Vaccination of special populations

The presence of contraindications, especially relative ones, as well as other deviations in health status does not mean a complete exemption from vaccinations - we are talking about the selection of the vaccine, the time of vaccination, and medicinal “cover”.

Pediatricians often use the terms "vaccination of risk groups", "gentle vaccination", which creates the illusion of the danger of vaccines for such children. It is better not to use them, since the selection of such groups is aimed at providing them with safe vaccination. And "preparation for vaccination" is the treatment of a chronically ill person, bringing him into remission, when it will be possible to vaccinate, and not the prescription of "general tonics", "stimulating" agents, vitamins, "adaptogens", etc. to a "weakened child". In case of chronic diseases that are not characterized by exacerbations (anemia, hypotrophy, rickets, asthenia, etc.), it is necessary to vaccinate, and then prescribe or continue treatment.

Acute diseases

For people with acute diseases, routine vaccination can usually be carried out 2-4 weeks after recovery. In case of mild acute respiratory viral infections, acute intestinal diseases, etc., according to epidemiological indications, it is permissible to administer ADS or ADS-M, ZHCV, VHB. Routine vaccinations are carried out immediately after the temperature has returned to normal. The attending physician bases the decision to carry out vaccination on an assessment of the patient's condition, in which the occurrence of complications is unlikely.

Those who have had meningitis and other severe CNS diseases are vaccinated 6 months after the onset of the disease - after the stabilization of residual changes, which, with earlier vaccination, could be interpreted as its consequence.

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Chronic diseases

Planned vaccination is carried out after the exacerbation of a chronic disease has subsided during the period of remission - complete or maximally achievable, including against the background of maintenance treatment (except for active immunosuppressive treatment). A marker for the possibility of vaccination may be a smooth course of ARVI in a patient. According to epidemiological indications, vaccination is also carried out against the background of active therapy - having compared the risk of possible complications of vaccination and possible infection.

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Persons who have had reactions to previous doses of the vaccine

A vaccine that caused a severe reaction (T°>40.0°, edema>8 cm in diameter) or complications is not administered again. In case of such reactions to DPT, although they are rare, subsequent vaccination can be carried out with acellular vaccine or ADS against the background of prednisolone orally (1.5-2 mg/kg/day - 1 day before and 2-3 days after vaccination). In case of a reaction to ADS or ADS-M, vaccination according to epidemiological indications is also completed against the background of prednisolone. Children who have had febrile seizures are administered acellular vaccine or DPT against the background of antipyretics.

Live vaccines (OPV, ZPV, ZPV) are administered to children with a reaction to DPT as usual. If a child has had an anaphylactic reaction to antibiotics or egg white contained in live vaccines, subsequent administration of these and similar vaccines (for example, ZPV and ZPV) is contraindicated.

Pregnancy

By the time pregnancy occurs, the woman should be fully vaccinated. Live vaccines are contraindicated in pregnant women: although the risk to the fetus has not been proven, their use may coincide with the birth of a child with a congenital defect, which will create a difficult-to-interpret situation. An unvaccinated pregnant woman should be vaccinated only in special cases, such as an upcoming move to an endemic area or contact with a controlled infection:

• in case of contact with measles, prophylaxis is carried out with immunoglobulin;
• If a woman who was not aware of her pregnancy is given a rubella or chickenpox vaccine, the pregnancy will not be terminated;
• vaccination against yellow fever is carried out only according to epidemiological indications not earlier than the 4th month of pregnancy;
• ADS-M can be administered upon contact with a patient with diphtheria;
• vaccination against influenza is carried out with split or subunit vaccines;
• Rabies vaccination is carried out in the usual manner;
• vaccination against hepatitis B is not contraindicated;
• In the first half of pregnancy, the administration of AS (ADS-M) and PSS is contraindicated, in the second half - PSS.

Premature babies

Premature infants give an adequate response to vaccines, and the frequency of reactions is even slightly lower than that of full-term infants. They are vaccinated with all vaccines in the usual doses after stabilization of the condition with adequate weight gain. The introduction of the DTP vaccine to a group of infants of gestational age <37 weeks at the age of 1 month was not accompanied by a higher frequency of episodes of apnea and bradycardia compared with the control group.

Children born in asphyxia or with signs of intrauterine infection can be diverted from the introduction of HBV if the mother does not have HBsAg. If the mother is a carrier, the child should be vaccinated, since the risk is less than the risk of infection (children weighing less than 1,500 g are vaccinated simultaneously with the introduction of specific human immunoglobulin against hepatitis B at a dose of 100 IU).

Very premature babies should be vaccinated in the 2nd stage hospital due to the possibility of increased apnea. BCG-M is not administered to children weighing less than 2,000 g, with widespread skin changes, or to patients, but they should be vaccinated in the 2nd stage department. Children in the first months of life who have suffered severe diseases (sepsis, hemolytic anemia, etc.) are usually vaccinated.

Breastfeeding

Breastfeeding is not a contraindication to vaccination of a woman, since only the rubella vaccine virus is excreted with milk; infection of the child is rare and asymptomatic.

Children with frequent acute respiratory viral infections

Frequent ARIs do not indicate the presence of immunodeficiency and should not be diverted from vaccinations, which are carried out 5-10 days after the next ARI, including against the background of residual catarrhal phenomena; waiting for their complete end is often accompanied by the onset of the next infection. "Preparation" of such children (vitamins, "adaptogens", etc.) does not enhance the immune response, which is usually no different from that of those rarely ill. Bacterial lysates contribute to the reduction of ARIs.

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Operations

Since the operation is a stressful impact, immunization should not be carried out earlier than 3-4 weeks unless absolutely necessary. Vaccinations should be carried out no later than 1 month before the planned operation. Hepatitis B is vaccinated (Engerix B) according to the emergency schedule 0-7-21 days - 12 months.

Vaccination of persons who have had contact with an infectious patient

Incubation of an acute infection does not disrupt the vaccination process; vaccination of children who have been in contact with patients with another infection should not cause concern.

Vaccination and administration of blood products

Human immunoglobulin, plasma and blood contain antibodies that inactivate live vaccines, they also protect an unvaccinated child from a controlled infection, so the intervals are observed. There are no antibodies to the yellow fever vaccine in domestic blood products, so this vaccination is not postponed. The presence of antibodies does not affect the survival rate of OPV, as well as the results of using inactivated vaccines (specific immunoglobulins are administered together with vaccines (hepatitis B, rabies).

Intervals between administration of blood products and live vaccines

Blood products	Dose	Interval
IG prevention: hepatitis A measles measles rabies	1 dose 1 dose 2 doses 12.5 U/kg	3 months 5 months 6 months 6 months
Washed red blood cells Red blood cell mass Whole blood Plasma, platelet mass	10 ml/kg 10 ml/kg 10 ml/kg 10 ml/kg	0 3-5 months 6 months 7 months
Immunoglobulin for intravenous administration	300-400 mg/kg 750 mg/kg >1000 mg/kg	8 months 9 months up to 12 months

Transfusion history is important beginning at 1 year of age and at 6 years of age before administration of live vaccines.

If a child who has received a live vaccine is given immunoglobulin, plasma or blood earlier than 2 weeks, he or she should be re-vaccinated at the interval given in the table, as the effectiveness of the first vaccination may be reduced.