National calendar preventive vaccinations in Russia are one of the most complete in the world. However, it is revised annually. Changes are made to it as necessary. Thus, an innovation for 2017 was the 4th vaccination against hepatitis B.

How necessary are vaccinations for children under one year of age?

How necessary and safe are vaccinations for children under one year of age? Unfortunately, the number of infectious diseases is not decreasing in our time. And while the incidence of many bacterial infections is now under control, viral infections still circulate freely among the population and pose a particular danger to children under one year of age.

Can parents refuse vaccinations for children under one year of age? Yes, they can. In accordance with existing legislation (Article 5 of Federal Law 157-FZ of September 17, 1998, as amended on July 24, 2009 “On Immunoprophylaxis of Infectious Diseases”), vaccinations can be refused, but only in writing, by writing a corresponding statement, which will indicate that parents are aware of the existing restrictions for children who have not received preventive vaccinations. Restrictions include:

• possible refusal to admit a child to a preschool or school due to the emerging epidemiological situation;
• possible refusal to allow a child to travel to countries that require certain vaccinations.

There are no other restrictions when refusing vaccinations. Therefore, if an unvaccinated child is not accepted into kindergarten or school without good reason (the presence of an appropriate epidemiological situation), then this will be a violation of the law. But parents themselves must understand that their child has to constantly deal with an infection against which it would be nice to have protection. The changes made to the domestic vaccination calendar in 2017 do not have any amendments in this part.

Of course, a large number of vaccinations for children under one year of age can negatively affect their health, but if you put on the scale the minor harm that immunization causes and the risk of developing a severe infection, then it will be clear to all sensible people which will outweigh.

Vaccination schedule for children under one year old in 2017: calendar

The vaccination schedule for children under one year old this year looks like this:

Age	Name of vaccination
first days after birth	against viral hepatitis B (1st vaccination)
3-7 days after birth	from tuberculosis
1 month	against viral hepatitis B (2nd vaccination)
3 months	against whooping cough, diphtheria, tetanus (1st vaccination) against polio (1st vaccination) against hemophilus influenzae infection (1st vaccination)
4.5 months	against whooping cough, diphtheria, tetanus (2nd vaccination) against polio (2nd vaccination) against hemophilus influenzae infection (2nd vaccination)
6 months	against whooping cough, diphtheria, tetanus (3rd vaccination) against polio (3rd vaccination) Against hemophilus influenzae infection (3rd vaccination) For viral hepatitis B (3rd vaccination)
1 year	against measles, rubella and mumps against viral hepatitis B (4th vaccination); introduced in 2017

If the vaccination schedule of a child under one year old is shifted for some reason, the pediatrician draws up an individual vaccination schedule for this child in accordance with the 2017 instructions.

What vaccines are vaccinated?

A vaccine is a biological preparation, when administered, the body develops immunity to various infections. Vaccines are divided into live and inactivated.

Live vaccines contain live weakened cells of infectious agents. After the introduction of such a vaccine, an erased infection develops. The body responds to it by producing specific (acting only against a specific infection) antibodies. Antibodies neutralize the infection, and the memory of this remains for some time (it is excellent for different vaccines, many live vaccines are valid for life). If a person encounters this infection during the period of action of the vaccine, he does not get sick.

Inactivated vaccines, in turn, are divided into:

• whole cell – contain killed microorganisms in the form of cells;
• cell-free – contain individual antigens obtained from destroyed cells of infectious agents;
• toxoids - contain weakened toxins of infectious agents that cannot harm the body, but can initiate the formation of specific antibodies.

In order for stable immunity to develop after the administration of an inactivated vaccine, several repeated vaccinations are required. Children under one year of age are vaccinated mainly with inactivated vaccines. The exception is live vaccines against tuberculosis, rubella, measles and mumps (vaccination calendar for 2017).

Vaccination against viral hepatitis B

For viral hepatitis B, domestic and imported (Euvax B - South Korea and Engerix B - France) vaccines are used, made according to the same principle of genetic engineering. These are so-called yeast recombinant vaccines, during the production of which the gene of one of the antigens of the hepatitis B virus (Australian antigen) is introduced into baker's yeast. After purification, such a vaccine promotes the production of antibodies to the hepatitis B virus. It is impossible to get hepatitis after such a vaccination (many parents worry about this), but after the formation of immunity, it may well protect against infection.

The vaccine is injected into the right shoulder and side effects are minor and rare. At the same time, there is no difference between the administration of domestic and imported vaccines to children under one year of age.

Taking into account the unfavorable epidemiological situation, in 2017, the 4th vaccination against viral hepatitis B was introduced into the vaccination schedule for children under one year of age.

Vaccination against tuberculosis

For immunoprophylaxis of tuberculosis in children under one year of age, domestic live vaccines BCG and BCG-M are used, which meet all international standards. Imported vaccines against tuberculosis are not used in our country.

The vaccine is administered intradermally into the left shoulder. Side effects from its administration occur only if the vaccine is administered subcutaneously rather than intradermally - the formation of cold abscesses is possible. With proper administration, a small bump appears at the vaccination site after about 1.5 months, then a white head, turning into a crust. The crusts are replaced several times, and only by six months a scar is formed. This is fine. The vaccination site should not be lubricated with anything - this may disrupt the process of immunity formation.

Tuberculosis is still widespread; moreover, today forms of this disease that are not amenable to antibacterial therapy are becoming more common. Vaccination against tuberculosis is very important; it will protect the child from severe forms of tuberculosis, including tuberculous meningitis.

Vaccination against whooping cough, diphtheria and tetanus

This vaccination is carried out domestically DPT vaccine. There are also imported analogues of this vaccine - Infanrix (Belgium) and Pentaxim (France). The advantage of imported vaccines is that they contain an acellular pertussis component, which very rarely causes post-vaccination complications.

Adults are often well aware of the vaccinations their children need, but are completely unaware and do not think that vaccination is important at any age, protecting against serious and often fatal infectious diseases.

Adult immunization planning also needs to consider:

• vaccination already received by a person in childhood;
• some adults may not have been vaccinated at all or not fully vaccinated in childhood and adolescence and they require a full or completed course of vaccination;
• Vaccinations against certain infections were not given when the person was a child (eg, chickenpox, pneumococcal disease, HPV);
• post-vaccination immunity may decline over time;
• As people age or because of their work, they may become more susceptible to developing severe infections (for example, influenza and pneumococcal infections as they age).

The organization and conduct of immunoprophylaxis, including in adults, in the Russian Federation is regulated by Federal Law of September 17, 1998 N 157-FZ “On Immunoprophylaxis of Infectious Diseases”, the National Calendar of Preventive Vaccinations and Preventive Vaccinations for Epidemic Indications, Sanitary and Epidemiological Rules and methodological recommendations.

Federal law on immunoprophylaxis establishes the legal framework in the field of immunization of the population Russian Federation. Article 5 of this Law states that when carrying out immunization, citizens have the right to receive complete and objective information from medical workers about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications.

Lack of preventive vaccinations entails:

• a ban on citizens traveling to countries where stay requires specific preventive vaccinations;
• temporary refusal to admit citizens to educational and health institutions in the event of an unfavorable epidemic. situations;
• refusal to hire citizens for work or removal of citizens from work, the performance of which is associated with a high risk of contracting infectious diseases.

