How to determine whether vaccination is needed or not
The situation with vaccinations is very simple: if it is possible not to do it, then it is better not to do it, because the consequences can be very diverse...
On the other hand, if a vaccination needs to be done, then it is better to do it, since it often happens that the vaccination was done, but the antibodies have not developed, immunity has not formed or has weakened over time.
Before vaccination against measles, it is advisable to conduct a blood test for antibodies (strength of immunity against measles). Everything is logical: if the analysis shows a sufficient amount of antibodies to measles, the vaccination is not done (because antibodies “say” that there is protection against measles in the body). Almost all people have a natural antibody titer that is quite high and literally 9-15% of the total amount is vaccinated.
A little theory
Even “at the dawn” of vaccination, it was known that THOSE who HAVE NOT developed specific (against a specific disease) immunity NATURALLY SHOULD BE VACCINED. Vaccinations are contraindicated for those who already have natural immunity against the disease! Often a healthy person has a high level of antibody titers to the infection. Before any vaccination, it is necessary to be tested for the presence of antibodies (immunity test)
The presence of internal immunity to infection may be due to the fact that the development of immunity (antibodies) occurs not only through vaccinations (this method, by the way, is very aggressive and causes a lot of controversy), but also in softer ways - through random short-term contacts with sick people. Any doctor will confirm that NOT EVERYONE gets sick when in contact with a patient, even the most contagious (infectious) disease! Why? Yes, because immunity against infectious diseases can be developed unnoticed (the same “vaccination”, but without artificial vaccines!). Antibody titers just show that an encounter with an infection has occurred, and that there is protection (this is exactly what is called “specific immunity”).
I repeat. Antibodies CAN be produced: a) during acute infection; b) when a healthy person encountered an infection and “overcame” it “unnoticeably” - i.e. “natural grafting” occurred. c) after the administration of a vaccine (inoculation). The main thing is the production of antibodies (whereas they say, “the vaccination has taken place”). How many antibodies are produced and how long they last is purely individual. It happens that a person gets ill with whooping cough three times in his life (that is, sufficient immunity is not developed even after the illness), and it happens that “imperceptibly developed immunity” (either after vaccination or without vaccination) protects against whooping cough for life .
Measles virus (IgM antibodies)
Measles (lat. Morbilli) is an acute infectious viral disease with a high level of susceptibility (the contagiousness index approaches 100%), which is characterized by high fever (up to 40.5 ° C), inflammation of the mucous membranes of the oral cavity and upper respiratory tract, conjunctivitis and characteristic maculopapular rash of the skin, general intoxication.
Measles has been known since ancient times. Its detailed clinical description was compiled by the Arab physician Rhazes (9th century), and the Englishmen T. Sidnam and R. Morton (17th century). Since the 18th century, measles has been considered as an independent nosology. The viral etiology of the disease was proven by A. Anderson and D. Goldberger (1911). The pathogen was isolated by D. Enders and T.K. Peebles (1954). Effective seroprophylaxis of measles was developed by R. Degkwitz (1916-1920). The live vaccine, used since 1967 for routine vaccination, was developed by A.A. Smorodintsev et al. (1960).
The causative agent of measles is an RNA virus of the genus Morbillivirus, family of Paramyxoviruses, has a spherical shape and a diameter of 120-230 nm. It consists of a nucleocapsid - an RNA helix plus three proteins and an outer shell formed by matrix proteins (surface glucoproteins) of two types - one of them is hemagglutinin, the other is a “dumbbell-shaped” protein.
All known strains of the virus belong to the same serovar; the antigenic structure is similar to the pathogens of parainfluenza and mumps. The most important antigens are hemagglutinin, hemolysin, nucleocapsid and membrane protein.
The virus is not stable in the external environment and quickly dies outside the human body from exposure to various chemical and physical factors (irradiation, boiling, treatment with disinfectants). At room temperature it remains active for about 1-2 days, at low temperatures for several weeks. The optimal temperature for preserving the virus is (-15)-(-20) °C.
Despite its instability to the external environment, there are known cases of the virus spreading over significant distances with the flow of air through the ventilation system - during the cold season in one single building. Weakened strains of measles virus are used to produce live measles vaccine.
The route of transmission of measles is airborne; the virus is released into the external environment in large quantities by a sick person with mucus during coughing, sneezing, etc.
The source of infection is a patient with measles in any form, who is contagious to others from the last days of the incubation period (last 2 days) until the 4th day of rash. From the 5th day of the rash, the patient is considered non-infectious.
Measles affects mainly children aged 2-5 years and much less often adults who did not have this disease in childhood. Newborn children have colostral immunity, passed on to them from their mothers if they have previously had measles. This immunity lasts for the first 3 months of life. There are cases of congenital measles due to transplacental infection of the fetus with the virus from a sick mother.
