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4.3.3. Bacterination of not full-term newborns
The key rule which should use at work with not full-term children, is that not full-term newborns should be vaccinated in the same chronological age and accordingly under the same schedule and with the same precautions, as full-term children.
Mass of the child at a birth less than 2000 g usually according to domestic official dokumetami are factors, sufficient for putting off of routine bacterination even clinically stable not full-term newborn. In all other cases for clinically stable not full-term children full recommended doses of each vaccine should be used. Separation or a dose decline is not recommended.
For the prevention of theoretical risk of transmission of viruses of a poliomyelitis in hospitals in which there are not full-term newborns, introduction OPV to such children should be delayed till the moment of their extract.
Those not full-term children who are born by HBs-Ag-positive mothers, should receive immunoprofilaktiku vaccines against a hepatitis In and Hib-b infections, beginning as soon as possible after a birth (it is desirable at the first 12 o'clock).
For not full-term children of HBs-Ag-negative mothers, optimum time of bacterination against a hepatitis In should not be limited, they can use any of schemes. However it is better to postpone to such children bacterination against a hepatitis In till that time, when the mass of the child will reach 2000 g (it for the countries where terms of immunization of not full-term children are not limited to mass and the sizes of the child), or later 2 months - together with AKDS, OPV, Hib-b.
4.3.4. Bacterination of pregnant women Bacterination of the pregnant woman provides occurrence in mother of specific antibodies which can be transported through a placenta to a foetus and the newborn that will frame at the child a high antiserum capacity, i.e. protective immunity. Such passive immunization of children is especially actual for developing countries where routine immunization of children widely does not practise. At the same time the future of such vaccines in many respects depends on their structure as demands are made to them not only achievements of protective immunity without development of immunologic tolerance (Zinder N., et.al., 1994), but also low risk of bacterination in pregnancy for a foetus as theoretically this risk can take place. The advantage of bacterination of pregnant women usually outweighs potential risk in following cases: - When the risk of an infectious disease approaches inevitably; - The infection carries an extra risk for mother and a foetus;
- If it is a little probable that the vaccine becomes the reason of damage for a foetus.
Pregnant women who were not earlier immunizirovany against a tetanus, should receive primary immunization (prajming). One or two doses of ADS TH can be entered before sorts. It is necessary to spend early vaccinating of those pregnant women which have not received ADS within last 10 years. They should enter busternuju dose AdS-anatoksina. There are no convincing proofs of risk of bacterination of pregnant women and others inaktivirovannymi virus either bacteriemic vaccines, or anatoxins. In particular, the vaccine against a hepatitis In is recommended for women with risk of development of a hepatitis In, influenzal and pneumococcal vaccines are recommended for women with risk of an infection or complications of a flu and pneumococcal diseases. OPV can be entered to the pregnant woman who has real risk of infection with a natural virus. In this situation IPV it is more preferable, than OPV. Pregnant women who should travel to a zone of risk of a yellow fever, should receive a vaccine against this disease. In this case the small theoretical risk of bacterination is considerably blocked by risk of the infection. At the same time pregnancy is contraindication for bacterination against a rubella, a measles, a parotitis. Though it has not been described cases of a congenital rubella in reply to krasnushnuju a vaccine from mothers who have received krasnushnuju bacterination during pregnancy, the case of a congenital parotitis infection at the newborn girl which mother on the eve of sorts had a bilateral parotitis at the same time is described. In this case at the child after a birth took place a fever, a splenomegaly, a thrombocytopenia, lesions of sialadens and a pancreas were not. Both have recovered after carrying out of symptomatic therapy [110]. It is necessary to stop also on cases when it is necessary to immunise children in a family where there is a pregnant woman. These children can receive vaccines against a measles, a parotitis, rubellas as it is not observed transmissions of these viruses and children remain are safe for the pregnant mother. Though live poliomyelitis viruses are deposited at persons recently immunizirovannyh, especially after the first dose, these vaccines nevertheless can be entered to children of the pregnant woman as experience shows that there is no risk of a virus poliovaktsiny for a foetus. All pregnant women should be estimated on presence of immunity to a rubella and are tested for presence HBsAg. The women sensitive to a rubella, i.e. not having a protective antiserum capacity, should be immediately vaccinated after the delivery. As to introduction of preparations of immunoglobulins to pregnant women the risk for a foetus from passive immunization of the pregnant woman at introduction of the specified preparations till now is not known.
