Прививка иммуноглобулина от гепатита а

Прививка иммуноглобулина от гепатита а

Переезд склада в Европу.
Реализуем препараты от гепатита С в России по закупочной цене - ликвидация склада
Перейти на сайт

«È íàîáîðîò — êðàéíå íèçêà âåðîÿòíîñòü òîãî, ÷òî â ÑØÀ íîâîðîæä¸ííûé èìååò õîòü ñêîëüêî-íèáóäü çíà÷èòåëüíûé ðèñê çàðàæåíèÿ ãåïàòèòîì  â äåòñêîì âîçðàñòå, ïîñêîëüêó ýòî áîëåçíü, ïåðåäàþùàÿñÿ êðîâüþ. Âðÿä ëè íîâîðîæäåííûå ìîãóò áûòü âîâëå÷åíû âî âíóòðèâåííîå èñïîëüçîâàíèå ïðåïàðàòîâ èëè íåáåçîïàñíûé ñåêñ. Âðÿä ëè îíè ìîãóò ïîñòðàäàòü îò çàðàæ¸ííîé èãëû, êàê ìåäèöèíñêèé ðàáîòíèê. Åäèíñòâåííûé ïóòü, êîòîðûì îíè ìîãóò çàðàçèòüñÿ ãåïàòèòîì — ÷åðåç óæå èíôèöèðîâàííóþ ìàòü.
Äëÿ ìåíÿ î÷åíü ïðèìå÷àòåëüíî òî, ÷òî, â ñâåòå îòñóòñòâèÿ íàó÷íîé è ìåäèöèíñêîé èíôîðìàöèè î íåîíàòàëüíîé èììóíîëîãèè, íîâîðîæäåííûå — è îñîáåííî òå, êîòîðûå íå íàõîäÿòñÿ â ãðóïïå ðèñêà ïî ãåïàòèòó  — ïîëó÷àþò ìíîãî÷èñëåííûå ïðèâèâêè ïðîòèâ ãåïàòèòà Â. Èìååòñÿ ìàëî, èëè íå èìååòñÿ âîîáùå, êëèíè÷åñêèõ èññëåäîâàíèé äëÿ àäåêâàòíîé îöåíêè âîçìîæíûõ îòñðî÷åííûõ ðåàêöèé íà ïðèâèâêè íîâîðîæäåííûì, îñîáåííî â òîì, ÷òî êàñàåòñÿ ãåíåòè÷åñêèõ ðàçëè÷èé».
Ñâèäåòåëüñòâî ïðîô. Áîííè Äþíáàð ïåðåä Êîíãðåññîì ÑØÀ
Âòîðíèê, 18-å ìàÿ 1999 ã.
http://www.homeoint.org/kotok/vaccines/dunbar.htm

«Èçó÷åíèå âîçìîæíîãî âëèÿíèÿ H-B-Âàêñ II íà ðåïðîäóêòèâíóþ ôóíêöèþ ó æèâîòíûõ íå ïðîâîäèëîñü».

Èñòî÷íèê: îôèöèàëüíûé ñàéò ôèðìû MERCK & CO., Inc., Whitehouse Station, N.J., U.S.A.  http://www.msd.ru/content/corporate/products/h-b-vaxii.html

Íàó÷íî-èññëåäîâàòåëüñêàÿ äåÿòåëüíîñòü êîìïàíèè Merck Research Laboratories

Ðàçðàáîòêà è èñëåäîâàíèå íîâûõ ëåêàðñòâ, ñïîñîáíûõ ïîìî÷ü Âàøåìó çäîðîâüþ 
 
Äåÿòåëüíîñòü êîìïàíèè õàðàêòåðèçóåòñÿ âíåäðåíèåì íîâîé ïðîäóêöèè èëè ðàçðàáîòêîé íîâîãî ïðèìåíåíèÿ äëÿ óæå ñóùåñòâóþùèõ ïðîäóêòîâ, ÷òî îáåñïå÷èâàåòñÿ áëàãîäàðÿ îáøèðíûì íàó÷íî-èññëåäîâàòåëüñêèì ïðîãðàììàì.  íàó÷íî-èññëåäîâàòåëüñêóþ äåÿòåëüíîñòü êîìïàíèè âîâëå÷åíû ïðèìåðíî 11.400 ÷åëîâåê. Ðàñõîäû êîìïàíèè íà íàó÷íî-èññëåäîâàòåëüñêóþ äåÿòåëüíîñòü ñîñòàâèëè 4,8 ìëðä. äîëëàðîâ ÑØÀ â 2006 ã., 3,8 ìëðä. äîëëàðîâ ÑØÀ â 2005 ã., 4,0 ìëðä. äîëëàðîâ ÑØÀ â 2004ã.

http://www.msd.ru/content/corporate/research/index.html

Äàííûé òåêñò, óâàæàåìûé ÷èòàòåëü, ñîñòàâëåí òàê: âíà÷àëå èä¸ò ïðîïàãàíäà îáÿçàòåëüíîé âàêöèíàöèè îò ãåïàòèòà Â, à çàòåì èíôîðìàöèÿ, êîòîðàÿ íàñòîðîæèò ëþáîãî òðåçâîìûñëÿùåãî ÷åëîâåêà…

http://www.privivka.ru/info/infections/hepatitis-b.php

Âñïîìíèòå, ÷òî êàðòèíà ãåïàòèòà ïðåäâàðèòåëüíî çàïèñàíà
çà äâå íåäåëè äî ïåðâîãî ýïèçîäà êîãäà â çåðêàëå ïðîÿâëÿþòñÿ âèðóñíûå íåãàòèâû
è âû çàìå÷àåòå ÷òî âàøè ãëàçà ñëåãêà æåëòåå ÷åì îáû÷íî»
(«Áèëåò, êîòîðûé ëîïíóë», Óèëüÿì Áåððîóç)
Âèðóñíûé ãåïàòèò  – èíôåêöèîííîå çàáîëåâàíèå ïå÷åíè, âûçûâàåìîå îäíîèìåííûì âèðóñîì, õàðàêòåðèçóþùååñÿ òÿæåëûì âîñïàëèòåëüíûì ïîðàæåíèåì ïå÷åíè. Áîëåçíü èìååò ðàçëè÷íûå ôîðìû – îò íîñèòåëüñòâà âèðóñà äî îñòðîé ïå÷åíî÷íîé íåäîñòàòî÷íîñòè, öèððîçà ïå÷åíè è ðàêà ïå÷åíè. Ãåïàòèò  ïðèíàäëåæèò ê çàáîëåâàíèÿì, ïåðåäàâàåìûì ðàçëè÷íûìè ïóòÿìè. Íàèáîëåå ðàñïðîñòðàíåííûå – ïîëîâîé êîíòàêò è êîíòàêò ñ êðîâüþ èíôèöèðîâàííîãî ãåïàòèòîì Â. Ìîæíî çàðàçèòüñÿ ãåïàòèòîì  ïðè ïîñåùåíèè ñòîìàòîëîãà, ïàðèêìàõåðñêîé, ïðè ïåðåëèâàíèè êðîâè âî âðåìÿ ïîäãîòîâêè ê îïåðàöèè, ïðè èñïîëüçîâàíèè çàðàæåííîãî øïðèöà, à òàêæå ïðè áûòîâûõ êîíòàêòàõ ñ èíôèöèðîâàííûì ÷åëîâåêîì. Çàðàçèâøèñü ñàì, ÷åëîâåê ïîäâåðãàåò çíà÷èòåëüíîìó ðèñêó ñâîèõ áëèçêèõ. Áîëüøîìó ðèñêó ïîäâåðãàþòñÿ è ìåäèêè, èìåþùèå ÷àñòûå êîíòàêòû ñ êðîâüþ — õèðóðãè, ñòîìàòîëîãèè, ñîòðóäíèêè ëàáîðàòîðèé. Êðîìå òîãî, âèðóñ ìîæåò ïåðåäàòüñÿ îò ìàòåðè ê åå áóäóùåìó ðåáåíêó âî âðåìÿ áåðåìåííîñòè èëè íåïîñðåäñòâåííî â ðîäàõ.
 Ðîññèè åæåãîäíî ðåãèñòðèðóåòñÿ ñâûøå 50 òûñ. íîâûõ ñëó÷àåâ çàáîëåâàíèÿ è íàñ÷èòûâàåòñÿ ñâûøå 5 ìèëëèîíîâ õðîíè÷åñêèõ íîñèòåëåé âèðóñà ãåïàòèòà Â, ïðåäñòàâëÿþùèõ îïàñíîñòü êàê ïîòåíöèàëüíûé èñòî÷íèê èíôèöèðîâàíèÿ. Ó áîëüøîãî ÷èñëà õðîíè÷åñêèõ íîñèòåëåé ñî âðåìåíåì ðàçâèâàåòñÿ õðîíè÷åñêàÿ ôîðìà çàáîëåâàíèÿ ñ ïåðåõîäîì åå â öèððîç è ïåðâè÷íûé ðàê ïå÷åíè. Âèðóñ ãåïàòèòà  – îñíîâíàÿ ïðè÷èíà îäíîé èç ñàìûõ ðàñïðîñòðàíåííûõ ôîðìû ðàêà – ïåðâè÷íîãî ðàêà ïå÷åíè (ãåïàòîöåëëþëÿíîé êàðöèíîìû). Ïî èìåþùèìñÿ äàííûì, âèðóñ ãåïàòèòà  â 100 ðàç áîëåå çàðàçåí ïî ñðàâíåíèþ ñ ÂÈ×.
Îñîáåííîñòü âèðóñà ãåïàòèòà  ñîñòîèò â òîì, ÷òî ñàì ïî ñåáå îí íå óáèâàåò êëåòêè ïå÷åíè. Çàáîëåâàíèå, òî åñòü ñàì ãåïàòèò, ÿâëÿåòñÿ ñëåäñòâèåì èììóííîé àòàêè îðãàíèçìà íà ñîáñòâåííûå êëåòêè ïå÷åíè. Ãåïàòèò  — ýòî èíôåêöèîííîå çàáîëåâàíèå, ïðèâîäÿùåå ê àóòîèììóííûì íàðóøåíèÿì â îðãàíèçìå.
Ïðèíöèïèàëüíî âñå ïóòè çàðàæåíèÿ ìîæíî ñâåñòè ê êîíòàêòó ñ áèîëîãè÷åñêèìè æèäêîñòÿìè è âûäåëåíèÿìè ÷åëîâåêà. Ïî ñòåïåíè êîíöåíòðàöèè â íèõ âèðóñà èõ ìîæíî ðàñïîëîæèòü ñëåäóþùèì îáðàçîì: êðîâü, ñïåðìà, âàãèíàëüíûå âûäåëåíèÿ, âûäåëåíèÿ èç øåéêè ìàòêè, ñëåçû, ïîò, ñëþíà, ôåêàëèè. Ïîñëåäíèå ÷åòûðå ìåíåå àêòóàëüíû äëÿ ïåðåäà÷è âèðóñà.
Çàðàæåíèÿ ïðè êîíòàêòå ñî ñëþíîé ÷åðåç ïîöåëóè, ÷àøêè, ìóçûêàëüíûå èíñòðóìåíòû íå ïðîèñõîäèò, îäíàêî åñëè â ñëþíå åñòü ïðèìåñü êðîâè, òî çàðàæåíèå áîëåå ÷åì âåðîÿòíî — ñòîìàòîëîãè÷åñêèå ïðîöåäóðû, óêóñû. Âèðóñ òàêæå íå ïåðåäàåòñÿ âîçäóøíî-êàïåëüíûì ïóòåì, ÷åðåç óêóñû êðîâîñîñóùèõ íàñåêîìûõ, ðåáåíêó ñ ìîëîêîì ìàòåðè.
Èñõîäÿ èç ýòîãî, ìîæíî ïåðå÷èñëèòü âñå âîçìîæíûå ïóòè ïåðåäà÷è âèðóñà: — ïåðåëèâàíèå êðîâè èëè åå êîìïîíåíòîâ:
; ïðÿìîé êîíòàêò ñ çàðàæåííîé êðîâüþ — ïðè ïåðåëèâàíèè êðîâè,
; îïîñðåäîâàííûé êîíòàêò ñ êðîâüþ áîëüíîãî (“øïðèöåâîé” ïóòü çàðàæåíèÿ, ðàñïðîñòðàíåííûé ñðåäè íàðêîìàíîâ, ïåðåäà÷à ÷åðåç ìåäèöèíñêèé íåîäíîðàçîâûé èíñòðóìåíòàðèé, ðàñ÷åñêè, áðèòâû),
; ïîëîâîé ïóòü (ãåòåðî- èëè ãîìîñåêñóàëüíûå êîíòàêòû) — ïîëîâîé ïóòü ïåðåäà÷è ÿâëÿåòñÿ äîìèíèðóþùèì â ñòðàíàõ ñ õîðîøèì óðîâíåì ìåäèöèíñêîãî îáåñïå÷åíèÿ. Åñëè ïðè ðàçíîïîëûõ ïîëîâûõ êîíòàêòàõ âèðóñ â îñíîâíîì ïåðåäàåòñÿ ñî ñïåðìîé è âëàãàëèùíûìè âûäåëåíèÿìè, òî ïðè ãîìîñåêñóàëüíûõ — ñî ñïåðìîé è ñ êðîâüþ èç ìèêðîðàçðûâîâ è òðåùèí. Ðèñê çàðàæåíèÿ óâåëè÷èâàåòñÿ ïðîïîðöèîíàëüíî ÷àñòîòå ïîëîâûõ êîíòàêòîâ ñ èñòî÷íèêîì âèðóñà.,
; ïåðåäà÷à âèðóñà îò ìàòåðè ê ðåáåíêó — ïåðåíîñ âèðóñà îò èíôèöèðîâàííîé ìàòåðè ê ïëîäó (ò.í. âåðòèêàëüíàÿ ïåðåäà÷à) ïðîèñõîäèò âíóòðèóòðîáíî (âñåãî 5% ñëó÷àåâ) èëè íåïîñðåäñòâåííî âî âðåìÿ ðîäîâ (95%), êîãäà êðîâü ìàòåðè è ðåáåíêà êîíòàêòèðóþò íàïðÿìóþ, íå ÷åðåç ïëàöåíòàðíûé áàðüåð. Ñ÷èòàåòñÿ, ÷òî åñëè âèðóñ íå áûë ïåðåäàí ðåáåíêó âî âðåìÿ ðîäîâ, òî çàðàæåíèå, åñëè ðåáåíîê íå áóäåò ïðèâèò, îáÿçàòåëüíî ïðîèçîéäåò â òå÷åíèå ïîñëåäóþùèõ 5 ëåò (ò.í. ãîðèçîíòàëüíàÿ ïåðåäà÷à). Íà ïåðâîì ãîäó æèçíè ðåáåíêà âèðóñ ìîæåò áûòü ïåðåäàí îò ìàòåðè ñ ãðóäíûì ìîëîêîì.
; áûòîâûå êîíòàêòû ñ áîëüíûì èëè õðîíè÷åñêèì íîñèòåëåì èíôåêöèè — Áûòîâîé ïóòü ïåðåäà÷è îñîáåííî àêòóàëåí â ñåìüÿõ, ãäå èìååòñÿ õðîíè÷åñêèé íîñèòåëü èíôåêöèè. Ñ÷èòàåòñÿ, ÷òî â ýòîì ñëó÷àå çàðàæåíèå âñåõ ÷ëåíîâ òàêîé ñåìüè îáÿçàòåëüíî ïðîèñõîäèò â òå÷åíèå 5-8 ëåò.
Èíêóáàöèîííûé ïåðèîä ãåïàòèòà  äëèòñÿ 45-180 äíåé, â ñðåäíåì — 120 äíåé. Ñ÷èòàåòñÿ, ÷òî îò ìîìåíòà çàðàæåíèÿ äî òîãî, êàê çàáîëåâàíèå ñòàíåò íåèçáåæíûì, åñòü ïåðèîä ñîñòàâëÿþùèé 1-2 íåäåëè, â òå÷åíèå êîòîðîãî èìååòñÿ âîçìîæíîñòü ïðåäîòâðàòèòü çàáîëåâàíèå ñ ïîìîùüþ âàêöèíàöèè ïî ñõåìå 0-1-2-12 (ýêñòðåííàÿ ïðîôèëàêòèêà ) è ââåäåíèÿ èììóíîãëîáóëèíà.
Äëÿ äåòåé ãåïàòèò  ïðåäñòàâëÿåò îñîáåííóþ îïàñíîñòü, òàê êàê áóäó÷è ïåðåíåñåííûì â ðàííåì âîçðàñòå, îí â 50-95% ñëó÷àåâ ïåðåõîäèò â õðîíè÷åñêóþ ôîðìó, â äàëüíåéøåì ïðèâîäÿùóþ ê öèððîçó ïå÷åíè è ïåðâè÷íîìó ðàêó ïå÷åíè. ×åì ìëàäøå âîçðàñò, â êîòîðîì ïðîèñõîäèò èíôèöèðîâàíèå, òåì âûøå âåðîÿòíîñòü ñòàòü õðîíè÷åñêèì íîñèòåëåì âèðóñà. Ó íîâîðîæäåííûõ âèðóñíûé ãåïàòèò â 90-95% ïðîòåêàåò áåññèìïòîìíî, áåç êëàññè÷åñêîé æåëòóõè è â 70-90% ñëó÷àåâ ïðèâîäèò ê õðîíè÷åñêîìó íîñèòåëüñòâó âèðóñà, à â 35-50% ê õðîíè÷åñêîìó ãåïàòèòó.
Ó âçðîñëûõ ýòè ñîîòíîøåíèÿ äðóãèå — ÷àñòîòà çàáîëåâàíèé ñ æåëòóõîé âûøå (30-40%), ðèñê õðîíèçàöèè èíôåêöèè – íèæå (6-10%). Ýòà çàâèñèìîñòü ñâÿçàíà ñ ñòåïåíüþ çðåëîñòè èììóííîé ñèñòåìû, èáî íà íàñòîÿùèé ìîìåíò äîêàçàíî, ÷òî ÷åì ëó÷øå ðàáîòàåò èììóíèòåò, òåì ÿð÷å, ñ áîëüøèì êîëè÷åñòâîì ñèìïòîìîâ òå÷åò çàáîëåâàíèå è òåì íèæå ðèñê ïåðåõîäà èíôåêöèè â õðîíè÷åñêóþ ôîðìó.
Æåëòóõà ïðè ãåïàòèòå ïðîÿâëÿåòñÿ â âèäå æåëòèçíû áåëêîâ ãëàç, æåëòèçíîé êîæíûõ ïîêðîâîâ, ïîòåìíåíèåì ìî÷è (äî öâåòà îòíîñèòåëüíî òåìíîãî ïèâà) è îáåñöâå÷èâàíèåì (äî áåëîãî öâåòà) êàëà. Êàê ïðàâèëî, ïåðâûìè æåëòóõó îáíàðóæèâàþò çíàêîìûå ïàöèåíòà ïî èçìåíåíèþ öâåòà áåëêîâ ãëàç ñ áåëîãî íà ëèìîííî-æåëòûé.  íåêîòîðûõ ñëó÷àÿõ æåëòóõà íà÷èíàåòñÿ ñ ïîòåìíåíèÿ ìî÷è è îáåñöâå÷èâàíèÿ êàëà.  òðåòè ñëó÷àåâ ãåïàòèò  ïðîòåêàåò êàê ãðèïïîïîäîáíîå çàáîëåâàíèå, ñîïðîâîæäàþùååñÿ ïîòåðåé àïïåòèòà è ñëàáîñòüþ, íå ðåãèñòðèðóåòñÿ êàê ãåïàòèò  è îáíàðóæèâàåòñÿ ñïóñòÿ íåêîòîðîå âðåìÿ, ïðè àíàëèçå íà «àâñòðàëèéñêèé àíòèãåí».
Æåëòóõà — ïîëîæèòåëüíûé ñèãíàë, ãîâîðÿùèé î òîì, ÷òî êëåòêè èììóííîé ñèñòåìû «âèäÿò» è ðàçðóøàþò èíôèöèðîâàííûå êëåòêè ïå÷åíè (÷òî ïðèâîäèò ê ïîïàäàíèþ æåë÷è â êðîâü è ò.ä.). Îòñóòñòâèå æåëòóõè ãîâîðèò î òîì, ÷òî èììóííàÿ ñèñòåìà áîëüíîãî íåäîñòàòî÷íî ýôôåêòèâíà, è âåðîÿòíåå âñåãî äàííûé ïàöèåíò ñòàíåò õðîíè÷åñêèì íîñèòåëåì.

Äåòè ÷àùå ñòàíîâÿòñÿ õðîíè÷åñêèìè íîñèòåëÿìè âèðóñà, ïîñêîëüêó èõ èììóííàÿ ñèñòåìà ìåíåå ýôôåêòèâíà, ïî ñðàâíåíèþ ñ èììóíèòåòîì âçðîñëûõ
Ñìåðòü ðåäêî íàñòóïàåò ïîñëå îñòðîãî çàáîëåâàíèÿ è íàáëþäàåòñÿ ëèøü ïðè ðåäêîé, êðàéíå òÿæåëîé ìîëíèåíîñíîé ôîðìå èíôåêöèè (ðèñê êîòîðîé óâåëè÷èâàåòñÿ ïðè íàëè÷èè ó áîëüíîãî õðîíè÷åñêèõ çàáîëåâàíèé ïå÷åíè). Ñ áîëüøåé âåðîÿòíîñòüþ ñìåðòü ìîæåò íàñòóïèòü ÷åðåç 35-40 ëåò, â ðåçóëüòàòå ïåðâè÷íîãî ðàêà ïå÷åíè, 60-70% ñëó÷àåâ êîòîðîãî ÿâëÿåòñÿ ñëåäñòâèåì õðîíè÷åñêîãî ãåïàòèòà Â.
Äèàãíîñòèêà ãåïàòèòà  îñíîâûâàåòñÿ, â îñíîâíîì íà âûÿâëåíèè ñïåöèôè÷åñêèõ àíòèãåíîâ âèðóñà. Îñíîâûâàÿñü íà òîì, êàêèå èìåííî àíòèãåíû âûÿâëÿþòñÿ â äàííûé ìîìåíò, ìîæíî ñ âûñîêîé ñòåïåíüþ óâåðåííîñòè âûÿâèòü îäíó èç ñåìè ôàç òå÷åíèÿ èíôåêöèè.
Ñîñòîÿíèå Àíòè-HBc
(àíòèòåëà) Àíòè-HBc
(IgM-àíòèòåëà) HBs-àíòèãåí
(àâñòðàë. àíòèãåí) Àíòè-HBs
(àíòèòåëà) HBeAg
(å-àíòèãåí) Àíòè-HBå
(àíòèòåëà)
Îñòðàÿ èíôåêöèÿ + + + — +/-(a) +/-(b)
Íîñèòåëüñòâî
(íèçêàÿ çàðàçíîñòü) + — + — — +
Íîñèòåëüñòâî
(âûñîêàÿ çàðàçíîñòü) + — + — + —
Âûçäîðîâëåíèå (íà÷àëî) + — — + — +
Âûçäîðîâëåíèå (ïîëíîå) + — — + — —
Èììóíèòåò ïîñëå âàêöèíàöèè — — — + — —
a — èçìåíåíèå ñ HBe-ïîçèòèâíîãî íà HBe-íåãàòèâíûé
b — èçìåíåíèå ñ àíòè-HBe-íåãàòèâíîãî íà àíòè-HBe-ïîçèòèâíûé
Ëå÷åíèå ãåïàòèòà  ÷àñòî íåýôôåêòèâíî, îáõîäèòñÿ äîðîãî íå ïðèâîäèò ê ïîëíîìó èçëå÷åíèþ è èìååò ìíîãî÷èñëåííûå ïîáî÷íûå ðåàêöèè. Êðîìå òîãî, ëå÷åíèÿ, ïîçâîëÿþùåãî èçáàâèòü çàáîëåâøåãî îò õðîíè÷åñêîãî íîñèòåëüñòâà âèðóñà ãåïàòèòà Â, íå ñóùåñòâóåò.
Åäèíñòâåííûé íàäåæíûé ñïîñîá íå çàðàçèòüñÿ ñàìîìó è íå çàðàçèòü Âàøèõ áëèçêèõ – ýòî ñäåëàòü ïðèâèâêó.

   

© Copyright 1998-2006 Ïðèâèâêà.Ðó.
Âñå î âàêöèíàõ è âàêöèíàöèè

Âèðóñíûé ãåïàòèò  — èíôåêöèîííîå çàáîëåâàíèå, ïðîÿâëÿþùååñÿ æåëòóõîé, êîòîðàÿ ñâÿçàíà ñ òÿæåëûì ïîðàæåíèåì ïå÷åíè. Îñíîâíûìè ïóòÿìè ïåðåäà÷è ÿâëÿþòñÿ ïîëîâûå êîíòàêòû è èíúåêöèè. Èñòî÷íèêàìè èíôåêöèè ÿâëÿþòñÿ õðîíè÷åñêèå íîñèòåëè è áîëüíûå. Ðèñê çàáîëåâàíèÿ ãåïàòèòîì  ïðåâûøàåò ðèñê çàáîëåâàíèÿ ÑÏÈÄ â 100 ðàç. Îêîëî 10% çàáîëåâøèõ âçðîñëûõ è 90% äåòåé â âîçðàñòå äî 1 ãîäà ñòàíîâÿòñÿ õðîíè÷åñêèìè íîñèòåëÿìè âèðóñà ãåïàòèòà Â. Îòäàëåííûìè ïîñëåäñòâèÿìè ïåðåíåñåííîãî çàáîëåâàíèÿ ÿâëÿþòñÿ öèððîç ïå÷åíè, õðîíè÷åñêèé ãåïàòèò è ðàê ïå÷åíè.
 

