Re-introduction of hib after a year has consequences. Vaccination against hemophilus influenzae for children

The widespread practice of immunizing children against Hib infection began in the mid-80s; since 1990, Hib vaccination has been introduced into the vaccination schedule in the USA, Canada and some countries Western Europe. Subsequently, in these countries, children became significantly less likely to suffer from epiglottitis and other very dangerous diseases caused by Hib infection. Today, Hib vaccination is administered to young children in many countries around the world. In Russia, children from risk groups are vaccinated at state expense; parents can get all other children vaccinated for a fee at any medical institution providing similar services.

What is Hib?

The abbreviation HBI is the name of the microorganism Hemophilus influenza type B (Haemophilus influenzae type B). All diseases caused by this pathogen are combined into one group, which I classify as hemophilus influenzae infection.

Haemophilus influenzae type B has a number of features that allow it from the site of primary localization (usually respiratory tract) penetrate the blood and spread throughout the body, provoking the formation of purulent foci in various organs - the brain, lungs, joints, ears, etc.

The most common clinical manifestations of hemophilus influenzae infection are the following acute diseases:

• Purulent.
• Epiglottitis (inflammation of the epiglottis), which leads to the development of croup.
• – inflammation of subcutaneous fatty tissue.
• Sepsis is a general inflammatory reaction of the body that occurs in response to pathogenic bacteria entering the bloodstream.

All these diseases develop mainly in those children who do not have immunity to CHIB. Particularly susceptible to severe forms hemophilus influenzae infection in children of the first two years of life. Only timely vaccination (started at 3 months of age) can protect them. It, of course, does not provide an absolute guarantee: children who have received the vaccine also become infected with Haemophilus influenzae and get sick, but their illness progresses as usual or is practically asymptomatic.

A child can encounter Hib infection anywhere (the pathogen enters the human body from the air - by airborne droplets). Many people have been carriers and distributors of dangerous Haemophilus influenzae for years, but do not even know it.

Important:Children's groups are especially dangerous from the point of view of contracting hemophilus influenzae infection, so parents, when sending their child to kindergarten, must necessarily vaccinate him against Hib.

Indications for Hib vaccination

All children under 5 years of age must be vaccinated with Hib. Older children, as a rule, already have immunity to hemophilus influenzae infection (since they encountered it at least once in kindergarten or school), so severe forms of the disease are not dangerous for them. This is confirmed by long-term observations of Hib infection: among children over 5 years of age and adults, meningitis, pneumonia, and epiglottitis caused by Haemophilus influenzae are extremely rare.

However, some groups of children are vaccinated with Hib regardless of age, one might say according to health conditions. In case of infection with Haemophilus influenzae, they experience the most high risk development of the most severe forms of infection - meningitis, pneumonia, sepsis. Risk groups include children with:

• immunodeficiencies;
• oncological diseases;
• serious developmental defects;
• long history of use of immunosuppressants;
• (this also includes babies born to HIV-infected mothers);
• asplenia (absence or absolute dysfunction of the spleen).

Moreover, in Russia mandatory vaccination Children from orphanages are susceptible to Hib infection.

Contraindications to Hib vaccination

An absolute contraindication to Hib vaccination is for the vaccine or its individual components. This fact is determined by the body’s abnormal reaction to the previous vaccination.

A child may be temporarily exempted from vaccination if, at the time of examination, he or she is diagnosed with acute illness or exacerbation of a chronic illness. Such children can be vaccinated with Hib a few weeks after recovery or improvement of their condition. If the illness was not severe (for example, intestinal disorders), vaccination is carried out immediately after normalization of body temperature, stool, etc.

To avoid any misunderstandings or undetected diseases that are contraindications to the vaccine, the child must be examined by a doctor before each vaccination.

Hib vaccination schedule

The Hib vaccination schedule is determined by the age at which this vaccination begins:

• If the child 3 months, then the Hib vaccination is done together with (often used for this combination drugs, for example, Pentaxim). The next vaccinations are carried out at 4.5 and 6 months, and revaccination at 18 months. The schedule may shift if, for example, the first vaccination is given not at 3, but at 4 months, but in general, for children under 6 months of age, the principle of immunization against Hib infection should be as follows.
• If vaccination is necessary for a child who it's already been 6 months, but not yet a year old, the following schedule is used: 2 vaccinations are carried out at an interval of a month and revaccination a year after the second vaccination.
• For kids from 1 year to 5 years Those who have not previously been vaccinated against Hib are given a single immunization.

Thus, you should not be upset if for some reason the vaccination had to be postponed. The pediatrician will always be able to choose the most suitable and effective scheme vaccinations depending on the age of the small patient.

Preparing for Hib vaccination

No special preparation required. Parents only need to follow the general recommendations:

• Make sure that the child does not come into contact with contagious patients, stay less in closed crowded rooms, etc.
• Do not make sudden changes in your baby's diet.
• Monitor the child's stool (if there is a tendency to, take measures for normal bowel movements).

