Combination vaccines

All vaccines prescribed for a child at a given age must be administered simultaneously in different syringes into different parts of the body, since manipulation of syringes and vaccines is fraught with technical errors.

This requirement was left in force by WHO even after it was proven that the measles vaccine is not inactivated when mixed with DPT, even when stored for several days. Manufacturers allow the administration of their DPT and Hib vaccines with one syringe. In order to reduce psychological trauma for the child, it is advisable to administer 2 vaccines at the same time (two sisters give an injection at the same time).

Acceptable combinations of vaccines for simultaneous administration

Vaccines	Acceptable combinations
ADS, ADS-M, AD-M	Typhoid Against yellow fever live
Anti-rabies	Tetanus toxoid
Brucellosis live	Against Q fever, plague and tularemia alive
Typhoid	ADS, ADS-M and AD-M
Q fever vaccine live	Brucellosis live
Hepatitis A	Leptospirosis + tularemia
Flu	Pneumo23, Bacterial lysates
Against yellow fever live	ADS, ADS-M, AD-M
Tick-borne encephalitis	Hepatitis A, ADS-M
Tularemia live	Plague live (all ages) Brucellosis live (adults)
Plague alive	Brucellosis and tularemia live

The simultaneous administration of “calendar” vaccines allows for maximum vaccination coverage of children with a minimum number of visits to the clinic.

However, simultaneous vaccination does not solve the issue of reducing the traumatic vaccinations for the child. The number of injections when using DPT and monovalent vaccines is 14-15 for the first 18 months of the child's life, the inclusion of influenza, Hib and pneumococcal vaccines in the Calendar will make this number prohibitive.

The solution is to use 5-7 component vaccines. We have registered the following vaccines: DPT + HBV (Bubo-Kok), measles-mumps, HBV + HAV (Twinrix), AaDPT + IPV + Hib (Pentaxim), which, however, lacks the hepatitis component. The following vaccines are in the registration stage: AaDPT + IPV (Tetraxim), AaDPT + IPV + HBV (Infanrix-Penta) and AaDPT + IPV + HBV + Hib (Infanrix-Hexa), but their mass use will depend on the funds allocated for vaccination. But without switching to combination vaccines, the number of injections will restrain the expansion of immunoprophylaxis.

The use of Pentaxim vaccine in children at risk will reduce the number of injections by 4. In the main group of children, the use of DTP + HBV vaccines at the age of 3-6 months will reduce the number of injections by 2, while Pentaxim - by 3, while it provides additional advantages, since it contains acellular pertussis and Hib components. For vaccinations against measles-rubella-mumps at the age of 1 year and 6 years, it is necessary to switch to the use of trivalent vaccines, as is done throughout the world.

A question is often asked about the possible "excessive" administration of one of the components of a combination vaccine to a child who has received a full course of vaccination with it (for example, the administration of a trivalent vaccine to prevent rubella and mumps in an adolescent who has received two injections of the measles vaccine). This practice is entirely justified, especially if the administration of a combination vaccine reduces the number of injections.

The organization of immunoprophylaxis is regulated by a large number of normative documents; they are collected in a collection published in 2007. The provisions of this chapter correspond to the provisions of the Sanitary and Epidemiological Rules on the safety of vaccination.

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