Brief essay
Vaccination is not mandatory according to the approved vaccination schedule. And, in fact, most of the population are not at all familiar with this disease, its causes and consequences.
This disease was previously called "rodent disease", "minor plague" and "rabbit fever". People accurately noted its appearance with the presence of small rodents and found some similarities with the well-known bubonic plague. Speculation and conjecture turned out to be not so groundless - scientists discovered the cause of the disease - the bacterium Francisella tularensis.
The carriers in nature, indeed, are rodents of small breeds. A person becomes infected through contact through poor heat treatment of meat, contaminated water, mosquito bites and when animal waste products come into contact with food. That is why tularemia poses the greatest threat to residents of rural areas, as well as to workers on livestock farms.
Tularemia is an acute infectious disease of focal distribution, which is prone to mass destruction of the population of adjacent territories. History has not seen widespread epidemics because tularemia is extremely difficult to transmit.
At the turn of the 1990s and 2000s, in Russia, no more than 300 people were identified as having been infected, and this was due to the fact that the authorities canceled mandatory vaccination for what they thought was a minor infection.
In almost 100% of cases, this disease is sensitive to treatment with standard broad-spectrum antibiotics (macrolides, fluoroquinolones), but the recovery process can take from 1 to 3 months.
Perhaps the main symptom of tularemia is enlarged lymph nodes, which are called bubo in medical terms. Inflammation of the bubo disappears after 3 months after the start of active therapy.
No more than half a percent of the total number of infected people were registered, but tularemia is dangerous due to its further complications such as lobar pneumonia, encephalopathy, acute delirious psychosis and multiple lesions of the joints of the arms and legs. Tularemia is characterized by a transition to a chronic course after active antibiotic therapy. This can happen several months after treatment, and if this process is allowed, the chronic course will worsen, which will lead to severe damage to the membranes of the brain and spinal cord. However, as already mentioned, such cases are rare.
Characteristics of the tularemia vaccine
Today, the vaccine against tularemia is an extract of pathogenic, but not virulent, that is, those that are capable of infecting, bacteria. The vaccine is stored strictly in a dry and dark place in an ampoule, and right before injection it is diluted in distilled water.
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Before direct injection, a so-called serology test should be performed in order to determine the presence of active immunity against this pathogen. This is done by applying a preparation containing tularemin to the skin treated with a disinfectant and making a small puncture with a needle to draw blood from the finger. If hyperemia and slight swelling appear at the puncture site, this will indicate that the cells of the immune system are interacting with the pathogen, beginning to overcome it, and in this situation, vaccination is not necessary.
The vaccination process itself is similar in methodology. Apply 2 drops of the substance to the inner surface of the upper third of the forearm at a distance of 3 cm, and then a parallel shallow incision is made with a scarifier. It is important not to cut too deeply, but only to small droplets of blood. Vaccination can be carried out in conjunction with other vaccinations, or at the same time, if you need to be vaccinated against plague or brucellosis.
Active, lasting immunity will be formed after a month and will be valid for the next five years. After this, revaccination should be carried out.
Possible body reactions
Considering that the vaccine against tularemia contains, although not virulent, but still pathogenic microorganisms Francisella tularensis, the body's reaction to its administration should be typical for such cases. Often, this manifests itself in this way:
- Hyperemia, myxedema at the injection site on days 3-5
- Formation of small papules that will eventually turn into crusts
- General malaise
- Low-grade fever (37.5 – 38 °C) up to 4 days
- Peripheral lymphadenopathy
Vaccination and its side effects do not pose any danger; on the contrary, this indicates successful vaccination and the beginning of the formation of cellular immunity in the body. If these reactions are not observed within a week, revaccination should be carried out after 1 month.
Along with this, sometimes much more dangerous effects occur:
- Persistent fever (40 °C or more)
- Anaphylaxis
- Inflammation of peripheral lymph nodes
The possibility of side effects occurring is extremely low, however, in order to exclude such reactions, experts recommend being under the strict supervision of the attending physician for an hour or two, who, if the above described occurs, will be able to provide emergency assistance as quickly as possible.
It is worth noting that a severe reaction to vaccination is observed during repeated vaccination and in people who have had tularemia. That is why, an absolute contraindication to vaccination against tularemia is the presence of active humoral antibodies, which are formed as a result of the repeated entry of a foreign agent, such as bacteria, into the body. There are recommendations from the World Health Organization, according to which vaccination against tularemia in children under the age of seven years is not carried out under any circumstances.
