Health & Care
Protection from birth: vaccination against hepatitis B
Hepatitis B is an infectious disease of the liver caused by the corresponding virus. It is characterized by acute, protracted or chronic course with symptoms of intoxication, manifested in the form of asthenovegetative syndrome (weakness, fatigue, sweating, etc.) and dyspeptic syndrome (popping vomiting, eructation, etc.). The disease is accompanied by an increase in the liver, often jaundice.
Anna Markeeva Doctor pediatrician, immunologist-allergist, children's city polyclinic № 124, Moscow
Symptoms of the disease
The disease often occurs in severely moderately severe forms, up to the development of massive necrosis (destruction of liver cells) with subsequent fatal outcome in children of the first year of life. But cases of jaundiceous and subclinical forms are not rare (with these forms there are no clear manifestations of hepatitis) with a high probability of forming primary chronic hepatitis or carriage, especially with perinatal infection (from the 28th week of pregnancy to the end of the first week of life of the newborn). The transition of hepatitis into a chronic form threatens the development of liver cirrhosis with hepatic insufficiency and liver cancer.
Infection occurs with transfusion of blood products, manipulations accompanied by damage to the skin and mucous membranes, with the use of razors, toothbrushes, with manicure, with sexual contact. For a newborn, the way of transmission through damaged skin is especially relevant. In this regard, special attention should be paid to the sterility of obstetric and other medical instruments used for injections, treatment of the umbilical cord, punctures, surgical interventions, etc.
For the prevention of hepatitis B, recombinant vaccines containing the purified surface antigen of the hepatitis B virus (HBsAg) obtained by recombinant DNA technology are used. This technology is based on the possibility of transferring foreign genetic material, i.e. DNA, into a living organism (in this case, into yeast), so that this organism starts producing the corresponding foreign protein (polypeptide). In turn, HBsAg is the polypeptide that is an active component of the vaccine. Thus, the yeast carrying the HBsAg gene is multiplied on an industrial scale, then the desired substance is isolated from the yeast biomass and purified.
It is known that the risk from the correct use of vaccines is negligible compared to the risk of infectious diseases. Therefore, in Russia there are rules of vaccination, which are obliged to perform in all maternity hospitals or departments. Vaccination measures are fixed in normative acts of the Ministry of Health of the Russian Federation (Order of the Ministry of Health of the Russian Federation
In Russia, vaccines have been registered and approved for use and have been certified by the National Control Authority for Medical Immunobiological Preparations. Currently, the following vaccines have been given this certificate: HB-VaxII (USA), Angieriks B (Belgium), Engerix B (Great Britain), Shangwak-B (India), Euwaks (France), Combirotech (Russia). The ability of a vaccine to produce the required amount of antibodies to protect against infection (immunogenicity) is approximately the same for all recombinant hepatitis B vaccines registered in Russia.
When storing and transporting vaccines, the main condition for maintaining their immunogenicity should be a temperature in the range 4-8 ° C.
It is important to note that vaccines of different manufacturers are interchangeable, i. starting vaccination activities with a single vaccine, you can continue with another vaccine.
When and how is vaccination carried out?
The first vaccination against hepatitis B is carried out in the maternity hospital in the first 12 hours after birth at a dose of 10 μg (except for the American vaccine HB-VaxII, which is administered at a dose of 2.5 μg). And the amount of active substance in these vaccines is the same. The injection is done intramuscularly (in the buttock or thigh). In the future, the vaccine is given again after a month and six months after the first vaccination. Children born to mothers who are carriers of HBsAg or who have undergone the disease in the third trimester of pregnancy, in addition to vaccination is recommended immediately after birth (in the first 48 hours) intramuscular injection of 0.5 ml of the preparation of immunoglobulin (ready antibodies to hepatitis virus) against hepatitis B. The risk of perinatal infection of a child from a mother with hepatitis B or a carrier of the virus, can reach 40%. The immunoglobulin preparation does not reduce the effectiveness of the hepatitis B vaccine. The following vaccinations are carried out after 1 month, 2 months and 12 months after the first vaccination.
Information about the vaccination performed in the hospital, such as the type of drug, dose, series, control number, date of administration, in the case of using an imported drug - its name in Russian, is entered into the exchange card that is given to the mother on hand at discharge from the hospital. From the exchange card, the data are transferred to the child's development history (p. 112-y) and the prophylactic vaccination card (file 063-y). In case of refusal of vaccinations, a note on the explanatory work of the medical worker and the signature of the parent and health worker is entered in the exchange card.
Theoretically, it can be assumed that if the pregnant woman is not infected and is not sick with hepatitis (there are no antibodies to hepatitis B in her blood), the vaccination of the newborn can be postponed for later periods of life. However, with this approach, it can not be guaranteed that there will be no infection in the postnatal period: in the maternity hospital, in the neonatal pathology department during surgical interventions, etc.
When is the vaccine contraindicated?
Constant contraindications (which will not be removed in the course of time) are not vaccinated against hepatitis B virus. The presence in the family of relatives with primary immunodeficiency states (genetically predetermined diseases) is not a contraindication for this vaccination.
There are temporary contraindications (they can be removed after a lapse of time). These include birth weight less than
The question of the advisability of initiating vaccination immediately after the birth of premature infants whose mothers are not carriers of HBsAg remains open. There is an opinion that these children should be vaccinated starting from 3 months.
The recombinant hepatitis B vaccines approved in the Russian Federation are equally low reactogenic (there are practically no or minimal vaccine responses). Only in a few cases there is a reaction at the injection site (mild hyperemia - redness, less swelling) or a general reaction in the form of a short-term rise in temperature. The reaction may occur in the first three days, the temperature, as a rule, is 37.5-38.5 ° C. Apparently, the reactions to the recombinant vaccine develop due to the admixture of yeast proteins in the vaccine. If the temperature rises, consult a doctor. Temperature to 38.5 "C should not be reduced.
So, we found out that the prevention of hepatitis B should begin whenever possible in the hospital, and the head of the medical institution is fully responsible for the vaccination. In Russia, several quality vaccines are available from different manufacturers. The severe course and consequences of hepatitis B make it imperative to recommend that parents do not give up this vaccination.
1 Hemolytic disease of newborns occurs when maternal and fetal blood are not compatible with erythrocyte antigens, in particular, in the Rh rhesus conflict, when the Rh positive fetal red blood cells are destroyed by antibodies produced in the body of the Rh-negative mother.