Prevention of measles

Description:

Passive prevention of measles.

Immunoglobulin of the person normal is used for passive prevention of measles, no later than 72 hours from the contact moment. It represents immunological the active protein fraction allocated from serum or plasma of donors. Is issued in ampoules on 1,5 ml (1 dose) or 3 ml (2 doses), in packaging of 10 ampoules. Store drug in the dry dark place at a temperature of +4... +8 °C, a period of validity make 2 years.

Active prevention of measles.

The high level of coverage reached in Russia the first inoculation exceeding 95% in the majority of regions, and introduction of a compulsory second vaccination in 6 years create real premises for achievement of elimination of measles in the terms specified by WHO. Incidence shift for the teenage and adult periods is a consequence of incomplete vaccination of children in recent years in previous years when the coverage on the first year did not reach 85%, and the second inoculation was carried out only after testing of children for existence of antibodies.
Vaccination against measles is effective at least at 95% of children, immunizirovanny at the age of 15 months or is more senior. However at the children vaccinated between 12 and 14 months, the persistention of maternal protivokorevy antibodies can weaken the response to immunization.
Part of vaccinated lose immunity to measles therefore there is an age shift of incidence: about a half of all registered cases falls to the share of adults. The real number of cases of measles by 5–6 times exceeds official indicators.


Vaccination terms.
Vaccination against measles is carried out to the children who did not have measles at the age of 12-15 months. The second inoculation is entered at the age of 6 years (before school). Use of the second dose of a vaccine allows to protect children who were not vaccinated (collective immunity), and also those who did not develop immunity after the first dose. Introduction of the second dose can bustirovat to a certain extent the immunity received as a result of the first inoculation.
Vaccination against measles in the countries with high incidence also even 6 months for the purpose of protection of babies at whom the disease proceeds especially hard are spent aged 9. At many children immunity at the same time can not be developed (in connection with interaction with maternal antibodies); in these cases to all children enter revaccination, usually on the second year of life.


Compatibility.
In a calendar of Russia the vaccine against measles is entered along with vaccines against parotitis, a rubella and hepatitis B. Introduction of vaccines has to be made by different syringes in different body parts. Naturally, 4 simultaneous injections create difficulties; less traumatic 2 introductions on 2 vaccines with an interval of 1 month.
In need of statement of a Mantoux test it has to be carried out either along with vaccination or in 6 weeks after it as clumsy vaccinal process can cause temporary decrease in sensitivity of skin to tuberculine that will serve as the reason of false-negative result.
Efficiency of an inoculation
At the correct vaccination immunity is developed at 95% vaccinated at the age of 12 months and at 98% vaccinated at the age of 15 months for 21-28 day after an inoculation. Immunity keeps more than 25 years, only at very small number vaccinated it can die away.
Introduction method
The vaccine is entered subcutaneously or intramusculary under a shovel or into the area of a shoulder (on border of the lower and average terta of a shoulder from the outer side). Because vaccinal viruses are easily inactivated by ether, alcohol and detergent, it is necessary not to allow contact of drug with these substances.


Inoculative reactions.
The clumsy vaccine is not enough reaktogenn. At most of children vaccination is not followed some was reactions. However in certain cases (probability of 5-15%) the following reactions can be observed (during the period from 5 to 15 day after an inoculation):
• fervescence (as a rule not higher than 39 C)
• catarral phenomena (cough, conjunctivitis, cold)
• not plentiful light pink korepodobny rash (at 5% of children)
• the children inclined to allergic reactions, can have a rash during the first hours after introduction of a vaccine.
Vaccinal reactions usually take place within 2-3 days.
Regardless of expressiveness of reaction the child is not infectious for people around.


Postvaccinal complications.