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Absolute contraindications:
- Pregnancy and/or breastfeeding
- Acute diseases, exacerbation of existing ones
- Asthmatic status
- History of any antitumor therapy
- Oncology
- HIV status
If there is such a possibility, then vaccination is carried out a little later, or is excluded completely; all this correlates with the type of contraindications and the epidemiological situation in the territory.
Tularemia
The incubation period of tularemia can range from one day to a month, but most often it is 3-7 days. Tularemia of any localization usually begins with an increase in body temperature to 38-40 degrees, the development of intoxication, manifested by weakness, muscle pain, and headache. Fever is most often remitting, but can also be constant, intermittent or wave-like (two to three waves). The duration of fever can range from a week to two to three months, but is usually 2-3 weeks.
On examination, hyperemia of the face, conjunctiva and mucous membranes of the oral cavity, nasopharynx, pastiness, and scleral injection are noted. In some cases, exanthema (skin rash) of various types is found. Bradycardia, low blood pressure. A few days after the onset of fever, hepatosplenomegaly appears.
The variety of clinical forms of tularemia is associated with the method of infection. If the skin serves as the entry point for infection, the bubonic form develops, which is regional lymphadenitis. The axillary, inguinal, and femoral lymph nodes may be affected; with further spread, secondary buboes may be observed.
The affected lymph nodes are enlarged in size (sometimes reaching the size of a chicken egg), with distinct contours, initially painful, then the pain decreases and subsides. Gradually, the buboes dissolve (often within several months), become sclerotic or suppurate, forming abscesses, which then open onto the skin to form a fistula.
The ulcerative-bubonic form usually develops during transmissible infection. At the site of introduction of microorganisms, an ulcer is formed (bypassing the successive stages of spots, papules, vesicles and pustules) with raised edges and a bottom covered with a dark crust, of small depth, reminiscent of a cockade. The ulcer heals extremely slowly. In parallel, regional lymphadenitis develops.
When the pathogen penetrates through the conjunctiva, tularemia manifests itself in the form of an oculobubonic form: a combination of ulcerative-purulent conjunctivitis with regional lymphadenitis. Conjunctivitis manifests itself in the form of inflammation (redness, swelling, pain, feeling of sand in the eyes), then papular formations appear, progressing to erosion and ulcers with purulent discharge. The cornea is usually not affected. This form of tularemia is often very severe and long-lasting.
The anginal-bubonic form occurs if the portal of infection is the pharyngeal mucosa; infection occurs through the consumption of contaminated food and water. Clinically manifested by sore throat, dysphagia (difficulty swallowing), upon examination, hyperemia and swelling of the tonsils are noted. On the surface of enlarged tonsils, fused with the surrounding tissue, a grayish necrotic coating is often visible, which is difficult to remove. As the disease progresses, the tonsils become necrotic, forming difficult-to-heal ulcers and, later, scars. Lymphadenitis in this form of tularemia occurs in the parotid, cervical and submandibular nodes on the side of the affected tonsil.
When the lymphatic vessels of the intestinal mesentery are affected by infection, tularemia manifests itself in the form of an abdominal clinical form, severe abdominal pain, nausea (sometimes vomiting), and anorexia. Diarrhea may occur. Palpation pain is localized in the navel area, hepatosplenomegaly is noted.
The pulmonary form of tularemia (developing from inhalation of dust containing bacteria) occurs in two clinical forms: bronchitis and pneumonic. The bronchitis variant (with damage to the bronchial, paratracheal mediastinal lymph nodes) is characterized by a dry cough, moderate chest pain and general intoxication, is quite mild, recovery usually occurs in 10-12 days. The pneumonic form lasts a long time, the onset is gradual, the course is debilitating with signs of focal pneumonia. Pneumonic tularemia is often complicated by bronchiectasis, pleurisy, the formation of abscesses, cavities, and even pulmonary gangrene.
The generalized form occurs as typhoid and paratyphoid infections or sepsis. Fever does not remit properly, persists for a long time, severe intoxication, intense muscle pain, progressive weakness, headache, dizziness, delirium, hallucinations, confusion.
Indications for vaccination
Due to the fact that at the moment outbreaks of tularemia are predominantly local in nature, it is not included in the list of mandatory vaccinations. However, there are some categories of the population that are more susceptible to contracting it:
- Residents of regions where a tularemia outbreak has been documented
- Agricultural and livestock workers, grain barn and mill employees
- People involved in processing the skins of small rodents
- Living in areas with high rodent populations
- Hunting animals
If contact with a pathogen is expected, then the minimum time for which it is worth getting vaccinated should be at least two to three weeks. This is not always possible, which is why agricultural workers are recommended to be vaccinated at the beginning of the season.