Side effects of Hib

Hib vaccination is easily tolerated by children. In 10% of cases, the following post-vaccination reactions are possible (develop at the site of vaccine administration):

• redness;
• compaction;
• soreness.

An increase in temperature (up to 38 degrees) is less common. You may also experience irritability, tearfulness, poor appetite. If Hib vaccination was carried out complex preparation(together with DPT), the reaction to the vaccine may be more pronounced, but this is due not so much to the Hib component as to the DPT.

In general, those rare and minimal consequences of Hib vaccination are completely disproportionate in terms of the risk to the life of a child with ailments caused by Hemophilus influenzae. It’s better to bring down the temperature once and endure his whims with your baby than to face such a terrible disease as meningitis or sepsis.

Frequent acute respiratory infections, otitis media and even meningitis - that’s all unpleasant consequences presence in the child's body. According to statistics, 40% of preschool children are carriers of the infection, which can be transmitted by sneezing, through saliva and household items. To protect the child from such a scourge, Hib is included in the routine vaccination schedule.

What is the Act-HIB vaccine for?

The essence and purpose of the Hib vaccination (HIB) become clear after deciphering the abbreviation: Haemophilus influenzae, which in Latin means nothing more than hemophilus influenzae, and “B”, in turn, is its type. It is Hib that is the most dangerous and pathogenic of all 6 existing strains and can cause serious illnesses in children. Since only this microbe has a special capsule, which in every possible way tries to hide the presence of an “enemy agent” from the immature immune system small child. The infection is resistant to antibiotics, and the diseases caused by it can affect many organs and systems of the child’s body. The only way to protect your baby from the insidious Hemophilus influenzae type b is the Act-HIB vaccine, which has already been successfully used in all developed countries for many years. The drug was developed by the French pharmaceutical company Sanofi Pasteur in 1989. Its effectiveness has been proven by research and practice. Thus, during the period of use, the incidence among children of kindergarten age decreased by 95-98%, and the number of carriers decreased to 3%. Also in favor Act-HIB vaccines They say positive reviews pediatricians and educators who insistently recommend vaccinating a child before visiting a kindergarten, especially a nursery.

Answering the question, what is it done from? Act-HIB vaccination, you can read a whole list of diseases: acute respiratory infections, bronchitis, pneumonia, meningitis, epiglottitis, otitis media - just a small list possible consequences infections that can be avoided by vaccination.

Immunization schedule

In order to develop immunity to the insidious Haemophilus influenzae in time, vaccination should be carried out according to the prescribed scheme. As a rule, children begin to be vaccinated at 3 one month old, then the vaccine is reintroduced at 4.5 and 6 months. After receiving three injections, revaccination is carried out a year later. that is, when the child reaches 18 months. This scheme allows you to protect the baby from the so-called Hib-meningitis, to which six-month-old babies are especially susceptible.

If parents have the goal of preparing their child to attend kindergarten and begin vaccination after a year, then one injection will be enough to develop immunity for the baby.

But in any case, the immunization schedule depends on the child’s health status, living conditions and mandatory is agreed with the local pediatrician.

Hemophilus influenzae infection is a dangerous disease, the insidiousness of which is disguised as a common acute respiratory infection, with corresponding and not particularly alarming symptoms.

Complications include the development of an inflammatory process in the lungs, damage to the bronchi and meningitis. Less common consequences are the formation purulent inflammation subcutaneous fatty tissue of the face, epiglottitis (inflammatory process of the epiglottis), arthritis (inflammation of the joints) and sepsis.

For children, hemophilus influenzae represents great danger, since the causative agent of the disease can long time be on toys and other objects that babies often put in their mouths. Haemophilus influenzae spreads by airborne droplets. Vaccination against Haemophilus influenzae can protect a child from this dangerous disease.

The article provides information about currently approved drugs for vaccination, indications and contraindications for vaccinations and possible complications after them.

This is an infectious disease caused by a special pathogen - Haemophilus influenzae. The most dangerous bacterium is Haemophilus influenzae, which belongs to type B.

Synonyms that are used all over the world in medical practice:

• Haemophilus influenzae.
• Afanasyev-Pfeiffer wand.

Reference . According to medical research, such an infection is found in 5-25% of representatives of the human population, while we draw attention to the fact that in many groups of children carriage can be at least 40%. Children under the age of five are most often infected.

The immunologist explains. Haemophilus influenzae is a so-called opportunistic microflora, and if it does not penetrate from the nasopharynx into the bloodstream or into the lungs, the disease does not develop. Otherwise, the Afanasyev-Pfeiffer bacillus causes disease varying degrees severity, and then, often, severe complications. By official statistics Before the introduction of mass vaccination, meningitis was regularly reported in children under five years of age in the United States (about 20,000 cases annually, 1,000 of which resulted in death).

