Иммунопрофилактика инфекционных болезней

IY «Kpb1MCKV1l71 rocygapcrseHHbllll

111MeHV1 C.V1.leoprviescKoro» M03 YKpa111Hb1

lllMMYHOnPO<l>111JlAKTll1KA 111H<l>EKU1110HHblX 60JlE3HElll

( MeTOA111YeCKll1e peKOMeHga LJ,111111)

. . ...

. ·, -..

CV1M¢epononb - 2012 r.

MeTOA111YecK111e peKoMeHAau.111111 «VIMMyHonpocln'l11aKTMKaHH<l>eKU,HOHHblX 6one3He'1»noArorosneHbl npocpeccopoM KacpeApbl 111HcpeKu,11tOHHblX 6one3Heill racpaposoilt M.T., 3as .KacpeApoil1 npocpeccopoM Kap11tMOBblM 111 .3., acc. Ko3noscKl!1M 0.A., AOU.eHTOM C111Hll1U,blHblM 5.cD.

MeTOA111'-1€CK1!1e peKOMeHAau.111111 noArOTOBneHbl B COOTBeTCTBl/1111 c yYe6Hotlt nporpaMMOilt no 3n111AeM11tOnor111111 Ans:! MeA111U,111HCKll1X cpaKynbTeTOB. np111BeAeHbl AaHHble o cospeMeHHblX MeA11tKo-6111onorw1ecK111x npenaparax, 111x 111cnonb30BaH111111 np111 nposeAeH111111 nnaHOBblX np111s111soK 111 np111s111soK no 3n111AeMll1'-leCKll1M noKa3aHll1S1M, peaKU,111S1X 111 ocnO)KHeHll1HX nocne np111Bll1BOK, opraH1113aU,ll1111 nposeAeH111s:i np111s111soK. B ocHosy MeTOAll1YecK111x peKOMeHAau,111ilt nono)KeH np111Ka3 M3 YKpa111Hbl or 16.09.2011 N~ 595 «npo nops:iAOK nposeAeHH5l npocpinaKTll1YH111X w.enneHb B YKpa'iHi Ta KOHTponb HKOCTi 111 o6iry M€All1'-IHV1X iMyHo6ionoriYHll1X npenapaTIB» a TaK)f(e 111HCTPYKTll1BHO-MeTOAl!1YeCKll1e Marep111anb1 no sonpocaM 111MMyHonpocp111naKT111K111. MeTOA11tYecK111e peKoMeHAaU,111ll1 npeAHa3HaYeHbl AfiH spaYeil1 111HcpeKu,1110H111cro0, spaYeilt AeTCKlltX 111HcpeKu,1110Hll1CTOB, neAll1arpos, ceMeillHblX spa4eil1, spaYeilt-111HTepHoB.

PeKoMeH.QOBaHO K 1113.QaHllllO l..l,MK npoTOKOnN~ 3 OT. 19.01.2012r.

B ClllCTeMe npOTlllB03n111A€MW-teCK111X Meponp1115Hll1tit C03AaH111e Hesocnp111111MLfll1BOCTll1 HaceneHlll~ K 111HcpeKL.l,1110HHblM 6one3H5lM 3aH111Maer OAHO 1113 3HaYll1-

TeJ1bHblX MeCT.

1'1MMyHonpo<1>1-111aKTMKa- 3aw.111ra opraH1113Ma OT 111HcpeKL.l,1110HHOii1 6one3Hll1 nyreM npoBeAeH11151 npocp111naKTW-leCKlllX np111BlllBOK BaKL.1,ll1HaM111 111 aHaTOKCll1HaMVI ( aKTlllBHa5l VIMMYH1113all,1115l), a TaK)l(e BBeAeHlll51 111MMYHHblX CblBOpOTOK 111Jllll VIMMyHorno6yn 111HOB ( naCClllBHa51 111 MMYHll13aLJ,11151).

