Vaccination with preventive vaccinations of persons subject to conscription for military service

"I have seen cases

when a person felt good at breakfast,

and by lunchtime he was already dead!

Dr Clayton Golledge, microbiologist, infectious disease specialist, USA.

Meningococcal infection is an acute infectious disease caused by the bacterium Neisseria meningitidis. The severity of meningococcal infection ranges from nasopharyngitis to fulminant sepsis, leading to death within a few hours.

In Russia, the incidence averages 5 per 100 thousand population per year, which is a fairly high figure. The highest prevalence of meningococcal infection in the world occurs in Central Africa, China, and South America (the so-called “meningitis belt”), where large epidemics of this disease regularly occur. Outbreaks of infection occur mainly in conditions of unsanitary conditions and crowded populations.

Meningococcal infection is characterized by seasonality - the incidence is highest in winter and early spring, because The immune system during this period is weakened by the entry into the body of a large number of viruses, which are also activated at this time of year - ARVI, influenza, etc. In addition, hypothermia is an important trigger for the development of meningococcal infection.

The only carrier of the bacterium Neisseria meningitidis is humans.

The infection spreads through airborne droplets and through direct contact with a patient or carrier. The incubation period averages 3-4 days, but can vary from 2 to 10 days. In the fulminant form of the disease, symptoms develop within a few hours from the moment the meningococcal infection enters the body.

The most common target for menigococcal infection is children under 5 years of age. The immune system of children at this age is not fully formed; In addition, children tend to touch their mouths with unwashed hands and various objects; they still poorly observe the rules of general hygiene, such as covering their mouths when coughing and sneezing, and regularly washing their hands. In addition, the spread of infection is facilitated by preschool institutions, where children closely interact with each other while playing and eating.

The mildest form of the disease is meningococcal nasopharyngitis, which symptomatically occurs as an uncomplicated acute respiratory viral infection, and therefore is often not diagnosed. At this stage, the disease may end, after which the infection becomes asymptomatic carriage, which occurs in 8-25% of patients. However, bacteria often enter the bloodstream and cause meningococcemia (or meningococcal sepsis). In this case, bacteria rapidly multiply in the blood and cause disruption of the blood coagulation system, which leads to hemorrhages in the skin and internal organs, and often ends in death. Meningococcal sepsis can be complicated by meningitis. Meningitis is an inflammation of the meninges that cover the brain and spinal cord. Meningitis is not only meningococcal - other bacteria (pneumococcus, staphylococcus, Haemophilus influenzae type B) can cause inflammation, and viral and fungal forms of meningitis also occur. Meningococcal infection has an increased tendency to affect the meninges.

Manifestations of meningococcal infection are insidious and deceptive. The first symptoms are often nonspecific; making a correct diagnosis at the initial signs of the disease can be extremely difficult. However, when a detailed picture of the disease appears, the patient often cannot be saved. There are three forms of meningococcal infection, each of which can occur independently, or have a sequential development - from nasopharyngitis to bacteremia (sepsis) and meningitis.

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About 1 in 10 people who contract meningitis die, and up to a quarter are left with lifelong complications, including amputations and deafness.

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Symptoms characteristic of menigococcal nasopharyngitis (similar to the symptoms of ARVI):

• Increase in body temperature to febrile levels (on average up to 38-38.5ºС)
• Phenomena of rhinitis
• A sore throat
• Headache
• Pale skin
• General weakness.

Among the above symptoms, it is extremely important not to miss a sharp deterioration in the condition, which usually develops in the shortest possible time.

Symptoms characteristic of meningococcal meningitis (50%):

• Fever that does not respond well to antipyretics and headache (flu-like symptoms)
• Stiffness of the neck (neck) muscles
• Nausea, vomiting
• Photophobia
• Impaired consciousness, confusion and disorientation
• Cramps.

Symptoms characteristic of bacteremia (sepsis), including meningococcemia (37.5%):

• Fever
• Petechial and purpuric rash (usually begins on the lower extremities)
• Hypotension
• Shock
• Multiple organ failure
• Death can occur within the first 24 hours from the onset of the first symptoms.

  About 10% of people with meningococcal infection die, and 20% experience disabling complications. The basis of effective treatment is early diagnosis of the disease; prevention also plays an important role, in particular, vaccination against meningococcal infection.

According to WHO recommendations, one of the recommended approaches to the prevention of meningococcal infection is primary mass vaccination of all children and adolescents aged 9 months to 18 years, followed by inclusion of the vaccine in the routine childhood immunization program. In countries with lower incidence (<2 cases/100 thousand people per year), vaccination against meningococcal disease is recommended only in certain risk groups:

• children and adolescents in closed institutions, i.e. boarding schools, military camps;
• bacteriology laboratory workers at high risk of exposure to meningococci;
• Travelers to highly endemic regions of the world should be vaccinated against serogroups common in those regions.

