Calendar of preventive vaccinations

The National Calendar of Preventive Vaccinations adopted in Russia in 2002 provided protection against 9 vaccine-preventable infections. It contained a provision on the simultaneous administration of all vaccines prescribed for a child by age (in different parts of the body), justified by both immunological data and data on the absence of an increase in the frequency of adverse reactions and complications. However, to avoid accidental contamination of syringes and needles, BCG is administered before or after other vaccines in a separate room.

This document did not specify the vaccines administered at a particular time, but the infections against which vaccination is carried out. This opened up the possibility of using, within the framework of the National Calendar of Preventive Immunizations, the entire spectrum of vaccines of domestic and foreign production, registered and approved for use in Russia in the established manner in accordance with the instructions for their use. All vaccines in the Calendar are interchangeable, including DPT and AaDPT, however, when using acellular pertussis vaccines (AaDPT), it is advisable to use preparations with the same components.

During 2006-2007, additional vaccinations were launched within the framework of the National Project - against influenza, hepatitis B and rubella, which led to a decrease in the incidence of these infections.

By Order No. 673 of October 30, 2007, amendments and additions were made to the National Immunoprophylaxis Calendar, adopted in Russia in 2002, which have been in effect since 2008.

The inclusion of measles, rubella and hepatitis C vaccinations in the Russian National Calendar - essentially "catch-up" vaccinations - is an extremely important measure that helps eliminate the first two infections and sharply reduce the transmission of hepatitis B. The effectiveness of these measures is shown in the relevant sections, but they also bring the structure of our Calendar closer to the Immunoprophylaxis Calendars of developed countries, where the "catch-up" ages are also indicated. In order to prevent vaccine-associated poliomyelitis (VAP), infants in Russia are vaccinated only with IPV, as many developed countries have done. This measure is also important for the future - after the eradication of poliomyelitis in the world, it is easiest to stop vaccination using IPV, which does not threaten outbreaks of poliomyelitis caused by vaccine revertant viruses.

In many (but not all) developed countries, vaccinations against whooping cough, diphtheria, tetanus, and polio begin at 2 months of age rather than 3 months of age in order to complete the primary series of vaccinations earlier (given the higher incidence of disease in children starting at 6 months of age).

Calendar of preventive vaccinations in Russia, 2008

Age	Name of the vaccination
Newborns (first 24 hours)	1st vaccination against hepatitis B
Newborns (3-7 days)	Vaccination against tuberculosis (BCG-M or BCG)
Children: 1 month	2nd vaccination against hepatitis B (children at risk)
2 month	Third vaccination against hepatitis B (children at risk)
3 months	2nd vaccination against viral hepatitis B, first vaccination against diphtheria, whooping cough, tetanus, polio
4.5 months	2nd vaccination against diphtheria, whooping cough, tetanus, polio
6 months	3rd vaccination of viral hepatitis B against diphtheria, whooping cough, tetanus, poliomyelitis
12 months	4th vaccination against viral hepatitis B (children at risk), vaccination against measles, rubella, mumps
18 months	5th revaccination against diphtheria, whooping cough, tetanus, 1st revaccination against poliomyelitis
20 months	2nd revaccination against polio
6 years	Revaccination against measles, rubella, mumps
6-7 years	2nd revaccination against diphtheria, tetanus
7 years	Revaccination against tuberculosis (BCG)
14 years old	3rd revaccination against diphtheria, tetanus, poliomyelitis, revaccination against tuberculosis (BCG)
Adults	Revaccination against diphtheria, tetanus - every 10 years

Children from 1 year to 17 years old, adults from 18 to 55 years old, not previously vaccinated	Against hepatitis B
Children from 1 year to 17 years old, girls from 18 to 25 years old, not sick, not vaccinated, vaccinated once against rubella	Against rubella
Children attending preschool institutions; students in grades 1-11; students of higher and secondary vocational educational institutions; adults working in certain professions and positions (medical and educational institutions, transport, utilities, etc.); adults over 60 years of age	Against flu
Adolescents and adults under 35 years of age who have not been ill, not vaccinated and have no information about measles vaccinations; contacts from foci of the disease who have not been ill, not vaccinated and have no information about measles vaccinations - no age limit	Against measles

Vaccination against hepatitis B is carried out on all newborns in the first 24 hours of life, including children from risk groups: newborns from mothers who are HBsAg carriers, have or have had hepatitis B in the third trimester of pregnancy, do not have HBsAg test results, from the drug addiction risk group; from families where there is an HBsAg carrier, a patient with acute hepatitis B or chronic viral hepatitis (hereinafter referred to as risk groups).

Vaccination against hepatitis B for newborns and all children not belonging to risk groups is carried out according to the 0-3-6 schedule (1 dose - at the start of vaccination, 2 dose - after 3 months, 3 dose - 6 months after the 1st vaccination).

Revaccination against hepatitis B for newborns and children from risk groups is carried out according to the 0-1-2-12 schedule (1st dose - in the first 24 hours of life, 2nd - at the age of 1 month, 3rd - at the age of 2 months, 4th dose - at the age of 12 months)

Revaccination against tuberculosis is carried out on tuberculin-negative children who are not infected with Mycobacterium tuberculosis at the age of 7 and 14 years.

