Types of specific and nonspecific immunoprophylaxis. Specific immunoprophylaxis and immunotherapy of infectious diseases. Allergies, types of allergic reactions. Antibiotics. Contraindications to vaccination

ALLERGY AND ANAPHYLAXIA.

SPECIFIC IMMUNOPREVENTION AND IMMUNOTHERAPY OF INFECTIOUS DISEASES.

Related questions:

1. Immunoprophylaxis and immunotherapy of infectious diseases.

2. Allergies. Reactions of HNT and HRT.

Attempts to prevent severe disease are fatal dangerous disease, causing a mild form of the disease, have been done for centuries in different countries of the world.

The scientific basis and practical implementation of immunoprophylaxis was first given by L. Pasteur, who created the principles of using weakened (attenuated) microorganisms and prepared drugs (vaccines) to prevent certain infectious diseases of humans and animals.

More than a hundred years have passed and now the artificial creation of immunity is the basis for the fight against infectious diseases.

Immunization- administration of drugs to create artificial active immunity - carried out in certain years throughout a person’s life. In the first days after birth, the child receives the BCG vaccine against tuberculosis. In the 1st year of life, he is vaccinated to prevent diseases of diphtheria, whooping cough and tetanus, vaccinated against polio, measles, etc. In this way, specific prevention of infectious diseases is carried out, for which vaccines are used.

Vaccines- preparations for active immunization can be:

1. Corpuscular (from microbial cells) - live and dead.

2. Chemical (antigens and antigenic fractions).

3. Anatoxins.

Live attenuated vaccines are prepared from living microorganisms, the virulence of which is weakened (from the Latin attenuer - to weaken, soften), and the immunogenic properties (the ability to cause immunity) are preserved.

To obtain such microorganisms there are different ways:

1) cultivation on nutrient media unfavorable for the growth and reproduction of the pathogen; under the influence of physical and chemical factors (this is how the BCG vaccine was obtained for tuberculosis prevention); 2) passage of the pathogen through the body of an animal that is not very susceptible to a reproducible infection (this is how L. Pasteur received the rabies vaccine); 3) selection of natural cultures of microorganisms that are low virulent for humans (this is how the vaccine against plague was obtained), etc.

Live vaccines create intense immunity, as they cause a process similar to a natural infectious one, only weakly expressed, almost without clinical manifestations. In this case, the entire mechanism of immunogenesis is activated - immunity is created.

Killed vaccines- cultures of microorganisms inactivated by high temperature, chemical substances(phenol, formaldehyde, alcohol, acetone), UV rays, etc. In this case, exposure factors are selected that completely preserve the immunogenic properties of microbial cells.

Chemical vaccines- individual components of a microbial cell (antigens), obtained by special processing of a microbial suspension.

Chemical vaccines are usually quickly absorbed after introduction into the body, which does not allow achieving the desired immunogenic irritation, so vaccines are added substances that lengthen the absorption time: aluminum hydroxide, aluminum-potassium alum, mineral oils, etc. This is called the creation of a “depot”.

Chemical vaccines are used to prevent typhoid fever, meningitis, etc.

Anatoxins(from Latin ana - back) - these are bacterial exotoxins, neutralized by exposure to formaldehyde (0.3-0.4%) and exposure to a temperature of 37 ° C for 3-4 weeks. In this case, there is a loss of toxic properties, but the preservation of immunogenic ones.

Currently, toxoids have been obtained and used from the toxins of diphtheria, tetanus, etc.

Toxoids are purified from impurities in nutrient media (ballast proteins) and adsorbed on substances that are slowly absorbed from the injection site.

By The number of antigens included in the vaccine is divided into: monovaccines (from one type of antigens), divaccines (from two antigens), trivaccines (from three antigens), etc.

Associated vaccines prepared from antigens of various bacteria and toxoids. For example, the associated pertussis-diphtheria-tetanus vaccine (DTP) contains killed pertussis germs and toxoids: diphtheria and tetanus.

Vaccines are administered intramuscularly, subcutaneously, cutaneously, intradermally, orally. Immunize either once, or twice or three times at intervals of 1-2 weeks or more. The frequency of administration and intervals between vaccinations depend on the nature of the vaccine - administration regimens have been developed for each.

After administration of the vaccine, there may be general and local reactions. TO general include increased temperature (up to 39 °C), headache, malaise. These phenomena usually disappear within 2-3 days. Local reactions - redness and infiltration at the site of vaccine administration may appear 1-2 days after vaccination. When a vaccine is administered cutaneously (against tularemia, BCG, etc.), the appearance of a local reaction indicates the effectiveness of the vaccination.

There are contraindications for vaccination: fever, acute infectious diseases, allergies, etc. Women are also not vaccinated in the second half of pregnancy.

Vaccines and toxoids are prepared at factories that produce bacterial preparations. Their production requires large quantities of microbial suspension (biomass) or material containing viruses.

The finished preparations are poured into ampoules or vials and for the most part dried. Dry preparations retain their activity and other properties longer.

Some vaccines, such as polio, come in tablet or pill form.

Each ampoule, bottle and box of drugs is labeled with the name of the drug, its volume, expiration date, batch number and control number.

Instructions for use are included in each box.

Preparations are generally stored at a temperature of 4 °C. Do not expose drugs to freezing and thawing or high temperatures. When transporting, observe special conditions. Do not use drugs that have cracks in the ampoules and a changed appearance.

Special view vaccines - autovaccines . They are prepared in bacteriological laboratories from microbes isolated from the patient. An autovaccine is used to treat only this patient. Most often, autovaccines are used to treat chronic infections (staphylococcal, etc.). The autovaccine is administered repeatedly, in small doses, according to a regimen developed for each vaccine. Autovaccines stimulate the body's defenses, which contributes to recovery.

Serum preparations used to create artificial passive immunity. These include specific immune sera and immunoglobulins.

These drugs contain ready-made antibodies. They are obtained from the blood of donors - specially immunized people or animals (against measles, influenza, tetanus). In addition, they use the serum of those who have been ill and even healthy people, if it contains a sufficient amount of antibodies. Placental and abortion blood are also used as raw materials for the preparation of immune preparations.

Available antibacterial and antitoxic serum. The former have more limited use. Antitoxic serums are used to treat diphtheria, tetanus, botulism, etc. These serums are produced with a certain antitoxin content, which is measured in international units (IU). Immune serum preparations are obtained from the blood of animals, mainly horses, that have been immunized multiple times. At the end of immunization, the level of antibodies in the blood is determined and bloodletting is performed. The resulting serum is preserved, its sterility, activity and physical properties are controlled.

Preparations obtained from the blood of horses contain proteins foreign to humans, which, when administered repeatedly, can cause allergic reactions: serum sickness and anaphylactic shock. To prevent complications, serum drugs should be administered with precautions (according to Bezredka). To free animal serum from ballast proteins and concentrate antibodies, various methods are used, the main one of which is the Diaferm-3 method, developed in our country and including enzymatic hydrolysis of ballast proteins.

In addition, to concentrate antibodies in a smaller volume of the drug, methods have been developed for isolating gamma globulins containing antibodies from blood serum. Such drugs are called immunoglobulins. They are prepared from human serum (homologous) and animal serum (heterologous).

The effectiveness of immunoglobulins is much higher than the effectiveness of immune serums, and disproportionately fewer complications are observed. Currently, immunoglobulins are used much more widely than serums.

In our country, immunoglobulins are used to prevent measles, hepatitis, rubella, etc. Prophylactic administration of immunoglobulins is carried out when infection is suspected or in case of infection. It is advisable to administer these drugs in the first days after infection (the beginning of the incubation period), while the pathological process has not yet developed. When using the drug therapeutically, its early administration gives a greater effect.

Serums and immunoglobulins are administered intramuscularly and intravenously.

Timely and correct use of serum preparations can reduce the incidence of many infections.

Immunoprophylaxis – is the use of immunological patterns to create artificial acquired immunity (active or passive).

For immunoprophylaxis use:

1) antibody drugs (vaccines, toxoids), when administered to a person, artificial active immunity is formed;

2) antibody preparations (immune serums), with the help of which an artificial passive immunity.

Vaccines are called antigenic drugs obtained from pathogens or their structural analogues, which are used to create artificial active acquired immunity.

According to the method of preparation, they are distinguished:

Live vaccines – drugs in which the active principle is weakened in one way or another, losing virulence, but retaining specific antigenicity. Attenuation (weakening) is possible through prolonged exposure of the strain to chemical or physical factors, or long-term passages through the body of immune animals. Divergent strains can be used as live vaccines, i.e. microbes that are non-pathogenic to humans and have common protective antigens with pathogenic pathogens of infectious diseases for humans, for example, a vaccine against smallpox human, which uses the cowpox virus, which is non-pathogenic for humans, BCG is a vaccine that uses bovine-type mycobacteria related in antigen terms.

IN last years The problem of obtaining live vaccines using genetic engineering is being successfully solved. The principle of production is to create safe recombinant strains that are non-pathogenic for humans. Such vaccines are called vector vaccines. Vaccinia virus, non-pathogenic salmonella strains, and other microbes are often used as vectors for creating recombinant strains.

Inactivated (killed) vaccines - crops killed by chemical or physical methods pathogenic bacteria or viruses. To inactivate bacteria and viruses, formaldehyde, alcohol, phenol or temperature exposure, ultraviolet irradiation, and ionizing radiation are used.

Molecular vaccines (molecular vaccine against hepatitis B, derived from a viral antigen produced by a recombinant yeast strain .

Anatoxins. The pathogenesis of many diseases (diphtheria, tetanus, botulism, gas gangrene) is based on the effect on the body of specific toxic products released by the causative agents of these diseases (exotoxins). After adding small amounts of formalin and maintaining for several days at 37-40 0 C, the toxins completely lose their toxicity, but retain their antigenic properties. The preparations obtained from toxins in this way were called toxoids. Toxoids intended for human immunization are prepared in the form of purified, concentrated preparations adsorbed on aluminum oxide hydrate.

Synthetic vaccines . Antigen molecules have low immunogenicity due to the relatively low molecular weight of the antigens. In this regard, a search is underway to increase the immunogenicity of molecular antigens by artificially enlarging their molecules due to a chemical or physicochemical bond (“cross-linking”) of the antigen with large-molecular polymer carriers harmless to the body (such as polyvinylpyrrolidone), which would play the role of an assistant.

Adjuvants used to enhance the immunogenicity of vaccines. Mineral sorbents (ammonium oxide and phosphate hydrate gels) are used as adjuvants. All adjuvants are substances foreign to the body and have different chemical compositions. The mechanism of action of adjuvants is complex. They act on both the antigen and the body. The effect on an antigen is reduced to the enlargement of its molecule. In addition, adjuvants cause an inflammatory reaction at the injection site with the formation fibrous capsule, as a result of which the antigen is preserved for a long time and deposited at the injection site. Adjuvants also activate the proliferation of cells of the T-, B-, A-immune systems and enhance the synthesis of the body’s protective proteins. Adjuvants enhance the immunogenicity of antigens several times.

Associated vaccines used to reduce the number of vaccines and the number of injections during mass vaccination, which include several heterogeneous antigens and allow immunization against several infections simultaneously. Associated preparations may include both inactivated and live vaccines. If the drug contains homogeneous antigens, such an associated vaccine is called a polyvaccine (live polio vaccine or polyanatoxin against tetanus, gas gangrene, botulism). Combined vaccines are preparations consisting of several dissimilar antigens (DPT vaccine).

Approximately 40 vaccines are currently used for vaccination, half of which are live. Indications for vaccination are the presence or threat of spread of infectious diseases, as well as the occurrence of epidemics among the population. General contraindications to vaccination are:

Acute infectious and non-infectious diseases;

Allergic conditions;

Diseases of the central nervous system;

Chronic diseases of parenchymal organs (liver, kidneys);

Severe diseases of the cardiovascular system;

Severe immunodeficiencies;

The presence of malignant neoplasms.

Post-vaccination reactions in the form of a short-term increase in temperature, local manifestations (hyperemia, swelling at the injection site). Every country, including Russia, has a vaccination calendar. The calendar indicates which vaccines and according to what time schedule each person should be vaccinated in childhood and adulthood. Thus, in childhood (up to 10 years), every person should be vaccinated against tuberculosis, measles, polio, whooping cough, diphtheria, tetanus, hepatitis B, and in endemic areas - against especially dangerous diseases and natural focal infections.

In vaccine prevention, several methods of administering vaccines are used, the use of which makes it possible to vaccinate a large number of people in a short time. These include needle-free injection, oral and aerosol methods of administering vaccines.

Bacteriophages created on the basis of viruses that infect bacteria. They are used in the diagnosis, prevention and treatment of many bacterial infections (typhoid fever, dysentery, cholera).

Probiotics contain a culture of living non-pathogenic bacteria, representatives of the normal microflora of the human intestine and are intended for correction, i.e. normalization, qualitative and quantitative composition of human microflora in case of their violation, i.e. with dysbacteriosis. Probiotics are used for both preventive and therapeutic purposes for dysbiosis of various etiologies. The most common probiotics include “Colibacterin”, “Bifidumbacterin”, “Lactobacterin”, “Bifikol”, “Subtilin”, which respectively contain Escherichia coli, bifidobacteria, lactobacilli, and spores. Currently, probiotics in the form of lactic acid products are widely used: “Bio-kefir”, kefir “Bifidox”. Given that probiotics contain living microbial cells, they must be stored under gentle conditions. Probiotics are prescribed orally in long courses (from 1 to 6 months) 2-3 times a day in combination with other treatment methods.

Anatoxins – these are antigenic preparations obtained from exotoxins during their sterilization treatment. In this case, the toxoid is devoid of the toxicity of the original exotoxin, but retains its antigenic properties. When toxoids are administered, antitoxic immunity is formed, since they induce the synthesis of antitoxic antibodies - antitoxins.

Passive immunoprophylaxis is carried out as emergency prophylaxis for contact persons when it is necessary to quickly create passive artificial immunity. It is carried out with ready-made antibody preparations - antimicrobial and antitoxic immune serums.

Vaccines (Latin vacca - cow) - preparations from pathogens or their protective antigens, intended to create active specific immunity for the purpose of preventing and treating infections.

Based on the method of production, vaccines are classified into live, killed, chemical, artificial, genetically engineered and toxoid.

