When vaccinations against the hepatitis virus are given to children and adults - schedule of mandatory and according to indications

Why is a vaccine needed for children?

Hepatitis B is a viral disease. Its pathogen can persist for a long time in the external environment. Infection can occur hematogenously - through the blood of an infected person. For example, this is possible due to blood transfusion or the use of non-sterile instruments that can damage the skin.

When the virus enters the body, it quickly provokes an acute attack of hepatitis B. If a person is vaccinated, then the immune system defeats the virus.

Hepatitis is especially dangerous for children. When the virus enters a child’s body, it provokes the development of chronic hepatitis in 95% of cases. There are a number of emergency cases when vaccination is done urgently :

• the child was infected during childbirth;
• mother used drugs;
• close relatives were infected with the virus;
• The pregnant woman was not examined for hepatitis B during pregnancy.

If vaccination is not carried out in a timely manner, the child may experience serious complications.

The vaccine against viral hepatitis is a medicinal solution containing a clearly defined amount of immunogenic hepatitis B protein
. IMPORTANT. During the immunization period, active production of antibodies to hepatitis is observed.
By combining a natural antibody and an enemy antigen, the body adequately responds to the pathogen. Vaccination allows you to develop fairly stable immunity against the disease.

General facts about hepatitis B

Hepatitis B or jaundice is a viral disease of the liver and surrounding organs. There are two forms of the disease - acute and chronic. The first develops over six months after the pathogen enters the human body. Specific symptoms in the early stages are rarely expressed, and the manifestations are similar to acute respiratory diseases. Sometimes, during the entire course of the disease, the patient’s condition remains the same. This makes diagnosis difficult.

Over time, a person's skin and mucous membranes turn yellow. Other symptoms include:

• Lack of appetite;
• Nausea;
• gag reflexes;
• Pain syndrome of the left hypochondrium;
• Changing the color of discharge;

In newborns and children under one year of age, manifestations of hepatitis are subtle. There is practically no change in the color of the dermis. The disease can last up to one and a half months, after which the child recovers. However, there are 1-2% of patients in whom a transition to the “fulminant form” is possible. This course of the disease leads to death in 93% of patients.

Incorrectly or untimely treated hepatitis becomes chronic. Approximately 10% of patients with jaundice are carriers of the virus. This pathology often leads to further complications in the functioning of organs.

Chronic hepatitis is much more common in children than in adults. When the disease occurs between the ages of one and five, the probability of chronicity of the process reaches 50%, and in children one year old and younger – 90%. The disease is transmitted only through contact with blood. Routes of infection:

• During blood transfusion, or direct contact with biological materials of the carrier;
• During sexual intercourse;
• By heredity;
• Everyday contact (handshakes, kisses);
• Through household items;

Vaccine manufacturers and their composition

The production of modern vaccines is based on the use of genetic engineering technology. Almost all medicinal solutions for vaccination consist of 90-95% antigen and only 5-10% are additional components.

All hepatitis vaccines are produced by different manufacturers, but using the same technology . They have the same or similar composition. These drugs contain the following substances:

• hepatitis B virus envelope protein;
• preservative;
• aluminum hydroxide;
• traces of yeast proteins.

Some vaccines do not contain preservatives. The following drugs are registered and approved for use in Russia :

• Eberbiovak NV;
• H-B-VAX II;
• Combiotech;
• Engerix-B (engerix-b);
• Microgen;
• Sci-B-Vac;
• Regevak B;
• Shanvak.

The vaccination drug EUVAX B has been withdrawn from use because it has caused deaths. In Russia, the most common type of virus is the ayw virus. To combat it, the drug Regevak is used.

There are a number of combination drugs for vaccination. The drug Bubo-M is used to prevent tetanus, diphtheria and hepatitis. Bobo-Kok is used to prevent whooping cough, diphtheria, hepatitis B and tetanus.

What vaccines are approved for use?

