Преодоление антипрививочного скепсиса: поиски решения выхода из сложившейся ситуации

Background. The problem of distrust of immunization is widespread not only in Russia but also all over the world. Many parents refuse to vaccinate their child reasoning that the vaccines can harm their health, the immune system may not cope with the body burden; and some doctors themselves discourage parents from vaccination. Our aim was to assess the attitude of doctors and parents towards vaccination whose children are vaccinated completely or partially; to study the most frequent reasons for refusals of vaccination by parents. Methods. We used the questionnaires for parents (n = 114) who brought their children for vaccination for the first time or repeatedly; and the questionnaires for students of 4–6 courses and interns of medical universities (n = 336) who expressed their sentiments towards vaccination and demonstrated the knowledge of the national and regional immunization schedules. AstonGroup also conducted studies among physicians of different specialties (n = 307) on the most frequent reasons for refusals of vaccination. Results. In most cases, the parents’ attitude towards vaccination was positive. One in three patient representatives considered that he was fully acquainted with immunization issues, and more than half wanted to be vaccinated only within the national immunization schedule. In almost 100% of cases, parents had trust in information about vaccination received from a doctor. The results of the AstonGroup survey showed that the most frequent medical exemptions were given by neurologists, immunologists, and surgeons. And the parents themselves, who brought their children to see doctors, reasoned their refusals of vaccination with fear of complications and also considered vaccination to be harmful and useless. The doctors participating in the survey offered methods for influencing the parents, namely: providing them with accessible information about vaccinations included in the national immunization schedule as well as about the experience of using vaccines, including other countries. Discussion. The survey revealed insufficient knowledge of the national immunization schedule among students as well as cautious attitude towards vaccination issues and the trust in vaccination myths among legally authorized representatives of patients. Conclusion. The effective measures to combat ‘anti-vaccination scepticism’ are lectures for parents; personal, social and health education at pediatric sites as well as continuing medical education.Обоснование. Проблема недоверия к иммунизации широко распространена не только в России, но и во всем мире. Многие родители отказываются прививать своего ребенка, аргументируя это тем, что вакцины могут нанести вред здоровью, иммунная система может не справиться с нагрузкой на организм, к тому же некоторые врачи сами отговаривают родителей от вакцинации.Цель исследования — оценить отношение к вакцинации врачей и родителей, дети которых привиты полностью либо частично; изучить наиболее частые причины отказов от прививок со стороны родителей.Методы. Использованы вопросники для родителей (n=114), приведших на вакцинацию своих детей впервые или повторно; анкеты для студентов 4–6-х курсов и интернов медицинских вузов (n=336), которые выражали свое отношение к вакцинации и демонстрировали знания национального и регионального календарей профилактических прививок. Компания Aston Group также проводила исследования среди врачей разных специальностей (n=307) о наиболее частых причинах отказов от вакцинации.Результаты. В большинстве случаев отношение родителей к вакцинации было позитивным, каждый третий представитель пациента считал, что полностью информирован в вопросах иммунизации и больше половины хотели прививаться только в рамках национального календаря профилактических прививок. Практически в 100% случаев родители доверяли информации о прививках, полученной от врача. Результаты опроса компании Aston Group показали, что самые частые медотводы давали неврологи, иммунологи и хирурги. А сами родители, приходящие с детьми на прием к врачам, мотивировали свои отказы от прививок боязнью осложнений, а также считали вакцинацию вредной и бесполезной. Врачами, участвующими в опросе, были предложены методы по воздействию на родителей пациентов, а именно: обеспечение их доступной информацией о прививках, входящих в национальный календарь профилактических прививок, а также об опыте применения вакцин, в том числе в других странах.Обсуждение. Проведенный опрос выявил недостаточное знание Национального календаря профилактических прививок среди студентов, а также многочисленные заблуждения в отношении профилактических прививок со стороны других педиатрических специалистов (особенно детских неврологов и детских аллергологов-иммунологов), осторожное отношение в вопросах вакцинации и доверие к «мифам» о прививках среди законных представителей пациентов. Заключение. Эффективными мероприятиями на пути борьбы с антипрививочным скепсисом являются лекции для родителей, санитарно-просветительская работа на педиатрических участках, а также повышение квалификации врачей.КОНФЛИКТ ИНТЕРЕСОВ Л.С. Намазова-Баранова — получение исследовательских грантов от фармацевтических компаний Пьер Фабр, Genzyme Europe B. V., ООО «Астра зенека Фармасьютикалз», Gilead/PRA «Фармасьютикал Рисерч Ассошиэйтс СиАйЭс», «Bionorica», Teva Branded Pharmaceutical products R&D, Inc/ООО «ППД Девелопмент (Смоленск)», «Сталлержен С. А.»/«Квинтайлс ГезмбХ» (Австрия). Остальные авторы данной статьи подтверждают отсутствие конфликта интересов, о котором необходимо сообщит