In accordance with the National Preventive Vaccination Calendar, adults are immunized:

From 18 years old	Revaccination against diphtheria, tetanus- every 10 years from the last revaccination
From 18 to 55 years old, not previously vaccinated	Vaccination against viral hepatitis B
Vaccination is carried out for children and adults who have not previously been vaccinated against viral hepatitis B, according to the scheme 0 - 1 - 6 (1 dose - at the start of vaccination, 2nd dose - one month after 1st vaccination, 3rd dose - 6 months from the start of vaccination)
Women from 18 to 25 years old (inclusive), not sick, not vaccinated, vaccinated once against rubella, who have no information about vaccinations against rubella	Vaccination against rubella
Adults under the age of 35 years (inclusive), not sick, not vaccinated, vaccinated once, with no information about measles vaccinations	Vaccination against measles. The interval between the first and second vaccinations should be at least 3 months.
adults, students in professional educational organizations and educational organizations of higher education; working in certain professions and positions (medical and educational organizations, transport, utilities); pregnant women; adults over 60 years of age; persons subject to conscription military service; people with chronic diseases, including lung disease, cardiovascular disease, metabolic disorders and obesity	Vaccination against flu

Some areas of the Arkhangelsk region are endemic for tularemia and tick-borne encephalitis. Therefore, when planning a visit to these regions, immunization against these infections is necessary.

Name preventive vaccinations	vaccinations
Against tularemia	Persons living in territories enzootic for tularemia, as well as persons arriving in these territories performing the following work: agricultural, irrigation, construction, other work on excavation and movement of soil, procurement, commercial, geological, survey, expeditionary, deratization and disinfestation; Persons working with live cultures of the causative agent of tularemia.
Vaccination against tularemia is carried out cutaneously or intradermally, once. Revaccination is carried out according to indications after 5 years with the same dose.
Against tick-borne viral encephalitis	Persons living in areas where tick-borne viral encephalitis is endemic; persons traveling to areas endemic for tick-borne viral encephalitis, as well as persons arriving in these territories performing the following work: agricultural, drainage, construction, excavation and movement of soil, procurement, fishing, geological, survey, expedition, deratization and disinfestation; for logging, clearing and landscaping of forests, health and recreation areas for the population. Persons working with live cultures of tick-borne encephalitis.
The vaccination course consists of 2 injections with an interval of 1-7 months. The vaccination course can be carried out throughout the year, incl. summer period(epidemic season), but no later than 2 weeks before visiting the site of tick-borne encephalitis. The optimal interval between the 1st and 2nd vaccinations is 5-7 months (autumn - spring). Revaccination is carried out once 1 year after completion of the vaccination course. Subsequent distant revaccinations are carried out once every 3 years.

In case of contact with a patient, emergency immunoprophylaxis is carried out:

Name preventive vaccinations	Categories of citizens subject to mandatory vaccinations
Against viral hepatitis A	Persons living in regions disadvantaged by the incidence of hepatitis A, as well as persons at occupational risk of infection ( medical workers, public service workers employed in food industry enterprises, as well as those servicing water supply and sewerage facilities, equipment and networks). Persons traveling to disadvantaged countries (regions) where outbreaks of hepatitis A are registered. Contact persons in hepatitis A outbreaks.
Against meningococcal infection	Children and adults in areas of meningococcal infection caused by meningococci of serogroups A or C. Vaccination is carried out in endemic regions, as well as in the event of an epidemic caused by meningococci of serogroups A or C. Persons subject to conscription for military service.
Against measles	Contact persons from the outbreaks of the disease who have not been sick, have not been vaccinated and do not have information about preventive vaccinations against these infections
Against viral hepatitis B
Against diphtheria
Against mumps
Against polio	Contact persons in foci of polio, including those caused by wild poliovirus (or if the disease is suspected): persons who had contact with people arriving from countries (regions) endemic (unaffected) with polio, from 3 months of life without age limit - once; persons working with live poliovirus, with materials infected (potentially infected) with wild poliovirus without age limit - once upon hiring.
Against pneumococcal infection	Adults from risk groups, including those subject to military service.
Against chickenpox	Adults at risk, including those subject to military service, who have not previously been vaccinated and have not had chickenpox.

And it is very important to remember for those who travel to work or travel to African countries: Angola, Benin, Burkina Faso, Burundi, Gabon, Ghana, Guinea-Bissau, Democratic Republic of the Congo, Cameroon, Congo, Ivory Coast, Liberia , Mali, Niger, Rwanda, Sierra Leone, Togo, Central African Republic, French Guiana Entry into these countries is possible only with an international vaccination certificate. yellow fever for all travelers.

Human papilloma virus infection- This is the most common disease that is sexually transmitted. The vaccine against human papillomavirus contains L1 proteins of the virus: 2 strains of papillomavirus, which cause about 70% of cases of cervical cancer and 2 strains, which cause 90% of genital genital candylomas. The human papillomavirus vaccine can prevent genital warts and cervical cancer in most cases.

• first dose - on the appointed day;
• the second - 2 months after the first;
• the third - 6 months after the first.

Consultant: Natalya Georgievna Brovina, head of the outpatient consultative infectious diseases department of the center of infectious diseases of the Arkhangelsk Regional Clinical Hospital JSC.

The national immunization calendar of the Russian Federation includes vaccinations against dangerous viruses that lead to severe complications, disability and death. This list of vaccinations is mandatory, however, parents can write a refusal to immunize their own child. These vaccinations are designed to create artificial immunity to certain viruses, which will allow the child either not to get sick or to suffer a mild form of the disease without complications. Consider the issue: children's vaccination schedule.

The national immunization calendar offers a strictly verified schedule of vaccinations important for the health of children.

All scheduled injections are given at your place of residence free of charge. Parents pay for additional immunization either in full or in part.

Routine immunization is carried out with drugs from domestic manufacturers. In cases of a severe allergic reaction to the components of the vaccine, it can be replaced with another drug.

Mandatory immunization includes injections against:

• hepatitis B;
• tuberculosis;
• pneumococcal infection;
• whooping cough/diphtheria/tetanus;
• polio;
• hemophilus influenzae infection;
• measles/mumps/rubella;
• flu (optional).

Hepatitis B affects liver cells. The chronic form of this disease can result in irreversible processes in the liver - cirrhosis.

Tuberculosis affects the lung tissue. In advanced cases, it turns into an open form, which leads to death.

Poliomyelitis leads to paralysis and paresis. This viral disease cannot be treated in a hospital setting due to the lack of a cure. The only protection against polio is vaccination.

Diphtheria affects internal organs, developing first in the larynx. Before the invention of the vaccine against diphtheria, the disease was almost always fatal.

Whooping cough is dangerous for children under five years of age; it does not threaten adults. Whooping cough affects the respiratory tract, causing paroxysmal coughing, during which the baby may suffocate.

Tetanus is a dangerous viral infection that can lead to death. The virus attacks the central nervous system, causing irreversible consequences. The virus is dangerous throughout life.

Measles is dangerous due to severe complications. This virus affects the nasopharynx, intoxication of the body with waste products from pathogenic bacteria is accompanied by hyperthermia and rash.

Rubella is more dangerous for expectant mothers than for small children. Women over 24 years of age are required to undergo revaccination if planning a pregnancy. Rubella is extremely dangerous in the first three months of gestation: the risk of miscarriage is likely.

Mumps (mumps) affects the salivary glands and nervous system of the child. A dangerous complication after an illness is infertility.

Vaccinations for newborns

When they do	Why
Immediately after birth	against hepatitis B (1st vaccination)
In the first week of life	from tuberculosis
Per month	from hepatitis B (2nd)
2 months	from hepatitis B (3rd)
3 months	DTP (1st); from polio (1st); from hemophilus influenzae infection (1st)
4.5 months	DTP (2nd); from poliomelitis (2nd); from hemophilus influenzae infection (2nd)
6 months	DTP (3rd); from poliomelitis (3rd); from hemophilus influenzae infection (3rd)

What vaccinations are given to a newborn baby? Until the baby is one month old, he is vaccinated against hepatitis B and tubercle bacilli:

• the first day of life - from hepatitis B;
• 3-7 days of life - from tuberculosis.