Live attenuated (weakened) vaccines are obtained by reducing the virulence of microorganisms when they are cultivated under unfavorable conditions or when passaged on low-susceptible animals. Under such unfavorable conditions, strains lose virulence. Attenuated bacteria and viruses with reduced virulence are widely used as live vaccines. With long-term cultivation on a medium containing bile, Calmette and Gerin obtained an avirulent strain of Mycobacterium tuberculosis (BCG, BCG - Bacille Calmette Guerin), which is used for vaccination against tuberculosis. Live vaccines include vaccines against rabies, tuberculosis, plague, tularemia, anthrax, influenza, polio, measles, etc. Live vaccines create intense immunity, similar to natural post-infectious immunity. As a rule, live vaccines are administered once, because the vaccine strain persists in the body. Live vaccines of many bacteria and viruses create immunity better, while killed ones do not always do so. This may depend on the antibody isotype induced, for example, effective opsonization of staphylococci requires IgG2 antibodies that are not induced by the killed vaccine. A new direction is the production of vaccine mutant strains that live for a short time but create immunity. In people with immunodeficiencies, even weakened bacteria or viruses from live vaccines can cause severe infectious complications. Killed vaccines are prepared from highly immunogenic strains of microorganisms that are inactivated by heat, ultraviolet irradiation or chemicals. Such vaccines include vaccines against whooping cough, leptospirosis, tick-borne encephalitis, etc. Often, not whole cells are used, but their extracts or fractions. The ribosomes of a number of bacteria are highly immunogenic. Attenuated and killed vaccines contain many different antigenic determinants, of which the protective ones, i.e. Few are capable of inducing immunity. Therefore, the isolation of protective antigens from microorganisms made it possible to obtain chemical vaccines. An example of such a vaccine is the chemical cholera vaccine, which consists of a cholera toxoid and lipopolysaccharide extracted from the cell wall of Vibrio cholerae. Analogues of bacterial chemical vaccines are viral subunit vaccines consisting of hemagglutinin and neuraminidase isolated from the influenza virus (influenza). Chemical subunit vaccines are less reactogenic. To increase immunogenicity, adjuvants are added to them (aluminum hydroxide, aluminum-potassium alum, etc. ), as well as immunomodulators: polyoxidonium in the vaccine - influenza.

Anatoxins obtained by treating exotoxins with formaldehyde solution. In this case, the toxin loses its toxic properties, but retains its antigenic structure and immunogenicity, i.e., the ability to cause the formation of antitoxic antibodies. The conditions for inactivation and transition to anatoxin differ for different toxins: for diphtheria toxin it is 0.4% formaldehyde at 39-40˚C for 30 days; for staphylococcal – 0.3-0.4% formalin at 37˚C for 30 days; for botulinum – 0.6-0.8% formalin at 36˚C for 16-40 days. Toxoids are used to create antitoxic immunity for diphtheria, tetanus and other infections whose pathogens produce exotoxins.

Toxoids can be used instead of toxoids. These are products of mutant exotoxin genes that have lost their toxicity. For example, E. coli enterotoxin and cholera toxin are composed of A and B subunits. Subunit A is responsible for toxicity. When the gene is mutated, it is lost, but the immunogenic B subunit is retained, which can be used to produce antitoxic antibodies. Recombinant toxoids have been obtained, for example, pertussis and diphtheria GRM197; in the latter, C52-glycine is replaced by glutamic acid, which sharply reduces its toxicity. Recent advances in immunology and molecular biology make it possible to obtain antigenic determinants in pure form . However, isolated antigenic determinants in the form of peptides do not have significant immunogenicity. They must be conjugated with carrier molecules (these can be natural proteins or synthetic polyelectrolytes). By combining several epitopes of varying specificity with a common polyelectrolyte carrier and adjuvant, artificial vaccines are created (Petrov R.V., 1987). When creating genetically engineered vaccines, they use the transfer of genes that control the desired antigenic determinants into the genome of other microorganisms, which begin to synthesize the corresponding antigens. An example of such vaccines is the vaccine against viral hepatitis B, containing the HBs antigen. It is obtained by inserting a gene that controls the formation of the HBs antigen into the genome of eukaryotic cells (for example, yeast). Plant vaccines: microbial genes are inserted into the plant genome to form the necessary antigens, which can induce immunity when the fruits of these plants are eaten (tomatoes or potatoes with hepatitis B antigen). The production of vaccines based on anti-idiotypic antibodies is fundamentally new. There is a structural similarity between the epitope of an antigen and the active site of an anti-idiotypic antibody, which recognizes the idiotypic epitope of an antibody to a given antigen. Therefore, for example, antibodies against antitoxic immunoglobulin (i.e., anti-idiotypic antibodies) can immunize laboratory animals like toxoid. DNA vaccines are nucleic acid from a pathogen that, when introduced into the body, causes protein synthesis and an immune response to them. Thus, a DNA vaccine based on the NP gene encoding the nucleoprotein of the influenza virus, administered to mice, protected them from infection with this virus. New vaccines - dendritic cells bearing immunizing antigen (DC-AG) are strong stimulators of the immune system, optimal antigen-presenting cells. DCs are isolated from blood in cell culture and made antigen-bearing in various ways: by sorption or antigens, or their infection, or by introducing DNA or RNA into them, which synthesizes the desired antigen in them. It has been shown that DC-AG vaccines create immunity in animals against chlamydia, toxoplasma, and also stimulate the formation of antitumor killer T cells. New methods for developing vaccines include genomic technologies for producing a complex of protective peptide-antigens of pathogens of several infections, to which pathogen-associated molecular structures that stimulate innate immunity are added as an adjuvant carrier (Semenov B. F. et al., 2005).

According to their composition they distinguish monovaccines (1 microbe), divaccines (2 microbes), polyvaccines (several microbes). An example of a polyvaccine is DTP (associated pertussis-diphtheria-tetanus vaccine), containing killed pertussis bacteria, diphtheria and tetanus anatoxin. Ribomunil is a multicomponent vaccine made from ribosomes and peptidoglycan of microbes that persist in the upper respiratory tract. Indications for vaccination vary. Some vaccines (see vaccination calendar) are used for mandatory routine vaccination of children: anti-tuberculosis vaccine BCG, polio, mumps, measles, rubella, DTP, hepatitis B (HBS). Other vaccines are used for occupational hazards (for example, against zoonotic infections) or for administration to people in specific areas (for example, against tick-borne encephalitis). To prevent the spread of epidemics (for example, with influenza), vaccination is indicated according to epidemiological indications. The effectiveness of vaccination depends on the creation of a sufficient immune layer of the population (herd immunity), which requires vaccination of 95% of people. The requirements for vaccines are strict: they must be a) highly immunogenic and create sufficiently stable immunity; b) harmless and not cause adverse reactions; c) do not contain other microorganisms. It should be noted that all vaccines are immunomodulators, i.e. they change the body’s reactivity. By increasing it against a given microorganism, they can reduce it against another. Many vaccines, by stimulating reactivity, initiate allergic and autoimmune reactions. Such side effects of vaccines are especially common in patients with allergic diseases. Contraindications for vaccination are strictly regulated (Table 10.2). For the purpose of immunotherapy, vaccines are used for chronic protracted infections (killed staphylococcal, gonococcal, brucellosis vaccines). Routes of vaccine administration: cutaneous (against smallpox and tularemia), intradermal (BCG), subcutaneous (DPT), orally (poliomyelitis), intranasal (anti-influenza), intramuscular (against hepatitis B). A transdermal method has also been developed, when using a helium jet, an antigen on gold particles is introduced into the skin, where it binds to keratinocytes and Langerhans cells, delivering it to the regional lymph node. A promising method of administering vaccines is the use of liposomes (microscopic vesicles with a bilayer phospholipid membrane). The vaccine antigen can be included in the surface membrane or introduced into liposomes. Vaccines, especially live ones, require special storage and transportation conditions to preserve their properties (constantly in the cold - “cold chain”).

National vaccination calendars declare the timing of vaccinations for each vaccine, rules of use and contraindications. Many vaccines, according to the vaccination calendar, are re-administered at certain intervals - revaccination is done. Due to the secondary immune response, due to the presence of an anamnestic reaction, the response intensifies and the antibody titer increases.

Calendar of preventive vaccinations in Belarus (Order of the Ministry of Health of the Republic of Belarus No. 275 dated September 1, 1999)

1 day (24 hours) – vaccine against hepatitis B (HBV-1);

3-4th day - BCG or tuberculosis vaccine with reduced antigen content (BCG-M);

1 month – HBV-2;

3 months – adsorbed pertussis-diphtheria-tetanus vaccine (DTP), inactivated polio vaccine (IPV-1), oral polio vaccine (OPV-1);

4 months – DPT-2, OPV-2;

5 months – DPT-3, OPV-3, VGV-3; 12 months – trivaccine or live measles vaccine (LMV), live mumps vaccine (LMV), rubella vaccine; 18 months – DTP-4, OPV-4; 24 months – OPV-5;

6 years – adsorbed diphtheria-tetanus toxoid (DT), trivaccine (or LCV, ZHPV, rubella vaccine); 7 years – OPV-6, BCG (BCG-M);

11 years old – adsorbed diphtheria toxoid with reduced antigen content (AD-M);

13 years old - HBV;

16 years and every subsequent 10 years up to 66 years inclusive - ADS-M, AD-M, tetanus toxoid (AS).

Vaccinations against hemophilus influenzae infection are permitted by information letter of the Ministry of Health of the Russian Federation No. 2510/10099-97-32 dated December 30, 1997 “On the prevention of hemophilus influenzae infection.”

It is predicted that the vaccination calendar will expand and by 2025 it will additionally include more than 25 vaccines for children: against hepatitis A, B, C, respiratory syncytial virus, parainfluenza virus types 1-3, adenoviruses 1, 2, 5-7, mycobacteria tuberculosis, diphtheria, tetanus, meningococci A, B, C, pneumococci, polio, hemophilus influenzae, rotavirus, measles, mumps, rubella, chickenpox, Lyme disease, cytomegalovirus, Epstein-Barr virus, human papilloma, herpes simplex 2, parvovirus and possibly HIV. Some of these vaccines are already in use, others are not used in all countries, and others are at the development stage. Most of them will be combined, multicomponent, including protective antigens of various pathogens, so the number of vaccinations will not increase.

IMMUNIZATION(lat. immunis free, free from something) - specific prevention of infectious diseases among people and animals.

Story

AND. long time was used only to prevent smallpox. After the discovery by E. Jenner in 1796 of the protective properties of cowpox, smallpox vaccination (see) became widespread in many countries. According to M.A. Morozov and V.S. Solovyov (1948), the number of vaccinated people in England by 1800 exceeded 10,000 people. In France in 1801, vaccinations were used in 105 cities. In the same year, vaccinations began in Moscow, and by 1814, according to official data, 1,899,260 people were vaccinated in Russia. In Northern Italy, 1.5 million vaccinations were given over 8 years (since 1801). Smallpox vaccination was accompanied by a sharp decrease in morbidity and mortality from smallpox. However, observations of the morbidity of vaccinated people indicated a limited duration of vaccination immunity and the need to repeat the vaccination after 5-10 years. For the first time, revaccination (repeated, distant I.) was carried out in Germany in 1831.

The further development of I. was determined by L. Pasteur’s assumption that pathogens of infectious diseases, under certain conditions, lose their pathogenic properties and the ability, when introduced into the body, to form immunity to infection under natural conditions. Vaccination of sheep in 1881 in a wide experiment with a strain of anthrax pathogen with weakened virulence (attenuated strain) gave undeniable results. Since the Pasteur vaccine turned out to be monopolized by the “Pasteur Vaccine Society” and the method of its production was classified, the live anthrax vaccine in Russia was independently developed by L. S. Tsenkovsky. It was used until 1942. It replaced it anthrax vaccine STI was first used in epizootol. practice, and then for I. people. In 1885, L. Pasteur first saved the life of a boy, bitten by a rabid dog, by inoculating with a live vaccine. Anti-rabies vaccinations (om.) soon gained universal recognition and widespread use. The idea of ​​using live vaccines turned out to be fruitful. They are used to prevent smallpox, tuberculosis, influenza, measles, plague, tularemia, yellow fever, brucellosis, polio and a number of other infectious diseases.

L. Pasteur's opinion about the possibility of creating immunity (q.v.) only with the help of living pathogens with altered properties somewhat slowed down the development of vaccines (q.v.) from killed microbes. Such vaccines were used by V. A. Khavkin in 1892 for I. against cholera and in 1896 against the plague. In 1896, R. Pfeiffer and W. Nolle in Germany, A. Wright and D. Semple in England vaccinated a limited number of people against typhoid fever. In Russia they were carried out in 1898 by V.K. Vysokovich. Vaccinations became widespread during the First World War (1914-1918). They were accompanied by a decrease in the incidence of typhoid fever in the armies of the warring states, despite the deterioration of dignity. conditions. I. killed vaccines were also carried out against dysentery, polio, typhus, brucellosis, tularemia, influenza and a number of other infectious diseases. Due to lack of effectiveness, many killed vaccines have fallen out of use. Since the 30s. 20th century tested I. chem. vaccines containing antigen complexes extracted from the corresponding microbes.

Opportunities for I. expanded after the discovery by G. Ramon in 1923 of a method for producing toxoid from the diphtheria bacillus toxin (see). I. diphtheria toxoid led to the elimination of the mass incidence of diphtheria. As a result of exposure to tetanus toxoid, only isolated cases of tetanus were observed during the Second World War. The effectiveness of I. toxoids against anaerobic and other infections has been less studied.

The importance of immunization in the system of preventive measures

In the system of preventive and anti-epidemic. measures, the role of I. in relation to different groups of infectious diseases is not the same. It is impossible to do without I. in the fight against infectious diseases with an easily implemented mechanism of transmission of infection. Among them, the first place is occupied by infections respiratory tract. With this group of infectious diseases, I., with some exceptions, is the main preventive measure. Smallpox vaccination, accompanied by the development of intense immunity, leads to the complete elimination of smallpox. Since 1958, at the suggestion of the USSR, WHO has successfully implemented a smallpox eradication program through widespread vaccination coverage of the population of countries where it is widespread. I. led to the elimination of the mass incidence of diphtheria, sharp decline incidence of whooping cough and measles.