Meningitis is a lesion meninges(brain and spinal cord). In addition, the spread of Haemophilus influenzae leads to a number of pathologies:

• Inflammation of the lungs (pneumonia)
• Breathing problems due to laryngeal edema.
• Damage to joints and the musculoskeletal system as a whole.
• Heart diseases.
• In some cases, it can lead to death.

How to detect hemophilus influenzae?

It is difficult to detect an infection due to the high cost of the procedure, so it is often quite difficult to establish a diagnosis.

Attention! The Afanasyev-Pfeiffer bacillus is resistant to modern antibiotics, so treatment with such agents is pointless.

Vaccination against hemophilus influenzae infection.

Haemophilus influenzae infection. Vaccination calendar

Vaccination course. Child age:

• three months.

Then revaccination is carried out for children at risk:

• at 4.5 months
• in six months
• at 18 months

Vaccines authorized in the Russian Federation:

1. PENTAXIM.
2. HYBERIX.

Memo for parents. If a three-time course of vaccinations against Haemophilus influenzae has not been carried out, then after one year of life it is enough to carry out one vaccination in order to form a stable immunity.

Place of administration of hemophilus influenzae vaccination

Children under 2 years of age – hip area, anterolateral part.

Older children - in the shoulder (deltoid muscle).

What to do if the established vaccination dates are missed?

Haemophilus influenzae bacterium, which causes dangerous diseases, poses a serious threat only to children under five years of age. After five years, this vaccination is not carried out.

Rules:

1. When the first two vaccinations are administered before the age of one year, the third vaccination is given six months later.
2. If only one hemophilus inoculation is given, then after 12 months. age, a second vaccination is carried out (the minimum interval between vaccinations is 30 days).
3. If up to 12 months. not a single vaccination against hemophilus influenzae infection has been given in his life; from the moment he is one year old, only one vaccination is carried out.

General properties of vaccines against Haemophilus influenzae

1. Formation of stable immunity in 90-99% of cases (confirmed by antibodies in the blood, which are detected during laboratory tests).
2. Reduction in the incidence of hemophilus influenzae infection in almost 90% of cases. In regions with a long tradition of vaccination against Haemophilus influenzae, official figures are at least 99%.

Drug for vaccination against Haemophilus influenzae infection ACT-HIB

Created in France (Sanofi Pasteur Company). The main component is represented by a defective antigen in the form of a polysaccharide of a Haemophilus influenzae bacterium with a connection (conjugation) with a tetanus toxoid protein molecule. It is the first registered drug against Haemophilus influenzae on earth, with proven clinical effectiveness.

Main advantage:

1. Possibility of use in children aged from six months to one year of age.
2. Formation of stable immunity.

Complex action:

• Thanks to the transformation into a full-fledged antigen during the manufacturing process, stable immunity is formed after vaccination.
• Reduced reactogenicity of the drug and its relative safety for the body (minimum of adverse reactions).
• Getting a booster effect ( reintroduction allows you to achieve an increased concentration of antibodies in the blood, which not only increases, but also grows exponentially).

In addition to AKT-Hib, in Russia and other countries former USSR Three types of hemophilus influenza vaccinations are used that can provide reliable protection from Haemophilus influenzae:

1. Monovaccine "Hiberix".
2. Combination vaccine "Pentaxim", which includes several vaccines, including against hemophilus influenzae. It is this drug that is most used in mass vaccination carried out in public maternity hospitals, private medical centers and community clinics.

Vaccination drug against hemophilus influenzae "Hiberix"

"Hiberix" (GlaxoSmithKline Company, Belgium) is an analogue of "Act-HIB". It has a similar effect and mechanism of action. Instructions.

Vaccination drug against hemophilus influenzae "Pentaxim"

"Pentaxim" (French Company Sanofi Pasteur) is a multicomponent vaccine that provides protection against five infections simultaneously (DPT plus Haemophilus influenzae). The drug is successfully used in various medical institutions, but since it has a pertussis component, experts classify this vaccine as a more reactogenic vaccination (the negative side effect increases).

Indications for vaccination against Haemophilus influenzae infection (Afanasyev-Pfeiffer bacillus)

Children after five years of age and adults most often do not need vaccinations against hemophilus influenzae infection at all, with the exception of those at risk (determined by an infectious disease doctor or immunologist after collecting a family history).

Children over the age of five, as well as adults who suffer from certain pathologies, are vaccinated.

Such diseases include:

• sickle cell anemia;
• confirmed diagnosis of HIV/AIDS;
• absence of spleen;
• bone marrow transplant surgery;
• course specific medicines in the presence of a malignant disease.

Attention! The list is not complete, more detailed information provided by a pediatrician or other specialist at your place of residence.