OrpoMHOe 3HaYeH111e, KaK npocp111naKT111YecKoe Meponp1115n111e, 111Meer aKTVIBHas:t VIMMYHll13aLJ,11151, KOTOpa51 C03AaeT B opraHll13Me LfeJlOBeKa CTOll1KYIO Hesocnp111lllMLfll1BOCTb K 111HcpeKu.1110HHotit 6one3Hll1 Ha Aflll1TeJlbHb1tit nep1110A. YAe.flbHblLll sec 111MMYHOnpocpvinaKH1Klll B Cll1CTeMe npOTlllB03nlllAeMl/1YeCK111X MeponpV151Tlllil1 np111 pa3JlVl'-IHblX 111HcpeKLJ,1110HHblX 6one3H51X HeOA111HaKOB Ill onpeAeJl51eTC5l Ha- Jllll'-llll€M 6e3onaCHblX, 3cpcpeKTll1BHblX Ill AOCTynHblX BaKL.1,111H, a TalOKe yposHeM 3a6onesaeMOCH1, aKTll1BHOCTblO MexaHll13Ma nepeAa'-1111B036YAlllT€Jl51, Hl)l(eCTblO KfllllHlllYeCKOro TeYeHlll5l 111 OCJ10)1(H€Hlll5lM111, cou.111anbHOil1 3HaYlllMOCTblO 6one3-

H Ill.

1'1MMyHonpo<1>1-111aKTMKa - 3TO C03AaHlll€ 111MMYHHOC1 npOCJ10171Klll cpeAlll Ha - ceneHlll5l c 111cnOJ1b30BaHV1€M )l(lllBblX, lllHaKH1B111pOBaHHblX, Xtl1Ml.1YeCKVIX BaKLl,lllH, aHaroKClllHOB 1-1 111MMyHorno6yn111Hos . BaKU.lllHau,11151 111Meer u.enb!O C03AaHllle Hesocnp111111M'-1111BOCTlll K 111HcpeKLJ,lllOHHOMY 3a6onesaHll1IO nyTeM lllMlllTau.111111 ecrecrseHHoro lllHcpeKU.lllOHHoro npou.ecca c 6naronp111HTHbtM 111cxoAOM . Bae-

AeH111e ocna6neHHoro so36yAV1TenH 111n111 ero aHr111reHoB a opraHV13M Bbl3b1Baer lllMMYHHblili OTBeT, 06ecneY111Ba10~111!71 pa3BlllTVle HeBocnp111111MLfVIBOCTlll K ecre-

CTB€HHOiit lllHcpeKU,111111.

1'1MMyHoreHHOCTbeaK~MHbl - 3TO COBOKynHOCTb csoilicTB, KOTOpble onpe - AeJ15llOT cnoco6Hocrb lllMMyHoreHa lllHAyu.111posaTb a - lllMMYHOKOMnereHTHbtX opraHlll3Max 111.fllll KJleTKax ryMopaflbHbti71 Ill ( lllfllll) KJleTOYHbli71 lllMMYHll1TeT.

1.1 3Tanbl "1MMYHHOro OTBeTa.

B lllMMYHHOM OTBeTe yYaCTBYIOT 2 OCHOBHblX Tlllna KJleTOK: MaKpocpar111 Ill JllllMcpOLl,lllTbl (T - 111 B-KJleTKlll) . npou.ecc Bb1pa60TKlll lllMMYHlllTeTa cxeMaTWieCKll1 npeACTaBnHeTCH B BlllAe pHAa nocneAosarenbHblX 3Tanos:

-MaKpocpar111 3axsaTb1Ba10T aHr111reHHb1iit Marep111an, pacw.ennHIOT era BHyrp111KneroLJHo Ill npeACTaBJ151IOT cpparMeHTbl aHTlllreHa Ha Kfl€TOLJHOl71 nosepXHO-

CTlll s lllMMyHoreHHoi71 cpopMe (3n111ronb1). 3ror npou.ecc conposo>KP,aeTc 51 npoAyKu,111eiit 111Hrepnei71K111Ha - cneu.111cpw-1ecK111x MoneKyn, cnoco6crsyto~111x

npvrnneYeH11110 Apyr111x 1t1MMYHOKOMnereHTHblX KJleToK (n111Mcpou,111ros);

-aKrvisau,11151, ,o,111cpcpepeHu,111posKa 111 npon111cpepau,vis::i T-KneroK: noHsneHvie M perynHTOpHbtX, 3cpcpeKropHblX KneroK 111 T- K.fleroK naM5tT111.