Результаты трехлетней вакцинации детей против пневмококковой инфекции в России

Background. After inclusion of pneumococcal vaccination in the National Vaccination Schedule, it is very important to evaluate the efficacy of routine immunisation of the child population for more than 3 years. The obtained results provide opportunity to analyse the problems in achieving the goal, determine their causes, and suggest the ways of overcoming. Our aim was to study the results of a three-year period of pneumococcal vaccination of children. Methods. The quality of immunoprophylaxis of pneumococcal infection in the territory of the Russian Federation were assessed by analysing the coverage of vaccination and timeliness of its conduct after the inclusion of pneumococcal vaccine in the National Vaccination Schedule. The actual epidemiological efficacy of pneumococcal vaccination was assessed based on morbidity and mortality due to community-acquired pneumonia, incidence of acute otitis media among children. By questioning parents (n = 352) who applied to the Federal State Autonomous Institution of the Russian Federation Ministry of Health ‘National Medical Research Centre for Children’s Health, the timeliness of pneumococcal vaccination for infants was established. Results. In most regions, a high level of pneumococcal vaccination coverage was reached (87% of children). Despite the fact that the majority of children (73%) were vaccinated untimely. In particular, the results of a questionnaire survey conducted in the Moscow vaccination centre indicate insufficient awareness of parents for the need to vaccinate infants against pneumococcal infection by primary care professionals and, as a consequence, a low level of timely initiated vaccine introduction (40.1%). The introduction of routine prophylactic pneumococcal vaccination in Russia resulted in a 35% reduction in the death rate of children from community-acquired pneumonia, led to a decrease in the incidence of acute otitis media. Conclusion. The introduction of routine prophylactic vaccination of children against Streptococcus pneumoniae helps to reduce morbidity and mortality from pneumococcal infections. The surveillance system for community-acquired pneumonia requires further improvement. It is advisable to conduct an additional analysis on the reasons for refusals and medical exemptions to vaccination. It is important to increase the professional level of paediatricians in prophylactic vaccination.Обоснование. После включения в Национальный календарь профилактических прививок вакцинации против пневмококковой инфекции очень важно оценить эффективность проводимой более 3 лет рутинной иммунизации детского населения. Полученные результаты позволят проанализировать проблемы в достижении цели, установить их причины и предложить пути преодоления. Цель исследования — изучить результаты трехлетнего периода вакцинации детей против пневмококковой инфекции. Методы. Проведена оценка качества иммунопрофилактики пневмококковой инфекции на территории Российской Федерации путем анализа охвата прививками, своевременности их проведения после включения пневмококковой вакцины в Национальный календарь профилактических прививок. Выполнена оценка фактической эпидемиологической эффективности вакцинации против пневмококковой инфекции на основании заболеваемости и смертности внебольничными пневмониями, заболеваемости острым средним отитом среди детского населения. Путем анкетирования родителей (n=352), обратившихся в ФГАУ «НМИЦ здоровья детей» Минздрава России, установлена своевременность вакцинации младенцев против пневмококковой инфекции. Результаты. В большинстве регионов достигнут высокий уровень охвата детей прививкой против пневмококковой инфекции (87%). При этом большинство детей (73%) были вакцинированы несвоевременно. В частности, результаты анкетирования, проведенного в центре вакцинации г. Москвы, указывают на недостаточную информированность родителей о необходимости вакцинации младенцев против пневмококковой инфекции специалистами первичного звена и, как следствие, низкий уровень своевременного начала введения вакцины (40,1%). Внедрение плановой вакцинопрофилактики против пневмококковой инфекции в России позволило на 35% снизить смертность детей от внебольничных пневмоний, привело к уменьшению заболеваемости острыми средними отитами. Заключение. Внедрение плановой вакцинопрофилактики детей против Streptococcus pneumoniae способствует снижению заболеваемости и смертности от пневмококковых инфекций. Система эпиднадзора за внебольничными пневмониями требует дальнейшего совершенствования. Целесообразно проведение дополнительного анализа причин отказов и медицинских отводов от вакцинации; важное значение имеет повышение профессионального уровня врачей-педиатров по вопросам вакцинопрофилактики.КОНФЛИКТ ИНТЕРЕСОВЛ.С. Намазова-Баранова — получение исследовательских грантов от фармацевтических компаний Пьер Фабр, Genzyme Europe B. V., ООО «Астра зенека Фармасьютикалз», Gilead / PRA «Фармасьютикал Рисерч Ассошиэйтс СиАйЭс», Teva Branded Pharma ceuti cal products R&D, Inc / ООО «ППД Девелопмент (Смоленск)», «Сталлержен С. А.» / «Квинтайлс ГезмбХ» (Австрия).М.В. Федосеенко — получение гонораров от компаний Pfizer, Sanofi Pasteur, MSD за чтение лекций.Остальные авторы статьи подтвердили отсутствие конфликта интересов, о котором необходимо сообщить

