Flu vaccine in children and adults: contraindications

The vaccination against influenza only since 2006 is included in the National Calendar. In Europe, there is a continuous record of cases of influenza, and although it is far from complete, the vaccination against influenza has reduced the incidence.

According to WHO, with annual epidemics of influenza, 5-10% of adults and 20-30% of children fall ill, 2500000-500 000 people die from this disease, economic damage amounts to 1 to 6 million dollars per 100 000 people.

A vaccine against influenza should be given to patients-chroniclers, who are often ill with ARI, children of preschool age. In the countries of Europe, the elderly, patients with cardiac, pulmonary (including bronchial asthma) and renal pathology, diabetes and people with immunosuppression are vaccinated. In the US since 2008, the vaccine against influenza is older than 6 months. Introduced into the National Calendar.

Influenza vaccination in children

Vaccination against influenza should be carried out in the first year, because at this age there is a high incidence and severe course. Thus, in the 2007/08 season, the share of children 0-2 years among those who developed the flu was 38.4%, 3-6 years - 43.5%, while schoolchildren only 14%, and adults - 2.8%. Among the children hospitalized with confirmed influenza, 50% were children under the age of 6 months, 2/3 - children under 1 year and 80% - up to 2 years. In another study, it was shown that of the number of children with influenza influenza at the age of 2-5 years, every 250th, 6-24 months is hospitalized. - every 100th. And 0-6 months. - every 10th .. According to the combined data of the American Academy of Pediatrics, the hospitalization rate for this disease is 240-720 per 100 000 children 0-6 months. And 17-45 per 100,000 children aged 2-5 years; 37% of those hospitalized were at risk - their hospitalization rate was 500 per 100 000.

And although the death rate of children is 1/10 of the death rate of older persons (0.1 and 1.0 per 100 000), a special study in the United States of this issue in 2004-2005. Showed that the children of the first half of this indicator is 0.88 per 100 000.

Symptoms of influenza in young children often differ from the classical picture - high fever + intoxication + cough and runny nose. At this age, febrile convulsions are frequent against the background of fever , the flu often causes croup, bronchiolitis, exacerbation of asthma, often complicated by otitis media, sinusitis and pneumonia. The frequency of otitis media in children with influenza is 18-40% according to data from different tori, much more often in children under 2 years old. Complication of myocarditis, as well as from the nervous system - is not uncommon. Thus, in one study of 842 children with confirmed laboratory flu in 72, neurologic complications occurred: encephalopathy in 10 children, febrile convulsions in 27 and afebrile in 29, meningitis 2 and cerebral stroke due to hypotension in 4.

Who should be vaccinated?

The contingent indicated in the National Calendar does not include a number of groups whose flu vaccine has undoubted effect and can be recommended; The immunoprophylaxis calendar for epidemiological indications does not decode the risk groups. The recommendations in force in the United States are presented below, the flu shot should be administered to the following categories of people:

• Healthy children over the age of 6 months.
• Asthma and other chronic lung diseases such as cystic fibrosis.
• Diseases of the heart with hemodynamic disorders.
• Conditions that are fraught with impairment of respiratory functions (aspiration, sputum stasis) - epilepsy, neuromuscular diseases, spinal cord injuries, mental retardation
• Immunodeficiencies, including HIV infection.
• Sickle cell anemia and other hemoglobinopathies.
• Chronic kidney disease, metabolism, diabetes,
• Diseases requiring long-term therapy with acetylsalicylic acid (rheumatic diseases, Kawasaki syndrome) as prevention of Reye's syndrome.
• Family members and staff caring for children under the age of 5 (especially important for children under 6 months of age).

These recommendations, although they do not include such obvious risk groups as patients with organic lesions of the central nervous system, who have long-term apnea influenza, children with malformations of lungs and bronchopulmonary dysplasia, are quite acceptable for our conditions. Of course, we should also recommend vaccination on an individual basis to all children and adults.

Vaccination against influenza for people with chronic diseases is safe. Published enough convincing work, allowing to vaccinate these contingents.