Vaccination against hemophilus influenzae infection. Contraindications

1. Allergy to a vaccine component presented tetanus toxoid, since this is an ingredient of the drug added by the manufacturer to enhance the effect.
2. Allergy to the first Haemophilus influenza vaccine in the past.
3. Less than six weeks of age from birth.
4. History of convulsive syndrome (diagnosis established by a neurologist).
5. Encephalopathy diagnosed by a neurologist.
6. Negative reaction to any previous vaccination.
7. Any chronic disease.
8. Acute condition.

Possible complications after vaccination against Haemophilus influenzae

Any vaccine, like any other medicine, can cause adverse reactions:

• minor complications in the form of a slight increase in body temperature;
• hyperemia (redness) at the injection site;
• inflammation or swelling in the injection area (one case per four vaccinations);
• a significant increase in temperature to 38.5°C or higher (one case per 20 vaccinations).

The reaction usually appears a few hours after the procedure and lasts no more than three days.

What to do if you have a severe reaction to a vaccine?

Severe and moderate reactions mean strong deviations from normal condition health, including not only a significant increase in body temperature and severe allergies, but unusual behavior of the child.

Allergies can manifest themselves:

• difficulty breathing;
• hoarseness of voice;
• whistling in the lungs;
• severe skin rash;
• pale face;
• severe weakness;
• tachycardia (rapid heartbeat);
• dizziness, etc.

Some manifestations are observed immediately after administration of the drug, others allergic reactions may appear within 10-20 minutes or during the first day after vaccination.

When warning signs appear negative reaction To get vaccinated, you should immediately consult a doctor or call an ambulance.

Parents

1. Full text scientific article You can read about hemophilus influenzae infection and vaccination.
2. Dissertation on the topic of vaccination of children with various pathologies

Haemophilus influenzae infection long period did not fall into the special category of diseases that attracted close attention doctors And, as it turned out, it was in vain. The danger lies in the fact that it sometimes begins and proceeds like a normal respiratory disease. However, not all known drugs can be treated. The consequences can turn into a real tragedy, especially for children.

And so, during the next revision of regulatory documentation, in 2011, the Ministry of Health of the Russian Federation included vaccination against hemophilus influenzae into the vaccination calendar. But the peculiarity is that it is not carried out for everyone. Children are vaccinated upon the recommendation and prescription of a pediatrician, as well as with the consent of their parents.

So what is this disease and what exactly is its insidiousness? In what ways can you protect your own child from this terrible misfortune? Let's figure it out.

Manifestations of the disease, characteristics of the virus and forms of development

Haemophilus influenzae infection - acute developing pathology, the causative agent of which is Haemophilus influenzae. There are only six types of sticks, which go by the abbreviation of the first Latin letters(a, b, c, d, e, f). Greatest harm brings pathogen type b.

For a long time, the influenza bacterium did not attract attention, since almost the entire population is healthy carriers (90% of adults and approximately 5% of children), only a few of them get sick. Of these, children from six months to five years old. However, the consequences can be devastating. And what? younger child, the more severe the disease and complications are more dangerous. And most often children aged 1-2 years are affected.

What causes the difference in the clinical manifestations of hemophilus influenzae infection and the severity of the disease? The main reason lies in an underdeveloped immune system, which is unable to provide protection. Amazing children's body, it spreads very quickly, causing massive inflammation and causing death.

The main route of spread is airborne. The virus penetrates the mucous membranes of the oropharynx by inhaling microscopic droplets of mucus that are released when the patient coughs, sneezes or talks. Less commonly, infection occurs through contact and household contact: through toys, household items, and dishes.

Haemophilus influenzae infection can look different. The most common form is respiratory manifestations. The child develops a cough, runny nose, and body temperature rises. Complications also do not keep you waiting long, tormenting you with pneumonia, sinusitis, purulent otitis, inflammatory phenomena of the epiglottis, joints.

Attention! The most severe consequences of hemophilus influenzae infection are inflammation of the membranes of the brain, spinal cord and sepsis. This pathology is fatal in 15% of outcomes. Therefore, you should promptly apply for medical care and treat the disease.

Sick children require complex treatment in a hospital setting with antibiotics wide range actions from the category of amoxicillin (amoxiclav, augmentin, amoxil), as well as a group of cephalosporins. As studies have shown, penicillin series, tetracyclines, erythromycin have no effect on hemophilus influenzae.

Vaccination against Haemophilus influenzae

Based on the facts stated above, it becomes clear the timeliness and necessity preventive measures against the pathogen. A specific vaccination will save the child from such a threat.

Vaccinations against Haemophilus influenzae are reliable and safe. They do not contain living microorganisms, but only their fragments containing polysaccharides. Performing the function of foreign agents, after introduction into the body they trigger an antigen-antibody reaction. As a result, immune defense is formed.