At Children's Medical, you can protect your child from a dangerous disease with Menactra.

Manufacturer: Sanofi Pasteur, France.

Compatibility with other vaccines

Menactra was administered concomitantly with a polysaccharide typhoid vaccine and with an adsorbed tetanus and diphtheria toxoid vaccine for use in adults (Td) in persons aged 18–55 years and 11–17 years, respectively. The BCG vaccine should not be used simultaneously with the Menactra vaccine. Vaccines must always be administered to different parts of the body, using separate syringes for each of them.

Administering several vaccines on the same day does not place an excessive burden on the immune system. All vaccines in the Russian national vaccination calendar are interchangeable.

What vaccines against meningococcal disease exist?

Meningococcus has many serotypes (subspecies) - more than 10, and there is no universal vaccine against them. The epidemic serogroups are considered the most dangerous: A, B, C, D, W-135 and Kh. V. S. Kovalev in the same interview notes an increase in the incidence of the W-135 group, affecting not only children, but also young adults in crowded groups (institutes, hostels, in the army), where the infection rate is, for obvious reasons, higher.

There are only three vaccines in the world that protect against meningococci: Nimenrix, Menactra and Bexero. At the same time, only Bexsero protects against serotype B, which accounts for up to 25% of all cases of meningococcal infection, and it is not certified in Russia. Doctors strongly recommend that parents vacationing with children in Europe vaccinate their children there.

But, in addition to serotype B, there are also vaccinations against equally dangerous serotypes A, C, Y and W-135. The most famous of them is the American Menactra. Fortunately, it is available in Russia - although they are not included in the National Calendar due to their high cost. Vaccination with Menactra in public clinics is possible only in emergency cases, for example, after contact with a patient. In other countries, for example, in the UK, Germany, Holland and the USA, this vaccine is on the National Calendar.

Personal application experience

At the Sanare clinic, patients (children) aged 9 months and older were vaccinated with Menactra. The vaccine was well tolerated. There were no complaints in the post-vaccination period. (All patients at the clinic were called and interviewed by a nurse the next day).

The first to be vaccinated with the drug "Menactra", after its arrival at the clinic, were pediatricians, clinic staff, as well as their children (aged from 2 to 11 years). The drug was also well tolerated.

When are anti-pneumococcal vaccinations against meningitis given to adults and children?

Many countries implement mandatory immunization of patients against pneumococcal infection. Since the beginning of the year, in the Russian Federation, such immunization has been included in the national vaccination calendar. Vaccination allows the body to receive the antigen in a safe minimum amount, which eliminates the possibility of a full-blown disease in the future.

In our country, vaccination is carried out using two types of serum: Pneumo-23 and Prevenar. Both of these drugs are characterized by the absence of side effects and high efficiency. The Prevenar vaccine can be administered to children over three months of age. Pneumo-23 is administered to children over 2 years of age.

How is vaccination carried out?

Vaccination is carried out in a vaccination room, in compliance with all sanitary requirements. All drugs are certified. A certificate for the drug is provided upon request.

Without reminders, before vaccination, the medical worker must show the drug and the expiration date of the vaccine.

Only sterile and disposable instruments are used. The vaccination must be carried out using disposable medical gloves.

On the day of vaccination, the child is examined by a pediatrician and the temperature is measured. In the absence of contraindications, vaccination is carried out. Information about the vaccination performed is entered into the card, vaccination certificate, and detailed recommendations for caring for the child in the post-vaccination period are given.

Before vaccination, the doctor will answer all your questions. Be sure to bring information about previous vaccinations to your appointment!

Please note that vaccination of a child, Mantoux test, Diaskintest can only be carried out in the presence of parents or legal representatives of the child (guardians), or if the accompanying person has a NOTARIZED power of attorney to carry out the manipulation (indicating the drug planned for administration) . Otherwise, vaccination will be denied. We comply with the laws of the Russian Federation.

Only here!

What is meningococcal infection?

Meningococci are the bacteria Neisseria meningitidis that cause meningococcal disease. Contrary to popular belief, meningococcal disease is not the same as meningitis, although both are extremely dangerous diseases. Meningitis, or inflammation of the meninges, can be caused by meningococci, pneumococci, or even Haemophilus influenzae. Unfortunately, it is meningococcal meningitis that causes the greatest number of deaths. In the so-called “meningitis belt” of West Africa, it accounts for 80% of all meningitis cases.

But meningococcal infection does not necessarily manifest itself as inflammation of the meninges. Bacteria can cause mild forms of infection, for example, nasopharyngitis (this is a standard sore throat and stuffy nose, as with ARVI), and very severe ones, for example, meningococcemia (sepsis, that is, blood poisoning). It happens that the disease develops at lightning speed and cannot be stopped. It is most dangerous for children.