Âàêöèíàöèÿ, ïîìèìî ëèö èç ãðóïï ðèñêà, ðåêîìåíäóåòñÿ âñåì , êòî æåëàåò èçáåæàòü çàáîëåâàíèÿ. Ê ãðóïïàì ïîâûøåííîãî ðèñêà îòíîñÿòñÿ ìåäèöèíñêèå ðàáîòíèêè, âçðîñëûå è äåòè, ïîäâåðãàþùèåñÿ ìíîãîêðàòíûì èíúåêöèÿì (õèðóðãè÷åñêèå âìåøàòåëüñòâà, ãîñïèòàëèçàöèÿ, ïîñåùåíèÿ ñòîìàòîëîãîâ), ëèöàì, â îêðóæåíèè êîòîðûõ èìåþòñÿ õðîíè÷åñêèå íîñèòåëè âèðóñà ãåïàòèòà Â.
Ýóâàêñ  — ïðåäñòàâèòåëü 2-ãî ïîêîëåíèÿ âàêöèí ïðîòèâ ãåïàòèòà Â, ïðîèçâîäèìûõ c ïîìîùüþ ãåííî-èíæåíåðíîé òåõíîëîãèè. Òàêèå âàêöèíû îòëè÷àåò âûñîêàÿ ñòåïåíü î÷èùåííîñòè è îòñóòñòâèå ïðèìåñåé. 95% îáúåìà âàêöèíû ñîñòàâëÿåò î÷èùåííûé HBs-àíòèãåí. Ðåçóëüòàòîì ýòîãî ÿâëÿåòñÿ ìèíèìóì ïîáî÷íûõ ðåàêöèé íà âàêöèíó Ýóâàêñ  è âîçìîæíîñòü ïðèìåíÿòü åå ó äåòåé c ïåðâûõ ÷àñîâ æèçíè.
Ïðåèìóùåñòâàìè âàêöèíû Ýóâàêñ Â ÿâëÿþòñÿ
; Áîëåå âûñîêàÿ äîçèðîâêà äëÿ ïîäðîñòêîâ â âîçðàñòå 16-19 ëåò, ïðåäñòàâëÿþùèõ ñîáîé ãðóïïó ìàêñèìàëüíîãî ðèñêà
; Çíà÷èòåëüíûé ìåæäóíàðîäíûé è ðîññèéñêèé îïûò ïðèìåíåíèÿ
; Ñîîòâåòñòâèå òðåáîâàíèÿì Âñåìèðíîé îðãíèçàöèè çäðàâîîõðàíåíèÿ, îòðàæåííîå â äâóêðàòíîé óñïåøíîé ñåðòèôèêàöèè
 ïðîèçâîäñòâå âàêöèíû Ýóâàêñ  íå èñïîëüçóåòñÿ æèâîé âèðóñ, ïðèâèâêà íå ìîæåò âûçâàòü çàáîëåâàíèÿ äàæå òåîðåòè÷åñêè, ïîñêîëüêó ñîäåðæèò òîëüêî îäèí áåëîê âèðóñà («àâñòðàëèéñêèé àíòèãåí»), òàêèì îáðàçîì ÿâëÿÿñü èíàêòèâèðîâàííîé (óáèòîé).
NB: Âàêöèíû íà îñíîâå ïîâåðõíîñòíîãî àíòèãåíà âèðóñà ãåïàòèòà  çàùèùàþò îò ÂÑÅÕ ðàçíîâèäíîñòåé âèðóñà. Ãåîãðàôè÷åñêîãî äåëåíèÿ ðàçíîâèäíîñòåé âèðóñà ãåïàòèòà  íå ñóùåñòâóåò. Âàêöèíû íà îñíîâå ðåêîìáèíàíòíîãî HBsAg, ê êîòîðûì îòíîñèòñÿ âàêöèíà Ýóâàêñ Â, çàùèùàþò îò âñåõ (â íàñòîÿùåå âðåìÿ èçâåñòíî 6) ðàçíîâèäíîñòåé âèðóñà ãåïàòèòà Â, âêëþ÷àÿ òå èç íèõ, êîòîðûå ðàñïðîñòðàíåíû â Ðîññèè.
Êàê è äëÿ ëþáîé äðóãîé ïðèâèâêè, îáùèì ïðîòèâîïîêàçàíèåì íà ìîìåíò âàêöèíàöèè ÿâëÿþòñÿ çàáîëåâàíèÿ, ñîïðîâîæäàþùèåñÿ ïîâûøåíèåì òåìïåðàòóðû òåëà, äðóãèå îñòðûå çàáîëåâàíèÿ è îáîñòðåíèÿ õðîíè÷åñêèõ çàáîëåâàíèé.  ýòîì ñëó÷àå ïðèâèâêó íåîáõîäèìî îòëîæèòü ìèíèìóì äî ìîìåíòà âûçäîðîâëåíèÿ (ñíèæåíèÿ òåìïåðàòóðû òåëà).
Åäèíñòâåííûì ñïåöèôè÷åñêèì ïðîòèâîïîêàçàíèåì ïðèâèâêè Ýóâàêñ  (êàê è äëÿ âñåõ ðåêîìáèíàíòíûõ âàêöèí ïðîòèâ ãåïàòèòà Â) ÿâëÿåòñÿ àëëåðãèÿ íà ïðîäóêòû, ñîäåðæàùèå äðîææè (õëåá, âûïå÷êà, êâàñ è ò.ï.).
Âàêöèíà Ýóâàêñ  áûëà âïåðâûå çàðåãèñòðèðîâàíà â 1992 ã. è â íàñòîÿùèé ìîìåíò ïðèìåíÿåòñÿ â 37 ñòðàíàõ ìèðà, âî âñåõ ÷àñòÿõ ñâåòà.  Åâðîïå âàêöèíà Ýóâàêñ  çàðåãèñòðèðîâàíà â Ðóìûíèè, Áîðëãàðèè, Ýñòîíèè, Ëàòâèè, Ëèòâå è ïðàêòè÷åñêè âñåõ áûâøèõ ðåñïóáëèêàõ ÑÑÑÐ. Ýóâàêñ  ñåðòèôèöèðîâàí ñïåöèàëüíîé êîìèññèåé ÂÎÇ ïî êà÷åñòâó âàêöèí â 1996 è 2001 ãã. ( ñì. îôèöèàëüíûé äîêóìåíò ÂÎÇ (PDF, 104kb)) è â íàñòîÿùåå âðåìÿ ïðèìåíÿåòñÿ â ðàìêàõ ïðîãðàìì ÞÍÈÑÝÔ è ÂÎÇ. Ïðîèçâîäñòâî ýòîé âàêöèíû (íà çàâîäàõ LG Chemical Ltd., Þæíàÿ Êîðåÿ) ñåðòèôèöèðîâàíî êàê îòâå÷àþùåå ìåæäóíàðîäíûì íîðìàì Good Manufacturing Practice è åâðîïåéñêèì ñòàíäàðòàì êà÷åñòâà.  íàñòîÿùåå âðåìÿ êîìïàíèÿ «Àâåíòèñ Ïàñòåð» ÿâëÿåòñÿ ýêñêëþçèâíûì äèñòðèáüþòåðîì âàêöèíû Ýóâàêñ Â.
Ýóâàêñ  çàðåãèñòðèðîâàíà Ìèíçäðàâîì ÐÔ ïî ðåçóëüòàòàì ïîëíîãî öèêëà ëàáîðàòîðíûõ, êëèíè÷åñêèõ èñïûòàíèé è èíñïåêöèè ïðîèçâîäñòâà. Ðåçóëüòàòû ðåãèñòðàöèîííûõ èñïûòàíèé Ìèíçäðàâà Ðîññèè äîêàçàëè, ÷òî Ýóâàêñ  ýòî áåçîïàñíàÿ (ïðîöåíò ïîáî÷íûõ ðåàêöèé íà ïðèâèâêó íå ïðåâûñèë ñòàíäàðòíûõ çíà÷åíèé äëÿ ýòîãî êëàññà âàêöèí) è ýôôåêòèâíàÿ âàêöèíà (ïîñëå ïðèâèâêè çàùèòíûé èììóíèòåò ñôîðìèðîâàëñÿ ó 93% ïðèâèòûõ).
Âàêöèíà Ýóâàêñ  øèðîêî ðàñïðîñòðàíåíà â Ðîññèè. Íà ñåãîäíÿøíèé äåíü, íà÷èíàÿ ñ 1998 ã. â Ðîññèè ïðèìåíåíî óæå îêîëî 4 ìèëëèîíîâ äîç.  1999-2000 ãã. Ýóâàêñ  áûëà âûáðàíà è çàêóïëåíà Êîìèòåòîì çäðàâîîõðàíåíèÿ Ìîñêâû äëÿ ïëàíîâîé òðåõêðàòíîé âàêöèíàöèè 110 òûñÿ÷ ïîäðîñòêîâ øêîëüíîãî âîçðàñòà. Èññëåäîâàíèå, ïðîâåäåííîå ïî ðåçóëüòàòàì ýòîé ìàñøòàáíîé ïðèâèâî÷íîé êàìïàíèè ïîêàçàëî, ÷òî âàêöèíà Ýóâàêñ  ñôîðìèðîâàëà èíòåíñèâíûé è äîëãîñðî÷íûé èììóííûé îòâåò â çàùèòíûõ çíà÷åíèÿõ ó 99% ïðèâèòûõ, ïðè÷åì ó 80% ïîäðîñòêîâ êîíöåíòðàöèè àíòèòåë â 100 ðàç ïðåâûøàëè ìèíèìàëüíûå çàùèòíûå çíà÷åíèÿ. Ïðè ýòîì íå áûëî çàðåãèñòðèðîâàíî íè îäíîãî îñëîæíåíèÿ. Ïîâûøåíèå òåìïåðàòóðû òåëà äî 39îÑ áûëî çàôèêñèðîâàíî òîëüêî ó 2 (èç 110 òûñÿ÷!) äåòåé. Ñëàáûå ìåñòíûå è îáùèå ðåàêöèè îòìå÷àëè ëèøü 0,06% ïðèâèòûõ (64 ðåáåíêà). Ýòè ðåçóëüòàòû õàðàêòåðèçóþò âàêöèíó Ýóâàêñ  êàê áåçîïàñíûé è âûñîêîýôôåêòèâíûé ïðåïàðàò äëÿ ïðîôèëàêòèêè âèðóñíîãî ãåïàòèòà Â.
Âàêöèíàöèÿ ïðîâîäèòñÿ ïî 2 ñõåìàì: «áûñòðîé» (0, 1, 2, 12 ìåñÿöåâ) è îáû÷íîé (0, 1, 6 ìåñÿöåâ). C ó÷åòîì ìàêñèìàëüíûõ îòêëîíåíèé îò ñõåìû ãðàôèê âàêöèíàöèè âûãëÿäèò ñëåäóþùèì îáðàçîì:
Âûáðàííûé äåíü — 1 ìåñÿö (4 ìåñÿöà) — 6 ìåñÿöåâ (18 ìåñÿöåâ îò ìîìåíòà ïåðâîé ïðèâèâêè). Ïî ðåçóëüòàòàì ïðèâèâêè â ñðåäíåì 95% ïðèâèòûõ âàêöèíîé Ýóâàêñ  îáëàäàþò íàäåæíûì èììóíèòåòîì ïðîòèâ âèðóñíîãî ãåïàòèòà Â. Ïðè ýòîì ó 90% êîíöåíòðàöèÿ àíòèòåë ïðåâûøàåò çàùèòíûå ïîðîãè è îáåñïå÷èâàåò äîëãîñðî÷íóþ çàùèòó, äëèòåëüíîñòü êîòîðîé, ñîãëàñíî ñóùåñòâóþùèì îöåíêàì, ñîñòàâëÿåò íå ìåíåå 15 ëåò.
Ïðèâèâêà Ýóâàêñ  — ýòî äåéñòâèòåëüíî «ìÿãêàÿ» âàêöèíà: ëèøü 2,5% ïðèâèòûõ îòìå÷àþò áîëåçíåííîñòü â ìåñòå èíúåêöèè è îêîëî 5% íåáîëüøîå (äî 37,5îÑ) ïîâûøåíèå òåìïåðàòóðû. Âñå ðåàêöèè ïîÿâëÿþòñÿ â òå÷åíèå ïåðâûõ ñóòîê ïîñëå âàêöèíàöèè è ïðîõîäÿò áåç ëå÷åíèÿ â òå÷åíèå 1-2 äíåé.
Îïûò Ðåñïóáëèêè Êûðãûçñòàí (EU_KYR.PDF (212 Kb)) (îêîëî 7000 ïðèâèòûõ íîâîðîæäåííûõ) ïîêàçàë, ÷òî ïîáî÷íûå ðåàêöèè âîçíèêàþò ëèøü ó 2,2% ïðèâèòûõ äåòåé, íîñÿò íåòÿæåëûé õàðàêòåð, ïðîÿâëÿþòñÿ â îñíîâíîì ìåñòíûìè ðåàêöèÿìè è ïðîõîäÿò áåç ëå÷åíèÿ â òå÷åíèå 1-2 äíåé. Òåìïåðàòóðíûõ ðåàêöèé íå çàðåãèñòðèðîâàíî.
Çà 2 ãîäà ïðèìåíåíèÿ âàêöèíû Ýóâàêñ  â Ðåñïóáëèêå Êàçàõñòàí íàêîïëåí îãðîìíûé (áîëåå 700 000 ïðèâèâîê íîâîðîæäåííûì â ðàìêàõ íàöèîíàëüíîãî êàëåíäàðÿ èììóíèçàöèè) îïûò â ïëàíîâîé ïðîôèëàêòèêå ãåïàòèòà  ñ ïîìîùüþ ýòîé âàêöèíû. Äîêàçàíî, ÷òî ìàññîâîå ïðèìåíåíèå ýòîé âàêöèíû ïîçâîëèëî â 3 ðàçà ñíèçèòü çàáîëåâàåìîñòü ãåïàòèòîì  ïî âñåé ðåñïóáëèêå. Ýòî äîêàçûâàåò, ÷òî Ýóâàêñ  îáëàäàåò âûðàæåííûì ïðîôèëàêòè÷åñêèì ýôôåêòîì è ìîæåò ñëóæèòü ñðåäñòâîì êîíòðîëÿ íàä çàáîëåâàåìîñòüþ ãåïàòèòîì Â.

   

© Copyright 1998-2006 Ïðèâèâêà.Ðó.
Âñå î âàêöèíàõ è âàêöèíàöèè.
×òî äåëàòü, åñëè ó Âàñ áûë ïîëîâîé êîíòàêò ñ íîñèòåëåì âèðóñà? Êàê ïðèâèâàòü äåòåé, ðîæäåííûõ îò ìàòåðåé-íîñèòåëüíèö âèðóñà ãåïàòèòà Â?

×åì îïàñåí âèðóñíûé ãåïàòèò Â
Âèðóñíûé ãåïàòèò  — ýòî òÿæåëîå èíôåêöèîííîå çàáîëåâàíèå, ïîðàæàþùåå ïå÷åíü, è ïðîÿâëÿþùååñÿ æåëòóõîé. Ìîæåò ñòàòü ïðè÷èíîé õðîíè÷åñêîãî ãåïàòèòà, öèððîçà è ðàêà ïå÷åíè. Ïåðåäàåòñÿ, â îñíîâíîì, ñ êðîâüþ îò áîëüíûõ è ñêðûòûõ íîñèòåëåé âèðóñà. Çàðàçèòüñÿ ìîæíî âî âðåìÿ îïåðàöèé, ïðè ïîñåùåíèè ñòîìàòîëîãà, ïàðèêìàõåðñêîé. Áîëåçíü òàêæå ïåðåäàåòñÿ ïîëîâûì ïóòåì, íîâîðîæäåííîìó îò ìàòåðè-íîñèòåëüíèöû âèðóñà.  íàñòîÿùåå âðåìÿ â Ðîññèè íîñèòåëÿìè âèðóñà ÿâëÿþòñÿ îêîëî 5 ìëí. ÷åëîâåê.
; Çà÷åì íóæíî âàêöèíèðîâàòü íîâîðîæäåííûõ?
Ýòî ñâÿçàíî ñ òåì, ÷òî ïðè çàáîëåâàíèè â âîçðàñòå äî 1 ãîäà ïðàêòè÷åñêè 100% áîëüíûõ ñòàíîâÿòñÿ õðîíè÷åñêèìè íîñèòåëÿìè âèðóñà. Âàêöèíàöèÿ ïðèçâàíà çàùèòèòü è òåõ ìàëûøåé, êîòîðûå ðîäèëèñü îò ìàòåðåé-íîñèòåëüíèö âèðóñà ãåïàòèòà Â. Ó âçðîñëûõ îêîëî 10% ñëó÷àåâ ïåðåõîäèò â õðîíè÷åñêóþ ôîðìó — íîñèòåëüñòâî, ýôôåêòèâíîãî ëå÷åíèÿ êîòîðîãî â íàñòîÿùèé ìîìåíò íåò. Ïðàêòè÷åñêè 100% ñëó÷àåâ íîñèòåëüñòâà çàêàí÷èâàåòñÿ ðàêîì ïå÷åíè.
Âàêöèíàöèÿ âñåõ íîâîðîæäåííûõ â ðîäèëüíîì äîìå (â 0-1-6 ìåñ.) ïîçâîëÿåò ïðåäîòâðàòèòü çàðàæåíèå ðåáåíêà, ó ìàòåðè êîòîðîãî áûë ïîëó÷åí ëîæíîîòðèöàòåëüíûé ðåçóëüòàò èññëåäîâàíèÿ íà HBsAg. Ê òîìó æå îðãàíèçàöèÿ âàêöèíàöèè â ðîääîìå ïðîùå, à ñâîåâðåìåííîñòü ÿâêè âàêöèíèðîâàííûõ òàì äåòåé äëÿ ââåäåíèÿ ïîñëåäóþùèõ äîç âàêöèíû âûøå, ÷åì ïðè íà÷àëå âàêöèíàöèè â âîçðàñòå 4 ìåñ.
; Íàñêîëüêî ñòîåê èììóíèòåò, ñîçäàâàåìûé âàêöèíàöèåé ïðîòèâ âèðóñíîãî ãåïàòèòà Â?
×åðåç 10 ëåò ïîñëå âàêöèíàöèè ó 13-60% âçðîñëûõ è äåòåé åùå èìåþòñÿ àíòèòåëà. Íî äàæå åñëè îíè èñ÷åçàþò, òî â òå÷åíèå 12 ëåò è áîëåå îñòàåòñÿ èììóíîëîãè÷åñêàÿ ïàìÿòü, ÷òî îáåñïå÷èâàåò çàùèòó îò çàáîëåâàíèÿ. Íàáëþäåíèå çà äåòüìè, âàêöèíèðîâàííûìè ïðè ðîæäåíèè, ïîêàçûâàåò, ÷òî çàùèòà äëèòñÿ íå ìåíåå 8 ëåò.  íàñòîÿùèé ìîìåíò ÂÎÇ íå ðåêîìåíäóåò ïðîâåäåíèå ïîãîëîâíîé ðåâàêöèíàöèè, îäíàêî îíà ìîæåò ïîòðåáîâàòüñÿ òåì, ó êîòîðûõ íå ñôîðìèðîâàëñÿ äîñòàòî÷íûé èììóíèòåò ïîñëå ïåðâè÷íîãî êóðñà âàêöèíàöèè.
; Ãåííàÿ èíæåíåðèÿ — ýòî íå îïàñíî?
Íè â êîåì ñëó÷àå. Ïðèìåíåíèå ãåííîèíæåíåðíûõ ìåòîäîâ ïðè ñîçäàíèè âàêöèí ñóùåñòâåííî ïîâûøàåò èõ áåçîïàñíîñòü, ïîçâîëÿÿ äîáèòüñÿ èñêëþ÷èòåëüíîé ñòåïåíè î÷èñòêè àíòèãåíîâ. Êðîìå òîãî, ïðè ïðîèçâîäñòâå íå èñïîëüçóþòñÿ ìàòåðèàëû ÷åëîâå÷åñêîãî ïðîèñõîæäåíèÿ, ÷òî ïîëíîñòüþ èñêëþ÷àåò ðèñê çàðàæåíèÿ èçâåñòíûìè è íåèçâåñòíûìè ìèêðîîðãàíèçìàìè. Ãåííîèíæåíåðíûå ìàíèïóëÿöèè ïðîâîäÿòñÿ òîëüêî ñ ÄÍÊ äðîææåâûõ êëåòîê, â êîòîðûõ âûðàùèâàþò àíòèãåí äëÿ ïðîèçâîäñòâà âàêöèíû, íèêàêîé îïàñíîñòè â ýòîì äëÿ ÷åëîâåêà íåò.
; Íóæíî ëè äåëàòü îáñëåäîâàíèå íà «àâñòðàëèéñêèé àíòèãåí» ïåðåä ïðèâèâêîé ïðîòèâ âèðóñíîãî ãåïàòèòà?
 îáùåì ñëó÷àå, òàêîå îáñëåäîâàíèå ÿâëÿåòñÿ ïîëåçíûì è èíôîðìàòèâíûì, îäíàêî ñïåöèàëüíîé íåîáõîäèìîñòè äåëàòü åãî ïåðåä ïðèâèâêîé íåò. Èññëåäîâàíèÿ ïîêàçûâàþò, ÷òî ïðèâèâêà áåçîïàñíà (õîòÿ è íåýôôåêòèâíà) äëÿ íîñèòåëåé âèðóñà ãåïàòèòà Â.
; Êàêèå ðåàêöèè âîçíèêàþò íà ãåïàòèòíûå âàêöèíû?
×èñëî ïîáî÷íûõ ðåàêöèé ìèíèìàëüíî, ïîñêîëüêó ñîâðåìåííûå âàêöèíû êàê ïðàâèëî íà 95% ñîñòîÿò èç àíòèãåíà. Êàê è íà ëþáóþ äðóãóþ èíúåêöèþ, â ìåñòå ââåäåíèÿ âàêöèíû âîçìîæíû óïëîòíåíèå è ïîêðàñíåíèå.  ðåäêèõ ñëó÷àÿõ, ÷àñòîòà êîòîðûõ íå ïðåâûøàåò 2-5%, âîçìîæíî íåçíà÷èòåëüíîå ïîâûøåíèå òåìïåðàòóðû òåëà ó 1% ïðèâèòûõ.
; Êàêîâû ïðîòèâîïîêàçàíèÿ äëÿ ïðèâèâêè ïðîòèâ ãåïàòèòà Â?
Ïðèâèâêà ïðîòèâ ãåïàòèòà  íå èìååò ñïåöèôè÷åñêèõ ïðîòèâîïîêàçàíèé, êðîìå àëëåðãèè íà ïðîäóêòû, ñîäåðæàùèå äðîææè. Îáùèìè ïðîòèâîïîêàçàíèÿìè, êàê è äëÿ äðóãèõ ïðèâèâîê, ÿâëÿþòñÿ ïîâûøåíèå òåìïåðàòóðû òåëà, îñòðîå çàáîëåâàíèå èëè îáîñòðåíèå õðîíè÷åñêîãî çàáîëåâàíèÿ íà ìîìåíò âàêöèíàöèè.
; Êóðñ ïðèâèâîê íà÷àò äðóãîé âàêöèíîé ïðîòèâ ãåïàòèòà Â, ìîæíî çàêîí÷èòü êóðñ äðóãîé âàêöèíîé?
Äà, ñîãëàñíî ìåæäóíàðîäíûì ðåêîìåíäàöèÿì âñå ðåêîìáèíàíòíûå âàêöèíû âçàèìîçàìåíÿåìû, õîòÿ âïîëíå åñòåñòâåííî, ÷òî íåñêîëüêî áîëåå ïðåäïî÷òèòåëüíî äåëàòü âåñü êóðñ ïðèâèâîê îäíîé âàêöèíîé.
; Íóæíî ëè íà÷èíàòü êóðñ ïðèâèâîê çàíîâî, åñëè îäíà èç ïðèâèâîê íå áûëà ñäåëàíà â ñðîê?
Íåò, íå íóæíî.  òàêèõ ñëó÷àÿõ ââîäÿò âñå íåäîñòàþùèå äîçû, êàê áóäòî íàðóøåíèÿ èíòåðâàëîâ íå áûëî. Íî ñïðàâåäëèâîñòè ðàäè íàäî ñêàçàòü, ÷òî ïðè ñóùåñòâåííûõ íàðóøåíèÿõ ñòàíäàðòíîé ñõåìû ýôôåêòèâíîñòü ïðèâèâîê ñíèæàåòñÿ è âîçìîæíî, ïî îêîí÷àíèè êóðñà, ïîòðåáóåòñÿ ïðîâåðèòü íàïðÿæåííîñòü èììóíèòåòà ê âèðóñó ãåïàòèòà Â.
Ïîìèìî ýòîãî, íóæíî ïîìíèòü î «áåçîïàñíûõ ñðîêàõ», ò.å. íîðìàëüíûõ èíòåðâàëàõ, ïðè ñîáëþäåíèè êîòîðûõ ýôôåêòèâíîñòü âàêöèíàöèè íå îòëè÷àåòñÿ îò îáû÷íîé. Äëÿ âòîðîé ïðèâèâêè äîïóñòèìûì èíòåðâàëîì ñ÷èòàåòñÿ îò 1 äî 4 ìåñ ïîñëå ïåðâîé ïðèâèâêè. Òðåòüÿ ïðèâèâêà ìîæåò áûòü ñäåëàíà â ñðîê 6-18 ìåñ. áåç óùåðáà äëÿ èììóíèòåòà ïðîòèâ ãåïàòèòà Â.
; Êàê ïðîâîäÿò ïðîôèëàêòèêó ãåïàòèòà  â ñëó÷àå âåðîÿòíîãî èíôèöèðîâàíèÿ?
Åñëè âêðàòöå, òî ïîñëå êîíòàêòà ñ êðîâüþ èëè âûäåëåíèÿìè áîëüíîãî èëè íîñèòåëÿ ïðîâîäÿò âàêöèíàöèþ ïðîòèâ ãåïàòèòà Â: ïåðâóþ äîçó âàêöèíû ââîäÿò â ïåðâûå ñóòêè ïîñëå êîíòàêòà (âìåñòå ñî ñïåöèôè÷åñêèì èììóíîãëîáóëèíîì, åñëè òàêîâîé èìååòñÿ â íàëè÷èè). Ñõåìà âàêöèíàöèè – 0-1-2-6 ìåñ. Ïðè ýòîì öåëåñîîáðàçíî îñóùåñòâëÿòü êîíòðîëü çà èììóíîëîãè÷åñêèìè ìàðêåðàìè èíôåêöèè âèðóñîì ãåïàòèòà B.
Ðàçâåðíóòóþ ñòàòüþ, ïîñâÿùåííóþ ýêñòðåííîé ïðîôèëàêòèêå âèðóñíîãî ãåïàòèòà, ìîæíî ïðî÷èòàòü [çäåñü].
; Ìîæíî ëè ñìåøèâàòü âàêöèíû ïðîòèâ ãåïàòèòà Â â îäíîì øïðèöå ñ äðóãèìè âàêöèíàìè?
Åñëè íà òî íåò ñïåöèàëüíîãî óêàçàíèÿ â èíñòðóêöèè ê îáåèì âàêöèíàì — íåâîçìîæíî. Âî-ïåðâûõ, ìîæåò ïðîèçîéòè ðåçêîå óâåëè÷åíèå ðèñêà òÿæåëûõ ìåñòíûõ ïîáî÷íûõ ðåàêöèé â ñèëó ïåðåäîçèðîâêè ãèäðîîêèñè àëþìèíèÿ, à âî-âòîðûõ — ñíèæåíèå èììóíîãåííîñòè ñàìîé ãåïàòèòíîé  âàêöèíû. Äðóãîå äåëî, êîãäà ðå÷ü èäåò î ãîòîâûõ êîìáèíèðîâàííûõ âàêöèíàõ, ïîñêîëüêó ïðè èõ ðàçðàáîòêå ýòè îñîáåííîñòè ó÷èòûâàþòñÿ è ñîîòâåòñòâåííî ïðåäïðèíèìàþòñÿ ñïåöèàëüíûå óñèëèÿ ïî èõ íèâåëèðîâàíèþ.

