"DT VAX" (diphtheria, tetanus) France

Despite the anti-vaccination movement, many myths and controversies surrounding vaccinations, vaccination still remains the most reliable and effective protection against dangerous infections.
Our country has a National Calendar of Preventive Vaccinations, but it lists only the minimum that parents can provide for their baby. Some very important vaccines still remain “overboard” from the national calendar. Such vaccinations are called additional and are given at will, but this in no way detracts from their importance and usefulness. This category includes vaccinations against rotavirus infection, chickenpox, hepatitis A, meningococcal infection, tick-borne encephalitis, and human papillomavirus (HPV). Some very important vaccines still remain “overboard” from the national calendar
“These dangerous infections are either difficult to treat or there is no treatment for them at all. They are often found in Russia and abroad. And here every person has a choice: to get sick or not to get sick,” notes Danil Nikolaevich Khlebnikov.

Question of finance

A reasonable question arises: if these vaccinations are so important, why are they not included in the national calendar? “This is due to the financial component; after all, vaccines are not cheap,” answers Danil Nikolaevich. We are talking about the limited financial capabilities of the state. These vaccinations are not included in compulsory medical insurance and therefore are not standard at the national level.

Nevertheless, Russia already has experience in moving vaccinations from the category of optional to mandatory - this is vaccination against pneumococcal infection. “It has successfully entered the national calendar and gives very good results, provides prevention of purulent otitis and meningitis, pneumonia,” emphasizes Danil Nikolaevich.

Meningococcal infection, although rare, is a very scary infection. It leads to the child's immediate death or brain damage. In St. Petersburg, 100-200 cases of meningococcal infection are registered per year.

What not to do after vaccination

Healthy children do not need to take any medications (antihistamines, antipyretics) after vaccination. On the day of the injection, it is not recommended to bathe the child; the next day you can wash without rubbing the injection site. In the first 2-3 days, you should not visit crowded places with your child (circus, cinema, shopping centers). It is important not to overheat or overcool the baby, and to dress according to the weather when walking.

In the next 2-3 days after the injection, there is no need to introduce new foods to rule out allergies; it is important not to overfeed the child and give plenty of fluids.

Rotavirus and chickenpox

Unfortunately, many parents do not take vaccinations against chickenpox or rotavirus seriously, believing that these infections are not so dangerous and scary and are quite easily tolerated by children. The pediatricians at our clinic do not agree with this approach.

“Rotavirus infection is perhaps one of the most severe viral intestinal infections with high mortality among children under three years of age. “There is no antiviral therapy against it. Clinically manifested by very high fever, uncontrollable vomiting and diarrhea. Rapid dehydration occurs, and children often end up in intensive care. This vaccination is done at an early age, from two to seven months,” notes the doctor.

After chickenpox, children often start to get sick longer

There is a treatment for chickenpox. But you have to sit at home for 10 days, not go anywhere, the only entertainment is a photo shoot with a “spotted” child.

After chickenpox, complications arise, and the most common of them is secondary infection. There are many cases where adults who had chickenpox fell ill again and suffered the disease very seriously. Another complication is chickenpox encephalitis, which is very difficult and is treated extremely poorly.

“But it’s not just about complications. The causative agent of chickenpox is human herpes virus type 3, and, like all herpes viruses, it causes long-term immunodeficiency. That is, after chickenpox, children begin to get sick longer and more severely: ordinary snot often ends with bacterial complications in the form of purulent rhinitis, otitis, pneumonia, bronchitis. And this pleasure lasts for about six months - usually until the summer, when everyone relaxes, goes to the sea, gains strength and the immune system is restored, explains Danil Nikolaevich. – Your child can be protected. After proper vaccination, the risk of infection is one percent.”

Measles-rubella-mumps vaccination

Young children should be vaccinated exactly at one year of age and again at the age of six. Revaccination of children at 6 years of age is necessary for the reason that not every body develops stable immunity from one vaccination.

