Perm State Medical University
named after acad. E.A. Wagner
Population aspects of vaccinal
prevention: problems and
solutions
Irina V. Feldblium MD, Professor
Perm State Medical University, Russia
The main achievements of Health Care in the ХХth century
(CDC)
1
Vaccinal prevention
2
Motor transport security
3
Labour Hygiene
4
Treatment of infection diseases
5
Decrease of deaths from cardiovascular pathology
6
Food Hygiene
7
Maternity and infant security
8
Family planning
9
Fluoridation of drinking water
10
Smoking harm
Pediatric and epidemiologic aspects of vaccinal
prevention
Levels of
vaccinal
prevention
Aim of vaccinal
prevention
Individual
Prevention of
disease
•Quality of vaccines
•Condition of microorganism
•Arrangement of vaccination
Population
Prevention of
incidence
•Rate coverage of prevention vaccines
•Immune status
•Herd immunity
•Side effects of vaccines
•Flexibility of vaccine schedule
Efficacy factors of vaccinal prevention
Strategy of vaccinal
prevention
(indicators of epidemical process)
Tactic of vaccinal
prevention
(results of epidemiological
experimental investigations)
National Vaccine schedules
THE POPULATION ASPECTS OF VACCINAL
PREVENTION
•Sporadic level of morbidity (diphtheria, whooping
cough, measles, rubella, hepatitis B)
and elimination
some
infection diseases
Addof
Your
Title here
gives no opportunity
To control vaccinal prevention
To provide the mobility
of vaccine schedules
THE POPULATION ASPECTS OF VACCINAL
PREVENTION
The existing immunization strategies
Doesn't have the
preventive effect
Immunization schedule
change
depends on the
epidemiological situation
ПЕРСПЕКТИВЫ РАЗВИТИЯ
The protection of Perm population from diphteria
among various age groups,% (1979-1980)
82,0
90
69,0
80
80,0
72,0
68,0
68,0
54,0
60
50
48,0
44,0
43,0
39,0
32,0
40
30
15,0
20
10
Age (years)
al
la
ge
s
40
+
30
-3
9y
.
25
-2
9y
.
20
-2
4y
.
15
-1
9y
.
13
-1
4y
.
11
-1
2y
.
710
y.
56y
.
34y
.
12
y.
0
in
fa
nt
s
frequency, %
70
EPIDEMIOLOGICAL CONTROL
FOR VACCINAL PREVENTION IS
Information and diagnostic system of
collection and processing of date
about vaccine prevention
for timely elimination of defects in
its organization and supply
of the vaccine schedule flexibility
The aim of epidemiological control
of vaccine prevention is
Management and control of vaccine
prevention for reducing the
incidence of infectious diseases
Epidemiological control
of vaccinal prevention
Информационная
The diagnostic
подсистема
subsystem
The information
subsystem
Nosological
form of risk
The management
subsystem
Risk territory
To collect date about
quality and quantity of
vaccinal prevention
The management
decisions
Risk factors
Risk groups
Evaluation of vaccine prevention
Fixed
immunization
Characteristic of postvaccination period
Immunological
efficacy
Epidemiological, social and
economic efficacy
60
70
55
65
50
60
45
55
40
50
35
45
30
40
25
35
Incidence
Coverage
Vaccine coverage rate (per 100,000)
Incidence of Tuberculosis
(per 100, 000)
Antitubercular vaccination influence on the
tuberculosis incidence in Perm
Children tuberculosis incidence by age 0 – 16 per
100,000 (Perm region, 2013)
140
120
100
80
125,05
60
40
20
52,2
0
incidence in vaccinated
incidence in non vaccinated
Mechanisms of formation of TB immunity
Intensive cell immunization reactions maintain
throw first 3 years after BCG- vaccination
Specific changes of
phagocytic activity of
leukocytes
High adhesiveness
of blood lymphocytes
Specific IgG in blood
Postvaccinal TB immunity disappears in 100% of
children within 6-7 years
The presence and size of scar after BCG
and BCG-M vaccination
120,0%
97,3%
100,0%
90,9%
80,0%
55,3% 54,9%
60,0%
44,6% 45,1%
40,0%
20,0%
0,0%
The presence of scar
1-4 mm scar
BCG
BCG-M
5 mm scar
Tuberculosis incidence in ones reimmunization,
twice reimmunization and non- reimmunization
children by age 7-14 (%)
45
39,8
40
35
30
25
20
15
10
9,1
9,9
1 booster dose
2 booster doses
5
0
no booster
Tuberculosis incidence of children
18
15,8
16
14,7
14
13,2
16,6
15,5
14,4
14,4
14,9
14,7
13,2
11,9
12
Per 100, 000
16,2
11
10,7
10
10
8
9,3
7,77,6
7,37,5
8,1
8
7,7
7,5
7
6,3
6
8,9
6,5
6,4
5,8
7,3
7,3
6,9
7,9
6,7
6
4
2
0
1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005
The characteristic of antimeasles immunity of
various population age groups
Ig concentration, IU/ml
3
2,9
2,5
2,0
2
1,6
1,4
1,5
1,1
1
0,8
0,5
0,6
0,5
0,5
0,2
0,0
0
<1
1-3 y.