Recently, there are many different vaccines against this virus. Every year their composition improves, so side effects are rarely observed. If a negative reaction occurs to one drug, it is replaced with another during the next procedure. Among the vaccines used in modern medicine are:

1. Engerix V. The manufacturer is Belgium. Release form - a bottle with 0.5 ml of suspension (10 μg of HBsAg antigen) or with 1 ml (the dose is already 20 μg). This drug is indicated for children of mothers who are carriers of hepatitis B or have had it, children in orphanages and boarding schools, patients with blood cancer, and people employed in the production of immunobiological agents. For newborns, the vaccine is injected into the thigh, and for adolescents and adults, the vaccine is injected into the shoulder. The vaccination schedule is 0-1-6. Engerix only promotes the development of immunity, without causing the disease itself.
2. Euvax V. The manufacturer is the South Korean company LG Chemical LTD, and its distributor is the French company Aventis Pasteur. The drug is an inactivated vaccine that produces immunity against hepatitis B. The production uses Saccharomyces cerevisiae produced in yeast cells. Intramuscular administration of the vaccine causes the development of immunity against hepatitis B for 10-15 years. The drug is indicated for newborns and adults. For babies, 0.5 ml is administered into the upper third of the thigh. Adults are vaccinated in the shoulder with a dose of 1 ml. Vaccination is carried out three times with intervals of 1 and 6 months. Euvax has a minimal risk of complications, including inflammation of the optic nerve, paralysis of the facial nerve, and exacerbation of multiple sclerosis.
3. HB-Vax-II. This is a recombinant drug containing the Australian antigen HBsAg produced by yeast cells. The manufacturer is Merck Sharp & Dohme, Switzerland. The drug is available in the form of a suspension with different dosages for children, adolescents, adults and individual dialysis patients. The vaccine is administered according to the same scheme - 0-1-6 months. It is indicated for all persons, regardless of age, if they are at risk of contracting the virus. The dosage for children is 0.5 ml, and for adults – 1 ml. HB-Vax-II, when immunized, creates persistent specific immunity to the hepatitis B virus.
4. Combiotech Ltd. This is the first and only vaccine that contains antigens of different serotypes (ay and ad). It provides maximum protection. The vaccine itself is a viral protein adsorbed on aluminum hydroxide and synthesized by a recombinant yeast strain. Combiotech Ltd provides a very high level of protection, so it allows the use of an alternative vaccination schedule - a two-time administration instead of a three-time one. The vaccine has confirmed safety for use in children with severe infectious diseases and patients with chronic hepatitis B. A child is administered 0.5 ml of the drug, and an adult – 1 ml. It is indicated for everyone who is at risk of getting sick.
5. EberBiovac. Joint development of Cuba and Russia. Recombinant vaccine in the form of a suspension for intramuscular administration. After vaccination, it forms specific antibodies to hepatitis B. A protective titer appears in 95% of vaccinated people. The drug is indicated for everyone, adults and children, for the purpose of immunization. The injection method remains the same: for newborns - into the thigh, and for adults - into the shoulder. The vaccination schedule also does not change and is 0-1-6 months.
6. Shanvak-V. The manufacturer is Shanta Biotecnics (India). There are two composition options for this vaccine: without a preservative and with the preservative thimerosal. It has no substances of animal or human origin. After a course of immunization, antibodies remain in 90% of cases. This vaccine is indicated for all newborns and adults who are at risk of contracting this virus. Persons under 19 years of age are administered 0.5 ml, and older adults - 1 ml. A weaker immune response occurs in people over 40 years of age due to age. They may require an additional course of vaccination. In general, the vaccination schedule is as follows: 0-1-6 months.
7. Bubo-M. The manufacturer is Combiotech, Russia. The vaccine has increased effectiveness, because it combines several vaccinations at once - against hepatitis B and ADS-M, i.e. from tetanus and diphtheria. In this case, immunity against all three pathologies will develop. The vaccine composition includes recombinant antigens, tetanus and diphtheria toxoid. The drug is indicated for children during the first or repeated vaccination against these diseases. It is also used for adults for the same purpose. A single dose is 0.5 ml intramuscularly.
8. Bubo-Kok. Another development of the Russian company Combiotech. The vaccine is a multicomponent injection against hepatitis B, whooping cough, tetanus and diphtheria. The vaccination schedule here is slightly different - 0-4.5-6 months. The vaccine is given in a dose of 0.5 ml in the thigh area or the upper outer quadrant of the buttock. The vaccine reduces the number of visits to the clinic, because a person is vaccinated against four dangerous diseases at once.

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Vaccination schedules for children

Newborns in the maternity hospital

The first vaccination for newborn children is done on the first day of their life, directly in the maternity hospital. It is important that the baby is healthy and weighs more than 2 kg. Vaccination can be carried out for jaundice, since the mechanism of action of the drug does not affect the liver.

