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How to test for polio antibodies. Protective levels of anti-polio antibodies Serological monitoring of herd immunity status

3.1. PREVENTION OF INFECTIOUS DISEASES

ORGANIZATION AND CONDUCT OF SEROLOGICAL
MONITORING THE STATE OF THE COLLECTIVE
IMMUNITY AGAINST VEGETABLE INFECTIONS
(DIPHTHERIA, TETANUS, MEASLES, RUBELLA,
MUMPS, POLIOMYELITIS)

health Russian Federation

G.G. Onishchenko

Date of introduction: from the moment of approval

1 . Scope of application

1.1. The guidelines outline the basic principles of organizing and implementing serological monitoring of the state of collective immunity against vaccine-preventable infections (diphtheria, tetanus, measles, rubella, mumps, polio).

1.2. Real guidelines are intended for specialists from bodies and institutions of the state sanitary and epidemiological service, and can also be used by specialists from medical and preventive institutions.

2 . General provisions

Serological monitoring of the state of collective immunity of the country's population is a mandatory element of epidemiological surveillance of diphtheria, tetanus, measles, rubella, mumps and polio. Its role seems extremely important, since epidemic well-being in relation to these infections is determined by the state of post-vaccination immunity. Monitoring is carried out through serological studies of blood sera of vaccinated people.

Serological monitoring includes:

Selection of indicator population groups characterizing the condition specific immunity, which allows you to extrapolate the results obtained to the population of the surveyed area as a whole;

Assessing the effectiveness of immunization.

The purpose of serological monitoring is to assess the state of individual and collective immunity in a specific territory, the level of actual protection from infections in certain age groups of the population, as well as assess the quality of vaccination work.

Serological monitoring of the state of collective immunity of the population is carried out by institutions of the state sanitary and epidemiological service and treatment and preventive institutions.

Carrying out serological monitoring of the state of collective immunity is formalized by a joint order of the medical institution and the center of state sanitary and epidemiological surveillance, which determines the territory, time (schedule), contingents and number of population groups to be examined, as well as the persons responsible for organizing and conducting this work.

3 . Materials and methods

The material for the study is blood serum, which is a source of comprehensive information about the presence of a spectrum of antibodies to the pathogens of these diseases.

The serum testing methods used for monitoring must be harmless, specific, sensitive, standard and accessible for mass examinations. These currently in the Russian Federation are:

1) passive hemagglutination reaction (RPHA) - to detect antibodies to diphtheria and tetanus toxoid;

2) enzyme immunoassay(ELISA) - to detect antibodies to measles, rubella and mumps viruses;

3) a reaction to neutralize the cytopathic effect of the virus in tissue cell culture (macro- and micromethod) to detect antibodies to the polio virus.

To assess the actual vaccination of children and adults against diphtheria and tetanus, blood serum is examined in parallel with diphtheria and tetanus antigen diagnosticums, because vaccinations are carried out with associated drugs. In case of diphtheria and tetanus, persons protected from these infections are those whose blood serum contains antitoxic antibodies in a titer of 1:20 or higher.

Seropositive for measles, rubella and mumps viruses are individuals in whose blood serum specific IgG antibodies are detected.

To eliminate method errors and identify truly seronegative results, blood sera are re-examined in which specific antibodies to the pathogens of diphtheria, tetanus, measles, rubella, and mumps are not detected.

The strength of collective immunity to polio and the quality of vaccination can be judged on the basis of three indicators.

Percentage of individuals with antibodies to poliovirus types 1, 2 and 3.

Sera with an antibody titer equal to or higher than 1:8 are considered seropositive. The percentage of such sera is calculated separately for each serotype of the polio virus.

Percentage of triple seronegative individuals.

Sera are considered seronegative if they do not contain antibodies to all three types of polio virus in a 1:8 dilution. Their percentage in the entire group of examined sera is calculated.

The geometric mean value of the antibody titer, which is calculated only for a group of sera that have antibodies to the corresponding poliovirus serotype in a titer of 1:8 or higher. Antibody titers are converted to logarithms with base 2, summed and divided by the number of sera with antibodies (see Appendix 1).

The results of the serological survey of contingents are entered into the work logs of laboratories, where the name is registered settlement, institutions, surname, initials, age of the subject and antibody titer. The results are also entered into accounting forms (history of the child’s development, outpatient card of the patient).

4 . Methodological approaches to selecting population groups

When forming population groups subject to serological survey, the following principles should be adhered to.

Uniformity of place for receiving vaccinations (therapeutic and preventive, children’s educational institutions, schools, etc., where vaccinations were carried out).

This principle of forming groups makes it possible to identify institutions with a low quality of organization of vaccination work, and with a subsequent thorough investigation, identify its specific defects (violation of the rules of storage and transportation of vaccines, falsification of vaccinations, their compliance with the deadlines and schemes of the existing calendar preventive vaccinations, technical defects and other reasons).

Unity of vaccination history.

The population group under study must be a homogeneous statistical population, which requires selection of individuals with the same number vaccinations and the period from the date of the last vaccination.

Similarity of the epidemiological situation under which the study groups are formed.

To implement the requirements of this principle, the formation of groups is carried out from groups in which no cases of diphtheria, tetanus, measles, rubella, or mumps were registered within one year. Sampling of populations for a survey begins with identifying the areas where the survey is planned.

The boundaries of the territory are determined by the scope of service of a particular medical institution. This can be a separate organized group of children and adults, a medical district, settlements assigned to a primary care facility, or the service area of one clinic.

It is advisable to carry out serological monitoring in large areas in the constituent entities of the Russian Federation (cities, regional centers) annually (every year different districts and clinics of the city, regional center are included in the survey), and in the territory of the districts of the constituent entities of the Russian Federation - according to the schedule, once every 6 - 7 years old.

For the survey, you should select 4 groups of the same age group (2 groups from two medical institutions), at least 25 people in each group, i.e. at least 100 people in each indicator group.

In children's groups, before a serological examination, medical workers must carry out explanatory work with parents about the need to prevent these infections and determine the strength of post-vaccination immunity to them.