-aKT111sau,vts::i B - KneroK 111 vtx co3pesaHvte s aHT1t1Teno np0Ayu.111py10~111e

KJleTKV1; cpopM111pOBaHV1e 8-KJleTOK naM51TV1.

1

nepBV14Hbli:;, \11MMYHHbli:;, OTBeT pa3Bv18aercH npVI nepsoi:;, BCTpeYe VIMMYHHOi:;,

cV1creMb1 c AaHHblM aHr111reHoM. OH xapaKrep1113yercs:i 6onee paHHei:;, npOAYKU,llletll lgM aHT\11TeJl VI n03:>Ke - lgG aHTll!TeJl.

BTOpM"IHblM OTBeT np111 nosropHOM KOHTaKTe c aHTvffeHOM npV1BOA111T K 6011ee 6b1CTpOMY VIHTeHC\11BHOMY CVIHTe3y aHTVITeJl npe111My~eCTBeHHO KJlacca

lgG . Brop1!14Hbti:;, KOHTaKT opraH\113Ma c aHTVlreHOM Bbl3bJBaeT HeMeAJleHHOe pa3BVITl!1e VIMMYHHOro OTBeTa c AOM\11H1!1pyto~etll npOAYKU.V1etll lgG aHTll!TeJl 3a cYer 6bterporo scryn11eHV1H s peaKU,V1to B- 111 T-KneroK naM5HVI.

3TOT ll1MMYHOJlOrw-1ecK111Lll np111Hu,111n Jle:>Kll1T B OCHOBe cospeMeHHOtll

HYIO C\11CTeMy, OAHaKO y Hero orcyrcrayer \11MMYHOJ10rV1YeCKa5l naMHTb (aHTVtreHHbti:;, onb1T).

nnau,eHTapHblLll nepeHOC Marep1!1HCK111X lgG nJlOAY nerKO npOV1CXOA111T B noCJleAHeM TplllMeCTpe 6epeMeHHOCT\11. lgG-aHT\11TeJla MarepV1, HanpasneHHbJe

npOTlllB aHTl!1reHOB 6aKTepV1aJlbHbtX Vt B1!1pyCHblX B036YAl!1TeJletll lllHcpeKU,V10HHblX 3a6onesaH1t1Lll, 111rpa10r 3a~1t1THY10 ponb s reYeH111e nepsoro nonyroAi..rn

:>Kl!13HVI pe6eHKa.

Heo6xoAlllMO 111MeTb s s111,rw, YTO rpyAHb1e MJla)J,eHU,bl nonyya10r Marepl!IH-

CK1t1e aHTVITena lll c rpyAHblM MOJlOKOM (B BV1Ae ceKperopHblX lg - G) . 3Tl!1 aHTl!1- rena npaKTlllYecK111 He nocryna10r s Kposb, HO Moryr co3,LJ,asaTb MeCTHbtl!1 V1MMYHlllTeT KO MHOf\11M B036yAV1T€Jls:IM B :>KeJlyAO'-IHO-K\11WeYHOMTpaKTe.

1.3 LllMMYHOAe<l>11tU.t.1Tbl l;1 BaKU.MHaU.MSI.

npenrtTCTBllleM K Bb1pa60TKe VIMMYHlllTeTa B OTBeT Ha BaKU,V1HaU,V1IO MOfYT

6b1Tb nepsw-1Hb1e \11MMYHOAecp111u,virb1, HanplllMep, r111noraMMarno6ynlllHeM111rt,

rs:i:>Kenbte ocno:>KHeH111rt ( reHepan1113osaHHart 5Ll>K-111HcpeKLJ,Vlrt, saKu,viHoaccou,111lllposaHHblLll non1110M111enlllT, rlllraHToKneroYHaH KopesaH nHeBMOHvrn) . nocneAH111e Ha6JllOAalOTC5l KpatllHe peAKO, TaK KaK nepBW-lHble KJleTOYHble Ill KOM6111 - H!11pOBaHHble lllMMYHOAe¢111u,\11Tbl BCTpeYalOTCH He L!aw_e, YeM 1 cnyyat/i Ha 1-3

MJlH . >t<111rene111.