Vaccination against pneumococcal infection

The third large group of microbes that cause purulent meningitis are pneumococci. They are also causative agents of severe pneumonia, joint damage, and purulent otitis media. Pneumococci are transmitted by airborne droplets from people sick with various forms of pneumococcal infection and its carriers. Young children, patients with immunodeficiency conditions, including HIV infection, and people over 65 years of age are most susceptible to the disease.

Pneumococcal pneumonia accounts for up to 50% of all pneumonia. As a result of this disease, several segments or lobes of the lung are affected, and the entire organ as a whole may be affected—the so-called lobar pneumonia. Often these problems are accompanied by damage to the pleura (pleurisy).

In the structure of bacterial meningitis, pneumococcus accounts for 20-30%. Purulent pneumococcal meningitis has common features with other bacterial meningitis, but is distinguished by its frequent combination with pneumonia, cardiac complications and the severity of residual conditions, such as impaired mental development, deafness, etc.

Recently, an increasing number of pneumococci have become insensitive to antibiotics, which complicates treatment and makes it more expensive.

When is vaccination necessary?

It is worth emphasizing that for infants and older children the indications for vaccination are almost the same. Doctors recommend using meningococcal conjugate vaccine (Menactra or Menveo) for children 2 months to 10 years of age if they:

• have a rare type of disorder (deficiency of certain components);
• are taking a medicine called Soliris;
• have problems with the spleen;
• have HIV;
• travel or live in countries where the disease is most common;
• belong to a portion of the population identified as “increased risk” due to an outbreak of meningococcal serogroup A, C, W or Y.

These same factors may determine the vaccination of older children and adults.

Vaccination against Haemophilus influenzae

Haemophilus influenzae infection (Hib infection) is caused by Haemophilus influenzae type B. It can cause purulent meningitis, pneumonia (inflammation of the lungs), epiglottitis (inflammation of the epiglottis), arthritis (inflammation of the joints), as well as purulent damage to the entire body - sepsis. Haemophilus influenzae infection is characterized by severe course and complications. It is easily transmitted by airborne droplets when talking, sneezing, coughing, especially among children under five to six years of age. In some of them, the microorganism may not cause disease, but remains living in the nasopharynx (these are healthy carriers). Such children will be a source of infection for other children who may develop a serious illness.

The most severe form of Haemophilus influenzae infection is purulent meningitis .

According to some data, in Russia, in children under 6 years of age, up to a third of all cases of purulent meningitis are caused by Haemophilus influenzae type B.

The disease begins with high temperature (up to 39-40 ° C), chills, fever, and severe malaise of the child. Sometimes unusual drowsiness, headache, and vomiting occur. In children under 1 year of age, the equivalent is loud crying (due to headache) and bulging fontanel. These symptoms are caused by increased intracranial pressure due to inflammation of the meninges. Symptoms increase over several days, and the condition becomes extremely severe.

The disease can occur as isolated meningitis, or with damage to other organs (joints, lungs), and sepsis may develop. Haemophilus influenzae meningitis is difficult to treat because its causative agent produces enzymes that make it resistant to antibiotics (about 20-30% of Haemophilus influenzae bacilli isolated from patients are insensitive to many antibiotics). Therefore, treatment results are not always successful, and mortality in severe forms of the disease can reach 16-20%. A third of patients who have had hemophilic meningitis develop irreversible neurological complications - seizures, delayed neuropsychic development, deafness, blindness, etc.

Pneumonia caused by Haemophilus influenzae type B occurs mainly in children from 2 to 8 years of age, and its course in 60% of cases also has various complications, including those affecting the heart and lungs. Hemophilus influenzae infection is associated with up to half of all purulent infections of the ear, throat, and nose, in particular recurrent purulent otitis (inflammation of the ear) and sinusitis (inflammation of the paranasal sinuses), as well as frequent acute respiratory diseases in children. In recent years, it has become known that sensitivity to this microbe is increased in children with chronic bronchopulmonary pathology and bronchial asthma provoked by infections.

Due to the severity of the course, the variety of clinical manifestations, the large number of complications, high mortality and insufficient effectiveness of treatment of hemophilus influenzae infection, a program for its prevention through vaccinations was developed. The World Health Organization recommends vaccination against Haemophilus influenzae for all children. This immunization is carried out in more than eighty countries around the world, and in countries with mandatory vaccination, hemophilus influenzae infection has been practically eliminated. The effectiveness of vaccination is estimated at 95-100%. In Russia, this vaccination is not included in the routine vaccination calendar. One of the reasons is the high cost of foreign vaccines registered in our country and the (currently) lack of domestic analogues. However, given the danger of meningitis to life and health, parents should think about vaccinating their child against this infection.