Ðå÷ü îá ýêñòðåííîé ïðîôèëàêòèêå âèðóñíîãî ãåïàòèòà  èäåò â ñëó÷àå, êîãäà êîíòàêò ñ âèðóñîì óæå ñîñòîÿëñÿ è òðåáóåòñÿ íåìåäëåííàÿ ïðîôèëàêòèêà èíôåêöèÿ — ýòîò âàðèàíò íàçûâàåòñÿ ïîñòýêñïîçèöèîííîé ïðîôèëàêòèêîé. Ïðèìåðîì òàêîé ïðîôèëàêòèêè ÿâëÿåòñÿ çàùèòà íîâîðîæäåííûõ, ìàòåðè êîòîðûõ ÿâëÿþòñÿ õðîíè÷åñêèìè íîñèòåëÿìè âèðóñà ãåïàòèòà Â.  îáùåì ñëó÷àå, â çàâèñèìîñòè îò ñòåïåíè âåðîÿòíîñòè çàðàæåíèÿ ïðèìåíÿþò ëèáî âàêöèíó ïî îñîáîé, «óñêîðåííîé ñõåìå», ëèáî ñïåöèôè÷åñêèé èììóíîãëîáóëèí ïðîòèâ ãåïàòèòà Â, ëèáî ñî÷åòàíèå âàêöèíû è èììóíîãëîáóëèíà.
Äðóãèì ñëó÷àåì ïðèìåíåíèÿ ýêñòðåííîé ïðîôèëàêòèêè ÿâëÿåòñÿ íåîáõîäèìîñòü â çàùèòå ââèäó ãðÿäóùåãî âåðîÿòíîãî êîíòàêòà ñ âèðóñîì. Ê ïðèìåðó, ïåðåä ïëàíîâîé, îáøèðíîé îïåðàöèåé, ïðè ïîäãîòîâêå ê áåðåìåííîñòè, ïðè óñòàíîâëåíèè ó îäíîãî èç ÷ëåíîâ ñåìüè ôàêòà õðîíè÷åñêîãî íîñèòåëüñòâà âèðóñà ãåïàòèòà Â. Äëÿ ïîäîáíîé ïðîôèëàêòèêè êàê ïðàâèëî èñïîëüçóåòñÿ òîëüêî âàêöèíà. Îäíàêî â ñëó÷àÿõ, êîãäà çàùèòà íóæíà íå íà äîëãèé ïðîìåæóòîê âðåìåíè è íåìåäëåííî, ìîæåò ïðèìåíÿòüñÿ òîëüêî èììóíîãëîáóëèí (ñåðîïðîôèëàêòèêà). Ïðåäåëüíàÿ äëèòåëüíîñòü ýôôåêòèâíîé çàùèòû ïðè ýòîì ñîñòàâëÿåò íå áîëåå 2 ìåñ.
Íèæå ïåðå÷èñëåíû ñèòóàöèè, â êîòîðûõ ìîæåò ïðèìåíÿòüñÿ ýêñòðåííàÿ ïðîôèëàêòèêà è ïðèâåäåíà òàêòèêà åå ïðîâåäåíèÿ.

ÏÎËÎÂÎÉ ÊÎÍÒÀÊÒ Ñ ÍÎÑÈÒÅËÅÌ ÂÈÐÓÑÀ
 òå÷åíèå ìàêñèìóì 2 íåäåëü ïîñëå ïîëîâîãî êîíòàêòà, ñ ÷åëîâåêîì, ñòðàäàþùèì îñòðîé ôîðìîé ãåïàòèòà  (÷òî ïîäðàçóìåâàåò âûñîêèé ðèñê çàðàæåíèÿ), íåîáõîäèìî ââåñòè îäíó äîçó ñïåöèôè÷åñêîãî èììóíîãëîáóëèíà è îäíîâðåìåííî ïðèñòóïèòü ê âàêöèíàöèè. Îäíîâðåìåííîå ââåäåíèå èììóíîãëîáóëèíà è âàêöèíû ïîçâîëÿåò ñäåëàòü ïðîôèëàêòèêó íåïðåðûâíîé, íåïîñðåäñòâåííî ñ ìîìåíòà åå íà÷àëà — àíòèòåëà èç èììóíîãëîáóëèíà áóäóò çàùèùàòü â òå÷åíèå âðåìåíè, íåîáõîäèìîãî äëÿ âûðàáîòêè èììóíèòåòà â îòâåò íà ïðèâèâêó.
Íàèáîëåå æåëàòåëüíûì âðåìåíåì ïðîâåäåíèÿ ïðîôèëàêòèêè ñ÷èòàþòñÿ ïåðâûå 48 ÷àñîâ, â ýòîì ñëó÷àå ýôôåêò ââåäåíèÿ èììóíîãëîáóëèíà ìàêñèìàëåí.  ñëó÷àå íà÷àëà ïðîôèëàêòèêè ÷åðåç 15 äíåé ïîñëå ïîëîâîãî êîíòàêòà ñ íîñèòåëåì âèðóñà âîçìîæíîñòü çàùèòû ñ ïîìîùüþ èììóíîãëîáóëèíà ìèíèìàëüíà.
Ïðîâåäåíèå òåñòà íà «àâñòðàëèéñêèé» àíòèãåí (íîñèòåëüñòâî) ïåðåä íà÷àëîì ïðîôèëàêòèêè íå ÿâëÿåòñÿ îáÿçàòåëüíûì óñëîâèåì. Ïðèâèâêà äëÿ ÷åëîâåêà, óæå ÿâëÿþùåãîñÿ íîñèòåëåì âèðóñà, áåçâðåäíà è ñïîñîáíà ñêîðåå ïîìî÷ü, íåæåëè íàâðåäèòü. Îïðàâäàííûì òåñòèðîâàíèå ÿâëÿåòñÿ â ñëó÷àå, åñëè îíî íå ïðåäñòàâëÿåò ñîáîé ìàòåðèàëüíóþ ïðîáëåìó è íå òðåáóåò çíà÷èòåëüíîãî âðåìåíè äëÿ îñóùåñòâëåíèÿ.
Âñå ïîëîâûå ïàðòíåðû õðîíè÷åñêèõ íîñèòåëåé âèðóñà äîëæíû áûòü ïðèâèòû êàê ìîæíî ðàíüøå, ïîñêîëüêó ñïåðìà è âëàãàëèùíûå âûäåëåíèÿ ÿâëÿþòñÿ ñëåäóþùèìè ïîñëå êðîâè ïî àêòóàëüíîñòè â êà÷åñòâå íîñèòåëåé âèðóñà.

ÂÀÊÖÈÍÀÖÈß ËÞÄÅÉ, Â ÎÐÃÀÍÈÇÌ ÊÎÒÎÐÛÕ ÌÎÃ ÏÎÏÀÑÒÜ ÂÈÐÓÑ
Òàêàÿ ñèòóàöèÿ ìîæåò èìåòü ìåñòî ïðè ïîïàäàíèè íà êîæó èëè ñëèçèñòûå îáîëî÷êè (ãëàçà, ðîò) êðîâè è äðóãèõ áèîëîãè÷åñêèõ æèäêîñòåé ÷åëîâåêà, ïîòåíöèàëüíî çàðàæåííûõ âèðóñîì ãåïàòèòà Â. Òàêòèêà ýêñòðåííîé ïðîôèëàêòèêè â òàêîì ñëó÷àå äîëæíà ñòðîèòüñÿ ñ ó÷åòîì íåñêîëüêèõ ôàêòîðîâ — âåðîÿòíîñòü èíôèöèðîâàíèÿ ãåïàòèòîì  ÷åëîâåêà-èñòî÷íèêà êðîâè è äðóãèõ æèäêîñòåé, áûë ëè ïîñòðàäàâøèé ïðèâèò ïðîòèâ ãåïàòèòà Â.
Òàêòèêà ýêñòðåííîé (ïîñòýêñïîçèöèîííîé) ïðîôèëàêòèêè ñòðîèòñÿ ïî ïðèíöèïàì, èçëîæåííûì â íèæåñëåäóþùåé òàáëèöå.
Ñòàòóñ ÷åëîâåêà, èìåâøåãî êîíòàêò ñ ÂàÌåðîïðèÿòèÿ â çàâèñèìîñòè îò ñèòóàöèè, êîãäà ñòàòóñ èñòî÷íèêà
Íå óñòàíîâëåí HBsAg — îòðèöàòåëåí HBs-ïîëîæèòåëåí
Íå ïðèâèò Âàêöèíàöèÿ ïî ýêñòðåííîé ñõåìå + èììóíîãëîáóëèí îäíîêðàòíî Íà÷àòü ïëàíîâóþ âàêöèíàöèþ Âàêöèíàöèÿ ïî ýêñòðåííîé ñõåìå + èììóíîãëîáóëèí îäíîêðàòíî
Ðàíåå ïðèâèò (êîíöåíòðàöèÿ àíòèòåë â ìîìåíò êîíòàêòà ìåíåå 10 ìÌÅ/ìë Îäíîêðàòíàÿ ðåâàêöèíàöèÿ Îäíîêðàòíàÿ ðåâàêöèíàöèÿ Îäíîêðàòíàÿ ðâàêöèíàöèÿ + èììóíîãëîáóëèí
Ðàíåå ïðèâèò (êîíöåíòðàöèÿ àíòèòåë â ìîìåíò êîíòàêòà çàùèòíàÿ, áîëåå 10 ìÌÅ/ìë Ìåðîïðèÿòèÿ íå ïðîâîäÿòñÿ Ìåðîïðèÿòèÿ íå ïðîâîäÿòñÿ Ìåðîïðèÿòèÿ íå ïðîâîäÿòñÿ
Îòñóòñòâèå èììóíèòåòà ïîñëå 3 äîç âàêöèíû Îäíîêðàòíàÿ ðåâàêöèíàöèÿ + èììóíîãëîáóëèí Îäíîêðàòíàÿ ðåâàêöèíàöèÿ èëè ìåðû íå ïðîâîäÿòñÿ Îäíîêðàòíàÿ ðåâàêöèíàöèÿ + èììóíîãëîáóëèí
Îòñóòñòâèå èììóíèòåòà ïîñëå 6 äîç âàêöèíû Èììóíîãëîáóëèí Ìåðîïðèÿòèÿ íå ïðîâîäÿòñÿ Èììóíîãëîáóëèí

 ÎÁÙÅÌ ÂÈÄÅ, ÒÀÊÒÈÊÓ ÝÊÑÒÐÅÍÍÎÉ ÏÐÎÔÈËÀÊÒÈÊÈ ÌÎÆÍÎ ÎÕÀÐÀÊÒÅÐÈÇÎÂÀÒÜ ÑËÅÄÓÞÙÈÌÈ ËÎÃÈ×ÅÑÊÈÌÈ ÏÐÈÍÖÈÏÀÌÈ
; Åñëè êàêîé-ëèáî èç ôàêòîðîâ íå âûÿñíåí, ñëåäóåò èñõîäèòü èç ñàìîãî ïåññèìèñòè÷åñêîãî âàðèàíòà.
; Óâåðåííîñòü â òîì èëè èíîì ïîêàçàòåëå ìîæåò äàòü ëèøü äîêóìåíòàëüíîå ïîäòâåðæäåíèå. Åñëè íåò óâåðåííîñòè â òîì, ÷òî ÷åëîâåê ðàíåå áûë ïðèâèò è áûë ïðèâèò ïðàâèëüíî, ñëåäóåò èñõîäèòü èç òîãî, ÷òî ó íåãî íåò èììóíèòåòà.
; Åñëè ïîñòðàäàâøèé íå áûë ïðèâèò (íå ïîëó÷èë ïîëíûé êóðñ ïëàíîâûõ ïðèâèâîê) ðàíüøå, åñëè êîíöåíòðàöèÿ àíòèòåë ìåíüøå çàùèòíîé èëè îïðåäåëèòü åå íåò âîçìîæíîñòè, îäíàêî èçâåñòíî, ÷òî èñòî÷íèê âåðîÿòíîãî èíôèöèðîâàíèÿ ÿâëÿåòñÿ íîñèòåëåì — îáÿçàòåëüíî èñïîëüçóåòñÿ èììóíîãëîáóëèí è ââîäèòñÿ êàê ìèíèìóì îäíà äîçà âàêöèíû äî âûÿñíåíèÿ âñåõ íåîáõîäèìûõ ïîêàçàòåëåé.
; Ìåðîïðèÿòèÿ íå ïðîâîäÿòñÿ ëèøü â ñëó÷àå, åñëè èìååòñÿ äîêóìåíòàëüíîå ïîäòâåðæäåíèå íàëè÷èå ó ïîñòðàäàâøåãî àíòèòåë â äîñòàòî÷íûõ äëÿ çàùèòû êîíöåíòðàöèÿõ.

ÏÐÎÔÈËÀÊÒÈÊÀ ÃÅÏÀÒÈÒÀ Â Ó ÄÅÒÅÉ, ÐÎÆÄÅÍÍÛÕ ÎÒ ÌÀÒÅÐÅÉ-ÍÎÑÈÒÅËÜÍÈÖ ÂÈÐÓÑÀ
Ïðåæäå âñåãî, íåîáõîäèìî îñòàíîâèòüñÿ íà âîïðîñå âåðîÿòíîñòè ïåðåäà÷è èíôåêöèè ðåáåíêó îò ìàòåðè-íîñèòåëüíèöû âèðóñà (òàêîé âàðèàíò ïåðåäà÷è âèðóñà íàçûâàåòñÿ âåðòèêàëüíûì). Ïîäàâëÿþùåå áîëüøèíñòâî, 95% ñëó÷àåâ ïåðåäà÷è âèðóñà ïðîèñõîäèò íåïîñðåäñòâåííî âî âðåìÿ ðîäîâ. Ñ äðóãîé ñòîðîíû, ýòî îçíà÷àåò, ÷òî ëèøü 5% äåòåé, ðîæäåííûõ îò ìàòåðåé-íîñèòåëüíèö, èíôèöèðóþòñÿ åùå äî ìîìåíòà ðîäîâ.
Ïåðåäà÷à âèðóñà ïðîèñõîäèò ïðè ïðÿìîì ñìåøèâàíèè êðîâè ìàòåðè è ðåáåíêà.  íîðìå ýòî ïðîèñõîäèò òîëüêî â ðîäàõ, ëèáî åñòåñòâåííûõ, ëèáî èñêóññòâåííûõ (ïîñðåäñòâîì Êåñàðåâà ñå÷åíèÿ) — ïîâðåæäåíèå ïëàöåíòû, çàãëàòûâàíèå êðîâè ìàòåðè ðåáåíêîì â ðîäàõ ÿâëÿþòñÿ ôàêòîðàìè, ïðèâîäÿùèìè ê èíôèöèðîâàíèþ.
Âàæíî îòìåòèòü, ÷òî â ñâÿçè ñ áîëåå âûñîêèì ðèñêîì êîíòàêòà ðåáåíêà ñ êðîâüþ ìàòåðè, îáíàðóæåíèå íîñèòåëüñòâà âèðóñà ó ìàòåðè íå ÿâëÿåòñÿ ïîêàçàíèåì ê Êåñàðåâó ñå÷åíèþ. È óæå òåì áîëåå íå ÿâëÿåòñÿ ïîêàçàíèåì ê ïðåðûâàíèþ áåðåìåííîñòè.
Ïðèíöèïèàëüíî åñòü äâå ñèòóàöèè, êîãäà æåíùèíà çàáîëåâàåò îñòðûì âèðóñíûì ãåïàòèòîì âî âðåìÿ áåðåìåííîñòè, ëèáî îíà ÿâëÿåòñÿ õðîíè÷åñêèì íîñèòåëåì âèðóñà. Ïåðåíåñåííûé â I òðèìåñòðå áåðåìåííîñòè îñòðûé ãåïàòèò  íå ïðèâîäèò ê èíôèöèðîâàíèþ çà èñêëþ÷åíèåì ñëó÷àåâ, êîãäà èíôåêöèÿ íå çàêàí÷èâàåòñÿ èçëå÷åíèåì, à ïåðåõîäèò â íîñèòåëüñòâî. Åñëè èíôåêöèÿ áûëà ïåðåíåñåíà âî II òðèìåñòðå, ðèñê çàðàæåíèÿ ñîñòàâëÿåò îêîëî 6%, îäíàêî ýòîò ðèñê óâåëè÷èâàåòñÿ äî 67% ïðè çàáîëåâàíèè ãåïàòèòîì â III òðèìåñòðå.
Îöåíèòü ñòåïåíü ðèñêà èíôèöèðîâàíèÿ ðåáåíêà â ðîäàõ ïîìèìî ñòàíäàðòíîãî òåñòà íà «àâñòðàëèéñêèé» àíòèãåí ïîìîãàåò òåñò ìàòåðè íà äðóãîé àíòèãåí, à èìåííî HBeAg («å-àíòèãåí»). Âûÿâëåíèå HBeAg ãîâîðèò îá àêòèâíîì ðàçìíîæåíèè âèðóñà è îñòðîé ôàçå çàáîëåâàíèÿ. Ïîëîæèòåëüíûé òåñò íà ýòîò àíòèãåí óêàçûâàåò íà âûñîêóþ âåðîÿòíîñòü (èìåííî âåðîÿòíîñòü!) èíôèöèðîâàíèÿ (70-90%) ðåáåíêà â ðîäàõ, â òî âðåìÿ êàê ïðè åãî îòñóòñòâèè ðèñê ñîñòàâëÿåò ëèøü îêîëî 10%. Ïðîâåäåíèå òåñòà íà HBeAg íå âëèÿåò íà òàêòèêó ýêñòðåííîé ïðîôèëàêòèêè è ñëóæèò ëèøü äëÿ îïðåäåëåíèÿ ñòåïåíè ðèñêà èíôèöèðîâàíèÿ.
Âñå äåòè, ðîæäåííûå îò ìàòåðåé, â êðîâè êîòîðûõ îáíàðóæåí HBsAg, â òå÷åíèå 12 ÷àñîâ äîëæíû ïîëó÷èòü îäíó äîçó ñïåöèôè÷åñêîãî èììóíîãëîáóëèíà ïðîòèâ ãåïàòèòà  è îäíîâðåìåííî, â äðóãóþ íîæêó, ïåðâóþ äîçó âàêöèíû ïðîòèâ ãåïàòèòà Â.  äàëüíåéøåì âàêöèíàöèþ íåîáõîäèìî çàêîí÷èòü íå ïî ñòàíäàðòíîé (0-1-6 ìåñ.), à ïî «ýêñòðåííîé» ñõåìå 0-1-2-12 ìåñ. Ýôôåêòèâíîñòü ýêñòðåííîé ïðîôèëàêòèêè ïî òàêîé ñõåìå ñîñòàâëÿåò 85-95%. Ôàêòè÷åñêè, ïðè îáíàðóæåíèè íîñèòåëüñòâà ó áåðåìåííîé æåíùèíû ñàìûì ãëàâíûì ÿâëÿåòñÿ ñàì ôàêò çíàíèÿ î òîì, ÷òî æåíùèíà èíôèöèðîâàíà, ïîñêîëüêó ýòî ïîçâîëèò âîâðåìÿ ïðîâåñòè ýêñòðåííóþ ïðîôèëàêòèêó èíôåêöèè ó ðåáåíêà, ýôôåêòèâíîñòü êîòîðîé áëèçêà ê 100%.

ÎÁÙÈÅ ÐÅÊÎÌÅÍÄÀÖÈÈ ÏÎ ÏÐÎÂÅÄÅÍÈÞ ÝÊÑÒÐÅÍÍÎÉ ÏÐÎÔÈËÀÊÒÈÊÈ
; Èììóíîãëîáóëèí è âàêöèíà äîëæíû ââîäèòüñÿ â ðàçíûå ìåñòà, äîñòàòî÷íî óäàëåííûå äðóã îò äðóãà.
; Âàêöèíó íåîáõîäèìî ââîäèòü èñêëþ÷èòåëüíî âíóòðèìûøå÷íî, ïîñêîëüêó ïðè ïîäêîæíîì ââåäåíèè èììóíîãåííîñòü âàêöèíû ïàäàåò
; Ïðè íåîáõîäèìîì îáúåìå ââîäèìîãî èììóíîãëîáóëèíà, ïðåâûøàþùåì 5 ìë, åãî ñëåäóåò ââîäèòü â íåñêîëüêî ðàçíûõ ìåñò
; Âñå èììóíèçèðîâàííûå èììóíîãëîáóëèíîì è/èëè ïðèâèòûå âàêöèíîé ëèöà äîëæíû íàáëþäàòüñÿ â òå÷åíèå 30 ìèí. ïîñëå ââåäåíèÿ ïðåïàðàòîâ

ÊÎÌÌÅÍÒÀÐÈÉ: î÷åâèäíî, ÷òî â Ðîññèè ïðèìåíÿåòñÿ èìåííî ÝÊÑÒÐÅÍÍÀß ïðîôèëàêòèêà. ×òî: ó íàñ ÂÑÅ íîâîðîæäåííûå æèâóò â ñåìüÿõ, ãäå åñòü íàðêîìàíû, êîòîðûå ìîãóò èì ñäåëàòü óêîë? Èëè: âñå âðà÷è â íàøèõ áîëüíèöàõ óæå çàðàæåíû ãåïàòèòîì Â? Èëè: âñå ïîâåðõíîñòè çàðàæåíû â áîëüíèöàõ, ãäå ñîäåðæàòñÿ íîâîðîæäåííûå? Ïî÷åìó âàêöèíàöèÿ äåëàåòñÿ èìåííî â 1 äåíü è èìåííî îò ãåïàòèòà Â, ãðóïïó ðèñêà äëÿ êîòîðîãî ñîñòàâëÿþò íàðêîìàíû, ãîìîñåêñóàëèñòû è óæå çàðàæ¸ííûå ãåïàòèòîì Â?
Âàêöèíàöèÿ ñòîëü ýêñòðåííàÿ íåîáõîäèìà,åñëè ðåá¸íîê ðîæä¸í îò ìàòåðè óæå èíôèöèðîâàííîé èëè âèðóñ ìîæåò ïîïàñòü åìó ïðè ïåðåëèâàíèè êðîâè (ïîëîâîé êîíòàêò, êîíå÷íî, èñêëþ÷àåòñÿ). ×òî: ó íàñ â áîëüíèöàõ è ðîääîìàõ íåò ñòåðèëüíûõ èíñòðóìåíòîâ, íå ñîáëþäàþòñÿ óñëîâèÿ ãèãèåíû?

ÑÏÅÖÈÔÈ×ÅÑÊÈÅ ÈÌÌÓÍÎÃËÎÁÓËÈÍÛ ÏÐÎÒÈ ÃÅÏÀÒÈÒÀ Â, ÇÀÐÅÃÈÑÒÐÈÐÎÂÀÍÍÛÅ Â ÐÎÑÑÈÈ
Äëÿ ïàññèâíîé èììóíèçàöèè äåòåé, ðîäèâøèõñÿ îò ìàòåðåé-íîñèòåëüíèö âèðóñà ãåïàòèòà Â, òðåáóåòñÿ îäíîêðàòíî ââåñòè 2 ìë. (100 ÌÅ) ëþáîãî èç ïðåïàðàòîâ. Äåòÿì äî 10 ëåò, ïîäâåðãøèìñÿ ðèñêó èíôèöèðîâàíèÿ, ââîäèòñÿ 100 ÌÅ ïðåïàðàòà. Äåòÿì ñòàðøå 10 ëåò è âçðîñëûì ïðåïàðàò ââîäÿò èç ðàñ÷åòà 6-8 ÌÅ íà êã âåñà., ïî âîçìîæíîñòè ââîäèòñÿ â òå÷åíèå 24-48 ÷àñîâ (äî 15 äíåé, õîòÿ ïðè ýòîì ýôôåêòèâíîñòü ïðîôèëàêòèêè ðåçêî ñíèæàåòñÿ) ïîñëå âåðîÿòíîãî èíôèöèðîâàíèÿ.
; «Àíòèãåï», èììóíîãëîáóëèí ÷åëîâåêà ïðîòèâ ãåïàòèòà  (ïð-âà ÍÏÊ «Êîìáèîòåõ Ëòä.» (Ìîñêâà, (095) 330-74-29) è ÍÏÎ «Áèîìåä» (Ïåðìü, (3422) 48-42-44)). Âûïóñêàåòñÿ â àìïóëàõ ïî 2 ìë (100 ìåæäóíàðîäíûõ åäèíèö àíòè-HBs àíòèòåë), â óïàêîâêå 10 àìïóë.
; Èììóíîãëîáóëèí ÷åëîâåêà íîðìàëüíûé, ñ ïîâûøåííûì ñîäåðæàíèåì àíòèòåë ê âèðóñó ãåïàòèòà  (ïð-âà ÍÈÈ ýïèäåìèîëîãèè è ìèêðîáèîëîãèè èì. Ïàñòåðà, Ñàíêò-Ïåòåðáóðã, (812) 233-56-83).  1 ìë. ñîäåðæèò íå ìåíåå 50 ÌÅ àíòèòåë ê âèðóñó ãåïàòèòà Â. Ôîðìà âûïóñêà: àìïóëû ïî 2 ìë (100 ÌÅ).
; «Ãåïàòåêò», èììóíîãëîáóëèí ÷åëîâåêà ïðîòèâ ãåïàòèòà  (ïð-âà «Áèîòåñò Ôàðìà Ãìáõ», Ãåðìàíèÿ, (095) 938-23-41). Âûïóñêàåòñÿ â àìïóëàõ ïî 2 ìë (100 ÌÅ) è 10 ìë (500 Å). Ââîäèòñÿ â/â, êàïåëüíî, íà ôèçðàñòâîðå.

