A significant progress in the management of controllable infections achieved by the early XXI century made it possible eliminate poliomyelitis across the nation, and practically eliminate measeles by vaccinating 96-99% of the children without raising the complication rate. The list of counterindications was shortened significantly, the Calendar of immunoprophylaxis was supplemented by inoculations against hepatitis B, rubella, flu, and type b Haemophilis influenzae infections. Morbidity of controllable infections in Russia decreased substantially compared with that in the 1990s. Nevertheless, the public health services are faced with the necessity of speedy application of new vaccines (including combined ones) allowing the inoculation impact on the child to be reduced. A rationale for the use of vaccines against pneumococcal and meningococcal infections, hepatitis A, varicella and for scaling up anti-pertussis vaccination coverage is proposed. Equally important is more extensive vaccination against papillomavirus infection as a means of cervical cancer prevention and introduction of the rotavirus vaccine to control most viral diarrheas.
Progress in immunology greatly contributed to the understanding of mechanisms of infectious immunity and vaccine action. Moreover, it facilitated the development of new vaccines and vaccination not only of healthy children but also of subjects with health problems and chronic diseases including the use of several vaccines. The number of contraindications could be decreased without a rise in the frequency of post-vaccination complications. Immunoprophylaxis allowed the incidence of controllable infections to be reduced; the level of epidemiologic well-being achieved in the course of this work provided a basis for eradication of some diseases. At the same time, successes of vaccination made mankind dependent on the use of vaccines. As a result, discontinuation of mass vaccination and even temporal decrease of its scale in the absence of certain infections or in the situation of their sporadic occurrence (i.e. the lack of natural immunization) lead to their reappearance. Specific features of modern immunoprophylaxis of infectious and non-infectious pathology and its timetable are described.
Modern principles of organization and planning of international clinical trials of vaccines and stages of development of domestic vaccines are presented. Factors that determine the success of large-scale clinical trials are thoroughly described. Differences between domestic registration trials and international multicenter randomized clinical trials are discussed. It has been recommended how national regulatory acts that legitimate conducting of clinical trials of both national and foreign vaccines should be harmonized.
Analytic materials on prevention of controlled infections in Russia and perspectives for extension of immunoprophylaxis field are presented. It was determined that immunization against pertussis should be expanded. Necessity to include vaccines against hepatitis A, Hib, pneumococcal infection, varicella as well as rotavirus and human papillomavirus infection in National immunization schedule is substantiated. It was noted that introduction of new vaccines will require both increase of funding for immunization and switch on use of combination vaccines containing 4 - 6 components.
Analysis of pneumococcal disease burden in Russia, which is a serious threat to children's and adults' health and which was underrecognized until last decade, is presented. Extrapolating data about etiologic structure of pneumonia and meningitis on published incidence figures, we can estimate the incidence of pneumococcal pneumonia in children in Russia: 490 per 100,000 for children aged 1 month - 15 years, and 1060 per 100,000 for children aged 1 month - 4 years. For complicated forms, these figures are 90 and 181 per 100,000 respectively. Mean incidence of pneumococcal meningitis is 8 per 100,000 children aged