Current Issues of Diagnosis and Treatment of Functional Gastrointestinal Disorders in Children

The analysis of the prevalence, clinical manifestations, diagnosis, and treatment of functional gastrointestinal disorders (FGID) in  infants was carried out. According to the analysis results the  development of FGID in infancy is caused by disorders of motor function and somatic sensitivity of the digestive organs,  changes in the secretory and suction functions of this system, largely due to anatomophysiological features of an early age. The  peculiarities of posseting, colic, and constipation are considered as  the most frequent FGID manifestations in infants. The current  approaches to the treatment of the specified manifestations are  analyzed, including a number of activities, in particular, psychological preparation of parents, support of breastfeeding, rational nutrition of the mother during breastfeeding, if necessary, the selection of  formulas for mixed or artificial feeding, the use of medicines and probiotics. We noted that the high incidence and adverse effects  of FGID in children determine the urgency to research on the mechanisms of their development in order to improve preventive and curative interventions

Safety of Combination of a Tetravalent Meningococcal Conjugate Vaccine Against Serogroups A, C, Y, W-135 With Other Vaccine Preparations: a Prospective Study of a Series of Cases Among Healthy Children and Children With Various Health Abnormalities

Meningococcal infection is an acute disease caused by Neisseria meningitidis, which proceeds with a diverse clinical aspect from nasopharyngitis to meningococcal meningitis and meningococcemia. Since 2014, a tetravalent meningococcal conjugate vaccine has been registered in Russia. This vaccine creates protection against serogroups A, C, W-135, Y and can be used from the age of nine months to 55 years. The actual issue is a vaccine tolerability, including when combined with other vaccine preparations.Objective: Our aim was to evaluate the safety of a tetravalent meningococcal conjugate vaccine against serogroups A, C, Y and W-135 when it is combined with other vaccine preparations.Methods. A prospective full-design study assessed the tolerability of immunization with a meningococcal conjugate vaccine, both in case of monovaccination and in combination with a pneumococcal 13-valent conjugate vaccine, measles-mumps-rubella, viral hepatitis A, influenza, and chicken pox vaccines.Results. 97 children aged from 9 months to 18 years were vaccinated, 20 of them were healthy and 77 had medical issues (with allergic pathology, ENT diseases, cardiovascular and nervous system diseases, lung diseases as well as orphan diseases). Among vaccinated children, general reactions were observed in 3/97 (3.1%) children, local reactions — in 5 (5.2%). The post-vaccination period passed asymptomatically and uneventfully in the prevailing majority of children vaccinated with a tetravalent meningococcal conjugate vaccine (in 91, 93.8%).Conclusion. The immunization with a tetravalent meningococcal conjugate vaccine against serogroups A, C, Y, W-135 is well tolerated, both in case of monovaccination and in combination with other vaccine preparations, in healthy children of different age groups and in patients with different health status

Overcoming ‘Anti-Vaccination Scepticism’: Seeking a Solution to the Situation

Background. The problem of distrust of immunization is widespread not only in Russia but also all over the world. Many parents refuse to vaccinate their child reasoning that the vaccines can harm their health, the immune system may not cope with the body burden; and some doctors themselves discourage parents from vaccination. Our aim was to assess the attitude of doctors and parents towards vaccination whose children are vaccinated completely or partially; to study the most frequent reasons for refusals of vaccination by parents. Methods. We used the questionnaires for parents (n = 114) who brought their children for vaccination for the first time or repeatedly; and the questionnaires for students of 4–6 courses and interns of medical universities (n = 336) who expressed their sentiments towards vaccination and demonstrated the knowledge of the national and regional immunization schedules. AstonGroup also conducted studies among physicians of different specialties (n = 307) on the most frequent reasons for refusals of vaccination. Results. In most cases, the parents’ attitude towards vaccination was positive. One in three patient representatives considered that he was fully acquainted with immunization issues, and more than half wanted to be vaccinated only within the national immunization schedule. In almost 100% of cases, parents had trust in information about vaccination received from a doctor. The results of the AstonGroup survey showed that the most frequent medical exemptions were given by neurologists, immunologists, and surgeons. And the parents themselves, who brought their children to see doctors, reasoned their refusals of vaccination with fear of complications and also considered vaccination to be harmful and useless. The doctors participating in the survey offered methods for influencing the parents, namely: providing them with accessible information about vaccinations included in the national immunization schedule as well as about the experience of using vaccines, including other countries. Discussion. The survey revealed insufficient knowledge of the national immunization schedule among students as well as cautious attitude towards vaccination issues and the trust in vaccination myths among legally authorized representatives of patients. Conclusion. The effective measures to combat ‘anti-vaccination scepticism’ are lectures for parents; personal, social and health education at pediatric sites as well as continuing medical education