At three months, the baby undergoes serious immunization against several viruses simultaneously - DTP vaccination along with polio vaccination. At this age, the baby faces the risk of becoming infected with dangerous viruses against which he has no immune defense. Also, the vaccination schedule and table provides for the first vaccination against hemophilus influenzae infection.

At 4.5 months, re-immunization with DTP is carried out against polio and hemophilus influenzae. At 6 months, babies are vaccinated for the third time with DPT, against polio, hepatitis B and Haemophilus influenzae. The final stage of DTP vaccination is 1.5 years. Thus, the full cycle of DPT vaccination ends with the fourth vaccination. At 6 months, the baby receives the third dose of vaccine against hepatitis B and Haemophilus influenzae.

The individual immunization calendar may deviate slightly from the national schedule in terms of vaccine administration.

Vaccinations after one year

What vaccinations are given to children after one year? The vaccination schedule recommends a fourth hepatitis vaccine for children at risk. The vaccination calendar also takes into account vaccination against measles/mumps/rubella and chickenpox. This is a new type of vaccine for children, which should be vaccinated to all children after one year.

At one year and three months they are revaccinated against pneumococcal infection. At one and a half years old, the last DPT vaccination is given, after which vaccination against these viruses is considered complete. The immunization calendar also reminds you of booster vaccination against hemophilus influenzae. After a year and eight months, they undergo a second booster vaccination against polio.

Vaccination from three to seven years

The immunization calendar recommends that children from three to six years old be vaccinated against viral hepatitis A. At the age of six, they are revaccinated against measles, mumps and rubella. Also, at 6 years of age, the vaccination schedule includes revaccination against tetanus and diphtheria (without the pertussis component). At 6-7 years old they are revaccinated against tuberculosis.

Vaccinations in adolescence

The vaccination calendar recommends immunization against human papilloma for teenage girls aged 12-13 years. At 14 years of age, they are revaccinated against tetanus/diphtheria. Subsequently, ADS vaccination is repeated every 10 years to maintain the concentration of antigens at the required level. Also at the age of 14 they are revaccinated against polio.

Additional vaccinations

In addition to the mandatory ones, a child can receive additional preventive vaccinations at the request of the parents. Additional (recommended) injections include vaccination against:

• pneumococcal infection;
• rotavirus gastroenteritis;
• meningococcus C;
• hepatitis A;
• chicken pox;
• tick-borne encephalitis;
• human papillomavirus.

Pneumococcal infection causes dangerous complications of the disease: pneumonia, meningitis, sepsis, inflammation of the middle ear. A child is susceptible to the virus from the third month of life. For children, the drug Pneumo 13 (or 7) is recommended, which forms an immune response to seven common strains of the virus.

Rotavirus gastroenteritis affects the organs of the digestive system. The drug can be administered to the child two months after birth. Prevention of infection with the virus saves from dangerous diseases of the gastrointestinal tract, which is especially important for the imperfect digestive system of infants.

Meninogococcus is especially common among adolescents over 14 years of age living in an epidemiological risk zone. Vaccines can be given to infants up to one year old, followed by booster vaccinations at two years of age. In cases of an epidemic outbreak, preventive vaccinations are given to adolescents.

Chickenpox is more dangerous for adults than for children. Therefore, this vaccine is included in the list of recommended ones, and not mandatory vaccinations. Chickenpox is tolerated by children in a mild form, however, before leaving for the United States, immunization against chickenpox is mandatory.

Vaccination against tick-borne encephalitis is given to children from the age of four, followed by annual revaccination. The epidemiological situation of the child’s region of residence should be taken into account. Vaccination is carried out two months before the activity of infected ticks.

The human papillomavirus vaccine is given to girls under 15 years of age. It is at the age of 14 that the vaccine administered protects against the aggression of the virus throughout life. If it was not possible to vaccinate a child at the age of 14, immunization can be carried out later - but before the onset of sexual activity. Three injections are given over the course of a year.

Infant immunization rules

The national calendar emphasizes the importance of meeting vaccination deadlines. In order for the immune response to form correctly, the body must contain antigens (memory cells) in sufficient quantities. It is before the baby is one year old that the largest number of vaccinations is given, because the body must be protected from the aggression of viruses. If the vaccination schedule is not followed, an immune response may not develop.

However, in practice, there are cases of delays in immunization due to the ill health of babies under one year old. The local pediatrician must be warned about this in advance so that he can draw up an individual child immunization schedule. An individual immunization schedule includes scheduled vaccinations with staggered timing.

Important! It is allowed to postpone the immunization period if the baby is ill for up to a year. However, it is forbidden to vaccinate before the scheduled time, which is determined by the national calendar.

According to the law, parents have the right to refuse routine vaccinations. However, in this case, inevitable obstacles will arise when enrolling the child in school/kindergarten/nursery.

You should not be afraid of complications after vaccinations, because they are easier to deal with than the virus itself.

It is important to be careful during immunization: the injection can only be given to a healthy baby. It is advisable to take tests (blood/urine) before immunization to be sure of the child’s overall health.

If the baby is susceptible to frequent acute respiratory infections/ARVI, it is recommended to additionally immunize him against meningococcal/pneumococcal infection. These viruses cause severe forms of meningitis/pneumonia with dangerous complications. Children with chronic bronchitis, tonsillitis and pharyngitis are strongly recommended to be vaccinated against strains of meningococcus/pneumococcus.

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1. According to statistics, every pregnant woman increases the risk of developing an unpleasant disease from the second trimester.
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Modern scientific developments have reached such a high level that doctors have learned not only to prevent, but also to treat many previously fatal diseases. Doctors also pay attention to the schedule of vaccination of the population - to prevent the spread of serious infections, which is especially important for patients younger age.

How to prepare a vaccination schedule for children

The introduction of antigenic material in order to create immunity is carried out within strictly established periods. The national vaccination calendar for children determines when and under what epidemiological conditions in a particular region vaccination should be carried out. The generally accepted vaccination plan is constantly changing, taking into account the danger of the spread of infectious diseases in a particular period.

Together with the national schedule, a regional schedule of childhood vaccinations is formed. The latter takes into account the peculiarities of the epidemiological situation of the constituent entities of the Russian Federation and is approved by local authorities of the Ministry of Health. Vaccination carried out by private and public medical institutions is carried out only with registered drugs of Russian or foreign production. At the same time, prophylactic injection drugs against meningococcus and pneumococcus are mostly purchased in developed European countries.

Children's vaccinations by age

Preventive vaccination involves stimulating children's immunity through mandatory and voluntary injections. The latter are introduced if there are special indications. They are recommended if the child travels to another country with a hot climate or goes to summer camp, sanatorium. Then it is necessary to vaccinate him against infections common in the area.