I. is not justified against infections with a short-term and predominantly mild course (for example, against chickenpox, etc.), which do not leave noticeable consequences in the body.

In connection with the indications for I., tuberculosis occupies an independent place in the group of respiratory tract infections. The practice of many countries, including those in which almost all newborns are immunized, shows that it is impossible to achieve the elimination of tuberculosis in this way. The main influence on the incidence of tuberculosis is exerted by social factors (material standard of living of the population, hygiene skills, housing, etc.) and preventive measures (elimination of animal tuberculosis and increasing the effectiveness of treatment of sick people). I. in this case is an auxiliary measure.

In Group intestinal infections I. is especially effective in the prevention of poliomyelitis. Vaccinations with live vaccines have led to the virtual elimination of paralytic forms of the disease and. imparting specific resistance to intestinal cells, according to M.K. Voroshilova (1966), sharply reduced the carriage of wild polioviruses. In the prevention of typhoid fever, paratyphoid A and B, the level of sanitary and communal amenities is important. Streamlining the water supply and disinfecting sewage systems is accompanied by a persistent decrease and cessation of morbidity. In this case, there is no need for information about the population. In settlements with poor amenities. in relation to individual groups of the population retains a certain significance.

The conditions are similar for I. against intestinal infections of a zoonotic nature. A radical measure for the prevention of brucellosis remains the improvement of the health of the herd of domestic animals, especially sheep. In the USSR, in the practice of combating brucellosis, the use of live vaccine for individual (so-called endangered) population groups has been used. As the epizootic situation improves, vaccination coverage of the population decreases, and in many livestock farms they are no longer carried out. The basis for the prevention of leptospirosis also consists of improving the health of the herd of domestic animals, exterminating rodents, regulating the access of animals to open water bodies and observing personal preventive measures. I. is used to a limited extent, mainly to protect people involved in animal husbandry.

In the prevention of blood infections, I. is used taking into account the epidemic, and in the case of diseases of a zoonotic nature, the epizootic situation. I. against typhus in the army and among certain groups of the population was carried out during the Great Patriotic War(1941 -1945). The need for it disappeared after the elimination of outbreaks of the disease in the temporarily occupied territory. I. remains the main measure for the prevention of tularemia. I. against tick-borne encephalitis, plague, Q fever, yellow fever and other blood infections has an auxiliary value and is used to protect limited groups of the population.

In case of infections of the outer integument, I.'s capabilities are limited. It remains the only measure to prevent the development of the disease in persons bitten by a rabid animal. As the epizootic situation improves, there is no need for anti-anthrax agents.

The epidemiological effectiveness of immunization for different infectious diseases varies and depends on a number of factors. The vaccines used are not the same in terms of immunogenicity. Live vaccines are more immunogenic than killed ones. The immunogenicity of vaccines used to prevent infections belonging to the same group also differs. Thus, the vaccine against tularemia has a higher immunogenicity than the vaccines against anthrax, brucellosis, and Q fever; Killed typhoid vaccine is more effective than killed tick-borne encephalitis vaccine. The immunogenicity of vaccines is affected by the process of storage and transportation. At high temperatures, in a relatively short period of time, the percentage of viable microbes in live vaccines decreases and the antigenic-immunogenic activity of vaccines made from killed microbes decreases, in particular due to the lysis of microbial bodies. Low temperature, especially repeated freezing and thawing, not only reduces the immunogenicity of many drugs, but can lead to their complete unusability.

Of great importance correct dosage drug and compliance with the intervals between vaccinations. The immunizing effect depends on the dose of the drug and increases with its increase. But the severity of immunol. the changes do not correlate with the degree of increase in the dose of the drug. Moreover, a vaccine in an excessively large dose immunizes less than the optimal dose. However, small doses of the drug are also undesirable, since they can cause an increase in the body’s sensitivity to infection. The most optimal intervals for I. killed vaccines are 7 - 10 days. A longer interval is required between the first and subsequent administration of toxoid. In accepted I. schemes, the duration of the interval ranges from 3 weeks. up to 1 month

The intensity of post-vaccination immunity depends both on the immunogenicity of the drug and its administration regimen, and on the reactivity of the vaccinated body. For the presence of the so-called refractoriness (immunizing inertia) in a number of people vaccinated against diphtheria with a single dose of toxoid was first indicated by P. F. Zdrodovsky (1936). According to his data, 108 children immunized with diphtheria toxoid were distributed according to the level of antitoxin in the blood as follows: children with insufficient and sluggish production of antitoxin (0.005-0.03 AE) - 27.7%; children with moderate antitoxin production (0.03-1 AE) - 52%; children with active antitoxin production (1 - 4 AE) - 2:0.3%. Immunization inertia is determined by the individual characteristics of the body, the degree of complete nutrition, and the influence of factors environment, strength and rhythm of immunizing irritation. To overcome it, normalization of nutrition, treatment of concomitant diseases, elimination of intoxication of various natures and long-term revaccination are necessary.

The result of revaccination is universal for all types of immune reactions in humans and animals. Consequently, the presence of preliminary immunol, restructuring has great importance, as it allows you to increase your immunity status more quickly.

The effectiveness of I. also depends on the coverage of the population with vaccinations. In case of infectious diseases with an easily implemented mechanism of transmission of infection, in order to achieve persistent epidemics and well-being, maximum I. of the population and its revaccination within the accepted time frame are necessary. Smallpox was the first to be eliminated in this way, then the incidence of diphtheria stopped within many administrative territories Soviet Union after immunization St. 90% of susceptible individuals and repeated booster vaccinations. The presence of certain diphtheria diseases is associated with the carriage of toxigenic diphtheria bacilli, loss of immunity in previously vaccinated people, and shortcomings in the implementation of vaccination and revaccination. Wide, almost universal, vaccination coverage of the population is one of the conditions for increasing the effectiveness of I. in other respiratory tract infections.

The effectiveness of I. is influenced by the epidemic and the situation. In conditions of widespread infectious disease the probability of infection, including a large dose of the pathogen, is more significant than with a low level of incidence. Diseases in such cases occur primarily among persons with insufficient immunity (inert in immunol, in relation to those who have lost immunity).

Assessing the effectiveness of immunization. In conditions of mass vaccination, the criterion for its effectiveness is a persistent decrease in the incidence rate over a number of years and, especially, in comparison with the period when the corresponding vaccine was not used. At the same time, the possible influence of other factors on reducing the incidence of disease is taken into account. Less commonly used is a comparison of morbidity among vaccinated and unvaccinated people. This is justified if the infection covers part of the population and it is possible to identify for comparison groups of the population that are equivalent in terms of the main characteristics that determine the risk of infection.

The effectiveness of I. is assessed by the mortality rate in the same way as by the morbidity rate. In this case, the change in the mortality rate may not coincide with the change in the morbidity rate. It is more difficult to use the mortality rate for this purpose. It can only be considered in comparison with the incidence rate and the treatment methods used.

Data about the wedge, the course of the disease (severity, duration of course, complications) and its outcome (recovery, death, transition to a protracted form, bacterial carriage) are usually considered in groups: vaccinated, revaccinated, incompletely vaccinated, unvaccinated e.

The effectiveness of I. can also be judged by the frequency of isolation of pathogens in people. Thus, anti-poliomyelitis in many areas has led to the cessation of circulation of “wild” strains of poliovirus, the frequency of carriage of toxigenic strains of diphtheria bacillus has decreased, and the ratio in the frequency of isolation of the causative agent of whooping cough and parapertussis has changed.

Immunization methods

I. is carried out: by introducing into the body antigens (live or killed vaccines, toxoids), antibodies (immune sera or gamma globulins), immune serum or gamma globulin and then an antigen (once or repeatedly) - see table.

Depending on the administration of certain drugs, the body acquires artificial active or passive immunity. Anti-epidemic In practice, I. is widely used with the help of vaccines (see) and toxoids (see), which provide the body with artificial active immunity for a long period. The duration of the immunity created allows vaccinations to be carried out in advance and for a number of infections, regardless of the season, throughout the year.

The use of immune serums and gamma globulin (see Immunoglobulins) creates short-term artificial passive immunity. Repeated administration of heterogeneous serum and gamma globulin prepared from it can cause anaphylactic shock or serum sickness, and therefore preliminary desensitization of the body is necessary.

Simultaneous administration of antigens and serum or gamma globulin is used in cases of obvious infection. reducing the body's defenses under the influence of various factors and to prevent a strong reaction to vaccination. So, in case of injury, a person who has not been vaccinated against tetanus is injected subcutaneously with 1 ml of adsorbed tetanus toxoid, and then with another syringe into another part of the body - 3000 IU of anti-tetanus serum (sensitivity to horse serum protein is first checked) or 3 ml of donor anti-tetanus gamma globulin; children over 3 years of age who have not been vaccinated against smallpox are given 3 ml of anti-smallpox gamma globulin before vaccination; The full course of anti-rabies vaccinations begins with the administration of anti-rabies gamma globulin at a dose of 0.25-0.5 ml per 1 kg of weight.

Indications and timing of immunization

I. is carried out as planned and according to epidemiological conditions. indications. The list of infectious diseases for I. in a planned manner and the timing of vaccinations are determined by the M3 of the USSR. At the same time, the need to observe a 2-month interval between vaccinations against certain infectious diseases is taken into account.

I. according to epidemiological indications is carried out according to the decision of the ministries of health of the union republics and in in some cases M3 USSR.

Children are routinely vaccinated against tuberculosis on the 5-7th day of the child’s life, and against polio from the 2nd month. life, against diphtheria and whooping cough - from 5-6 months, against smallpox - from 1 year to 2 years and against measles from 10 months. life (table). Revaccination of children against these infections is carried out differently. In areas where the incidence of tuberculosis in children has been practically eliminated and local forms of tuberculosis are not detected among them, only two revaccinations are carried out - at 7 and 15 years of age. Children are revaccinated against polio at 1, 2 and 3 years of age, each time three times with an interval of 3 months, and then once at 7-8 and 15-16 years of age; against diphtheria, whooping cough and tetanus - with DTP vaccine 1.5-2 years after vaccination and once at 6 years, and in some cases (table) - with DTP vaccine at 11 years. Revaccination against smallpox is carried out at 8 and 16 years of age. Children traveling abroad are allowed to be vaccinated against smallpox at the age of up to 1 year, but not earlier than 3 months, subject to the established interval between vaccinations against other infectious diseases.

The indication for I. against influenza, smallpox and cholera is WHO information on the incidence and occurrence of infection outside the country (detection of a new variety of influenza virus, identification of patients, including among persons arriving from countries endemic for these infections, isolation of Vibrio cholerae from sewage and open water). As a result of the successful implementation of the smallpox eradication program in countries around the world, the need for additional smallpox vaccination has not arisen for more than 20 years. I. against yellow fever is carried out for those traveling to countries unfavorable for this infection.

Unscheduled revaccination against diphtheria is advisable if the results of the skin test (Schick reaction) are taken into account. If the number of non-immune people during a random survey at a school or boarding school does not exceed 5%, vaccinations are not carried out. If the Schick reaction is positive within 6-15% of the number of those examined, a comprehensive examination of children and revaccination of non-immune children is recommended. If 20% or more are non-immune, it is necessary to carry out a single revaccination of all children, provided there is no medical treatment. contraindications. In this case, the intensity of Schick's reaction is not taken into account. For revaccination, DTP vaccine is used. Revaccination against whooping cough is not carried out separately from diphtheria.

I. against typhoid fever is used in populated areas with increased morbidity. Vaccinations cover age, professional and other groups of the population, due to which the epidemic and troubles are maintained. In some cases, in the presence of diseases, workers in new buildings and members of their families are vaccinated before the completion of sanitary and communal improvement of settlements, migrants traveling for seasonal agricultural work. work, and other contingents.

The basis for I. against brucellosis is the presence of agricultural diseases. animals, especially small livestock. Sanitary hygiene is also taken into account. conditions in livestock farms and the results of analysis of population morbidity over a number of years.

I. against anthrax is carried out to limited groups of the population working in animal husbandry in areas unfavorable for morbidity. There may be a need for I. of persons involved in the collection, storage, transportation and processing of raw materials of animal origin.

The need for I. against tularemia may arise in the territory of natural foci and in areas considered epizootic-free in the event of an epizootic and the appearance of human diseases. In some cases, vaccinations are given to people leaving cities for agriculture. and other work in areas unfavorable for tularemia.

Contraindications for vaccinations are some diseases, convalescent states, congenital malformations, pregnancy, etc. For more information on contraindications, see Vaccination.

Immunization planning and drug supply

The basic principles of vaccination planning are determined by M3 of the USSR. For the next year, the contingents that should be vaccinated are indicated, the drugs that should be administered are named. The timing and frequency of vaccinations against individual infections are also determined.

In cities, the vaccination plan for children is drawn up by the vaccination offices of children's clinics together with local doctors on the basis of the vaccination card, which is composed of separate records of preventive vaccinations (form No. 63). The card file is preliminarily verified with the data on registering children, which is carried out once a year by visiting nurses, information from the registry office about newborns and from the police about new arrivals.

In rural areas, children's clinics, consultations and medical stations are involved in planning vaccinations for children. Ilais are compiled on the basis of preventive vaccination records cards (form No. 63) or a vaccination log book, as well as on the basis of data from village councils on children born and arriving.

A significant decrease in the incidence rate, in particular typhoid fever, in recent years, as well as facts indicating a pronounced side effect typhoid vaccines, necessitated the development of a system of criteria for planning vaccinations. A. A. Sumarokov and JI. V. S al.miny m (1974) proposed the formula:

R = (100000*100)/mE

where R is the coefficient of preventive effectiveness of the vaccine that is supposed to be used; m is the expected incidence rate per 100,000 population, determined on the basis of long-term epidemiological data; E is the number of people who must be vaccinated to reduce diseases by 1 case. The nomogram created on the basis of the formula, according to the authors, can be used to substantiate I. and, in particular, when planning immunoprophylaxis of typhoid fever according to epidemiological indications.

Planning of vaccinations according to epidemic indications, carried out regularly (tularemia, plague, tick-borne encephalitis, etc.), is carried out as for other infections. In this case, the SES also determines the territory within which vaccinations should be carried out.

