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Efficiency of vaccination of children who undergone severe bacterial infections
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Mullaeva Lola Javlanovna, senior staff scientist of Republican Specialized Scientific-Practical
Medical Center of Pediatrics
Efficiency of vaccination of children who undergone severe bacterial infections
Abstract: When immunization of children after the disease against vaccine-preventable diseases in the standard calendar dates of preventive vaccinations, there was a high frequency of seronegative results (20.8%) and low titer (31.3%) of antibody against diphtheria. Children who underwent sepsis, in the development of seronegative results and low titers of antibodies against diphtheria play an important role in ante, intranatal factors and particular in postnatal that are the state of health of vaccinated child.
Keywords: children, sepsis, risk factors, vaccination, diphtheria, tetanus
The health status of children who need vaccination is an important part of the list of factors, determining the state of immunity and epidemiological safety for the controlled vaccination of childhood infections [2]. Due to the practical impossibility of massive individual monitoring of the effectiveness of immunization, lack of objective methods of predicting outcomes, it remains unaccounted quite a large group of children, not producing or quickly losing protective level of immunity after the standard of immunization schemes [3; 6].
Transferred at an early age severe bacterial infections is crucial in the future formation of the immune system, in particular forming the ability to adequately respond to any antigenic exposure, including vaccination [5]. On this basis, the aim of the research was to study the results of immunization of children who had sepsis, soon after clinical recovery.
Materials and methods. The study involved children who had sepsis at the age of 1 month to 1 year 6 months (before vaccination and n=46 after vaccination n=144) immu-
nized 3 times DPT vaccine until 6 months from the revaccination at 1 year 4 months according to the national calendar of preventive vaccinations. Selection and formation of groups conducted specifically on the principle of "a couple of copies". At the design were included only cases of sepsis with laboratory confirmed of etiology. Status of children after transferred or carried sepsis was evaluated according to physical and neurological status, the dynamics of the curve of body weight and laboratory studies. In this category of children was used the classification of Ostrovsky and AT Vorobyov, 1978. The control group consisted healthy children of the same age (n=45), immunized with DTP vaccine in the standard times of the national calendar of preventive vaccinations — 3-fold to 6 months with revaccination at 1 year 4 months (according to the rules and regulations on organization and conducting the immunization of infectious diseases of Republic of Uzbekistan) [4].
To solve complex tasks was conducted serological methods of research. To study the response of immune cells to
Section 7. Medical science
antigenic stimulus and the formation of specific immunity to all children who have had sepsis, and subsequent vaccinated according to the calendar of preventive vaccinations against diphtheria and tetanus, serological studies were conducted — determining the level of antibodies against tetanus and diphtheria toxin serum using the direct hemagglutination reaction with diphtheria and tetanus diagnosticums. Seronegative considered persons having antibody titers less than 1:20, protecting against diphtheria antibody titers considered RPGA 1:40 and more. The titers of antitoxins 1:20-1:40 considered low, 1:80-1:160 average, 1:320 and higher considered as characterizing the high level of security.
Analytical studies. The data of complex examination of patients were processed using a special computer program. In the analysis of the data were used modern mathematical methods of statistical processing of data from clinical studies — clinical trials "case-control" with the estimate of the relative of chance (OR) and the relative risk (RR), to establish which were evaluated the ante, intra and postnatal factors. For predicting inadequate response to vaccination, as well as study the contribution of each risk factor or a complex in the development of a system used by the inadequate response prediction is the method of mathematical and statistical analysis [1].
Results. In the study of post-vaccination immunity in children, immunized after transferred or carried sepsis, following data were obtained. Seronegative results (20,8%) and low titers (31,3%) diphtheria antitoxic antibodies were detected in children who undergone sepsis is 2.1 times more likely, than in healthy children of the same age (P<0,05). The detection rate of average titers was 1.4 times lower than in the control group. High titers were detected in children of the main group in 2,1 times less often. The geometric mean of titers of antibodies to diphtheria toxoid was 50,7±1,7 in the basic 1:153,7±113,7 and in the control group (P<0,01). The detection rate of seronegative results to tetanus in 2,1 times higher in children undergone sepsis in comparison with healthy children (P<0,05). Geometric mean of titers of antibodies against tetanus was in the main group 151,1±11,9 and in the control group 310,7±12,7 (P<0,01).
