submitted in writing to the head of the medical, preschool child care institution or school.

What does the lack of preventive vaccination entail?

The absence of preventive vaccinations entails the following consequences, according to Article 5 of the Law of the Ministry of Health of the Russian Federation No. 157-F3 of September 17, 1998:
1) a ban on citizens traveling to countries whose stay, in accordance with international health regulations or international treaties of the Russian Federation, requires specific preventive vaccinations;
2) temporary refusal to admit citizens to educational and health institutions in the event of the occurrence of mass infectious diseases or the threat of epidemics;
3) refusal to hire citizens or removal from work, the performance of which is associated with a high risk of contracting infectious diseases. The list of works, the performance of which is associated with a high risk of contracting infectious diseases, requires mandatory preventive vaccinations, is established by the federal executive body authorized by the government of the Russian Federation.

As can be seen from the law, a child or an adult may not be allowed to visit a child care facility, and an employee may not be allowed to enter the workplace if there are no vaccinations and the epidemiological situation is unfavorable. In other words, when Rospotrebnadzor announces the danger of an epidemic or the transition to quarantine, unvaccinated children and adults are not allowed into groups. The rest of the time, children and adults can work, study and attend kindergartens without restrictions.

Preventive vaccination in kindergarten

For children, preventive vaccination can be carried out individually or in an organized manner. In an organized manner, vaccinations are given to children attending kindergartens and schools, where immunization specialists come with ready-made drugs. In this case, the medical workers of the children's institution draw up vaccination plans, which include those children who need vaccination. All information about the manipulations performed in kindergarten is recorded on a special vaccination sheet (form 063/y) or in a medical record (form 026/y-2000). Vaccinations in kindergarten are carried out only with the consent of the parents or other legal representatives of the child. If you wish to refuse vaccinations for your child, you must register your refusal in writing with the office and notify the nurse.

PREVENTIVE VACCINATIONS

Second vaccination against viral hepatitis B

First vaccination against diphtheria, whooping cough, tetanus, polio

Revaccination against measles, rubella, mumps

Second revaccination against diphtheria, tetanus

Vaccination against rubella (girls).

Vaccination against viral hepatitis B (not previously vaccinated)

Third revaccination against diphtheria, tetanus.

Revaccination against tuberculosis.

Third revaccination against polio

Adults

Revaccination against diphtheria, tetanus - every 10 years from the date of the last revaccination

If the timing of the start of vaccinations is violated, the latter are carried out according to the schemes provided for in this calendar and instructions for the use of drugs.

8.2. Immunization against whooping cough

8.2.1. The goal of pertussis vaccine prevention, according to WHO recommendations, should be to reduce the incidence by 2010 or earlier to a level of less than 1 per 100 thousand population. This can be achieved by ensuring at least 95% coverage of children aged 12 months with three-time vaccination. and the first revaccination of children at the age of 24 months.

8.2.2. Children from 3 months of age to 3 years 11 months 29 days are subject to vaccination against whooping cough. Vaccinations are carried out with DTP vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterior outer region of the thigh in a dose of 0.5 ml.

8.2.3. The vaccination course consists of 3 vaccinations with an interval of 45 days. Reducing intervals is not allowed. If the interval between vaccinations increases, the next vaccination is carried out as soon as possible, determined by the child’s health condition.

8.2.4. The first vaccination is carried out at the age of 3 months, the second - at 4.5 months, the third vaccination - at the age of 6 months.

8.2.5. Revaccination with DPT vaccine is carried out once every 12 months. after completed vaccination.

8.2.6. Vaccinations with the DPT vaccine can be carried out simultaneously with other vaccinations in the vaccination calendar, and the vaccines are administered with different syringes to different parts of the body.

8.3. Immunization against diphtheria

Vaccinations are carried out DTP vaccine, toxoids ADS, ADS-M, AD-M.

8.3.1. The goal of vaccination against diphtheria, according to WHO recommendations, is to achieve an incidence rate of 0.1 or less per 100 thousand population by 2005. This will become possible by ensuring at least 95% coverage of completed vaccination of children at the age of 12 months, with the first revaccination of children at the age of 24 months. and at least 90% vaccination coverage of the adult population.

8.3.2. Children from 3 months of age, as well as adolescents and adults who have not previously been vaccinated against this infection are subject to vaccination against diphtheria. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterior outer region of the thigh in a dose of 0.5 ml.

8.3.3. The first vaccination is carried out at the age of 3 months, the second vaccination - at the age of 4.5 months, the third vaccination - at the age of 6 months. The first revaccination is carried out after 12 months. after completed vaccination. Children from 3 months of age to 3 years 11 months 29 days are subject to vaccination with the DTP vaccine.

Vaccination is carried out 3 times with an interval of 45 days. Reducing intervals is not allowed. If the interval is forced to increase, the next vaccination is carried out as soon as possible, determined by the state of health of the child. Skipping one vaccination does not entail repeating the entire vaccination cycle.

8.3.4. ADS toxoid is used to prevent diphtheria in children under 6 years of age:

Those who have had whooping cough;

Over 4 years of age, not previously vaccinated against diphtheria and tetanus.

8.3.4.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Reducing intervals is not allowed. If the interval between vaccinations increases, the next vaccination is carried out as soon as possible, determined by the child’s health condition.

8.3.4.2. The first revaccination with ADS toxoid is carried out once after 9 to 12 months. after completed vaccination.

8.3.5. DS-M-anatoxin is used:

For revaccination of children 7 years old, 14 years old and adults without age limit every 10 years;

For vaccination against diphtheria and tetanus in children from 6 years of age who have not previously been vaccinated against diphtheria.