After an illness, stable immunity develops; re-infection with measles in humans, without concomitant pathology of the immune system, is doubtful, although such cases have been described. Most cases of measles are observed in the winter-spring (December-May) period, with an increase in incidence every 2-4 years.
Currently, in countries that carry out total measles vaccination, the disease occurs in the form of isolated cases or mini-epidemics.
The gates of infection are the mucous membranes of the upper respiratory tract and, possibly, the conjunctiva. After primary replication in epithelial cells and regional lymph nodes, the pathogen enters the blood, and primary viremia develops already in the incubation period. As a result, the virus disseminates, becomes fixed in various organs and accumulates secondarily in the cells of the macrophage system. In organs (lymph nodes, tonsils, lungs, intestines, liver and spleen, myeloid tissue of bone marrow), small inflammatory infiltrates develop with proliferation of the reticuloendothelium and the formation of multinucleated giant cells. During the incubation period, the number of viruses in the body is still relatively small and can be neutralized by administering measles immunoglobulin to persons who have been in contact with a measles patient no later than the 5th day after contact.
The appearance of catarrhal symptoms of the disease coincides with the occurrence of the second wave of viremia. The maximum concentration of the virus in the blood persists throughout the catarrhal period and the first day of the rash, then drops sharply. By the 5th day of the rash, virus-neutralizing antibodies appear in the blood, but the virus is no longer detectable.
Having a tropism for epithelial cells of the mucous membranes and the central nervous system, the virus mainly affects the upper respiratory tract (sometimes also the bronchi and lungs), the conjunctiva, and to a small extent the gastrointestinal tract. Inflammation develops with the appearance of giant cells in the lymphoid formations of the intestine, as well as in the central nervous system, as a result of which there is the possibility of developing complications in the form of meningitis and meningoencephalitis. The protein components of the virus and biologically active substances released in response to the circulation of the virus give catarrhal inflammation in the affected organs an infectious-allergic character. A specific inflammatory focal process with an allergic reaction, epithelial degeneration, increased vascular permeability, perivascular infiltration and edema underlies the formation of measles enanthema, Filatov-Koplik-Velsky spots on the mucous membrane of the cheeks and lips, and later exanthema.
Systemic damage to lymphoid tissue, macrophage elements, parts of the central nervous system (reticular formation, subtubercular region, etc.) leads to transient suppression of humoral and cellular immune reactions. The weakening of the activity of nonspecific and specific protective factors characteristic of measles, extensive damage to the mucous membranes of the respiratory tract and gastrointestinal tract, as well as a decrease in vitamin metabolism with a deficiency of vitamins C and A constitute a group of factors that contribute to the occurrence of various bacterial complications.
After recovery, immunity is formed with lifelong preservation of anti-measles antibodies in the blood. At the same time, it is believed that the virus can remain in the human body for a long time and be responsible for the development of a slow infection in the form of multiple sclerosis, subacute sclerosing panencephalitis, and also, possibly, some systemic diseases - systemic lupus erythematosus, systemic scleroderma, rheumatoid arthritis.
Microscopic picture : the mucous membrane of the respiratory tract - edema, vascular congestion, foci of necrosis, areas of epithelial metaplasia, focal lymphohistiocytic infiltration in the submucosal layer. Reticuloendothelial system - Warthin-Finkeldey cells. Skin - changes in the papillary layer of the dermis in the form of edema, congestion of blood vessels, hemorrhages with perivascular lymphohistiocytic infiltration, foci of necrosis in the epidermis.
The incubation period averages 1-2 weeks; with passive immunization with immunoglobulin, it can be extended to 3-4 weeks. Existing clinical classifications distinguish the typical form of measles of varying degrees of severity and the atypical form. The cyclical nature of the disease in its typical form allows us to distinguish three successive periods of clinical manifestations of measles:
- catarrhal period;
- rash period;
- period of convalescence.
The catarrhal period begins acutely. General malaise, headache, loss of appetite, and sleep disturbances appear. Body temperature rises, in severe forms it reaches 39-40 °C. Signs of intoxication in adult patients are much more pronounced than in children. From the first days of illness, a runny nose with copious mucous, sometimes mucopurulent, discharge is noted. An obsessive dry cough develops; in children it often becomes rough, “barking”, accompanied by hoarseness and (in some cases) stenotic breathing. At the same time, conjunctivitis develops with swelling of the eyelids, conjunctival hyperemia, scleral injection and purulent discharge. Often in the morning the eyelids stick together. The patient is irritated by bright light. When examining children with measles, puffiness of the face, hyperemia of the mucous membrane of the oropharynx, and granularity of the posterior pharyngeal wall are revealed. In adults, these symptoms are mild, but lymphadenopathy is observed (mainly in the cervical lymph nodes), harsh breathing and dry wheezing in the lungs are heard. Some patients experience short-term, pasty stools.