6e30CHOBaTeJlbHbl yrsep:>KAeH\11H, YTO OTKJlOHeHl!1e \11MMYHOJ10rll14€CKlllX napaMerpos (ypoBHH \11MMYHOrJlo6yJllllHOB, L!\11CJla T-KJleTOK 111 VIX cy6nonyns:1u.111il1) OT HOpMbl y AeTetll 6e3 np1!13HaKOB nepB1!1L!HOro nplllo6peTeHHOro \11Jll!1 neKapCTBeHHoro ll1MMYHOAecp111u,111ra HBJlHIOTCH npenHTCTBll1eM Aflrt nposeAeHVIH BaKLJ,ll1Hau,111111. VlMMYHOJlOrll1YeCKl!1e napaMeTpbl 1113MeHrtlOTCH U,111KJ1111YHO, nOA BJ11!1- s:IHl!1eM 111HcpeKu,1110HHb1x, nc111xo3Mou,1110Hanb Hbtx, n111~esb1x l!1 Aa:>Ke ce30HHblX

2

111 KJ1111MaTlll4eCKll1X cpaKTOpOB, Ill 111X OTKJlOHeHll1Tl OT cpegH111X HOpMaTll1BOB He AOJl>KHbl paccMaTpv1BaTbCSi KaK CBll1A€TeJlbCTBO HenOJlHOLJ,€HHOCTll1 ll1MMYHHOill Cll1CTeMbl.

1.4 AnneprMSI .,, eaKU,MHaU,MSI.

,[ler111 c anneprll1eii1 Moryr orseTll1Tb pa3Bll1Tll1eM a1111eprw-1ecK111x peaKLJ,111ll1 Ha BaKLJ,ll1HaLJ,ll110. 3Tll1 peaKLJ,ll1ll1 Moryr pa3BlllTbCSi He TOJlbKO Ha aHTll11€Hbl, HO 111 Ha gpyr111e KOMnOHeHTbl BaKLJ,l/IH.

AnnepreHHblM geii1crsvieM 06naga10r KOKI110WHb1tli KOMnoHeHT AKACsaKLJ,111Hbl, KOMnOHeHT n111raTeJlbHblX cpeg Ill KJleT04HblX KYilbTyp, aHT11161110Tll1Kll1, KOTOpble 111cnOJlb3YIOTO:I np111 np111roTOBJleH111111 BaKLJ,111H. TSi>KeJlblM KOMnOHeHTOM annepr111111 ~rnnTJeTCSi aHacp111naKT111L.JecK111iil WOK, pa3s111sa10w,111illcs:i no HeMegneHHOMY n11ny rll1nepYyBCTBl/ITeJlbHOCT111, B s111ge OCTpo pa3Bll1BalOW,lllXCTl Cblnetll,

CblBOpOTOL.JHaSi 6o.ne3Hb, reMoppar111YeCKll1ii1 Cll1HAPOM.

2.1 BaKU,MHaU,MSI no eo3paci-y

Ka>Kgoe rocygapcrso ocyw,ecrsns:ier nposegeH111e nnaHoso111 Maccoso111

ll1MMyHonpocp111naKTll1Kll1 B cpOKl/1111 no cxeMe, npegycMOTpeHHOii1 Hau,1110HaJlbHblM

KaneHgapeM np111s111soK. KaneHgapb np111s111soK 3TO 111HcrpyKTll1BHO

3aKpenneHHas:i nocnegosarenbHOCTb ssegeH111H saKL.J,111H . B ra6n111u,e 2.1 nplllBOAlllTCH KaneHgapb np111Bll1BOK YKpa111Hbl B COOTB€TCTBll1lll c np111Ka30M M03

npena par1 s ».