Blood serum of adults for research can be taken at blood transfusion stations without taking into account the vaccination history of donors.

5 . Indicator groups of the population subject to serological examination for the presence of specific antibodies

Serological monitoring of the state of collective immunity provides for a multi-purpose serological survey in each territory of “indicator” population groups. Children must have a documented vaccination history. In this case, the period that elapsed from the last vaccination to the examination for the presence of diphtheria and tetanus antibodies, antibodies to measles, rubella, mumps, and polio viruses must be at least 3 months.

Indicator groups cannot include people who have had diphtheria, tetanus, measles, rubella, mumps and polio; children who lack information about vaccinations; unvaccinated against these infections; have suffered any disease 1 - 1.5 months before the examination, because some diseases can lead to a temporary decrease in the titer of specific antibodies.

The state of immunity to diphtheria, tetanus, measles, rubella, mumps, and polio viruses in adults is determined without taking into account vaccination data.

The introduction of “indicator” groups makes it possible to unify the forms and methods of analyzing vaccination work. Currently, it is advisable to distinguish the following indicator groups (Table 1).

Diphtheria and tetanus

Based on the results of a serological examination of children aged 3 - 4 years, one can judge the formation of basic immunity; at the age of 16 - 17 years - the quality of vaccinations carried out at school and secondary educational institutions; in adults - about the actual level of protection against diphtheria and tetanus.

Measles, mumps, rubella

Based on the results of a serological examination of children aged 3 - 4 years and 9 - 10 years, the level and intensity of anti-measles, anti-mumps and anti-rubella immunity in the immediate period after vaccination and revaccination are judged.

Serological examination of children aged 16-17 years allows us to evaluate the effectiveness of revaccination in the long term, as well as the level of the immune layer to these infections in newly formed groups of secondary and higher educational institutions.

The results of a survey of adults aged 23 - 25 years characterize the state of specific immunity among the young adult population, incl. for rubella - women of childbearing age.

Polio

Based on the results of a serological examination of children aged 1 - 2, 3 - 4, 14 years old, the level and intensity of immunity to polio in the immediate future after vaccination and revaccination with live polio vaccine is judged; in adults, the actual state of immunity to polio is assessed.

At the discretion of epidemiologists, serological testing for the infections in question can be carried out in other age groups Oh.

6 . Evaluation of the effectiveness and quality of vaccinations performed

Assessment of the state of specific immunity of the population to diphtheria, tetanus, measles, rubella, mumps and polio is carried out based on the results of a serological survey of indicator groups of the population.

The detection in each study group of no more than 10% of individuals with a titer of diphtheria and tetanus antibodies less than 1:20 and of adults no more than 20% of individuals with the absence of protective titers of diphtheria and tetanus antibodies serves as an indicator of sufficient protection from diphtheria and tetanus.

The criteria for epidemic well-being in case of measles are considered to be the identification of no more than 7% of seronegative individuals in each indicator group.

Among those vaccinated against mumps, the proportion of those who are seronegative should not exceed 15% - in those vaccinated once and 10% - in those vaccinated twice, and the proportion of those who are seronegative among those vaccinated against rubella should be no more than 4%.

The detection in each study group of no more than 20% seronegative to each of the three serotypes of the polio virus serves as an indicator of sufficient protection from polio.

If more than:

10% of persons with diphtheria and tetanus antibody titres below the protective level or

7% of individuals seronegative for measles virus, or

15% of persons vaccinated against mumps once, and more than 10% - twice, or

20% of individuals seronegative for each of the three serotypes of the polio virus, should carry out the activities listed below.

1. Identify the reasons low level immunity:

Conduct an analysis of vaccination documents for identified seronegative individuals to establish the fact of vaccination - compare information about vaccinations in all registration forms (card of preventive vaccinations, history of child development, outpatient card of the patient, work logs, etc.);

Assess the conditions of storage and transportation of vaccines, the procedure for immunization.

2. Additionally, check the state of immunity to these infections in people of the same age in an amount of at least 100 people, but in two other institutions (preschools, schools, orphanages, etc.) of the same medical institution where high percentage of seronegative individuals.

If after additional examination the number of people unprotected to diphtheria, tetanus, measles, rubella, mumps and polio will exceed the given criteria, the issue of immunoprophylaxis tactics in these groups should be addressed.

To do this, it is necessary to examine people of other age groups at the discretion of the epidemiologist. If the proportion of seronegative to the corresponding pathogens among these individuals does not exceed the above indicators, then additional vaccinations in the surveyed groups will be given to persons of that age where a high percentage of seronegative to the viruses of measles, rubella, mumps, polio, and persons with a titer of diphtheria and tetanus antibodies are identified. below the protective level.

If the percentage of seronegative people among those examined turns out to be significantly higher than the given criteria, then the issue of additional vaccinations should be decided on for all persons medical care which are carried out by this medical institution.

If teams with high percentage seronegative persons belonging to two treatment and preventive institutions, then to assess the vaccination work in this area it is necessary to conduct a serological survey of indicator groups in other institutions (preschools, schools, etc.) in this area. The issue of expanding preventive measures in the territory must be agreed upon with the Department of State Sanitary and Epidemiological Surveillance of the Russian Ministry of Health.

Data on low protection against diphtheria are confirmed by the results of a study of immunity to tetanus. Thus, a high percentage of those vaccinated against diphtheria and tetanus in registration documents, combined with a high percentage of people with an antibody titer of less than 1:20 not only to diphtheria, but also to tetanus, indicate the unreliability of vaccination records.

A high percentage of people protected from diphtheria, combined with a low level of immunity to tetanus, is not the result of preventive vaccinations, but indicates their infection with the causative agent of diphtheria (patients or carriers). The absence of a registered incidence of diphtheria may be due to poor work in identifying patients, especially mild forms of the disease (insufficient bacteriological examinations of patients diagnosed with tonsillitis, violation of the rules for taking and delivering material for bacteriological examination; poor quality work bacteriological laboratory- lack of inoculation of even non-toxigenic corynebacteria diphtheria, etc.).

