Контактная информация:Вишнёва Елена Александровна, кандидат медицинских наук, заместитель директора НИИ педиатрии по научной работе, заведующая отделом стандартизации и клинической фармакологии, врач аллерголог-иммунолог отделения стационарозамещающих технологий НИИ педиатрии ФГАУ «НМИЦ здоровья детей» Минздрава России Адрес: 119991, Москва Ломоносовский пр-т, д. 2, стр. 3, тел.: +7 (499) Вакцинопрофилактика пневмококковой инфекции у детей * ХАРАКТЕРИСТИКА ВОЗБУДИТЕЛЯ Streptococcus pneumoniae -неподвижный грам-положительный, каталазо-и оксидазоотрицательный ланцетовидный диплококк. Основой клеточной стенки пневмококка является пептидогликан со встроенными углеводами, тейхоевыми кислотами, липопротеинами и поверхностными белками. Полисахаридная капсула пневмококка -главный фактор патогенности и виру-лентности возбудителя -способна ограничивать ауто-лиз и снижать активность антибиотиков. В то же вре-мя выработка протективных специфических антител в ходе развития инфекционного процесса, а также в результате вакцинации происходит именно в отноше-нии антигенов полисахаридной оболочки пневмококка.На основании разнообразия состава полисахарид-ной капсулы в настоящее время выделено 96 серотипов S. pneumoniae. Серотип определяет степень вирулент-* Публикация является обновленным вариантом методических рекомендаций Министерства здравоохранения РФ по вакцинопро-филактике пневмококковой инфекции, опубликованных на сайте www.cr.rosminzdrav.ru, https://www.rosminzdrav.ru/poleznyeresursy/klinicheskie-rekomendatsii-po-vaktsinoprofilaktike-pnevmokokkovoy-infektsii ности пневмококка, уровень устойчивости к антибио-тикам, форму и тяжесть заболевания. Распространение серотипов варьирует в зависимости от возраста, прак-тики применения антибактериальной терапии, клини-ческих проявлений, географического местоположения и сезона. Результаты исследований, проведенных в раз-ных странах, свидетельствуют, что более 80% наиболее тяжелых инвазивных случаев болезни обусловлены 20 серотипами пневмококка, а 13 вызывают до 70-75% заболеваний. Повышенной устойчивостью к основным антибактериальным препаратам обладают пневмококки серогрупп 23, 19 и 6.S. pneumoniae -представитель условно-патогенной флоры человека. Единственно эпидемически значимым резервуаром возбудителя является человек, больной той или иной формой пневмококковой инфекции, или бактерионоситель.
Active hydrogen inhalation (H(H2O)m) has powerful antioxidant and antiapoptotic effects. In recent years, it has been used in a number of experimental and clinical studies.Aim. To study the safety and effectiveness of inhalation of the “active form of hydrogen” (AFV;(H(H2O)m)) in the rehabilitation program of coronavirus disease 2019 (COVID-19) survivors during the recovery period.Material and methods. This randomized controlled parallel prospective study included 60 COVID-19 survivors with post-COVID-19 syndrome (ICD-10: U09.9) during the recovery period, with clinical manifestations of chronic fatigue syndrome (CFS), who received standard therapy in accordance with the management protocol of patients with CFS (ICD-10: G93.3): physiotherapy and medication therapy with drugs containing magnesium, B vitamins and L-carnitine. The patients were divided into 2 groups. The experimental group (n=30) included patients who received hydrogen inhalation for 90 minutes every day during 10 days (SUISONIA hydrogen inhalation device, Japan). The control group (n=30) consisted of patients who received standard therapy. In both groups, patients were comparable in sex and mean age: in the experimental group — 53 (22; 70) years, in the control group — 51 (25; 70) years. Biological markers of systemic inflammation, oxygen transport, lactate metabolism, intrapulmonary shunting, 6-minute walk test, and vascular endothelial function were determined in all patients on the 1st and 10th days of follow-up.Results. In the experimental group, a decrease in following