Vestnik Kavkaza opens a new interactive project "Ask Doctor Kozlova’’. Lyudmila Kozlova, Professor, Doctor of Medical Sciences, Honored Doctor of Russia and Honored Scientist of Russia answers questions of readers and listeners. The theme of the first program is vaccination. Ludmila Kozlova advises at what age children should be vaccinated, as well as when it is best to refrain from vaccination.
See part 1 Ludmila Kozlova: A competent doctor should convince parents to vaccinate their children
- One of the first vaccinations given to our children is the BCG. What degree of protection does the BCG vaccination give? It is known that, for example, in most European countries, in France since 2007, in Austria and Germany since 1998, in Italy, Spain, Greece, the Netherlands, even in Ukraine they refused to carry out a general BCG vaccination. Is it needed for us?
- It's all about the prevalence. And in the countries you listed the prevalence of tuberculosis is lower among adults than in ours. And healthcare is organized like that because they take what tuberculosis is, and spread it, it shows a not quite prosperous socio-economic development of the country. The growth of tuberculosis has continued among adults. The growth slowed down a little bit, but there are many such strains of pathogens that virtually do not respond to antibiotics. Tuberculosis germs have a sustainable resistance to antibiotics. With children, the situation in our country is slightly better than with adults, thanks to these vaccines.
In pediatric treatment 50% of the success of the treatment depends on whether the parents believe a doctor. If you believe the doctor, it is easy to cure you, at least not to let your illness intensify, not to allow relapses to happen, if it is a chronic disease course. It is difficult for pediatricians in the time that is given to convince sometimes very negatively minded parents. If a doctor had been studying for 6 years and then his whole life, the parents did not studied for a single day.
I'm not saying that virtually all vaccinations are safe and they can be given to everyone. No. But in some cases those unpleasant events can be avoided, which are happening sometimes and are called post-vaccination. And, of course, there is an individual intolerance. How to avoid this? We must think together. But when there was a question personally about my relatives, about my grandchildren, they are all vaccinated. And, probably, it says that I am really "for". I was afraid too. But in general, I believe that we should not be obsessed and be afraid, we must believe that everything will be fine. The main thing is that children are healthy, and a good vaccine with good conditions of storage, transportation and conditions.
- This is a question that parents cannot control. This remains on the conscience of the medical institution, doesn’t it?
- No, it doesn’t. Parents can come to check and say: "Before my child will be vaccinated, I would like to see where you store it, the dates of the one you will use, and from where you brought it." Doctors have to show them. And when something is being hidden, it immediately creates a negative attitude. And so the baby remains defenseless against that infection.
Vaccines are not 100% protection, but if a child gets sick, a disease will flow much easier and without complications. There are different infections. For example, measles, scarlet fever, pneumonia, they are flowing differently. You can prevent this with the vaccine prophylaxis. Adults suffering from tuberculosis often allow themselves to refuse treatment, although they excrete the pathogen known as bacilli-pathogens. And a child can encounter these people everywhere. And he also remains vulnerable. That is why the BCG is done, and then after one year a mantoux test is carried out almost every year, because immunity also fades. And the time for being revaccinated, as it stands, is usually somewhere around 7 years old, but it is decided based on the results of the mantoux test.
- Tell me, to what extent is it important to vaccinate children right from infancy? Maybe vaccination should be started after six months or a year, when the child's immunity has formed sufficiently?
- There are such children to whom it should be given after a year. If they suffered, for example, heavy intrauterine hypoxia, they have changes in the nervous system. There are changes that are passable over time, but a child needs time. And so they are not vaccinated in a year.
- If for some reason, parents did not allow a child to be vaccinated, but before the kindergarten suddenly decided to start this vaccination campaign. Where to start?
- From the national vaccination calendar with the sequence that is listed there. The only thing is that the BCG, if the hospital is doing it without a mantoux test, then if a child came already after two years, the Mantoux test should be done before that, and then decide to vaccinate or not. Doctors know this well.
- Just 6-7 years ago, in addition to the DPT, I will tell our listeners that it means whooping cough, diphtheria, tetanus, there was a complex 5 in 1 vaccine - Pentaxim. Diphtheria, tetanus, pertussis, poliomyelitis and haemophilus influenzae. How justified was the use of such immunization cocktails? How are they being transferred? Are there no complications?
- Pentaxim has been around so long, in all countries of the world, that the safety and efficacy of this vaccine has been proven. If not for this vaccine, we must actually do five separate inoculations and plus something is repeated. It is a fairly large injection pressure on the child, it's stressful for him and stressful for the parents. Such a negative reaction and the state of the nervous system are not good for health. Of course, it is correct to use combined vaccines. But before they are also clinically tested.
The composition of this vaccine includes the vaccination against Haemophilus influenza. This is a good thing for young children up to 2-5 years, because along with the main agent of pneumococcus, the causative agent of otitis, otitis media, of sinusitis, inflammation of the sinuses, and even pneumonia, one of the main agents is a hemophilic infection. That is why vaccination calendars of developed countries have introduced a vaccine against haemophilus influenzae long ago.
- The next question that our listeners sent us is a question related to the poliomyelitis vaccine. This disease is almost defeated in the world. Why is a vaccine still being used?
- If it was defeated, no one in the world would vaccinate. But all countries are vaccinating. Because the migration processes are very large. And the disease can be spread.
- Is it true that a child who has not been vaccinated can catch, for example, in kindergarten, some infection from a child who was vaccinated with a live vaccine, for example, in the playground, in the pool, anywhere?
- It is possible. You need to follow the hygiene measures. According to our national immunization schedule, the first two vaccines are inactivate vaccine, and the third is a live one, there is some separation, after some time, somewhere within a month, you cannot get infected.
- There is an opinion that if a child is breastfed, he or she is not afraid of any disease. Is it so?
- Breastfeeding allows a child to grow up healthy, because the immune system is improved. During the first period of life he has maternal immunity, which he receives with the breast milk. Further, he grows as a more gentle person, affectionate, because it is a psychological communication, a continuous relationship with his mother. It is already proven. His immune system is stronger, but he can also get sick from any infections, just like other child. It all depends on the virulence and on the period he falls ill. Therefore, it is not a panacea.
- Lyudmila Vyacheslavovna, how long should breastfeeding continue? Because there are completely different opinions: someone makes it for 2-3 months, but others are feeding until the child is running and has all the teeth in his mouth.
- A perfect option is to finish it when the child is almost prepared, that means he gets all the lures. A child should be brestfed till he is 1-year old. And this is right. In recent time there is a discussion of feeding a child till he is 2-3-year old. Up to 4-6 months at least, a child should be purely breastfeeding. And then it is necessary to begin to introduce solid foods – various juices and cereals, vegetables and mashed potatoes, and meat dishes, etc. The longer a child is breastfed, this child is psychologically more balanced, less prone to all sorts of disorders of the nervous system.
- Is it right or not to vaccinate a child before going to kindergarten?
- Often, parents begin to vaccinate children before kindergarten registration. This should not be done. But it is good to vaccinate at least two-three weeks before kindergarten starts. Because, again, this is a stress for a child. His immunity reduces, when the child is under stress, and his adaptation to the kindergarten also reduces.
- And if there were no immunizations and a child goes to kindergarten, should there be any limitations?
- There are no restrictions.
