Subject childhood vaccines now being actively discussed, but on adult vaccination say little. About that, on what should be vaccinated adults, “Matrona” talked with Julia Viktorovnoj Andronnikova – head of pediatric department of the Center of the traditional obstetrics (Moscow), a pediatrician of the highest category.
Yulia V., now a lot of debate about children’s vaccinations. And from what you need to be vaccinated adults, and why is it important?
several areas of adult vaccination can be identified.
The first – a vaccination against the infections that people are ill as a child, because they were vaccinated. These include, first of all, measles. Now in our country the rise in measles, and when this happens, then all adults up to 55 years should be vaccinated. And a few years ago it was the age limit is 35 years, but now, due to the spread of infection, it was increased to 55 years, as in the older age against measles is more complications. As for people older than 55 years, most of them have antibodies to measles, because they are ill as a child, and they do not need to be vaccinated, but among 25-35-year-olds are not, despite the fact that they have been vaccinated in childhood.
I think that a similar situation will happen to chickenpox when most children are vaccinated, and not been ill as a child, as is happening now. The same can be said about rubella in women who have been vaccinated in childhood and are planning to give birth over the age of 33 years: vaccination immunity lasts an average of about 20 years (someone 15 someone 18 someone 20 years), and the last time vaccinated against rubella do in 13 years. Therefore, it makes sense to check the presence of antibodies during pregnancy planning and, accordingly, to be vaccinated.
The second direction of vaccination – booster vaccination against the infection, from which you have already been vaccinated, but vaccination immunity in this case the principle is maintained for long. This, for example, diphtheria and tetanus, against which definitely need to be vaccinated to all people every 10 years. These vaccinations can be done at any age without restrictions.
That is, for adults, these diseases are no less dangerous than for children?
Exactly. These diseases are sick, not only children but also adults, the elderly particularly hard. Until 1989, there was an order of Ministry of Health, which limited vaccination against diphtheria 55 years. But when, in the late 80’s was a rise in incidence of diphtheria, it became clear that more complications and deaths were in the elderly. Then the age restriction has been removed, and now by the rules need to be vaccinated every 10 years.
This may also include hepatitis B: the vaccinated person from it slowly there is a decrease in antibody levels, and so every 10-15 years should be vaccinated again.
About vaccination against hepatitis B is usually written, that it is relevant to 30 years, and then there is no …
This recommendation is based on the fact that the main routes of transmission of hepatitis B – sex and drugs. It is believed that if a person, let’s say, 30 years was not included in the risk group, then it is unlikely. However, in the Soviet time were ill with hepatitis B mainly elderly people after surgery. The main mode of transmission was then a dirty, non-sterile surgical instruments. Now this is not.
However, the effect of the vaccine against hepatitis B itself is not yet fully understood, research is in full swing. After all, it is not so long ago appeared – only about 20 years ago, and there is no understanding of how long the immunity. All the time there are some new recommendations. At the moment, it is considered that the three-dose vaccine gives a fairly strong immunity.
Therefore, it is desirable to hepatitis B be vaccinated every 10 years, especially those who are at work in contact with blood (surgeons, dentists, obstetricians and others.). Everyone else should periodically check the level of antibodies, if they fall, and the risk of infection exists, you need to be vaccinated.
Finally, the third area of adult vaccination – a vaccination of pregnant women at 30-36 weeks from whooping cough, diphtheria and tetanus. This is an interesting practice, which exists today in the United States, Australia, England, that is sufficiently developed countries. I do not have their own strong opinions on this subject. The logic is clear: this year, for example, quite widespread whooping cough. Two-three-month children vaccinated against whooping cough have not yet shown, and even if it is carried out, it can not give a good effect, and can give and any complications. Vaccinating future mother, we protect the child by means of maternal antibodies in the most dangerous period (we know that whooping cough for children two months of age can sometimes be fatal).
