Vaccination of special groups of the population

The presence of contraindications, especially relative, as well as other abnormalities in the state of health, does not mean a complete withdrawal from vaccinations - it is about selecting a vaccine, the time of vaccination, the drug "cover".

Pediatricians often use the terms "vaccination at risk", "sparing vaccination", which creates the illusion of the dangers of vaccines for such children. It is better not to use them, since the allocation of such groups is intended to ensure their safe vaccination. And "preparation for vaccination" is the treatment of a chronically ill patient, bringing him into remission, when it will be possible to vaccinate, and not the appointment of "fortifying", "stimulating" drugs, vitamins, "adaptogens", etc. To the "weakened child." In chronic diseases, which are not peculiar to exacerbations (anemia, hypotrophy, rickets, asthenia, etc.), it is necessary to instill, and then to appoint or continue treatment.

Acute illnesses

For people with acute illness, a planned vaccination is usually possible after 2-4 weeks after recovery. For non-severe acute respiratory viral infections, acute intestinal diseases, etc., according to the epidemiological indications, it is allowed to administer ADP or ADS-M, HCV, HBV, Routine vaccinations are carried out immediately after the temperature normalization. The doctor decides to conduct the vaccination on the assessment of the patient's condition, in which the occurrence of complications is unlikely.

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

[1], [2], [3], [4], [5], [6], [7],

Chronic diseases

Routine vaccination is performed after the aggravation of chronic disease subsides during the period of remission - complete or as high as possible, including against the background of maintenance treatment (except for active immunosuppressive). The marker for the possibility of vaccination can be a smooth course in an ARVI patient. By epidemics, they are vaccinated against the backdrop of active therapy - comparing the risk of a possible complication of vaccination and possible infection.

[8], [9], [10], [11], [12], [13], [14], [15]

Persons who responded to previous doses of the vaccine

Repeated vaccine, which caused a strong reaction (T °> 40.0 °, edema> 8 cm in diameter) or complication, is not administered. In such DPT reactions, although they are rarely repeated, subsequent vaccination can be performed with an acellular vaccine or ADS on the background of prednisolone (1.5-2 mg / kg / day - 1 day before and 2-3 days after vaccination). In case of a reaction to ADP or ADS-M, vaccination according to epidemiological indications is also completed on the background of prednisolone. Again, children who gave febrile convulsions are given an acellular vaccine or DTP against the antipyretic.

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

Pregnancy

By the time of pregnancy, a woman must be fully vaccinated. The introduction of live vaccines to pregnant women is contraindicated: although the risk to the fetus is not proven, their application may coincide with the birth of a child with a birth defect, which will create a difficult to interpret situation. It is necessary to vaccinate a vaccinated pregnant woman only in special cases, for example, when moving to an endemic area or in contact with a controlled infection:

• in case of contact with measles, prophylaxis is carried out by immunoglobulin;
• In the case of a rubella or chickenpox vaccine, a woman who does not know about pregnancy is not interrupted;
• vaccination against yellow fever is carried out only on epidemiological evidence not earlier than the 4th month of pregnancy;
• ADS-M can be administered by contact with a patient with diphtheria;
• vaccination against influenza is carried out by split or subunit vaccines;
• vaccination against rabies 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 contra-indicated, in the second half - PSS.

Premature babies

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

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

Deep premature babies should be vaccinated in the hospital of the second stage in view of the possibility of enhancing apnea. BCG-M is not administered to children weighing less than 2,000 grams, with widespread changes on the skin, as well as patients, but they must be vaccinated in the department of the second stage. Children of the first months of life who have suffered severe illnesses (sepsis, hemolytic anemia, etc.) are usually vaccinated.

Lactation

Breastfeeding is not a contraindication to vaccination of a woman, since only the virus of the rubella vaccine is allocated with milk; Infection of the child is rare and occurs asymptomatically.

Children with frequent ARI

Frequent acute respiratory viral infections do not indicate the presence of immunodeficiency and should not be diverted from vaccinations, which take place 5-10 days after the next acute respiratory viral infection, incl. Against the background of residual catarrhal phenomena; waiting for their complete termination is often accompanied by the onset of the next infection. "Preparation" of such children (vitamins, "adaptogens", etc.) does not enhance the immune response, which usually does not differ from that of the rarely sick. Bacterial lysates contribute to the reduction of acute respiratory viral infections.

[16], [17], [18], [19], [20],

Operations

Since the operation is a stressful effect, immunization, without extreme necessity, should be carried out sooner than in 3-4 weeks, should not be. Vaccinations should be conducted no later than 1 month before the planned operation. Against hepatitis B vaccine (Engeriks B) on an emergency schedule 0-7-21 day - 12 months.

Vaccination of persons who had contact with an infectious patient

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

Vaccination and administration of blood products

Human immunoglobulin, plasma and blood contain antibodies that inactivate live vaccines, they also protect the non-vaccinated child from a controlled infection, so that compliance with intervals. To vaccine yellow fever antibodies in domestic preparations of blood are not present, therefore this inoculation is not postponed. The presence of antibodies does not affect the survival of OPV, as well as the results of the use of inactivated vaccines (specific immunoglobulins are administered together with vaccines (hepatitis B, rabies).

Intervals between the administration of blood products and live vaccines

Blood products	Dose	Interval
IG prophylaxis: hepatitis A measles measles rabies	1 dose 1 dose 2 doses 12.5 U / kg	3 months 5 months 6 months 6 months
Washed erythrocytes Erythrocyte mass Whole blood Plasma, thrombomass	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 the age of 1 year and 6 years - before the introduction of live vaccines.

If immunoglobulin, plasma or blood is injected to a child who received a live vaccine, before 2 weeks later, he should receive a second dose inoculation after the interval given in the table, since the effectiveness of the first vaccine can be reduced.