8.3.5.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Reducing intervals is not allowed. If it is necessary to increase the interval, the next vaccination should be carried out as soon as possible.

8.3.5.2. The first revaccination is carried out at intervals of 6 - 9 months. after completed vaccination once. Subsequent revaccinations are carried out in accordance with the national calendar.

8.3.5.3. Vaccinations with ADS-M toxoid can be carried out simultaneously with other vaccinations on the calendar. Vaccinations are carried out with different syringes in different parts of the body.

8.4. Immunization against tetanus

8.4.1. In the Russian Federation, tetanus in newborns has not been registered in recent years, and sporadic incidence of tetanus among other age groups of the population is recorded annually.

8.4.2. The goal of tetanus immunization is to prevent tetanus in the population.

8.4.3. This can be achieved by ensuring at least 95% coverage of children with three doses of vaccination by 12 months. life and subsequent age-related revaccinations by 24 months. life, at 7 years old and at 14 years old.

8.4.4. Vaccinations are carried out with DTP vaccine, ADS toxoids, ADS-M.

8.4.5. Children from 3 months of age are subject to vaccination against tetanus: the first vaccination is carried out at the age of 3 months, the second at 4.5 months, the third vaccination at the age of 6 months.

8.4.6. Vaccinations are carried out with DPT vaccine. The drug is administered intramuscularly into the upper outer quadrant of the buttock or the anterior outer region of the thigh in a dose of 0.5 ml.

8.4.7. The vaccination course consists of 3 vaccinations with an interval of 45 days. Reducing intervals is not allowed. If the interval is forced to increase, the next vaccination is carried out as soon as possible, determined by the state of health of the child. Skipping one vaccination does not entail repeating the entire vaccination cycle.

8.4.8. Revaccination against tetanus is carried out with DPT vaccine once every 12 months. after completed vaccination.

8.4.9. Vaccinations with the DTP vaccine can be carried out simultaneously with other vaccinations in the vaccination calendar, and the vaccines are administered with different syringes to different parts of the body.

8.4.10. ADS toxoid is used to prevent tetanus in children under 6 years of age:

Those who have had whooping cough;

Those who have contraindications to the administration of DTP vaccine;

Over 4 years of age, not previously vaccinated against tetanus.

8.4.10.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Reducing intervals is not allowed. If the interval between vaccinations increases, the next vaccination is carried out as soon as possible, determined by the child’s health condition.

8.4.10.2. The first revaccination with ADS toxoid is carried out once after 9 to 12 months. after completed vaccination.

8.4.11. ADS-M-anatoxin is used:

For revaccination of children against tetanus at 7 years old, 14 years old and adults without age limit every 10 years;

For vaccination against tetanus in children from 6 years of age who have not previously been vaccinated against tetanus.

8.4.11.1. The vaccination course consists of 2 vaccinations with an interval of 45 days. Reducing intervals is not allowed. If it is necessary to increase the interval, the next vaccination should be carried out as soon as possible.

8.4.11.2. The first revaccination is carried out at intervals of 6 - 9 months. after completed vaccination once. Subsequent revaccinations are carried out in accordance with the national calendar.

8.4.11.3. Vaccinations with ADS-M toxoid can be carried out simultaneously with other vaccinations on the calendar. Vaccinations are carried out with different syringes in different parts of the body.

8.5. Immunization against measles, rubella, mumps

8.5.1. The WHO program provides:

Global elimination of measles by 2007;

Prevention of cases of congenital rubella, the elimination of which, according to the WHO goal, is expected in 2005;

Reducing the incidence of mumps to a level of 1.0 or less per 100 thousand population by 2010.

This will become possible when at least 95% vaccination coverage of children is achieved by 24 months. life and revaccination against measles, rubella and mumps in children aged 6 years.

8.5.2. Children over the age of 12 months who have not had these infections are subject to vaccination against measles, rubella and mumps.

8.5.3. Children from 6 years of age are subject to revaccination.

8.5.4. Girls aged 13 years who have not previously been vaccinated or who have received one vaccination are subject to vaccination against rubella.

8.5.5. Vaccination and revaccination against measles, rubella, mumps are carried out with monovaccines and combined vaccines (measles, rubella, mumps).

8.5.6. The drugs are administered once subcutaneously in a dose of 0.5 ml under the shoulder blade or in the shoulder area. Simultaneous administration of vaccines with different syringes to different parts of the body is allowed.

8.6. Immunization against polio

8.6.1. WHO's global goal is to eradicate polio by 2005. Achieving this goal is possible if children 12 months of age are vaccinated three times. life and revaccinations of children 24 months. life at least 95%.

8.6.2. Vaccinations against polio are carried out with live oral polio vaccine.

8.6.3. Children from 3 months of age are subject to vaccination. Vaccination is carried out 3 times with an interval of 45 days. Reducing intervals is not allowed. If the intervals are extended, vaccinations should be carried out as soon as possible.

8.6.4. The first revaccination is carried out at the age of 18 months, the second revaccination at the age of 20 months, the third revaccination at 14 years.

8.6.5. Vaccinations against polio can be combined with other scheduled vaccinations.

8.7. Immunization against viral hepatitis B

8.7.1. The first vaccination is given to newborn children in the first 12 hours of life.

8.7.2. The second vaccination is given to children aged 1 month.

8.7.3. The third vaccination is given to children aged 6 months.

8.7.4. Children born to mothers who are carriers of the hepatitis B virus or patients with viral hepatitis B in the third trimester of pregnancy are vaccinated against viral hepatitis B according to the schedule of 0 - 1 - 2 - 12 months.