4.3.5. Feeding by a breast and bacterination Children receiving thoracal feeding, should be vaccinated according to the schedule as thoracal milk does not render by-effects on immunization and is not contraindication for bacterination. Both killed, and live vaccines do not carry risk for mothers who nurse, or for their children. If necessary to vaccinate feeding woman it is necessary to remember that the rubella virus can be transmittirovan in thoracal milk, but this virus usually does not infect the newborn. For all other killed and live vaccines possibility of an egestion of vaccine strains in thoracal milk has not been shown. Feeding women can receive OPV or a vaccine against a yellow fever without disturbance of the schedule of feeding.
4.3.4. Bacterination of pregnant women Bacterination of the pregnant woman provides occurrence in mother of specific antibodies which can be transported through a placenta to a foetus and the newborn that will frame at the child a high antiserum capacity, i.e. protective immunity. Such passive immunization of children is especially actual for developing countries where routine immunization of children widely does not practise. At the same time the future of such vaccines in many respects depends on their structure as demands are made to them not only achievements of protective immunity without development of immunologic tolerance (Zinder N., et.al., 1994), but also low risk of bacterination in pregnancy for a foetus as theoretically this risk can take place. The advantage of bacterination of pregnant women usually outweighs potential risk in following cases: - When the risk of an infectious disease approaches inevitably; - The infection carries an extra risk for mother and a foetus;
- If it is a little probable that the vaccine becomes the reason of damage for a foetus.
Pregnant women who were not earlier immunizirovany against a tetanus, should receive primary immunization (prajming). One or two doses of ADS TH can be entered before sorts. It is necessary to spend early vaccinating of those pregnant women which have not received ADS within last 10 years. They should enter busternuju dose AdS-anatoksina. There are no convincing proofs of risk of bacterination of pregnant women and others inaktivirovannymi virus either bacteriemic vaccines, or anatoxins. In particular, the vaccine against a hepatitis In is recommended for women with risk of development of a hepatitis In, influenzal and pneumococcal vaccines are recommended for women with risk of an infection or complications of a flu and pneumococcal diseases. OPV can be entered to the pregnant woman who has real risk of infection with a natural virus. In this situation IPV it is more preferable, than OPV. Pregnant women who should travel to a zone of risk of a yellow fever, should receive a vaccine against this disease. In this case the small theoretical risk of bacterination is considerably blocked by risk of the infection. At the same time pregnancy is contraindication for bacterination against a rubella, a measles, a parotitis. Though it has not been described cases of a congenital rubella in reply to krasnushnuju a vaccine from mothers who have received krasnushnuju bacterination during pregnancy, the case of a congenital parotitis infection at the newborn girl which mother on the eve of sorts had a bilateral parotitis at the same time is described. In this case at the child after a birth took place a fever, a splenomegaly, a thrombocytopenia, lesions of sialadens and a pancreas were not. Both have recovered after carrying out of symptomatic therapy [110]. It is necessary to stop also on cases when it is necessary to immunise children in a family where there is a pregnant woman. These children can receive vaccines against a measles, a parotitis, rubellas as it is not observed transmissions of these viruses and children remain are safe for the pregnant mother. Though live poliomyelitis viruses are deposited at persons recently immunizirovannyh, especially after the first dose, these vaccines nevertheless can be entered to children of the pregnant woman as experience shows that there is no risk of a virus poliovaktsiny for a foetus. All pregnant women should be estimated on presence of immunity to a rubella and are tested for presence HBsAg. The women sensitive to a rubella, i.e. not having a protective antiserum capacity, should be immediately vaccinated after the delivery. As to introduction of preparations of immunoglobulins to pregnant women the risk for a foetus from passive immunization of the pregnant woman at introduction of the specified preparations till now is not known.
4.3.5. Feeding by a breast and bacterination Children receiving thoracal feeding, should be vaccinated according to the schedule as thoracal milk does not render by-effects on immunization and is not contraindication for bacterination. Both killed, and live vaccines do not carry risk for mothers who nurse, or for their children. If necessary to vaccinate feeding woman it is necessary to remember that the rubella virus can be transmittirovan in thoracal milk, but this virus usually does not infect the newborn. For all other killed and live vaccines possibility of an egestion of vaccine strains in thoracal milk has not been shown. Feeding women can receive OPV or a vaccine against a yellow fever without disturbance of the schedule of feeding.