ÌÈÍÇÄÐÀÂÑÎÖÐÀÇÂÈÒÈß ÐÎÑÑÈÈ
ÔÅÄÅÐÀËÜÍÀß ÑËÓÆÁÀ ÏÎ ÍÀÄÇÎÐÓ Â ÑÔÅÐÅ ÇÀÙÈÒÛ ÏÐÀ ÏÎÒÐÅÁÈÒÅËÅÉ È ÁËÀÃÎÏÎËÓ×Èß ×ÅËÎÂÅÊÀ
(ÐÎÑÏÎÒÐÅÁÍÀÄÇÎÐ)
127994, ã. Ìîñêâà, Âàäêîâñêèé ïåð., ä. 18, ñòðîåíèå 5,7
Òåë: (499) 973-18-02 Ôàêñ: (499) 973-18-02
E-mail: depart@gsen.ru http://www.rospotrebnadzor.ru/
ÎÊÏÎ: 00083339 ÎÃÐÍ: 10477961512
ÈÍÍ: 7707515984 ÊÏÏ: 770701001
 18.05.2007  ¹  0100/5136-07-32 Ðóêîâîäèòåëÿì óïðàâëåíèé
Ðîñïîòðåáíàäçîðà ïî
ñóáúåêòàì Ðîññèéñêîé Ôåäåðàöèè
 
Ðóêîâîäèòåëÿì îðãàíîâ óïðàâëåíèÿ
çäðàâîîõðàíåíèÿ ñóáúåêòîâ
Ðîññèéñêîé Ôåäåðàöèè
Î âðåìåííîì ïðèîñòàíîâëåíèè èñïîëüçîâàíèÿ ñåðèé âàêöèíû «Ýóâàêñ »
Ôåäåðàëüíàÿ ñëóæáà ïî íàäçîðó â ñôåðå çàùèòû ïðàâ ïîòðåáèòåëåé è áëàãîïîëó÷èÿ ÷åëîâåêà èíôîðìèðóåò, ïî äàííûì Äåïàðòàìåíòà Èììóíèçàöèè, Âàêöèí è Áèîïðåïàðàòîâ Âñåìèðíîé Îðãàíèçàöèè Çäðàâîîõðàíåíèÿ âî Âüåòíàìå âûÿâëåíû ñåðüåçíûå ïîáî÷íûå ðåàêöèè (âêëþ÷àÿ ëåòàëüíûå èñõîäû) ó äåòåé, ñâÿçàííûå ïî âðåìåíè ñ ââåäåíèåì îïðåäåëåííûõ ñåðèé âàêöèíû ïðîòèâ ãåïàòèòà  Euvax B, ïðîèçâåäåííîé LG Life Sciences, Ðåñïóáëèêà Êîðåÿ.  íàñòîÿùåå âðåìÿ ïðîâîäèòñÿ ðàññëåäîâàíèå ïî äàííîìó ôàêòó.
 ñâÿçè ñ èçëîæåííûì âûøå, âïðåäü äî îñîáîãî ðàñïîðÿæåíèÿ, íåîáõîäèìî âðåìåííî èçúÿòü èç óïîòðåáëåíèÿ ñëåäóþùèå ñåðèè âàêöèíû ãåïàòèòà  Euvax B, ïðîèçâåäåííîé LG Life Sciences, Ðåñïóáëèêà Êîðåÿ:
• Ïàðòèÿ UVN05012 è ñîîòâåòñòâóþùèå ñåðèè UVX05027, UVX05028 è UVX05029
• Ïàðòèÿ UVN06004 è ñîîòâåòñòâóþùèå ñåðèè UVX06005, UVX06006 è UVX06007,
• Ïàðòèÿ UVN05014 è ñîîòâåòñòâóþùèå ñåðèè UVX05030, UVX05031 è UVX05032.
Ïîñëå çàâåðøåíèÿ ðàññëåäîâàíèÿ ïîáî÷íûõ ðåàêöèé âî Âüåòíàìå ÂÎÇ íàïðàâèò ñîîòâåòñòâóþùèå ðåêîìåíäàöèè, à òàêæå îáçîð ïî êà÷åñòâó è áåçîïàñíîñòè íàçâàííîé âàêöèíû.
Êðîìå òîãî, ïðîñèì íåìåäëåííî ïðåäñòàâèòü ñëåäóþùóþ èíôîðìàöèþ î  âàêöèíå ïðîòèâ ãåïàòèòà Â Euvax B (ïî ñóáúåêòó Ðîññèéñêîé Ôåäåðàöèè):
— çàêóïëåíî äîç (âñåãî, â ò.÷. äëÿ äåòåé è äëÿ âçðîñëûõ);
— èçðàñõîäîâàíî äîç (âñåãî, â ò.÷. äëÿ äåòåé è äëÿ âçðîñëûõ);
— ïðèâèòî ÷åëîâåê (âñåãî, â ò.÷. äåòåé è âçðîñëûõ);
— îñòàòîê äîç (âñåãî, â ò.÷. äëÿ äåòåé è äëÿ âçðîñëûõ);
— çàðåãèñòðèðîâàíî ïîñòâàêöèíàëüíûõ îñëîæíåíèé/ðåàêöèé (ïîäðîáíî).
Ðóêîâîäèòåëü
Ãåííàäèé Ãðèãîðüåâè÷ Îíèùåíêî

http://rospotrebnadzor.ru/documents/letters/1021/

Ñâèäåòåëüñòâî Ìàéêëà Áåëêèíà ïåðåä Êîíãðåññîì ÑØÀ.
Âòîðíèê, 18-å ìàÿ 1999 ã.
Îðèãèíàë íà http://www.whale.to/vaccines/belkin.html http://www.whale.to/vaccines/belkin.htm
Ìîÿ äî÷ü Ëåéëà Ðîçà Áåëêèí óìåðëà 16-ãî ñåíòÿáðÿ 1998 ã. â âîçðàñòå 5-è íåäåëü, 15 ÷àñîâ ñïóñòÿ ïîñëå òîãî, êàê ïîëó÷èëà âòîðóþ ïðèâèâêó ïðîòèâ ãåïàòèòà Â. Ëåéëà áûëà ïîëíûì æèçíè, ýíåðãè÷íûì ïÿòèíåäåëüíûì ðåá¸íêîì, êîãäà ÿ ïîñëåäíèé ðàç äåðæàë å¸ â ñâîèõ ðóêàõ. Ìîã ëè ÿ ïðåäñòàâèòü, êîãäà îíà ïðèñòàëüíî âãëÿäûâàëàñü â ìîè ãëàçà, ñî âñåé ïðåëåñòíîé íåâèííîñòüþ íîâîðîæä¸ííîãî, ÷òî îíà óìð¸ò â òó æå íî÷ü? Îíà íè÷åì íå áîëåëà ïåðåä òåì, êàê ïîëó÷èëà ïðèâèâêó â ïîëäåíü òîãî äíÿ. Âî âðåìÿ å¸ ïîñëåäíåãî êîðìëåíèÿ òîé íî÷üþ, îíà áûëà êðàéíå âîçáóæäåíà, êðè÷àëà — è âäðóã âíåçàïíî çàñíóëà è ïåðåñòàëà äûøàòü. Âñêðûòèå èñêëþ÷èëî óäóøüå. Ìåäèöèíñêèé èíñïåêòîð Íüþ-Éîðêà ïðèïèñàë å¸ ñìåðòü ñèíäðîìó âíåçàïíîé äåòñêîé ñìåðòè (ÑÂÄÑ).
Îäíàêî ìåäèöèíñêèé èíñïåêòîð (ä-ð Ïåðñå÷èíî) íå îáðàòèë âíèìàíèå íà îò¸ê ìîçãà Ëåéëû è íà ñîîáùåíèå î ïðèâèâêå ïðîòèâ ãåïàòèòà  â îò÷¸òå î âñêðûòèè. Ñëåäîâàòåëü ðàçãîâàðèâàë ñ ìîåé æåíîé è ñî ìíîþ, à òàêæå ñ íàøèì ïåäèàòðîì (ä-ðîì Çóëëî) â äåíü âñêðûòèÿ è çàÿâèë, ÷òî å¸ ìîçã áûë îò¸÷åí. Âîò çàìåòêè ä-ðà Çóëëî î òîé áåñåäå: «Ìîçã îò¸÷åí… ïðè÷èíà íåïîíÿòíà… íå ïîíèìàþ, êàê ðåêîìáèíàíòíàÿ âàêöèíà ìîãëà îáóñëîâèòü ïðîáëåìó».
ÑÂÄÑ — äèàãíîç èñêëþ÷åíèÿ. «Òîãî íå áûëî, äðóãîãî íå áûëî, âñ¸ áûëî îòâåðãíóòî è ìû íå çíàåì, ÷òî æå ýòî áûëî». Îò¸ê ìîçãà — ýòî íå ÑÂÄÑ. Ïîñëå áåñåä ñ îïûòíûìè ïàòîëîãîàíàòîìàìè, ÿ óçíàë, ÷òî âîñïàëåíèå ìîçãà — êëàññè÷åñêàÿ ïîáî÷íàÿ ðåàêöèÿ íà ïðèâèâêó (ëþáîé âàêöèíîé), îïèñàííàÿ â ìåäèöèíñêîé ëèòåðàòóðå.
ß íà÷àë èññëåäîâàòü âàêöèíó ïðîòèâ ãåïàòèòà  è ïðèñóòñòâîâàë íà ôåâðàëüñêîì ñèìïîçèóìå ïî «Íåîíàòàëüíîé ñìåðòè è ïðèâèâêå ïðîòèâ ãåïàòèòà » Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå (ACIP) ïðè Íàöèîíàëüíîé Àêàäåìèè íàóê, à òàêæå áûë ñâèäåòåëåì äèñêóññèè ìåæäó ä-ðîì Ìîäëèíûì, ïðåäñåäàòåëåì Êîìèòåòà, è ä-ðîì Âåéñáðåíîì îòíîñèòåëüíî áåçîïàñíîñòè âàêöèíû ïðîòèâ ãåïàòèòà Â. ß ïîëó÷èë âñþ áàçó äàííûõ Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê (VAERS) ïî ïîáî÷íûì ýôôåêòàì ïðèâèâêè ïðîòèâ ãåïàòèòà  è òùàòåëüíî å¸ èçó÷èë.
Âîò âûâîäû, ê êîòîðûì ÿ ïðèø¸ë, àíàëèç è îáîñíîâàíèå êîòîðûõ äà¸òñÿ â ïðèëàãàåìûõ ìàòåðèàëàõ.  ïðåäîñòàâëåííîå äëÿ ìîåãî âûñòóïëåíèÿ âðåìÿ ÿ íå ñìîãó ïîçíàêîìèòü âàñ ñ íèìè öåëèêîì. Ïîæàëóéñòà, ïðî÷èòàéòå ðåçóëüòàòû ìîåãî èññëåäîâàíèÿ, ïîñêîëüêó ýòî ïîìîæåò âàì ëó÷øå ïîíÿòü âñþ çíà÷èìîñòü òåìû ïðèâèâêè ïðîòèâ ãåïàòèòà Â.
Ãåïàòèò  íå ãðîçèò íîâîðîæä¸ííûì äî òåõ ïîð, ïîêà èõ ìàòü íå çàðàçèëàñü èì Ãåïàòèò  — ïðåèìóùåñòâåííî áîëåçíü íàðêîìàíîâ, ãîìîñåêñóàëèñòîâ è íåðàçáîð÷èâûõ â ïîëîâûõ ñâÿçÿõ ãåòåðîñåêñóàëîâ
Ïðèâèâêà äåëàåòñÿ äåòÿì ïîòîìó, ÷òî îðãàíû çäðàâîîõðàíåíèÿ íå ìîãóò çàñòàâèòü âûøåóêàçàííûå ãðóïïû ðèñêà ïîëó÷èòü ïðèâèâêó
Íè÷åãî íå áûëî ñäåëàíî ñ öåëüþ èçó÷èòü ïîáî÷íûå ðåàêöèè âàêöèíû
Ýòè ïîáî÷íûå ðåàêöèè âêëþ÷àþò ìíîãî÷èñëåííûå ñìåðòè, ñóäîðîãè è àðòðèòû, ñëó÷àþùèåñÿ â òå÷åíèå íåñêîëüêèõ äíåé ïîñëå ïðèâèâêè ïðîòèâ ãåïàòèòà Â
Öåíòð êîíòðîëÿ çàáîëåâàíèé (CDC) ââîäèò íàñ â çàáëóæäåíèå, ïðåäñòàâëÿÿ îöåíî÷íóþ, ãèïîòåòè÷åñêóþ ñòàòèñòèêó çàáîëåâàíèÿ êàê ðåàëüíûå ñëó÷àè çàáîëåâàíèÿ
Ñîâåùàòåëüíûé êîìèòåò ïî èììóíèçàöèîííîé ïðàêòèêå ðåêîìåíäóåò íîâûå âàêöèíû äëÿ íåäîíîøåííûõ ìëàäåíöåâ, íå èìåÿ íàó÷íûõ èññëåäîâàíèé, äîêàçûâàþùèõ èõ áåçîïàñíîñòü
Ïðîöåññ ðåêîìåíäàöèè ê èñïîëüçîâàíèþ âàêöèí â ÑØÀ áåçíàä¸æíî ñêîìïðîìåòèðîâàí çëîóïîòðåáëåíèåì ñëóæåáíûì ïîëîæåíèåì ïðîèçâîäèòåëåé âàêöèí è ëèö â Àìåðèêàíñêîé Àêàäåìèè ïåäèàòðèè (AAP ) è Öåíòðà êîíòðîëÿ çàáîëåâàíèé
Âûâîä: Åñëè (êàê ýòî áûëî â ñëó÷àå ñ íåäàâíî ðåêîìåíäîâàííîé ðîòàâèðóñíîé âàêöèíîé) âàêöèíà ïðîòèâ ãåïàòèòà  áûëà ðåêîìåíäîâàíà áåç íàó÷íûõ äîêàçàòåëüñòâ å¸ áåçîïàñíîñòè äëÿ øèðîêîãî ñïåêòðà ðàñîâî è ãåíåòè÷åñêè ðàçëè÷íûõ íîâîðîæä¸ííûõ â âîçðàñòå äî 48 ÷àñîâ, òî Öåíòð êîíòðîëÿ çàáîëåâàíèé. ýêñïåðèìåíòèðóåò íà íîâîðîæä¸ííûõ êàê íà ìîðñêèõ ñâèíêàõ, è íàñòîÿùèé êîìèòåò (ïî ïðàâèòåëüñòâåííûì ðåôîðìàì — À.Ê.) äîëæåí ïðåêðàòèòü ïîëèòèêó ìàññîâûõ ïðèâèâîê.
 