Vaccines against Haemophilus influenzae infection are represented by HIBERIX and others.

Briefly about vaccines and their adverse reactions

Vaccinal prevention in Russian Federation is carried out with the drugs Act-HIB from the French manufacturer and the English manufacturer HIBerix. Hib components are included in the polyvalent Pentaxim (France) and the English Infanrix Hexa.

Vaccines do not contain living organisms; they themselves are not capable of causing disease and are safe in this regard. However, after them the following reactions are still possible:

• fever;
• hyperemia and local swelling;
• rash like urticaria;
• in children with a tendency to general manifestations- anaphylaxis, Quincke's edema.

Important! To avoid negative consequences after vaccination, it is necessary to examine the child in detail before the procedure, notify the doctor about previous manifestations after the administration of vaccines or other drugs, the presence of food or other allergies. If necessary, conduct a tolerance test.

Age limits for vaccination

The vaccine is given from three months to five years. In this case, it will be possible to avoid serious complications: meningitis and septic complications.

It is not advisable to vaccinate a child over five years old, since the child’s immunity is already so strong that it can handle it on its own.

Problems and goals of vaccination in questions and answers

The process and features of vaccination raise a lot of questions among parents. This is not surprising: what exactly does it protect against, and will it cause more harm than good? Here are some answers to topics of interest.

Question No. 1. The child was vaccinated against hemophilus influenzae. Is there a guarantee that he will now not get sick with acute respiratory infections and will not have meningitis, pneumonia and other inflammations?

Expert's answer. There is no 100% guarantee. Typically, the vaccine contains Haemophilus influenzae subtype b antigen. The drug protects against this most common and most common dangerous virus. The purpose of vaccination is to avoid its dangerous manifestations: pneumonia, sepsis and meningitis. Next, reduce the percentage of hemophilic otitis media and bronchitis. If the disease is caused by another type of bacteria, the child may get meningitis, otitis media, or any other form. For example, meningococcal infection: the vaccine does not protect against it.

Question No. 2. The drug contains an toxoid. So the vaccine can replace the tetanus shot, right?

Answer. The drug against Haemophilus influenzae infection cannot replace tetanus vaccination. The fact is that the toxoid is contained in small quantity, so he is not able to create immunity from such a disease.

The controversy surrounding vaccines continues to this day. However, despite the pros and cons considered, it should be noted that this strain of the virus is more common than others. With the introduction of vaccination against Haemophilus influenzae, starting in 2011, the incidence and level of complications from meningitis and sepsis in the Russian Federation significantly decreased.

Which vaccine is better

Act-HIB and HIBerix are approved for use in Russia. Both vaccines are effective, the reaction is safe and there is no significant difference between them.

Components that they contain in the same forms and ratios:

• cell wall fragments consisting of polysaccharides;
• tetanus toxoid.

The differences are minimal and are expressed as follows:

• Act-Hib uses sucrose as a stabilizer, and HIBerix uses lactose;
• Act-HIB contains Trometamol, which regulates the composition of ions.

Where should the vaccine be administered?

The injection site of the drug depends on the age of the child. Children are injected with the vaccine into the outer part of the thigh. If the child is more than a year old - in the upper-outer part of the shoulder.

Why does the sequence of vaccinations differ among different age groups?

As mentioned above, the child’s immune system is still imperfect, and it is even less adapted to protection. Therefore, large doses of antigen inoculation will be needed to create immunity at an early age.

In addition, at infants there are antibodies passed on by the mother. They act quickly, binding the foreign component and inactivating it. During this time, the baby should develop a defensive response.

Current vaccination schedules

1. It is carried out if the child receives. In this case, the vaccination is carried out three times with a break of one to two months. Revaccination is carried out at one and a half years. It usually coincides with routine vaccinations against polio, the causative agent of tetanus, and.
2. If the child is 6-12 months old, there will be a different scheme. Two injections of the vaccine are given, between which the baby is kept at an interval of 1-2 months. Revaccination is carried out, as in the previous case, at 1.5 years.
3. Baby's age is 1-5 years old: only one vaccination is given without revaccination. This technique provides the child with strong immunity.

Attention! Children over 5 years of age are not vaccinated against hemophilus influenzae. This is due to the sufficient development protective system to fight the virus.

Not everyone is vaccinated against hemophilus influenzae. What is this connected with?

Currently, clinics in sufficient quantity provided with vaccine material. Consequently, there are enough drugs to vaccinate all children who need it. However, as you may have already noticed, there are age restrictions administration of the drug. Often parents think too long and do not dare to carry out the manipulation. By the time they agree, the child reaches an age when the vaccination simply will no longer benefit him. There is no need for it if the child is five years old, and his body is already able to get rid of hemophilus influenzae.

Take care of your children!

There are contraindications. Consult your doctor.