Reaction to vaccination against meningitis in children

In children, reactions to the meningitis vaccine may include:

• fever, chills, increased body temperature not higher than 37.50C;
• drowsiness;
• feeling of muscle soreness;
• local reactions in the form of swelling in the injection area, redness or mild rash.

Adverse reactions should subside within two days; the lump in the injection area completely disappears after 14 days. If symptoms do not disappear, you should immediately seek help from a doctor.

You can get advice and make an appointment with a neurologist by calling the Yusupov Hospital.

Immunization schedules against meningococcus

Vaccines against meningococcus are recommended for administration to people in areas of infection, as well as for routine use in children over 18 months, adolescents and adults living in areas with high incidence rates or traveling to such regions. Also, vaccination against meningococcal infection is necessary (according to WHO recommendations) for mass vaccination during epidemics caused by meningococci of groups A and C.

Domestic vaccines - MENINGOCOCCAL A, A + C - are used from 18 months, and are also administered to adolescents and adults. These drugs can also be administered to children under 18 months of age if there is a sick person in the family, or depending on the epidemic situation in the region, but this measure does not create long-term, lasting immunity, and vaccination must be repeated after 18 months.

The vaccine is administered once, subcutaneously under the shoulder blade or in the upper third of the shoulder. Children from 1 to 8 years old - 0.25 ml of the dissolved drug, and older children and adults - 0.5 ml.

The MENINGO A+C vaccine is administered to children from 2 years of age and adults, 0.5 ml once, subcutaneously under the shoulder blade or in the upper third of the shoulder. Children from 6 months. You can use this vaccine if there is a sick person in the family, but the effectiveness will be less high and repeated vaccinations will be required. Six-month-old babies, if they are taken to an area dangerous for meningococcal meningitis, must be vaccinated no later than two weeks before departure so that immunity has time to develop. Children over 6 years of age and adults can be vaccinated immediately before departure.

Children vaccinated before 2 years of age are given a second dose after 3 months and then given another vaccination - once after 3 years.

When vaccinating children over 2 years of age, the effectiveness of vaccination reaches 85-95%, and after 3 years a single revaccination is recommended to maintain immunity. In adults, after a single immunization, protection lasts for 10 years.

In regions where the incidence of meningococcal meningitis is episodic, there are groups of children and adults who must receive this vaccination. These are patients with a removed spleen, with immunodeficiencies, including AIDS patients, and people with anatomical defects of the skull. If there is a high risk of the disease, even pregnant women are vaccinated.

There are no permanent contraindications for vaccination. Temporary - the same as for hemophilus influenza vaccination.

Pneumococcal vaccination schedule

The vaccine is given to children from 2 years of age and adults, once, in an amount of 0.5 ml, subcutaneously or intramuscularly. Immunization is indicated for all children who often suffer from respiratory infections, especially those with repeated bronchitis (inflammation of the bronchial mucosa), pneumonia (pneumonia), otitis (ear inflammation), as well as chronic diseases leading to decreased immunity, and immunodeficiency states.

When vaccinating patients with immunodeficiency, it is recommended to repeat the vaccination once every 5 years.

Separately, it should be said about the need for routine vaccination of patients with chronic diseases of the heart, blood vessels, lungs, liver, kidneys, diabetes mellitus, oncological processes, including after bone marrow transplantation, removal of the spleen, infected with HIV, since this category of children and adults may be an extremely severe infection with a fatal outcome.

It is important to note that the PNEUMO 23 vaccine, like ACT-HIB, reduces the incidence of respiratory diseases and is therefore indicated for frequently ill children attending child care institutions. If necessary, even pregnant women in the last trimester are vaccinated (if there was contact with a patient with a severe form of infection, and the risk of infection for the fetus, as well as the risk of infection for the woman, is significantly higher than the risk of complications from vaccination).

When is it undesirable to get vaccinated?

Vaccination can either save you from the disease or become a destructive factor for your health. Due to age or general condition, some people are not eligible for certain vaccines. Tell the doctor who is giving you or your child the meningococcal vaccine if:

• you or your child have had a life-threatening allergic reaction;
• you had a severe allergic reaction after a previous dose of meningococcal vaccine - a second dose of this vaccine is prohibited;
• you are pregnant or breastfeeding;
• you feel unwell.

Conjugate vaccines may be given to pregnant women who are at increased risk of developing serogroup A, C, W, or Y infection. Meningococcal serogroup B vaccines should be given only to pregnant or breastfeeding women who are at increased risk of developing serogroup B meningococcal disease. Pregnant women should Please consult your doctor. If the benefits of vaccination outweigh the risks, then the procedure can be performed. If you or your child does not feel well, vaccination should be postponed until complete recovery.