In the future, revaccination is carried out at the age of 15-17 years in order to prevent serious health consequences:

1. It is extremely necessary to extend protection against rubella for women planning pregnancy before pregnancy, since this disease is the most dangerous for this process.
2. Immunity against measles acquired in childhood must be reactivated by receiving a new dose of the vaccine.
3. It is important to prolong protection against mumps for men, since it is during adolescence that all the negative consequences for male reproductive function can occur when suffering from this infection.

In childhood, multicomponent vaccination is tolerated quite easily, the body rarely reacts to vaccination with severe conditions, and protection is fully formed. If a child was not vaccinated in early childhood, then he must receive the first vaccine at 13 years of age.

In modern medicine, there is a clear prescription for vaccination of adults with the above vaccine. For example, for those people who were born before 1957, vaccination is not indicated due to the fact that in all the years before, epidemics of this disease broke out everywhere, and people with a 90% probability have already suffered from the disease. All those who were born after 1957 and have not been vaccinated are recommended to receive two doses of a live vaccine, administered at intervals of 1 calendar month. This prescription is intended for adolescents, but 1 dose of vaccine is recommended for older adults.

For young women, the main goal should be mandatory vaccination against rubella, since this is the disease that has a very bad effect on the child if you get it during pregnancy. Rubella in the first 90 days of pregnancy often causes miscarriages and stillbirths. Other negative consequences include the birth of a child with congenital rubella syndrome, which is accompanied by the presence of developmental anomalies such as heart disease, cataracts and deafness. This syndrome may be accompanied by mental retardation, liver damage, kidney damage and other serious diseases.

An important point is the fact that the course of rubella can be in a latent form. In this case, the woman feels great, not paying attention to the minor rash, which goes away on its own after a few days. Meanwhile, the virus penetrates the placenta into the fetus, affecting all vital organs and systems. If a pregnant woman is suspected of having latent rubella, doctors carry out several stages of laboratory testing, the results of which should demonstrate the production of antibodies to this disease. If this occurs in the early stages, it is recommended to terminate the pregnancy to avoid the birth of a child with multiple deformities.

That is why, before planning a pregnancy, women who have not been ill should definitely take care of the appropriate vaccination, which protects against the disease 100% for the next 15 years. After vaccination, it is necessary to protect against pregnancy for another month.

Pregnant women are not specifically vaccinated, but sometimes vaccination occurs already during pregnancy. At the same time, the risk of intrauterine damage to the fetus is very low. As a rule, no changes in fetal development occur when vaccinated against rubella, which has been confirmed by numerous studies.

Myths around the HPV vaccine

Some parents refuse the HPV vaccine because they believe the vaccine causes infertility or cervical cancer. Pediatrician Danil Nikolaevich Khlebnikov refutes this myth: “There is no scientific evidence for this. The only disadvantage of the vaccine is its cost. Unfortunately, it's expensive."

But the vaccine provides protection against several types of the HPV virus, which are associated with a high risk of developing cervical cancer. The vaccination should be done before the onset of sexual activity, both for girls and boys. Men are not afraid of this type of cancer, but they often carry HPV and infect women. In Moscow, schoolchildren are vaccinated at the expense of the local budget. In St. Petersburg this has been done for several years, but not systematically - the city government does not have enough funds.

We begin all additional vaccinations, except for rotavirus, after one year.

Types of vaccines

The vaccine against the viruses in question comes in several types. The type of vaccine chosen by the doctor differs from analogues in the types of viruses included in the drug. All modern injections consist of typed viruses, which contribute to the guaranteed development of immunity to diseases. The vaccine is three-component, two-component and mono-, which indicates the complete interchangeability of injectable drugs with each subsequent revaccination.

Mono-vaccines

Ervevax

The Belgian monovaccine Ervevax helps fight the rubella virus, developing immunity within 15 days from the date of its administration. The effect of Ervevax lasts for 16 years. The vaccine can be used for children from 1 year of age.

Ervevax can be administered on the same day with DPT, DPT, polio, measles and mumps vaccines, provided that vaccination is performed in different parts of the human body. With other live vaccines, Ervevax can be administered with an interval of at least 1 month between injections.