If, when examining adults in one of the age groups, the number of people seronegative for diphtheria exceeds 20%, it is necessary to increase the number of people examined in the same age group. If the number of seronegative people again exceeds 20%, it is necessary to analyze the vaccination work in order to identify the unvaccinated and immunize them.

Materials of serological monitoring of the state of collective immunity are summarized by institution different types, clinics, districts and constituent entities of the Russian Federation as a whole (Table 2). Next, for each infection, the results of the serological survey are compared with morbidity rates and the level of vaccination coverage, which makes it possible to confirm official data on immunization of the population or identify differences in vaccination coverage and morbidity rates.

Dynamic monitoring of the state of the population’s immunity to vaccine-preventable infections allows for timely identification of signs of epidemic troubles. The forecast of the epidemiological situation for each of the observed infections is considered unsatisfactory if there is a tendency towards an increase in the proportion of seronegative ones.

When the first prognostic signs are identified in any territory, indicating an approaching worsening of the epidemiological situation for any of the infections under consideration, management decisions are made aimed at increasing the level of the immune layer among the population.

Table 1

“Indicator” groups for serological monitoring of the state of collective immunity to infections controlled by drugs specific prevention

Table 2

Report on the results of monitoring the state of collective immunity against diphtheria, tetanus, measles, rubella, mumps and polio

Infections

Indicator groups (years)

30 and older

total survey

number of serones.

% seroneg.

total survey

number of serones.

% seroneg.

total survey

number of serones.

% seroneg.

total survey

number of serones.

% seroneg.

total survey

number of serones.

% seroneg.

total survey

number of serones.

% seroneg.

total survey

number of serones.

% seroneg.

Diphtheria

Tetanus

Red ha

Epid. mumps

Polio

For polio, the percentage of triple seronegative (to types 1, 2, 3 polioviruses) and to each separately should be indicated.

Appendix 1

Calculation of the geometric mean value of antibody titer
to polio viruses

For example: among the 20 examined sera, 18 had antibodies to poliovirus type 1, among them 3 had a titer of 1:8; 5 - title 1:16; 5 - title 1:32 and 5 - title 1:64.

Converting the absolute titer values into logarithms with base 2, we obtain the following value for the geometric mean antibody titer:

Returning to absolute numbers, the geometric mean antibody titer would be 1:26.

Appendix 2

Rules for collecting, transporting and storing blood serum

1 . Technique for taking and primary processing blood

Capillary blood is taken from a finger under aseptic conditions. Before drawing blood, the patient's hand is warmed hot water, then wipe dry with a clean towel. The finger, wiped with 70° alcohol, is pierced with a sterile disposable scarifier. Blood in a volume of 1.0 - 1.5 ml is collected directly through the edge of a sterile disposable centrifuge tube with a stopper (or into special microtubes for collecting capillary blood). After taking blood, the injection site is lubricated with a 5% iodine solution.

A label should be placed on the test tube with blood (it is better to use a strip of adhesive tape) indicating the registration number, surname, first name, for adults - initials, and the date of blood collection.

Together with a list of examined persons, which indicates the city (district), child No. preschool, group, school, class, No. of secondary special institution, group, name of university, faculty, group, registration number, surname, first name of the patient, date of birth, dates of vaccinations against diphtheria, tetanus, measles, rubella, mumps and polio, date of blood collection, signature of the person in charge, blood samples are sent to the laboratory of the territorial Central State Medical Examination Center on the day of blood collection.

In the laboratory, to obtain serum, a test tube with blood is left in an inclined (at an angle of 10 - 20°) position at room temperature for 30 minutes to form a clot; after which the test tube with blood is shaken to separate the clot from the wall of the tube and left overnight in the refrigerator at a temperature of 4 - 8 ° C.

After separating the serum from the clot (the test tubes are circled inner surface Pasteur pipette), it is centrifuged at 1000 - 1200 rpm for 15 - 20 minutes. Then the serum is carefully poured or aspirated with a pipette with a bulb into sterile centrifuge (plastic) tubes or Eppindorf tubes with the obligatory transfer of the label from the corresponding tube to them.

Serums received by the laboratory (without a clot) can be stored in household refrigerators at a temperature of 4 °C for 7 days until testing. For longer storage, the whey should be frozen at -20? C. Having collected the required amount of sera, they are sent to the laboratory of the Center for Sensitivity and Epidemiology for testing.

2 . Transportation of serum (blood) samples.

Before transportation collected material from the survey area, it is very important to take precautions: check the availability of the collected information, tightly cap the tubes, arrange the samples according to their numbers, etc. Lists of surveyed persons should be kept at the collection site. Thermal containers (cooler bags) are used to transport blood (serum).

When sending samples by rail or by air the laboratory must be notified (by phone, telegram) about the train (flight) number, date and time of departure and arrival, number of samples, etc. When transporting to winter time years and storage of blood, freezing is not allowed.

MU 3.1.2943-11

METHODOLOGICAL INSTRUCTIONS

3.1. PREVENTION OF INFECTIOUS DISEASES

Organization and conduct of serological monitoring of the state of collective immunity to infections controlled by means of specific prevention (diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio, hepatitis B)

1. DEVELOPED by the Federal Service for Supervision of Consumer Rights Protection and Population Welfare (E.B. Ezhlova, A.A. Melnikova, G.F. Lazikova, N.A. Koshkina); FBUZ "Federal Center for Hygiene and Epidemiology" of Rospotrebnadzor (N.Ya. Zhilina, O.P. Chernyavskaya); Federal State Budgetary Institution "Moscow Research Institute of Epidemiology and Microbiology named after G.N. Gabrichevsky" of Rospotrebnadzor (N.M. Maksimova, S.S. Markina, T.N. Yakimova, N.T. Tikhonova, A.G. Gerasimova, O.V. Tsvirkun, N.V. Turaeva, N.S. Kushch); Federal State Budgetary Institution "Central Research Institute of Epidemiology" of Rospotrebnadzor (V.P. Chulanov, N.N. Pimenov, T.S. Selezneva, A.I. Zargaryants, I.V. Mikheeva); State Institution "Institute of Poliomyelitis and viral encephalitis them. M.P. Chumakov" RAMS (V.B. Seybil, O.E. Ivanova), State Institution "Moscow Research Institute of Vaccines and Serums named after. I.I. Mechnikova RAMS (N.V. Yuminova, R.G. Desyatskova); Omsk State Medical Academy (V.V. Dalmatov); Office of Rospotrebnadzor for the Novosibirsk region (N.I. Shulgina); Office of Rospotrebnadzor for Moscow (I.N. Lytkina, V.S. Petina, N.I. Shulakova).

