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

EFFICACY AND SAFETY OF ENZYME REPLACEMENT THERAPY IN CHILDREN WITH MUCOPOLYSACCHARIDOSIS TYPE I, II, AND VI: A SINGLE-CENTER COHORT STUDY

Background. There are limited data on the efficacy of long-term enzyme replacement therapy (ERT) in children with mucopolysaccharidosis (MPS).Objective. Our aim was to study the efficacy and safety of long-term ERT in children with MPS type I, II, and VI.Methods. We analyzed the results of ERT with laronidase, idursulfase, and galsulfase in children with MPS type I, II, and VI admitted to the federal research center from January 2007 to November 2016. The response rate was assessed by the level of normalized urinary excretion of glycosaminoglycans (GAGs) (the ratio of GAGs concentration to urine creatinine) recalculated in percent (%) exceedance of the upper limit of normal for the corresponding age. Data on the administered therapy and its results, including adverse events, is extracted from the medical records of in-patients.Results. The results of treatment (intravenous infusions, intervals between administrations from 4 to 10 days) were studied in 33 children (5 of them were girls) with MPS type I (n = 4; laronidase at a dose of 0.58 mg/kg), II (n = 26; idursulfase at a dose of 0.5 mg/kg), and VI (n = 3; galsulfase at a dose of 1 mg/kg). A decrease in the normalized urinary excretion of GAGs from 376% (172; 791) to 54% (0; 146) exceedance of the upper limit of normal for the age (p < 0.001) was noted in the course of ERT lasting (median) 27 (14; 41) months. A decrease in the normalized GAGs excretion below the upper limit of normal for the age was established in 12/33 (36%) patients. ERT-associated adverse events were identified in 12 patients; one case required a two-fold therapy interruption. The development of nephrotic syndrome in the course of ERT in patients with severe MPS II was first described.Conclusion. Long-term ERT in children with MPS type I, II, and VI is characterized by acceptable efficacy and safety. Key words: children, mucopolysaccharidosis, enzyme replacement therapy, laronidase, idursulfase, galsulfase, glycosaminoglycans

Pneumococcal Vaccine in Patients with Systemic Juvenile Idiopathic Arthritis Receiving Biologic Therapy: International Practice Review

International practice of immunization against pneumococcus in patients with systemic juvenile idiopathic arthritis (SJIA) receiving biological therapy is generalized in this review. High efficiency and safety of pneumococcal vaccines in children with SJIA is presented. Numerous researches show the adequate immune response after vaccination as well as alongside with genetically engineered biologic drugs therapy. Prevention of pneumococcal disease in patients with SJIA reduces the risk of development of pneumococcal diseases severe complications

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

Распространенность цитомегаловирусной инфекции среди подростков в Российской Федерации: результаты одномоментного популяционного анализа серопревалентности