Âàêöèíà ïðîòèâ ãåïàòèòà  áûëà ðåêîìåíäîâàíà â 1991 ã. äëÿ ìàññîâûõ ïðèâèâîê íîâîðîæä¸ííûõ Ñîâåùàòåëüíûì êîìèòåòîì ïî èììóíèçàöèîííîé ïðàêòèêå (ïðèäàòêîì Öåíòðà êîíòðîëÿ çàáîëåâàíèé). Ïàðàäîêñàëüíî, íî â èíôîðìàöèîííîì ëèñòêå «Ôàêòû î áîëåçíè» îòíîñèòåëüíî ãåïàòèòà  ñàìîãî Öåíòðà êîíòðîëÿ çàáîëåâàíèé, íîâîðîæä¸ííûå íå ôèãóðèðóþò â ãðóïïå ðèñêà. «Ôàêòû» ïåðå÷èñëÿþò íàðêîìàíîâ, èñïîëüçóþùèõ âíóòðèâåííûå èíúåêöèè, ãîìîñåêñóàëèñòîâ, ñåêñóàëüíî àêòèâíûõ ãåòåðîñåêñóàëîâ, ìëàäåíöåâ èëè äåòåé ýìèãðàíòîâ èç ýíäåìè÷åñêèõ ðàéîíîâ, íèçêèé ñîöèàëüíî-ýêîíîìè÷åñêèé óðîâåíü, ñåêñóàëüíûå/áûòîâûå êîíòàêòû ñ èíôèöèðîâàííûìè ëèöàìè, ìëàäåíöåâ, ðîæä¸ííûõ èíôèöèðîâàííûìè ìàòåðÿìè, ðàáîòíèêîâ çäðàâîîõðàíåíèÿ è ïàöèåíòîâ ãåìîäèàëèçà. Íîâîðîæä¸ííûõ íåò!
Âîïðîñ: Ïî÷åìó òîãäà Ñîâåùàòåëüíûé êîìèòåò ïî èììóíèçàöèîííîé ïðàêòèêå óñòàíîâèë, ÷òî àìåðèêàíñêèå íîâîðîæä¸ííûå, íå íàõîäÿùèåñÿ â ãðóïïå ðèñêà ïî ýòîé áîëåçíè, äîëæíû ïðèíóäèòåëüíî ïîëó÷àòü òðè óêîëà ïðîòèâ ãåïàòèòà Â?
Îòâåò: Âîò ãëàâíàÿ ïðè÷èíà, èçëîæåííàÿ â çàÿâëåíèè êîìèòåòà îòíîñèòåëüíî îôèöèàëüíîé ïîëèòèêè â îáëàñòè ïðèâèâîê «Âèðóñ ãåïàòèòà Â: íûíåøíÿÿ ñòðàòåãèÿ íà èñêîðåíåíèå ïåðåäà÷è ïîñðåäñòâîì âñåîáùèõ äåòñêèõ ïðèâèâîê»: «Áîëüøèíñòâî ñëó÷àåâ â ÑØÀ ðåãèñòðèðóåòñÿ ñðåäè âçðîñëûõ è ïîäðîñòêîâ…. Ðåêîìåíäóåìîé ñòðàòåãèåé ïðåäîòâðàùåíèÿ çàðàæåíèÿ ÿâëÿåòñÿ âûáîðî÷íîå ïðèâèâàíèå ëèö ñ óñòàíîâëåííûìè ôàêòîðàìè ðèñêà…. Òåì íå ìåíåå, ýòà ñòðàòåãèÿ íå ñíèçèëà çàáîëåâàåìîñòü, ãëàâíûì îáðàçîì âñëåäñòâèå òîãî, ÷òî ëèö ñ ñîîòâåòñòâóþùèì ïîâåäåíèåì, ñòèëåì æèçíè èëè ðîäîì äåÿòåëüíîñòè íåâîçìîæíî ïðèâèòü äî òîãî, êàê îíè çàðàçÿòñÿ…. Ïîïûòêè ïðèâèâàòü ëèö ãðóïï ðèñêà èìåþò îãðàíè÷åííûé óñïåõ. Íàïðèìåð, íàðêîìàíîâ, èñïîëüçóþùèõ âíóòðèâåííûå ïðåïàðàòû, íå óäàëîñü óáåäèòü ïîëó÷èòü òðè äîçû âàêöèíû…. Ñòàëî î÷åâèäíî, ÷òî ïåðåäà÷à âèðóñà ãåïàòèòà  â ÑØÀ íå ìîæåò áûòü ïðåäîòâðàùåíà ïóò¸ì âàêöèíàöèè òîëüêî ãðóïï âûñîêîãî ðèñêà…. Ãîâîðÿ î äîëãîñðî÷íîé ïåðñïåêòèâå, âñåîáùàÿ âàêöèíàöèÿ íîâîðîæäåííûõ ìîãëà áû èñêëþ÷èòü íåîáõîäèìîñòü ïðèâèâàòü ïîäðîñòêîâ è âçðîñëûõ èç ãðóïï âûñîêîãî ðèñêà…. Ïðèâèâêà ïðîòèâ ãåïàòèòà  ðåêîìåíäóåòñÿ äëÿ âñåõ ìëàäåíöåâ, íåçàâèñèìî îò òîãî, îáíàðóæèâàåòñÿ ëè ó èõ ìàòåðåé àíòèãåí âèðóñà ãåïàòèòà  (HBsAg)…. Ïåðâàÿ äîçà ìîæåò äàâàòüñÿ â ïåðèîä íîâîðîæä¸ííîñòè, ëó÷øå âñåãî äî òîãî, êàê íîâîðîæä¸ííûé áóäåò âûïèñàí èç ãîñïèòàëÿ, íî íå ïîçäíåå, ÷åì äî äâóõ ìåñÿöåâ æèçíè….» (ïîä÷¸ðêèâàíèå äîáàâëåíî).
Òàêèì îáðàçîì, ïî ñëîâàì ñàìèõ Öåíòðà êîíòðîëÿ çàáîëåâàíèé è Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå, ïîÿâëåíèå íà ñâåò ïî÷òè êàæäîãî íîâîðîæä¸ííîãî â ÑØÀ ïðèâåòñòâóåòñÿ ïðèâèâêîé âàêöèíû ïðîòèâ áîëåçíè, ïåðåäàâàåìîé ïîëîâûì ïóò¸ì, ðèñêà çàáîëåòü êîòîðîé ó ðåá¸íêà íåò — ëèøü ïîòîìó, ÷òî íå ìîãóò äîáðàòüñÿ äî íàðêîìàíîâ, ïðîñòèòóòîê, ãîìîñåêñóàëèñòîâ è íåðàçáîð÷èâûõ â ñâÿçÿõ ãåòåðîñåêñóàëîâ è óáåäèòü èõ ïîëó÷èòü âàêöèíó. Ýòî — ñóùíîñòü ïðîãðàììû âñåîáùèõ ïðèâèâîê.
Âîïðîñ: Êàêîâû ïðåèìóùåñòâà è íåäîñòàòêè èñïîëüçîâàíèÿ ýòîé âàêöèíû ó ìëàäåíöåâ?
Îòâåò: Ãåïàòèò  — ðåäêîå, ïåðåäàâàåìîå ãëàâíûì îáðàçîì ñ êðîâüþ, çàáîëåâàíèå.  1996 ã. Öåíòð êîíòðîëÿ çàáîëåâàíèé ñîîáùèë âñåãî î 54 ñëó÷àÿõ áîëåçíè â âîçðàñòíîé ãðóïïå äî ãîäà.  òîì ãîäó â ÑØÀ áûëî 3,9 ìëí. ðîäîâ. Òàêèì îáðàçîì, íàáëþäàåìàÿ ÷àñòîòà ãåïàòèòà  â âîçðàñòíîé ãðóïïå äî îäíîãî ãîäà, áûëà ëèøü 0,001%.  Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê áûëî ñîîáùåíî î 1080 ñëó÷àÿõ ïîáî÷íûõ ðåàêöèé íà ââåäåíèå âàêöèíû ïðîòèâ ãåïàòèòà Â, 47 èç êîòîðûõ çàêîí÷èëèñü ñìåðòüþ. Ñîîòâåòñòâåííî, êîëè÷åñòâî ñîîáùåíèé â Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê ïðåâûñèëî êîëè÷åñòâî ñëó÷àåâ áîëåçíè â 20 ðàç.
Âîïðîñ: Ïî÷åìó æå, âìåñòî ïðèâèâàíèÿ ìëàäåíöåâ, ïðîñòî íå ïðîâåðÿþò ìàòåðåé íà íîñèòåëüñòâî âèðóñà ãåïàòèòà  (ò.ê. ýòî åäèíñòâåííûé ïóòü, êîòîðûì íîâîðîæä¸ííûé ìîæåò çàðàçèòüñÿ ýòîé áîëåçíüþ)?
Îòâåò: Ïðîäàæà âàêöèí ÿâëÿåòñÿ êðàéíå âûãîäíûì áèçíåñîì, à ïðîöåññ ðåêîìåíäàöèè âàêöèí çàïÿòíàí çëîóïîòðåáëåíèåì ñëóæåáíûì ïîëîæåíèåì ïðîèçâîäèòåëåé âàêöèí è ëèö â Ñîâåùàòåëüíîì êîìèòåòå ïî èììóíèçàöèîííîé ïðàêòèêå è Àìåðèêàíñêîé Àêàäåìèè ïåäèàòðèè. Ìîäåëü áèçíåñà, ïðè êîòîðîì ïîêóïêà òîâàðà íàâÿçûâàåòñÿ ãîñóäàðñòâîì, ÿâëÿåòñÿ ìå÷òîé ìîíîïîëèñòà.
Âîïðîñ: Êàêèå èññëåäîâàíèÿ áûëè ñäåëàíû ïî äàííûì, ïîëó÷åííûìè Ñîâåùàòåëüíûì êîìèòåòîì ïî èììóíèçàöèîííîé ïðàêòèêå?
Îòâåò: Àáñîëþòíî íèêàêèõ. 25 000 ñîîáùåíèé áûëè îòïðàâëåíû â ÿùèê ñòîëà è çàáûòû. Ñêîëüêî æå ñîîáùåíèé äîñòàòî÷íî, ÷òîáû ïðîäåìîíñòðèðîâàòü îïàñíîñòü ëåêàðñòâà èëè âàêöèíû — 2 500? 25 000? 250 000? ×åíü èç Öåíòðà êîíòðîëÿ çàáîëåâàíèé è Ýëëåíáåðã èç Óïðàâëåíèÿ êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ (FDA) èçó÷èëè ýòè äàííûå è âûñòóïèëè ñ äîêëàäàìè î òîì, ÷òî â ñîîáùåíèÿõ î ïîáî÷íûõ ðåàêöèÿõ, ïîñòóïèâøèõ â Öåíòð êîíòðîëÿ çàáîëåâàíèé íåò íè÷åãî èç ðÿäà âîí âûõîäÿùåãî è ÷òî îíè äåìîíñòðèðóþò «îòíîñèòåëüíóþ áåçîïàñíîñòü âàêöèíû ïðîòèâ ãåïàòèòà Â, êîòîðîé ïðèâèâàþò íîâîðîæä¸ííûõ è äåòåé». Íè÷åãî ïîäîáíîãî. Ïîñìîòðèòå ñàìè íà ýòè äàííûå. Ìåäèöèíñêèå âëàñòè ïðîäîëæàþò ïðåíåáðåæèòåëüíî îòìàõèâàòüñÿ îò ïîñòîÿííîãî ïîòîêà ñîîáùåíèé î ñåðü¸çíûõ ïîáî÷íûõ ðåàêöèÿõ íà ýòó ïðèâèâêó, è âñ¸ áîëüøå ìëàäåíöåâ è âçðîñëûõ óìèðàþò èëè ñòðàäàþò îò òÿæ¸ëûõ ïîðàæåíèé öåíòðàëüíîé íåðâíîé ñèñòåìû è ïå÷åíè.
Âîïðîñ: Ïî÷åìó Öåíòðî êîíòðîëÿ çàáîëåâàíèé, Ñîâåùàòåëüíûé êîìèòåò ïî èììóíèçàöèîííîé ïðàêòèêå è «Ìåðê» ãîâîðÿò íàì î 140 000-320 000 íîâûõ ñëó÷àåâ èíôèöèðîâàíèÿ â ãîä (70 000 — 160 000 ñëó÷àåâ ñèìïòîìàòè÷åñêèõ èíôåêöèé â ãîä), â òî âðåìÿ êàê äàííûå ñàìîãî Öåíòðà êîíòðîëÿ çàáîëåâàíèé äåìîíñòðèðóþò ëèøü 10 000 ñëó÷àåâ â ãîä?
Îòâåò: Îíè ïðåäñòàâëÿþò îöåíî÷íîå, ãèïîòåòè÷åñêîå ÷èñëî êàê ðåàëüíûå ñëó÷àè áîëåçíè. Ýòî ñòàòèñòè÷åñêîå ìîøåííè÷åñòâî.  ôèíàíñîâîì ìèðå òàêîå èñêàæåíèå ôàêòîâ ïðèâåëî áû ê ñóäåáíîìó ïðåñëåäîâàíèþ. Åñëè êîìïàíèÿ ðàçäóâàåò ñâîè äîõîäû äî 300% (êàê äåëàåò Öåíòð êîíòðîëÿ çàáîëåâàíèé ñî ñòàòèñòèêîé ïî çàáîëåâàåìîñòè ãåïàòèòîì Â) è ïîäñîâûâàåò ýòè äàííûå êàê îôèöèàëüíûå, à íå êàê îöåíêè-ïðèêèäêè — å¸ äåÿòåëüíîñòüþ çàéì¸òñÿ Êîìèññèÿ ïî öåííûì áóìàãàì è áèðæå, à äåðæàòåëè àêöèé ïîäàäóò èñêè â ñóä. Ïî÷åìó ýòîãî íå ïðîèñõîäèò â ìåäèöèíñêîì ìèðå? Íàä äåÿòåëüíîñòüþ Öåíòðà êîíòðîëÿ çàáîëåâàíèé íåò êîíòðîëÿ. Íàì íå ãîâîðÿò, ÷òî ýòî ãèïîòåòè÷åñêèå, îöåíî÷íûå öèôðû, îíè èñêàæàþò ôàêòû. Ïîïðîáóéòå òùàòåëüíî ïðîâåðèòü ýòè ïðåäïîëàãàåìûå 320 000 íîâûõ ñëó÷àåâ èíôèöèðîâàíèÿ â ãîä. Âû èõ íå íàéä¸òå. Âåñü ýòîò òðþê áûë ïðîäåëàí ëèøü äëÿ òîãî, ÷òîáû ðàçäóòü îáùåñòâåííóþ èñòåðèêó ïî ïîâîäó áîëåçíè, ðèñê çàáîëåòü êîòîðîé íèçîê, è ïîçâîëèòü Öåíòðó êîíòðîëÿ çàáîëåâàíèé óñèëèòü ñâî¸ âëèÿíèå, à «Ìåðêó» óâåëè÷èòü ñâîè äîõîäû îò ïðîäàæè âàêöèí íà 900 ìëí. äîëëàðîâ â ãîä.
Âîïðîñ: Êàê ïðîèñõîäèò ïðîöåññ ðåêîìåíäàöèè Öåíòðîì êîíòðîëÿ çàáîëâàíèé íîâîé âàêöèíû?
Îòâåò: ß ïðèñóòñòâîâàë íà ôåâðàëüñêîì çàñåäàíèè Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå â Àòëàíòå è ïðîñòî ïðèø¸ë â óæàñ. Ëþáîå ãîëîñîâàíèå êîìèòåòà ïî íîâûì îáÿçàòåëüíûì ïðèâèâêàì ïðîõîäèëî åäèíîãëàñíî (çà èñêëþ÷åíèåì îäíîãî ãîëîñà ïðîòèâ ðîòàâèðóñíîé âàêöèíû äëÿ íåäîíîøåííûõ ìëàäåíöåâ). Ïðàêòè÷åñêè íå áûëî íèêàêèõ äèñêóññèé ïî ïîáî÷íûì ðåàêöèÿì âàêöèí, Ñîâåùàòåëüíûé êîìèòåò ïî èììóíèçàöèîííîé ïðàêòèêå ïðîñòî øòàìïîâàë ðåøåíèÿ ïî ïîâåñòêå äíÿ. ß íàçûâàþ ýòî «ïðèâèâêè áåç âîïðîñîâ». Íàïðèìåð, Ñîâåùàòåëüíûé êîìèòåò ïî èììóíèçàöèîííîé ïðàêòèêå ðåêîìåíäîâàë ðîòàâèðóñíóþ âàêöèíó äëÿ íåäîíîøåííûõ ìëàäåíöåâ, õîòÿ íèêàêèõ íàó÷íûõ èññëåäîâàíèé òîãî, ÷òî îíà áåçîïàñíà, íå áûëî. Ä-ð Ìîäëèí, ïðåäñåäàòåëü Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå , çàÿâèë íà ïðîâàêöèíàòîðñêîì îáñóæäåíèè âàêöèíû ïðîòèâ ãåïàòèòà Â, ñîñòîÿâøåìñÿ â Íüþ-Ãåìïøèðå: «Êàê ìû îïðåäåëÿåì, ÷òî ÿâëÿåòñÿ íàó÷íî îáîñíîâàííûì, à ÷òî íåò?… 1. ßâëÿåòñÿ ëè òåîðèÿ áèîëîãè÷åñêè ïðàâäîïîäîáíîé? 2. Èññëåäîâàëàñü ëè ñîîòâåòñòâóþùèìè ìåòîäàìè? 3. Ñäåëàíû ëè îáîñíîâàííûå âûâîäû? 4. Áåçóïðå÷íû ëè ðåçóëüòàòû ñî ñòàòèñòè÷åñêîé òî÷êè çðåíèÿ?». Íî âîò ñëîâà Ìîäëèíà èç îò÷¸òà î ôåâðàëüñêîì çàñåäàíèè Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå, ïðîøòàìïîâàâøåì îäîáðåíèå ðîòàâèðóñíîé âàêöèíû äëÿ íåäîíîøåííûõ ìëàäåíöåâ: «Èìåþùèåñÿ â ðàñïîðÿæåíèè äàííûå íåäîñòàòî÷íû äëÿ òîãî, ÷òîáû îïðåäåëèòü áåçîïàñíîñòü è ýôôåêòèâíîñòü ðîòàâèðóñíîé âàêöèíû äëÿ íåäîíîøåííûõ ìëàäåíöåâ….  ðàçäåëå ïî ïîáî÷íûì ðåàêöèÿì îòìå÷àåòñÿ, ÷òî èíôîðìàöèÿ ïî íåäîíîøåííûì ìëàäåíöàì ñêóäíà…. Íàñêîëüêî ìíå èçâåñòíî, ìû íå ðàñïîëàãàåì äàííûìè íåïîñðåäñòâåííûõ êëèíè÷åñêèõ èñïûòàíèé…. Êîå-êàêàÿ èíôîðìàöèÿ, êàê ìíå ïðèïîìèíàåòñÿ, èç Ñèýòòëà, ïîêàçûâàåò, ÷òî áûëî íåáîëüøîå óâåëè÷åíèå ðèñêà ãîñïèòàëèçàöèè äëÿ íåäîíîøåííûõ ìëàäåíöåâ…. Íåñîìíåííî, ýòî ñèòóàöèÿ, â êîòîðîé ìû äîëæíû ïðèíÿòü ðåøåíèå î âàêöèíå, äàííûå ïî êîòîðîé îòñóòñòâóþò è êîòîðàÿ íå òåñòèðîâàëàñü â ãðóïïå…. » («Îò÷¸ò Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå «, ñ. 102-112). Çäåñü Ìîäëèí óìîëê, è ðåøåíèå áûëî ïðèíÿòî ñîîòíîøåíèåì äåâÿòü ê îäíîìó; Ìîäëèí ãîëîñîâàë çà, ä-ð Ãëîóä ïðîòèâ. Âîò âàì îòëè÷íûé ïðèìåð, êàê ìåäèöèíñêàÿ áþðîêðàòèÿ (âîçãëàâëÿåìàÿ Ñîâåùàòåëüíûì êîìèòåòîì ïî èììóíèçàöèîííîé ïðàêòèêå è Öåíòðîì êîíòðîëÿ çàáîëåâàíèé) ðåêîìåíäóåò âàêöèíû áåç íàó÷íûõ äîêàçàòåëüñòâ áåçîïàñíîñòè òîãî, ÷òî âàêöèíû áåçîïàñíû äëÿ øèðîêîãî ñïåêòðà ðàñîâî è ãåíåòè÷åñêè ðàçíîðîäíûõ ìëàäåíöåâ.
×òî äîëæíî áûòü ñäåëàíî? Íàñòîÿùèé êîìèòåò äîëæåí èçó÷èòü ðåêîìåíäàöèþ Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå îò 1991 ã. ââåñòè âñåîáùèå ïðèâèâêè ïðîòèâ ãåïàòèòà  äëÿ íîâîðîæä¸ííûõ â áîëüíèöàõ.  ñëó÷àå åñëè (êàê ñ îïèñàííîé âûøå ðîòàâèðóñíîé âàêöèíîé) íå áûëî ñäåëàíî èññëåäîâàíèé, ïîäòâåðæäàþùèõ å¸ áåçîïàñíîñòü äëÿ øèðîêîãî ñïåêòðà ðàñîâî è ãåíåòè÷åñêè ðàçíîðîäíûõ íîâîðîæä¸ííûõ â âîçðàñòå äî 48 ÷àñîâ, òî âûâîä òàêîâ, ÷òî Öåíòð êîíòðîëÿ çàáîëåâàíèé ýêñïåðèìåíòèðóåò íà íîâîðîæä¸ííûõ, êàê íà ìîðñêèõ ñâèíêàõ, è Êîìèòåò äîëæåí ïðåêðàòèòü ýòè âñåîáùèå ïðèâèâêè.
Àíàëèç äàííûõ Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê (VAERS)
ß èçó÷àë ñòàòèñòèêó â Êàëèôîðíèéñêîì óíèâåðñèòåòå â Áåðêëè è, âïîñëåäñòâèè, ñàì ðàçðàáîòàë çàïàòåíòîâàííûå óñîâåðøåíñòâîâàííûå ñòàòèñòè÷åñêèå ìîäåëè îöåíêè ðèñêà è ïðèáûëè â «Ñîëîìîí Áðàçåðñ» â 1986-1991 ãã. ß çàíèìàþñü ðàçðàáîòêîé ñòàòèñòè÷åñêèõ, ýêîíîìè÷åñêèõ è ôèíàíñîâûõ ïðîãíîçîâ äëÿ äîâåðèòåëüíûõ, ïåíñèîííûõ è ñòðàõîâûõ ôîíäîâ, à òàêæå äëÿ èíâåñòèöèîííûõ áàíêîâ.
ß èçó÷èë ñòàòèñòèêó Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê, ïîëó÷åííóþ Íàöèîíàëüíûì Öåíòðîì èíôîðìàöèè î âàêöèíàõ (NVIC) â ñîîòâåòñòâèè ñ Àêòîì î ñâîáîäå èíôîðìàöèè. Õîòÿ äàííûå è íå áåç èçúÿíà (íåçàïîëíåííûå ïîëÿ, íåêîòîðûå ñîîáùåíèÿ ïîâòîðÿþòñÿ), íî ëþáîé êâàëèôèöèðîâàííûé íåïðåäâçÿòûé àíàëèòèê èëè ñòàòèñòèê, íå ñâÿçàííûé ñ «Ìåðêîì», «Ñìèò Êëàéí», Öåíòðîì êîíòðîëÿ çàáîëåâàíèé, Óïðàâëåíèåì êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ èëè Àìåðèêàíñêîé Àêàäåìèåé ïåäèàòðèè, êîòîðûé ïðîâåðèò ýòè ñîîáùåíèÿ, íàéä¸ò ÿñíóþ è íåîïðîâåðæèìóþ ñâÿçü ñ áîëåçíÿìè ïå÷åíè è öåíòðàëüíîé íåðâíîé ñèñòåìû, ïîðàçèâøèìè òûñÿ÷è ëþäåé â òå÷åíèå ÷åòûð¸õ äíåé ïîñëå ïðèâèâêè ïðîòèâ ãåïàòèòà Â. Ýòè ñîîáùåíèÿ èãíîðèðóþòñÿ, îïðîâåðãàþòñÿ èëè ñ÷èòàþòñÿ «ïðèåìëåìûìè» Óïðàâëåíèåì êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ, Öåíòðîì êîíòðîëÿ çàáîëåâàíèé è ïðîèçâîäèòåëÿìè ëåêàðñòâ. Íàñòîÿùèé êîìèòåò äîëæåí óïîëíîìî÷èòü ãðóïïó íåçàâèñèìûõ ó÷¸íûõ, íå èìåþùèõ ñâÿçè ñ ïðîèçâîäèòåëÿìè ëåêàðñòâ èëè ñ áþðîêðàòèåé Óïðàâëåíèÿ êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ è/èëè Öåíòðà êîíòðîëÿ çàáîëåâàíèé, íà÷àòü èññëåäîâàíèå ñòàòèñòèêè Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê ïî âàêöèíå ïðîòèâ ãåïàòèòà Â. Ïðåäëàãàåìîå äàëåå ìîæåò ïîñëóæèòü îòïðàâíîé òî÷êîé äëÿ òàêîãî èññëåäîâàíèÿ. Ýòî íå ïîëíûé, èñ÷åðïûâàþùèé àíàëèç — ïðîñòî áåãëûé îáçîð äàííûõ, ïðåæäå íå ïðèâëåêàâøèõ âàøå âíèìàíèå.
Âñåãî ïî âàêöèíå ïðîòèâ ãåïàòèòà  Ñèñòåìà ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê ïîëó÷èëà ñ èþëÿ 1990 ã. ïî 31 îêòÿáðÿ 1998 ã. 24 775 ñîîáùåíèé.  439 ñëó÷àÿõ íàñòóïèëà ñìåðòü.  9 673 ñëó÷àÿõ ñåðü¸çíûõ ïîñëåäñòâèé ïðèâèâêè ðåçóëüòàòàìè å¸ áûëè âèçèòû â ïðè¸ìíûå îòäåëåíèÿ áîëüíèö, ãîñïèòàëèçàöèè, èíâàëèäíîñòè èëè ñìåðòè. Òàêèì îáðàçîì, áîëåå îäíîé òðåòè âñåõ ñîîáùåíèé áûëè ïðåäñòàâëåíû ñåðü¸çíûìè îñëîæíåíèÿìè. 17 497 ñîîáùåíèé îòíîñèëèñü èñêëþ÷èòåëüíî ê ïðèâèâêå ïðîòèâ ãåïàòèòà Â, à îñòàëüíûå — ê âàêöèííûì «êîêòåéëÿì», êîãäà ïðèâèâêà ïðîòèâ ãåïàòèòà  ïðîâîäèëàñü âìåñòå ñ ÀÊÄÑ, îðàëüíîé è èíúåêöèîííîé ïîëèâàêöèíîé, âàêöèíîé ïðîòèâ ãåìîôèëüíîé ïàëî÷êè è ò.ä.
Ñîîáùåíèÿ î ïîáî÷íûõ ðåàêöèÿõ èñêëþ÷èòåëüíî íà âàêöèíó ïðîòèâ ãåïàòèòà  ïîêàçûâàþò ïóãàþùå áîëüøîå ÷èñëî æåíùèí, íà÷èíàÿ ñ ïîäðîñòêîâîãî âîçðàñòà (äî 16 ëåò ñîîòíîøåíèå ìóæ÷èíû/æåíùèíû ïðèìåðíî îäèíàêîâî).  âîçðàñòíîé ãðóïïå 16-55 ëåò 77% ñîîáùåíèé, ïîñòóïèâøèõ â Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê îòíîñèòñÿ ê æåíùèíàì — â òðè ðàçà áîëüøå, ÷åì ê ìóæ÷èíàì.  ñðåäíåì, ðåàêöèè ðàçâèâàþòñÿ â òå÷åíèå ïåðâîãî äíÿ ïîñëå ïðèâèâêè, 70% ðåàêöèé íàáëþäàþòñÿ â òå÷åíèå ÷åòûð¸õ äíåé ïîñëå ïðèâèâêè. Íåçàâèñèìûå ó÷¸íûå äîëæíû èññëåäîâàòü, ïî÷åìó æåíùèíû áîëåå ïðåäðàñïîëîæåíû ðàçâèâàòü ïîáî÷íûå ðåàêöèè íà ïðèâèâêó ïðîòèâ ãåïàòèòà  è/èëè ñîîáùàòü î íèõ â Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê. Âîçìîæíûì îòâåòîì íà âîïðîñ ìîæåò áûòü òî, ÷òî ìåäñ¸ñòðû äîëæíû áûòü ïðèâèòû ïðîòèâ ãåïàòèòà Â, à ïîòîìó æåíùèíû ïîëó÷àþò áîëüøå ïðèâèâîê è ÷èñëî ñîîáùåíèé î ïîáî÷íûõ ðåàêöèÿõ ó æåíùèí áîëüøå. Âåðîÿòíî, èññëåäîâàòåëÿì ñëåäóåò ïîäóìàòü è î òîì, ÷òî ìåäñåñò¸ð, êàê ðàáîòíèêîâ ñôåðû çäðàâîîõðàíåíèÿ, ñëåäóåò âûñëóøàòü ñ îñîáûì âíèìàíèåì îòíîñèòåëüíî ïîáî÷íûõ ðåàêöèé ëþáîé ïðèâèâêè, âìåñòî òîãî, ÷òîáû îòíîñèòñÿ ê ñîîáùåíèÿì î òàêèõ ðåàêöèÿõ êàê «ïðåóâåëè÷åííîìó ïðåäðàññóäêó», êàê ýòî ñäåëàë ×åíü èç Öåíòðà êîíòðîëÿ çàáîëåâàíèé íà ôåâðàëüñêîì çàñåäàíèè Ñîâåùàòåëüíîãî êîìèòåòà ïî èììóíèçàöèîííîé ïðàêòèêå. Ëè÷íûå èñòîðèè, ñòàâøèå èçâåñòíûìè ìíå, ðàññêàçûâàþò î òÿæ¸ëûõ ïîáî÷íûõ ðåàêöèÿõ íà ïðèâèâêó ïðîòèâ ãåïàòèòà Â, ñëó÷èâøèõñÿ ó äåâî÷åê-ïîäðîñòêîâ, íå èìåþùèõ íèêàêîé ñâÿçè ñ ïðîôåññèåé ìåäñåñòðû. Áîëåå ëè ñêëîííû æåíùèíû ê àóòîèììóííûì ðåàêöèÿì â îòâåò íà ïðèâèâêó ïðîòèâ ãåïàòèòà Â? ßâëÿåòñÿ ëè ïðàâèòåëüñòâåííàÿ ïîëèòèêà, ïðèêàçûâàþùàÿ äåëàòü ýòó ïðèâèâêó, íåâçèðàÿ íà ãåíåòè÷åñêèé ðèñê áîëåçíåé ïå÷åíè è öåíòðàëüíîé íåðâíîé ñèñòåìû, äèñêðèìèíèðóþùåé ïî îòíîøåíèþ ê æåíùèíàì? Ýòî òå âîïðîñû, íà êîòîðûå äîëæíû îòâåòèòü íåçàâèñèìûå èññëåäîâàòåëè.
Äðóãîé ïðîáëåìîé, âûçûâàþùåé áåñïîêîéñòâî, ïðîñëåæèâàþùåéñÿ â ñâåäåíèÿõ, ïîñòóïàþùèõ â Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê, ÿâëÿþòñÿ ðåàêöèè, ñòàâøèå ñëåäñòâèåì ïðîâåäåíèÿ ïðèâèâêè ïðîòèâ ãåïàòèòà  âìåñòå ñ èíûìè ïðèâèâêàìè («ïðèâèâî÷íûé êîêòåéëü»). ×èíîâíèêè ñëóæáû çäðàâîîõðàíåíèÿ ëþáÿò îòðèöàòü, ÷òî ýòè ñîîáùåíèÿ îòíîñÿòñÿ ê âàêöèíå ïðîòèâ ãåïàòèòà  (êàê åñëè áû îíè õîòåëè ñïðÿòàòü ðåàêöèè èìåííî íà âàêöèíó ïðîòèâ ãåïàòèòà Âîò òùàòåëüíîãî èçó÷åíèÿ). Äàâàéòå íå áóäåì îñòàíàâëèâàòüñÿ íà ýòîé äèñêóññèè, à ïîïðîáóåì ñêîíöåíòðèðîâàòüñÿ íà êðàéíå íàñòîðàæèâàþùèõ äàííûõ Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê îá èñïîëüçîâàíèè âàêöèíû ïðîòèâ ãåïàòèòà  âìåñòå ñ äðóãèìè âàêöèíàìè. Ýòè ñîîáùåíèÿ ïðåäñòàâëÿþò ñîáîé ëèøü òðåòü ñîîáùåíèé îáî âñåõ ïîáî÷íûõ ðåàêöèÿõ (7 275), íî ïðè ýòîì íà íèõ ïðèõîäèòñÿ äâå òðåòè âñåõ ñìåðòåé (291).  ñðåäíåì ñìåðòè ïðîèñõîäèëè â òå÷åíèå äâóõ äíåé ïîñëå ïðèâèâêè, äåìîíñòðèðóÿ ÷¸òêóþ âðåìåííóþ ñâÿçü. Ñðåäíèé âîçðàñò óìåðøèõ áûë ïîëãîäà. 50% âñåõ ñîîáùåíèé î ïîáî÷íûõ ðåàêöèÿõ íà «âàêöèííûå êîêòåéëè» áûëè ñåðü¸çíûìè (ñìåðòè, îáðàùåíèÿ â ïðè¸ìíûå îòäåëåíèÿ áîëüíèö, ãîñïèòàëèçàöèè, èíâàëèäíîñòè). ß ñãðóïïèðîâàë êîíâóëüñèâíûå ðåàêöèè, íàáëþäàâøèåñÿ â îòâåò íà ââåäåíèå «êîêòåéëåé» è îáíàðóæèë ñëåäóþùèå ïóãàþùèå äàííûå. Ïîä êîíâóëüñèÿìè â äàííûõ Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê ðàññìàòðèâàþòñÿ êîíâóëüñèè, ñóäîðîãè è äðîæü. Èç 1 189 òàêèõ ñîîáùåíèé, ïîäàâëÿþùåå áîëüøèíñòâî, 80% (950) áûëè ñåðü¸çíûìè (ñìåðòè, îáðàùåíèÿ â ïðè¸ìíûå îòäåëåíèÿ áîëüíèö, ãîñïèòàëèçàöèè, èíâàëèäíîñòè), â ñðåäíåì â âîçðàñòå ïîëóãîäà, â òå÷åíèå ïåðâîãî äíÿ ïîñëå ïðèâèâêè. Êòî-òî äîëæåí èçó÷èòü ýòè äàííûå è âûÿñíèòü, ÷òî ñëó÷èëîñü ñ ýòèìè íåñ÷àñòíûìè äåòüìè, èñïûòàâøèìè êîíâóëüñèè ïîñëå ìóëüòèêîêòåéëÿ ñ âàêöèíîé ïðîòèâ ãåïàòèòà Â. Ìíå ñòàëè èçâåñòíû è ëè÷íûå èñòîðèè äåòåé, ó êîòîðûõ îñòàëîñü ïîâðåæäåíèå ìîçãà è îòñòàâàíèå â ðàçâèòèè ïîñëå ïðèâèâêè ïðîòèâ ãåïàòèòà Â. Èçó÷èâ âîïðîñ, äîëæíû ëè áûòü ïðèïèñàíû ïðèâèâêå ïðîòèâ ãåïàòèòà  äàííûå Ñèñòåìû ñîîáùåíèé î ðåàêöèÿõ íà «êîêòåéëè», ìû äîëæíû ïðèçíàòü, ÷òî äàííûå îäíîçíà÷íî ïîäòâåðæäàþò: êîìáèíèðîâàííûå ìíîæåñòâåííûå âàêöèíû ìîãóò áûòü î÷åíü óäîáíû è âûãîäíû äëÿ ïåäèàòðîâ, íî ñìåðòåëüíû èëè êàëå÷àùè äëÿ ìëàäåíöåâ. Ãäå íàó÷íûå èññëåäîâàíèÿ, äåìîíñòðèðóþùèå, ÷òî âàêöèíó ïðîòèâ ãåïàòèòà  ìîæíî áåçîïàñíî íàçíà÷àòü âìåñòå ñ DTP (ÀÊÄÑ), âàêöèíîé ïðîòèâ ãåìîôèëüíîé ïàëî÷êè, îðàëüíîé èëè èíúåêöèîííîé ïîëèâàêöèíàìè è ò.ä.? Êòî-íèáóäü çàíèìàëñÿ àíàëèçîì ñòîèìîñòè òàêèõ èññëåäîâàíèé, ó÷èòûâàÿ è äàííûå, äåìîíñòðèðóþùèå áîëåå âûñîêóþ ñìåðòíîñòü è ñåðü¸çíûå ðåàêöèè, èìåþùèåñÿ â ðàñïîðÿæåíèè Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê? Ïî÷åìó íåò? Èìååòñÿ ëè îïðåäåëÿåìûé ãåíåòè÷åñêèé ìàðêåð ó òåõ, ó êîãî ñëó÷èëèñü êîíâóëüñèè, ÷òîáû îòñåÿòü ïîäâåðæåííûõ êîíâóëüñèÿì â áóäóùåì? Âîò òåìû äëÿ èçó÷åíèÿ íåçàâèñèìûìè ó÷¸íûìè.
Åù¸ îäíà ãðóïïà çàáîëåâàíèé, îáðàùàþùàÿ íà ñåáÿ âíèìàíèå èç ñòàòèñòèêè Ñèñòåìû ñîîáùåíèé î íåæåëàòåëüíûõ ýôôåêòàõ ïðèâèâîê — àðòðèòè÷åñêèå ðåàêöèè. Ýòî âîñïàë¸ííûå ñóñòàâû, ïîêðàñíåíèå, ÷óâñòâî îíåìåíèÿ, áîëè, ñëàáîñòü è ò.ä. ß îáíàðóæèë 2 400 ñîîáùåíèé î òàêèõ ðåàêöèÿõ ëèøü ïðè áåãëîì ïðîñìîòðå ïåðâîé êîëîíêè äàííûõ Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê (òîëüêî îòíîñèòåëüíî ïðèâèâêè ïðîòèâ ãåïàòèòà Â). Ïî÷òè ïîëîâèíà èç íèõ áûëè ñåðü¸çíûìè, âêëþ÷àÿ âèçèòû â ïðè¸ìíûå îòäåëåíèÿ áîëüíèö, ãîñïèòàëèçàöèè, ñìåðòè è èíâàëèäíîñòè. Ñîîáùåíèÿ î ïîáî÷íûõ ðåàêöèÿõ òàêîãî òèïà ïîñòóïàëè îò âçðîñëûõ, êîòîðûõ çàñòàâèëè ïðèâèòüñÿ ïðîòèâ ãåïàòèòà  äëÿ èõ ðàáîòû.  îòîáðàííûõ ìíîþ ñîîáùåíèÿõ ñèìïòîìû íå èñ÷åçàþò ñî âðåìåíåì, ïðè÷¸ì áîëüøèíñòâî ïàöèåíòîâ æàëóåòñÿ, ÷òî îíè ñòàíîâÿòñÿ ëèøü áîëåå ÿâíûìè. Ó÷¸íûå, íå çàïÿòíàâøèå ñåáÿ ñîòðóäíè÷åñòâîì ñ ôàðìàöåâòè÷åñêèìè êîìïàíèÿìè è íå ðàçäåëÿþùèå ïðåäâçÿòûå ìíåíèÿ Öåíòðà êîíòðîëÿ çàáîëåâàíèé è/èëè Óïðàâëåíèÿ êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ, äîëæíû èçó÷èòü òûñÿ÷è ñîîáùåíèé îá àðòðèòè÷åñêèõ ðåàêöèÿõ ïîñëå ïðèâèâêè ïðîòèâ ãåïàòèòà  è óñòàíîâèòü òî÷íûé äèàãíîç çàáîëåâàíèÿ, ðàçâèâàþùåãîñÿ ïîñëå ïðèâèâêè ïðîòèâ ãåïàòèòà Â.
Êàæäûé, êòî ñîìíåâàåòñÿ â ñóùåñòâîâàíèè ïîáî÷íûõ ðåàêöèé íà ïðèâèâêó ïðîòèâ ãåïàòèòà Â, äîëæåí ñåñòü è èçó÷èòü ñèìïòîìû è êîììåíòàðèè â ñîîáùåíèÿõ, ïîëó÷åííûõ Ñèñòåìîé ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê. Êîãäà îí ýòî ñäåëàåò, îí îáíàðóæèò îáøèðíûé ñïèñîê ðåàêöèé ñî ñòîðîíû öåíòðàëüíîé íåðâíîé ñèñòåìû è ïå÷åíè, ðàçâèâøèõñÿ â òå÷åíèå íåñêîëüêèõ äíåé ïîñëå ïðèâèâêè. Âêëàäûø «Ìåðêà» èíôîðìèðóåò: «Ñîîáùåíèÿ î ìåñòíûõ è ñèñòåìíûõ ðåàêöèÿõ áûëè ïîëó÷åíû â 17% è 15% âñåõ ïðèâèâîê ñîîòâåòñòâåííî». Èçâåñòíî, ÷òî â Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ýôôåêòàõ ïðèâèâîê äîêëàäûâàåòñÿ ëèøü î 10% ïîáî÷íûõ ðåàêöèé ïðèâèâîê. Òàêèì îáðàçîì, èñòèííîå êîëè÷åñòâî îñëîæíåíèé è íàñòîÿùèé óæàñ èñòîðèè ñ ïðèâèâêîé ïðîòèâ ãåïàòèòà Â, ñêîðåå âñåãî, ìíîãî áîëüøå ïðåäïîëàãàåìîãî ïî äàííûì Ñèñòåìû.