2. DEVELOPED to replace the guidelines MU 3.1.1760-03 “Organization and conduct of serological monitoring of the state of collective immunity against vaccine-preventable infections (diphtheria, tetanus, measles, rubella, mumps, polio).”

3. APPROVED on July 15, 2011 and put into effect by the Chief State Sanitary Doctor of the Russian Federation G.G. Onishchenko.

1. Scope of application

1.1. The guidelines outline the basic principles of organizing and implementing serological monitoring of the state of collective immunity to infections controlled by means of specific prevention (diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio, hepatitis B).

1.2. These guidelines are intended for specialists from bodies carrying out state sanitary and epidemiological supervision, and specialists from medical and preventive organizations.

2. General provisions

2.1. Conducting serological monitoring allows for a continuous process of objective assessment of the state of specific post-vaccination immunity to pathogens of infections controlled by means of specific prevention in “indicator” population groups and risk groups and is a mandatory element of epidemiological surveillance of diphtheria, tetanus, whooping cough, measles, rubella, mumps , polio and hepatitis B, since epidemiological well-being in relation to these infections is determined by the state of post-vaccination immunity.

2.2. The purpose of serological monitoring is to assess the level of actual protection from infections of individuals, groups and the population as a whole, as well as to assess the quality of vaccination work in a specific territory and in a specific healthcare organization.

2.3. Serological monitoring includes:

selection of “indicator” population groups, the state of specific immunity of which allows us to extrapolate the results obtained to the population of the surveyed territory as a whole;

organizing and conducting serological studies of blood sera of vaccinated people (in “indicator” population groups);

assessment of the effectiveness of immunization.

The procedure for collecting, transporting and storing blood sera for research is carried out in accordance with Appendix 1.

2.4. "Indicator" populations include individuals with a documented vaccination history. In this case, the period from the last vaccination to the examination for the presence of diphtheria and tetanus antibodies, pertussis agglutinins, antibodies to measles, rubella, mumps, polio, and hepatitis B viruses must be at least 3 months.

The introduction of “indicator” groups makes it possible to unify the forms and methods of analyzing grafting work.

2.5. The organization and conduct of serological monitoring of the state of collective immunity of the population is carried out by health care organizations and bodies carrying out state sanitary and epidemiological surveillance.

2.6. Carrying out serological monitoring of the state of collective immunity is formalized by a resolution of the Chief State Sanitary Doctor for the constituent entity of the Russian Federation, in which, in agreement with the health authorities, the territories, time (schedule), contingents and number of population groups to be examined are determined, microbiological laboratories for conducting research are determined, and as well as persons responsible for organizing and carrying out this work.

In furtherance of the resolution of the Chief State Sanitary Doctor for the constituent entity of the Russian Federation, an order is issued by the health care management body of the constituent entity of the Russian Federation.

Conducting serological monitoring is annually included in the work plans of territorial bodies of Rospotrebnadzor and healthcare organizations.

3. Materials and methods

3.1. The material for the study is blood serum, the identified antibodies in which are a source of information about the level of immunity to infectious agents controlled by means of specific prevention.

3.2. The methods used for testing serums must be harmless, specific, sensitive, standard and accessible for mass examinations.

3.3. To conduct serological studies of blood serum in the Russian Federation, the following are used:

passive hemagglutination reaction (RPHA) - to detect antibodies to measles virus, diphtheria and tetanus toxoids;

agglutination reaction (RA) - to detect agglutinins of the pertussis microbe;

enzyme-linked immunosorbent assay (ELISA) - to detect antibodies to measles, rubella, mumps, hepatitis B viruses, as well as the causative agent of whooping cough;

reaction to neutralize the cytopathic effect of the virus in tissue cell culture (macro- and micromethod) - to detect antibodies to polio viruses.

3.4. To conduct serological studies, diagnostic kits and test systems registered in the Russian Federation must be used.

4. Methodological approaches to selecting population groups

4.1. When forming “indicator” population groups subject to serological survey, the following principles should be adhered to.

4.1.1. Uniformity of the place where vaccinations were received (health care organization, preschool institution, school and other organizations where vaccinations were carried out).

This principle of forming groups makes it possible to identify organizations with low quality vaccination work, and with a subsequent thorough investigation, identify its specific shortcomings (violation of the rules of storage and transportation of vaccines, falsification of vaccinations, their inconsistency with the timing and schemes of the existing calendar of preventive vaccinations, technical errors, etc.).

4.1.2. Unity of vaccination history.

The population under study must be homogeneous, which requires selection of individuals with the same number of vaccinations and the period since the last vaccination.

4.1.3. Similarity of the epidemiological situation under which the study groups are formed.

To implement the requirements of this principle, groups are formed from groups in which no cases of diphtheria, whooping cough, measles, rubella, mumps, or hepatitis B have been recorded for one year or more.

4.2. The selection of contingents for the survey begins with the identification of territories.

The boundaries of the territory are determined by the scope of service of a particular health care organization. This can be a separate organized group of children and adults, a medical district, a settlement assigned to a paramedic-midwife station, or the service area of one clinic.

4.3. It is advisable to carry out serological monitoring primarily in large administrative territories of the constituent entities of the Russian Federation (in cities, regional centers) - annually. Every year, different districts and clinics of the city (district center) should be included in the survey. The frequency of their examination should be 6-7 years (according to schedule).