Vaccines against influenza

The vaccine against influenza is prepared from the current strains of A / H1N1 /, A / H3N2 / and B viruses, recommended annually by WHO. Vaccination against influenza is carried out in the autumn, preferably before the onset of morbidity.

Instead of the previously released anti-influenza gamma globulin, a normal human immunoglobulin is used in a doubled dosage.

Currently, a vaccine against influenza is being tested, which is based not on hemagglutinin and neuraminidase, but on matrix protein 1 and the virion nucleoprotein that do not mutate; if successful, there will be no need for an annual vaccination.

Live vaccines are made from attenuated strains of the virus (adapted to cold mutants), they are able to produce local immunity (production of IgA antibodies) with intranasal administration. In the USA, where a live vaccine has been used since 5 years, incl. In children with asthma, it is shown to be more effective than the inactivated vaccine against A / H1N1 and B.

Allantoin intranasal live flu vaccine for children from 3 years and adults (Microgen, Russia) - lyophilizate for solution preparation. The contents of the ampoule are dissolved in 0.5 ml (1 dose) of boiled water (cooled). Age-appropriate vaccine is injected once in 0.25 ml into each nasal passage to a depth of 0.5 cm with the attached dispenser of a single-use RD type.

Vaccination against influenza is weakly reactogenic. Storage of drugs at a temperature of 2 to 8. Shelf life - 1 year.

Inactivated all-virion vaccination against influenza is used in children older than 7 years and adults. It is a purified virus, cultured on chick embryos, inactivated by UV irradiation.

Grippovak (NIIVS, Russia) contains in 1 ml of 20 μg hemagglutinin subtypes A and 26 μg B. Preservative - merthiolate. Form release: 1 ml ampoules (2 doses), vials of 40 or 100 doses. Store at 2-8 °. Children from 7 years and adolescents are injected intranasally (by the RJ-M4 sprayer) 0.25 ml into each nasal passage twice with an interval of 3-4 weeks, adults - from 18 years - intranasally according to the same scheme or parenterally (SC) once in a dose of 0.5 ml.

Vaccination against influenza inactivated eluate-centrifuge liquid (Russia) - is applied according to the same scheme as Grippovac

Subunit and split vaccines are used in children older than 6 months, adolescents and Roslyh. Children vaccinated for the first time and neoblevshim influenza, as well as patients with immunodeficiency is recommended to enter 2 doses with an interval of 4 weeks, in subsequent years - once. With the introduction of 1 dose in the spring and one fall, the vaccines are less immunogenic

A vaccine against influenza is injected intramuscularly or deeply subcutaneously into the upper third of the outer surface of the shoulder. The vaccines are stored at 2-8 °. Shelf life 12-18 months.

Subunit and split vaccines registered in Russia 

Vaccination against influenza	Composition, preservative	Doses and methods of vaccination
Grippol Subunit-Microgen, Russia	5 μg of 2 strains of A and 11 μg of strain B, + polyoxidonium of 500 μg, merthiolate. Ampoules 0.5 ml	Children 6 months - 3 years 2-fold to 0.25 ml with an interval of 4 weeks. Over 3 years - 0.5 ml each 1 time.
Grippol® plus Polymer-subunit - Petrovax FC, Russia	5 μg 2 strains A and B (Solvay Biolodzh.) + Polyoxidonium 500 μg, without preservative. Syringe, amp., 0.5 ml bottles	Children over 3 years and adults at 1 dose (0.5 ml) once
Agrippal S1 - Subunit, Novartis Vaccine and Diagnostics Srl, Italy	15 mcg 3 strains, without cone. Syringe-dose.	Children older than 3 years and adults 1 dose (0.5 ml) once, up to 3 years - 1/2 dose (0.25 ml) - vaccinated for the first time and not sick of the flu - 2 times after 1 month.
Begrivak Split, New Artis Vaccine, Germany	15 mcg 3 strains, without preservative. Syringe-dose
Vaxigrip Split, sanofi pasteur, France	For 15 mcg 3 strains, no preservative. Syringe doses, amp. 0.5 ml, 10 dose vials	Children under 9 years 2-fold, 0.25 ml (up to 3 years) or 0.5 ml (3-8 years); > 9 years - 1 dose of 0.5 ml.
Inflexal V Subunit, Berna Biotech, Switzerland	For 15 μg 3 strains; virosomes mimic the virion. Without preservatives, formaldehyde and antibiotics	Children older than 3 years and adults - 0.5 ml IM or deeply n / k, children from 6 months. Up to 3 years in 0.25 ml (previously not vaccinated with 2 doses).
Influwak Subunit, Solvay Pharma, The Netherlands	15 mcg 3 strains, free of preservatives and antibiotics. Self-destroying syringe-dose.	Persons> 14 years 0.5 ml. Children <3 years - 0.25 ml, 3-14 years - 0.5 ml, not painful and not vaccinated before -2-fold. Vaccination of pregnant women is allowed.
Fluarix Split, SmithKlein Forms. GmbH, KG, Germany	15 μg 3 strains, traces of merthiolate and formaldehyde. Syringe-dose.	Children over 6 years of 0.5 ml once, 6 months - 6 years - 0.25 ml 2-fold