http://www.homeoint.org/kotok/vaccines/belkin.htm

Michael Belkin Testimony to Congress
Tuesday, May 18,1999
My daughter Lyla Rose Belkin died on September 16, 1998 at the age of five weeks, about 15 hours after receiving her second Hepatitis B vaccine booster shot. Lyla was a lively, alert five-week-old baby when I last held her in my arms. Little did I imagine as she gazed intently into my eyes with all the innocence and wonder of a newborn child that she would die that night. She was never ill before receiving the Hepatitis B shot that afternoon. At her final feeding that night, she was extremely agitated, noisy and feisty — and then she fell asleep suddenly and stopped breathing. The autopsy ruled out choking, The NY Medical Examiner ruled her death Sudden Infant Death Syndrome (SIDS).
But the NY Medical Examiner (Dr. Persechino) neglected to mention Lyta’s swollen brain or the hepatitis B vaccine in the autopsy report. The coroner spoke to my wife and I and our pediatrician (Dr. Zullo) the day of the autopsy and clearly stated that her brain was swollen. The pediatrician Dr. Zullo’s notes of that conversation are «brain swollen … not sure cause yet … could not see how recombinant vaccine could cause problem.»
SIDS is a diagnosis of exclusion .. «it wasn’t this, it wasn’t that, everything has been ruled out and we don’t know what it was.» A swollen brain is not SIDS. Through conversations with other experienced pathologists, I subsequently discovered that brain inflammation is a classic adverse reaction to vaccination (with any vaccine) in the medical literature.
I set out to do an investigation of the hepatitis B vaccine and attended a workshop at the National Academy of Sciences, Institute of Medicine on «Neo-Natal Death and the Hepatitis B Vaccine,» the Advisory Committee on Immunization Practices (ACIP) February’ meeting and a debate in New Hampshire between the Chairman of the ACIP Dr. Modlin and Dr. Waisbren about the safety of the hepatitis B vaccine. I also obtained the entire Vaccine Adverse Events Reporting System (VAERS) database on hepatitis B vaccine adverse reactions and have investigated it thoroughly.
These are my conclusions, supported by the following pages of text and analysis that are too lengthy to present in entirety in the time allotted for this appearance. Please read the results of my investigation, as it will help you understand the magnitude of the hepatitis B vaccine issue.
• Newborn babies are not at risk of contracting the hepatitis B disease unless their mother is infected Hepatitis B is primarily a disease of junkies, gays, and promiscuous heterosexuals
• The vaccine is given to babies because health authorities couldn’t get those risk groups to take the vaccine
• Adverse reactions out-number cases of the disease in government statistics
• Nothing is being done to investigate those adverse reactions
• Those adverse reactions include numerous deaths, convsions and arthritic conditions that occur within days after hepatitis B vaccination
• The CDC is misrepresenting hypothetical, estimated disease statistics as real cases of the disease
• The ACIP is recommending new vaccines for premature infants without having scientific studies proving it is safe
• The US vaccine recommendation process is hopelessly compromised by conflicts of interest with vaccine manufacturers, the American Academy of Pediatrics and the CDC
Conclusion: If (as with the recently-recommended rotavirus vaccine) hepatitis B vaccine was recommended in 1991 without scientific proof that it was safe in a broad sample of racially and genetically diverse babies less than 48 hours old before they established that recommendation, then the CDC has been experimenting on babies like guinea pigs and this Committee should suspend that universal immunization policy.
 
The hepatitis B vaccine was effectively mandated in 1991 for universal immunization of newborn babies by the Advisory Committee on Immunization Practices (ACIP) — an adjunct of the Centers for Disease Control and Prevention (CDC). Paradoxically, the CDC’s own Fact Sheet on the hepatitis B disease does not include newborn babies as a risk group for that disease. That Fact Sheet lists the risk groups as injection drug users, homosexual men, sexually active heterosexuals, infant/children of immigrants from disease-endemic areas, low socio-economic level, sexual/household contacts of infected persons, infants born to infected mothers, health care workers and hemodialysis patients NOT NEWBORN BABIES.
Question: Why then, did the ACIP establish a policy mandating that newborn babies not at risk of the disease be automatically administered the 3-shot hepatitis B vaccine as their first involuntary indoctrination into the pediatric care of America?
Answer: Here is that rationale from the original ACIP 1991 statement establishing the official vaccination policy «Hepatitis B Virus: A Comprehensive Strategy for Eliminating Transmission in the United States Through Universal Childhood Vaccination …» «In the United States, most infections occur among adults and adolescents … The recommended strategy for prevent/rig these infections has been the selective vaccination of persons with identified risk factors … However, this strategy has not lowered the incidence of hepatitis B, primarily because vaccinating persons engaged in high-risk behaviors, life-styles, or occupations before they become infected generally has not been feasible … Efforts to vaccinate persons in the major risk groups have had limited success. For example, programs directed at injecting drug users failed to motivate them to receive three doses of vaccine … In the United States it has become evident that HBV transmission cannot be prevented through vaccinating only the groups at high risk of infection … In the long term, universal infant vaccination would eliminate the need for vaccinating adolescents and high-risk adults … Hepatitis B vaccination is recommended for all infants, regardless of the HBsAg status of the mother … The first dose can be administered during the newborn period, preferably before the infant is discharged from the hospital, but no later than when the infant is 2 months of aqe …» (emphasis added).
So in the CDC and ACIP’s own words, almost every newborn US baby is now greeted on its entry into the world by a vaccine injection against a sexually transmitted disease for which the baby is not at risk ‘-because they couldn’t get the junkies, prostitutes, homosexuals and promiscuous heterosexuals to take the vaccine. That is the essence of the hepatitis B universal vaccination program.
Question: What are the risks and benefits for administering this vaccine to infants?
 
Answer: Hepatitis B is a rare, mainly blood-transmitted disease. In 1996 only 54 cases of the disease were reported to the CDC in the 0-1 age group. There were 3.9 million births that year, so the observed incidence of hepatitis B in the 0-1 age group was just 0.001%. In the Vaccine Adverse Event Reporting System (VAERS), there were 1,080 total reports of adverse reactions from hepatitis B vaccine in 1996 in the 0-1 age group, with 47 deaths reported. Total VAERS hepatitis B reports for the 0-1 age group outnumber reported cases of the disease 20 to 1.
 