4.4. To form an “indicator” group, you should select 4 groups of subjects of the same age (2 groups from 2 health care organizations), at least 25 people in each group, that is, each “indicator” group should have at least 100 people.

4.5. Before conducting a serological examination of persons selected for the “indicator” group (children and adults), medical workers must carry out explanatory work, including with the parents of the children being examined, about the purpose of checking their strength of post-vaccination immunity to infections controlled by means of specific prevention.

4.6. Blood serum of adults for research can be taken at blood transfusion stations.

The procedure for collecting, transporting and storing blood serum is defined in Appendix 1.

5. “Indicator” population groups subject to serological examination for the presence of specific antibodies

5.1. Serological monitoring of the state of collective immunity provides for a multi-purpose serological survey in each territory of “indicator” population groups.

Multipurpose serological studies involve determining in one blood serum sample maximum spectrum of antibodies to the pathogens of the studied infections.

5.2. The "indicator" groups do not include:

who have had whooping cough, diphtheria, tetanus, measles, rubella, mumps, polio and acute hepatitis B, as well as patients with chronic hepatitis B and carriers of the hepatitis B virus;

children who lack information about vaccinations;

not vaccinated against these infections;

who have suffered any disease 1-1.5 months before the examination, since individual diseases may lead to a temporary decrease in the titer of specific antibodies.

5.3. The state of collective immunity to diphtheria, tetanus, mumps, polio, and hepatitis B in adults is determined without taking into account vaccination data. The state of immunity to measles and rubella - without taking into account vaccination data - is determined in adults only in the age group of 40 years and older.

5.4. Diphtheria and tetanus.

Based on the results of a serological examination of children aged 3-4 years, the formation of basic immunity is assessed; at the age of 16-17 years, the quality of vaccinations carried out at school and secondary educational institutions is assessed.

The results of serological surveys of adults aged 18 years and older (by age group) without taking into account their vaccination status make it possible to assess the actual level of protection from diphtheria and tetanus in adults in each age group and to identify risk groups in terms of incidence and severity of the disease.

5.5. Whooping cough.

Based on the results of a serological examination of children aged 3-4 years, the formation of basic immunity is assessed.

5.6. Measles, mumps, rubella.

Based on the results of a serological examination of children aged 3-4 years and 9-10 years, the level of anti-measles, anti-mumps and anti-rubella immunity after vaccination and revaccination is assessed.

Serological examination of children aged 16-17 years allows us to evaluate the effectiveness of revaccination in the long term, as well as the level of the immune layer to these infections in newly formed groups of secondary and higher educational institutions.

The results of a survey of adults aged 25-29 and 30-35 years, vaccinated against measles, rubella and mumps, characterize the state of specific immunity among the young adult population, including rubella - women of childbearing age.

Based on the results of a survey of adults aged 40 years and older (donors, excluding vaccination history), an assessment is made of the actual protection of the adult population from measles, rubella and mumps.

5.7. Polio.

Based on the results of a serological examination of children aged 1-2 years, 3-4 years and 16-17 years, the level of immunity to poliomyelitis in the immediate period after vaccination and revaccination with polio vaccine is assessed; in adults, the actual state of immunity to poliomyelitis in the age groups 20- 29 years old, 30 years old and older.

5.8. Hepatitis B.

Based on the results of a serological examination of children aged 3-4 years and 16-17 years, as well as adults and medical workers at the ages of 20-29 years, 30-39 years and 40-49 years, the level of immunity to hepatitis B is assessed.

5.9. At the discretion of specialists carrying out state sanitary and epidemiological surveillance, serological examination for the infections in question can be carried out in other age and professional groups.

Recommended "indicator" groups for serological monitoring of the state of collective immunity to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B are presented in Appendix 2 (Tables 1, 2).

6. Assessment of the effectiveness and quality of vaccinations performed

6.1. Assessment of the state of specific immunity of the population to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B is carried out based on the results of a serological survey of “indicator” population groups.

6.2. To assess the actual vaccination and protection of children and adults from diphtheria and tetanus, blood serum is examined in parallel with diphtheria and tetanus antigen diagnostic kits. Protected from these infections are persons in whose blood serum antitoxic antibodies are detected in a titer of 1:20 or higher.

6.3. When assessing the level of post-vaccination anti-pertussis immunity, those protected from whooping cough are those whose blood serum contains agglutinins at a titer of 1:160 or higher.

6.4. Seropositive for measles, rubella and mumps viruses are persons in whose blood serum specific antibodies are determined at the level specified in the relevant instructions for the test systems.

6.5. When assessing the level of post-vaccination immunity to the hepatitis B virus, protected persons are those whose blood serum contains antibodies to HBsAg at a concentration of 10 IU/l or more.

6.6. The strength of collective immunity to polio and the quality of vaccination can be judged based on three indicators:

proportion of persons seropositive for polio viruses types 1, 2 and 3(sera in which the antibody titer is equal to or higher than 1:8 are considered seropositive; the proportion of seropositive results is calculated for the entire group of examined sera);

proportion of persons seronegative for polio viruses types 1, 2 and 3(sera are considered seronegative if they do not contain antibodies to one of the types of poliovirus in a 1:8 dilution; the proportion of seronegative results is calculated for the entire group of examined sera);

proportion of seronegative individuals(absence of antibodies to all three types of the virus) are considered persons whose sera do not have antibodies to all three types of polio virus.

An indicator of the intensity of collective immunity to polio is geometric mean antibody titer, which is calculated only for a group of sera that have antibodies to the corresponding poliovirus serotype in a titer of 1:8 or higher (Appendix 3).

6.7. The results of a serological survey of contingents are recorded in laboratory workbooks, indicating the locality, organization, surname, initials, age of the person being examined and antibody titer. The results are also entered into accounting forms(child’s development history (form N 112/u), patient’s outpatient card (form N 025/u), preventive vaccination card (form N 063/u), vaccination certificate and other accounting forms.