A cell culture-grown subunit vaccine against influenza On-taflu, Novartis Vaccine and Diagnosis GmbH, FRG and Split Vaccine FluvaxiN, ChangchukLife Science Ltd., China, is registered.

A vaccine against influenza is not active against avian influenza viruses and possible future mutants. Vaccines from "avian" strains in case of an epidemic have been created in Russia and other countries.

Contraindications to the vaccination against influenza

For all vaccines - an allergy to egg hen proteins, to aminoglycosides (for vaccines containing them), allergic reactions to the administration of any vaccine. Split- and subunit vaccination against influenza can be used in persons with chronic pathology, incl. With immune defects, pregnant and lactating women, patients with immunosuppressive therapy, combined with other vaccines (in different syringes). It is not recommended to vaccinate people who have undergone Guillain-Barre syndrome.

Contraindications for live vaccines - immunodeficiency states, immunosuppression, malignant neoplasms, rhinitis, pregnancy, intolerance of chicken protein. Temporary contraindications, as for inactivated vaccines, are acute diseases and exacerbations of chronic.

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Vaccination reactions and complications

The live vaccine against influenza is slightly reactogenic, the temperature above 37.5 ° in the first 3 days is allowed for no more than 2% of the vaccinated. When subcutaneous injection of whole-cell vaccines, it is allowed to develop a short-term temperature above 37.5 ° or infiltrates up to 50 mm in no more than 3% of the vaccinated. With their intranasal administration, subfebrile within 1 to 3 days is allowed for no more than 2% of the vaccinated.

Subunit and split vaccines give weak short-term (48-72 hours) reactions in no more than 3% of vaccinated. The least reactogenic according to international independent studies are subunit vaccines. Clinical experience confirms the low reactogenicity of inactivated sipit and subadynamic vaccines and in children even in the second half of life. The largest amount (about 70,000 doses) of vaccine safety is from the United States. There are observations that the vaccine against influenza is safe in children in the first half of the year.

Rare cases of vasculitis are described. Observations in England for 34,000 vaccinated with different vaccines (of which 75% with chronic pathology) showed a low incidence of all and allergic reactions (overall, within 1-3% for different vaccines).

Rare immediate reactions after the introduction of the vaccine against influenza Grippol in 2006 in the subsequent almost did not recur.

Is the flu vaccine effective?

The vaccination against influenza develops immunity 14 days after the injection, but in children who did not previously have contact with the virus, this requires 2 doses of the vaccine administered at intervals of 4-6 weeks. Immunity is type-specific; Vaccination against influenza should be performed every year, because there is an antigenic drift of strains of viruses, as well as its short duration (6-12 months), even if its strain composition, as compared to the previous season, has not changed.

Vaccination against influenza has a prophylactic efficacy against a laboratory-confirmed disease of 60-90%, although the degree of protection in children and the elderly is considered to be lower. When infected with strains of the virus, different from vaccine, the effectiveness is reduced; although the disease in vaccinated people flows more easily, but the incidence of influenza and mortality remain above the epidemic threshold.