B Ka.neHgapb npocp111naKT111YecK111x np111s111soK BKillOL.JeHo nT!Tb pa3genos :

111MMYHv13aL.J,llHl no B03pacry, 111MMYHll13aL.J,111Si no COCTOTIHll1IO 3AOPOBb5l, 111MMYHll13aL.J,lllH KOTOpaT! npOBOAlllTCSi Ha 3HAeMW-IHblX 111 3H300Tll1'-IHblX repp111rop111s:ix 111 no 3n111geMw-1ecK111M noKa3aHll1HM, 3 KCTpeHHaH npocp111naKT111Ka CTOJ16HT!Ka Ill 6eweHCTBa, a TaK>Ke peKOMeHgyeMble np1118111BKll1 .

3

B 3TOM «KaneHAape» TepMl!lHbl ynoTpe6ns:iioTcs:i B TaKOM 3Ha~eHl!ll!l: eaK4111Ha4111s:1 (npMBMBK"1, MMMyH1113a4111s:1) - C03AaHl!le l!lcKyccTBeHHOro l!lMMyHvneTa y nioAeiil K onpeAeneHHblM l!lHcpeKL.J,l!lOHHblM 3a6onesaHl!lS1M, nyTeM BBeAeHllls:! BaKL.J,lllHbl lllnlll aHaTOKCl!lHa;

peBaKU.MHaU.MH - noBTOpHoe BBeAeHllle BaKL.J,lllHbl lllnll1 aHaTOKClllHa c u.enblO nOAAep>t<aHl!ls:! l!lCKYCCTBeHHOIO l!lMMyHv1TeTa y n10,IJ,e111 K onpe,IJ,e - neHHblM l!lHcpeKLJ.VIOHHblM 3a6onesaH111s:iM;

nepBM4HblH BaKU.MHanbHblH KOMnneKC - Kypc npocp111naKTV1LJeCKVIX nplllBl/IBOK, He06XO,lJ,l!lMblVl ,IJ,ns:i C03,IJ,a Hll1S1 6a3osoro VIMMYHl!lTeTa npOTVIB onpe,IJ,eneHHblX l!lHcpeKL.J,l!lOHHbtX 3a6onesaHV!VI.

npMMe4aHMSI:

1V1MMYHll13aL.J,l/1111 no,o,ne>KaT see HOBOpO>t<,D,eHHble, KOTOpb1e He ll1MelOT npon11sonoKa3aHviVI . BaKL.J,l!lHaLV'1fl npoBOAlllTcs:i Ha 3-5 cyTKl!l >Klll3Hlll pe6eHKa

4

(He paHee 48 YaCOB nocne po>K,IJ,eHlllH) . )J,nH BaKLJ,lllHau,111111 HeAOHOWeHHblX ,JJ,ereii! c Maccoiil re11a > 2000 r Heo6xo,JJ,111Mo 111cnonb30BaTb AJlH lllMMyH1113au,1-11-1 BaKU,1t1HY c yMeHbWeHHblM COAep>KaHl!leM aHTl!lreHa (,JJ,anee - 5U>K-M) .

HeAonycT1.1Mo npoBeAeH1.1e lilMMyH1.1Jau,1.11.1 npoT111s Ty6epKyne3a s OAl.1H AeHb c Apyr1.1M111 napeHTepallbHblMl.1 MaH1.1nynS1LJ.lilS1Ml.1.

)J,eTl!l, KOTOpble He 6blnl!1 1!1MMYHl!131!1pOBaHbl B POAl!1JlbHOM AOMe 1113-3a Me,JJ,lllLl,l!lHCKlllX npOTll1BOnOKa3aH1!1lll, nO,JJ,Jle>KaT o65BaTeJlbHOlll saKLJ,l!lHau,111111 BaKU,l!lHOill 5U>K-M B ,JJ,eTCKl!lX no11111KnlllHl!1Kax nocne CHHTl!\51 npor111sonoKa3aH1t1ii1 . nocne 111cno11HeH111S1 pe6eHKY 2-x MeGlYHoro so3pacra nepeA 1!1MMYHl!13au,111ei/1 saKU,l!lHOVJ Allrl npocj:wmaKTl!lKl!l ry6epKyne3a (,o,anee - 5U>K) Heo6xo,D,111Mo nocrasl!1Tb npo6y MaHTY 111 nposecr111 1!1MMYHl!13aU,l!llO B cnyyae orp111u,arenbHOV! npo6b1 MaHTy.