3-6 y.
6-9 y.
10-14 y.
15-20 y.
21-25 y.
26-30 y.
31-40 y.
41-50 y.
51 +
Age (years)
Russia, 2013
The number of individuals with protective level of
pertussis antibodies in blood serum, %
(Perm, 2006)
68 %
70
52 %
60
54,3 %
50,7 %
50
40
30
20
10
0
3-4y.
5-6 y.
9-10 y.
Age (years)
16-17 y.
Vaccination strategy of children with anemia with
diphtheria toxoid
Rate protection from diphtheria of 3
years old children (%)
Immunological efficacy of diphtheria
toxoid within combined with balsam
“Berezka” experimentally
95,0
77,3
4,5
2,5
healthy children
children with
anemia
Case group
Control group
The number of individuals without protective level of antimeasles
antibodies and diphtheritic antitoxins in children with syndrome of
defect of anti-infective protection
Observation groups
The number
of children
The number of children without
protective level of antibodies
Against diphtheria
n=166
Against measles
n=257
With syndrome of
defect of anti-infective
protection
506
32,8± 1,6*
50,8± 1,7*
Without syndrome of
defect of anti-infective
protection
406
16,8± 1,8*
28,2± 2,2*
*p<0,001
SYNDROME OF DEFECTION OF ANTI-INFECTIVE PROTECTION
(The main pathogenetic mechanism)
Inefficiency of cell’s immunity
macrophage’s due to
suppression
The immunomodulatory therapy must
be focused on correction of
microphages. It determines antigen
specific immune response.
Postvaccinial antidiphtheria immune condition in the
environmental risk territories
Xenobiotics
Rate protection from diphtheria 3-4
years old children, who lives in a
territories with different levels of air
pollution (%)
94,0
100
76,0
70
Control
group
Excess of
control
urine mg/cdm
Copper
0.086
0.005
17.2
Manganese
0.032
0.005
6.4
Lead
0.25
0.1
2.5
Chromium
0.1
0.04
2.5
93,5
90
80
Case group
Hair mcg/ml
Copper
6.56
1.92
3.42
Chromium
6.23
2.12
2.94
Nickel
10.22
8.65
1.18
60
Urine mcg/ml
50
Toluene
0.0000136
0.0000003
45.3
40
Methanol
0.0129
0.0006
21.5
30
Acetone
0.0069
0.00096
7.18
20
Hydrogen
sulfide
0.0413
0.0154
2.68
Phenol
0.2277
0.0738
3.08
10
0
Н
П
Б
The program includes nonspesific pharmacological maintenance
of vaccinal prevention
The program work out with:
 children infection disease department
of Perm Medical University (I.I. Lvova);
 Perm Pharmaceutical Academy (I.B.
Yakovlev, A. V. Solonina);
 Scientific-Research Institution of
ecology and genetic of microorganisms
(B.A. Bakhmetyev)
The incidence of reaction of post vaccination period while using
different investigation methods (per 100 vaccinated)
5,6
serious adverse drug
reaction
1,4
0,3
16,4
medium adverse drug
reaction
8,0
1,7
35,0
all adverse drug
reactions
28,0
4,0
0
Fixing
5
10
Assessment
15
20
25
30
Survey
35
40
The value of the system of epidemiological
control after vaccinal prevention
1
Provides necessary capacity of vaccination
2
Near the indexes of documented vaccination to the real protected
3
Keep the principle of individual vaccinal prevention
4
Intensify the possibility of control after postvaccinal complications
and reactions
5
Provide flexibility of vaccine schedule
6
Provide the management of vaccinal prevention
7
Keep population trust