Contraindications for the use of Ervevax:

• pregnancy;
• hypersensitivity;
• HIV infection;
• use of endogenous immunostimulants before vaccination with Ig preparations;
• acute and aggravated chronic diseases;
• allergic reactions to vaccine components.

Women of childbearing age can be vaccinated with Ervevax only if they do not plan to conceive a child within the next 3 months after vaccination.

Rudivaks

The French live attenuated rubella vaccine Rudivax forms appropriate immunity 15 days after injection. This immunity against rubella in humans lasts about 20 years. Contraindications to the use of this vaccine are the same factors as for Ervevax vaccination.

Measles cultural live dry vaccine (Russia)

The measles cultural live dry vaccine produced in Russia has a pronounced ability to stimulate the production of antibodies against measles in 95% of vaccinated people 28 days after administration. Immunity from vaccination lasts for 18 years.

Contraindications to the use of this vaccine are:

• acute and chronic diseases;
• HIV infection;
• neoplasms, malignant diseases of the circulatory system;
• allergy to aminoglycosides and quail egg protein.

Measles mono-vaccination is carried out at least 60 days after other vaccinations, and also no earlier than 90 days after and 2 weeks before the use of immunoglobulin or medications containing antibodies.

Ruvax (Aventis Pasteur, France)

The single-component French anti-measles drug Ruvax causes immunity against the virus 15 days after administration. This immunity lasts in the body for 20 years. The drug can be vaccinated in children from the age of nine months.

Contraindications to the use of Ruvax are:

• allergy to chicken egg white and neomycin;
• leukemia and other malignant diseases;
• immunodeficiency;
• corticosteroid, alkylating and antimetabolic therapy;
• radiation therapy;
• administration of immunoglobulin on the eve of vaccination.

LPV (live mumps vaccine)

The live mumps vaccine is designed to protect the body from mumps. The vaccine is administered from the age of 12 months. Emergency administration of the drug is possible to those who have been in contact with a patient with mumps (mumps) and have not been vaccinated before, no later than three days after such contact. Contraindications for VPV vaccination are the same symptoms and conditions as for Ruvax vaccination. You should also not vaccinate with VPV during pregnancy and breastfeeding.

Combined three-component vaccines

MMR II (measles, rubella, mumps)

The three-component American vaccine MMR-II is quite popular because it forms immunity to 3 viruses at once - measles, rubella and mumps. With its help, antibodies to the measles virus are produced in 98% of people, and to mumps and rubella - in 96.1% and 99.3%, respectively. It is compatible with DTP, DPT, polio, Haemophilus influenzae type B and chickenpox vaccines. These injections can be done on the same day, but in different parts of the body.

Contraindications to the use of MMR-II are pregnancy, sensitivity to neomycin, chicken proteins, HIV infection, viral and chronic diseases in an acute state.

Priorix (measles, rubella, mumps)

The Belgian three-component vaccine Priorix is ​​very effective against measles, mumps and rubella. This vaccine is highly purified, making reactions to its administration less pronounced than to other similar vaccines.

Among the main contraindications to the use of Priorix, doctors identify:

• high sensitivity to chicken egg white and neomycin;
• neomycin contact dermatitis;
• HIV infection;
• ARVI, acute stomach diseases;
• exacerbation of infectious, viral and chronic diseases;
• pregnancy.

Two-component drug

Among two-component vaccines, the most common are domestic vaccines - mumps-measles and measles-rubella vaccine. It is important to remember that when vaccinated with these drugs, it will be necessary to carry out additional vaccination with a single-component vaccine against a disease that is not covered by this vaccination.

Mumps-measles vaccine (Russia)

The domestically produced mumps-measles vaccine can be administered to children from the age of 12 months to form stable immunity to mumps and measles. Revaccination with this drug is prescribed upon reaching the age of 6 years.

Among the main contraindications for the use of this two-component vaccination are:

• anaphylactic and allergic reactions;
• neoplasms and malignant diseases of the circulatory system;
• severe reactions to previous vaccination with such a drug;
• pregnancy and breastfeeding;
• acute viral or exacerbated chronic diseases.