Immunization With a Pneumococcal Polysaccharide Vaccine in Children With Juvenile Idiopathic Arthritis Without Systemic Manifestations: a Prospective Study

Background. Patients with juvenile idiopathic arthritis (JIA) have an increased risk of being infected. Approximately half of all serious infections in children with JIA are associated with airway involvement.Objective. Our aim was to study the efficacy and safety of the pneumococcal 13-valent conjugate vaccine (PCV) in children with JIA.Methods. In a prospective cohort study, 5 groups were formed:  children with JIA in the remission phase on methotrexate therapy  (group 1) or etanercept (group 2), with JIA in the active phase prior  to the appointment of methotrexate (group 3) or etanercept (group  4), control group (conditionally healthy children). 0.5 ml of the 13-valent PCV was administered once subcutaneously during therapy in patients in the remission phase or 3 weeks before the appointment  of methotrexate or etanercept in patients in the active phase. The  main study outcome was the proportion of patients with a protective  ( 40 mg/L) level of specific anti-pneumococcal antibodies (anti-SPP) IgG to Streptococcus pneumoniae 4 weeks after vaccination. In  addition, we assessed the incidence of infectious events before and  after vaccination as well as changes in the content of a high-sensitivity C-reactive protein, S100 protein, and post-vaccination period.Results. The study included 125 children. Four weeks after  vaccination, the protective level of anti-SPP IgG was established in  21 (84%) patients in the 1st, 23 (92%) in the 2nd, 22 (88%) in the  3rd, 24 (96%) in the 4th and 5th groups (p =1.0). Increase in the  concentration of S100 protein and high-sensitivity C-reactive protein  after vaccination was not noted. JIA exacerbation episodes were not  recorded in any patient. After immunization, the total number of infectious events decreased in all observed groups (p 0.001). Serious adverse events were not registered during the study.Conclusion. Vaccination with the 13-valent PCV in children with JIA  is highly effective and is not accompanied by the development of serious adverse events

The Results of a Three-Year Pneumococcal Vaccination of Children in Russia

Background. After inclusion of pneumococcal vaccination in the National Vaccination Schedule, it is very important to evaluate the efficacy of routine immunisation of the child population for more than 3 years. The obtained results provide opportunity to analyse the problems in achieving the goal, determine their causes, and suggest the ways of overcoming. Our aim was to study the results of a three-year period of pneumococcal vaccination of children. Methods. The quality of immunoprophylaxis of pneumococcal infection in the territory of the Russian Federation were assessed by analysing the coverage of vaccination and timeliness of its conduct after the inclusion of pneumococcal vaccine in the National Vaccination Schedule. The actual epidemiological efficacy of pneumococcal vaccination was assessed based on morbidity and mortality due to community-acquired pneumonia, incidence of acute otitis media among children. By questioning parents (n = 352) who applied to the Federal State Autonomous Institution of the Russian Federation Ministry of Health ‘National Medical Research Centre for Children’s Health, the timeliness of pneumococcal vaccination for infants was established. Results. In most regions, a high level of pneumococcal vaccination coverage was reached (87% of children). Despite the fact that the majority of children (73%) were vaccinated untimely. In particular, the results of a questionnaire survey conducted in the Moscow vaccination centre indicate insufficient awareness of parents for the need to vaccinate infants against pneumococcal infection by primary care professionals and, as a consequence, a low level of timely initiated vaccine introduction (40.1%). The introduction of routine prophylactic pneumococcal vaccination in Russia resulted in a 35% reduction in the death rate of children from community-acquired pneumonia, led to a decrease in the incidence of acute otitis media. Conclusion. The introduction of routine prophylactic vaccination of children against Streptococcus pneumoniae helps to reduce morbidity and mortality from pneumococcal infections. The surveillance system for community-acquired pneumonia requires further improvement. It is advisable to conduct an additional analysis on the reasons for refusals and medical exemptions to vaccination. It is important to increase the professional level of paediatricians in prophylactic vaccination