• Allergic reactions. Children with an allergy can have a rash, urticaria, a Quincke's edema, etc. Extremely seldom reactions of anafilatichesky shock can be observed (on Neomycinum and protein of egg)
• Spasms. At development of temperature reaction to an inoculation in predisposed children febrile spasms, usually lasting 1-2 min. can develop. Usually these spasms pass without effects. For prevention of this complication, to children with tendency to spasms the doctor usually appoints paracetamol from the 5th day after an inoculation.
• Defeats of TsNS. Cases of a subacute sclerosing panencephalitis (PSPE) at the children who did not have measles, but received a clumsy vaccine were described. Some of them a cause of illness, perhaps, had not recognizable measles within the first year of life or vaccination against measles. Considering settlement prevalence of vaccination against measles, the possible risk of development of PSPE at its carrying out makes about 1 case on one million doses of a vaccine. It is much less, than at a disease of measles - 6 - 22 cases of PSPE on one million cases of measles. Results of the retrospective research conducted by the center for incidence control allow to assume that vaccination against measles in general warns PSPE, reducing incidence of measles at which the risk of this complication is high.
• Thrombocytopenia. Meets extremely seldom (1 on 40 000) after use of a trivaccine, it is connected usually with influence of a krasnushny component. However separate cases of thrombocytopenia with an absolute recovery and after use of a clumsy monovalent vaccine are described.
• Syndrome of toxic shock. The described cases (including with a lethal outcome), were result of pollution of an open ampoule of a vaccine golden staphylococcus.
Probability of complications
  Measles (on 100000 persons) the Inoculation (on 100000 persons)
Encephalomyelitis 50-400 0,1
PSPE 0,5-2,0 0,05-0,1
Pneumonia 3800-1000 -
Death 10-10000 0,02

Contraindications:

• Strong reactions or complication to the previous dose of a vaccine.
• If the child received blood preparations (including immunoglobulins, a blood plasma), then vaccination is carried out not earlier than in 3 months after introduction of blood preparations.
• Anaphylactic or anaphylactoid reactions to aminoglycosides (including, Neomycinum - contains in each dose of a liquid vaccine about 25 mkg of this drug).
• Existence of anaphylactic or anaphylactoid reactions to eggs in the anamnesis. Reaction to protein of egg is a contraindication for use of import vaccines (as they prepare with use of chicken embrin), however in this case it is possible to do vaccination of the Russian. To the contrary, in case of reaction to quail eggs, an inoculation it is better to make an import vaccine.
• Any acute disease or exacerbation of a chronic disease. However in special cases (the contact with the clumsy patient and so forth) an inoculation can be done to children with not severe forms respiratory, etc. diseases (ORZ, diarrhea, etc.) even in the presence of subfebrile temperature.
• Active not treated tuberculosis. However preliminary statement of a Mantoux test before an inoculation is not required.
• The patients receiving immunosuppressive therapy. After medicinal or radiation immunosuppression the vaccine is entered not earlier than in 3 months, after use of corticosteroids in high doses - not earlier than in 1 month after the termination of a course of treatment. This contraindication does not concern to the patients receiving the replacing therapy by corticosteroids, for example, concerning Addison's disease.
• Patients with the blood diseases, leukoses, lymphoma of any types or other malignant tumors affecting marrow or lymphatic system.
• Primary and acquired immunodeficiency, including patients with AIDS or other clinical manifestations of infection with a human immunodeficiency virus; disturbance of cellular immunity; hypogammaglobulinemia or dysgammaglobulinemia. Vaccination is not contraindicated to the infected HIV (without the expressed immunosuppression).
• Existence of congenital or hereditary immunodeficiency disorders at the patient's relatives, his sufficient immunocompetence will not be proved yet.
• Pregnancy in connection with theoretical risk for a fruit.
Emergency prevention
Predpochititelno introduction of a vaccine against measles in the first 3 days from the moment of contact with the patient which is carried out to the not being ill to a bark and not vaccinated children is more senior than 12 months, to teenagers and adults. At children at the age of 3-12 months the emergency prevention in the form of vaccination is also possible.
The alternative of vaccination yavdlyatsya introduction of the 1 or 2 doses (depending on the state of health and time which passed from the contact moment) immunoglobulin of the person normal. It is used for children aged up to one year, patients with an immunodeficiency and pregnant women. This form of prevention is most effective at introduction till 4th day from the contact moment.