Haemophilus influenzae infection (Hib infection) is a group of acute infectious diseases caused by Pfeiffer's bacillus (picture on the left), with an aerogenic mechanism of infection, affecting mainly the children's age group and characterized by inflammatory processes respiratory organs, central nervous system with the possible formation of purulent foci in various tissues and organs (sepsis).

Haemophilus influenzae infection is a fairly common disease in children. age group. The incidence of hemophilus influenzae infection is high, but it is difficult to fully calculate it statistically. One of the reasons is poor registration, because clinically acute respiratory infections of hemophilic origin differ little from, for example, pneumococcal or staphylococcal infection. Therefore, only severe cases with the development of pneumonia, meningitis and other manifestations can be taken into account.

The possibility of healthy carriage of hemophilus influenzae infection raises concerns, as it is an uncontrollable process from an epidemiological point of view. In a number of countries, the carriage rate in preschool groups reaches 40%, which explains the high incidence of acute respiratory infections in kindergartens. However, the presence of specific prevention saves this situation up to a reduction in morbidity in the form of isolated cases in a number of cases. European countries. For example, in the UK, the introduction of routine vaccination has reduced the incidence rate to 1-2 cases per year. In our country, free vaccine has been introduced in National calendar vaccinations only for a certain category of children (oncology, HIV infection, immunodeficiencies, as well as children in orphanages), therefore the vaccination campaign for other children is carried out exclusively on the initiative of the parents and depends only on their awareness of this issue.

The causative agent of Haemophilus influenzae infection

Pathogen– Haemophilus influenzae Afanasyev-Pfeiffer type B (hence the name Hib). Currently, there are about 16 types of Haemophilus influenzae and 6 antigenically various types(from a to f), however, type B is the most pathogenic for humans. This is a gram “-” microorganism (not stained when stained by Gram and microscopy) of very small size (diameter up to 1 µm), capable of transforming into the S-form ( with the formation of a protective polysaccharide capsule). It is this capsule that allows Haemophilus influenzae to survive for a long time in the human body, evading the immune system, as well as the action of antibacterial drugs. “Thanks to” the capsule, the child’s body cannot produce protective antibodies or are produced in small quantities, so children can get this infection many times. Haemophilus influenzae is an opportunistic microorganism, often a representative normal microflora mucous membrane of the human respiratory tract, therefore the frequency of healthy carriage of this pathogen is high.

Haemophilus influenzae after Gram stain

Causes of the spread of hemophilus influenzae infection

Source of infection is a patient with a clinically pronounced form of the disease (from acute respiratory infections to pneumonia, meningitis and sepsis). Also a source of infection are healthy carriers of Haemophilus influenzae. In the focus of hemophilus influenzae infection, the carriage rate can reach 70% in children and 30-40% in adults.

Mechanism of infection- aerogenic, and the path is airborne (spread of the pathogen occurs by sneezing, coughing, talking with the mucus of the bronchial tree - sputum, as well as mucus of the oropharynx and nasopharynx). Highest probability infection in persons in close proximity to the source of infection (3 meters or less). The patient becomes contagious when symptoms of the disease appear. The carrier is apparently healthy, therefore, with epidemiological side the most dangerous, but in such people the least contagious types of Haemophilus influenzae are isolated. Additional path infection - contact-household (through household items - towels, dishes, toys).

Seasonality for this infection is winter-spring. Susceptibility to this infection is high among children early age– from 6 months to 2, and sometimes 4 years. Up to 6 months, due to “maternal protection,” children rarely get sick. Over 5 years of age and adults get sick in isolated cases.

Risk groups for susceptibility to Haemophilus influenzae infection:

1) Age group of children from 6 months to 2 years.
2) Elderly persons over 65 years of age.
3) Children who are bottle-fed.
4) Immunodeficiencies ( oncological diseases, blood diseases, HIV infection, etc.).
5) Persons after removal of the spleen.
6) Social immunodeficiency (chronic alcoholism, drug addiction).
7) Children from closed institutions(children's homes, orphanages).

The path of Pfeiffer's bacillus in the human body:

The entrance gate of infection is the mucous membrane of the nasopharynx, where the pathogen can remain for a long time. Further development The process largely depends on the local resistance of the mucous membrane (a decrease in resistance can be caused by frequent colds, hypothermia, and stress). With weak resistance, the rod multiplies, accumulates and penetrates into the blood (bacteremia). And then the infection spreads to its favorite organs and tissues (lungs, paranasal sinuses nose, skeletal system, central nervous system, and others) with the possibility of developing sepsis (multiple purulent foci).

Symptoms of hemophilus influenzae infection

The incubation period (from the moment of infection until the appearance of the first symptoms of the disease) is almost impossible to determine, because Haemophilus influenzae can remain on the mucous membrane of the nasopharynx for a long time without causing any changes (asymptomatic course) and only begins to multiply when the protective forces decrease.