8.7.5. Vaccination against hepatitis B for children aged 13 years who have not previously been vaccinated is carried out according to the schedule of 0 - 1 - 6 months.

8.7.7. The vaccine is administered intramuscularly to newborns and young children in the anterolateral thigh, and to older children and adolescents - into the deltoid muscle.

8.7.8. The dosage of the vaccine for vaccinations of people of different ages is carried out in strict accordance with the instructions for its use.

8.8. Immunization against tuberculosis

8.8.1. All newborns in the maternity hospital are subject to vaccination against tuberculosis on the 3rd - 7th day of life.

8.8.2. Revaccination against tuberculosis is carried out for tuberculin-negative children not infected with Mycobacterium tuberculosis.

8.8.3. The first revaccination is given to children aged 7 years.

8.8.4. The second revaccination against tuberculosis at 14 years of age is carried out to tuberculin-negative children not infected with Mycobacterium tuberculosis, who did not receive the vaccine at 7 years of age.

8.8.5. Vaccination and revaccination are carried out with live anti-tuberculosis vaccine (BCG and BCG-M).

8.8.6. The vaccine is administered strictly intradermally at the border of the upper and middle third of the outer surface of the left shoulder. The vaccination dose contains 0.05 mg BCG and 0.02 mg BCG-M in 0.1 ml of solvent. Vaccination and revaccination are carried out with one-gram or tuberculin disposable syringes with thin needles (N 0415) with a short cut.

9. The procedure for carrying out preventive vaccinations

according to epidemic indications

If there is a threat of infectious diseases, preventive vaccinations for epidemic indications are carried out to the entire population or individual professional groups, contingents living or visiting areas endemic or enzootic for plague, brucellosis, tularemia, anthrax, leptospirosis, tick-borne spring-summer encephalitis. The list of works, the performance of which is associated with a high risk of contracting infectious diseases and requires mandatory preventive vaccinations, was approved by Decree of the Government of the Russian Federation of July 17, 1999 N 825.

Immunization for epidemic indications is carried out by decision of the state sanitary and epidemiological surveillance centers in the constituent entities of the Russian Federation and in agreement with health authorities.

An endemic territory (relative to human diseases) and enzootic (relative to diseases common to humans and animals) is considered a territory or group of territories with a constant occurrence infectious disease, caused by specific, local, natural-geographical conditions necessary for constant circulation of the pathogen.

The list of enzootic territories is approved by the Russian Ministry of Health on the basis of state sanitary and epidemiological surveillance centers in the constituent entities of the Russian Federation.

Emergency immunoprophylaxis is carried out by decision of the bodies and institutions of the state sanitary and epidemiological service and local health authorities in the constituent entities of the Russian Federation.

9.1. Immunoprophylaxis of plague

9.1.1. Preventive measures aimed at preventing infection of people in natural plague foci are provided by anti-plague institutions in cooperation with territorial institutions of the state sanitary and epidemiological service.

9.1.2. Vaccination against plague is carried out on the basis of the presence of an epizootic of plague among rodents, identification of domestic animals suffering from plague, the possibility of infection being introduced by a sick person and epidemiological analysis carried out by an anti-plague institution. The decision on immunization is made by the Chief State Sanitary Doctor of the constituent entity of the Russian Federation in consultation with health authorities.

9.1.3. Immunization is carried out in a strictly limited area to the entire population from 2 years of age or selectively to threatened populations (livestock breeders, agronomists, employees of geological parties, farmers, hunters, harvesters, etc.).

9.1.4. Vaccinations are carried out by local medical workers or specially organized vaccination teams with the instructional and methodological assistance of anti-plague institutions.

9.1.5. The plague vaccine provides immunity to those vaccinated for up to 1 year. Vaccination is carried out once, revaccination is carried out after 12 months. after the last vaccination.

9.1.6. Measures to prevent the importation of plague from abroad are regulated by sanitary and epidemiological rules SP 3.4.1328-03 “Sanitary protection of the territory of the Russian Federation”.

9.1.7. Control over the implementation of preventive vaccinations is carried out by anti-plague institutions.

9.2. Immunoprophylaxis of tularemia

9.2.1. Vaccinations against tularemia are carried out based on the decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities.

9.2.2. Planning and selection of groups to be vaccinated is carried out differentially, taking into account the degree of activity of natural foci.

9.2.3. There are scheduled and unscheduled vaccinations against tularemia.

9.2.4. Routine vaccination from the age of 7 is carried out for the population living in the territory with the presence of active natural foci of the steppe, floodplain-marsh (and its variants), and foothill-stream types.

In meadow-field areas, vaccinations are carried out for the population from the age of 14, with the exception of pensioners, disabled people, people not engaged in agricultural work and who do not have livestock for personal use.

9.2.4.1. On the territory of natural foci of tundra and forest types, vaccinations are carried out only in risk groups:

Hunters, fishermen (and members of their families), reindeer herders, shepherds, field farmers, land reclamation workers;

Persons assigned to temporary work (geologists, prospectors, etc.).

9.2.4.2. In cities directly adjacent to active foci of tularemia, as well as in areas with inactive natural foci of tularemia, vaccinations are carried out only to workers:

Grain and vegetable storage facilities;

Sugar and alcohol factories;

Hemp and flax plants;

Feed shops;

Livestock and poultry farms working with grain, fodder, etc.;

Hunters (members of their families);

For producers of game animal skins;

Employees of fur factories involved in the primary processing of skins;

Employees of the departments of especially dangerous infections of state sanitary and epidemiological surveillance centers and anti-plague institutions;

Workers of deratization and disinfection services;

9.2.4.3. Revaccination is carried out after 5 years for contingents subject to routine immunization.

9.2.4.4. Cancellation of routine vaccinations is allowed only on the basis of materials indicating the absence of circulation of the tularemia pathogen in the biocenosis for 10 - 12 years.