Parents may refuse vaccination. To do this, they must confirm their refusal in writing.

If the injection was not given on the first day of life, then the series of vaccinations can begin on any other subsequent day.

Second – at 1 month

The second vaccination is carried out when the child is one month old. The optimal interval between injections is 4 weeks.

This time the vaccine is administered at the clinic. You must first obtain a referral from a pediatrician; this is done during a routine examination.

It is important that the interval between the first and second vaccination does not exceed 5 months. Otherwise, vaccination will have to start again.

Third – after 6 months

The period between the first and third injection is 6 months. Lasting immunity is formed 2 weeks after the third vaccination.

If there is a high risk of infection, then immunization is carried out according to an accelerated plan. The first injection is given within 12 hours after the baby is born, the second after a month, the third at 2 months and the last one a year.

What to do if the schedule is missed?

If a vaccination is missed without an aggravating factor, vaccination continues as usual. If the second injection was not given on time, the third should not be postponed. Immunity after two procedures of vaccine administration lasts for 1.5 years. During this period the last vaccination should be given.

If more than 1.5 years have passed since the second administration of the drug, then it is necessary to be tested for the presence of antibodies to the virus. If their concentration is insufficient, another series of injections is performed.

How long does it last?

If fully vaccinated in infancy, immunity against hepatitis B lasts for 22 years. Some may lack antibodies against the hepatitis virus, but this is not an indicator that you need to get vaccinated. This is explained by the fact that for analysis it is not always possible to take a blood sample in which antibodies will be present.

According to WHO research, on average, the duration of active immunity from hepatitis after injection lasts about 8 years. In Russia there are no exact methods and criteria for reintroducing the vaccine. According to WHO recommendations, you should undergo examination 5-6 years after vaccination. In practice, many people remain immune to hepatitis B for life.

Preparing the child

In order for the child’s body to react normally to the administered vaccine, it must be prepared in advance. It is important that the baby is healthy a week before the vaccination.

Otherwise, all the body’s forces will be aimed at fighting ARVI or a runny nose, and not at producing antibodies.

To administer the vaccine, it is advisable to choose a period when the child will not be bothered by teething.

IMPORTANT . A few days before and after vaccination, you should not introduce new foods and dishes into your baby’s diet.

This is necessary to ensure that an allergic reaction to vaccines does not overlap with an allergy from the product. Without prior consultation with a doctor, 5-7 days before the administration of the drug, you should not give your baby new medications or vitamins.

Where is the injection given?

The vaccine is injected into muscle tissue. Subcutaneous injections are not provided. Most often, the graft is done in the thigh or shoulder, since in these places the muscles come as close to the skin as possible. If you choose the wrong place, the vaccine gets into the fat layer.

REFERENCE. For children under 3 years of age, the drug is administered into the thigh area. It is not recommended to inject the vaccine into the buttock. For older children, intramuscular injection is made into the deltoid muscle - shoulder.

Where do children get vaccinated against hepatitis?

The hepatitis B vaccine is injected into the lateral upper third of the thigh, where muscle tissue is well developed, for children in the maternity hospital and in subsequent months.
For children of preschool and school age, the solution, like for adult patients, is injected into the outer upper third of the shoulder (deltoid muscle of the arm).

This method of vaccination prevents the immune suspension from entering large vessels or prevents damage to nerve trunks.

It is important to ensure that the hepatitis B vaccine is not given subcutaneously. Only the intramuscular route of administration of solutions containing adjuvants makes it possible to minimize the risk of systemic and local reactions in the form of tissue hyperemia, swelling and pain.

Adverse reactions in a child

How do side effects change with the first, second and third vaccinations?

Modern vaccines cause virtually no complications or side effects. A negative reaction is observed in rare cases. Most often, unwanted effects appear after 2 or 3 vaccinations.

The child experiences:

• redness and soreness at the injection site;
• increased body temperature;
• weakness;
• headache;
• digestive problems;
• increased sweating.

The appearance of redness and pain at the site of vaccine administration is explained by the body's reaction to aluminum hydroxide. The following conditions occur as severe side effects and complications:

• hives;
• anaphylactic shock;
• allergy to yeast dough;
• rash.