HIV and hepatitis B are known to be widespread in Southern and parts of Central Africa. It is important to know that any pathological agent can be “brought” from almost anywhere. As for Russia, for example, the population of the Siberian district receives mandatory injections against tick-borne encephalitis. According to the Russian national vaccination schedule, children receive the following preventive vaccinations against:

1. Tuberculosis (BCG). The vaccine has been used for more than 80 years. The drug does not develop the body's resistance to tuberculosis, but helps children under 10 years of age avoid severe consequences this disease. The disadvantages of BCG include possible complications:
   • abscess;
   • osteomyelitis;
   • inflammation of the lymphatic ducts.
2. Whooping cough, diphtheria, tetanus (DTP). The drug is a polyvaccine, the effectiveness of which has been proven by numerous studies. DTP allows you to achieve immunity of the child to the above diseases. Injection can provoke the development of severe pathologies nervous system.
3. Hepatitis B. The vaccine contains particles of the virus shell. The advantage of the drug can be considered the formation of stable immunity to the pathogen. The vaccination schedule recommends administering the vaccine three times per certain deadlines. Experts warn about the possible occurrence of the following side effects after injection for hepatitis B:
   • encephalitis;
   • meningitis;
   • seizures,
   • runny nose

1. Haemophilus influenzae. The drug includes only that part of the microbial shell that carries the antigen. A distinctive feature of this material is its joint introduction with DPT, which fully meets the requirements of the national schedule. The following side effects may occur after the antigen vaccine:
   • hypoplastic anemia;
   • decreased platelet count;
   • sudden death.
2. Chicken pox. The introduction of antigenic material from this disease very effectively fights the pathogen. The vaccination schedule for children involves a single dose of the drug to obtain a stable immune response. An injection against chickenpox helps eliminate a number of severe complications that arise from the disease. However, the injection can also cause a number of negative consequences:
   • convulsions;
   • loss of consciousness;
   • allergies;
   • arthritis.
3. Flu. Vaccination requires annual revaccination according to the established schedule. At the same time, the influenza virus is constantly mutating, which complicates the production of a vaccine. Influenza injections often provoke:
   • headaches;
   • increase in temperature;
   • loss of consciousness.

1. Rubella, measles and mumps (RMR). An extremely important vaccine. Immunity to rubella is formed after the first vaccination, and in order for antibodies to measles and mumps to appear, it is necessary to administer the vaccine twice on schedule. Failure to comply with this rule may result in loss of the protective mechanism. Doctors warn about the following possible side effects after the MMR vaccine:
   • anaphylactic shock;
   • sleep or digestive disorders;
   • mumps.
2. Meningococcus. The introduction of antigenic material against this serious disease in Russia is done from the very birth of the child. The procedure is voluntary. In case of severe spread of infection, it is recommended to carry out mandatory vaccination against meningitis. The consequences of injections against meningococcus can be:
   • Quincke's edema;
   • decreased muscle tone;
   • headache.
3. Poliomyelitis. A couple of decades ago, this disease affected a huge number of people. After the introduction of compulsory vaccination against polio, the picture changed dramatically. In Russia, infants receive their first vaccination against this infection at 3 months. Further administration of the drug against meningitis is carried out according to the routine vaccination schedule. Parents often refuse polio injections due to the high risk of developing vaccine-associated polio.
4. Pneumococcus. Vaccination guarantees resistance to 7 types of this microbe. Parents should be aware of possible consequences administration of pneumococcal vaccine:
   • loss of consciousness;
   • low-grade fever;
   • allergies.

Vaccinations for children under one year old

The baby, as a rule, is given drugs for tuberculosis (BCG) and hepatitis B while still in the maternity hospital. About a week later, the baby is given a Mantoux test. The further vaccination schedule for children is drawn up taking into account the individual characteristics of each child. At the same time, doctors often resort to delaying the upcoming vaccination due to medical withdrawal or parental refusal to administer it, which is recorded in the vaccine card. In the first year of life, the child’s body experiences the effects of the following injections:

1. DPT;
2. against polio;
3. from hepatitis B;

What vaccinations are given to children from one to three years of age?

Many parents postpone mandatory vaccination until a later period, which is actually justified in some situations. A child's body from one to three years of age is able to cope with many pathogenic agents; it has already developed immunity to many serious diseases. According to the planned schedule, at the age of one and a half years, the child is vaccinated against polio, hemophilus influenzae, whooping cough, diphtheria and tetanus. Children under 3 years of age are not vaccinated against other diseases.

Revaccination of children

Repeated administration of antigenic material is necessary to maintain the immune response over a long period of time. Often, revaccination is not required at all, and to create immunity to a pathogenic agent, only one injection within the prescribed time frame is enough. In a situation where the next vaccination is missed, the child’s body loses resistance to microbes. The childhood vaccination schedule includes repeated administration of an injectable drug against the following infections:

• tuberculosis;
• whooping cough, diphtheria, tetanus;
• rubella, mumps, measles;
• polio;
• hepatitis B.

Scheduled vaccination schedule for children

Vaccination is carried out according to the National and regional schedule. It is important to note that these lists are constantly being updated. Additions and amendments reflect the epidemiological situation in a particular territory. For this reason, parents should not be surprised if the schedule of routine vaccinations for children has been supplemented with new vaccinations. The general plan for carrying out injection stimulation of children's immunity is as follows:

	Graft
Newborn babies	Hepatitis B and BCG
	Hepatitis B
	Hepatitis B
	DPT, polio, first vaccination against Haemophilus influenzae.
	DTP, revaccination against polio, hemophilus influenzae, hepatitis B.
	Mantoux test, PDA, hepatitis B (children at risk).
	DPT, revaccination against polio, hemophilus influenzae infection.
	Repeated vaccination against polio.
	DTP and CPC.
	Revaccination against polio, tuberculosis, tetanus and diphtheria.

Vaccination of children for epidemic indications

It may happen that the spread of infection in certain areas is considered more likely than in others. For this reason, regional childhood vaccination schedules are constantly updated with new regimens for the administration of specific drugs. Thus, it is known that injections against anthrax and brucellosis are recommended for people living near livestock farms. Vaccination of children for epidemic reasons is voluntary, so parents must independently decide whether or not to vaccinate their children against plague, cholera and other serious diseases.

Video: Childhood vaccination calendar

Conclusion of the clinical expert commission (KEC)

Academic leave

Form No. 027/u, discharge summary, medical extract from the medical history, outpatient and/or inpatient (from the clinic and/or hospital)

Doctor's persona

Midterm control in the discipline "Outpatient Pediatrics" Module: Organization of the work of a children's clinic.

Examples of boundary control tests

Topic 3. Assessment of factors that determine health.

Topic 4. Assessment of physical development

General procedure (algorithm) for determining physical development (fr):

2. Determination of the child’s biological age by dental formula (up to 8 years) and by the level of sexual development (from 10 years).

3. Mastering practical skills

4.List of essay topics for students

Topic 5. Assessment of the neuropsychic development of children 1-4 years of age.

1. Assess the child’s neuropsychic development:

2. Mastering practical skills:

Topic 6. Assessment of functional state and resistance. Chronic diseases and developmental defects as criteria characterizing health.

1. Predominant emotional state:

Topic 7. Total assessment of health criteria. Health groups.

Midterm control in the discipline "Olyclinic Pediatrics" Module: Fundamentals of the formation of children's health.

Examples of boundary control tests

Topic 8. Organization of medical and preventive care for newborns in a clinic.

Prenatal care

Social history

Genealogical history Conclusion on genealogical history

Biological history

Conclusion on antenatal history: (underline)

General conclusion on prenatal care

Recommendations

Sheet of primary medical and nursing care for a newborn

Topic 9. Dispensary method in the work of a pediatrician. Dispensary observation of healthy children from birth to 18 years.

Clinical observation of a child in the first year of life

Section 1. List of studies during preventive medical examinations

Topic 10. Principles of clinical examination of children with chronic diseases.

Topic 11. Tasks and work of a doctor in the department of organizing medical care for children and adolescents in educational institutions (DSO).

Section 2. List of studies during preliminary medical examinations

Preparing children to enter school.

Section 2. List of studies carried out

Section 1. List of studies carried out

Applications for basic medical documentation in preschool and school.

Factors that determine children's readiness for school are the following:

Topic 12. Rehabilitation of children, general principles of organization and specific issues.

Organization of sanatorium and resort assistance for children.

Hospital-substituting technologies in modern pediatrics.

States of the day hospital of the children's clinic:

Day hospital of a children's clinic (equipment)

Task No. 1

Task No. 2

Midterm control in the discipline "Olyclinic Pediatrics" Module: Preventive work of the local doctor.