Measles-rubella vaccine

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This vaccine has all the same properties as the domestically produced mumps-measles vaccine. It requires the additional introduction of a monovaccine against mumps for comprehensive protection of the human body.

Hepatitis A in St. Petersburg?

Hepatitis A, “jaundice,” is an acute infectious disease of the liver. It is generally accepted that hepatitis A is mainly characteristic of developing countries with hot climates and a lack of clean sources of drinking water.

Is this so, says Danil Nikolaevich: “We had an outbreak of hepatitis A in St. Petersburg in 2003-2004. Children were brought to the emergency room of the hospital where I worked in an ambulance, five people at a time, and put in a box, all of them were yellow,” - the doctor recalls. – This virus is transmitted as an intestinal infection, mainly through water, of course. We are all traveling now - we go on vacation to our south, to Turkey, where hepatitis A can also be present. There is a risk of infection, but there is no treatment. Yes, the prognosis is favorable, but the person loses life for about three to four weeks. This is a whole month of productive life! Why not just get vaccinated and not get sick?”

As far as I can remember, not a single case of post-vaccination complications has been registered with the hepatitis A vaccine. Although any administration of the drug can theoretically cause natural pathological reactions due to individual intolerance. This, unfortunately, happens with any drug, even an intramuscular antibiotic: until you do it, you won’t know whether there will be a reaction or not.”

Preparations for vaccination

In our country, imported (Priorix, MMR-II) and domestic trivaccines are used. They contain laboratory-cultivated, live and weakened viruses from three infections. According to indications, a divaccine (against two infections) or vaccinations against only one disease can be administered. Drugs can be imported or domestic.

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6605874/ Hervé Haas, Patrick Richard, Cécile Eymin, Anne Fiquet, Barbara Kuter and Benoit Soubeyrand. Immunogenicity and safety of intramuscular versus subcutaneous administration of a combined measles, mumps, rubella, and varicella vaccine to children 12 to 18 months of age // Hum Vaccin Immunother. 2019; 15(4): 778–785.
2. I.L. Solovyova, E.A. Alexandrova, E.M. Lezhen, O.V. Anosova, A.A. Solovyova. Vaccinal prevention of measles and mumps in children in modern conditions // Ulyanovsk Journal of Medical Biology, 2013, No. 4, pp. 47-53.
3. N.V. Yuminova, E.O. Kontarova, N.V. Balaev, S.V. Artyushenko, N.A. Kontarov, N.V. Rossoshanskaya, E.S. Sidorenko, R.R. Gafarov, V.V. Zverev. Vaccinal prevention of measles, mumps and rubella: objectives, problems and realities // Epidemiology and Vaccinal Prevention, 2011, No. 4(59), pp. 40-44.

When to do it

“We start giving all additional vaccinations, except for rotavirus, after a year. The most optimal solution is to make the main mandatory calendar up to a year and then gradually begin to do additional vaccinations. You can do it in a year, just before entering kindergarten. Because when children start going to kindergarten, they, logically, begin to get sick. Against the background of an acute condition, ARVI, no vaccination can be done. Some “snots” smoothly flow into others throughout the season. Accordingly, vaccination is almost impossible,” explains Danil Nikolaevich.

Misconceptions, disputes and myths

There are many misconceptions, disputes and myths associated with vaccination – both mandatory and additional.

EMS Clinic pediatrician Danil Nikolaevich Khlebnikov refutes the most popular of them:

Myth No. 1: After vaccination, a child’s immunity decreases.

Parents sometimes say: “We got vaccinated and started getting sick all the time.” It's a delusion. Numerous studies have not revealed a negative effect of modern vaccines on the immune system; on the contrary, in fact, vaccines strengthen the immune system: the child is protected against dangerous diseases. We have cells that are responsible for the immune response. When we administer a vaccine, a protein is produced, immunological memory appears, the cells themselves are not destroyed, and other proteins - that is, immunological memory in relation to other infections - will also work perfectly

Myth No. 2: Vaccinations cause cerebral palsy and autism

It is important to understand that there are under-examined children. Until three or four months, it is sometimes difficult to say that a child has cerebral palsy, because the reflexes are alive, the child eats, assimilates everything, develops normally, and it is sometimes difficult to say anything specific. They got vaccinated, and the child became disabled - this, of course, cannot happen. And there is definitely no connection between autism and vaccination; there have also been many studies on this matter.