The SES of a city or district draws up a consolidated vaccination plan and, after approval by the city health department or the chief physician of the district, sends it to the regional, regional or republican SES, which summarizes these plans and submits them for approval to the Ministry of Health of the Union Republic. The consolidated plan for the republic and the application for bacterial preparations are sent to the M3 of the USSR, from where, after consideration, they are returned to the Ministry of Health of the union republic for implementation.

In accordance with the approved plan, a stock notification for bacterial preparations is received through Soyuzkhimpharmtorg. Based on it, regional, regional and republican SES enter into contracts with institutes for the supply of bacterial preparations. As bacterial preparations are imported, they are distributed to institutions conducting I. In these institutions, stocks of other materials necessary for I. are also created at the rate of: cotton wool 0.5 g, alcohol 0.5 ml, ether 0.25 ml per vaccinated person, alcohol solution iodine 10-15 ml per 100 vaccinated; 20-30 needles, 10-15 syringes per vaccinator or one needle-free Injector.

The organization of vaccinations of the population is carried out by the dignity. -epid. M3 institutions of the USSR. I. is carried out by cutaneous, subcutaneous, intravenous, enteral, intranasal, aerosol and combined methods (see Vaccination, Needleless injector).

Recording and reporting of vaccinations

The main accounting documents for registering vaccinations for children in cities are the child’s development history (form No. 112) and the preventive vaccination record card (form No. 63). The notes on vaccinations and the results of skin tests (Chic reaction, Mantoux reaction, etc.) are entered into the specified forms by the nurse.

In preschool institutions, vaccinations are recorded in registers indicating the date, name of the drug, batch number and dose. The logs are handed over to the vaccination office once a month to enter information about the vaccinations performed into the vaccination record cards and in the child’s development history.

In schools, vaccinations are recorded in the vaccination card, if it is in the school, or in the vaccination and medical register. student card (form No. 26). If records are kept in a journal, they are handed over to the vaccination office once a month.

In rural areas, records of childhood vaccinations are kept in a preventive vaccination record card or in a journal in accordance with Form No. 63.

Vaccinations for adults in the city and in rural areas are recorded in a journal.

Vaccination offices and other institutions conducting vaccinations compile a summary statement at the end of the month, which is sent no later than the second day of the month following the reporting month to the city or district SES. The named institutions draw up a summary report for the city or district as a whole (form No. 85, 86, 87) and send it to the higher SES and the inspector of the Central Statistical Office on the fifth day of the month following the reporting month. Reports are also compiled by regional, regional, and republican SES and submitted to the Ministry of Health of the Union Republic. Basic information about biol, drugs and their use in the prevention of certain infectious diseases is given in the table.

Immunization of troops

Immunization of troops is an integral part of the prevention of infectious diseases in the Armed Forces. I. in the army first began to be carried out against intestinal infections at the end of the 19th century. In the Russian army, I. was first administered the carbolized typhoid vaccine by V. K. Vysokopich in 1898. Mass I. against typhoid fever and cholera began to be carried out in the Russian army in 1915. Soviet army in 1919, vaccinations against typhoid fever and cholera were widely carried out, and starting in 1926, vaccinations in the army against typhoid fever and paratyphoid B became mandatory for all personnel. Since 1937, I. has been introduced against dysentery (enteral) and tetanus. During the Great Patriotic War, I. was carried out in chapter. arr. against intestinal infections and tetanus with the NIISI polyvaccine.

I. in the Soviet Army and Navy is carried out as planned and according to epidemiological indications. The following are routinely carried out: vaccination and revaccination against typhoid fever, paratyphoid A and B, tetanus and smallpox. According to epidemiological indications, vaccinations can be carried out against any infectious diseases.

The list of scheduled vaccinations is established by the Central Military Medical Directorate of the USSR Ministry of Defense, and the timing is established by orders of the commanders of district troops (groups of troops), fleets (flotillas) on the proposal of medical chiefs. services. The timing and procedure for vaccinations according to epidemiological indications are established by orders of formation commanders on the recommendation of medical chiefs. connection services and with the permission of the heads of medical. services of military districts, groups of troops and fleets.

The direct organization of vaccinations and control over their implementation are entrusted to medical managers. services of formations, units and ships. The procedure for vaccinations in a unit or on a ship is determined by the order of the commander of the unit or ship.

Before I. the chiefs of medical Unit and ship services organize medical services. examination with thermometry of personnel to identify persons in Crimea for health reasons, vaccinations are contraindicated; compile lists and schedules of vaccinations by department; prepare premises and the necessary amount of equipment for vaccinations; they check the suitability of vaccination preparations, and on the eve of I. they carry out sanitary education and work.

Mass I. is preceded by testing the reactogenicity of each series of the vaccine used in a group of 40-50 people. A vaccine series that caused severe post-vaccination reactions in more than 7% of vaccinated individuals is not allowed for use. Vaccinations may only be carried out by a doctor or, in exceptional cases, by an experienced paramedic under the supervision of a doctor.

In the list of those vaccinated after administration of the drug, the date of vaccination, series and dose of the administered vaccine are indicated. At the end of the vaccinations, notes are made in the medical center. military personnel books. The doctor who carried out the I. checks the health status of the vaccinated, as well as the results of vaccination after 24, 48 and 72 hours, taking into account local and general reactions.

I. against typhoid fever, paratyphoid A and B and tetanus is carried out with sorbed typhoid-paratyphoid-tetanus vaccine (TABte) as planned. I. are subject to conscription into the Soviet Army and Navy at recruiting stations or upon arrival in the troops and navies, as well as military personnel in the order of annual revaccination, but not earlier than after 4-6 months. after primary I. Vaccination with TABte vaccine is done once under the skin both during primary vaccination and during revaccination.

Conscripts and personnel of the Soviet Army and Navy undergo routine preventive vaccinations (re-vaccinations) against smallpox every 4-5 years. The results of revaccination are recorded on the 2-4th day after vaccination. In case of a negative result, vaccinations are repeated after 5-7 days. I. against smallpox according to epidemiological indications is carried out to all personnel, regardless of the timing of the previous vaccination. Vaccinations with smallpox detritus are given cutaneously in a dose of 0.01 ml of the drug, usually simultaneously with TABte.

I. against tuberculosis is carried out dry BCG vaccine for intradermal administration. Conscripts who do not have a reaction to intradermal injection are vaccinated (re-vaccinated). standard solution tuberculin (Mantoux test). The vaccine is administered in a dose of 0.05 mg in 0.1 ml of fiziol, sodium chloride solution. The occurrence of post-vaccination allergies is monitored by performing a Mantoux test after 10-12 months. after vaccination. If there is no reaction, re-vaccination is carried out.

Animal immunization

The scientific foundations of animal health were laid by L. Pasteur, who created the first vaccines against anthrax (1881) and swine erysipelas (1883). In 1883, the anti-anthrax vaccine was obtained by the Russian scientist L. S. Tsenkovsky, and the anti-erysipelas vaccine by P. F. Borovsky (1896) and D. F. Konev (1899). Soviet scientists S.N. Muromtsev, N.A. Mikhin, S.G. Kolesov, N.V. Likhachev, I.I. Kulesko, S.Ya. Lyubashenko and others made a great contribution to the field of animal vaccination. against a number of diseases of domestic and commercial animals. In the USSR, vaccines are being successfully developed for complex and associated animal immunosuppression, as well as immunity for protozoal diseases. In the early 70s. 20th century For the first time in the world, active I. was introduced for trichophytosis of cattle (A. Kh. Sarkisov et al.). Animal health played a major role in the elimination and reduction of epizootic foci of such dangerous animal diseases as anthrax, rinderpest, swine fever, brucellosis, etc.

I. of animals are divided into preventive, or planned, and I. for epizootic indications.

Preventive immunization is carried out taking into account the unfavorability of the farm for a particular disease in certain calendar periods against anthrax, brucellosis of cattle and small ruminants, foot and mouth disease, rabies, tetanus, leptospirosis, Aujeszky's disease, etc.

Immunization for epizootic indications is carried out to eliminate emerging outbreaks of infectious diseases, as well as to prevent their possible penetration into a certain farm from places unfavorable for the disease.

I. is carried out only on healthy animals; weak and exhausted animals, animals in the last stage of pregnancy or after childbirth and with elevated temperature are not immunized. In animal immunotherapy, it is taken into account that sudden changes in ambient temperature, changes in housing and feeding conditions, and diets deficient in protein, especially before vaccination and during the adaptive phase of immunogenesis, can inhibit the formation of immunity. Vaccinated animals, after exposure to these factors, may remain susceptible to infection and support epizootic foci of infectious diseases.

Most vaccines are administered to animals subcutaneously or intramuscularly; some are used with drinking water, intranasally or aerogenously, as well as by rubbing.

Passively immunize weakened animals, animals in the last stage of pregnancy, and also if it is necessary to quickly create immunity, for example, with developing epizootic. Immune sera are used against anthrax, rabies, foot and mouth disease, Aujeszky's disease, hemorrhagic septicemia, tetanus, swine erysipelas, salmonellosis and colibacillosis of young animals, diplococcal infection, dysentery of lambs, infectious enterotoxemia of sheep.

Immunized animals are observed for a certain time, during which the reaction to the administered drug usually ends. In case of a strongly expressed reaction or in case of complications, animals are injected with a specific hyperimmune serum with treatment. purpose or medications. The use of products obtained from vaccinated animals before the end of the reaction to vaccination for some infectious diseases is allowed with restrictions.

Table. Brief characteristics of biological drugs and their use for the specific prevention of certain infectious diseases