9.2.4.5. Vaccination according to epidemic indications is carried out:

In settlements located in territories previously considered free from tularemia, when people become ill (even isolated cases are registered) or tularemia cultures are isolated from any objects;

In settlements located in the territories of active natural foci of tularemia, when a low immune layer is detected (less than 70% in meadow-field foci and less than 90% in floodplain-marsh foci);

In cities directly adjacent to active natural foci of tularemia, populations at risk of infection - members of horticultural cooperatives, owners (and members of their families) of personal vehicles and water transport, water transport workers, etc.;

In the territories of active natural foci of tularemia - to persons coming to carry out permanent or temporary work - hunters, foresters, land reclamation workers, surveyors, peat developers, harvesters of fur skins (water rats, hares, muskrats), geologists, members of scientific expeditions; persons sent for agricultural, construction, survey or other work, tourists, etc.

Vaccination of the above-mentioned contingents is carried out by health care organizations in the places of their formation.

9.2.5. In special cases, persons at risk of contracting tularemia need to undergo emergency antibiotic prophylaxis, after which, but not earlier than 2 days after it, they are vaccinated with a tularemia vaccine.

9.2.6. Simultaneous cutaneous vaccination of adults against tularemia and brucellosis, tularemia and plague on different areas the outer surface of the third shoulder.

9.2.7. The tularemia vaccine ensures the development of immunity lasting 5 years 20 to 30 days after vaccination.

9.2.8. Monitoring the timeliness and quality of vaccination against tularemia, as well as the state of immunity, is carried out by territorial centers of state sanitary and epidemiological surveillance by selective examination of the adult working population using a tularin test or serological methods at least once every 5 years.

9.3. Immunoprophylaxis of brucellosis

9.3.1. Vaccinations against brucellosis are carried out based on the decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities. The indication for vaccination of people is the threat of infection by a pathogen of the goat-sheep species, as well as the migration of Brucella of this species to cattle or other animal species.

9.3.2. Vaccinations are carried out from the age of 18:

For permanent and temporary livestock workers - until the complete elimination of animals infected with Brucella of the goat-sheep species on farms;

To the personnel of organizations for the procurement, storage, processing of raw materials and livestock products - until the complete elimination of such animals in the farms from which livestock, raw materials and livestock products come;

Workers of bacteriological laboratories working with live cultures of Brucella;

Employees of organizations for the slaughter of livestock with brucellosis, procurement and processing of livestock products obtained from them, veterinary workers, livestock specialists in farms enzootic for brucellosis.

9.3.3. Persons with clear negative serological and allergic reactions for brucellosis.

9.3.4. When determining the timing of vaccinations for workers on livestock farms, it is necessary to strictly follow the data on the time of lambing (early lambing, planned, unscheduled).

9.3.5. The brucellosis vaccine provides the highest intensity of immunity for 5 - 6 months.

9.3.6. Revaccination is carried out after 10 - 12 months. after vaccination.

9.3.7. Control over the planning and implementation of immunization is carried out by territorial centers of state sanitary and epidemiological supervision.

9.4. Immunoprophylaxis of anthrax

9.4.1. Immunization of people against anthrax is carried out on the basis of a decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities, taking into account epizootic and epidemiological indications.

9.4.2. Persons over 14 years of age who perform the following work in anthrax-enzootic areas are subject to vaccination:

Agricultural, drainage, survey, expeditionary, construction, excavation and movement of soil, procurement, fishing;

For the slaughter of livestock infected with anthrax, the procurement and processing of meat and meat products obtained from it;

With live cultures of the anthrax pathogen or with material suspected of being contaminated with the pathogen.

9.4.3. Persons who have had contact with anthrax-infected animals, raw materials and other products contaminated with anthrax pathogens during an epidemic outbreak are not recommended to undergo vaccination. They are given emergency prophylaxis with antibiotics or anti-anthrax immunoglobulin.

9.4.4. Revaccination anthrax vaccine carried out after 12 months. after the last vaccination.

9.4.5. Monitoring the timeliness and completeness of coverage of contingents with immunization against anthrax is carried out by territorial centers of state sanitary and epidemiological surveillance.

9.5. Immunoprophylaxis of tick-borne encephalitis

9.5.1. Vaccinations against tick-borne encephalitis are carried out based on the decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities, taking into account the activity of the natural outbreak and epidemiological indications.

9.5.2. Proper planning and careful selection of populations at high risk of infection ensure the epidemiological effectiveness of vaccination.

9.5.3. The following are subject to vaccination against tick-borne encephalitis:

Population over 4 years of age living in areas enzootic for tick-borne encephalitis;

Persons arriving in territories enzootic for tick-borne encephalitis and performing the following work - agricultural, irrigation, construction, geological, survey, expedition; for excavation and movement of soil; procurement, fishing; deratization and disinfestation; for logging, clearing and landscaping of forests, health and recreation areas for the population; with live cultures of the causative agent of tick-borne encephalitis.

9.5.4. The maximum age of those vaccinated is not regulated; it is determined in each specific case based on the advisability of vaccination and the health status of the person being vaccinated.