Question: Why don’t they just screen the mother to see if she is infected with hepatitis B (since that is about the only way a baby is likely to get the disease), instead of vaccinating infants?
Answer: Selling vaccines is extremely profitable and the process of mandating vaccines is fraught with conflicts of interest between vaccine manufacturers, the ACIP and the American Academy of Pediatrics. The business model of having the government mandate everyone must buy your product is a monopolist’s delight.
Question: What studies are being done on the data from the FDA’s    Vaccine Adverse Event Reporting System (VAERS)?
Answer: Absolutely nothing. The 25,000 reports are going into a drawer and being forgotten. How many reports are enough to show a drug or vaccine is dangerous — 2,500? 25,000? 250,000? Chen of the CDC and Ellenberg of the FDA monitor this data, write reports and deliver speeches about how VAERS hepatitis B adverse reaction reports show nothing out of the ordinary and show «the relative safety of HB vaccine when given to neonates and infants.» VAERS shows nothing of the kind. TAKE A LOOK AT THE VAERS DATA YOURSELF. The health authorities continue to negligently downplay the steady stream of serious adverse reactions to this vaccine and more infants and adults continue to die and suffer central nervous system and liver damage after HB vaccination.
Question: Why do the CDC, ACIP and Merck say that there are 140,000-320,000 new infections/yr (70,000-160,000 symptomatic infections/yr) when their own CDC data shows only 1O,000 reported cases year?
Answer: They are passing off estimated, hypothetical numbers as actual cases. This is statistical fraud. In the financial world such misrepresentation would lead to criminal charges. If a company inflated its earnings or revenues by 300% (as the CDC does hepatitis B disease statistics) and foisted those figures off as official data (and not some back-of-the-envelope guess-timate) — that company would be investigated by the SEC and sued by shareholders. Why doesn’t that happen in the medical world? There’s no regulator to keep the CDC honest. They do not say those figures are hypothetical estimates, they misrepresent the data. Go try to audit those 320,000 supposed new infections/yr. You will not find them. The whole exercise is designed to increase public hysteria about the risk of a low-risk disease so the CDC can extend it’s pervasive influence and Merck can increase its $900 million/year vaccine revenues.
Question: What process does the Center for Disease Control employ to make a vaccine recommendation?
I attended the February Advisory Committee on Immunization Practices (ACIP) meeting in Atlanta and was absolutely appalled. Every vote by the Committee on new vaccine mandates was unanimous (except for one dissenting vote on Rotavirus vaccine for premature infants). There was hardly any discussion of adverse reactions, the ACIP simply rubber-stamped every proposal on the agenda. I call it Vaccination Without Representation. In one instance, the ACIP passed a recommendation for Rotavirus vaccine for premature infants even though no scientific studies had been done showing it was medically safe. Dr. Modlin, (Chairman of the ACIP), said in a pro-hepatitis B vaccine debate in New Hampshire «How do we determine whether something is scientifically valid or not?… 1) Is the theory biologically plausible? 2) Has it been tested by appropriate methods? 3)Is the study well concluded? 4) Are the results statistically sound? But at the February ACIP meeting, when it came time for the ACIP to rubber-stamp approval of Rotavirus vaccine for premature infants, here are Modlin’s quotes from the official transcript: «.. available data are insufficient to fully establish the safety and efficacy of rotavirus vaccine in premature infants … there is a section under Adverse Events that details what little information there actually are with respect to premature infants … To my knowledge we don’t have data from a clinical trial specifically … Some bit of information from Seattle, as I recall, that had suggested that was a slight increase in relative risk for hospitalization for premature infants … Obviously a situation where we have to make a judgment in the absence of data, and with a vaccine that has not yet been tested in the group …» (ACIP transcript, pages 102-112) Modlin then held a vote and the recommendation for premature infants passed nine to one — Modlin voted yes, Dr. Glode against. This is a clear example of how the medical bureaucracy (led by the CDC and ACIP), is recommending vaccines without scientific evidence that those vaccines are safe in a broad sample of racially and genetically diverse infants.
What Should Be Done? This Committee should investigate the 1991 ACIP recommendation establishing universal hepatitis B vaccination of newborn babies in the hospital — and if (as with the Rotavirus vaccine example above) no studies were done to prove this was safe in a broad sample of racially and genetically diverse babies less than 48 hours old before they established that recommendation, then the CDC has been experimenting on babies like guinea pigs and this Committee should suspend that universal immunization policy.
VAERS ANALYSIS (Vaccine Adverse Event Reporting System)
I studied statistics at the University Of California at Berkeley and went on to develop sophisticated proprietary risk/reward statistical models at Salomon Brothers from 1986-91 — and in my subsequent, ongoing business provide statistical economic and financial forecasts to mutual funds, investment banks, pension funds and hedge funds.
I studied VAERS hepatitis B vaccine data obtained by the National Vaccine Information Center (NVIC) under the Freedom of Information Act. The data has some flaws (incomplete fields, some multiple reports) but any qualified, impartial quantitative analyst or statistician not affiliated with Merck, Smithkline, the CDC, the FDA or the AAP who examines these reports will find a clear and undeniable pattern of central nervous system (CNS) and liver disease striking thousands of people within 0-4 days after vaccination with hepatitis B vaccineany qualified, impadial quantitative analyst or statistician not affiliated with Merck, Smithkline, the CDC, the FDA or the AAP who examines these reports will find a clear and undeniable pattern of central nervous system (CNS) and liver disease striking thousands of people within 0-4 days after vaccination with hepatitis B vaccine. These reports have been ignored, explained away, or considered «acceptable» by the FDA, CDC and drug companies. This Committee should launch an investigation of the VAERS hepatitis B data by a team of independent scientists not beholden to vaccine manufacturers or the FDA/CDC bureaucracy. The following is intended to be a starting point for such an investigation. This does not profess to be a complete, exhaustive analysis — simply an overview, highlighting aspects of the data that may not previously have been brought to your attention.
The total 24,775 VAERS hepatitis B reports from July 1990 to October 31, 1998 show 439 deaths and 9673 serious reactions involving emergency room visits, hospitalization, disablement or death. Therefore, more than one third of total reports were serious events. 17,497 of those total reports were for hepatitis B vaccine only, the remainder were vaccine cocktails where hepatitis B was administered along with DPT, HIB, IPV, OPV, etc.
The hepatitis-B-vaccine-only reports show a shocking cluster of reactions in females starting in their teenage years (the male/female reporting ratio is balanced before age 16). For ages 16-55, 77% of VAERS reports are women — more than three times as many women as men are reporting adverse reactions to hepatitis B vaccine. The median onset of adverse event after vaccination is one day, 70% of reactions happen within four days of vaccination. independent scientists should investigate why females are more disposed to have adverse reactions to hepatitis B vaccine and/or report them to VAERS. One possible explanation is that nurses have to take this vaccine for their jobs and are thus more exposed than most adults to hepatitis B vaccine adverse reactions. Rather than dismiss that factor as an «over-reporting bias» as Dr. Chen of the CDC did at the February ACIP meeting, perhaps investigators might consider that nurses are alert health care workers and ought to be listened to with regard to the dangers of adverse events with any vaccine (rather than ignored). Personal case studies reported to the author have showed many teenage girls getting severe, debilitating adverse reactions to hepatitis B vaccine, having nothing to do with nursing. Do women have a greater vulnerability to auto-immune reactions to hepatitis B vaccine? Is the government discriminating against women by administering this vaccine without regard for genetic risk of CNS and liver disease? Those are questions that independent scientists should investigate.
A second area of concern is the VAERS reports involving hepatitis B vaccine administered with other vaccines (vaccine cocktails). Health officials are fond of dismissing those repeals as being attributable to hepatitis B vaccine, because of the multiple other antigens present (almost as if they wanted to cloak hepatitis B vaccine reactions from scrutiny). Let’s avoid that controversy and focus on the extremely disturbing VAERS data of hepatitis B vaccine with other vaccines. These reports amount to only one third of total reports (7,275), but account for two thirds of total deaths (291). The median onset of those deaths was 2 days after vaccination — displaying a clear temporal association. The median age of death was 0.5 years in this group. 50% of all hepatitis-B-vaccine-cocktail reports were serious (died, emergency room, hospitalized, disabled). I grouped convulsive reactions together from the hep-B-vaccine-cocktail data and found a deeply disturbing pattern. These were anything labeled convulsions, seizures or tremors in the VAERS hep-B-cocktail data. Of the 1189 such reports, fully 80% (950) were serious (died, ER, hospitalized, disabled) median age 0.5 years, median onset after vaccination 0 days (less than one day). Someone should do follow-up and find out what happened to those poor infants who suffered severe convulsions after a hepatitis B-multi-vaccine cocktail. In the personal reports I’ve taken of similar adverse reactions, the children were left brain damaged and developmentally disabled. Looking beyond the debate over whether VAERS reports of vaccine cocktails can be attributed to hepatitis B, the data strongly suggests combining multiple vaccines may be convenient and profitable for pediatricians — but fatal or debilitating for infants. Where are the scientific studies showing hepatitis B vaccine is safe to administer with DPT, HIB, IPV, OPV, etc.? Did anyone doing cost/benefit analysis for those studies include data showing the higher mortality and serious reactions present in the VAERS data? Why not? Is there an identifiable genetic marker in those who suffered convulsive reactions to screen out those vulnerable in the future? These are all matters for independent scientists to audit.
Another area that leaps out of the VAERS database is something I dubbed arthritic reactions. These are joint pains, tingling, numbness, aching, fatigue, etc. I found 2,400 of those reports in just a quick survey of the first reporting column of VAERS (hepatitis B vaccine only). Almost one half of those are serious, involving an ER visit, hospitalization, death or disablement. These are the type of adverse reactions reported by many adults who are forced to take the hepatitis B vaccine for their jobs. In the reports of such adverse reactions I’ve taken, the symptoms do not go away, most patients complain it gets worse over time. Scientists not corrupted by drug company or CDC/FDA institutional bias should examine the thousands of VAERS hepatitis B arthritic reaction reports and develop a diagnosis of their hepatitis B vaccine-related illness.
Anyone who doubts if hepatitis B vaccine adverse reactions exist should sit down and read the symptoms and text comments of a random selection of VAERS reports. When one does so, they will find a similar but wide-ranging list of CNS and liver reactions that occur within days of vaccination. The Merck package insert claims «Injection site reactions and systemic complaints were reported following 17% and 15% on the injections, respectively.» The standard rule of thumb is only about 10% of reactions are reported to VAERS. So the actual number and full horror of the hepatitis B vaccine reaction story is potentially much larger than even VAERS suggests.
Ñâèäåòåëüñòâî ïðîô. Áîííè Äþíáàð ïåðåä Êîíãðåññîì ÑØÀ
Âòîðíèê, 18-å ìàÿ 1999 ã.
Îðèãèíàë ïî àäðåñó: http://www.whale.to/vaccines/dunbar4.html
Ä-ð Áîííè Ñ. Äþíáàð
Ìîëåêóëÿðíûé áèîëîã
Áýéëîðîâñêèé ìåäèöèíñêèé êîëëåäæ
Äîáðîå óòðî!
ß áëàãîäàðíà âàì çà ýòó âîçìîæíîñòü îáñóäèòü ñ âàìè ýòó âàæíåéøóþ ïðîáëåìó çäðàâîîõðàíåíèÿ. Ìåíÿ çîâóò Áîííè Äþíáàð, ÿ ïðîôåññîð è èññëåäîâàòåëü. Ñâûøå 25 ëåò ÿ çàíèìàþñü èçó÷åíèåì àóòîèììóííûõ áîëåçíåé è ðàçðàáîòêîé âàêöèí (ïîñëåäíèå 17 ëåò — â Áýéëîðîâñêîì ìåäèöèíñêîì êîëëåäæå â Õüþñòîíå).
Çà ìîè íîâàòîðñêóþ ðàáîòó â ðàçðàáîòêå âàêöèí ÿ áûëà íàãðàæäåíà ïðåìèåé Ìàðãàðåò Ïèòìåí Íàöèîíàëüíîãî Èíñòèòóòà çäîðîâüÿ (National Institute of Health). Äëÿ ìåíÿ ýòà íàãðàäà áûëà îñîáåííî çíà÷èìà, ïîñêîëüêó ðàáîòû ä-ðà Ïèòìåí áûëè î÷åíü âàæíû äëÿ ðàííèõ ýòàïîâ ðàçðàáîòêè âàêöèí, à òàêæå ïîòîìó ÷òî ÿ ïîíèìàëà, êàêîå âëèÿíèå ïðèâèâêè èìåëè è èìåþò íà âñ¸ íàøå îáùåñòâî. Íûíåøíåå ìî¸ èññëåäîâàíèå â îáëàñòè ðàçðàáîòêè âàêöèí î÷åíü âàæíî äëÿ ìåíÿ. ß ðàáîòàþ â òåñíîì êîíòàêòå ñ Àìåðèêàíñêèì Àãåíòñòâîì ïî Ìåæäóíàðîäíîìó ðàçâèòèþ (US Agency for International Development) è ÂÎÇ. ß ÷óâñòâóþ ñåáÿ îáÿçàííîé ïðîäîëæàòü èññëåäîâàíèÿ äëÿ òîãî, ÷òîáû ïîíÿòü è, íàäåþñü, ïîìî÷ü ðàçðåøèòü ïðîáëåìû, ñâÿçàííûå ñî çäîðîâüåì íàñåëåíèÿ ìèðà.
Ïîñêîëüêó ÿ ïðèãëàøåíà âûñòóïèòü ïåðåä ýòèì ïîäêîìèòåòîì, ÿ ñ÷èòàþ âàæíûì îáñóäèòü ìîé îïûò ñ íåñîìíåííûìè òÿæ¸ëûìè ðåàêöèÿìè íà ïðèâèâêó ïðîòèâ ãåïàòèòà Â. Ïðèìåðíî ïÿòü ëåò íàçàä â ìîåé ëàáîðàòîðèè ðàáîòàëè äâà ÷åëîâåêà, êîòîðûõ ïîòðåáîâàëè ñäåëàòü ïðèâèâêó ïðîòèâ ãåïàòèòà Â. Ó îáîèõ ðàçâèëèñü òÿæ¸ëûå è, âåðîÿòíî, ïîæèçíåííîé äëèòåëüíîñòè îñëîæíåíèÿ ïðèâèâêè. Îáà áûëè àáñîëþòíî çäîðîâû è äàæå îòëè÷àëèñü àòëåòè÷åñêèì òåëîñëîæåíèåì ïåðåä òåì, êàê ïîëó÷èëè ïðèâèâêó. Ñåé÷àñ æå îíè ñòðàäàþò îò òÿæ¸ëûõ, ðàçðóøèòåëüíûõ àóòîèììóííûõ ïîáî÷íûõ ýôôåêòîâ ïðèâèâêè. ß èçó÷èëà èñòîðèþ áîëåçíè ìîåãî áðàòà, ä-ðà Áîíà Äþíáàðà, ó êîòîðîãî ðàçâèëèñü ñåðü¸çíûå õðîíè÷åñêèå ñóñòàâíûå è ìûøå÷íûå áîëè, óñòàëîñòü è ñèìïòîìû, íàïîìèíàþùèå òàêîâûå ðàññåÿííîãî ñêëåðîçà. Åìó áûë ñíà÷àëà ïîñòàâëåí äèàãíîç POTS (àóòîèììóííûå, ñåðäå÷íî-ñîñóäèñòûå è íåâðîëîãè÷åñêèå ïðîáëåìû), à çàòåì äèàãíîç õðîíè÷åñêîé äåìèåëèíèçèðóþùåé íåéðîïàòèè. Åãî çàáîëåâàíèå ïðèïèñûâàåòñÿ ïðèâèâêå ïðîòèâ ãåïàòèòà  äåñÿòêîì ñïåöèàëèñòîâ â ÑØÀ. Îí ïîñòîÿííî ïðîõîäèò ýêñïåðòèçû è íûíå óùåðá, íàíåñ¸ííûé åãî çäîðîâüþ, ïðåâûøàåò 90%. Ðàñõîäû ïî åãî ìåäèöèíñêîé ñòðàõîâêå óæå ñòîèëè ïðîãðàììå êîìïåíñàöèé øòàòà Òåõàñ ïðèìåðíî ïîëîâèíó ìèëëèîíà äîëëàðîâ, è ýòà öèôðà áóäåò ïðîäîëæàòü âîçðàñòàòü, ó÷èòûâàÿ òÿæåñòü áîëåçíè, êîòîðîé îí ñòðàäàåò.
Îäíà èç ìîèõ ñòóäåíòîê ÷àñòè÷íî îñëåïëà ïîñëå ïåðâîé áóñòåðíîé äîçû âàêöèíû. Ñîñòîÿíèå åù¸ áîëåå óõóäøèëîñü ïîñëå âòîðîé ïðèâèâêè, ïîòðåáîâàëàñü ãîñïèòàëèçàöèÿ. ß ãîâîðèëà ñ íåé è óçíàëà, ÷òî å¸ çðåíèå ïðîäîëæàåò óõóäøàòüñÿ. Ïîñêîëüêó îíà ñòóäåíòêà ìåäèöèíñêîãî ôàêóëüòåòà, ïîíÿòíî å¸ íåæåëàíèå ïðåäàâàòü ãëàñíîñòè ëè÷íûå ìåäèöèíñêèå ïðîáëåìû èç îïàñåíèÿ, ÷òî ýòî ïîâðåäèò êàðüåðå.
ß ñ áîëüøèì ïîíèìàíèåì îòíîøóñü ê ïðîáëåìå íåîáõîäèìîñòè âçâåøèâàòü âîçìîæíûå ðèñê è ïîëüçó ïðèâèâîê. Áëàãîäàðÿ ìîåìó îïûòó â ýòîé îáëàñòè, ÿ èíòóèòèâíî ïîíÿëà, ÷òî àóòîèììóííûå áîëåçíè, ðàçâèâøèåñÿ ó ýòèõ äâóõ çäîðîâûõ ëþäåé, ðàáîòàâøèõ â ìîåé ëàáîðàòîðèè, ñëó÷èëèñü â ïåðèîä âðåìåíè, ïðåäñêàçóåìûé â ñìûñëå èììóííîãî îòâåòà. Ýòî ïðîèçîøëî ïîñëå áóñòåðíûõ ïðèâèâîê ïðîòèâ ãåïàòèòà Â. Èçó÷èâ áîãàòóþ íàó÷íóþ ëèòåðàòóðó ïî ýòîìó âèðóñó è ýòîé âàêöèíå, ÿ ïîíÿëà, ÷òî åñòü âûñîêàÿ âåðîÿòíîñòü òîãî, ÷òî èìåííî âàêöèíà — ïðè÷èíà ýòèõ òÿæ¸ëûõ ðåàêöèé. È îïóáëèêîâàííûå èññëåäîâàíèÿ ðåàêöèé íà âèðóñíóþ èíôåêöèþ, è âðåìåíí;ÿ ñâÿçü ïðèâèâêè è òÿæ¸ëûõ ðåàêöèé, íåñîìíåííî ïîäòâåðæäàþò òî, ÷òî ýòè ðåàêöèè èìåþò îòíîøåíèå ê ïðèðîäå âèðóñíîãî ïðîòåèíà, ðåêîìáèíàíòíîãî ïîâåðõíîñòíîãî àíòèãåíà — ãëàâíîãî êîìïîíåíòà âàêöèíû.
ß áåñåäîâàëà ñî ìíîãèìè âðà÷àìè è èññëåäîâàòåëÿìè èç ðàçíûõ ñòðàí, êîòîðûå îïèñàëè àíàëîãè÷íûå ðåàêöèè íà ïðèâèâêó ó òûñÿ÷ ïðåäñòàâèòåëåé åâðîïåéñêîé ðàñû. Èõ íàáëþäåíèÿ, â îñíîâíîì, îòâåðãàþòñÿ èëè èãíîðèðóþòñÿ Ñëóæáîé Îáùåñòâåííîãî çäðàâîîõðàíåíèÿ, ÷òî ïîäòâåðæäàåòñÿ èñêàìè, ïîäàííûìè ïðîòèâ ÷èíîâíèêîâ Ñëóæáû çäðàâîîõðàíåíèÿ è ôàðìàöåâòè÷åñêèõ êîìïàíèé âî Ôðàíöèè. Îòìåíà ýòîé ïðèâèâêè äëÿ äåòåé âî Ôðàíöèè íå áûëà ñâÿçàíà ñ íåäîñòàòêîì äîêóìåíòîâ. Ñåé÷àñ ÿ â êîíòàêòå ñ ñîòíÿìè ëþäåé (âêëþ÷àÿ ðîäèòåëåé ìëàäåíöåâ è ñòàðøèõ äåòåé), êîòîðûå ñîîáùèëè î ñìåðòÿõ, òÿæ¸ëûõ ïðîáëåìàõ ñî çäîðîâüåì è ïîæèçíåííûõ óâå÷üÿõ, ïðèâåäøèõ ê îãðîìíûì äåíåæíûì çàòðàòàì, ñòàâøèõ ñëåäñòâèåì ïðèâèâêè ïðîòèâ ãåïàòèòà Â. Ïîõîæå, ÷òî òÿæ¸ëûå ðåàêöèè íà ýòó ïðèâèâêó èìåþò ñâÿçü ñ îïðåäåë¸ííûì ãåíåòè÷åñêèì ïóëîì. ß ñ÷èòàþ, ÷òî íåîáõîäèìû òùàòåëüíûå íàó÷íûå èññëåäîâàíèÿ âîçìîæíîñòè òîãî, ÷òî âàêöèíà ìîæåò âûçâàòü òÿæ¸ëûå àóòîèììóííûå áîëåçíè.
Íèæå ÿ äàì êîíêðåòíûå îòâåòû íà âîïðîñû, çàäàííûå ìíå â ïðèãëàøåíèå âûñòóïèòü ïåðåä ïîäêîìèòåòîì.
1. Óïðàâëåíèå êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ (FDA) ñîçäàëî Ñèñòåìó ñîîáùåíèé î ïîáî÷íûõ ðåàêöèÿõ íà ïðèâèâêè (VAERS). Êàê ýòà ñèñòåìà ðàáîòàåò? ×òî äåëàåòñÿ äëÿ èçó÷åíèÿ ýòèõ ðåàêöèé?
Ïåðâîé ìîé îïûò ñ ýòîé Ñèñòåìîé ñâÿçàí ñ äâóìÿ ñîòðóäíèêàìè ìîåé ëàáîðàòîðèè, ó êîòîðûõ íà÷àëèñü ñåðü¸çíûå ïðîáëåìû ñî çäîðîâüåì â ïåðèîä âðåìåíè, ïðåäñêàçóåìûé ñ òî÷êè çðåíèÿ èììóííîãî îòâåòà. Óâèäåâ, ÷òî ýòè ðåàêöèè îòìå÷åíû â «Íàñòîëüíîé êíèãå âðà÷à» (Physician’s Desk Reference Book), ÿ óçíàëà î ñóùåñòâîâàíèè Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ðåàêöèÿõ íà ïðèâèâêè. Êîãäà ÿ ïåðâûé ðàç îáðàòèëàñü â Óïðàâëåíèå êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ ñ ýòîé ïðîáëåìîé, êòî-òî èç åãî ñîòðóäíèêîâ ñêàçàë ìíå: «Äà, ýòà âàêöèíà — ïðîáëåìà, è ïðîáëåìà áîëüøàÿ». Ñíà÷àëà ÿ ïîëó÷èëà èíôîðìàöèþ î ðåàêöèÿõ, î÷åíü ïîõîæèõ íà òå, êîòîðûå ñëó÷èëèñü ó ìîèõ ñîòðóäíèêîâ. ß ïûòàëàñü çàâÿçàòü ñâÿçè ñ ñîòðóäíèêàìè Óïðàâëåíèÿ êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ, íî ìíå ïðîñòî ñêàçàëè, ÷òî ÿ ìîãó ïîëó÷èòü èíôîðìàöèþ â ñîîòâåòñòâèè ñ Àêòîì î ñâîáîäå èíôîðìàöèè. ß çàïëàòèëà è ïîëó÷èëà êîïèè íåîáõîäèìûõ ìíå äîêóìåíòîâ. ß áûëî çàâàëåíà òûñÿ÷àìè ëèñòîâ äîêóìåíòîâ — áåñ÷èñëåííûìè ñîîáùåíèÿìè, ìíîãèå èç êîòîðûõ áûëè èäåíòè÷íû òåì, êîòîðûå ÿ ñàìè íàïðàâëÿëà îòíîñèòåëüíî äâóõ ñîòðóäíèêîâ ìîåé ëàáîðàòîðèè. Ê ñîæàëåíèþ, â ñîîáùåíèÿõ íå îêàçàëîñü äîñòàòî÷íîãî êîëè÷åñòâà äåòàëåé äëÿ òîãî, ÷òîáû ñ äîñòàòî÷íîé ñòåïåíüþ óâåðåííîñòè ñäåëàòü âûâîä îòíîñèòåëüíî ìåõàíèçìîâ ðàçâèòèÿ ýòèõ ðåàêöèé.
ß íå ïîëó÷èëà îòâåòà íà ìîè ïèñüìåííûå çàïðîñû, íàïðàâëåííûå â ýòîò îòäåë Óïðàâëåíèÿ (ìíå èçâåñòíî, ÷òî áþäæåòíûå ñîêðàùåíèÿ â Óïðàâëåíèè ìîãëè ñûãðàòü â ýòîì ñâîþ ðîëü). Ñòàëî ÿñíî, ÷òî íåîáõîäèìûå ìåäèöèíñêèå äåòàëè (ëè÷íîñòè ïàöèåíòîâ, ãåíåòè÷åñêèé ôîí, ñåìåéíàÿ èñòîðèÿ àóòîèììóííûõ áîëåçíåé) îòñóòñòâóþò â ýòîé ñèñòåìå ñîîáùåíèé, è íåò âîçìîæíîñòè âñòóïèòü â êîíòàêò ñ âðà÷àìè, îá ýòèõ ðåàêöèÿõ ñîîáùèâøèõ. Òàêèì îáðàçîì, èìåþùàÿñÿ èíôîðìàöèÿ íåäîñòàòî÷íà è íåäîñòóïíà äëÿ òåõ èç íàñ, êòî èçó÷àåò ñëó÷àè ñåðü¸çíûõ íåáëàãîïðèÿòíûõ ðåàêöèé, âåðîÿòíî, ñâÿçàííûõ ñ ýòîé âàêöèíîé. Òàêæå âåðîÿòíî, ÷òî íèêòî íå ñëåäèò çà ñóäüáàìè ïîñòðàäàâøèõ, ïîñêîëüêó íèêòî íå îáðàùàëñÿ ê ìîèì äâóì ñîòðóäíèêàì, ÷òîáû óçíàòü î ñîñòîÿíèè èõ óõóäøàþùåãîñÿ çäîðîâüÿ.
Èç èíôîðìàöèè, ïîëó÷åííîé ìíîþ èç Ñèñòåìû ñîîáùåíèé, ÿñíî, ÷òî åñòü òûñÿ÷è ñîîáùåíèé î ïîâðåæäåíèè íåðâíîé ñèñòåìû, àðòðèòè÷åñêèõ ñèìïòîìàõ è äðóãèõ òÿæ¸ëûõ èììóííûõ ðàññòðîéñòâàõ. Ýòî òå æå ñàìûå çàáîëåâàíèÿ, êîòîðûå óïîìèíàþòñÿ â äåñÿòêàõ ìåäèöèíñêèõ æóðíàëîâ â ïóáëèêàöèÿõ î ñâÿçè ýòîé ïðèâèâêè è òÿæ¸ëûõ èììóííûõ ðåàêöèé (Òàáëèöà ñî ññûëêàìè äåìîíñòðèðóåòñÿ âî âðåìÿ ñëóøàíèé). Òîò ôàêò, ÷òî Ñèñòåìà ñîîáùåíèé «ïàññèâíà», ò.å. íå ÿâëÿåòñÿ îáÿçàòåëüíîé, ïîäòâåðæäàåò òî, ÷òî ìû ðàñïîëàãàåì ëèøü ÷àñòüþ (ïî îöåíêàì ñëóæàùèõ Óïðàâëåíèÿ êîíòðîëÿ ïèùåâûõ ïðîäóêòîâ è ëåêàðñòâ îò 1 äî 10%) èñòèííîãî êîëè÷åñòâà ñëó÷àåâ ïîáî÷íûõ ðåàêöèé. Ñóììèðóÿ: ïî ìîåìó ìíåíèþ, íûíåøíÿÿ ñòðóêòóðà Ñèñòåìû ñîîáùåíèé î ïîáî÷íûõ ðåàêöèÿõ íå ïðèâèâêè àáñîëþòíî íå ïðèñïîñîáëåíà äëÿ ïîëó÷åíèÿ íàó÷íî çíà÷èìîé èíôîðìàöèè.
Ñåé÷àñ ÿ íàõîæóñü â ïðÿìîì êîíòàêòå ñ ñîòíÿìè òÿæåëî áîëüíûõ ëþäåé (à òàêæå ñ âðà÷àìè, ó êîòîðûõ ñîòíè òàêèõ ïàöèåíòîâ), ó êîòîðûõ ðàçâèëèñü òÿæ¸ëûå íåáëàãîïðèÿòíûå ðåàêöèè â îòâåò íà ïðèâèâêó ïðîòèâ ãåïàòèòà Â. ß ñ÷èòàþ, ÷òî êðàéíå íåîáõîäèìî èññëåäîâàòü êàê ðàííèå ðåàêöèè, òàê è èõ äàëüíåéøåå ïðîãðåññèðîâàíèå â àóòîèììóííûå áîëåçíè, â íàäåæäå, ÷òî íàì óäàñòñÿ íàéòè áîëåå ñïåöèôè÷åñêîå ëå÷åíèå è ïðåäîòâðàòèòü îòñðî÷åííûå ðåàêöèè ó òåõ, êòî óæå ïîñòðàäàë îò ýòîé ïðèâèâêè. ß âåðþ â òî, ÷òî ýòî âîçìîæíî, â ñâåòå íîâûõ ìåòîäîâ ëå÷åíèÿ àóòîèììóííûõ áîëåçíåé, îðèåíòèðîâàííûõ íà èäåíòèôèêàöèþ ñïåöèôè÷åñêèõ àíòèòåë ê àíòèãåííûì äåòåðìèíàíòàì.
2. Ïåðåâåøèâàåò ëè ïîëüçà ïðîâåäåíèÿ ïðèâèâêè ïðîòèâ ãåïàòèòà  íîâîðîæäåííûì ðèñê îò íå¸?
Äî íûíåøíåãî äëÿ ìîè èññëåäîâàíèÿ áûëè ñêîíöåíòðèðîâàíû íà âçðîñëûõ. Ê íåñ÷àñòüþ, îòíîñèòåëüíî èììóííûõ ðåàêöèé ó íîâîðîæäåííûõ èçâåñòíî åù¸ ìåíüøå, òàê êàê îíè íå ìîãóò ñîîáùèòü î ñèëüíîé áîëè, óñòàëîñòè èëè èíûõ íåâðîëîãè÷åñêèõ èëè ôèçè÷åñêèõ ðàññòðîéñòâàõ, êàê ýòî ìîãóò ñäåëàòü ñòàðøèå äåòè èëè âçðîñëûå.  ñëó÷àå ñìåðòè ïîñëå ïðèâèâêè ìû ïîëó÷àåì òîëüêî ñîâåðøåííî íåäîñòàòî÷íóþ äëÿ îöåíêè èíôîðìàöèþ, ïðåäîñòàâëÿåìóþ íàì ïàòîëîãîàíàòîìàìè.
ß îñïîðèëà áû óòâåðæäåíèÿ ìîèõ êîëëåã, èññëåäîâàòåëåé â êëèíè÷åñêèõ èëè ôóíäàìåíòàëüíîé îáëàñòÿõ, çàÿâëÿþùèõ, ÷òî ìû, â îáùèõ ÷åðòàõ, ïîíèìàåì èììóííóþ ñèñòåìó ìëàäåíöåâ. Íà ìîäåëÿõ æèâîòíûõ äîêàçàíî, ÷òî èììóííàÿ ñèñòåìà íîâîðîæäåííûõ î÷åíü îòëè÷àåòñÿ îò èììóííîé ñèñòåìû âçðîñëûõ è äàæå ïîäðîñòêîâ. Ôàêòè÷åñêè, èììóííóþ ñèñòåìó íîâîðîæä¸ííûõ æèâîòíûõ î÷åíü ëåãêî ïîòðåâîæèòü òàê, ÷òîáû óáåäèòüñÿ, ÷òî âî âçðîñëîé æèçíè å¸ ôóíêöèÿ áóäåò íàðóøåíà.
È íàîáîðîò — êðàéíå íèçêà âåðîÿòíîñòü òîãî, ÷òî â ÑØÀ íîâîðîæä¸ííûé èìååò õîòü ñêîëüêî-íèáóäü çíà÷èòåëüíûé ðèñê çàðàæåíèÿ ãåïàòèòîì Á â äåòñêîì âîçðàñòå, ïîñêîëüêó ýòî áîëåçíü, ïåðåäàþùàÿñÿ êðîâüþ. Âðÿä ëè íîâîðîæäåííûå ìîãóò áûòü âîâëå÷åíû âî âíóòðèâåííîå èñïîëüçîâàíèå ïðåïàðàòîâ èëè íåáåçîïàñíûé ñåêñ. Âðÿä ëè îíè ìîãóò ïîñòðàäàòü îò çàðàæ¸ííîé èãëû, êàê ìåäèöèíñêèé ðàáîòíèê. Åäèíñòâåííûé ïóòü, êîòîðûì îíè ìîãóò çàðàçèòüñÿ ãåïàòèòîì — ÷åðåç óæå èíôèöèðîâàííóþ ìàòü.
Äëÿ ìåíÿ î÷åíü ïðèìå÷àòåëüíî òî, ÷òî, â ñâåòå îòñóòñòâèÿ íàó÷íîé è ìåäèöèíñêîé èíôîðìàöèè î íåîíàòàëüíîé èììóíîëîãèè, íîâîðîæäåííûå — è îñîáåííî òå, êîòîðûå íå íàõîäÿòñÿ â ãðóïïå ðèñêà ïî ãåïàòèòó  — ïîëó÷àþò ìíîãî÷èñëåííûå ïðèâèâêè ïðîòèâ ãåïàòèòà Â. Èìååòñÿ ìàëî, èëè íå èìååòñÿ âîîáùå, êëèíè÷åñêèõ èññëåäîâàíèé äëÿ àäåêâàòíîé îöåíêè âîçìîæíûõ îòñðî÷åííûõ ðåàêöèé íà ïðèâèâêè íîâîðîæäåííûì, îñîáåííî â òîì, ÷òî êàñàåòñÿ ãåíåòè÷åñêèõ ðàçëè÷èé.
3. ×òî ñîáîé ïðåäñòàâëÿåò ïðîöåññ ðåêîìåíäàöèè òîé èëè èíîé ïðèâèâêè Öåíòðà êîíòðîëÿ çàáîëåâàíèé (ÑDÑ)? Êàêóþ ðîëü â ýòîì ïðîöåññå èãðàþò ôàðìàöåâòè÷åñêèå êîìïàíèè? Åñòü ëè çëîóïîòðåáëåíèå ñëóæåáíûì ïîëîæåíèåì?
Ïîñêîëüêó ÿ íå ñïåöèàëèñò â îáëàñòè îáùåñòâåííîãî çäðàâîîõðàíåíèÿ, ÿ íå çíàêîìà ñî âñåìè íþàíñàìè ïîëèòèêè ðåêîìåíäàöèé âàêöèí ê îáÿçàòåëüíîìó èñïîëüçîâàíèþ. Òåì íå ìåíåå, ïðåêðàñíî äîêóìåíòèðîâàíû ôàêòû òîãî, ÷òî ÷ëåíû êîìèññèé Öåíòðà êîíòðîëÿ çàáîëåâàíèé è ÷ëåíû èíûõ îðãàíèçàöèé (íàïðèìåð, Àìåðèêàíñêîé Àêàäåìèè ïåäèàòðèè è ÂÎÇ) ïîëó÷àþò çíà÷èòåëüíîå ôèíàíñèðîâàíèå èç ôàðìàöåâòè÷åñêèõ êîìïàíèé. Áîëåå òîãî, ïðåêðàñíî èçâåñòíî è òî, ÷òî èññëåäîâàòåëè, ïðîâîäÿùèå êëèíè÷åñêèå èñïûòàíèÿ ïðèâèâîê, ëè÷íî çàðàáàòûâàþò íà ýòîì è ïîëó÷àþò ôèíàíñèðîâàíèå íà ñâîè ëàáîðàòîðèè â êà÷åñòâå êîíñóëüòàíòîâ, ðàçðàáàòûâàþùèå âàêöèíû è ýêñïåðòîâ íà ñóäåáíûõ ðàçáèðàòåëüñòâàõ. Äîêóìåíòèðîâàíî, ÷òî ëîááèñòû, êîíñóëüòèðóþùèå ôàðìàöåâòè÷åñêèå êîíñóëüòàöèè — ýòî òå æå ñàìûå ëîááèñòû, êîòîðûå êîíñóëüòèðóþò ïðåäñòàâèòåëåé ñëóæá çäðàâîîõðàíåíèÿ. Âûâîäû îòíîñèòåëüíî âîçìîæíîãî çëîóïîòðåáëåíèÿ ñëóæåáíûì ïîëîæåíèåì ÿ îñòàâëÿþ ýòîìó óâàæàåìîìó êîìèòåòó.
Òåì íå ìåíåå, äëÿ ìåíÿ î÷åâèäíî, ÷òî îòñóòñòâèå ïðàâèòåëüñòâåííîãî ôèíàíñèðîâàíèÿ, ïðåäíàçíà÷åííîãî äëÿ íåçàâèñèìûõ èññëåäîâàòåëåé, êîòîðûå ñìîãëè áû îöåíèòü ðèñê íåáëàãîïðèÿòíûõ ðåàêöèé íà ïðèâèâêè — ãëàâíàÿ ïðè÷èíà, ïî êîòîðîé ó÷¸íûå âûíóæäåíû îáðàùàòüñÿ çà ôèíàíñèðîâàíèåì ê ôàðìàöåâòè÷åñêèì êîìïàíèÿì, ïîä äèêòîâêó êîòîðûõ, â èòîãå, è ïðîâîäÿòñÿ ýêñïåðèìåíòû.
4. ×òî äîëæíî áûòü èçâåñòíî ïàöèåíòó ïåðåä òåì, êàê ïðîâîäèòñÿ ïðèâèâêà? Ïîëó÷àåìàÿ èì èíôîðìàöèÿ äîñòàòî÷íà?
Äëÿ ìåíÿ, êàê è äëÿ ìíîãèõ äðóãèõ, èññëåäóþùèõ ýòó ïðîáëåìó, íåñîìíåííî, ÷òî îòñðî÷åííûå ïîñëåäñòâèÿ ïðèâèâîê â êëèíè÷åñêèõ èñïûòàíèÿõ íå èçó÷àëèñü. Ýòî îñîáåííî âåðíî â îòíîøåíèè íàñåëåíèÿ åâðîïåéñêîãî ïðîèñõîæäåíèÿ. Ñëåäîâàòåëüíî, ìîæíî çàäàòü âîïðîñ: «Ñóùåñòâóåò ëè èíôîðìàöèÿ îòíîñèòåëüíî âîçìîæíîãî ðèñêà ïðèâèâêè, êîòîðàÿ äîëæíà áûòü ïðåäàíà ãëàñíîñòè?». Î çëîâåùåì ñïèñêå âîçìîæíûõ îñëîæíåíèé, ïåðå÷èñëÿåìûõ âî âêëàäûøå ê âàêöèíå, áîëüíûì èõ âðà÷è íå ñîîáùàþò. Áîëüíîé äîâåðåí âðà÷ó. Ýòî òà ïðè÷èíà, ïî êîòîðîé àäâîêàò, ïðåäñòàâëÿþùèé ìîåãî áðàòà, èìåâøåãî òÿæ¸ëóþ ðåàêöèþ íà âàêöèíó, ïîäàë èñê, îáâèíÿþùèé âðà÷à â ìîøåííè÷åñòâå. Ïî çàÿâëåíèþ ýòîãî àäâîêàòà, èñê áåçóñëîâíî áàçèðóåòñÿ íà ñâîäå ãðàæäàíñêèõ ïðàâîíàðóøåíèé.
Ìíîãèå âðà÷è è ñòóäåíòû-ìåäèêè ãîâîðèëè ìíå, ÷òî åñëè ýòà ïðèâèâêà ðåêîìåíäîâàíà è âíåñåíà ïðàâèòåëüñòâåííûìè ÷èíîâíèêàìè â ñïèñîê îáÿçàòåëüíûõ, òî «ïî÷åìó îíè äîëæíû ïðîâåðÿòü å¸ èëè îáñóæäàòü ñ ïàöèåíòàìè?». Äðóãèå ãîâîðÿò, ÷òî èõ êîëëåãè íå ñîîáùàþò îá ýòèõ ñëó÷àÿõ, ïîòîìó ÷òî «îíè íå õîòÿò áûòü âîâëå÷åíû â ýòî äåëî». Êðîìå òîãî, ìíå ãîâîðèëîñü, ÷òî èõ èíôîðìèðóþò î òîì, ÷òî ýòà âàêöèíà áåçîïàñíåéøàÿ èçî âñåõ, êîãäà-ëèáî ðàçðàáîòàííûõ, ïîòîìó ÷òî ýòî âàêöèíà, îñíîâàííàÿ íà ðåêîìáèíàíòíîé ÄÍÊ, «ñëåäîâàòåëüíî, îíà íå ìîæåò âûçâàòü áîëåçíü». Ê ñîæàëåíèþ, îíè ÿâíî óïóñêàþò âàæíåéøèé çàêîí ôóíäàìåíòàëüíîé èììóíîëîãèè. Ëþáîé ïåïòèä (îãðàíè÷åííàÿ ïîñëåäîâàòåëüíîñòü àìèíîêèñëîò áåëêà) èëè ïîëíûé ïåïòèäíûé íàáîð, èëè «óñå÷¸ííûé» áåëîê (ïîëó÷àþùèéñÿ â ðåçóëüòàòå âûäåëåíèÿ èç áèîëîãè÷åñêîãî èñòî÷íèêà è î÷èñòêè, èëè ïóò¸ì èñïîëüçîâàíèÿ òåõíîëîãèè ðåêîìáèíàíòíîé ö-ÄÍÊ), áóäó÷è ââåä¸ííûì â îðãàíèçì, ìîæåò áûòü «ïåðåðàáîòàí èììóííîé ñèñòåìîé» è, â çàâèñèìîñòè îò ïðèðîäû ýòîãî áåëêà, ìîæåò ñòàòü ïðè÷èíîé îòñðî÷åííûõ àóòîèììóííûõ ðåàêöèé.
Ê íåñ÷àñòüþ, â êóðñå ôóíäàìåíòàëüíûõ äèñöèïëèí ìåäèöèíñêèõ ôàêóëüòåòîâ ìíîãèå èç ýòèõ äåòàëåé èììóíîëîãèè (îáëàñòè ìåäèöèíñêèõ èññëåäîâàíèé, çàáðîøåííîé â ïîñëåäíåå äåñÿòèëåòèå) íå ïðåïîäàþòñÿ.  òå÷åíèå ïîñëåäíèõ ïÿòíàäöàòè ëåò ÿ ïðåïîäàþ ñòóäåíòàì ôóíäàìåíòàëüíûå äèñöèïëèíû, òàê ÷òî ÿ ïðåêðàñíî çíàþ îá ýòîì íåäîñòàòêå. Íåäàâíî ÿ áûëà ïðèãëàøåíà âûñòóïèòü ñ ëåêöèåé â Èíñòèòóòå ìåäèöèíû ïðè Íàöèîíàëüíîé Àêàäåìèè íàóê íà ýòó òåìó. ß áûëà ïîòðÿñåíà, êîãäà îäèí èç âàæíûõ ÷èíîâ â Íàöèîíàëüíîì êîìèòåòå ïî çäðàâîîõðàíåíèþ (òàêæå âîâëå÷¸ííîì â ïðîöåññ ðåêîìåíäàöèè äåòñêèõ ïðèâèâîê), ïîäîø¸ë êî ìíå è ñêàçàë: «Ýòî áûëî î÷åíü èíòåðåñíàÿ áåñåäà. ß çíàþ, ÷òî Âû ïðåïîäà¸òå ñòóäåíòàì íà÷àëüíûõ êóðñîâ. Íå ìîãëè áû Âû ïîðåêîìåíäîâàòü ìíå êàêîå-ëèáî ðóêîâîäñòâî ïî èììóíîëîãèè äëÿ íà÷èíàþùèõ? Ìíå êàæåòñÿ, ÿ äîëæåí êîå-÷òî âçÿòü äëÿ ñåáÿ èç ýòîé îáëàñòè».
ß õî÷ó ñóììèðîâàòü: ñ ìîåé òî÷êè çðåíèÿ, íåîáõîäèìî ÷òîáû âðà÷è áîëüøå çíàëè î âîçìîæíîì ðèñêå ýòîé ïðèâèâêè, à òàêæå î âçàèìîäåéñòâèÿõ ìåæäó ðàçíûìè âàêöèíàìè è î ðèñêå ïðèâèâàòü áîëüíûõ äåòåé. Êðàéíå íåîáõîäèìî ïðîâåñòè èññëåäîâàíèå, êîòîðîå ïîìîæåò âðà÷àì ïîëó÷èòü áîëüøå èíôîðìàöèè äëÿ îïðåäåëåíèÿ ëþäåé, íàõîäÿùèõñÿ â ãðóïïå ðèñêà ïî íåáëàãîïðèÿòíûì ðåàêöèÿì.  ëþáîì ñëó÷àå, ðàííÿÿ äèàãíîñòèêà òàêèõ ðåàêöèé ïðèâåä¸ò ê áîëåå ýôôåêòèâíîìó ëå÷åíèþ.
Ìîè êîëëåãè è ÿ ïîäàëè ïðåäëîæåíèå îá èçó÷åíèè íàó÷íîé îñíîâû ýòèõ íåáëàãîïðèÿòíûõ ðåàêöèé íà ïðèâèâêè. Ìíîãèå èç ýòèõ ðåàêöèé ïîäîáíû ðåàêöèÿì ëþäåé, èíôèöèðîâàííûõ ñàìè âèðóñîì. Íåñîìíåííî, ÷òî åñòü òêàíåâàÿ ñîâìåñòèìîñòü, ãåíåòè÷åñêèå ñâÿçè ìåæäó ëþäüìè, ó êîòîðûõ ðàçâèâàþòñÿ òÿæ¸ëûå ðåàêöèè. Óæå ïðîäåìîíñòðèðîâàíî, ÷òî ó îò 10 äî 30% ïðèâèòûõ íå ðàçâèâàþòñÿ àíòèòåëà, è, ñëåäîâàòåëüíî, îíè ìîãóò áûòü íå çàùèùåíû îò áîëåçíè. Îòñóòñòâèå îòâåòà ìîæåò áûòü ïðèïèñàíî ãåíàì èíäèâèäóàëüíîé òêàíåâîé ñîâìåñòèìîñòè.
Ìû ïðåäëàãàåì ïðîâåñòè èññëåäîâàíèå äëÿ îïðåäåëåíèÿ äîëãîñðî÷íîãî ïðîãíîçà äëÿ ïàöèåíòîâ, ó êîòîðûõ óæå èìåþòñÿ íåáëàãîïðèÿòíûå ðåàêöèè. Òàêîé ïðîãíîç íóæåí äëÿ ñëåäóþùèõ öåëåé: 1. Äëÿ ðàçðàáîòêè ïðîôèëàêòè÷åñêîé ñòðàòåãèè îïðåäåëåíèÿ ïàöèåíòîâ ñ âûñîêîé âåðîÿòíîñòüþ ðàçâèòèÿ òàêèõ ðåàêöèé, ÷òîáû îíè ñìîãëè èçáåæàòü ïðèâèâîê 2. Äëÿ ðàçðàáîòêè òåðàïåâòè÷åñêîé ñòðàòåãèè ýôôåêòèâíîé ðàííåé èäåíòèôèêàöèè òåõ, êòî ñòðàäàåò îò íåáëàãîïðèÿòíûõ ïîñëåäñòâèé ïðèâèâîê, â íàäåæäå ïîäîáðàòü èì áîëåå ñïåöèôè÷åñêîå ëå÷åíèå. ß è ìîè ñîòðóäíèêè èìååì ïðåêðàñíî îñíàù¸ííûå ëàáîðàòîðèè ñî âñåì òðåáóåìûì äëÿ èììóíîëîãè÷åñêèõ è áèîõèìè÷åñêèõ àíàëèçîâ, è ìû ñîáðàëè îáðàçöû êðîâè ïîñòðàäàâøèõ îò ýòèõ íåáëàãîïðèÿòíûõ ðåàêöèé. Òàêèì îáðàçîì, ó íàñ åñòü óíèêàëüíûå îáðàçöû äëÿ òîãî, ÷òîáû íà÷àòü íàó÷íîå èññëåäîâàíèå äëÿ òî÷íîãî óñòàíîâëåíèÿ ïðè÷èí ýòèõ íåáëàãîïðèÿòíûõ ðåàêöèé. Ìû óæå ðàñïîëàãàåì çíà÷èòåëüíûìè ïðåäâàðèòåëüíûìè äàííûìè, êîòîðûå ìîãóò îáúÿñíèòü ýòè ðåàêöèè, è ìû ïðîäîëæàåì èñêàòü ôèíàíñèðîâàíèå äëÿ ýòèõ èññëåäîâàíèé. Ìû ïîëó÷èëè íåêîòîðûå ñðåäñòâà èç ÷àñòíûõ ôîíäîâ, íî, ïîñêîëüêó äëÿ èçó÷åíèÿ íåáëàãîïðèÿòíûõ ðåàêöèé íà ýòó ïðèâèâêó ïðàâèòåëüñòâåííîå ôèíàíñèðîâàíèå îòñóòñòâóåò, ïðîäâèãàåìñÿ ìû ìåäëåííî.
Íå âûçûâàåò ñîìíåíèÿ, ÷òî âèðóñ ãåïàòèòà  (è âàêöèíà, ñîçäàííàÿ íà îñíîâå ïîâåðõíîñòíîãî àíòèãåíà âèðóñà) î÷åíü îòëè÷àåòñÿ îò äðóãèõ âèðóñîâ (âàêöèí). Ðàçðàáàòûâàþòñÿ íîâûå òåîðèè è ýêñïåðèìåíòû (íàïðèìåð, òåîðèÿ ò.í. ìîëåêóëÿðíîé ìèìèêðèè è àíòèèäèîïàòè÷åñêèõ àíòèòåë), êîòîðûå ìîãëè áû îáúÿñíèòü íåáëàãîïðèÿòíûå ðåàêöèè, âûçûâàåìûå ýòèì âèðóñîì è âèðóñíûì ïðîòåèíîì, èñïîëüçóåìûì â âàêöèíå. (Îïóáëèêîâàííàÿ â íîìåðå «Íüþ-Éîðê Òàéìñ» îò 26 äåêàáðÿ 1996 ã. ñòàòüÿ, ñóììèðóþùàÿ èññëåäîâàíèÿ ïî òåîðèÿì «ìîëåêóëÿðíîé ìèìèêðèè» âèðóñîâ, âûçûâàþùèõ àóòîèììóííûå áîëåçíè, äà¸ò îáùóþ êàðòèíó). Äåñÿòêè ïóáëèêàöèé, ñâÿçûâàþùèõ ýòîò âèðóñ è åãî âàêöèíó ñ àóòîèììóííûìè è èíûìè áîëåçíÿìè ñîåäèíèòåëüíîé òêàíè, äîêàçûâàþò íàì, ÷òî âèðóñíûé àíòèãåí âûçûâàåò àóòîèììóííûå áîëåçíè.
 çàêëþ÷åíèå: íèêòî, âêëþ÷àÿ è ìåíÿ, íèêîãäà íå óòâåðæäàë, ÷òî âèðóñ ãåïàòèòà  íå ÿâëÿåòñÿ ñåðü¸çíîé ïðîáëåìîé äëÿ ìèðîâîãî çäðàâîîõðàíåíèÿ. Òåì íå ìåíåå, åñëè ýòà, ðàâíî êàê è äðóãèå âàêöèíû, ñïîñîáíà â ñèëó ïðèðîäû ñâîåãî ïðîòåèíà (íàòèâíîãî èëè ïîëó÷åííîãî èç ö-ÄÍÊ â êà÷åñòâå ðåêîìáèíàíòíîãî ïðîòåèíà) èëè åãî ÷àñòåé, òÿæåëî ïîðàæàòü èììóííóþ ñèñòåìó áîëüøîãî êîëè÷åñòâà ëþäåé, ÷òî ïðèâîäèò ê ñåðü¸çíûì íåáëàãîïðèÿòíûì ðåàêöèÿì (ïóñòü äàæå îãðàíè÷åííûõ îïðåäåë¸ííûìè ãåíåòè÷åñêèìè ãðóïïàìè), òî ðåïóòàöèÿ ÂÑÅÕ âàêöèí, âêëþ÷àÿ òå, êîòîðûå áåçóñëîâíî ÍÅ èìåþò ïîáî÷íûõ ðåàêöèé (ê ñîæàëåíèþ, ïðîô. Äþíáàð íå óêàçûâàåò êàêèõ èìåííî. Î ñóùåñòâîâàíèå òàêèõ âàêöèí ìíå, íàïðèìåð, íè÷åãî íå èçâåñòíî — ÀÊ) , ñèëüíî óïàä¸ò â ãëàçàõ ïóáëèêè. Ýòî îòíîñèòñÿ è ê ðàçðàáîòêå âàêöèí ê âèðóñàì, ïåðåäàâàåìûì ïî âîçäóõó, ÷òî ìîæåò ñòàòü ñåðü¸çíîé óãðîçîé íàñåëåíèþ ìèðà. Áëàãîäàðÿ óñïåõó ôèíàíñèðîâàííîãî ïðàâèòåëüñòâîì «Ïðîåêòà ÷åëîâå÷åñêîãî ãåíîìà» è ïðîãðåññó â êîìïüþòåðíîé òåõíîëîãèè, ñêîðî, âåðîÿòíî, ñòàíåò âîçìîæíûì èçó÷àòü ìîëåêóëÿðíûå ñòðóêòóðû è ïðåäñêàçûâàòü ïðîáëåìû ñ ïðèâèâêàìè çàðàíåå èëè íà ðàííèõ ýòàïàõ ðàçðàáîòêè âàêöèí.
Çàâåðøó ñâî¸ âûñòóïëåíèå ñëåäóþùèì íàáëþäåíèåì. ß ñàìà âèäåëà ïîâåäåíèå àôðèêàíñêèõ ñëîíîâ. Ãäå áû íå íà÷àë êðè÷àòü ñëîí¸íîê, âñ¸ ñòàäî, äî ñòà ãîëîâ, íåìåäëåííî íà÷èíàåò òðóáèòü, è âîêðóã ìàëûøà íà÷èíàåòñÿ íåâåðîÿòíàÿ ñóìàòîõà. Äàæå åñëè è î÷åâèäíî, ÷òî îïàñíîñòè íåò, êàæäûé õî÷åò äîòðîíóòüñÿ äî íåãî ñâîèì õîáîòîì, ÷òîáû óáåäèòñÿ, ÷òî âñ¸ â ïîðÿäêå, ïðåæäå ÷åì âåðíóòüñÿ ê ñâîèì äåëàì. Êîíå÷íî, îíè íèêîãäà íå ïîçâîëÿò ìàëûøó èëè ÷ëåíó ñåìüè ïîäâåðãíóòüñÿ íåèçâåñòíîé îïàñíîñòè.
http://www.whale.to/vaccines/dunbar4.html