In the subjects of the Russian Federation with tuberculosis incidence rates below 40 per 100 thousand population, revaccination against tuberculosis at the age of 14 is carried out for tuberculin-negative children who did not receive the vaccine at the age of 7.

Notes:

1. Vaccines used within the framework of the National Calendar of Preventive Immunizations (except BCG, BCG-M) can be administered at intervals of 1 month or simultaneously with different syringes into different parts of the body.
2. If the vaccination schedule is not met, they are administered according to the schedules provided by the National Immunization Schedule and in accordance with the instructions for use of the preparations. Missing one vaccination from a series (hepatitis B, DPT or poliomyelitis) does not entail repeating the entire series; it is continued as if the required interval had been maintained. Immunization of children born to HIV-infected mothers is carried out within the framework of the National Immunization Schedule (according to an individual vaccination schedule) and in accordance with the instructions for use of vaccines and toxoids.
3. Immunization of children born to HIV-infected mothers is carried out taking into account the following factors: the type of vaccine (live, inactivated), the presence of immunodeficiency, taking into account the child’s age, and concomitant diseases.
4. All inactivated vaccines (including toxoids), recombinant vaccines are administered to children born to HIV-infected mothers, including HIV-infected children, regardless of the stage of the disease and the number of CD4+ lymphocytes.
5. Live vaccines are administered to children with a confirmed diagnosis of HIV infection after an immunological examination to exclude an immunodeficiency state. In the absence of immunodeficiency, live vaccines are administered in accordance with the National Calendar of Preventive Immunizations. In the presence of immunodeficiency, the administration of live vaccines is contraindicated. 6. Six months after the primary administration of live vaccines against measles, mumps, rubella to HIV-infected individuals, the level of specific antibodies is assessed and, if absent, a repeat dose of the vaccine is administered with preliminary laboratory monitoring of the immune status.

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Vaccination in cases of calendar violation

Regardless of the start date of vaccination, it is carried out at intervals specified in the Calendar. As stated above, missing one vaccination from a series does not entail repeating the entire series. Delays in carrying out the primary series not only increase the risk of infection of the child at the most dangerous age, but also the development of unfavorable events, since the general incidence of disease increases in the 2nd half of the year.

The orders of the Russian Ministry of Health directly indicate that if the calendar is violated, all necessary vaccinations may be administered simultaneously. For subsequent vaccinations, the minimum interval is 1 month (instead of 1.5 months, specified for vaccinations administered on time).

For children (including refugees) whose vaccination status is unknown, vaccination against all infections is carried out according to the plan below:

1. Children in the first year of life are vaccinated in accordance with the vaccination schedule.
2. Children from 1 to 6 years old receive three doses with an interval of 30 days of OPV (or IPV) + DPT (up to 3 years) or ADS (4-6 years - twice) + live viral vaccines (for example, a measles-mumps vaccine with the first, rubella - with the second vaccination). Revaccination is carried out 1 year after the first dose. The hepatitis B vaccine can be administered with the 1st and 2nd doses of DPT (preferably Bubo-Kok) and the 3rd dose - 6 months after the first.
3. Children aged 7-14 years are vaccinated once with OPV (or IPV), ZPV + ZPV and ADS-M (at the same time) and 30 days later - with rubella vaccine and ADS-M. Vaccinations against hepatitis B at the time indicated in the previous paragraph are best done with the Bu-bo-M vaccine.
4. Adults are vaccinated once with ADS-M.
5. The need for BCG is determined by the presence of a vaccination scar and the Mantoux test. When parenteral vaccines are administered on the same day, they are administered with separate syringes into different parts of the body. To avoid contamination, combining BCG with other parenteral manipulations on the same day is not allowed; BCG should be administered the day before or the day after the administration of other vaccines.

Calendar of preventive vaccinations according to epidemic indications

This calendar has not changed since 2002; in Table 1.2 it is presented with amendments, since a number of its positions are reflected in the new National Calendar.

Calendar of preventive vaccinations according to epidemic indications (with correction)