6.8. The detection in each group of children and adolescents of no more than 5% of persons with a titer of diphtheria and tetanus antibodies less than 1:20 and no more than 10% of persons with the absence of protective titers of diphtheria and tetanus antibodies in the group of adults serves as an indicator of sufficient protection from diphtheria and tetanus.

6.9. The criterion for epidemiological well-being in case of whooping cough should be considered to be the identification of no more than 10% of individuals in the examined group of children with an antibody level of less than 1:160.

6.10. The criteria for epidemiological well-being for measles and rubella are considered to be the identification of no more than 7% of seronegative individuals in each “indicator” group.

6.11. Among those vaccinated against mumps, the proportion of those who are seronegative should not exceed 10%.

6.12. The detection in each study group of no more than 10% seronegative for each of the three serotypes of the polio virus serves as an indicator of sufficient protection from polio.

6.13. Among those vaccinated against hepatitis B, the percentage of people with an antibody concentration of less than 10 IU/l should not exceed 10%.

6.14. If below the specified indicators are detected in any “indicator” group:

more than 5% of individuals among children and adolescents and more than 10% of individuals among adults with diphtheria and tetanus antibody titers below the protective level;

more than 10% of individuals with pertussis antibody titers below the protective level;

more than 7% of people seronegative for measles and rubella virus;

more than 10% are seronegative among those vaccinated against mumps;

more than 10% of individuals seronegative for each of the three serotypes of the polio virus;

more than 10% of people seronegative for the hepatitis B virus, with a concentration of antibodies to HBsAg less than 10 IU/l

necessary:

carry out an analysis of vaccination documentation for identified seronegative individuals to establish the fact of vaccination - compare information about vaccinations in all registration forms (preventive vaccination card (form N 063/u), child development history (form N 112/u), outpatient card patient (form N 025/u), work journals and others);

assess the conditions of storage and transportation of vaccines, the procedure for immunization;

additionally check the state of immunity to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B in persons of the same age in an amount of at least 100 people, but in 2 other teams of the same health care organization, where a high proportion of seronegative persons;

vaccinate identified seronegative individuals in accordance with current regulations.

6.15. If, after an additional examination, the number of people unprotected to these infections exceeds the given criteria, it is necessary to check the availability of vaccinations in people of the same age groups with a high proportion of seronegative, whose medical care is provided by this health care organization in order to establish falsification of vaccinations. Identified unvaccinated persons should be vaccinated in accordance with current regulations.

6.16. Materials of serological monitoring of the state of collective immunity are summarized for organizations of various types, clinics, districts, cities ( district center) and the subject of the Russian Federation as a whole (Appendix 2, Tables 3, 4, 5, 6). Next, for each infection, the results of the serological survey are compared with morbidity rates and the level of vaccination coverage, which will confirm official data on immunization of the population or identify discrepancies in vaccination coverage with the level of collective immunity.

6.17. Dynamic monitoring of the state of the population's immunity to infections controlled by means of specific prevention allows for timely identification of signs of epidemiological troubles. The forecast of the epidemiological situation for each of the observed infections is considered unsatisfactory if there is a tendency towards an increase in the proportion of seronegative ones.

6.18. When the first prognostic signs are identified in any territory, indicating an approaching worsening of the epidemiological situation for any of the infections under consideration, management decisions are made aimed at increasing the level of the immune layer among the population.

Appendix 1. Procedure for collecting, transporting and storing blood serum

Appendix 1

1. Technique for collecting and primary blood treatment

Capillary blood is taken from a finger under aseptic conditions. Before drawing blood, the patient's hand is warmed with hot water, then wiped dry with a clean towel. The finger, having been wiped with 70° alcohol, is pierced with a sterile disposable scarifier. Blood in a volume of 1.0-1.5 ml is collected directly through the edge of a sterile disposable centrifuge tube with a stopper (or into special microtubes for collecting capillary blood). After taking blood, the injection site is lubricated with a 5% iodine solution.

The tube should be numbered and a label should be attached to it indicating the registration number, surname, initials, and date of blood collection.

To obtain serums, a test tube with blood is placed in the room where the blood was drawn, in an inclined (at an angle of 10-20°) position at room temperature for 20-30 minutes to form a clot, after which the test tube with blood is shaken to separate the clot from the wall of the tube .

A list of examined persons is compiled, which indicates the city (district), number of the preschool institution, group, school, class, number of the secondary special institution, group, name of the university, faculty, group, registration number, surname, first name of the patient, date of birth, date vaccinations against diphtheria, tetanus, measles, rubella, mumps, polio and hepatitis B, date of blood draw, signature of the responsible person.

The test tubes along with the lists are sent to the clinical diagnostic laboratory of the hospital, where the test tubes with blood are left overnight in the refrigerator at a temperature of 4-8 °C.

After separating the serum from the clot (the tubes are circled along the inner surface with a sterile Pasteur pipette), it is centrifuged at 1000-1200 rpm for 15-20 minutes. Then the serum is carefully poured or aspirated with a bulb pipette into sterile centrifuge (plastic) tubes or Eppendorf tubes, with the label from the corresponding tube necessarily transferred to them.

In the laboratory, serum (without clot) can be stored in refrigerators at a temperature of (5 ± 3) ° C for 7 days before testing. For longer storage, the whey should be frozen at -20 °C. Re-freezing of thawed whey is not allowed. Having collected the required amount of sera, they are sent to the laboratory of the Federal Budgetary Institution of Health "Center for Hygiene and Epidemiology" of Rospotrebnadzor in a constituent entity of the Russian Federation for research.

2. Transportation of serum (blood) samples

Before transporting the collected material from the survey area, it is very important to take precautions: check the availability of the collected information, tightly cap the tubes, arrange the samples according to their numbers, etc. Lists of surveyed persons should be kept at the collection site. Thermal containers (refrigerator bags) are used to transport blood serum. When transporting and storing blood in the winter, it is necessary to create conditions under which it does not freeze.