9.5.5. In case of violation of the vaccination course (lack of a documented full course), vaccination is carried out according to the primary vaccination schedule.

9.5.6. Revaccination is carried out after 12 months, and subsequently every 3 years.

9.5.7. Control over the planning and implementation of immunization against tick-borne encephalitis is carried out by territorial centers of state sanitary and epidemiological supervision.

9.6. Immunoprophylaxis of leptospirosis

9.6.1. Vaccinations against leptospirosis are carried out based on the decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities, taking into account the epidemiological situation and epizootological situation. Preventive vaccination is carried out for the population from 7 years of age according to epidemiological indications. The risk groups and timing of immunization are determined by the territorial centers of state sanitary and epidemiological supervision.

9.6.2. Persons at increased risk of infection who perform the following work are subject to immunization:

For the procurement, storage, processing of raw materials and livestock products obtained from farms located in areas enzootic for leptospirosis;

For the slaughter of livestock suffering from leptospirosis, the procurement and processing of meat and meat products obtained from it;

On catching and keeping stray animals;

With live cultures of the causative agent of leptospirosis;

Sent for construction and agricultural work in places of active natural and anthropourgic foci of leptospirosis (but no later than 1 month before the start of work in them).

9.6.4. Revaccination against leptospirosis is carried out after 12 months. after the last vaccination.

9.6.5. Control over immunization against leptospirosis of contingents at risk of infection and the population as a whole is carried out by territorial centers of state sanitary and epidemiological surveillance.

9.7. Immunoprophylaxis of yellow fever

9.7.1. A number of countries with territories enzootic for yellow fever require from persons traveling to these territories an international certificate of vaccination or revaccination against yellow fever.

9.7.2. Adults and children, starting from 9 months of age, traveling abroad to areas enzootic for yellow fever are subject to vaccination.

9.7.3. Vaccination is carried out no later than 10 days before departure to an enzootic area.

9.7.4. Persons working with live cultures of the yellow fever pathogen are subject to vaccination.

9.7.5. For persons over 15 years of age, the yellow fever vaccine can be combined with the cholera vaccine, provided that the drugs are administered to different parts of the body using different syringes, otherwise the interval should be at least one month.

9.7.6. Revaccination is carried out 10 years after the first vaccination.

9.7.7. Vaccinations against yellow fever are carried out only at vaccination points at clinics under the supervision of a doctor with the mandatory issuance of an international certificate of vaccination and revaccination against yellow fever.

9.7.8. The presence of an international certificate of vaccination against yellow fever is checked by officials at sanitary quarantine points when crossing the state border in case of travel to countries that are unfavorable for the incidence of yellow fever.

9.8. Immunoprophylaxis of Q fever

9.8.1. Vaccinations against Q fever are carried out by decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities, taking into account the epidemiological and epizootological situation.

9.8.2. Vaccinations are carried out to persons aged 14 years in areas affected by Q fever, as well as to professional groups performing work:

For the procurement, storage, processing of raw materials and livestock products obtained from farms where Q fever in small and large livestock is recorded;

On the procurement, storage, processing of agricultural products in enzootic areas for Q fever;

Caring for sick animals (persons who have had Q fever or have positive reaction complement fixation (CF) in a dilution of not less than 1:10 and (or) a positive indirect immunofluorescence reaction (IRIF) in a titer of not less than 1:40);

Working with live cultures of Q fever pathogens.

9.8.3. Vaccination against Q fever can be carried out simultaneously with vaccination with a live vaccine against brucellosis using different syringes in different hands.

9.8.4. Revaccination against Q fever is carried out after 12 months.

9.8.5. Control over immunization against Q fever of subject contingents is carried out by territorial centers of state sanitary and epidemiological supervision.

9.9. Immunoprophylaxis of rabies

9.9.1. Vaccinations against rabies are carried out by decision of the territorial centers of state sanitary and epidemiological supervision in coordination with local health authorities.

9.9.2. The following are subject to rabies vaccinations from the age of 16:

Persons performing work on catching and keeping stray animals;

Working with the “street” rabies virus;

Veterinarians, hunters, foresters, slaughterhouse workers, taxidermists.

9.9.3. Revaccination is carried out after 12 months. after vaccination, then every 3 years.

9.9.4. Persons exposed to the risk of infection with the rabies virus undergo a course of therapeutic and prophylactic immunization in accordance with regulatory and methodological documents on the prevention of rabies.

9.9.5. Control over the immunization of subject populations and persons at risk of infection with the rabies virus is carried out by territorial centers of state sanitary and epidemiological surveillance.

9.10. Immunoprophylaxis of typhoid fever

Preventive vaccinations against typhoid fever are carried out from the age of 3 to the population living in areas with high level incidence of typhoid fever, revaccination is carried out after 3 years.

9.11. Immunoprophylaxis of influenza

9.11.1. Immunoprophylaxis of influenza can significantly reduce the risk of disease, prevent negative consequences and impacts on public health.

9.11.2. Flu vaccinations are given to people at increased risk of infection (over 60 years of age, those suffering from chronic somatic diseases those who often suffer from acute respiratory infections, preschool children, schoolchildren, medical workers, workers in the service sector, transport, educational institutions).

9.11.3. Any citizen of the country can receive a flu vaccine if they wish, provided they have no medical contraindications.

9.11.4. Vaccinations against influenza are carried out annually in the fall (October-November) during the pre-epidemic period for influenza by decision of the territorial centers of state sanitary and epidemiological supervision.