Examples of boundary control tests

Topic 13. Specific and nonspecific prevention of infectious diseases in primary care.

National calendar of preventive vaccinations

Topic 14. Diagnosis, treatment and prevention of airborne infections in the pediatric area.

Topic 15. Treatment and prevention of acute respiratory viral infections in children.

Clinical classification of acute respiratory infections (V.F. Uchaikin, 1999)

General provisions on the treatment of acute respiratory viral infections

Algorithm (protocol) for the treatment of acute respiratory infections in children

3. Differential diagnosis of acute pneumonia - with bronchitis, bronchiolitis, respiratory allergies, airway obstruction, tuberculosis.

Midterm control in the discipline "Olyclinic Pediatrics" Module: Anti-epidemic work of the local doctor:

Examples of boundary control tests

Topic 16. Basic methods of emergency treatment at the prehospital stage.

Primary cardiopulmonary resuscitation in children

Topic 17. Diagnostics, primary medical care, pediatrician tactics for urgent conditions.

Fever and hyperthermic syndrome

Convulsive syndrome

Acute stenosing laryngotracheitis

3.For I degree of stenosis:

4. With increasing phenomena of stenosis (I-II degree, II-III degree):

5. For III-IV degree of stenosis:

Task No. 1

Task No. 2

B. 1. Intussusception.

Midterm control in the discipline “Olyclinic Pediatrics” Module: Emergency therapy at the prehospital stage.

Examples of boundary control tests

Topic 18. Conducting intermediate control of students’ knowledge and skills in the discipline “outpatient pediatrics”.

Criteria for student admission to course credit:

Examples of course assignments in outpatient pediatrics.

Criteria for assessing a student during a practical lesson and based on the results of independent work

Guidelines for independent work of students

I. Requirements for writing an abstract

II. Requirements for conducting a lecture

III. Basic requirements for the design and issuance of a standard sanitary bulletin

IV.Work in focus groups on a selected topic

National calendar of preventive vaccinations

	Name of vaccination	The procedure for carrying out preventive vaccinations
Newborns in the first 24 hours of life	First vaccination against viral hepatitis B	It is carried out in accordance with the instructions for the use of vaccines in newborns, including those from risk groups: those born to mothers who are carriers of HBsAg; patients with viral hepatitis B or who have had viral hepatitis B in the third trimester of pregnancy; who do not have test results for hepatitis B markers; drug addicts, in families in which there is a carrier of HBsAg or a patient with acute viral hepatitis B and chronic viral hepatitis (hereinafter referred to as risk groups).
Newborns on the 3rd - 7th day of life	Vaccination against tuberculosis	Vaccines are administered to newborns to prevent tuberculosis (for gentle primary immunization) in accordance with the instructions for their use. In subjects of the Russian Federation with incidence rates exceeding 80 per 100 thousand population, as well as in the presence of tuberculosis patients in the newborn’s environment, a vaccine for the prevention of tuberculosis
Children at 1 month	Second vaccination against viral hepatitis B	Incl. from risk groups
Children at 2 months
Children at 3 months	First vaccination against diphtheria, whooping cough, tetanus	Carried out in accordance with the instructions for the use of vaccines in children of this age group
	First vaccination against Haemophilus influenzae	It is carried out in accordance with the instructions for the use of vaccines for children at risk: with immunodeficiency conditions or anatomical defects leading to a sharply increased risk of Hib infection; with oncohematological diseases and/or receiving immunosuppressive therapy for a long time; HIV-infected or born from HIV-infected mothers; located in closed preschool institutions ( children's home, orphanages, specialized boarding schools (for children with psychoneurological diseases, etc.), anti-tuberculosis sanitary and health institutions). Note. The course of vaccination against hemophilus influenzae for children aged 3 to 6 months consists of 3 injections of 0.5 ml with an interval of 1-1.5 months. For children who have not received the first vaccination at 3 months, immunization is carried out according to the following scheme: for children aged 6 to 12 months. of 2 injections of 0.5 ml with an interval of 1-1.5 months. for children from 1 year to 5 years, a single injection of 0.5 ml.
	First vaccination against polio
Children at 4.5 months	Second vaccination against diphtheria, whooping cough, tetanus
	Second vaccination against Haemophilus influenzae	Carried out in accordance with the instructions for the use of vaccines for children of this age group who received their first vaccination at 3 months
	Second vaccination against polio	Carried out with vaccines for the prevention of polio (inactivated) in accordance with the instructions for their use
Children at 6 months	Third vaccination against diphtheria, whooping cough, tetanus	It is carried out in accordance with the instructions for the use of vaccines for children of this age group who received the first and second vaccinations at 3 and 4.5 months, respectively.
	Third vaccination against viral hepatitis B	Carried out in accordance with the instructions for the use of vaccines for children of this age group who do not belong to risk groups who received the first and second vaccinations at 0 and 1 month, respectively
	Third vaccination against Haemophilus influenzae	Carried out in accordance with the instructions for the use of vaccines for children who received the first and second vaccination at 3 and 4.5 months, respectively
	Third vaccination against polio	Children in closed nurseries preschool institutions(children's homes, orphanages, specialized boarding schools (for children with psychoneurological diseases, etc.), anti-tuberculosis sanitary and health institutions), according to indications, they are vaccinated three times with vaccines for the prevention of polio (inactivated).
Children at 12 months	Vaccination against measles, rubella, mumps	Carried out in accordance with the instructions for the use of vaccines in children of this age group
	Fourth vaccination against viral hepatitis B	Carried out in accordance with the instructions for the use of vaccines for children at risk
Children at 18 months	First revaccination against diphtheria, whooping cough, tetanus	Carried out in accordance with the instructions for the use of vaccines in children of this age group
	First revaccination against polio	Children of this age group are given vaccines to prevent polio (live) in accordance with the instructions for their use.
	Revaccination against Haemophilus influenzae	Revaccination is carried out once for children vaccinated in the first year of life in accordance with the instructions for the use of vaccines.
Children at 20 months	Second revaccination against polio	Children of this age group are given vaccines to prevent polio (live) in accordance with the instructions for their use.
Children aged 6	Revaccination against measles, rubella, mumps	Conducted in accordance with the instructions for the use of vaccines for children of this age group who have received vaccination against measles, rubella, and mumps
Children aged 6 - 7 years	Second revaccination against diphtheria, tetanus
Children aged 7		Vaccines for the prevention of tuberculosis are administered to tuberculin-negative children of this age group who are not infected with Mycobacterium tuberculosis in accordance with the instructions for their use
Children aged 14	Third revaccination against diphtheria, tetanus	It is carried out in accordance with the instructions for the use of toxoids with a reduced content of antigens to children of this age group
	Third revaccination against polio	Children of this age group are given vaccines to prevent polio (live) in accordance with the instructions for their use.
	Revaccination against tuberculosis	Vaccines for the prevention of tuberculosis are administered to tuberculin-negative children of this age group who are not infected with Mycobacterium tuberculosis in accordance with the instructions for their use. In constituent entities of the Russian Federation with tuberculosis incidence rates not exceeding 40 per 100 thousand population, revaccination against tuberculosis at 14 years of age is carried out for tuberculin-negative children who have not received the vaccine at 7 years of age.
Adults over 18 years old	Revaccination against diphtheria, tetanus	Carried out in accordance with the instructions for the use of toxoids with reduced antigen content in adults over 18 years of age every 10 years from the date of the last revaccination
Children from 1 year to 18 years old, adults from 18 to 55 years old, not previously vaccinated	Vaccination against viral hepatitis B	It is carried out in accordance with the instructions for the use of vaccines for children and adults of these age groups according to the 0-1-6 scheme (1 dose - at the start of vaccination, 2 dose - a month after 1 vaccination, 3 dose - 6 months from the start of immunization).
Children from 1 to 18 years old, girls from 18 to 25 years old	Immunization against rubella	It is carried out in accordance with the instructions for the use of vaccines for children from 1 to 18 years of age who have not been sick, not vaccinated, vaccinated once against rubella and girls from 18 to 25 years of age who have not been sick and have not been vaccinated previously.
Children from 6 months, students in grades 1-11; students of higher and secondary professional educational institutions	Flu vaccination	It is carried out in accordance with the instructions for the use of vaccines annually to these categories of children and adolescents, as well as adults working in certain professions (medical and educational institutions, transport, utilities, etc.) and adults over 60 years old
Children aged 15-17 years inclusive and adults up to 35 years of age	Immunization against measles	Immunization against measles for children aged 15-17 years inclusive and adults under the age of 35 who have not been vaccinated previously, have no information about vaccinations against measles and have not previously had measles is carried out in accordance with the instructions for the use of vaccines twice with an interval of at least 3- x months between vaccinations. Persons previously vaccinated once are subject to a single immunization with an interval of at least 3 months between vaccinations