When sending samples by rail or air, the laboratory must be notified (by telephone, telegram) of the train (flight) number, date and time of departure and arrival, number of samples, etc.

Appendix 2. Tables

Appendix 2

Table 1

"Indicator" groups for serological monitoring of the state of collective immunity to diphtheria, tetanus, whooping cough, measles, rubella, mumps, polio and hepatitis B


"Indicator" groups	Diphtheria	Tetanus	Rubella	Epidemi- chelic mumps	Polio- myelitis	Hepatitis B
1-2 years

Poliomyelitis - acute viral disease, which can lead to death or severe damage to the central nervous system. Mass vaccination has made significant progress in the fight against this disease. However, it still remains endemic in several countries in Africa and Asia. Outbreaks of the disease were recorded in recent years and in states bordering Russia.

Immunity to polio

Having immunity to polio reduces the likelihood of getting sick to a minimum. Vaccination allows the body to develop resistance to infection. However, even if all the activities were carried out, over time immune defense the body may weaken. Persistent immunity is developed in persons who have had the disease or been vaccinated with a live vaccine.

To find out whether a person has antibodies to the polio virus, serological analysis blood. This study allows you to determine the risk of infection when exposed to the virus. Typically, an antibody test is performed before traveling to regions where polio cases have been reported.

Where can I get an antibody test?

Testing for antibodies to the polio virus is performed in government and commercial laboratories. The research is not in great demand, so it is not carried out in all medical centers. To find out where exactly the test can be done in your city, consult with your local doctor or a specialist at the sanitary-epidemiological station.

IN government institutions the study is performed if indicated. Direction to free analysis an infectious disease specialist can give district clinic. IN paid centers the cost of determining antibodies to polio varies from 1000 to 3000 rubles.

How to get tested for polio antibodies

For quality and quantification antibodies to the polio virus are used enzyme immunoassay method. Antibodies are detected in serum or plasma. The result ranges from 0 to 150 U/ml. If the titer is above 12 U/ml, we can talk about the presence of immunity to infection.

It is better to come to the study morning hours before the first meal. In a patient from a vein. It is believed that 0.5-1 ml of blood is sufficient for diagnosis. Paid analysis completed within 1-2 business days, free - within two weeks.

A person is considered protected from disease caused by a particular type of poliovirus if that person has developed type-specific neutralizing antibodies. However, the titers of serum neutralizing antibodies that would provide protection against infection have not yet been definitively established. Experiments on animals have shown that passive transfer of antibodies, accompanied by the appearance of antibodies in moderate titers (1:20 and above), provides protection against the disease. However, these results cannot be extrapolated to human populations in which wild or vaccine strains of poliovirus circulate.

Studies conducted in the 1950s showed that individuals with low serum neutralizing antibody titers could be reinfected with wild poliovirus. This was confirmed by the observation of 237 people with natural immunity to polio and neutralizing antibody titers of 1:40 or less during familial outbreaks of polio in Louisiana in 1953-1957. Cases of reinfection, proven by a fourfold increase in serum antibody titers, were recorded in 98% of those examined. In contrast, out of 36 people with neutralizing antibody titers of 1:80 above, cases of reinfection were noted in only 33% of those examined.

Recent studies in Japan and the UK have shown that people with low post-vaccination titres of serum neutralizing antibodies may develop reinfection after infection with the vaccine strain of poliovirus. In Japan, when observing 67 children vaccinated with two doses of trivalent PPV for 5 years, 19 children had antibody titers to type 1 poliovirus of 1:8 or lower. After administration of the permissive dose of PPV, 18 of 19 children in this group developed reinfection, as indicated by the release of polio virus in feces. In the UK, a study was carried out in a group of 97 children who, 8-16 years after immunization in early childhood A new (“permitting”) dose of the same vaccine was administered in three doses of trivalent PPV. In 17 children of this group, before the introduction new dose vaccine, antibody titers to all three poliovirus serotypes were low (average geometric antibody titers ranged from 1:9 to 1:36). Although the number of children in this group is too small to draw statistically reliable conclusions, it should be noted that of the 8 children without an immune response to the new dose of the vaccine, seven had neutralizing antibody titers of 1:32 or higher. At the same time, in children who responded by seroconverting to the new dose, antibody titers before vaccination were low.

These data are consistent with previous studies showing that children with low serum antibody titers can be reinfected with the vaccine strain of poliovirus. These studies suggest that people with low but detectable serum antibody titers do not have an increased risk of developing clinically expressed forms polio. However, they can be reinfected with the polio virus and serve as sources of infection for people who have not been immunized.

The local barrier to polio viruses is provided by secretory IgA antibodies. The level of secretory IgA antibodies that would provide protection against infection remains unknown. Also unknown are the relationships between serum and secretory antibody titers. Children may be resistant to reinfection with poliovirus even in the absence of serum antibodies in cases where they have secretory antibodies in sufficiently high titers.
In 1955, J. Salk formulated his concept of “increased immunological reactivity", which can warn deaths against polio, even after using low-quality vaccines. As this concept developed, it was suggested that even after neutralizing antibody titers had fallen below the minimum detectable level immunological memory persists for an indefinite period of time, with the result that repeated immunological stimulation by vaccine or reinfection leads to a rapid and significant increase in antibody titers. It has been suggested that this secondary immune response to infection develops quickly enough to protect the individual from developing the paralytic form of the disease.

J. Salk suggested that lifelong immunity to polio could be induced by administering a single dose of inactivated polio vaccine(IPV), which a child should be vaccinated between 5 and 7 months of age. However, since this publication there have been reports of cases paralytic poliomyelitis in people who have received one or more doses of intensified IPV (uIPV). Moreover, the protective efficacy of a single dose of uIPV (39%) was found to be almost equivalent to the level of neutralizing antibodies induced by a single dose of this vaccine.

Please note
Consultation with a doctor is the key to your health. Do not neglect your personal safety and always consult a doctor on time.