C u.enblO paHHeiil ,[J,111arHocr111K111 ry6epKyne3a npo6a MaHTY c 2-Mri ry6epKyJ11!1HOBblMl!1 e,[J,l!lHl!lU,aMl!l (TE) ry6epKyn111Ha npOBO,O,l!lTCH ,[J,JlH scex ,o,ereiil c 12-MeCHLJHoro 803paaa Cl!1CTeMaTl!1YeCKll1 pa3 B ro,o, He3a81!1Cl!1MO OT npe,O,blAYl.l.liero pe3yJlbTaTa. B CBH31!1 c TeM, YTO npocp111naKTl!1LJeCKl!le np1!1Bl!18Klt1 Moryr noBJ11!1SlTb Ha Yyscrs111renbHOCTb K ry6epKyn111Hy, npo6y MaHTY Heo6XOAl!1MO nnaH1!1posarb ,o,o npose,JJ,eH111H npocp111naKTl!1YecK111x np1-1s111soK. B cnyyae, ecn111 no KaKl!lM-1111160 np111LJ111HaM ry6epKyn111HOA111arHocr111Ky nposo,o,SlT nocne npocp11111aKTl!1YecK111x np111s111soK, npo6a MaHTY AOJl>KHa 6b1Tb npose,o,eHa He paHbWe, YeM Yepe3 1 Mecs:iu, nocne saKU,lllHau,111111 .

PesaKU,l!lHau,111111 B 7 neT no,o,ne>KaT )J,eT111 c orp111u,are11bHOi:1 peaKu,111ei:1 Ha npo6y MaHry saKU,1!1Hoi:1 5U>K.

2 BaKu,111Hau,111111 c u,enblO npocj:)V111aKT111K111 renarvira B no)J,ne>KaT see HOBOpO>K,IJ,eHHble, saKU,l!lHau,vrn npOBOAl!lTCrl MOHOBaneHTHOVJ saKU,1!1HOi:1. )J,nri saKU,l!lHau,111111 npor111s renar111ra B)J,eretll 111cnonb3YeTcSl cxeMa - 0,1,6 Meo:iu,es co )J,HSl pO>K,D,eHl!lSl pe6eHKa. HosopO>K,JJ,eHHbte, KOTOpble p0,0,1!1J1111Cb OT Marepeiil - Hoc111re11ei:1 s111pyca renar111ra 8 (HbsAg), 1!1MMYHll131!1pyiorc>i no cxeMe - 0-1-2-7 (0- nepsb1e cyTKl!1 >Kl!13Hll1, ,o,ara nepsoro sse,[),eHl!151 saKU,l!lHbl, Ml!1Hl!1ManbHblVJ 1!1HTepsan Me>KAY nepsoV! 111 sropoill saKu,111Hau,111eill 1 Mecm.1,, sropoV! 111 rperbeV! BaKU,1!1HaLJ,1!1r!Ml!1 - 1 MeCSlU,, rpeTbelll lt1 YeTBeproi:1 BaKU,l!lHaU,l!ls:JMl!l - 5 MeCHLJ,eB).

3 V1MMYHll13au.vrn c U,eJlblO npo¢11111aKTl!1Kl!1 Al!1tj:nep111111, CTOJ16HS1Ka 111 KOKJllOWa no so3paay B 3, 4, 5 111 18 MecSlu,es nposo,o,111rcH AKJJ.C (accou,1-1111posaHHaSl

)J,nri saKL.1,1!1HaL.1,1!11!1 ,o,ereili npOTlllB KOKJllOWa Ha nepBOM rOAY >Kl!13Hl!1 Moryr 111cnonb30BaTbCH saKU,VlHbl KaK c au,ennionSlpHblM (,o,anee - AaKDC), raK 111 c u.enbHOKneTOLfHblM (,o,anee - AK)J,C) KOKJllOWHblM KOMnOHeHTOM. nepeHeceHHbltll KOKnlOW B aHaMHe3e He 5iBJlfleTC5i npOTl!1BOnOKa3aH1!1eM K BaK~lllHau,111111 K ,o,aHHotll 6one3H1!1. BaKu,111Hau,111ri nporvis KOKJllOWa npoBOAlllTcs=i AeTriM AO 6 ner 11 MeCSlU,eB 29 AHeVt.