On the 3-5th day, the patient’s health improves somewhat, and the fever decreases. However, after a day, the manifestations of intoxication and catarrhal syndrome intensify again, and the body temperature rises to high numbers. At this moment, on the mucous membrane of the cheeks opposite the small molars (less often on the mucous membrane of the lips and gums), one can detect a cardinal clinical diagnostic sign of measles - Filatov-Koplik-Velsky spots. They are slightly protruding and tightly fixed white spots, surrounded by a thin border of hyperemia (a type of “semolina porridge”). In children, the elements usually disappear with the appearance of exanthema; in adults, they can persist during its first days. Somewhat earlier than Filatov-Koplik-Velsky spots or simultaneously with them, measles enanthema appears on the mucous membrane of the soft and partially hard palate in the form of red spots of irregular shape, the size of a pinhead. After 1-2 days they merge and are lost against the general hyperemic background of the mucous membrane.
At the same time, with increasing symptoms of intoxication, dyspeptic symptoms can sometimes be observed. In general, the catarrhal period lasts 3-5 days, in adults it sometimes lasts up to 6-8 days.
The period of rash is replaced by a catarrhal period. Characteristic is the appearance of a bright maculopapular exanthema, which tends to merge and form figures with areas of healthy skin between them.
- On the first day, elements of the rash appear behind the ears, on the scalp, then on the same day they appear on the face and neck, and upper chest.
- On the 2nd day of the rash, the rash covers the torso and upper arms.
- On the 3rd day, elements of the exanthema appear on the lower extremities and distal parts of the arms, and turn pale on the face.
A descending sequence of rashes is characteristic of measles and serves as a very important differential diagnostic feature. In adults, the rash is more abundant than in children; it is large macular-papular, often confluent; with a more severe course of the disease, hemorrhagic elements may appear.
The period of rash is accompanied by an increase in catarrhal symptoms - runny nose, cough, lacrimation, photophobia - and the maximum severity of fever and other signs of toxicosis. When examining patients, signs of tracheobronchitis, moderate tachycardia and arterial hypotension are often revealed.
The period of convalescence (pigmentation period) is manifested by an improvement in the general condition of patients: their health becomes satisfactory, body temperature normalizes, and catarrhal symptoms gradually disappear. The elements of the rash fade and fade in the same order in which they appeared, gradually turning into light brown spots. Subsequently, the pigmentation disappears in 5-7 days. After its disappearance, pityriasis-like peeling of the skin can be observed, mainly on the face. Pigmentation and peeling are also diagnostic, although retrospective, signs of measles. During this period, a decrease in the activity of nonspecific and specific protective factors (measles anergy) is noted. The body's reactivity is restored slowly; over the next few weeks and even months, reduced resistance to various pathogenic agents remains.
Mitigated measles. An atypical form that develops in individuals who have received passive or active immunization against measles or who have previously had it. It is distinguished by a longer incubation period, a mild course with little or no pronounced intoxication, and a shortened catarrhal period. Filatov-Koplik-Velsky spots are most often absent. The rash is typical, but the rash may occur simultaneously over the entire surface of the torso and limbs or have an ascending sequence.
Abortion measles is also an atypical form of the disease. It begins as a typical form, but is interrupted after 1-2 days from the onset of the disease. The rash appears only on the face and torso; an increase in body temperature is usually observed only on the first day of the rash.
There are also subclinical variants of measles, detected only by serological testing of paired blood sera.
Complications of measles.
The most common complication of measles is pneumonia. Laryngitis and laryngotracheobronchitis in young children can lead to the development of false croup. Stomatitis occurs. Meningitis, meningoencephalitis and polyneuritis are more often observed in adults; these conditions usually develop during the period of pigmentation. The most serious, but fortunately rare complication (more often in adults) is measles encephalitis.
Laboratory data for measles:
lymphopenia, leukopenia, in case of bacterial complications - leukocytosis, neutrophilia. With measles encephalitis, there is an increased content of lymphocytes in the cerebrospinal fluid. 1-2 days after the rash, specific IgM increases. After 10 days IgG. To identify specific anti-measles antibodies, the hemagglutination reaction is used. In the early stages of the disease, the virus is detected by immunofluorescence.
Measles should be differentiated from rubella, scarlet fever, pseudotuberculosis, allergic (drug-induced, etc.) dermatitis, enterovirus infections, serum sickness and other diseases accompanied by the appearance of skin rashes.
Measles is distinguished by a complex of main clinical manifestations in the catarrhal period: intoxication, runny nose with copious discharge, obsessive rough, “barking” cough, hoarseness, severe conjunctivitis with swelling of the eyelids, injection of scleral vessels and purulent discharge, photophobia, the appearance of a cardinal clinical diagnostic sign - Filatov’s spots -Koplik-Velsky on the 3-5th day of illness. Then a bright maculopapular exanthema appears, which tends to merge. A very important differential diagnostic feature characteristic of measles (with the exception of mitigated measles) is the descending sequence of rashes.