parameters was revealed: stiffness index (SI), from 8,8±1,8 to 6,8±1,5 (p<0,0001); ALT, from 24,0±12,7 to 20,22±10,61 U/L (p<0,001); venous blood lactate, from 2,5±0,8 to 1,5±1,0 mmol/L (p<0,001); capillary blood lactate, from 2,9±0,8 to 2,0±0,8 mmol/L (p<0,0001); estimated pulmonary shunt fraction (Qs/Qt, Berggren equation, 1942) from 8,98±5,7 to 5,34±3,2 (p<0,01); white blood cells, from 6,64±1,57 to 5,92±1,32 109/L. In addition, we revealed an increase in the refractive index (RI) from 46,67±13,26% to 63,32±13,44% (p<0,0001), minimum blood oxygen saturation (SpO2) from 92,25±2,9 to 94,25±1, 56% (p<0,05), direct bilirubin from 2,99±1,41 to 3,39±1,34 pmol/L (p<0,01), partial oxygen tension (PvO2) from 26,9±5,0 to 34,8±5,6 mm Hg (p<0,0001), venous oxygen saturation (SvO2) from 51,8±020,6 to 61,1±018,1% (p<0,05), partial capillary oxygen tension (PcO2) from 48,7±15,4 to 63,8±21,2 mm Hg (p<0,01), capillary oxygen saturation (ScO2) from 82,2±4,2 to 86,2±4,8% (p<0,01), distance in 6 minute walk test from 429±45,0 to 569±60 m.Conclusion. Inhalation therapy with H(H2O)m in the rehabilitation program of COVID-19 survivors during the recovery period is a safe and highly effective method. Manifestations of silent hypoxemia and endothelial dysfunction decreased, while exercise tolerance increased. As for laboratory tests, a decrease in the white blood cell count, estimated pulmonary shunt fraction and lactate content parameters was revealed.
Aim. Determination of intensity of immunity against measles in patients on waiting-list for lung transplantation. Materials and methods. IgG levels against measles virus were studied in blood sera of 80 adult patients (mean age 35.8± 11.4 years) on waiting-list of lung transplantation, without history of this disease. Determination of IgG levels against measles virus was carried out by ELISA using a standard kit from «Vektor-Best» (VectoMeasles-IgG). Results. Protective level of IgG against measles virus (above 0.18 I U/ml) was registered in 83.3% of examined patients. Mean level of anti-measles antibodies was within protective values - 1.53 IU/ml (95% confidence interval 1.17 - 1.89). Medium level of anti-measles antibodies (1 - 5 IU/ml) was registered in most of the analyzed samples (55.2%). A positive correlation between values of antibodies and age of patients (r=0.43) was detected. Dependence between levels of antibodies and previously executed hormonal and cytostatic therapy was not detected. Conclusion. Patients on waiting-list of solid organ transplantation are a group of risk for development of severe course of measles infection, that dictates the necessity of execution of vaccination at short terms before or after registration on the waiting-list.
The trend in the formation of postvaccinal antibodies (Ab) to a mixture of S. pneumoniae polysaccharides (PS) was studied in 100 Pneumo 23-vaccinated children and adolescents with type 1 diabetic (T1D) (Group 1, n = 72) and its combination with the subunit vaccine Grippol (Group 2, n = 28). Following 1-1.5 months, the protective level of Ab l 40 conventional units (CU/ml) was revealed in 95.1 and 85.2% of Groups 1 and 2, respectively; and after 1 year, this was in 55.1 and 37%, respectively (p > 0.05). The level of formation of IgG Ab to a PS mixture did not depend on the age of patients, the duration of T1D, the presence of late diabetic complications. A relationship was found between the formation of postvaccinal Ab and their baseline level: in patients with very low (< 10 CU/ml) and low (10-20 CU/ml) levels of Ab after administration of pneumococcal vaccine, the level of IgG Ab to a S. pneumoniae PS mixture increased by 8.8-4.1 times in the early periods and exceeded the baseline levels by 4.8-2.8 times, respectively. The putative protective level of IgG AB to a S. pneumoniae PS mixture is proposed to be l 20 CU/ml.
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