Name of infectious disease*	Name of the drug	Indications for use	Method of application, dose	validity drug	drug	storage drug
Anaerobic infection (gas gangrene)	Anti-gangrenosis polyvalent serums (anti-perfringens type A, anti-edematiens and antisepticum), purified and concentrated by the “Diaferm-3” method And EM USSR Academy of Medical Sciences	Prevention of wound infection and treatment of patients. Administration as soon as possible after injury, wounds with crushed muscle tissue, complicated open wounds, fractures, gunshot wounds contaminated with soil, scraps of clothing or other foreign bodies; after criminal abortions; removing old ones postoperative scars, burns, etc.	For prophylactic purposes, subcutaneously or intramuscularly, with treatment. target intramuscularly. Before administering the serum, an intradermal test is used to detect sensitivity to horse protein. In case of a positive test or anaphylactic reaction, the serum is administered only for health reasons (with mandatory desensitization according to Bezredka). Prevention - 30,000 (10,000 each) ME of antiperfringens, antiedematis, antisepticum serums. Treatment - frequency, dose and amount of serum depend on the severity of the disease. Treatment dose - 150,000 (50,000 each) ME of antiperfringens, antiedematis, antisepticum serums. Injections are repeated once a day until the symptoms of the disease disappear		In ampoules of 1 prophylactic dose, complete with an ampoule of serum (1: 10 0) for intradermal testing	In a dark, dry place at t° 3-10°
Rabies	Anti-rabies dry vaccine* Fermi type	Prevention of rabies from bites, scratches, salivation skin and mucous membranes of clearly rabid, suspected rabies and unknown animals. In case of bites and scratches by healthy animals, a course of vaccinations is prescribed according to conditional indications, i.e. for the period of i 0-day veterinary observation of the bitten animal, or only observation of the animal is carried out	Subcutaneously at or below the navel, 2-3 fingers away from the midline of the abdomen. Dosage according to a special scheme (attached to the box with ampoules) depending on the characteristics of contact with animals, data on the health of the animal, epizootic situation, location and severity of the injury, age of the victim, timing of seeking help, etc. There may be a need for vaccinations in a hospital setting under the supervision of specialists (see Anti-rabies vaccinations)		In ampoules of 1.5 ml, complete with an ampoule of solvent - dist. water (3 ml)	In a dry, dark place at t° 2-8°
	Rabies culture inactivated lyophilized vaccine	The same. In addition, for preventive immunization of dog catchers, employees of research and diagnostic laboratories working with street rabies virus			In bottles or ampoules of 3 ml, complete with a bottle (ampoule) of solvent - dist, water (3 ml)	In a dry, dark place at t° 4°
	Anti-rabies gamma globulin from horse serum	Prevention of diseases in people bitten by rabid or suspected rabid animals, in combination with a course of rabies vaccine. Treatment of patients with post-vaccination complications, bitten by rabies or suspected of rabies ANIMALS	Intramuscularly. Before administration, an intradermal test is performed to determine the body’s sensitivity to horse protein. In case of a positive intradermal test or in case of an anaphylactic reaction, gamma globulin is administered only for health reasons (with mandatory desensitization according to Bezredka). For prevention purposes, children under 2 years old - 4 ml; from 3 to 12 years - 1 ml for each year 4-2 ml; children over 12 years of age and adults - 0.2 5 ml per 1 kg of weight. If bitten by a rabid or unknown animal: children from 1 to 10 years old - 1 ml for each year 4-6 ml; children over 10 years old and adults - 0.5 ml per 1 pg of weight. Features of application depending on the location, severity of the bite, type of biting animal, etc., as well as combination with vaccination are given in the instructions for the use of rabies vaccine		In ampoules of 5 or 10 ml, complete with an ampoule of 1% solution. gamma globulin 1 ml for intradermal test	In a dry, dark place at t° 2-10°
Rabies (continued)			and anti-rabies gamma globulin. For the treatment of patients with post-vaccination complications, bitten by a rabid or suspected rabid animal, upon termination of vaccination - 0.25 ml per 1 kg of weight for 1-2 days
Botulism	Antibotulinum treatment - professional, serums of types A, B, E, purified and concentrated by the “Diaferm-3” method of the Institute of Economics and Mathematics of the USSR Academy of Medical Sciences	Treatment of patients with botulism at the first signs of the disease; for preventive purposes for people who consumed the product that caused poisoning at the same time as patients	For prophylactic purposes intramuscularly, with treatment. intramuscularly and in severe cases - intravenously. To identify sensitivity to horse protein, an intradermal test is first performed. In case of a positive intradermal test or in case of an anaphylactic reaction, the serum is administered only for health reasons according to a special regimen. Prevention - 10 0 0 - 2000 IU of serum of the same type as the pathogen is administered. If the type of pathogen is not established, then 1000-20 00 IU of each type of serum. Treatment - serum types A and E - 10,000 IU each, type B - 50 0 0 IU in the form of a mixture. The injections are repeated until a wedge effect is obtained. Injections are carried out at intervals of 5 to 24 hours		In ampoules (10 0 00 ‘ME types A or E and 5 0 0 0 ME type B) complete with serum ampoule for intradermal test	In a dark place at t°3 10
Brucellosis	Brucellosis dry skin vaccine	Prevention of brucellosis in persons associated or temporarily involved in the work of servicing small livestock (sheep and goats) in farms unfavorable for brucellosis, as well as persons engaged in receiving, transporting and driving small livestock; owners of small livestock and members of their families (from 7 years of age) for epizootic and epidemiological indications; workers serving cattle on mixed farms, where, due to the conditions of keeping animals, migration of the causative agent of brucellosis of the goat-sheep species is possible; workers of meat processing plants, slaughterhouses and enterprises for processing livestock products, which receive animals or raw materials and semi-finished products from areas unfavorable for goat-sheep brucellosis; med., vet. and other personnel working with live cultures of Brucella, animals infected with brucellosis or other infectious material; all other population groups in the presence of epizootic or epidemic indications	Cutaneously, in outer surface middle third shoulder Before use, the dry vaccine is diluted with fiziol, solution. The number of drops of solvent should be twice the number of vaccine doses indicated on the label of the vaccine ampoule. Vaccination - once. Adults - 2 drops (1 dose). Children 7-15 years old - 1 drop (0.5 doses). Revaccination after 10 - 12 months. persons with a negative serol, or an allergic reaction to brucellosis - adults and children over 7 years old - 1 drop		In ampoules 5-3 0 doses
Typhoid fever	Typhoid chem. sorbed vaccine	Prevention of typhoid fever in persons from 7 to 55 years of age	Subcutaneously in subscapular region once in a dose of 0.6 ml for children (7 - 14 years old) and 1.0 ml for adults. Revaccination after 6 months. once in the same doses		In bottles of 8 ml	In a dry, dark place at temperature io
	Typhoid alcohol vaccine enriched with Vi-antigen	Prevention of typhoid fever in men from 7 to 6 0 years and in women up to 5 5 years	Subcutaneously into the subscapular region, a single dose of 0.5 ml for children and 0.7-5 ml for adults. Revaccination after 2 years once in the same doses. Before administration, the vaccine is diluted with Vi-antigen (5 ml)		In ampoules of 0.5 ml and 1 ml, complete with a solvent ampoule (Vi-antigen) of 5 ml	In a dry, dark place at t°4 10°
Viral hepatitis	The method of application is the same as for measles, see table Measles, viral hepatitis
	Live influenza vaccine for intranasal administration	Prevention of influenza in people over 1-6 years of age	Intranasally. Before use, dilute in 5 ml dist, or boiled water. Three times 0.5 ml at intervals of 2 - 3 weeks.		In ampoules of 2 ml	At a temperature not higher than 4
	Influenza live dry vaccine for oral administration	Prevention of influenza and treatment of children with influenza from 1 to 16 years of age, as well as elderly people in the autumn-winter period for 2-3 months. before the outbreak of the epidemic, the rise of influenza	Orally. Before use, dissolve with dist or boiled water in the volume indicated on the bottle label. For preventive purposes: three times with an interval of 10 - 15 days. Single dose for children from 1 year to 3 years - 0.5 ml: from 3 to 7 years - 1.0 ml; from 8 to 16 years -2.0 ml; for adults - For emergency prevention and treatment 1 time per day for 2 days. Single dose for children from 1 year to 3 years - 1.0 ml; from 3 to 7 years -2.0 ml; from 8 to 16 years -3.0 ml and for adults - 5.0 ml		In bottles of 3 0 ml	At a temperature not higher than 43
	Gamma globulin from blood serum of donors immunized against influenza virus types A2 and B	Prevention of influenza in epidemics and outbreaks; treatment of patients with influenza, especially toxic forms, prevention of post-influenza complications in people of any age	Prophylactically intramuscularly in a single dose of 1.0 liters. Treatment is most effective when administered in the first two days of the disease, but with the development of toxicosis and complications it can be used later. Treatment dose - 1.0 ml (children under 2 years - 1.0 ml; from 2 to 7 years - 2.0 ml, over 7 years and adults - 3.0 ml). According to the indications, repeated administration is possible		In ampoules of 1 ml	In a dry place at t°2-10°
Respiratory viral	Human leukocyte concentrated dry interferon	Prevention and treatment of patients with influenza, as well as other respiratory and viral diseases in adults and children of all ages	Intranasally. Before use, interferon is dissolved in 0.5 ml of dist (or boiled) water. Prophylactic dose of 0.2 5 ml (5 drops) in each nostril 2 times a day during the entire period of the epidemic. Therapeutic dose: 0.25 ml (5 drops) in each nasal passage every 1-2 hours (at least 5 times a day) for 2-3 days. The dosage for children and adults is the same		In ampoules of 2 ml, complete with an ampoule of solvent (dist, water) - 2 ml	In a dry place at t°4-10°
	Human leukocyte native dry interferon	The same as for the previous drug	Intranasally. Before use, interferon is dissolved in 2 ml of dist (or boiled) water. Otherwise the same as for the previous drug
Dysentery	Dysentery dry alcohol vaccine Flexner - Sonne	Treatment of adult patients with chronic and subacute dysentery	Subcutaneously into the subscapular region. The intervals between injections are 2-3 days. In the absence of exacerbation: first injection - 0.25 ml; second - 0.5 ml; third - 0.7 5 ml; fourth - 1.0 ml; fifth - 1.5 ml;		In ampoules of 1 ml, complete with an ampoule of solvent (sodium chloride solution - 5 ml)
Dysentery (continuation)	Colibacterin dry	Prevention of dysentery and others intestinal diseases from May to September - October	sixth - 2.0 ml. In the acute stage, the following are added: seventh injection - 2.5 ml; eighth - 2.5 ml; ninth - 3.0 ml. Repeat course vaccinations - after 2 - 3 weeks. By mouth 2 times a day, 30 - 40 minutes. before meals. Before use, dissolve with boiled cooled water (1-2 ml per dose of the drug). Then the contents are transferred to 7* glasses of water and after 15 - 20 minutes. drink, children are given 2 - 3 tables. l. water. Dosage: children from 6 months. up to 1 year - 2 - 3 doses, from 1 year and older - 6 doses for 10 days in a row, then after 2 days on the third	From 6 months up to 1 year (indicated on the label)	In ampoules or vials of 1 - 150 doses	In a dark, dry place at t° 2 - 6°
Diphtheria	Diphtheria toxoid purified, adsorbed on aluminum hydroxide (AD)	Immunization according to epidemics, indications of children who have had diphtheria or with a positive Schick reaction	Intramuscularly. For children under 11 years of age who have been ill, 0.5 ml once, but not earlier than 6 months. after illness. Children under 11 years of age with a weakly positive Schick reaction - 0.5 ml once, with a pronounced Schick reaction - 0.5 ml twice with an interval of 30 - 40 days. Adolescents and young men 12 - 19 years old, once 0.3 ml		In ampoules of 1.0 ml *
Diphtheria, Whooping cough, Tetanus	Adsorbed pertussis-diphtheria-tetanus vaccine (DTP vaccine)	Prevention of whooping cough, diphtheria and tetanus; vaccinations for children 5 - 6 months up to 6 years (except for those who have previously had whooping cough). Older children 6 years old, not vaccinated with DTP vaccine, are vaccinated with DTP toxoid	Intramuscularly. Vaccination: three times 0.5 ml at intervals of 30 - 40 days; revaccination after 1.5 - 2 years and at the age of 6 years (before entering school), once 0.5 ml		In ampoules of 1.0 ml	In a dry, dark place at t°3-10°
Diphtheria, Tetanus	Diphtheria-tetanus purified toxoid adsorbed on aluminum hydroxide (ADS toxoid)	Prevention of diphtheria and tetanus in children from 5 to 6 months. up to 6 years of age, who have had whooping cough or have contraindications to the administration of DPT vaccine and in unvaccinated children over 6 years of age	Intramuscularly. 0.5 ml twice with an interval of 30 - 40 days (in some cases up to 6 - 12 months). Revaccination after 1.5-2 years, once, in a dose of 0.5 ml and at the age of 6 and 11 years, once in a dose of 0.5 ml		In ampoules of 1.0 ml
	Diphtheria-tetanus purified adsorbed toxoid with reduced antigen content (ADS-M)	Prevention of diphtheria and tetanus in children with allergic reactivity under the age of 11 years: a) vaccination and revaccination of children suffering from bronchial asthma, asthmatic bronchitis, eczema, neurodermatitis, exudative diathesis, food and drug allergies, etc.; b) revaccination of children who have had rheumatism, diffuse glomerulonephritis, pyelonephritis; c) vaccination of children whose vaccinations with DTP vaccine or DTP toxoid were stopped due to hyperthermia (temperature 39° and above) or unusual reactions - rash, Quincke's edema, asthmatoid syndrome, extensive hyperemia and swelling at the site of vaccine administration, febrile convulsions, ma-	Intramuscularly. Vaccination twice 0.5 ml with an interval of 45 - 60 days. The interval may be extended to 12 months. Revaccination after 9-12 months. once 0.5 ml (even if the interval after vaccination had to be extended for medical reasons). Subsequent revaccinations are once 0.5 ml at the ages of 6 and 11 years, but not earlier than 3 to 5 years after the last vaccination. In case of epidemic or unwellness, children who do not have documentary evidence of vaccinations, 0.5 ml twice with an interval of 30 - 40 days. Previously vaccinated - once 0.5 ml		In ampoules	In a dry dark place at t 3-10°
Diphtheria, Tetanus (continued)		severe convulsive seizures, etc. In case of the indicated reactions to AD S and DPT, vaccination with ADS-M begins after 6-12 months. in consultation with a pediatrician and neurologist. Revaccination of children over 11 years old according to epidemiological indications (without preliminary Schick reaction)
	Anti-diphtheria serum "Diaferm-3"	Treatment of patients with diphtheria or suspected diphtheria	Subcutaneously or intramuscularly in a dose of 5 0 00-1 5 000 IU, depending on the severity of the disease. In the toxic form - up to 30,000 - 50,00OME. If the wedge is insufficient, the effect is reintroduced in doses reduced by 2 to 3 times compared to the initial one. An intradermal test is first performed. In case of a positive intradermal test or in case of an anaphylactic reaction, the serum is administered only for health reasons (with mandatory desensitization according to Bezredka)		In ampoules of 10,000 or 20,000 IU, complete with serum ampoule for intradermal testing	In a dry, dark place
	Vaccinations are carried out simultaneously against diphtheria, whooping cough and tetanus, see table Diphtheria, Whooping cough, Tetanus
	Measles live vaccine	Prevention of measles in children from 10 months. under 14 years of age who have not had measles	Subcutaneously once, in a dose of 0.5 ml. Before administration, the vaccine is diluted with a solvent		In ampoules or vials complete with solvent	In a dark, dry place at t°4° or below
Measles, viral hepatitis	Human serum gamma globulin for the prevention of measles and infectious hepatitis	Prevention of measles in children aged 3 to 10 months who have not had measles and have had contact with a measles patient; in children older than 10 months who have not had measles and have not been vaccinated according to medical standards. indications; prevention of viral hepatitis in children of preschool groups and the first four grades of schools with an increase in incidence; in epid. foci in children from 3 months of age, weakened adults, pregnant women, if there have been no scheduled vaccinations or after 6 months. after they have been carried out	Intramuscularly. For the prevention of measles in a dose of 1.5 or 3.0 ml, depending on the child’s health status and age. For the prevention of viral hepatitis in children from 3 months. up to 10 years - 1.0 ml: children over 10 years and adults - 1.5 ml		In ampoules of 1.5 and 3 ml	In a dry place at t°3-10°
Q fever	Against Q fever, dry live* vaccine M-44 for cutaneous use	Prevention of Q fever in persons aged 14 to 60 years arriving in areas unfavorable for infection; for persons involved in servicing large and small livestock; among workers processing raw materials and livestock products; the staff of meat processing plants and slaughterhouses, veterinary and zootechnical personnel; in persons working with living Burnet cultures	Subcutaneously, on the outer surface of the middle third of the shoulder, 2 drops once. Before use, the vaccine is dissolved in 0.5 ml or 1 ml of physiol, solution, depending on the number of vaccination doses contained in the ampoule with the vaccine. Revaccination of persons with negative CSC no earlier than 2 years later at the same dose as during vaccination		In ampoules of 0.5 ml or 1 ml (10 or 2 0 vaccination doses each) complete with a solvent of 1 or 2 ml	In a dry, dark place at t°2 - 60