9.12. Immunoprophylaxis of viral hepatitis A

9.12.1. Vaccinations against hepatitis A are subject to:

Children over 3 years of age living in areas with a high incidence of hepatitis A;

Medical workers, teachers and staff of preschool institutions;

Workers in the public service sector, primarily employed in public catering organizations;

Workers maintaining water supply and sewerage structures, equipment and networks;

Persons traveling to regions of Russia and the country that are hyperendemic for hepatitis A;

Persons who have been in contact with the patient(s) in hepatitis A outbreaks.

9.12.2. The need for immunization against hepatitis A is determined by the territorial centers of state sanitary and epidemiological surveillance.

9.12.3. Monitoring of immunization against hepatitis A is carried out by territorial centers of state sanitary and epidemiological supervision.

9.13. Immunoprophylaxis of viral hepatitis B

9.13.1. Vaccinations against hepatitis B are carried out:

Children and adults who have not previously been vaccinated, whose families include a carrier of HbsAg or a patient with chronic hepatitis;

Children of orphanages, orphanages and boarding schools;

Children and adults who regularly receive blood and its preparations, as well as those on hemodialysis, and hematological oncology patients;

Persons who have had contact with material infected with the hepatitis B virus;

Medical workers who have contact with the blood of patients;

Persons involved in production immunobiological preparations from donor and placental blood;

Students of medical institutes and students of secondary medical educational institutions (primarily graduates);

Persons who inject drugs.

9.13.2. The need for immunoprophylaxis is determined by the territorial centers of state sanitary and epidemiological supervision, carrying out subsequent monitoring of immunization.

9.14. Immunoprophylaxis of meningococcal infection

9.14.1. Vaccinations against meningococcal infection are carried out:

Children over 2 years of age, adolescents, adults in areas of meningococcal infection caused by meningococcus serogroup A or C;

Persons at increased risk of infection - children from preschool institutions, students of 1st - 2nd grades of schools, teenagers of organized groups united by living in dormitories; children from family hostels placed in unfavorable sanitary and hygienic conditions, with a 2-fold increase in incidence compared to the previous year.

9.14.2. The need for immunization against meningococcal infection is determined by the territorial centers of state sanitary and epidemiological surveillance.

9.14.3. Control over the implementation of immunoprophylaxis is carried out by territorial centers of state sanitary and epidemiological supervision.

9.15. Immunoprophylaxis of mumps

9.15.1. Vaccinations against mumps are carried out for persons over 12 months of age who have been in contact with the patient(s) in areas of mumps. up to 35 years of age, not previously vaccinated or vaccinated once and have not had this infection.

Carrying out preventive vaccinations at FAP

General principles of preventive vaccinations

Concept of vaccination and immunization

Precautionary vaccinations(immunization, vaccination) creation of immunity to infectious diseases by introducing vaccines, toxoids, immunoglobulins, immune serums into the body. Preventive vaccinations are also carried out in order to create active immunity or short-term specific protection from the pathogen or its toxins (creation of passive immunity).

Actively acquired immunity occurs as a result of exposure to an infectious disease or the introduction of a vaccine into the body. It is formed 1-2 weeks after the introduction of the antigen and persists for years and tens of years (with measles for life). Passively acquired immunity occurs when antibodies are transferred from mother to fetus through the placenta, providing newborns with immunity to certain infectious diseases (for example, measles) for several months.

The same immunity is created artificially when immune serums containing antibodies against the corresponding microbes or toxins produced by bacteria are introduced into the body.

The high effectiveness of immunoprophylaxis, primarily for a number of infectious diseases with an airborne transmission mechanism of pathogens, not only determined a sharp decline level of morbidity, but also ensured the elimination of some common and dangerous infectious diseases (for example, smallpox).

Immunization with vaccines (vaccine prophylaxis) and toxoids as a routine preventive measure is more effective than immunization with serum preparations (seroprophylaxis), as it provides protection for a longer period.

Immunization with serums is carried out primarily to persons who have not previously received vaccines due to contraindications, as well as to patients in serious condition. Immunization with serums is carried out as soon as possible after contact with the source of infection in epidemic focus. To create passive immunity, immunoglobulins (vaccine preparations containing ready-made protective antibodies) are also introduced. Immunoglobulins are administered in cases where it is necessary to quickly increase the body’s protective functions, create temporary immunity to a particular infectious disease, or reduce the severity of the onset of the disease.

To create active immunity, vaccines or toxoids are introduced into the human body. Vaccines contain killed or live, but weakened, non-disease-causing pathogens, in response to the introduction of which specific protective substances called antibodies are produced. Toxoids are obtained by neutralizing microbial toxins (poisons) with formaldehyde. In this case, the toxin loses its toxicity, but retains the ability to induce immunity.

Vaccines can be administered intradermally (vaccine against tuberculosis), subcutaneously (typhoid and many others), intramuscularly (diphtheria-tetanus, measles, mumps, etc.); orally (poliomyelitis), intranasally (influenza).

For each vaccine, the most effective scheme has been established: frequency of administration (once, twice or three times); intervals between injections, drug dose. Toxoids are administered subcutaneously or intramuscularly. To achieve a constant high level of immunity, in some cases repeated vaccinations (re-vaccination) are carried out at various times after vaccination.

Considering the ability of the human body to simultaneously develop immunity to several infectious diseases, complex vaccination preparations are widely used, representing a mixture of several vaccines and toxoids (for example, pertussis-diphtheria-tetanus vaccine, trivaccine - rubella, measles, mumps).

Vaccinations in order to obtain active immunity are carried out routinely and according to epidemic indications. Routine vaccinations carried out by the calendar of preventive vaccinations established by the Ministry of Health, regardless of the epidemiological situation, include vaccinations against childhood infections (measles, whooping cough, polio, mumps, diphtheria, rubella, etc.).