Started this practice in the eighties, when the WHO has been working for the prevention of neonatal tetanus in countries with a low level of development of medicine. For example, African newborns infected with tetanus when they are traditionally sprinkled with ashes from the fire navel (ash in these countries, not from trees and manure). Then we started to vaccinate local pregnant women and got a good result: their children in the neonatal period were immune to tetanus.
Based on my experience, I have found it correct, as in the case of rubella, vaccinate women planning pregnancy only about six months to a year before conception. Then it would be and the level of antibodies was good, and the child would have received protection – yet the body of a pregnant woman is very fragile and vulnerable, and how he would react to the vaccine – the big question. Nevertheless, vaccination of pregnant women in the later stages is actively practiced in developed countries.
In our country, this practice is not, perhaps, in this direction will soon be working. I would like just to not very intrusive.
What immunizations must be put in old age?
Apart from the sound system, the most important for the elderly is a vaccination against pneumococcus. Despite the fact that pneumococcal infections are ill and children especially hard, he moved to an older age. There is an ordinary phrase that most people in the world die from pneumococcal it. Why is this happening?
A person who has suffered a stroke, heart attack, hip fracture, or previous chemotherapy tumors, very often does not die from these diseases, and pneumococcal infections. What is meant? If the person did not die of a heart attack in the first two hours, he was dying of pneumococcal complications that develop when he lies, when he is immobilized, and he disrupted the heart, there is congestive pneumococcal pneumonia or sepsis. The same can be said about the injury resulting from a car accident: if a person does not die immediately, in place of the injury begins the inflammatory process caused by, usually pneumococcal agent. Unfortunately, Streptococcus pneumoniae – is one of the main reasons that people are dying.
Even in developed countries?
In any country, even in countries with a low level of development of medicine it happens more often. Why in the developed countries are trying as quickly as possible to rouse, to rehabilitate a person with an injury, having a heart attack? To avoid complications. And we often people lie for weeks, and their condition is getting worse, until death. And that is why in France, Germany, States, elderly people aged 60-65 years is recommended vaccination against pneumococcus.
Pneumococcus lives including the nasopharynx, and the weaker the human immune system, the more of it. I therefore strongly recommended to vaccinate the elderly, who often communicate with their grandchildren. Children often go with a cold, and this is the most pneumococcus, but his children are transferred easily and quickly recover and grandparents talking to their grandchildren, receive any complication. In my practice, I often vaccinated against pneumococcus and grandparents watch their patients and that vaccinated seniors really significantly less likely to suffer. It is known that elderly people do not take the United States to chemotherapy without re-vaccination against chickenpox, and pneumococcal vaccination.
Do I need to put the elderly vaccinated against meningococcus?
Just to put this so we do not recommend the vaccination, and during the rise of morbidity – yes. In this situation, we consider two things: first – that an adult can be a source of infection, the second – in the elderly decreased immunity. Outside the rise of morbidity, we still only vaccinate young children.
Is it true that vaccinations should be done not only to those who are at risk, but also those who are afraid to infect the baby?
Oh sure. This is especially true of meningococcus.
Do I need to put an adult vaccine BCG and polio?
BCG vaccine to adults in general has nothing to do, because in theory (only in theory!) It protects infants from a rare form of tuberculosis, but I would say that the damage from it more than good.
A polio – a childhood infection to adults, it is not described.
As far as adults need a vaccination against tick-borne encephalitis?
If you live in an epidemiologically significant area or are going to go there, irrespective of age, you should be vaccinated. Tick-borne Encephalitis more, and then the age does not depend on anything from tick-borne encephalitis can be lost as a five-year, and forty people. Children between one and a half years of age and older need to select a vaccine and vaccinated course. Some vaccines are designed for 3-4 years, the other for 5-7 years. Of course, it is desirable to select a quality vaccine.
This summer, often wrote that the mites are found in city parks …
Mites in Moscow is full, and pick up can be not only in parks but also just walking with a dog in the house. Another thing is that no cases of encephalitis were recorded in Moscow, we remain non-endemic area (and Moscow). We have the tick-borne Lyme disease, which is also unpleasant, but from it, unfortunately there is no vaccination.
