Клинические наблюдения Обоснование. Омализумаб рекомендован для лечения хронической спонтанной (идиопатической) крапивницы, резистентной к блокаторам Н1-гистаминовых рецепторов, у детей с 12 лет. Цель исследования-оценить результаты терапии, включавшей омализумаб, у подростков с хронической идиопатической крапивницей. Методы. Изучали истории болезни пациентов дневного стационара в возрасте 12-17 лет с хронической крапивницей, неконтролируемой антигистаминными препаратами 2-го поколения и/или иммунодепрессантами не менее 1 мес (в стандартной или выше стандартной дозировке), получавших омализумаб (300 мг 1 раз в 4 нед подкожно). Основной исход терапии-контроль болезни (индекс активности крапивницы за предыдущие 7 сут, ИАК7, равный нулю) к 3 и 6 мес терапии. Дополнительные исходы: количество значимых обострений (применение глюкокортикостероидов или экстренная госпитализация) к 6 мес терапии и через 6 и 12 мес после ее завершения; отмена сопутствующей терапии (антигистаминные препараты и/или иммунодепрессанты) к 3 и 6 мес и генно-инженерных биологических препаратов (ГИБП); ремиссия (ИАК7=0) через 6 и 12 мес после отмены ГИБП; нежелательные реакции на омализумаб (любые медицинские события, связанные с ГИБП). Результаты. Из 18 детей с хронической крапивницей контроль болезни к 3 мес лечения достигнут у 12 (67%) пациентов, к 6 мес-у 13 (72%). В период терапии омализумабом и через 6 мес после завершения значимых обострений крапивницы не было, через 12 мес после ее завершенияу 1 (6%) подростка. После 3 мес лечения сопутствующая терапия отменена у 3 (17%) пациентов, после 6 мес-у 10 (56%). Ремиссия заболевания сохранялась у 11 (61%) из 18 пациентов через 6 мес и у 9 из 15 оставшихся под наблюдением (60%) через 12 мес после завершения терапии. Нежелательных реакций на омализумаб не отмечено. Заключение. Добавление омализумаба к терапии подростков с неконтролируемой хронической идиопатической крапивницей позволяет достичь контроля болезни к 6 мес лечения у большинства пролеченных больных. Ключевые слова: подростки, хроническая крапивница, индекс активности крапивницы, антигистаминные препараты 2-го поколения, омализумаб, эффективность, безопасность.
Background. Monitoring of documented vaccination is one of the indicators of the epidemiological supervision quality of preventive vaccination. It is crucial for epidemical situation prevention. Objective. The aim of the study is to estimate immunization and immunization coverage levels according to National Immunization Schedule (NIS) for children population in Russia. Methods. Immunization rates were estimated according to preventive vaccination cards (form №063/y) and children development cards (form №112/y) among children aged from 6 months to 15 years in 8 towns of Russia. Immunization was determined by the ratio of people who has fully performed all the vaccines from NIS (version of the year 2014), while immunization coverage – by the ratio people who has received at least one dose of corresponding vaccine. Results. The study has included data from 2,687 vaccinated children. The highest levels of immunization and immunization coverage were against tuberculosis (98.1% each), hepatitis B (85.9% and 96.5%), measles, mumps and rubella (84.4% and 93.9%). Immunization against diphtheria, pertussis and tetanus significantly differed from their immunization coverage (60.5% and 94.9%), as well as for poliomyelitis (65.0% and 94.9%). Relatively low immunization and immunization coverage levels were observed for pneumococcal infection (27.6% and 47.1%) and influenza (5.8% and 30.5%). The increase in the immunization level with age was observed for all vaccines, except pneumococcal vaccine. Conclusion. Immunization and immunization coverage against infections included in NIS vary significantly. The highest immunization and immunization coverage levels for all age groups were revealed for tuberculosis vaccine, and the lowest — for influenza vaccine.
Background. Worldwide private health care system plays significant role in promoting immunization programs for the children population. The role of private medical facilities in Russia in combating children vaccination issues has not been previously studied.Objective. The aim of the study is to study immunization and immunization coverage in children population according to the national immunization schedule (NIS) in outpatient clinics of different forms of property.Methods. The study of medical documentation of children in private (n = 1) and public (n = 2) facilities in Moscow and Moscow region was performed. Immunization (complete vaccination course in those who should be vaccinated by age) and immunization coverage (at least one dose of vaccine by those who have to be vaccinated) were estimated against the NIS schemes according to the data from preventive vaccination cards (form 063/y) and from preventive vaccination lists (form 112/y).Results. The study includes 313 cards of children from private outpatient clinic and 305 — from public outpatient clinic. Immunization and immunization coverage of children against tuberculosis were similar in these facilities: 293 (94%) and 294 (96%) (p = 0.114), respectively, as well as immunization coverage against hepatitis B — in 282 (90%) and 269 (88%) (p = 0.448). Rates of immunization and immunization coverage against the remaining NIS infections were higher in the private clinic. Maximum differences were noted in immunization (178 (57%) in private and 19 (6%) in public facilities; p < 0.001) and immunization coverage (238 (76%) and 52 (17%), respectively; p < 0.001) against pneumococcal disease. Immunization coverage of children for epidemic indications was also higher in private clinic: the largest differences were in immunization against hemophilic and meningococcal infections.Conclusion. Children followed up in private outpatient clinic have higher immunization and immunization coverage rates against most of the NIS infections.
Background. Vaccination of infants with 13-valent pneumococcal conjugate vaccine (PCV) was implemented in national immunization schedule in 2014. In this regard epidemiological monitoring of routine immunization results with vaccination coverage and efficiency control is required. Objective. Our aim was to study correlation between pneumococcal disease routine immunization in infants and morbidity and mortality rates due to community-acquired pneumonia in children under 18 years of age and morbidity rate due to acute otitis media in children under 14 years of age. Methods. Morbidity (Form № 2, 2011–2017 yrs) and mortality (Form № 51S, 2009–2017 yrs) rates due to community-acquired pneumonia, morbidity rate (Form № 12, 2009–2017 yrs) due to acute otitis media, vaccination coverage rate (Form № 5, 2014–2017 yrs, and Form № 6, 2016–2017 yrs) were analysed according to the data of Forms of Federal Statistical Monitoring. Medical exemptions and refusals to vaccinate rates were estimated according to the data from doctors who was performing infants vaccination. Results. During PCV routine vaccination within national immunization schedule in Russian Federation the 35% reduction of mortality due to community-acquired pneumonia in children under 1 year of age as well as reduction of morbidity with acute otitis media have been established. Moreover, low percentage of etiology clear community-acquired pneumonias (29%) complicates the estimation of vaccination efficiency. It has been revealed that despite the high pneumococcal disease vaccination coverage rate of infants under 2 years of age (87%), considerable part of children (73%) are vaccinated untimely in most Russian Federation regions. 9.3% (3.4% due to medical exemptions) of children (among 1st year infants) remained unvaccinated due to medical exemptions and refusals to vaccinate in 2016, and 8% (3.4%) in 2017 respectively. Conclusion. Implementation of PCV routine immunisation for three years in a row leads to reduction of morbidity rate due to acute otitis media among children under 14 years of age and infant mortality rate due to community-acquired pneumonias. Though, the estimation of routine immunisation efficiency can be difficult due to such factors as untimely start of vaccination, medical exemptions and refusals to vaccinate and limited laboratory diagnostics of community-acquired pneumonias etiology.
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