Leptospirosis	Leptospirosis I vaccine	Prevention of leptospirosis in natural epidemics, foci, regardless of the presence of diseases; persons serving animals are vaccinated as planned (February - March); work-	Subcutaneously, twice: 2.0 and 2.5 ml with an interval of 7 - 10 days. Revaccination after 1 year, once, 2.0 ml		In ampoules of 10 ml	In a dry, dark place at t°3 - 10°
Leptospirosis (continuation)		workers in meat processing plants, slaughterhouses, people engaged in haymaking on water meadows, engaged in fishing, hunters; children from 7 to 16 years old. Ilo epidemic, according to indications, vaccination is carried out when there is a threat of an outbreak of the disease among people
natural	Smallpox dry vaccine (EM-6 3) and dry smallpox vaccine (L-IVP)	Prevention of smallpox. Primary vaccination is carried out from the age of 1 to 2 years (and for children traveling abroad, from 3 months). Revaccination at 8 and 16 years of age. Medical workers, employees of hotels, boarding houses, campsites, laundries, and passenger transport are revaccinated every 5 years. Children over 3 years of age who have not been vaccinated before are vaccinated under the protection of smallpox gamma globulin	Cutaneously, on the outer surface of the shoulder; once, 0.01 ml of vaccine diluted with a solvent is applied in two places. Before use, transfer the entire volume of solvent into the ampoule with the vaccine. When revaccination, the same dose is applied in three places		In ampoules of 10 and 2 0 doses complete with a solvent (50% glycerin solution)	In a dry, dark place at a temperature not exceeding 10°
	Anti-smallpox immunoglobulin from the blood of donors revaccinated with smallpox vaccine	Prevention and treatment of complications of the vaccination process (chief education in children); according to epidemiological indications, seroprophylaxis and treatment of smallpox in cases where vaccination or revaccination may be insufficient	Intramuscularly, once, in a dose of 1.5 ml immediately before vaccination of the child. During treatment - 0.5 - 1 ml per 1 kg of weight in one or several injections during the day. If necessary, you can repeat the administration of the drug		In ampoules of 3 ml	In a dry place at t° 2-10°
Epidemic mumps (mumps)	Mumps live dry vaccine	Prevention of mumps in children from 3 to 7 years of age who have not had mumps and attend preschool institutions	Subcutaneously under the shoulder blade, once, in a dose of 0.5 ml. Before use, the vaccine is dissolved in 2.0 ml of solvent		In ampoules of 1 - 10 vaccination doses, complete with a bottle of solvent (fiziol, solution)	In a dry, dark place at a temperature no higher than 4"
Polio	Seibin oral live polio vaccine types I, II, III	Prevention of polio in adults and children starting from 2 months.	Through the mouth. Children aged 2 months and older. - 3 times with an interval of 3 months. One dose of liquid vaccine - 0.2 ml (4 drops), one dose of vaccine in dragees - 1 g. The vaccination dose of liquid vaccine is poured into a spoon with water or on a piece of sugar. The first three revaccinations for children aged 1, 2 and 3 years are carried out three times with an interval of 3 months, the subsequent ones - once at 7 - 8 and 15 - 16 years. The dosages are the same as for vaccination. Ilo epid, other regimens are allowed for indications	Liquid vaccine: at t°-20°- 2 years; at t° 4-8° - 6 months; at t° 22-2 5° - 3 weeks. Vaccine pills: at / -15 - 20 - 6 months; at t°4° - 3 months; at t°	Liquid vaccine - in 5 ml bottles. Dragee in boxes, jars or plastic bags of 1 00-3 00 g	In a dry place at the temperature indicated in the column “Shelf life of the drug”
anthrax	Anthrax live dry vaccine (STV)	Prevention of anthrax among workers of enterprises processing animal raw materials, especially leather and wool, as well as among workers of meat processing plants; for workers of collective and state farms - in the event of livestock diseases. According to epidemiological indications, others can be vaccinated; linden; from 12 years and older	Subcutaneously, 2 drops once. Before use, the vaccine is diluted with 1 ml of aqueous 30% glycerol solution. Revaccination after 1 year, once, at the same dose		In ampoules of 2 0 doses complete with an ampoule of solvent (3 0% glycerin solution) 1.5 ml	In a dry, dark place at a temperature not exceeding 4°
Anthrax (continued)	Counter- bikerulcer globulin	Prevention of anthrax in persons exposed to infectious material; who took part in the slaughter or cutting of the carcass of an animal that turned out to be sick with anthrax; caring for sick animals and taking part in the burial of their corpses; who prepared food from the meat of a sick animal or ate this meat; close contacts with anthrax patients. Treatment of anthrax patients	Intramuscularly, as early as possible after contact. Children - 5 -8 ml, adolescents 14 - 17 years old -12 ml, adults - 20 - 2 5 ml. For treatment - immediately upon diagnosis 30 - 5 0 ml; if necessary, repeat on subsequent days in the same doses. Beforehand, sensitivity to horse protein is checked using an intradermal test. In case of a positive skin test and in case of an anaphylactic reaction, globulin is administered only for absolute indications. It is not advisable to use globulin after 3 days. after eating meat from a sick animal or 10 days later. after possible skin infection		In ampoules of 10 ml, complete with an ampoule of diluted globulin (1 ml) for intradermal testing	In a dry, dark place at t°4-8°
Staphylococcal infection	Staphylococcal vaccine	Treatment only for adults with pustular diseases of strepto-, staphylococcal etiology	Intradermally, subcutaneously or intramuscularly 10 - 12 injections of 0.1 ml at intervals of 3 - 4 days. The dose can be increased with subsequent injections by 0.1 -0.2 ml, gradually increasing to 1.0 ml. For chronic and recurrent diseases, start with diluting the vaccine 10 to 100 times (with sterile physiol, solution)		In ampoules of 1 ml	In a dry, dark place at t°4-10°
	Staphylococcal purified adsorbed toxoid	Prevention of various inflammatory diseases and their relapses caused by staphylococci (staphyloderma, purulent mastitis, recurrent furunculosis, etc.)	Subcutaneously into the subscapular region, 0.5 ml twice with an interval of 30 - 45 days. Pregnant women 0.5 ml: 1st vaccination - at 32 - 34 weeks. pregnancy, 2nd - at 3 7 -38 weeks, 3rd - upon admission to the maternity hospital. Revaccination after 3 months. and after 1 year, 0.5 ml, as well as in case of danger of infection with staphylococci (open injury, etc.), regardless of the period of previous administration of the toxoid, but not earlier than 1 month. after the last injection of toxoid		In ampoules of 1 ml	In a dry, dark place at t°4-10°
	Staphylococcal native toxoid	Prevention and treatment various diseases staphylococcal etiology (staphyloderma, chronic, and recurrent furunculosis, hidradenitis, mastitis, osteomyelitis, septicemia, pneumonia, etc.)	Subcutaneously. Prophylactically three times 0.5 ml; through 2 0 days 1.0 ml; after 10 days 1.0 ml. Revaccination through 3 months -1.0 ml and after 12 months. - 1.0 ml. For the treatment of adults - at intervals of 3 - 5 days 0.1; 0.3; 0.5; 0.7; 1.0; 1.2; 1.5; 1.7; Children - at intervals of 2 - 3 days 0.1; 0.2; 0.3; 0.4; 0.6; 0.8; 1.0; 1.0 ml.		In ampoules of 2 ml	In a dry, dark place at t° 3-10°
	Human serum gamma globulin for prevention and therapy staphylococcal infection	Prevention and treatment of diseases of staphylococcal etiology (septicemia, pneumonia, staphyloderma, carbuncles, hidradenitis, mastitis, osteomyelitis, postoperative suppuration)	Intramuscularly; daily or every other day, depending on the patient’s condition and the course of the disease. A course of treatment of 3 - 5 or more injections (100 ME each)		In ampoules of 100 ME	cool place at t°3 -1 00
Tetanus - see also in the table Diphtheria, Whooping cough, Tetanus and Diphtheria, Tetanus,	Purified tetanus toxoid adsorbed on aluminum hydroxide (AS-toxoid)	Prevention of tetanus. Immunize children and adolescents aged 5 - 6 months. up to 17 years old; agricultural, railway and construction workers	Subcutaneously. When immunizing, 0.5 ml twice with an interval of 30 - 40 days. After 9 - 12 months. - 0.5 ml and then every 5-10 years at a dose of 0.5 ml. Children from 5 - 6 months. up to 6 years of age are vaccinated simultaneously against tetanus, diphtheria and whooping cough,		In ampoules of 1 ml	In a dry dark place at 13-10°
Tetanus (continued)		workers, workers of sewage disposal and treatment facilities, landfill sites, peat mining and logging, laboratory employees working with tetanus culture or toxin, workers of vivariums and immunodepartments, athletes of all sports, citizens undergoing pre-conscription training and retraining, secondary, general and specialized students schools, industrial and technical schools, etc., students of higher educational institutions of all specialties; persons with long-term non-healing ulcers of the external integument; persons with injuries due to violation of the integrity of the skin and mucous membranes, as well as burns of II and III degrees	and for children from 6 to 11 years old - against tetanus and diphtheria. For injuries, burns, out-of-hospital abortions, etc., previously vaccinated people are given 0.5 ml (no earlier than 6 months after vaccination and 1 year after revaccination), and unvaccinated people are given 1.0 ml of toxoid and then, after an intradermal test, anti-tetanus serum; in 9-12 months. - 0.5 ml toxoid
	Antitetanus gamma globulin from the blood of donors immunized with sorbed tetanus toxoid	Prevention of tetanus in unvaccinated persons with injuries involving skin damage, especially in persons allergic to horse serum. The drug can be used to treat tetanus	Intramuscularly. Prophylactic dose - 3 ml (450 - 60 0 IU). Treatment the dose for severe cases of tetanus is 10,000 IU, then 50,000 IU, but not more than 20,000 IU in total. Children - from 30 00 to 6000 IU, depending on the severity of the disease and age. Infants once 400 - 500 IU		In ampoules of 3 ml (the amount of ME in 1 ml is indicated on the ampoule label)	In a dark place at t°2-10°
	Antitetanus serum, purified and concentrated by peptic digestion	Prevention of tetanus and treatment of patients with tetanus. Prevention is prescribed for any injuries with violation of the integrity of the skin and mucous membranes, second and third degree burns; during childbirth at home without medical assistance; out-of-hospital abortions; frostbite of II and III degrees; during operations on went.-intestinal. tract; when bitten by animals. With lech. target - when the first symptoms of tetanus appear	For prophylactic purposes subcutaneously and intramuscularly, with treatment. the purpose is subcutaneous, intramuscular, intravenous and into the spinal canal. Before administering the serum, an intradermal test is performed to detect sensitivity to horse protein. In case of a positive test or in case of an anaphylactic reaction, the serum is administered only for health reasons (with mandatory desensitization according to Bezredka). Prevention - only for unvaccinated children and adults. After administering 1 ml of tetanus toxoid, serum in a dose of 3 0 00 IU is injected into another area of ​​the body with another syringe. Previously vaccinated people are given only 0.5 ml of tetanus toxoid. Antitetanus serum should not be administered. Newborns born at home without medical care, from mothers who were not actively immunized against tetanus, are administered no later than 15 days after birth with 300 0 IU with preliminary desensitization. Treatment - once 100,000-200,000 IU; depending on the severity of the disease, the administration of serum is repeated until the seizures disappear		In ampoules (bottles) of 3000 - 50,000 IU, complete with an ampoule of serum (1:100) for intradermal testing	In a dry, dark place at t°3-10°
Epidemic typhus	Typhoid fever dry combined vaccine E	Immunization (according to epidemiological indications) against typhus of people aged 16 to 60 years	Subcutaneously. Before use, the dry vaccine (0.5 ml) is diluted with 5 mlfiziol solution. Once 0.2 5 ml. Revaccination after 2 years, once 0.2 5 ml		In ampoules of 0.5 -1.0 ml, complete with solvent of 5.0 ml	At t° 4-6°
Tuberculosis	BCG dry vaccine for intradermal use	Prevention of tuberculosis. Primary vaccination of newborn children on the 5th -7th day of life. Revaccination of healthy children aged 7, 12 and 17 years; adults every 5 - 7 years until the age of 30 (with a negative reaction to intradermal administration of tuberculin PPD-L at a dose of 2 TU). The interval between the Mantoux reaction and revaccination should be at least 3 days and no more than 2 weeks. In areas where there is practically no tuberculosis, children are given only two revaccinations at 7 and 15 years of age.	One time. Before use, dissolve in 2.0 ml of solvent. Strictly intradermally, on the border of the upper and middle third of the outer surface of the left shoulder; one vaccination dose (0.0 5 mg BCG) is contained in 0.1 ml of diluted vaccine		In ampoules of 1 mg (2 0 doses) complete with a solvent (isotonic solution of sodium chloride) - 2 ml	At a temperature not higher than 8°
Tularemia	Tularemia dry skin vaccine	Prevention of tularemia. Active immunization of the population from 7 years of age in areas where diseases have been registered or pathogen cultures have been isolated from rodents, blood-sucking arthropods or environmental objects; in enzootic areas - workers of agricultural processing enterprises. products and raw materials, livestock and poultry farms; persons involved in the procurement of muskrat, water rat, etc. skins; population of coastal zones in places of settlement of the water rat and muskrat; persons sent to agriculture. work in places unfavorable for tularemia; laboratory and epidemiological personnel, teams working with cultures of the causative agent of tularemia	Apply cutaneously to the outer surface of the left shoulder in the middle third. Before use, the vaccine is dissolved with dist, water in the volume indicated on the label of the ampoule with the vaccine. Children - 1 drop, adults - 2 drops once. Revaccination after 5 years, once, in the same dose as for vaccination. In case of epidemiological indications, children from 2 years of age can be vaccinated		In ampoules of 5 - 30 doses complete with solvent (dist, water)	In a dry, dark place at a temperature not exceeding 6°
	Cholera (or El Tor) killed vaccine (dry or liquid)	Prevention of cholera (according to epidemiological indications)	Subcutaneously. Before use, the dry vaccine is dissolved in an isotonic solution of sodium chloride. The dose of solvent is indicated on the ampoule label. Vaccination twice with an interval of 7 - 10 days. The doses of the dry dissolved vaccine are the same for both vaccinations: for children from 2 to 7 years old - 0.15 ml; from 7 to 10 years - 0.3 ml; from 10 to 15 years - 0.4 ml; over 15 years old and adults - 0.5 ml. Doses for liquid vaccine: children from 2 to 7 years old - 0.15 ml and 0.2 ml; from 7 to 10 years - 0.3 and 0.45 ml; from 10 to 15 years - 0.4 and 0.6 ml; over 15 years old and adults - 0.5 ml. Revaccination after 6 months. Dose as for the first vaccination shot	For dry vaccine - 5 years; for liquid - 2 years	Dry vaccine in 1-2 ml ampoules. Liquid vaccine in 100 ml bottles
Cholera (continued)	Cholerogen toxoid (dry)	Prevention of cholera according to epidemiological indications for persons from 7 years of age	Subcutaneously. One time. Before use, the drug is dissolved in 0.85 ml of isotonic sodium chloride solution. Doses: children from 7 to 10 years old - 0.1 ml: from 11 to 14 years old - 0.2 ml; from 15 to 17 years - 0.3 ml; adults from 18 years of age and above - 0.5 ml. Revaccination annually in doses of 0.5; 0.5; 0.4; 0.2 ml, but not earlier than after 3 months. after vaccination. Only adults are vaccinated using the needle-free method (injector).		In ampoules of 1-2ml	In a dry, dark place at t°5-10°
	Plague live dry vaccine	Prevention of plague (according to epidemiological indications)	Subcutaneously or cutaneously (depending on age and health status) once. Before use, the vaccine is diluted with physiol solution in accordance with the instructions on the label of the box with the vaccine. Doses: a) for subcutaneous administration - children from 7 to 10 years - 0.3 ml; from 10 to 14 years - 0.5 ml; over 14 years old and adults - 1 ml; b) for cutaneous application - children from 2 to 7 years old - 0.05 ml (1 drop); from 7 to 10 years - 0.1 ml (2 drops); over 10 years old and adults - 0.15 ml (3 drops). Children from 2 to 7 years of age, women in the first half of pregnancy, nursing mothers and adults over 60 years of age are vaccinated only subcutaneously	1 or 2 years (indicated on the ampoule label)	In ampoules of 1 or 2 ML	In a dry, dark place at /С0-6°
Tick-borne viral encephalitis	Inactivated culture vaccine against tick-borne encephalitis	Prevention of tick-borne encephalitis among people in endemic areas or among laboratory personnel working with tick-borne encephalitis virus. Vaccinate people aged 4 to 65 - 70 years at risk of infection	Subcutaneously. Before use, the dry vaccine is dissolved in 3 ml dist. water. Four times. Children from 4 to 7 years old - 0.5 ml; adults and children over 7 years old - 1.0 ml. Second vaccination after 7 - 10 days; 3rd - after 14-20 days; 4th - in 4-6 months. Revaccination - annually for 3 - 4 years in a row in the same doses as for vaccination	Liquid - 2 years, dry - 3 years	In bottles and l pi ampoules (the number of doses is indicated on the label) complete with a solvent (dist, water) 3 ml
	Gamma globulin against tick-borne encephalitis	Prevention of encephalitis in cases of ticks sticking to humans in endemic foci and in laboratory infections of persons working with the encephalitis virus. Treatment of patients with tick-borne encephalitis and related diseases (two-wave meningoencephalitis, etc.)	Intramuscularly. Before administering the drug, sensitivity to horse serum protein is checked using an intradermal test. If the test is positive, dosage according to a special scheme included in the box of ampoules. Prevention - once for children under 12 years old - 1.5 ml, from 12 to 16 years old - 2.0 ml, for adults - 3.0 ml. Treatment - in the first 3 - 5 days of the disease, twice on the first day with an interval of 10-12 hours. 3 - 6 ml, then 2-3 days in a row once at the same dosage		In ampoules of 3 - 6 ml complete with diluted (1: 100) gamma globulin for intradermal testing	In a dry, dark place at a temperature of 4-10°