Background. Cytomegalovirus infection (CMVI) is the reason of high mortality in perinatal period, disability in children from risk groups with further development of congenital malformations and chronic diseases. Clear understanding of epidemiology and determination of focus population groups is crucial for development of measures and algorithms of congenital CMVI prevention.Objective. The aim of the study is to study CMVI seroprevalence among immunocompetent adolescents in Russian Federation with reference to the gender, regional, social and economic, and age factors.Methods. We have used for our study data from the survey of senior schoolchildren from 7 municipalities representing various regions of Russian Federation: group 1 (10–12 years old) and group 2 (14–16 years old). The study of CMVI seroprevalence and immune response was performed via the analysis of the level of IgG antibodies to cytomegalovirus (CMV) in blood serum. The social and economic well-being of the region was determined by "RIA Rating" experts.Results. Serological prevalence of CMVI in the study group of adolescents (n = 1403) was 70.6% (n = 990). There were no statistically significant gender differences in the distribution of seropositive children in regions (p = 0.525). Infection in boys (72.6%; n = 455; median age — 12.9 (11.0; 14.9)) did not prevail over the infection in girls (68.8%; n = 535; median age — 13.1 (11.0; 14,9)); p = 0,117. The overall prevalence of CMVI increased statistically significant with age — from 68% (n = 486) in group 1 to 73% (n = 504) in group 2 (p = 0.036). The prevalence of CMVI varied statistically significant by region (p = 0.003). There was no correlation between the regional seropositive level and the social and economic situation in the region (r = 0.034, p = 0.192). Immune response intensity did not differ by age, gender, and region with the antibody median of 88.9 CU/ml.Conclusion. More than half of adolescents (by the age of 10) in Russian Federation are infected, and infection increases with approaching to childbearing age, however, age is not the only aspect associated with serological status. Factors affecting immune response intensity require further study. Understanding of the CMV prevalence among children is crucial for determining future prevention approaches in target groups.Обоснование. Цитомегаловирусная инфекция (ЦМВИ) — причина высокой летальности перинатального периода, инвалидизации детей групп риска с формированием врожденных пороков развития и хронических заболеваний. Для разработки мероприятий и алгоритмов профилактики врожденной ЦМВИ необходимы четкое понимание эпидемиологии и выделение целевых групп популяций.Цель исследования — изучить серопревалентность ЦМВИ среди иммунокомпетентных подростков в Российской Федерации с учетом влияния гендерных, региональных, социально-экономических и возрастных факторов.Методы. Для исследования использовались данные обследования старших школьников 7 муниципальных образований, представляющих различные субъекты Российской Федерации: группа 1 (10–12 лет) и группа 2 (14–16 лет). Изучение серопревалентности и напряженности иммунного ответа к ЦМВИ проводилось путем анализа уровня антител класса IgG к цитомегаловирусу (ЦМВ) в сыворотке крови. Социально-экономическое благополучие региона определялось экспертами «РИА Рейтинг».Результаты. В исследуемой группе подростков (n = 1403) серологическая распространенность ЦМВИ составила 70,6% (n = 990). Статистически значимых гендерных различий в распределении серопозитивных детей по регионам не отмечалось (p = 0,525). Инфицированность мальчиков (72,6%; n = 455; медиана возраста — 12,9 (11,0; 14,9)) не преобладала над инфицированностью девочек (68,8%; n = 535; медиана возраста — 13,1 (11,0; 14,9)); p = 0,117. Общая распространенность ЦМВИ статистически значимо увеличивалась с возрастом — с 68% (n = 486) в группе 1 до 73% (n = 504) в группе 2 (р = 0,036). Распространенность ЦМВИ статистически значимо различалась по регионам (p = 0,003). Взаимосвязи между региональным уровнем серопозитивности и рейтингом социально-экономического положения региона нет (r = 0,034, p = 0,192). Напряженность иммунного ответа не различалась по возрасту, полу и регионам с медианой антител 88,9 УЕ/мл.Заключение. К 10 годам инфицированы более половины подростков Российской Федерации, инфицированность нарастает с приближением к детородному возрасту, хотя возраст — не единственный аспект, связанный с серологическим статусом. Факторы, влияющие на напряженность иммунного ответа, требуют дальнейшего изучения. Понимание распространенности ЦМВ среди детей имеет решающее значение для определения будущей политики профилактики в целевых группах

13-valent Pneumococcal Conjugate Vaccine and Haemophilus Influenzae-Tetanus Toxoid Conjugate Vaccine in Patient with Systemic Juvenile Idiopathic Arthritis Receiving Tocilizumab: Clinical Case

Background. Vaccination coverage in patients with rheumatic diseases remains extremely low. Moreover, infections are the leading cause of death in such patients. Respiratory infections mortality is 2–5 times higher in adults with rheumatoid arthritis than in overall population. The most frequent infectious complications in patients receiving Tocilizumab (first-line drug for treatment of patients with systemic juvenile idiopathic arthritis (SJIA)) are pneumonia and acute sinusitis. Their clinical course differs: slight clinical presentation, reference ranges of laboratory tests of disease activity (ESR, C-reactive protein), significant changes in lungs and paranasal sinuses according to the computer tomography. Infectious complications development can cause aggravation of prior disease itself or due to temporary immunosuppressive therapy cessation. Clinical Case Description. The experience of immunization with 13-valent pneumococcal conjugate vaccine (PCV13) and haemophilus influenzae-tetanus toxoid conjugate vaccine in the 1,5 years old boy with SJIA receiving interleukin-6 receptor monoclonal antibody Tocilizumab is presented. The result of such vaccination was increase of pneumococcal and haemophilus influenzae antibodies levels by more than two times. Meanwhile vaccination had no negative impact on the prior disease course: the levels of predictors of prior disease aggravation such as protein S100 and highly sensitive C-reactive protein did not increase significantly in comparison with the period before vaccination. Conclusion. The efficiency and safety of immunization with PCV13 and haemophilus influenzae-tetanus toxoid conjugate vaccine in the child with SJIA receiving Tocilizumab is presented