Taking into account the results of post-vaccination immunity, in this category of children, we were analyzed the risk factors contributing to the development of protective and not protective antibody titers against diphtheria. For this purpose the children of the main group were divided into two groups: 1st subgroup - children who undergone sepsis with seronegative and low titers of antibodies to diphtheria (n=75) and 2nd subgroup - children who undergone sepsis with medium and high titers of antibodies to diphtheria (n=69).
Analysis of the ante, intranatal period in 1st subgroup identified most reliably significant risk factors for inadequate (seronegative and low) immune response. Pathology in labor occurred in 76.3% of the mothers in surveyed group, relative chance of developing no protective antibody titers increased in 7.2 times, and a relative risk in 2.2 times. Taking medicines
during pregnancy was diagnosed in 45.4% of mothers - OR and RR inadequate immune response increased in 2.23 and in 1.75 times. Mastitis after delivery were recorded significantly more frequently in mothers of children subgroup I - OR and RR seronegative and low immune response increased in 2.7 and in 2.47 times. The relative risk of developing chance and no protective antibody titers were less pronounced in the presence of a history of the following factors: in cases of anemia OR and RR increased in 2.6 and in 1.6 times; at chronic inflammatory diseases of the mother OR and RR increased in2.3 and 1.43 times; with SARS, acute respiratory infections during pregnancy OR and RR increased in 2.1 and in1.63 times, respectively; when genital infections OR and RR increased in 2.0 and 1.84 times.
Statistical evaluation of the relative opportunities and risks of inadequate post-vaccination response in the analysis of the postnatal period in children who undergone sepsis, with no protective antibody titers revealed the most significant risk factors. Protein energy malnutrition was observed in 13.9% of children in 1 subgroup, OR and RR seronegative or low titers of antibodies to diphtheria increased in 10.47 and in
9.5 times, respectively. Disorders of the gastrointestinal tract (anorexia, dysfunction functional nature) in 77.8% of children - OR and RR inadequate immune response increases in 7,3 in 2,43 times. Neurodevelopmental disability was observed in 73.3% of children - OR and RR increased to 7.22 and 2.66 times. In surveyed children, a violation of the calendar of preventive vaccinations was in 68.0% of children - OR and RR increased to 4.85 and 2.2 times. Changes in the functional state of the CNS (reduction of physiological reflexes) was observed in 61.8%, about the chances and risks does not produce protective antibody titers increased to 4.84 and 2.49 times. Functional disorders of the cardiovascular system in children subgroup 1 were recorded at 32.0%- OR and RR increased to 4.16 and 2.16 times, respectively. Anemia was observed in 56.0% of children - OR and RR increased by 3.6 and 2.15 times.
The lower relative risk of chance and not protective immune response to vaccination in children who underwent sepsis was observed with the following risk factors: frequent SARS and acute respiratory disease OR and RR increased by 3.4 and 2.1 times; artificial feeding OR and RR increased to 2.83 and 1.84 times; mixed feeding OR and RR increased by
2.6 and 2.1 times; thymomegaly OR and RR increased to 2.17 and 1.8 times.
Discussion. Thus, children with a history of severe bacterial infections are not able to adequately respond to the vaccination, using standard approaches. The definition of "inadequate response" includes, along with post-vaccination reactions and complications, immune response, does not protect against infectious diseases, to prevent that the vaccine is used. Vaccination of children is limited to the scope of the requirements of immunization schedule, a variety ofregulations and instructions. The calendar of vaccinations with the average doses of vaccines and rigid framework equalizes of immunization conditions the