Preventive vaccination calendar

The calendar of preventive vaccinations is a document regulating the indications, sequence and timing of vaccination and revaccination of the population; is the basis for drawing up immunoprophylaxis plans (see Immunization, Immunoprophylaxis).

The calendar of preventive vaccinations regulates two groups of vaccinations: planned, carried out regardless of the epidemic situation, and vaccinations according to epidemic indications.

The first group (table) includes vaccinations against tuberculosis (see), polio (see), whooping cough (see), diphtheria (see), tetanus (see), measles (see) and mumps (see . Epidemic mumps). Regardless of the epidemic situation, all children are immunized against these diseases in the first days or months of life. This is due to the peculiarities of epidemiology, the severity of the wedge, the course and outcome of these inf. diseases in children, high susceptibility to their pathogens and easy airborne transmission of infectious agents (see Mechanism of transmission of infection).

Routine vaccinations of the entire child population of our country against measles, mumps, diphtheria, and whooping cough are carried out due to the widespread prevalence of these diseases, their high contagiousness, as well as the severity of their course and outcomes. Routine vaccinations against tuberculosis, polio and tetanus, despite the fact that their incidence in the USSR is low and continues to consistently decline, is due to the characteristics of immunity in tuberculosis, the severity of the course and severe outcomes of polio and tetanus. Anti-tuberculosis immunity is non-sterile in nature, when after infection resistance is formed only to superinfection, i.e. to tuberculosis pathogens entering the body from the outside, and not to existing ones. In this regard, early vaccinations of newborns with a harmless vaccine strain of tuberculosis bacteria with residual virulence (see) ensure the formation of non-sterile immunity (see), which persists as long as there are living microbes of the vaccine strain in the body. To maintain non-sterile immunity, five-fold revaccination is carried out (see). The early timing of immunization against polio is due to the possibility of infection of children, as well as the easy tolerability of the polio vaccine and the possibility of combining these vaccinations with immunization against whooping cough, diphtheria and tetanus with the DTP vaccine. Routine vaccinations of children against tetanus are carried out due to the high risk of infection from frequent minor wounds, scratches, and abrasions received by children during play.

The timing and schedule of use of vaccines used in different countries for vaccination against tuberculosis, polio, whooping cough, diphtheria, tetanus, measles and mumps do not differ significantly from each other. The same calendar of preventive vaccinations, in force in the vast majority of developed countries of the world, is taken as the basis for drawing up an expanded immunization program, according to which by 1990, almost all children in the world should be vaccinated against the listed childhood infections. diseases that are one of the causes of child mortality.

The second group of vaccinations is against typhoid fever (see), brucellosis (see), Q fever (see), leptospirosis (see), anthrax (see), tularemia (see), cholera (see .), plague (see), tick-borne encephalitis (see) and other inf. diseases - carried out according to epidemic indications. Individual profs are vaccinated (and revaccinated). groups or the entire population of limited areas with a high risk of infection. Epidemic indications are: residence in an area endemic (enzootic) for a particular infection; epizootics among rodents (plague, tularemia); participation in muskrat and water rat fishing (possibility of contracting tularemia); work at enterprises processing animal raw materials (risk of anthrax infection); work in logging, participation in expeditions to areas endemic for tick-borne encephalitis; caring for livestock in areas unfavorable for brucellosis, etc. The classification of a territory as endemic or enzootic for a particular infection is established by the ministries of health of the Union republics on the proposal of district (regional, regional) health authorities. Vaccinations for epidemic indications are planned according to the decision of the ministries of health of the Union republics. For timing and methods of vaccinations for epidemic indications, see the articles listed above.

CALENDAR OF PREVENTIVE VACCINATIONS

Disease against which vaccinations are carried out	carrying out vaccinations	Revaccination and timing				Features of vaccination and revaccination
					fourth
Whooping cough, diphtheria and tetanus	At 3 months of age	1y2 - 2 years after completed vaccination				Vaccination is carried out with DTP vaccine three times with an interval of 1 g/2 months. simultaneously with vaccination against polio. The first revaccination is carried out once. The second and third revaccinations are directed only against diphtheria and tetanus; they are carried out once with a preparation containing a reduced amount of toxoids (ADS-M-anatoxin). The fourth revaccination (only against tetanus and diphtheria) is carried out once; subsequent (only against tetanus) - once every 10 years
	At 15 -18 months		Not carried out			Vaccination is carried out once, simultaneously with vaccination against mumps.
Epidemic mumps	At 15 -18 months		Not carried out			Vaccination is carried out once, simultaneously with vaccination against measles.
Polio	At 3 months of age	From 1 year to 2 years	From 2 to 3 years		At 15 - 16 years old	Vaccination is carried out three times with an interval between vaccinations of 1-2 months. It is carried out simultaneously with vaccinations against whooping cough, diphtheria and tetanus. The first two revaccinations are carried out twice with an interval of 1-2 months, the third and fourth - once
Tuberculosis*	On the 5th -7th day of life				At 22 - 23 years old	Vaccination and revaccination are carried out once. In cities and regions where the incidence of tuberculosis in children has been practically eliminated and local forms of the disease are not detected, revaccinations are carried out at 7 and 14-15 years of age. Subsequent revaccinations of persons not infected with tubercle bacilli are carried out at intervals of 5 - 7 years until the age of 30
* Note: for tuberculosis, the fifth revaccination is carried out at the age of 2 7-3 0 years.

Bibliography: Zdrodovsky P. F. Problem of infection, immunity and allergies, M., 1969; Mechnikov I.I. Academic collected works, vol. 8, M., 1953; Nikolsky V.V. Fundamentals of immunity of farm animals, M., 1968, bibliogr.; New in the treatment and prevention of infectious diseases of animals, M., 1972; Practical immunology, ed. P. N. Burgasova and I. S. Bezdenezhnykh, M., 1969; Handbook on the use of bacterial and viral drugs, ed. S. G. Dzagurova and F. F. Rezepova, M., 1975; From u-marokov A. A. and Salmin L. V. On the issue of indications and criteria for planning preventive vaccinations, Zhurn, mikr., epid, i immun., No. 6, p. 118, 1974, bibliogr.

I. S. Bezdenezhnykh; L. I. Bespalov (animal immunization), compilers of the table, E. N. Zonova, G. Ya. Kuzminskaya. A. A. Sumarokov.

Immunoprophylaxis of infectious diseases- a system of measures carried out to prevent, limit the spread and eliminate infectious diseases through preventive vaccinations.

Preventive vaccinations- introduction of medical immunotherapy into the human body biological drugs to create specific immunity to infectious diseases.

Vaccination, how preventative measure, is indicated for acute infections that occur cyclically and quickly end with the development of immunity (measles, diphtheria, tetanus, polio).

It is important to consider the duration of immunity developed under natural conditions. For infections accompanied by the formation of long-term or lifelong immunity, after a natural encounter with the pathogen, one can expect the effect of vaccination (measles, polio, diphtheria, etc.), while for infections with short-term immunity (1-2 years for influenza A), one can count on vaccination as a leading measure is not necessary.

The antigenic stability of microorganisms should also be taken into account. In smallpox, measles and many other infections, the pathogen is antigenically stable, and immunoprophylaxis of these diseases is completely justified. On the other hand, with influenza, especially caused by type A viruses, as well as HIV infection, the antigenic variability of pathogens is so great that the pace of vaccine development may lag behind the pace of the emergence of new antigenic variants of viruses.

For infections caused by opportunistic microorganisms, vaccination cannot radically solve the problem, since the outcome of the meeting between the macroorganism and the microorganism determines the state of the body's nonspecific defenses.

Vaccine prevention is a very effective (cost-effective) measure in economic terms. The smallpox eradication program cost $313 million, but the annual cost prevented is $1-2 billion. In the absence of immunization, 5 million children would die every year, more than half of them from measles, 1.2 and 1.8 million from neonatal tetanus and whooping cough.

Worldwide, 12 million children die annually from infections potentially controlled by immunoprophylaxis; The number of children who become disabled, as well as the costs of treatment, cannot be determined. At the same time, 7.5 million children die due to diseases for which there are currently no effective vaccines, but more than 4 million die from diseases that are completely preventable with the help of immunoprophylaxis.

Section 2. Immunobiological drugs

Immunobiological drugs

TO immunobiological drugs include biologically active substances that cause a state of immunological defense, change the functions of the immune system, or are necessary for the production of immunodiagnostic reactions.

Considering the mechanism of action and the nature of immunobiological drugs, they are divided into the following groups:

vaccines (live and killed), as well as other medicines prepared from microorganisms (eubiotics) or their components and derivatives (toxoids, allergens, phages);

immunoglobulins and immune sera;

immunomodulators of endogenous (immunocytokines) and exogenous (adjuvants) origin;

diagnostic medicines.

All drugs used for immunoprophylaxis are divided into three groups:

creating active immunity- include vaccines and toxoids

providing passive protection- blood serum and immunoglobulins

intended for emergency prevention or preventive treatment infected persons - some vaccines (for example, rabies), toxoids (in particular, tetanus), as well as bacteriophages and interferons

Vaccines and toxoids

Live vaccines- alive attenuated (weakened) strains bacteria or viruses characterized by reduced virulence with pronounced immunogenicity, i.e. ability to induce the formation of active artificial immunity. In addition to the use of attenuated strains of pathogens, they are widely used for immunoprophylaxis of a number of infections. divergent strains(causative agents of cowpox and bovine mycobacterium tuberculosis).

Live vaccines include BCG, vaccines against tularemia, yellow fever, smallpox, rabies, polio, measles, brucellosis, anthrax, plague, Q fever, influenza, mumps, tick-borne encephalitis, rubella. In the group of live vaccines, in addition to previously known from attenuated strains (poliomyelitis, measles, mumps, tularemia, etc.), as well as vaccines from divergent strains of microorganisms (smallpox virus, mycobacterium tuberculosis), vector vaccines obtained by genetic engineering (recombinant vaccine) have appeared against HBV, etc.).

Killed vaccines- strains of bacteria and viruses killed (inactivated) by heat or chemicals (formalin, alcohol, acetone, etc.). It is advisable to divide inactivated, or killed, vaccines into

corpuscular (whole cell or whole virion, subcellular or subvirion) and

molecular.

Killed vaccines are usually less immunogenic than live ones, which necessitates their repeated administration. Killed vaccines include typhoid, cholera, pertussis, leptospirosis, vaccine against tick-borne encephalitis, etc.

Corpuscular vaccines are the most ancient and traditional vaccines. Currently, to obtain them, not only inactivated whole microbial cells or viral particles are used, but also supramolecular structures containing protective antigens extracted from them. Until recently, vaccines made from supramolecular complexes of microbial cells were called chemical vaccines.

Chemical vaccines are a type of killed vaccine, but in them, instead of a whole microbial cell or virus, the immunogenic function is performed by soluble antigens chemically extracted from them. In practice, chemical vaccines are used against typhoid fever, paratyphoid fever A and B.

It should be noted that vaccines are used not only for prevention, but also for the treatment of certain chronic infections (in particular, diseases caused by staphylococci, brucellosis, herpetic infections, etc.).

Anatoxins- as an immunizing factor they contain exotoxins of toxin-forming bacteria, deprived of toxic properties as a result of chemical or thermal effects. Toxoids are usually administered multiple times. Currently, toxoids are used against diphtheria, tetanus, cholera, staphylococcal infection, botulism, and gas gangrene.

Associated vaccines- medicines containing a combination of antigens.

The following associated vaccines are used: DPT (adsorbed pertussis-diphtheria-tetanus), ADS (diphtheria-tetanus), measles-mumps-rubella vaccine, divaccine (typhoid fever-paratyphoid A and B, measles-mumps), etc. Numerous studies have shown that that the simultaneous administration of several vaccines does not inhibit the formation of immune reactions to any of the individual antigens.

Immune sera and immunoglobulins

Blood serum(venous, placental) hyperimmune animals or immune people contain protective antibodies - immunoglobulins, which, after being introduced into the recipient’s body, circulate in it from several days to 4-6 weeks, creating a state of immunity to infection during this period.