The onset of infection may be similar to acute respiratory disease(ARI), then generalization of the process occurs (the rod penetrates the blood and spreads throughout the body) and one of the clinical forms arises.

There are several typical forms of hemophilus influenzae infection:

1) Purulent meningitis(inflammation of the pia mater)
2) Acute pneumonia (pneumonia)
3) Sepsis, in particular one of its forms – septicemia ( systemic disease)
4) Cellulite or panniculitis (inflammation of the subcutaneous tissue)
5) Epiglottitis (damage to the epiglottis)
6) Acute arthritis(joint damage)
7) More rare forms (otitis, sinusitis, pericarditis, respiratory tract lesions and others).

Purulent meningitis of hemophilic etiology is the most common cause of meningitis in children aged 6 months to 4 years. How younger age patient, the more severe the disease. The percentage of neurological complications is high - up to 40%, mortality is slightly more than 10%. Symptoms are grouped into three syndromes:
- infectious toxic syndrome(a feature is a gradual onset with acute respiratory infections, high temperature up to 38-39° or more, redness of the face and neck);
- cerebral symptoms(severe headaches, nausea, vomiting, often repeated, increased sensitivity to all types of stimuli);
- meningeal syndrome(rigidity occipital muscles– inability to passively flex the head in a supine position, Kernig’s, Brudzinski’s symptoms). The course of hemophilic meningitis is long and wave-like.

Features in children of the first year of life:

1) The equivalent of a headache is a “brain scream” - a long, even constant, shrill cry of a child, similar to a high-timbre howl.
2) Due to severe hypersensitivity skin it is impossible to determine meningeal signs. Lessage's symptom helps (when hanging a child by the armpits, children first tuck their legs, and then do not straighten them like healthy ones, but keep them tucked in for a long time).
3) Due to high temperature high danger convulsive syndrome.
4) Children in the first year of life quickly fall into unconsciousness.
5) Bulging of a large fontanelle (on the top of the child’s head). How smaller size large fontanel, the faster loss of consciousness may occur.
6) The equivalent of vomiting is regurgitation.
7) Indications for carrying out lumbar puncture A high temperature without other symptoms and a shrill cry of the baby are indicated.
During lumbar puncture, cerebrospinal fluid flows out under pressure (in frequent drops), is cloudy, greenish, pleocytotic, or enlarged. cellular composition cerebrospinal fluid is several hundred in 1 μl, neutrophils predominate.

If the symptoms of meningitis persist, as well as the addition of convulsions, a second wave of fever, or psychomotor agitation of the patient, you need to think about the addition of ventriculitis (inflammation of the ventricles of the brain), as well as subdural suppurations.

What should make you see a doctor? Persistent high fever, headache or constant crying of the child, vomiting or regurgitation, muscle twitching. There is no need to wait, call an ambulance immediately.

Acute pneumonia. One of common reasons pneumonia in children is Haemophilus influenzae. Pneumonia can be focal or lobar (affecting a lobe of the lung or several lobes), often complicated by pleurisy (inflammation of the pleura - the lining of the lung) - up to 70% of cases in children. The patient has a high fever, weakness, lethargy, a cough that is initially dry or unproductive, and then becomes wet (purulent sputum with a yellowish tint). Often there are disturbances in respiratory excursion, which is manifested by shortness of breath. The course of pneumonia is protracted, difficult to treat, and can be undulating.

It will force you to see a doctor: high fever, lethargy of the child, refusal to eat, drowsiness, regurgitation, coughing and vomiting.

Septicemia– a systemic disease caused by the penetration of Haemophilus influenzae into the blood, having various clinical manifestations. More often, hemophilic sepsis occurs among children 6-12 months old. It proceeds like gram “-” sepsis - without the appearance of secondary purulent foci, it is difficult, even lightning fast. There is a high likelihood of developing septic shock and fatal outcome.
It is characterized by high temperature (up to 40°), an enlarged spleen, rapid hemodynamic disturbances (a drop in blood pressure, an increase in pulse rate), and microcirculatory disorders appear (hemorrhages on the skin of the torso, limbs, face). Mortality is high.

What will make you see a doctor? High temperature, lethargy of the child, refusal to eat, drowsiness, pale skin, blue lips, rapid heartbeat, the appearance of hemorrhages on the skin from small to large, decreased frequency of urination. Call an ambulance immediately.

Cellulite develops more often in children under one year of age. Against the background of an acute respiratory infection, swelling appears in the affected area (usually the face, less often the limbs). In the affected area there is redness of the skin with a bluish tint, swelling, and pain when palpated. Sometimes it can be accompanied by other symptoms (for example, inflammation of the middle ear - otitis media). The temperature in most cases is low (37-37.5°).