Vaccination against influenza is the most effective method of reducing the incidence of influenza and mortality from it both among the general population and at risk groups. A vaccination against influenza reduces the hospitalization of children aged 6-23 months. (who received 2 doses of the vaccine) by 75%, and deaths by 41%, and the protective effect of the vaccination, carried out for 2 years or more, is much higher than the one-time before the epidemic. Among adults with community-acquired pneumonia vaccinated against influenza, during the influenza season, mortality was lower - RR 0.3 (0.22-0.41). Especially pronounced effect among the elderly: for 10 seasons, the relative risk of pneumonia was 0.73 and death - 0.52.

Vaccination against influenza also reduces the incidence of children with acute otitis media (by 2.3-5.2%) and exudative otitis media (by 22.8-31.1%). Vaccination against influenza reduces the frequency of all ARI.

To protect children of the first half of this disease, the effect of vaccination of pregnant women is studied . Data from Bangladesh showed that this flu shot has an efficacy of 63%: up to the age of 24 weeks, 4% of children were infected with influenza, compared to 10% in controls. In addition, the frequency of febrile ARI decreased by 29%.

The problem of bird flu

The highly pathogenic avian influenza virus (H5N1) multiplies in the intestines of birds - its neuraminidase N1 is resistant to acidic medium, and H5 hemagglutinin recognizes epithelial receptors containing sialic acids characteristic of birds. There are few such receptors (therefore people rarely get sick), but the trachea of pigs contains both types of sialic acids, which makes them the main "mixer" of viruses. Mass transmission from a person to a person is possible only if the specificity of the hemagglutinin of the avian virus changes.

Post-exposure prophylaxis

Vaccination against influenza should be performed before the beginning of the cold season. During the epidemic, interferon-a-nasal drops of Alfaron, Grippferon (10,000 U / ml) and in aeozoles are used: children 0-1 years, 1 drop (1,000 ME); 1-14 years old - 2, over 14 years and adults - 3 drops 2 times a day for 5-7 days (in contact with a sick person) or an age dose in the morning every 1-2 days (during the epidemic season). The same scheme uses the suppository Viferon 1. Interferon-gamma (Ingaron - 100 000 ME in a vial, diluted in 5 liters of water) for children over 7 years and adults for 2 drops in the nose: in contact with a sick flu - once, in a season of epidemics - 2-3 drops 30 minutes before meals after the toilet bow 1 time every other day 10 days (repeated course if necessary - after 2 weeks).

For prevention in adults and children older than 1 year, use rimantadine (tablets 50 mg, 2% syrup for children Algeria with sodium alginate), although the virus A1 has become resistant to it. Doses of rimantadine: 100 mg / day (children 7-10 years), 150 mg / day (children over 10 years and adults); Algirem: children 1-3 years 10 ml (20 mg) children 3-7 years - 15 ml: (30 mg) - once a day for 10-15 days. Similar effect in Arbidol - according to the same scheme: children 2-6 years - 0.05, 6-12 years - 0.1, over 12 years - 0.2 g.

The neuraminidase inhibitor oseltamivir (Tamiflu) is allowed to treat and prevent influenza A and B from 1 g. When administered within 36 hours of contact with the patient, it prevents influenza in 80%, is active in avian influenza (but not in ARVI). Prophylactic dose for children 1-2 mg / kg / day, for adults - 75-150 mg / day - 7 days after contact or up to 6 weeks during the epidemic. Zanamivir (Relenza in an aerosol is used from the age of 5 years for 2 inhalations 2 times a day (total 10 mg / day) treatment and prevention.

Vaccination against influenza in people with chronic diseases

Vaccination against influenza in the form of split and subunit vaccines has shown its effectiveness and safety when administered to patients with serious pathology (asthma, leukemia, liver transplant recipients, diabetes, multiple sclerosis, etc.). Clinical experience of vaccination of more than 5,000 children, 31 of them with various pathologies, showed its safety and effectiveness.