The incidence of complications is minimal because all vaccines are pre-tested to ensure their safety. There is an opinion that after vaccination for hepatitis B, the risk of developing multiple sclerosis increases. According to studies conducted by WHO, no such relationship was found. The vaccine does not have any effect on neurological disorders.

How to deal with these effects?

Mild side effects after vaccination are normal. In most cases, they go away on their own within 2-3 days after the vaccine is administered. To alleviate the baby's condition, you can use antihistamines and antipyretics. If there are more serious manifestations and a deterioration in the child’s condition, you should immediately consult a doctor.

Possible side effects and complications

Preparations containing jaundice antigens have an extremely high degree of purification. Other substances included in the medication are needed to activate the immune system and distribute it throughout the body. Therefore, vaccination of newborns against hepatitis is one of the safest to use.

Attention! A typical post-vaccination reaction to an injection is irritation at the injection site.

A reaction from vaccination against hepatitis in infants occurs in no more than 10% of cases. Redness and thickening of the injection site are noted. Occasionally, pain may occur when moving. Such reactions occur due to the action of an adjuvant - aluminum hydroxide, which is needed to enhance the immune response.

Hyperthermia, weakness, and lethargy appear much less frequently. All these ailments are considered expected and, with bed rest, go away without the use of antihistamines in 1-2 days.

Contraindications

The main contraindication to vaccination is the presence of an allergic reaction to products that contain baker's yeast. There are a number of temporary contraindications in which vaccination is carried out only after the patient’s condition improves. Temporary contraindications include the following clinical situations:

• exacerbation of a chronic disease;
• the presence of an acute infectious lesion;
• prematurity;
• ARVI;
• intestinal diseases.

What can and cannot be done after vaccination?

To avoid complications and side effects, you should carefully follow all doctor’s recommendations. After vaccination against hepatitis B, the child can be bathed. Water treatments should not be excluded from his usual routine.

There is a greater chance that itching at the injection site will be caused by sweat rather than clean water. The grafting site should not be rubbed with a sponge or wetted with river water. In this case, there are risks of infection from dirty water.

Vaccination is not a ban on walking outdoors, but in rainy or cold weather it is better to stay at home.

Important! During the immunization period, it is better not to take a small child to the playground or to crowded places.

How is hepatitis B vaccination tolerated in children?

In most cases, the use of the vaccine against viral hepatitis B in healthy children occurs without significant complications or with complications associated directly with the injection (redness, the formation of a small nodule and pain at the injection site).

In very rare cases, the following negative reactions may occur:

1. increase in body temperature (slight);
2. malaise, weakness and sweating;
3. stomach upset;
4. skin redness, itching, urticaria;
5. headaches and dizziness.

Where can I do it and how much does it cost?

For free

Vaccination against hepatitis B in accordance with the National Vaccination Calendar is free of charge, that is, at the expense of government funding. To receive such a vaccination, you need to go to the clinic at your place of residence. The state provides routine vaccinations to children and adults up to 55 years of age.

Paid

A paid vaccination can be done at any private medical organization that has permission to provide services of this kind. It is important that the procedure is carried out by a physician who is authorized to administer vaccinations.

For example, in Invitro the price for vaccination with the children's hepatitis B vaccine Regevak is 700 rubles, Combiotech - 500 rubles. The cost of vaccination with Twinrix is ​​1200 rubles. On average, the price in all clinics is almost the same; it can only vary depending on the drug that will be used for injection.

Is it possible to combine vaccines on the same day?

Combination vaccines

The hepatitis B vaccine can be combined with the DTP vaccine. For newborns, such drugs are administered on the same day. In the future, the doctor himself determines the appropriate frequency of vaccine administration.

The compound vaccine DTP-hepatitis involves intramuscular administration, most often the injection is given in the anterior outer part of the thigh. Do not inject medicine into adipose tissue.

If the baby has received 1-2 DTP vaccinations without hepatitis vaccine, then a combined injection is allowed. A month later, and then after half a year, the missed injections are given with a mono hepatitis vaccine.

The use of combination drugs is more convenient, as it allows you to make the vaccination schedule as flexible as possible. Double vaccination does not have any additional negative effects on the baby’s body.

Together with the polio vaccine

Often the combined DPT-hepatitis vaccine is supplemented with the polio vaccine. One vaccine may contain several pathogens at once. Some parents refuse to carry out combined vaccinations in order to reduce the burden on the child's body, but combining several vaccinations at a time is also possible.