Haemophilus influenzae orbital cellulitis

Epiglottitis mainly occurs in children from 2 to 4-5 years old and is characterized by severe course. Against the background of high temperature, severe pain in the throat, problems with swallowing, and breathing problems appear due to narrowing of the larynx in the area inflamed epiglottis. The patient has speech impairment (dysphonia), pale skin, excessive salivation, and head tilt. When examining the throat and pressing on the root of the tongue with a spatula, you can see a bright red epiglottis. Laryngoscopy reveals inflammation of the epiglottis, swelling in the subglottic space. If help is not provided in time, complete blockage of the larynx in the area of ​​inflammation is possible, leading to loss of consciousness and death. The patient urgently needs intubation or tracheostomy.

See a doctor if: emergence severe pain in the throat and throwing back the child’s head, shortness of breath against this background, inability to swallow a sip of water and pronounce a word, high temperature.

Acute arthritis– is rarely isolated. Against the background of acute respiratory infections, damage to one or more joints of the limbs appears. Sometimes arthritis is complicated by inflammation bone tissue(osteomyelitis).

Complications of hemophilus influenzae infection

Brain edema due to the development of hemophilic meningitis with the syndrome of herniation of the cerebellar tonsils into the foramen magnum and death.
- Acute respiratory failure due to acute pneumonia.
- Asphyxia (obstruction of the respiratory tract) due to epiglottitis with the development respiratory failure and death.
- Septic shock due to septicemia with the development of hemodynamic disorders, microcirculation and death.

After past infection stable long-term immunity is formed. Repeated diseases possible only in immunocompromised individuals.

Diagnosis of hemophilus influenzae infection

A preliminary diagnosis is made based on the patient’s age (from 6 months to 4 years mainly), characteristic symptoms(the appearance of the most common forms against the background of acute respiratory infections - meningitis, pneumonia, sepsis, etc.). Similarity clinical symptoms with almost everyone bacterial infections reduces diagnosis to prompt laboratory confirmation. A general blood test shows a decrease in red blood cells (anemia), an increase in leukocytes, neutrophils, and ESR.

The final diagnosis is after laboratory research. Materials for research – nasopharyngeal mucus, sputum, cerebrospinal fluid, blood, purulent contents of lesions. Methods:
- bacteriological (inoculation of material on blood agar, chocolate agar);
- bacterioscopy (microscopy of Gram-stained preparations);
- detection of capsular antigen using counter immunoelectrophoresis reaction;
- serological studies(latex agglutination reaction, microprecipitation reaction).

Treatment of hemophilus influenzae infection

1. Organizational and routine measures (hospitalization of children with moderate and severe forms of infection in a hospital, bed rest for the entire febrile period, proper nutrition with the exception of highly salty foods, drink plenty of fluids as indicated)

2. Etiotropic antibacterial therapy(prescribed before laboratory test results) in order to prevent severe complications of hemophilus influenzae infection. In severe cases, the drugs of choice are third and fourth generation cephalosporins, carbapenems, ampicillin, aminoglycosides. For milder forms - amoxicillin, cefaclor. In case of resistance to ampicillin, chloramphenicol is prescribed, but it is prescribed less frequently. The duration of treatment depends on the clinical form of the infection: from 7 to 14 days. Only a doctor prescribes the drug. Self-prescription at home can lead to disastrous consequences (complications).

3. Pathogenetic therapy is carried out in a hospital and includes the restoration of impaired functions of vital organs and systems (detoxification infusion therapy, prevention of complications).

4. Syndromic therapy
antipyretics (Panadol, Nurofen, Efferalgan and others);
vasoconstrictor nasal drops (Aquamaris for infants, Nazivin, Nazol, Tizin, Otrivin and others);
expectorants (lazolvan, ambroxol, gedelix);
For cellulite and epiglotitis, the basis of treatment is antibacterial therapy.

Mild forms of the disease can occur under the guise of an acute respiratory infection, but in any case, either sinusitis, or sinusitis, or bronchitis, or otitis media will appear in the future. That is, when you see a doctor, you will need to be prescribed antibiotics. If etiotropic treatment will not be, then in most cases some kind of clinical form hemophilus influenzae infection, that is, the prognosis will be with worsening of the disease.

Prevention of hemophilus influenzae infection

Exists specific prevention- vaccine. Act-HIB (France) is registered in Russia. The vaccine contains capsular polysaccharide of Haemophilus influenzae type b, combined with tetanus toxoid to make it possible to administer it and develop immunity from the age of 2 months. Requires 3 injections.

Vaccination in children's groups can significantly reduce the frequency of hemophilus influenzae infection among frequently ill children. Carriage during vaccination can decrease from 40% to 3%, as can be seen in the example of vaccination of children in the Moscow region. Similar effects published in other regions of Russia.

Infectious disease doctor N.I. Bykova