Notes:

1. Immunization within the framework of the national calendar of preventive vaccinations is carried out with medical immunobiological preparations registered in accordance with the legislation of the Russian Federation, in accordance with the instructions for use.

2. If the timing of immunization is violated, it is carried out according to the schedules provided for in the national calendar of preventive vaccinations, and in accordance with the instructions for the use of drugs. It is allowed to administer vaccines (except for vaccines for the prevention of tuberculosis), used within the framework of the national calendar of preventive vaccinations, on the same day with different syringes in different parts of the body.

3. Immunization of children born to HIV-infected mothers is carried out within the framework of the national calendar of preventive vaccinations in accordance with the instructions for the use of vaccines and toxoids. When immunizing such children, the following are taken into account: the child’s HIV status, the type of vaccine, indicators of immune status, the child’s age, and concomitant diseases.

4. Immunization of children born to HIV-infected mothers and who received three-stage chemoprophylaxis for mother-to-child transmission of HIV (during pregnancy, childbirth and the neonatal period) is carried out in the maternity hospital with vaccines for the prevention of tuberculosis (for gentle primary immunization). In children with HIV infection, as well as when HIV nucleic acids are detected in children by molecular methods, vaccination against tuberculosis is not carried out.

5. Children born to HIV-infected mothers are immunized against polio with an inactivated vaccine, regardless of their HIV status.

6. Immunization with live vaccines within the framework of the national calendar of preventive vaccinations (with the exception of vaccines for the prevention of tuberculosis) is carried out for HIV-infected children with immune categories 1 and 2 (absence or moderate immunodeficiency).

7. If the diagnosis of HIV infection is excluded, children born to HIV-infected mothers are immunized with live vaccines without a preliminary immunological examination.

8. Toxoids, killed and recombinant vaccines are administered to all children born to HIV-infected mothers as part of the national schedule of preventive vaccinations. These drugs are administered to HIV-infected children in the absence of pronounced and severe immunodeficiency.

9. When immunizing against hepatitis B in children of the first year of life, against influenza in children from 6 months of age and schoolchildren in grades 1-11, vaccines without mercury-containing preservatives are used.

Vaccination calendar

Type and type of vaccination		Planned vaccination age		Dose and method of administration	Date of vaccination	Vaccine series	Reaction to vaccination
Against polio (IPV, OPV)
Against whooping cough, diphtheria and tetanus (DPT IM; ADS-M IM or SC)	1 RV, DTP 2 RV ADS-M 3 RV ADS-M
Against measles
Against mumps
Against rubella (i.m. or s.c.)
Against hepatitis B				10 mcg IM 10 mcg IM 10 mcg IM 10 mcg IM
Against tuberculosis (BCG / BCG-M)				0.05 mg i.c. 0.05 mg i.c. 0.05 mg i.c.
Against hemophilus influenzae (i.m. or s.c.)

Post-vaccination reactions, as a rule, do not require correction, but they should be remembered in cases where vaccinations are given to children at risk and when an intercurrent disease occurs in the post-vaccination period.

The vaccination process as a whole and especially post-vaccination reactions and complications are determined by the vaccine preparation itself. The vaccination process after the introduction of live vaccines into the body is largely reminiscent of the infectious process.

The interval between the vaccination and the appearance of a general and local reaction depends on the nature of the drug, the immunological status of the child and other factors. The maximum increase in temperature is observed after 9–12 hours, and its normalization after 36–48 hours. Intoxication phenomena in most children disappear simultaneously with a decrease in temperature. Some children experience weakness, lethargy, increased fatigue, sleep disturbance, and decreased appetite for several days.

Local reactions may appear 1–2 hours after using sorbed drugs. Their maximum development is observed after 24–48 hours and can last from 2 to 7 days. A clear relationship between the intensity of local and general reactions, as a rule, is not identified.

The severity of the general reaction is assessed by the degree of temperature increase. The reaction is considered weak at a temperature of 37–37.5°C, medium - at 37.6–38.5°C. The intensity of the local reaction is assessed as follows: weak reaction - hyperemia without infiltrate or with infiltrate up to 2.5 cm in diameter, average reaction - infiltrate from 2.6 to 5 cm, strong reaction - infiltrate more than 5 cm in diameter or lymphangitis with lymphadenitis.

Sometimes develop unusual post-vaccination reactions or abnormalities of the post-vaccination process. In this case, there is an increase in both general and local reactions, a weak, fast or slow local reaction. Unusual reactions to vaccinations include the possibility of measles despite vaccination if vaccinated before the age of 1 year.

Post-vaccination complications are divided into the following groups:

associated with violation of the rules of asepsis and antisepsis,

due to the nature and specific properties of vaccination preparations,

in the development of which the main importance is individual characteristics the body and the initial state of reactivity, pathological processes (exacerbation of latent diseases and the accumulation of intercurrent diseases) provoked by vaccinations.

Currently, it is customary to distinguish 4 risk groups for immunoprophylaxis:

TO first group include children who are suspected or have CNS damage. Such children are vaccinated after consultation with a neurologist and, as a rule, with weakened vaccines.

In second group included children prone to various allergic reactions and with a history of allergic diseases. They are vaccinated with the exception of the pertussis component of the vaccine and, as a rule, against the background of hyposensitizing therapy.

Third group are often sick children. Their vaccination is carried out no less than 6 months after clinical and laboratory remission.

TO fourth group include children with local and general pathological reactions to vaccinations and a history of post-vaccination complications. These children are also excluded from the pertussis component and, accordingly, the vaccine that caused the reaction.

Contraindications to vaccination are diseases taken into account by orders of the Ministry of Health of the Russian Federation No. 375 of December 18, 1997 and No. 229 of June 27, 2001

Vaccines	Contraindications
All vaccines	Severe reaction or complication to a previous vaccine
All live vaccines	Immunodeficiency state (primary). Immunosuppression; malignant neoplasms. Pregnancy
	Child's weight at birth is less than 2000 g. Keloid scar
	Progressive diseases of the nervous system. History of afebrile seizures (ADS is administered instead of DPT)
Live vaccines: measles (MMR), mumps (MPV), rubella, as well as combined di- and trivaccines (measles-mumps, measles-rubella-mumps)	Severe forms of allergic reactions to aminoglycosides (gentamicin, kanamycin, etc.). For foreign-made vaccines prepared on chicken embryos: anaphylactic reaction to chicken egg white
Hepatitis B vaccine (HBV)	Allergic reaction to baker's yeast
Acute infectious and non-infectious diseases, exacerbation of chronic diseases are temporary contraindications for vaccinations. Scheduled vaccinations are carried out 2-4 weeks after recovery or during the period of convalescence or remission. For mild ARVI, acute intestinal diseases, etc., vaccinations are carried out immediately after the temperature has normalized. ADS-M is not administered before age 6 years, and ADS is not recommended before age 4 years unless there is a severe reaction to whooping cough.