In some cases, routine vaccinations are also carried out for the population on the territory of natural foci of zoonotic infections (gularemia, tick-borne encephalitis). Unscheduled (emergency) immunoprophylaxis is carried out by decision of the territorial health authorities and civil service epidemiological surveillance.

Organization and implementation of preventive vaccinations

Carrying out preventive vaccinationsrequires strict compliance rules of asepsis to prevent purulent-inflammatory diseases. Only healthy healthcare workers who do not have even minor injuries on their hands, purulent lesions of the skin and mucous membranes, regardless of their location, are allowed to carry out vaccinations. After 30 injections, you must wash your hands with soap and then wipe them with alcohol. The health worker conducting the vaccination puts on a sterile, clean gown ironed with a hot iron and a cap (scarf) on his head.

Preventive vaccinations are carried out only in medical institutions (polyclinics, first aid stations).

Each vaccination room (point) must have: a refrigerator, a cabinet for instruments and medications, containers with sterile material, a changing table and (or) a medical couch, tables for preparing drugs for use, a table for storing documentation, a container with a disinfectant solution. The office must have instructions for the use of all drugs for vaccinations, as well as a tonometer, thermometers, disposable syringes, ethanol. In case of an unusual reaction or anaphylactic shock, the vaccination room should have anti-shock therapy: 0.1% tavegil solution, 2.4% aminophylline, 0.9% sodium chloride solution, cardiac glycosides (strophanthin, korglykon) , cordiamine, caffeine, hormonal drugs (prednisolone, hydrocortisone).

Vaccinations against tuberculosis and tuberculin diagnostics should be carried out in separate rooms or on specially designated days. In the absence of a separate room, it is carried out on a specially designated table. To accommodate syringes and needles dedicated to BCG vaccines and tuberculin, use a separate cabinet.

It is prohibited to use instruments intended for vaccination against tuberculosis for other purposes. On the day of BCG vaccination, all other manipulations are not carried out.
To carry out preventive vaccinations on the territory of the Russian Federation, vaccines are used that are registered in the Russian Federation and have a certificate from the National Authority for the Control of Medical Immunobiological Preparations - GISC named after. L. A. Tarasevich.

Transportation, storage and use of vaccines is carried out in compliance with the requirements of the “cold chain”.

Preventive vaccinations are carried out medical workers trained in the rules of organization, storage and vaccination techniques, as well as the necessary assistance in the event of the development of post-vaccination reactions and complications.

Seminars on the theory of immunization and the technique of preventive vaccinations with mandatory certification must be visited at least once a year.

Responsible for the organization and carrying out preventive vaccinations is the leader medical institution(at the FAP - paramedic). The procedure for planning and carrying out preventive vaccinations is established by order of the head of the medical institution with a clear definition of the responsible and functional responsibilities of medical workers involved in planning and carrying out vaccinations.

The organization of primary work is based on:

Complete and reliable accounting of the entire population (separately the child population) living in each territory;
availability of medical documentation (form No. 063/u, form No. 026/u, form No. 112/u, etc.);
planning preventive vaccinations for all those subject to vaccination, taking into account the calendar and existing contraindications;
providing the medical institution with all necessary and high-quality vaccine preparations, subject to the rules of transportation and storage;
strict registration of persons who have received vaccinations and serums, as well as new arrivals who do not have preventive vaccinations corresponding to the calendar;
conducting reporting of the immune layer of the population (separately the children's population) - monthly, quarterly, annual. Reliable population registration is a necessary condition
not only for planning preventive vaccinations, but also for organizing the entire preventive work at FAP.

It is advisable to conduct a population census twice a year (spring-autumn); Additionally, changes are made to the lists of arrivals to include arrivals and departures, as well as newborn children.

Upon completion of the population census, the lists are checked against the availability of existing registration forms; if the latter are not available, they are drawn up. The doctor creates a vaccination file for all residents using registration form No. 063/u. It is advisable to arrange the card index alphabetically, by year and by the groups they visit. The vaccination file is stored in a separate office or closet; The paramedic at the FAP is responsible for the completeness and accuracy of maintaining documents.

Scheduling vaccinations for next year carried out by a FAP paramedic or a medical worker responsible for immunization, taking into account the entire population of the district, individual children who are subject to preventive vaccinations according to the plan according to the “Calendar of Preventive Vaccinations” by age, and those who were not vaccinated on time for various reasons.

Upon completion of planning, the total number of people vaccinated in the coming year is calculated, a consolidated plan is drawn up, which is sent to the territorial authorities of sanitary and epidemiological supervision.

Based on the quantitative information contained in the plans about the persons subject to vaccination, an application for vaccine and serum preparations is drawn up.

Vaccination tactics. Methods of administering vaccines
The selection of adults and children for vaccination is carried out by a paramedic at FAPs. Vaccinations are carried out by trained medical personnel.

Before vaccinations, it is necessary to carefully check the quality of the drug, its labeling, and the integrity of the ampoule (vial).

Vaccines cannot be used:

With inappropriate physical properties;
with violation of the integrity of the ampoules;
with unclear or missing markings on the ampoule (bottle);
sorbed vaccines (in particular DTP, ADS, ADS-M), stored or transported in violation of the temperature regime, especially those subjected to freezing;
live (measles, mumps, rubella) exposed to temperatures above 8 °C; BCG - more than 4 g. Celsius. The opening of ampoules, the dissolution of lyophilized vaccines (measles, mumps), and the vaccination procedure are carried out in accordance with the instructions with strict adherence to the rules of asepsis.