PesaKu,111HaU,l!110 npor111s ,o,111cf:nep111111 1t1 cron6HSlKa s 6 ner nposo,o,5n aHaTOKCll1HOM Al!1¢rep111V!Ho-cron6HS1'-lHblM( ,o,anee - A)J,C) , cneAyio~yio B 14 ner 111 s 18 ner

5

- aHaTOKClllHOM A1t1cf:nep111illHO - CTOJ16HHYHblM c yMeHbWeHHblM COAep>KaHl!1eM aHr111reHa (,[],anee - A,LJ,C-M).

nepsy10 nnaHosy10 pesaKu,111Hau,11110 B3pocnbtM no so3pacry 111 no3n111AnoKa3aH111riM,

KOTOpble 6blJ1111 np111Bll1Tbl paHee, Heo6XO,[J,111MO 111MMYHll131!1pOBaTb A,LJ,C-M - aHaTOKCll1HOM LJepe3 5 neT nocne nocne,[J,Heill np111s111sK111. 3aTeM nnaH08ble

nepBblX .o.syx np111811180K, a np111 Ha11111Y111111 npoT111sonoKa3aH111111 K 8Be,[J,eH11110

opallbHOill nOJlll10Mll1eJlll1THOill BaKLl,VIHbl ( onB) - ,[J,J151 Jll06oil!. BaKLJ,111Ha onB np111MeHrieTcr1 grrn 3-6-oill np111s111soK ( np111s111sK111 no 803pacry - 5 Mecriu,es, 18

Mecs:1u,es, 6 neT 111 14 ner) np111 orcyrcrs111111 npor111sonoKa3aH111ill .

BaKLJ,111Ha V1nB MO>KeT 6b1Tb np111MeHeHa ,[J,Jl51 3-6-oil1111MMYHll13aLJ,111111 KaK OT,JJ.eJlbHO,

Jlll1LJ,aM111, KOTOpbJM npOTll180nOKa3aHO BBeAeH!lle OnB, BaKLJ,111HaLJ,11151 np080)J.111TCSi 1!1CKJ1IO'-lll1TeJlbHOV1nB.

nocne np111Bll1BOK OnB peKOMeH,o.yeTCS1 orpaHll1LJll1Tb lllHbeKLJ,111111, napeHTepailbHble BMewarenbCTBa, nnaH08bte onepau,111111 Ha npors:i>1<eH111e 40 AHeill .

5 8aKu,111Hau,11110 ,D,IIH npocp111naKr111K111 111HcpeKu,111111, Bbl3BaHHoill nanoYKoill Haemoph- ilus influenzae r111n b (,LJ,anee - HibsaKu,111Ha) cne,LJ,yer nposo,[),1t1Tb no cxeMe 3-4-

18 Mecm.J,es. BaKu,111Hau,111s:i npor111s Hib - 111HcpeKu,111111 nposoA111rcr1 AeT51M AO 4 ner 11

MeCHLJ,eB 29 ,[),Helli MOHOBaKu,111HaM111 111 KOM6111H111posaHHblMll1 BaKLJ,111HaM111, KOTOpb1e CO,JJ.ep>KaT HibKOMnOHeHT. PeKOMeH,[J,yercri np111MeHeH111e KOM6111H111posaHHblX saKLJ,111H c HibKOMnoHeHTOM ,[J,JlS1 neps111YHOlll 8aKL1,ll1Hau,111111.

6 BaKLJ,111HaLl,11151 npOTlllB K0p111, 3n111,JJ.eM111YeCKOro napOT!llTa 111 KpacHyx111 npoBOA111TCrl KOM6111H111pOBaHHOill 8aKLl,111HOill 8 803pacre 12 Mecs:iu,es. BropylO ,[J,03Y BaKLJ,ll1H npOTll1B KOp111, napOTlllTa 111 KpacHyx111 peKOMeH,LJ,yeTC51 880,JJ.lllTb ,JJ.eT51M B 6 neT.