False contraindications to preventive vaccinations.

States	Anamnesis data
Perinatal encephalopathy	Prematurity
Stable neurological conditions
Enlargement of the thymus shadow	Hemolytic disease of the newborn
Allergies, asthma, eczema	Complications after vaccination in the family
Congenital defects	Allergies in the family
Dysbacteriosis	Epilepsy
Maintenance therapy	Sudden death in the family
Topical steroids

Anti-epidemic measures for chickenpox.

1. Isolation of the patient from the moment of illness until recovery (until the 5th day after the last addition). On average, isolation stops 10 days from the moment of rash.

2. Separation of contacts: separation of not sick children under 7 years of age from the 11th to the 21st day from the moment of contact. In case of repeated cases of the disease in a children's institution, separation is not applied. Contacts should be examined daily for rash detection and thermometry should be performed.

3. Team quarantine for 21 days.

4. Disinfection is not carried out; daily wet cleaning and frequent ventilation of the room are sufficient.

Anti-epidemic measures for measles.

1. Isolation of the patient from the moment of detection until the 5th day from the onset of the rash.

2. Separation of contacts from the 8th to the 21st day from the beginning of contact.

3.Quarantine. Contact children who have previously had measles, who have been vaccinated, and who have anti-measles antibody titers of 1:5 or higher are not subject to quarantine. Other contacts are subject to quarantine from the moment of separation from the patient until the 17th day. Unvaccinated people, in the absence of contraindications, are recommended to be actively immunized. Sick and weakened people need to undergo passive immunization against measles: administer donor immunoglobulin in a dose of 3.0 ml to 6.0 ml, depending on the condition of the contact child. After administration of immunoglobulin, quarantine is extended to 21 days.

4. Disinfection is not carried out; wet cleaning and frequent ventilation are sufficient.

Anti-epidemic measures for rubella.

1. Isolation of the patient is carried out until the 5th day from the onset of the disease.

2. Isolation of contacts: isolation of contacts with rubella is not required, but observation is carried out until the 21st from the beginning of contact, since children who have not previously had rubella may become ill.

3.Quarantine is not imposed

4. Disinfection is not carried out; wet cleaning and frequent ventilation of the room where the patient is located are sufficient.

Anti-epidemic measures for epidemic paratitis:

1. Isolation of the patient until recovery, but for no less than 9 days from the onset of the disease, for the nervous form - no less than 21 days. Children who have had mumps meningitis are admitted to a child care facility no earlier than 10 days after discharge from the hospital.

2. Separation of contacts from the 11th to the 21st day from the moment of contact.

3. Quarantine for 21 days.

4. Disinfection: not carried out, wet cleaning of the room and frequent ventilation are sufficient.

Clinical observation for scarlet fever.

Observation is carried out by a rheumatologist or nephrologist for children who have suffered complicated scarlet fever. Patients with chronic tonsillitis should be treated by an otolaryngologist. The examination plan should include three times (once a week) general analysis urine, clinical blood test and ECG.

List of analyzes due to complications from the cardiovascular and urinary systems:

during the illness - 3 general urine tests;

2–3 days after the end of antibacterial therapy - a general urine test; clinical blood test; culture of tonsil mucosa for hemolytic streptococcus;

after 2–4 weeks: general urinalysis; clinical blood test; culture for hemolytic streptococcus; according to indications - consultation with a cardiologist + consultation with an ENT doctor.

Surveillance system local doctor for a patient with scarlet fever:

1st week - every other day a pediatrician and a nurse;

2nd week - 2 times pediatrician;

3rd week - 1 time pediatrician.

On the 22nd day of illness, if there are no complications and tests are normal, the child is discharged to the preschool or school.

Anti-epidemic measures for scarlet fever:

1. Isolation of the patient is carried out for at least 22 days, until complete clinical and laboratory recovery and bacteriological clearance of hemolytic streptococcus.

2. Isolation of contacts: contacts are isolated for 7 days from the date of contact, and children from the outbreak of tonsillitis for 22 days. If a patient with scarlet fever is being treated at home and there are children of preschool and primary school age in the apartment, then they are isolated for 17 days. Contacts are subject to clinical observation; if indicated, a bacteriological examination (throat culture for hemolytic streptococcus) is recommended; if necessary, treatment with erythromycin or bicillin-3 is prescribed. A sore throat in a child in contact with a patient with scarlet fever is interpreted as an analogue of this infection. Treatment, examination and duration of observation of the patient are the same as for scarlet fever.

3. Quarantine - 7 days from the moment the patient is isolated.

4.Disinfection. Routine disinfection is carried out during the entire period of isolation of the patient and includes thorough washing of dishes, care items and toys using detergents. Clothes, handkerchiefs and bed linen must be changed and boiled frequently. At the end of the contagious period of the disease or after hospitalization of the patient, final disinfection is carried out in the same way.

Anti-epidemic measures for whooping cough:

Isolation of the patient is carried out for 25 days from the onset of the disease at home or in a hospital.

Quarantine is imposed for 14 days

Separation of contact children is carried out under the age of 7 years from 1 to 14 days from contact.

Newborns and unvaccinated children in the first two years of life are recommended to undergo passive immunization (immunoglobulin).

All contacts should be tested for whooping cough.

No disinfection is carried out; wet cleaning is sufficient.

Anti-epidemic measures for diphtheria.

1. Isolation of the patient is carried out in the hospital until complete clinical recovery and bacteriological clearance (2 negative tests for BL, taken with a two-day interval). Admission to a child care facility after an additional one-time bacterial test for BL. Hospitalization of carriers of toxigenic strains is mandatory. Their isolation is terminated after sanitization and two negative BL tests taken 3 days after the end of treatment. Admission to a child care facility without additional bacterial analysis.

2.Working with contacts. Those in contact with diphtheria patients or bacteria carriers are quarantined until a final response from a bacteriological study is received, but for no less than 7 days. During this time, all contact children and adults must be examined daily, paying attention to the pharynx and other mucous membranes, skin, and thermometry must be performed. In the first days of isolation, all contacts should be examined by an otolaryngologist. To prevent the spread of infection, active immunization with diphtheria toxoid is carried out for those contacts whose next vaccination or revaccination is due, as well as children and adults who have not received diphtheria vaccinations over the previous 10 years. For immunization, an toxoid is used in the composition of ADS, ADS-M or AD-M, which is administered once intramuscularly in a dose of 0.5 ml. Previously vaccinated children who, during a serological examination for diphtheria antitoxin in the blood serum, have an antitoxin titer lower than or equal to 1/20 according to the RNGA, urgently need to be immunized with diphtheria toxoid due to the high risk of developing toxic forms of diphtheria during infection.

3.Working with bacilli carriers of the toxigenic strain of diphtheria bacillus . All children who are found to be carriers of a toxigenic strain of Loeffler's bacillus, as well as patients, should be hospitalized. If, during a bacterial examination, a non-toxigenic strain of diphtheria bacillus is isolated from a child, isolation and hospitalization are not required, and treatment is carried out if clinical indicators are present. Carriers of the toxigenic strain of diphtheria bacillus are given complex treatment taking into account the state of macroorganism carriage - chronic tonsillitis, adenoiditis, sinusitis, etc., as well as intensive local conservative treatment - washing the tonsils with disinfectant solutions, irrigation, gargling, physiotherapy, etc. The prescription of immunostimulating therapy under laboratory testing is indicated immunological control. Antibacterial therapy is used only if treatment with the above methods is ineffective. After repeated positive culture of toxigenic diphtheria bacillus, a 7-day course of treatment with erythromycin, chloramphenicol or penicillin can be carried out.