Every autumn recommend be vaccinated against influenza, to the winter, in the midst of an epidemic to have at least some protection. Is it appropriate?
My relation to influenza vaccination is the following: if there is any violation in the state of health, for example, bronchial asthma, and the person is weakened, it is grafted, because the flu, despite its familiarity, – severe disease, with high mortality.
Now vaccinated against influenza is recommended even for pregnant …
This is a delicate and difficult time. In pregnant women, and so reduced immunity, and vaccinating them personally, I would not. It is best to be vaccinated before pregnancy and during – grafted to her husband and closest associates who can bring home the virus. Pregnant women, as well as newborn babies, I would recommend to keep the shots.
If an adult has decided to put itself the necessary vaccinations, he should be treated to what expert?
The national adult vaccination calendar includes diphtheria, tetanus, measles – to be grafted, it is necessary to apply to the usual clinic to the local doctor. The same thing – about flu shots in a season. This you have to do for free (although in the clinic may not be the vaccine of choice).
When it comes to vaccinations, which are not included in the national calendar, for example, against pneumococcus and meningococcus, the need to go to a specialist, vaccinology, in any state or non-state hospital. A more thorough and detailed schedule based on the state of your health you can make in the Research Institute of Vaccines and Sera. II Mechnikov and immunological centers under him.
Unfortunately, we do not have a system for monitoring the vaccination of adults, so it is now a question of your self-control and respect to their health.
In the case of children’s vaccination always carefully monitor the child’s health status prior to vaccination, it is recommended to be tested. Adults also need to be tested prior to vaccination?
With adults all easier: adult vaccination is safer than vaccination of infants, they need smaller doses, they quickly produced an immune response.
If a person is generally healthy, vaccinated Td he can get and without any special tests. If he has any chronic disease, of course, it is desirable to check whether there is an exacerbation.
Are there any contraindications to vaccination of adults, such as allergies?
If a person has an exacerbation of a chronic disease, it is better to postpone the vaccination because the disease even more aggravated, and vaccination can go badly. But in general, there are no contraindications, if the temperature is not imparted.
And acute reactions to vaccinations, too, does not happen in adults?
In general, no. In adults, most are local reactions, seal and redness at the injection site, especially after vaccination Td. But there is nothing wrong with that, it takes 1-2 days. Sometimes there are reactions to the flu shot, but the rest of the vaccine reactions usually do not give. Streptococcus pneumoniae is always well tolerated.
And if a person does not remember what vaccinations he put in his childhood as a schedule of vaccination?
Vaccinations usually last put in school age. Few people still can instill in high school – as a rule, this is due to the unfavorable epidemiological situation. For example, the last time you put vaccination at age 13, then 10 years have passed, at 23, you are already well aware that you are not on anything planted, the 25-30 and older can be safely vaccinated at least against diphtheria and tetanus.
For other diseases (measles, rubella, hepatitis B), you can see the level of antibodies, and if it is low, then re-vaccinated. If the antibody is high – perhaps you’ve had. Unfortunately, some of the disease is not always diagnosed correctly, can be a kind of allergic reactions (especially measles and rubella).
Why on the vaccination of children we now have a lot of information, and this issue is constantly discussed and relatively vaccination of adults can not hear anything, no awareness campaigns does not pass? What is the reason such silence?
For the vaccination of children has always been a good control, and if the child attends the clinic, a kindergarten, a school, the question arises vaccination periodically. They always ask, or even require, the child can not tolerate in any institution. This is a very large section of the medical preventive work, and in relation to the child he still preserved.
A vaccination of adult attention is paid only if the adult draws medical book. Healthy adults in our country, no one does. Earlier adults yearly medical examinations took place at the place of work or residence, and fixed the doctor what vaccinations were made to a specific person. Now most people and no medical records, and they do not come in clinics. In other words, they completely lost, for their health, and one never follows. Therefore, a person has to worry about themselves and their health and engage in prevention of possible diseases.
Interviewed by Anastasia Hramuticheva