The drug in an opened ampoule (vial) cannot be stored!
Instruments for vaccination (syringes, needles, scarifiers) must be disposable and rendered unusable in the presence of the person who was vaccinated or his parent.

When carrying out the vaccination procedure, it is necessary to strictly adhere to the relevant provisions of the “Instructions for use of the drug”.
The vaccination should be carried out in a lying or sitting position to avoid falling due to fainting conditions, which occur during the procedure in adolescents and adults.

When carrying out immunoprophylaxis, the following methods of drug administration are used: cutaneous, intradermal, subcutaneous, intramuscular, enteral, intranasal.

Parenteral administration of drugs (cutaneous, intradermal, subcutaneous and intramuscular method) can be carried out using scarifiers, syringes and needleless injectors. Needle-free injectors provide injection of vaccines and serum preparations with a warm jet through the skin under high pressure. The latter method is painless; they can vaccinate up to 1,500 people in 1 hour.

Before parenteral administration inactivated vaccine the skin of the person being vaccinated in the injection area is wiped with alcohol or ether, and after vaccination is lubricated with 70% alcohol or 5% alcohol solution Yoda.

Intradermal vaccines are administered strictly into the skin. inside forearm or outer side of the shoulder, inserting the needle with the cut downwards at an angle of 10-15 ° C. An indicator of correct administration is the formation on the skin at the injection site of the drug of a small, whitish, clearly defined and dense formation that looks like a lemon peel. When administering the vaccine subcutaneously, the needle is injected at an angle of 45-50 °C into the subcutaneous tissue of the subscapular region or the outer side of the shoulder (thigh), or into the lateral areas of the abdomen. An intramuscular injection of the vaccine is carried out in the upper outer quadrant of the buttock.

Before inoculation of live vaccines applied cutaneously, the area where the skin is supposed to be scarified is treated with alcohol, then with ether. Then apply a few drops of the drug at such a distance from each other as indicated in the Instructions this drug. After this, using the tip of a special scarifier (pen), through the applied drops, shallow incisions are made in the skin to the papillary layer (drops of blood should appear). Then the vaccine should be wiped with the surface of the scarifier, allowed to dry for 5-10 minutes, and the area of the incisions should be covered with a sterile napkin for 45-60 minutes.

When immunizing with enteral vaccines, which are administered through the mouth, liquid and tablet preparations are distributed using a spoon or tweezers, respectively; the polio vaccine is administered through the mouth with a special pipette.

Oral medications are administered to vaccine recipients only in the presence of a medical professional.

For intranasal immunization using a special sprayer, before administering the vaccine to each person being vaccinated, the tip of the sprayer is wiped with 70% alcohol and injected to a depth of 0.5 cm into the nasal passages, previously cleared of mucus.

Violations of the technique or volume of the administered drug can lead to various complications and reactions in those vaccinated.

Monitoring of vaccinated people is carried out in accordance with the instructions for the use of drugs in the first 30 minutes after administration, since at this time the development of immediate reactions, including anaphylactic shock, is theoretically possible. Next, vaccinated children are monitored according to the appropriate calendar of preventive vaccinations after 24 hours, 48 and 72 hours, after the administration of live vaccines - on days 5-6 and 10-11. BCG vaccination observation is carried out until 9 months of age with a description of general and local manifestations. If the frequency and intensity of general local reactions or the occurrence of unusual reactions, vaccinations with drugs in this series are stopped and this is reported to the territorial sanitary and epidemiological surveillance authorities.

According to the Law of the Russian Federation on the sanitary and epidemiological welfare of the population, vaccinations against tuberculosis, polio, diphtheria, tetanus, whooping cough, measles, and mumps are mandatory. Vaccinations are also required for some professional groups in the case of an increased risk of infection for a worker in contact with its source, as well as in the case of a danger of mass spread of infection by a worker (for example, in a catering department).

A number of vaccinations are mandatory for citizens traveling abroad, especially to countries with hot climates or epidemiologically disadvantaged countries.

Legal approach to immunoprophylaxis

The legal approach to immunization involves a combination of the rights, duties and responsibilities of the individual and the state; These principles, reflected to varying degrees in the legislation of many countries, provide for the following:

All citizens are provided by the state with the opportunity to receive all necessary vaccinations free of charge, as well as receive information about the nature of the vaccination, its effectiveness, possible situations, etc. Vaccinations are carried out only with the consent of the person being vaccinated or his parents (guardians), and the state guarantees free medical care, which may be needed in case of a reaction or complication;

Every citizen has the right to refuse vaccination for himself or his child (with the exception of vaccination against especially dangerous infections carried out for epidemiological reasons), which he must record in writing; if he refuses to sign, at least 2 health workers do this;

If an unvaccinated person (or his child) becomes ill with a corresponding infection, he is not paid for days of incapacity for work. Unvaccinated children are not allowed into children's institutions, health camps and educational establishments, since they can be sources of epidemic outbreaks. Provides manufacturer liability related to
with the quality of the drug. Medical workers conducting vaccinations are responsible for correctly determining indications and contraindications, for achieving the required vaccinations, as well as for the correct storage of drugs, as well as for the technique of administering the vaccine and monitoring vaccinated children according to the instructions.

Before vaccination, all vaccinated persons are examined by a paramedic in order to identify persons for whom it is contraindicated. Before the examination, thermometry is required, and, if necessary, preliminary laboratory tests and consultations with specialists. Mass-use vaccines have a minimum of contraindications and can be used without special examination.