Population groups subject to vaccination	Vaccinations against:	Vaccination	Revaccination
"The population in enzootic territories, as well as persons arriving in these territories, performing the following work: - agricultural, irrigation and drainage, construction, and other works on excavation and movement of soil, procurement, industrial, geological, survey, expeditionary, deratization and disinfestation works; - on logging, clearing and improvement of forests, health and recreation areas for the population. Persons working with live cultures of the tularemia pathogen.	Tularemia	From 7 years old (from 14 years old in field-type foci)	Every 5 years
Population living in territories enzootic for plague. Persons working with live cultures of the plague pathogen.	Plagues	From 2 years old	In 1 year
Persons performing the following work: - in farms enzootic for brucellosis - livestock breeders, veterinarians, zootechnicians; - for the slaughter of cattle infected with brucellosis, the procurement and processing of meat and meat products obtained from them Livestock breeders, veterinarians, zootechnicians on farms, Enzootic for brucellosis. Persons working with live cultures of the causative agent of brucellosis.	Brucellosis (goat-sheep type)	From 18 years old	In 1 year
Persons performing the following work in enzootic areas: - agricultural, irrigation and drainage, construction, soil excavation and movement, procurement, industrial, geological, survey, expeditionary; - for the procurement, storage and processing of agricultural products; - for the slaughter of cattle infected with anthrax, the procurement and processing of meat and meat products obtained from them; Persons working with anthrax cultures	Anthrax	From 14 years old	In 1 year
Persons performing work on catching and keeping stray animals Animals. Veterinarians, hunters, foresters, slaughterhouse workers, taxidermists. Persons working with the "street" rabies virus.	Rabies	Since 16 years old	Every 1 g every 3 years
Persons performing the following work: - for the procurement, storage, and processing of raw materials and livestock products from farms in territories enzootic for leptospirosis; - for the slaughter of cattle infected with leptospirosis, and the procurement and processing of meat products obtained from them; - for the capture and maintenance of stray animals. Persons working with live cultures of the leptospirosis pathogen.	Leptospirosis	From 7 years old	In 1 year
Persons performing work on procurement, storage, processing of raw materials and livestock products obtained from farms where Q fever diseases of livestock are registered; Persons performing work on procurement and processing of agricultural products in areas enzootic for Q fever; Persons working with live cultures of Q fever pathogens	Q fever	From 14 years old	In 1 year

Population contingent subject to vaccination	Vaccinations against:	Vaccination	Revaccination
The population living in areas endemic for tick-borne encephalitis, as well as persons arriving in this area who perform the following work: - agricultural, irrigation and drainage, construction, soil, procurement, industrial, geological, survey, deratization and disinfestation; - on logging, clearing and improvement of forests, health and recreation areas for the population. Persons working with live tick-borne encephalitis virus	Tick-borne encephalitis	From 4 years old	After 1 year, then every 3 years
Persons traveling to areas where yellow fever is endemic Persons working with live cultures of the yellow fever pathogen	Yellow fever	From 9 months	In 10 years
Population living in areas with a high incidence of typhoid fever; Population living in areas with chronic waterborne typhoid fever epidemics; Persons engaged in the maintenance of sewerage structures, equipment, and networks. Traveling to hyperendemic regions and countries, as well as contingents in foci according to epidemiological indications; Persons working with live cultures of S. typhi pathogens	Typhoid fever	From 3 years old, depending on the type of vaccine	In 3 years
Children over 2 years of age, adolescents, adults in foci of meningococcal infection caused by meningococcus serogroups A or C. Persons at increased risk of infection (children from preschool institutions, students in grades 1-2, adolescents from organized groups living in dormitories, children from family dormitories in unfavorable sanitary and hygienic conditions) with a 2-fold increase in morbidity compared to the previous year	Meningococcal infection	From 1 year	In 3 years
Children in areas with a high incidence of hepatitis A. Healthcare workers, educators and staff of preschool institutions. Service workers, primarily those employed in public catering organizations. Workers servicing sewerage facilities, equipment and networks. Traveling to hyperendemic regions and countries, as well as contacts according to epidemiological indications.	Viral hepatitis A	From 3 years old
People suffering from chronic somatic diseases, often suffering from acute respiratory infections, preschool children	Flu	From 6 months.	Annually
Contacts in outbreaks of mumps, not vaccinated and not sick	Epidemiological mumps	From 1 year
Contacts in diphtheria foci, previously unvaccinated	Diphtheria	From 3 months.
Persons traveling to countries with unfavorable cholera conditions (subject to agreement with the Department of State Sanitary and Epidemiological Surveillance of the Russian Ministry of Health) Population of border regions of Russia in the event of an unfavorable cholera epidemiological situation in the adjacent territory (subject to the decision of Rospotrebnadzor of Russia)	Cholera	From 2 years old	In 6 months

Notes:

1. Vaccinations within the framework of the calendar of preventive vaccinations for epidemiological indications are carried out with vaccines of domestic and foreign production, registered and released for use in accordance with the established procedure in accordance with the instructions for their use.
2. Inactivated vaccines (except anti-rabies vaccines) used within the framework of the Calendar of Preventive Vaccinations for Epidemiological Indications and inactivated vaccines of the National Calendar of Preventive Vaccinations can be administered simultaneously with different syringes into different parts of the body.

Additional vaccination

Improvement of immunoprophylaxis should provide for expansion of the spectrum of mass vaccinations with all vaccines licensed in Russia, which requires the publication of a consolidated set of recommendations regarding vaccinations (in addition to those included in the National Calendar and the Calendar of Vaccinations for Epidemiological Indications) indicated for all children based on alternative financing schemes. Such vaccines are administered annually to tens of thousands of children, although official instructions for their use (appropriateness, age, administration schemes) are often absent. Of course, some information is available in the instructions for the use of vaccines, and there are also recommendations from individual researchers and their groups, which we provide below, but this is not enough in such a sensitive area as immunoprophylaxis.