D,eTr!M, He np111Bll1Tb1M npOTll18 KOp111, napOT!llTa 11111111 KpacHyx111, saKL1,ll1HaL1,1t110 MO>KHO HaY111HaTb B Jll060M B03pacre AO 18 JleT. B 3TOM cnyyae pe6eHOK )J.OJl>KeH

no11yY111Tb 2 A03bl c co6n10,[J,eHl11eM Me>t<Ay ,[J,03aM111 M111H111MaJ1bHoro 111Hrepsana. nepeHeCeHHble 3a6onesaHll151 KOpblO, 3m~,[J,eMll1LJeCKll1M napOTll1TOM 111Jlll1 KpacHyxot/1

He r1snr110rcr1 npor111sonoKa3aH111eM ,JJ.JlS1 111MMyH1113au,111111.

2.2 1'1MMYHM3aU.MSIAeTe~ c HapyweHMeM KaneHAapst np111e111eoK

nplll peWeHl!ll!I sonpoca 0 V1MMYH1113aLJ.VIV1 geTeVt C HapyweHVleM 3TOrO KaneH.aapH Heo6xog111Mo nnaH111posaTb saKu,111Hau.11110 c co6n10.aeH111eM TaKV1X MV1HV1ManbHblX V1HTepsanos:

1.He cne)J.yer HaY111HaTb cHaYana cep11110 saKU.V1Hau111V!, ecnl/1 6b1na nponyw.eHa A03a, He3aBV1CVIMO OT Toro, CKOnbKO BpeMeHlll npowno. Heo6XOAV1MO BBeCTlll A03bl, KOTOpblX He xsaraeT no rpacp111Ky, c co6nioAeHV1eM MV1Hl!1ManbHblX V1HTepsanos.

6

2. M"1HMMa11bHb1V. "1HTepea11 - V1Hrepsan, KOTOpbl~ ,o.onycKaercri np111 ssegeHV1111 BaKLJ.l!lHbl npOTl/18 OAHOlii V1 TOlii >Ke 111HcpeKU111V1, Jll!lLJ.aM c HapyweH111e 3Toro KaneH,o.apH .

AnS1 AeTeait OT 3 Mecsn.1,es AO 6 neT 11 Mecsn.1,ee 29 AHeait

JlnS1 neTeait B B03DaCTe OT 7 neT .D.O 17 neT 11 MeCSIUeB 29 JlHeait

npoBeAeHHe

OnpeAeneHHe on-yau,HH

HMMVHH3aUHH

7

*BaKu,111Hau,111H onB 3aMeHs:iercH vins Ha npoTH>KeH111111 scero KaneHAaps:i npll1Bll1BOK. onB He Ha3HaYaeTCH YJleHaM ceMbll1 BV1Y-1t1Hcp1t1u,111poBaHHblX,

2.4 ll1MMytilf13a41"1SI no COCTOSIHlf1IO 3AOPOBbSI.

111MMYHll13aLJ,111H no COCTOHHll1IO 3,0,0pOBbH HBJlHeTCH o65l3aTeJlbHOVl Ill npOBO,D,111TCH nOA Ha61110,o,eH111eM spaYa y nau,1t1eHTOB c BblCOKll1M p111CKOM 111 TH>KeJlblM TeYeH111eM 111HcpeKLJ,lll111, 111MMYHll13aLJ,lllH npOTlllB KOTopoilt He npe,o,ycMOTpeHa B n11aHe ll1MMyH1113au,111111 no so3pacry .

3. lllMMYH1t13aU.lt1S1 no COCTOS1H1'1K> 3AOPOBbS1

3.1 CxeMa lf1MM}'Hlf13a4"1lf1no COCTOSIHHIO 3AOpoBbSI.

XpoHw-1ecK111e 3a6onesaH111H nerKlllX ( BpO>KAeHHbfe aHOMan111111, MYKOBOCl...\111,D,03)

8