Scientific research suggests that administering multiple vaccines at the same time does not have a negative effect on a child's immune system.

Myth #3: Vaccinations cause disease.

For example, if you were vaccinated against rotavirus infection and fell ill, this also cannot happen; you cannot get sick from a vaccine. Some vaccines that were used in the past could, although very rarely, cause the disease - for example, the live polio vaccine. Modern vaccines are killed or very weakened, and they cannot cause disease.

Vaccine injection site

The complex vaccine is administered in two ways - subcutaneously or intramuscularly. Children under three years of age are most often vaccinated in the outer thigh, and subsequently in the deltoid brachialis muscle.

The choice of such places for vaccination is explained by the fact that here the skin is very thin, there is little subcutaneous fat and the muscles are very close. When the vaccine gets into the fatty layer, it is deposited, enters the blood slowly and subsequently does not have the desired effect.

The buttocks are also not suitable for vaccine administration due to the inaccessibility of the gluteal muscles for the vaccination needle, due to the developed subcutaneous fat in these areas.

Preparation, contraindications, reactions

No special preparation is needed for vaccination, you just need to consult a pediatrician. “The main contraindication is an acute condition, that is, a state of illness. Plus, after the end of the illness, some time must pass to make sure that the child has fully recovered; this sometimes happens very individually. After a common acute respiratory viral infection, the medical withdrawal from vaccination is two weeks, after a severe infection, such as tonsillitis, pneumonia, one month. Again, there is no clear regulation anywhere,” says Danil Nikolaevich.

There are also neurological contraindications. Usually the pediatrician and parents know that neurological pathology can exist. The child is under observation for a month, and the neurologist gives a conclusion - either he is allowed to undergo vaccination, or it is postponed for some reason.

“It would be wrong to talk about side effects. There are reactions to vaccination. For example, pathological - anaphylactic shock upon drug administration. Unfortunately, this happens, although it is extremely rare. And until you get vaccinated, you won’t know about it. You can also drink an antipyretic and get anaphylactic shock due to some component, or eat something and get Quincke's edema, explains the pediatrician. – In addition, after administration of the drug, body temperature may rise - this cannot be considered a pathology, this is a normal reaction. Painful sensations and infiltration at the injection site may occur - all this happens, but rarely, and this can be considered a normal reaction to the vaccine.”

Contraindications to vaccination against measles, rubella, mumps

Among all contraindications to vaccination against measles, mumps and rubella, there are 2 main groups - temporary and permanent.

Temporary specialists include:

• the presence of any diseases in the acute period;
• pregnancy period;
• use of gamma globulin and other blood products;
• vaccination or testing for antibodies to tuberculosis.

All these factors do not eliminate the need for vaccination, but require a short time period (on average 2 to 6 weeks) until the body’s condition stabilizes.

Among the constant and absolute contraindications, in which measles-rubella-mumps vaccination is impossible in principle, are:

• allergy to gentamicin, neomycin;
• allergy to egg whites;
• Quincke's edema;
• neoplasms of various types;
• the occurrence of complications due to previous vaccination;
• blood diseases accompanied by thrombocytopenia;
• HIV infection;
• various damage to the immune system (for example, the period after transplantation of any organs).

All or just some?

“All of our children are at risk. How can they not be at risk in such climatic conditions? All children go to kindergarten, to the playground, and communicate with each other,” emphasizes Danil Nikolaevich.

Despite all the controversy and controversy, vaccination is the only reliable way to protect against dangerous infections. A combination of mandatory and additional vaccinations will protect your child’s health to the maximum. We must take advantage of the fact that science has already invented these vaccines. “The latest example is the COVID-19 coronavirus pandemic. It keeps everyone in fear and has radically changed our way of life. If there was a vaccine, no one would be afraid, everyone would be vaccinated and there would be no problems,” emphasizes Danil Nikolaevich.

“Additional” vaccinations and vaccination dates