A person can become infected:
- direct contact with animals (for example, during hunting or skinning);
- when consuming contaminated food and water (for example, from a well, mountain streams and other open bodies of water);
- less commonly, the disease is transmitted by inhaling contaminated dust during threshing of grain crops;
- infection is possible through the bites of blood-sucking insects (horsefly, tick, mosquito, etc.).
The causative agent of tularemia is highly pathogenic for humans; 3-7 days pass from the moment of infection to illness.
Conclusion about tularemia vaccination
As a result, it can be argued that the vaccine against tularemia is necessary for people who live in endemic areas or those whose work involves animals. The pros and cons of tularemia vaccination is an extremely controversial issue.
Vaccination is carried out by applying the reagent to slightly cut skin where, under normal circumstances, the body's response should occur. Cellular and humoral immunity once formed lasts up to five years.
If, under any circumstances, you have been infected with tularemia, immediately consult a doctor for an accurate diagnosis! An infectious disease doctor, having carried out diagnostic measures, will determine the presence or absence of contraindications to vaccination, explain to you how the drug works and what it is, prescribe treatment and give recommendations on prevention. After which, he will send a notification about the infectious disease to the district SES to take measures to deratize and detoxify the affected area.
How the tularemia vaccine works
Prevention methods help prevent severe infections. We are talking about vaccination. The vaccine against tularemia contains a portion of microbial cells: they enable the immune system to form the correct response to the causative agent of the disease.
The drug for tularemia (and there is only one) is called “Live tularemia vaccine.” The ampoule contains a dry substance - lyophilisate, intended for dissolution in liquid. In addition to the directly active substance, the product contains additional components (sucrose, sodium glutamate monohydrate, etc.) that promote absorption.
There is only one drug for vaccination against tularemia - “Live tularemia vaccine”
Vaccination options
There are two ways to administer the vaccine into the human body:
- Subcutaneous. Moreover, 0.1 ml of the reconstituted drug contains (1.0±0.1) x 10 x 7 living pathogen cells.
- Cutaneous. Applying small incisions to the skin. In 0.1 ml of the drug there will already be (2.0±0.5) x 10 x 8 microbial cells.
In each specific case, the vaccination method is chosen by the attending physician.
Is the tularemia vaccine mandatory?
The vaccine against tularemia is not included in the routine vaccination calendar (as, for example, vaccination against tuberculosis, measles, tetanus, polio, etc.). That is, it is not mandatory, which is understandable: many citizens of the Russian Federation live in natural conditions that are not conducive to the spread of this infection. However, if adults and children live in a region with a dangerous infectious situation, vaccination against tularemia for children is already carried out as planned. Most often, it is done at school (the health worker distributes forms in advance to the students, where parents must express their consent or refusal of vaccination), you can also go to the clinic for this purpose.
Most often, children are vaccinated right at school.
Naturally, no one will force a child to be vaccinated. But if there are periodic outbreaks of infectious foci in the region, doctors will strongly recommend that parents get vaccinated.
Children are immunized only from 7 years of age. The vaccination provides protection against tularemia for 5 years, after which revaccination will be required.
You should be aware that certain categories of the population are particularly at risk of contracting tularemia. These are people working in agriculture, livestock farming, working in mills, in grain barns, processing the skins of small rodents, and hunters. If the father or mother of the child is employed in such areas, this is an additional reason to vaccinate the baby.
If the child’s father, for example, is a hunter, then the risk of contracting tularemia increases
Immunity after vaccination is developed after 20–30 days. However, at the time of vaccination the child must be healthy. Otherwise, the opposite effect may work: the body will be affected by the bacterium instead of creating protection against it.
How do you feel about mandatory vaccination?
- Positively, it prevents many diseases. 60%, 2623 votes
2623 votes 60%2623 votes - 60% of all votes
- Negatively, these are all government schemes to make it easier to manage us. 26%, 1150 votes
1150 votes 26%
1150 votes - 26% of all votes
- Neutral, I don’t think it has any effect on my health. 13%, 588 votes
588 votes 13%
588 votes - 13% of all votes
Total votes: 4361
Voted: 4336
January 17, 2018
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