Bacteriological cleansing of carriers of toxigenic strains of Loeffler's bacillus is confirmed after 2 negative cultures from the mucous membrane of the nose and pharynx, taken 3 days after the end of treatment. Only then is the child considered non-infectious, not dangerous to others, and can attend the children's group. In case of prolonged release of toxigenic diphtheria bacilli, which continues despite the completion of 2 courses of antibiotic therapy, the issue of further treatment is decided at a consultation with the participation of a pediatrician, epidemiologist and otolaryngologist. Such “persistent” carriers of a toxigenic strain of diphtheria bacillus can sometimes be admitted to those children's groups whose children have a sufficiently high antitoxic immunity.

4.Disinfection . After hospitalization of the patient, a thorough final disinfection should be carried out at the site of diphtheria using a 1% chloramine solution. At home, disinfection of the premises, care items, dishes, linen, and toys is carried out by parents.

INDEPENDENT WORK OF STUDENTS:

1.Work in the office of a local pediatrician: familiarization with medical records. Rules for the preparation of medical documentation during the initial treatment of a sick child with an acute infectious disease.

2. Drawing up an individual vaccination calendar.

Assignment for independent work:

Task 1.

Create an individual vaccination schedule for your child:

_____________________________________________________________________

LIST OF REFERENCES FOR INDEPENDENT PREPARATION:

Basic literature:

1. Outpatient pediatrics: textbook / ed. A.S. Kalmykova. - 2nd edition, revised. and additional – M.: GEOTAR-Media. 2011.- 706 p.

Polyclinic pediatrics: textbook for universities / ed. A.S. Kalmykova. - 2nd ed., - M.: GEOTAR-Media. 2009. - 720 pp. [Electronic resource] – Access from the Internet. ‑ //

2. Guide to outpatient pediatrics / ed. A.A. Baranova. – M.: GEOTAR-Media. 2006.- 592 p.

Guide to outpatient pediatrics / ed. A.A.Baranova. - 2nd ed., rev. and additional - M.: GEOTAR-Media. 2009. - 592 pp. [Electronic resource] – Access from the Internet. ‑ // http://www.studmedlib.ru/disciplines/

Further reading:

Vinogradov A.F., Akopov E.S., Alekseeva Yu.A., Borisova M.A. CHILDREN'S POLYCLINIC. – M.: GOU VUNMC Ministry of Health of the Russian Federation, 2004.

Guide for a local pediatrician / ed. T.G. Avdeeva. – M.: GEOTAR-Media. 2008.- 352 p.

Local pediatrician: reference manual: textbook / edited by Rzyankina M.F., Molochny V.P. - 3rd edition. – Rostov on Don: Phoenix. 2006.- 313 p.

Chernaya N.L. Local pediatrician. Preventative medical care: training manual. – Rostov on Don: Phoenix. 2006.- 284 p.

Baranov A.A., Shcheplyagina L.A. Physiology of growth and development of children and adolescents - Moscow, 2006.

[Electronic resource] Vinogradov A.F. and others: textbook / Tver State. honey. academic; Practical skills for a student studying in the specialty “pediatrics”, [Tver]:; 2005 1 electric wholesale (CD–ROM).

Software and Internet resources:

1.Electronic resource: access mode: // www. Consilium- medicum. com.

catalog of medical resources INTERNET

2. "Medline"

4.Corbis catalogue,

5.Professionally oriented website : http:// www. Medpsy.ru

6.Student advisor: www.studmedlib.ru(name – polpedtgma; password – polped2012; code – X042-4NMVQWYC)

The student’s knowledge of the main provisions of the lesson topic:

Examples of initial level tests:

1. Card of preventive vaccinations:

2. Standard equipment of the vaccination room:

a) per 10 thousand children - 1 doctor, 2 nurses, 2 orderlies;

b) for 20 thousand children - 1 doctor, 5 nurses, 2 orderlies;

c) for 20 thousand children - 2 doctors, 5 nurses, 2 orderlies;

* d) for 20 thousand children - 1 doctor, 2 nurses, 2 orderlies;

3. Children attending kindergarten or school are vaccinated:

a) in the clinic;

* b) in children's institutions;

c) at home;

d) the location does not matter.

4. Plan of preventive vaccinations, deadlines, complications and

reactions to vaccinations are noted:

a) only in form 112/у;

b) only in form 063/у;

* c) in form 063/у and in detail in form 112/у;

d) in form 131/у.

5. Form 063/у for organized children is drawn up:

a) in 1 copy;

b) in 3 copies;

c) not compiled;

* d) in 2 copies.

Questions and typical tasks of the final level:

1. In what case should a child be re-vaccinated with BCG if at 12 months at the site of the previous vaccination there is:

a) scar 2 mm;

b) scar 5 mm;

* c) there is no scar;

d) pustule 7 mm;

e) papule 5 mm.

2. Under what variant of the dynamics of tuberculin tests is it possible to carry out BCG revaccination?

a) negative Mantoux river for 2 years;

b) negative Mantoux river for 5 years;

c) doubtful Mantoux river for 2 years;

* d) negative Mantoux river for 3 years;

e) when there is a change in tuberculin tests.

3. Which variant of the Mantoux reaction may indicate tuberculosis, vaccine allergy or infection? ANSWER: The papule is more than 4 mm in diameter.

4. Which risk groups (I, II, III, IV) for the possibility of developing post-vaccination complications include the following children:

a) children who have or suspect damage to the central nervous system;

b) children with pathological reactions to vaccinations and a history of post-vaccination complications;

c) frequently ill children;

d) children prone to various allergic reactions who have a history of allergic diseases.

ANSWER: I - a

5. Determine the relationship between the data in the first and second columns of the problem

(each point from the first column corresponds to one point from the second):

A. negative p. Mantoux; a.papule from 2-4 mm;

B. doubtful p. Mantoux; b.papule > 4 mm;

V. positive r. Mantoux. v.papule > 17 mm;

g.papule > 5 mm;

d. prick reaction.

ANSWER: A - d

Task 1.

The local pediatrician served a house call to a 3-month-old child. A boy from the first normal pregnancy, term birth.

Body weight at birth 3400 g, length 52 cm. Attached to the chest on the 1st day. The course of the neonatal period is not complicated. She is still breastfed. I wasn't sick. In the maternity hospital, on the 5th day of life, he was vaccinated against tuberculosis. During the first three weeks of life, a pink papule measuring about 4 mm occurred at the vaccination site, which then disappeared without a trace. At the age of 3 months, an infiltrate in the subcutaneous fat, measuring 1.2x1.2 cm, formed at this site, moderately painful when pressed. The skin over it is hyperemic and swollen. Soon a purulent melting area formed in the center. During the next hygienic bath, the abscess was touched with a sponge and opened, a white, cheesy discharge appeared. The boy's general condition did not suffer.

Having examined the wound, the doctor said in a harsh tone that she could not be held responsible for the negligence of her colleagues, who did not know how to properly vaccinate and ruined the child’s hand. Then, she prescribed local treatment, which consisted of applying bandages with Levosin ointment and furacillin. However, the wound remained virtually unchanged and the doctor referred the child to a surgeon.

Exercise:

1. Presumable diagnosis.

2.Tactics of the local doctor in this case.

3. Necessary measures

4. Indicate the mistakes made by the doctor from the point of view of medical ethics and deontology.

Standard answer.

1. Normal reaction to BCG vaccination.

2. No treatment required.

3. Observe hygiene rules. Do not rub the affected area of ​​skin.

4. Violations in the doctor-doctor, doctor-parent system.