Pathogenesis of polio
poliovirus

mucous membrane: nasopharynx (entrance gate)

epithelial cells of the mucous membrane intestines lymph nodes pharyngeal ring small intestine (Peyer's patches) (primary reproduction)		Isolation of poliovirus: from the pharynx (from the incubation period until the appearance of the first symptoms) - infection of people by airborne droplets in epidemic foci with feces (1 g contains 1 million infectious doses) - the main route of transmission of infection

(viremia stage lasts from several hours to several days)

formation of immune complexes

increasing the permeability of the blood-brain barrier

penetration of poliovirus (through the axons of peripheral nerves) into neurons: spinal cord brain		If virus-neutralizing antibodies accumulate in the blood, blocking the penetration of poliovirus into the central nervous system, no central nervous system damage is observed.

poliovirus reproduction (secondary target organs): motor neurons of the anterior horn of the spinal cord cerebral neurons neurons medulla oblongata

deep (often irreversible) degenerative changes in the cytoplasm - crystal-like accumulations of virions

flaccid atrophic paresis and paralysis

There are four clinical forms polio:

paralytic (1% of cases), it is most often caused by polyvirus serotype I

meningeal (1% of cases - aseptic meningitis, without the development of paralysis)

abortifacient or " minor illness» ( light form proceeding without damage to the central nervous system)

inapparent (hidden).

Poliomyelitis often occurs in two stages: after a mild form and significant improvement, a severe form of the disease develops.

Immunity in polio

Active post-infectious - humoral (virus-neutralizing antibodies have protective properties - therefore post-infectious immunity is type-specific - which appear even before the onset of paralysis, reach maximum titers after 1 - 2 months and persist for many years, providing almost lifelong immunity).

Passive (maternal) persists for 4–5 weeks of the child’s life.

It should be noted that a high concentration of antibodies in the serum does not prevent the development of paralysis after poliovirus has penetrated the central nervous system.

Diagnosis of polio

Isolation of the virus from the patient’s body (from nasopharyngeal swabs, blood, feces - depending on the period of the disease, posthumously - pieces of brain tissue and lymph nodes)

cultivation method - in cell cultures

indication - CPD

identification - RN

It should be noted that virus isolation, especially from feces, is not an absolute basis for diagnosis, given the widespread prevalence of asymptomatic carriage.

In conditions of mass vaccination with a live vaccine, intratype differentiation of “wild” (virulent) and vaccine variants of poliovirus is necessary:

Serological diagnosis in paired sera (the first days of the disease and 2 - 3 weeks after the onset of the disease, diagnostic value has an increase in titer of at least 4 times), antibodies are also detected in the cerebrospinal fluid:

For both methods, you can also use RPG and color proof.

Immunoprophylaxis of polio

Inactivated vaccine. Obtained by J. Salk (1953, USA) by treating the virus with a formaldehyde solution. Provides intense type-specific humoral immunity.

Advantages:

deprived of the possibility of mutations that can lead to an increase in virulence

less reactogenic (can be used for prophylaxis in persons with immunodeficiency and weakened children)

Flaws:

the need for three times parenteral administration

does not provide reliable local intestinal immunity, and therefore does not prevent the circulation of polioviruses among the population.

Attenuated vaccine. Obtained by A. Sabin (1956, USA). Vaccine strains are genetically stable, do not revert to the “wild type” when passaged through the human intestines, and do not reproduce in CNS cells.

In 1958, A.A. Smorodintsev and M.P. Chumakov developed an oral vaccine based on Sabin strains (currently available in liquid form). This vaccine is one of the mandatory vaccinations.

Advantages:

provides not only general humoral, but also local intestinal immunity (due to the synthesis of IgAS)

as a result of the interference of vaccine viruses with “wild” types in the epithelial cells of the mucous membrane of the small intestine, the latter are eliminated from the intestine

administered orally, which greatly facilitates its use

Flaws:

necessity constant monitoring for the genetic stability of the vaccine strain

less reliable in tropical countries

cannot be used for vaccination of immunodeficient persons and weakened children (risk of developing paralysis)

Passive immunoprophylaxis

Human immunoglobulin is used (to prevent the development of paralytic forms), although its use is very limited.

The role of Coxsackie and ECHO viruses in human pathology.

These viruses cause polio-like diseases in humans, lesions internal organs, acute respiratory infections, acute respiratory infections, central nervous system lesions.

Aftovirus and human pathogenicity of foot and mouth disease virus.

The foot-and-mouth disease virus, which causes a highly contagious disease in cloven-hoofed domestic animals, is classified as a separate genus of the picornavirus family.

The source of infection is sick animals.

A person becomes infected:

contact (when caring for sick animals) is the main route of infection

the nutritional route (when eating contaminated milk and meat without sufficient heat treatment) is a rarer method of infection.

Clinically, foot and mouth disease in humans manifests itself as vesicular rashes on the mucous membranes of the mouth, larynx and skin. Internal organ damage is rare.

Rhinoviruses, epidemiology, pathogenesis, immunity and diagnosis of acute contagious rhinitis.

Rhinoviruses

Rhinovirus virions are spherical in shape, with a diameter of 20 - 30 nm.

Unlike enteroviruses, they lose their infectious properties in an acidic environment.

Cultivated in cell cultures, causing CPE in them.

115 serotypes of rhinoviruses have been identified, many of which have identical antigens responsible for cross-reactions.

Epidemiology

The spread of rhinoviruses occurs through airborne droplets.

Rhinoviruses are the main causative agents of colds in humans.

Pathogenesis

Immunity

After the disease, a short-term (2 years) type-specific immunity remains, which is determined mainly by IgAS.

Diagnostics

General characteristics and composition environmental group arboviruses. Togaviruses: classification, structure, role in human pathology. The concept of filoviruses.

General characteristics and ecological groups of arboviruses.

Arthropod borne – transmitted by arthropods.

Arthropods are both vectors and hosts.

Syndromes:

Fevers of undifferentiated type

Hemorrhagic fevers

Encephalitis

2 and 3 – high mortality

Definition– viruses that cause natural focal diseases, usually transmitted by arthropods and causing 1 - 3.