For practical reasons, there is a distinction

homologous (prepared from human blood serum) and

heterologous (from the blood of hyperimmunized animals) drugs.

In practice, anti-tetanus, polyvalent anti-botulinum (types A, B, C and E), anti-gangrenous (monovalent), anti-diphtheria, anti-influenza serums, measles, anti-rabies, anthrax immunoglobulins, immunoglobulin against tick-borne encephalitis, lactoglobulin, etc. are used.

Homologous purified immunoglobulins for targeted purposes- used not only as medicinal or prophylactic agents, but also for the creation of fundamentally new immunobiological drugs, such as anti-idiotypic vaccines. These vaccines are very promising because they are homologous to the body and do not contain microbial or viral components.

Bacteriophages

Typhoid, cholera, staphylococcal, dysentery and other bacteriophages are produced, but the most effective are bacteriophages prepared using specific strains of pathogens.

Immunomodulators

Immunomodulators- substances that specifically or nonspecifically change the severity of immunological reactions. These drugs have one thing in common - immunomodulators have “immunological points of action”, i.e. targets among immunocompetent cells.

Endogenous immunomodulators are represented by interleukins, IFN, thymus peptides, bone marrow myelopeptides, tumor necrosis factor, monocyte activation factors, etc. Endogenous immunomodulators take part in the activation, suppression or normalization of the immune system. Therefore, it is quite natural that after the discovery of each of them, attempts were made to use them in clinical medicine. Many drugs are used in the treatment of various infections, cancer, immune disorders, etc. For example, α-IFN and γ-IFN are used to treat HB B, HH C, herpetic infections and acute respiratory viral infections (ARVI), cancer and some forms of immune pathology. Drugs thymus gland widely used to correct immunodeficiency conditions.

Exogenous immunomodulators are represented by a wide group of chemicals and biologically active substances that stimulate or suppress the immune system (prodigiosan, salmosan, levamisole). As mentioned above, immunomodulators are among the drugs that are promising for increasing use, especially endogenous immunomodulators, since they are the most effective and are among the

Interferons (IFNs)- pleiotropic cytokines with a relatively low molecular weight (20,000-100,000, less often up to 160,000), causing an “antiviral state of cells”, preventing the penetration of various viruses into them. They are synthesized by lymphocytes, macrophages, bone marrow cells and spectacle gland cells in response to stimulation by certain biological and chemical agents. Currently, genetic engineering methods have been developed for the production of IFN. In this way, reaferon, α-IFN and γ-IFN are obtained, which are used in medical practice for the treatment of diseases of malignant growth, viral hepatitis B, viral hepatitis C, herpes infection and other diseases.

Methods of introducing vaccines into the body

Several are known methods of introducing vaccines into the body.

Percutaneous routes (cutaneous application) - solution, suspension - smallpox, plague, tularemia, brucellosis, anthrax, etc.

Intradermal - for immunization against tuberculosis.

Subcutaneous - solution, suspension - live measles vaccine (LMV), DTP, etc.

Intramuscular - solution, suspension - sorbed toxoids: DTP, ADS, adsorbed diphtheria-tetanus vaccine with a reduced dose of antigen (ADS-M), anti-diphtheria toxoid, immunoglobulins, anti-rabies drugs.

Oral - liquid (solution, suspension), tablets without acid-resistant coating - BCG, OPV (poliomyelitis vaccine for oral administration), plague, smallpox, etc.

Enteral - tablets with acid-resistant coating - plague, smallpox, against Q fever.

Aerosol - liquid, suspension, powder - influenza, plague, gastrointestinal tract infections.

Organization of vaccination work in healthcare institutions

The organization of vaccination work in healthcare institutions is regulated by the relevant documents of the Ministry of Health.

When organizing vaccination work, special attention should be paid to:

equipping the vaccination room and complying with the requirements for space, ventilation, sanitary equipment;

availability of the required accounting documentation;

availability of medical equipment to provide emergency medical care;

availability of medical equipment for vaccinations and compliance with asepsis and antisepsis;

transportation and storage of immunobiological agents in compliance with the “cold chain” regime;

compliance with the expiration dates of immunobiological medicinal products;

disposal of ampoules and vials containing (containing) immunobiological drugs;

organization of vaccinations (permission to work, appointment of vaccinations, vaccinations, prevention of post-vaccination complications).

Vaccination room equipment

The vaccination room of an outpatient healthcare organization should consist of:

premises for storing medical records;

premises for preventive vaccinations (1 and 2 can be combined in clinics for adults);

additional premises for carrying out preventive vaccinations against tuberculosis and tuberculin diagnostics.

On-site preventive vaccinations can be carried out in treatment rooms of healthcare organizations or other premises of organizations subject to the requirements specified above. Carrying out preventive vaccinations in dressing rooms of healthcare organizations forbidden.

Premises for preventive vaccinations vaccination room organizations must be equipped with:

supply and exhaust ventilation or natural general ventilation;

running water with hot water supply and sewerage;

sink with installation of elbow taps with mixers;

dispensers (elbow) with liquid (antiseptic) soap and antiseptic solutions.

Accounting documentation

The vaccination room should contain:

instructions for use immunobiological medicinal products (IMDs);

vaccination logs by type of vaccination;

logs of accounting and use of ILS;

refrigerator temperature log;

emergency plan in case of violations in the “cold chain”;

a list of current regulatory legal acts regulating the implementation of immunoprophylaxis among the population of the Republic of Belarus.

Medical equipment of the vaccination room

In the premises for carrying out preventive vaccinations of the vaccination room of the organization there must be:

refrigeration equipment;

cold packs;

medical cabinet;

• a set of medicines for providing emergency (emergency) medical care;

  a set of medicines for emergency prevention of HIV infection and parenteral hepatitis;

  tools;

  disposable syringes with needles;

  packs with sterile material (cotton wool at the rate of 1.0 g per injection; bandages; napkins.);

medical couch or chair;

baby changing table;

medical tables;

containers with disinfectant solution;

bactericidal lamp;

thermal container (thermal bag).

The vaccination room must be equipped with:

a container for collecting used instruments;

puncture-resistant container with a lid for disinfection of used syringes, swabs, used ampoules and vials with ILS;

tonometer;

thermometer;

transparent millimeter ruler;

5 tweezers;

2 scissors;

rubber bands in the amount of 2 pcs.;

• adhesive plaster;

  towels;

  disposable gloves (one pair per patient);

  antiseptics;

  ethyl alcohol;

Disposable syringes for preventive vaccinations should be of the following types:

volume: 1, 2, 5 and 10 ml. with an additional set of needles;

tuberculin syringes.

Transportation and storage of immunobiological drugs

Transportation and storage of immunobiological medicinal products must be carried out using a “cold chain”, with a storage temperature within 2-8 °C, unless otherwise specifically stated. The cold chain uses thermal cabinets (refrigerators), refrigerated containers, refrigerators, and thermal containers.

A portable medical thermal container is a special container that is used for storing and transporting a vaccine.

Thermal container with cold elements

When transporting ILS from a warehouse and carrying out preventive vaccinations on site, the organization must have:

at least one thermal container (thermal bag);

two sets of cold elements for each thermal container (thermal bag).

When storing and transporting ILS to an organization, the following requirements must be met:

the temperature regime must be observed - from +2 to +8°С, unless otherwise specified in the instructions for their use;

use thermal containers (thermal bags) fully equipped with cold elements;

the thermal container (thermal bag) must contain a thermometer to control the temperature;

the temperature in the thermal container (thermal bag) must be maintained for 48 hours within the range of +2°C - +8°C at ambient temperatures up to + 43°C;

use temperature indicators;

Storage and transportation of ILS in healthcare organizations should be carried out by medical workers who have undergone special training and certification at the level of healthcare organizations in compliance with the “cold chain” system.

In the organization, the ILS must be stored in a specially designated refrigerator.

Storing other medicines (with the exception of adrenaline solution for emergency medical care) and food in the refrigerator for storing ILS is prohibited.

When storing ILS in a refrigerator, the following requirements must be met:

the number of doses must correspond to the number of planned preventive vaccinations for the current month;

the duration of storage in the organization should not exceed 1 month;

the order of arrangement of packages with ILS must provide for access of cooled air to each package;

ILS of the same name should be stored in series, taking into account the expiration date;

storing the HUD on the door panel or bottom of the refrigerator is prohibited;

the volume of stored ILS should not exceed half the volume of the refrigerator;

When the freezer is located on top of the refrigerator, the ILS should be located in the following order:

2- on the top shelf of the refrigerator - live vaccines (poliomyelitis, measles, rubella, mumps, BCG, tularemia, brucellosis);

3 - on the middle shelf of the refrigerator - adsorbed vaccines, toxoids, vaccine against hepatitis B, Hib infection;

4 - on the bottom shelf of the refrigerator - solvents for lyophilized ILS;

when the freezer compartment is located in the refrigerator at the bottom, the ILS should be located in the following order:

on the top shelf of the refrigerator - solvents for lyophilized ILS;

on the middle shelf of the refrigerator - adsorbed vaccines, toxoids, vaccine against hepatitis B, Hib infection;

on the bottom shelf of the refrigerator are live vaccines (poliomyelitis, measles, rubella, mumps, BCG, tularemia, brucellosis).

Disposal

When disposing ampoules (vias) containing inactivated ILS (live measles, mumps and rubella vaccines, human immunoglobulins and heterologous sera or their residues) must comply with the following requirements:

Disinfection treatment of ampoules (vias) with ILS residues is not carried out;

the contents of ampoules (vials) are poured into the sewer;

glass from ampoules (vials) is collected in puncture-proof containers.

Ampoules (vials) with live IDPs must be disinfected by physical or chemical means.

Shelf life of immunobiological medicinal products

Opened multi-dose vials of ILS containing a preservative (other hepatitis B vaccine) should be used for preventive vaccinations for no more than four weeks, subject to the following conditions:

the HUD used has not expired;

ILS are stored at a temperature of +2 - + 8°C;

ILS was taken from the vial in compliance with aseptic rules;

the color of the thermal indicator for the bottles has not changed;

in the absence of visible signs of contamination (change appearance ILS, presence of floating particles).

The use of an open vial of live (oral) polio vaccine must comply with the following requirements:

when using a dropper, the vaccine should be stored for no more than two days at a temperature of +2 - + 8°C, the bottle should be tightly closed;

when removing a dose from a vial through a syringe, the ILS must be drawn up each time with a new syringe through a rubber stopper in compliance with aseptic conditions; in this case, the period of use of the ILS is limited by the expiration date.

Opened vials of ILS against measles, mumps, rubella, and tuberculosis must be disposed of 6 hours after opening or at the end of the working day if less than 6 hours have passed.

Organization of preventive vaccinations in a healthcare institution

When carrying out preventive vaccinations, the head of the organization must appoint persons responsible for:

organization of work on the section of immunoprophylaxis;

planning and carrying out preventive vaccinations;

receipt, transportation, storage and use of ILS;

compliance with the system of uninterrupted storage of ILS in conditions of constant low temperature;

collection, disinfection, storage and transportation of medical waste generated during preventive vaccinations.

Carrying out preventive vaccinations in an organization must meet the following requirements:

Prescription of preventive vaccinations should be carried out by medical workers with special training and certification in the section of immunoprophylaxis;

Newly hired medical workers in organizations should receive permission to work related to preventive vaccinations after completing on-the-job training;

the introduction of ILS to the patient must be carried out by a medical professional, trained in the technique of carrying out preventive vaccinations, methods of providing emergency (emergency) medical care in the event of a complication developing preventive vaccination;

introduction of ILS against tuberculosis and tuberculin diagnostics must be carried out by medical workers who have been trained on the basis of anti-tuberculosis organizations and have a document issued in accordance with the legislation of the Republic of Belarus;

in the absence of additional premises for carrying out preventive vaccinations against tuberculosis and tuberculin diagnostics, the introduction of ILS against tuberculosis and tuberculin diagnostics should be carried out on separate days or separate hours on a specially designated table, with separate instruments, which should be used only for these purposes;

in patients at risk of developing complications from the introduction of ILS, preventive vaccinations should be carried out in a hospital healthcare organization;

To carry out preventive vaccinations, medical workers with acute respiratory diseases, tonsillopharyngitis, injuries on the hands, pustular skin lesions (regardless of their location) not allowed.

The introduction of ILS should provide for the following anti-epidemic requirements:

preventive vaccination should be carried out only if there is a record of its appointment in the medical documentation;

Aseptic rules must be observed when opening the ampoule, diluting the lyophilized ILS, removing the dose from the vial and when processing the injection field;

preventive vaccinations should be given to the patient in a lying or sitting position;

Only disposable or auto-disable syringes should be used;

re-administration of ILS to patients who, after a preventive vaccination, developed a strong reaction or complication to a preventive vaccination is prohibited;

when registering a strong reaction or complication to the introduction of ILS, sending an extraordinary report in accordance with the legislation of the Republic of Belarus;

Information about the use of ILS and preventive vaccination must be included in the medical documentation of the established form and transferred to organizations at the place of study or work of the patient who received the preventive vaccination.

Preventing complications

To prevent complications from preventive vaccinations, the medical worker of the organization who carried out the preventive vaccination must:

warn a patient who has received a preventive vaccination, or child's parents, trustees and other legal representatives about the need for a vaccinated person to stay near the vaccination room for 30 minutes;

monitor a patient who has received a preventive vaccination for 30 minutes;

provide primary medical care in the event of the development of immediate allergic reactions in a patient who has received a preventive vaccination, call a resuscitator to provide specialized medical care.

Measures to prevent post-vaccination reactions and complications should include:

medical observation for three days (when administering non-live vaccines) of the specialist doctor who prescribed the preventive vaccination for the patient who received the preventive vaccination;

medical observation from the fifth to the eleventh day (when administering live vaccines) of the medical specialist who prescribed the preventive vaccination for the patient who received the preventive vaccination;

registration of post-vaccination reactions and complications to preventive vaccination in medical records;

medical observation for thirty days when a patient who has received a prophylactic vaccination applies and registers strong and moderate reactions to the prophylactic vaccination;

quarterly analysis of the reactogenicity of ILS by the medical worker of the organization responsible for organizing work on immunoprophylaxis;

development (based on analysis) and implementation of measures aimed at reducing the number of post-vaccination reactions and preventing post-vaccination complications.