Dr. Bonnie S. Dunbar
Molecular Biologist
Baylor College of Medicine
May 18, 1999
Good morning and thank you for this opportunity to discuss these critical health care issues. My name is Bonnie Dunbar, and I am a research scientist and medical and graduate student professor who has worked in the areas of autoimmunity and vaccine development for over twenty five years (the past 17 years at Baylor College of Medicine in Houston).
I have been honored by the National Institutes of Health as the first Margaret Pittman lecturer for my pioneering work in vaccine development. This honor was special for me because Dr. Pittman’s contributions were instrumental in early aspects of vaccine development and because I understand the impact that some vaccines have had, and will continue to have, on our society. My ongoing research in the area of vaccine development continues to be a major commitment. I have worked extensively with the US Agency for International Development and the World Health Organization programs and have a life long commitment to carrying out research to understand, and hopefully, to help solving problems associated with world population as well as disease problems.
As I have been invited to speak to this distinguished subcommittee, it is important to discuss my experience with the clearly apparent severe adverse effects of the Hepatitis B vaccine. About five years ago, I had two individuals working in my laboratory who were required to take the Hepatitis B vaccine. Both of those individuals developed severe and apparently permanent adverse reactions as a result of the vaccine. Both of them were completely healthy and very athletic before this vaccine and have now suffered severe, debilitating autoimmune side effects from the vaccine. I have studied the complete medical history of my brother, Dr. Bohn Dunbar, who developed seriously chronic joint and muscle pain, fatigue, and multiple sclerosis-like symptoms. And now he has further been diagnosed with POTS (an autoimmune, cardiovascular, and neurological problem) and subsequently with chronic inflammatory, demyelinating polyneuropathy. His problems have been attributed to the Hepatitis B vaccine by over a dozen different specialists around the United States of unquestionable medical expertise. He has now been rated permanently and totally impaired at greater than 90%. His health care has already cost the state of Texas about a half million dollars in the Texas Worker’s Compensation Program to date, and that figure will continue to rise given the severity of his health condition.
My other student went partially blind following her first booster injection, a medical condition that was markedly exacerbated by her second booster that resulted in hospitalization. Personal communications are that her eyesight is continuing to deteriorate. Because she is in medical school she has been, understandably in my opinion, afraid to pursue investigation into her medical problems because of her concern that they might affect her medical career.
I am extremely sensitive to the need to evaluate the risk vs. benefits of any vaccine. Because of my experience in this area, it became intuitively clear to me that these two active, healthy individuals working in my laboratory developed autoimmune syndromes within a predictable immunological time frame following their booster injections of the Hepatitis B vaccine. After carrying out extensive literature research on the nature of this virus and this vaccine, it became intuitively obvious to me that there is a significant scientific probability that the vaccine is the cause of those adverse reactions. Both the published studies of reactions to viral infection and the temporal relationship of vaccine administration to adverse events suggest strongly that these adverse reactions are related to the nature of the viral protein, the recombinant surface antigen of which is the principal component of the vaccine.
I have been in contact with numerous physicians and research scientists from several countries who have independently described identical severe reactions to the vaccine in thousands of Caucasians. Their observations have been, for the most part, denied or ignored by the public health systems, as is evidenced by the serious charges against healthcare officials and pharmaceutical companies brought recently in France. The reversal of the vaccine mandate for children in France was not based on lack of documentation. I have now been contacted personally by hundreds or more individuals (including parents of infants and children) who have reported deaths, severe health problems and life long disabilities, resulting in major medical costs following the administration of this vaccine. It appears that the adverse events related to this vaccine are within a gene pool that is capable of genetic definition. I respectfully submit that rigorous scientific studies into the possibility that the vaccine can cause severe autoimmune disorders is necessary.
The following points specifically address the issues listed in my invitation to speak to this committee.
1. The Food & Drug Administration has set up a system for reporting adverse reactions to the vaccine. How does this system work? What is being done to study these adverse reactions.
My first experience with this reporting system followed my observation of the two individuals in my laboratory who developed serious medical problems within a time frame predictable for immunological reactions. After seeing that these reactions were listed in the Physician’s Desk Reference text as reported reactions to this vaccine, I learned about the VAER’s reporting system. When I first called the FDA about this, I was told by an individual that «this vaccine is a problem and it is a big one.» I was initially sent some information on reports of reactions that were similar, if not identical, to those of these two individuals. I attempted to initiate a dialogue with individuals at the FDA but was simply told that I could obtain the information under the Freedom of Information Act. I subsequently paid to obtain copies of these documents; and I was overwhelmed by the thousand of pages of documents I received listing thousands of reports, hundreds of which were identical to the reports I had filed for the two individuals working in my laboratory. Unfortunately, the details on these lists were insufficient for studies to critically evaluate the mechanisms by which these reactions occur.
There was no response to my subsequent correspondence with members of this branch of the FDA. (I am aware that the cutbacks in FDA funding may have played a role in this issue.) It became apparent that the essential medical details (e.g. patient identity, genetic background, family history of autoimmune diseases, etc.) are not provided by this reporting system and that there is no way to contact physicians reporting these reactions. This information is, therefore, inadequate and not accessible to those of us who are studying the serious adverse reaction events apparently related to this vaccine. It was also apparent that there is no follow-up on these reactions since the two patients I reported were never contacted to evaluate their deteriorating health conditions.
What was obvious from the information I obtained from the VAERS reports were that there are thousands of reports listing such conditions as neurological damage, arthritis symptoms, and other serious immunological disorders. These are the same types of medical conditions that, in my extensively detailed investigation of the literature, have been published in dozens of medical journals that cite the correlation of this vaccine and severe immunological reactions. (Table of references to be provided at time of hearing). The fact that this reporting system is «passive», i.e. not mandatory, also suggests that only some fraction of adverse events (estimated by FDA officials as 1-10%). In summary it is my opinion that the VAERS system, as currently structured, is highly inadequate to collect scientifically useful information.
I have now been in direct contact with hundreds of severely ill patients (as well as with physicians who have hundreds more patients) having developed adverse reactions to this Hepatitis B vaccine. I feel that it is critical to investigate the early onset effects as well as subsequent development of autoimmune adverse reactions in the hope that we might find more directed treatments to avert the long term effects in those already afflicted with these problems. I believe this is possible in view of new technologies for treatment of autoimmune diseases that are targeted to the identification of specific autoantibodies to defined epitopes.
2. Do the benefits of administering the vaccine to infants outweigh the risks?
To date my studies have concentrated on the adult population. Sadly, even less is known about immunological reactions in infants, especially since they cannot communicate, as can older children or adults, their severe pain, fatigue, or other neurological or physical disturbances. In the event of deaths following vaccination, there is generally inadequate information collected by pathologists to adequately evaluate these reactions.
I would challenge any colleague, clinician or research scientist to claim that we have a basic understanding of the human newborn immune system. It is well established in studies in animal models that the newborn immune system is very distinct from the adolescent or adult. In fact, the immune system of newborns in animal models can easily be perturbed to ensure that it cannot respond properly later in life.
In contrast, it is highly improbable in the US that a newborn has any significant risk of contracting Hepatitis B as a child because the disease is caused by a blood-borne virus. Newborns are not likely to engage in intravenous drug use or promiscuous sex. Nor are they likely to suffer an accidental needle stick, as might a medical worker. About the only way they are likely to be exposed to the disease is by being born to an already infected mother.
In view of this lack of scientific and medical information of neonatal immunology, it is remarkable to me that newborn infants, especially those not at risk for the Hepatitis B disease itself are being administrated multiple injections of this vaccine and that there have been few, if any, clinical trials to adequately evaluate the potential long term effects of neonatal immunization especially as it relates to genetic diversity.
3. What process does the CDC employ to make a recommendation for a vaccine: What role do pharmaceutical companies play in that process? Do conflicts of interest exist?
As I am not an expert on public health policy, I am not familiar with all of the nuances of policies for recommending vaccine mandates. It is well documented, however, that committee members advising the CDC and members of organizations (such as the American Academy of Pediatrics, and the World Health Organization) obtain substantial funding from pharmaceutical companies. Furthermore, it is well documented that investigators who have carried out clinical trials on this vaccine also benefit personally and obtain laboratory funding as consultants promoting the vaccine and as expert witness in legal conflicts. It is also documented that lobbyists who consult for pharmaceutical companies are the same lobbyists for medical health care providers. I leave it up to this distinguished committee to investigate and evaluate the seriousness of these apparent conflicts of interest.
 
However, it is also apparent to me that the lack of government funding specified for independent scientists to evaluate adverse vaccine reactions is a major reason for scientists to seek funding for experiments dictated by pharmaceutical companies.
4. What disclosure is required before the vaccine is given? Is it adequate?
It is apparent to me, as it is to many others who have been investigating this issue, that adequate long-term follow-up information was not collected in clinical trials for this vaccine. This is particularly true with respect to the Caucasian population. One might therefore ask: «Is there is sufficient information concerning risks of this vaccine to be disclosed»? The ominous lists of potential reactions listed in the vaccine inserts appear not to be given to patients by their physicians. The physician-patient relationship is fiduciary. That is why the lawyer representing my brother, who had an adverse reaction to this vaccine, made a claim of fraud, a claim which this lawyer says has a strong basis in the Restatement of Torts.
Many physicians and medical students have told me that, if this vaccine is recommended and mandated by government officials, «why should they look at it or discuss it with their patients?» Others have said that their colleagues do not report these incidences because they «don’t want to get involved.» They further tell me that they have been informed that this vaccine is the safest ever developed because it is a recombinant DNA vaccine and «therefore you can’t get the disease». Unfortunately, they have clearly missed a major point of basic immunology. Any peptide (a limited sequence of amino acids of a protein) or a full length or truncated protein (produced by purification from a biological source or using recombinant cDNA technology) when introduced into the body will be «processed by the immune system» and, depending on the nature of that protein, could result in long term autoimmune reactions.
Sadly, in basic science courses in medical schools, many of these details of immunology (a medical research field that has exploded over the last decade) are not taught. I have taught in the basic science curriculum for over 15 years so I am well aware of this limitation. In fact, I recently was invited to speak at the Institute of Medicine at the National Academy of Sciences on this subject. I was quite shocked when a senior member of a national health committee (involved in recommending mandates for childhood vaccines) came up to me and said: «Very interesting talk. I know you teach beginning medical students. Could you recommend me a basic immunology textbook? I think I need to catch up on some of this immunology stuff.»
In summary, it is essential in my opinion that physicians be better educated on the potential risks of this vaccine, as well as the interactions with other vaccines and the increased risks of vaccinations of sick children. It is also critically important to conduct the research necessary so that they will have better information to identify people at risk for adverse reaction. In any event early diagnoses of these reactions will result in more effective therapies.
My colleagues and I have submitted proposals to investigate the scientific bases for these vaccine adverse reactions. Many of these reactions are similar to those reactions from individuals having the virus itself. It is also apparent that there are major histocompatability, genetic linkages among patients who are having the severe reactions. It has already been shown that as many as 10 to 30% have been reported as not developing antibodies when they are vaccinated and, therefore, they may not to be protected from the disease. This non-responsiveness may be attributed to the individual histocompatability genes.
We have proposed to carry out research to determine the long-term prognosis for patients having such adverse reactions for two purposes: (1) Developing a prophylactic strategy of identifying those likely to react adversely so they can avoid the vaccine if at risk; and (2) developing a therapeutic strategy by early and more effective identification of those who have had adverse reactions with the hope of developing more specific therapies. I and my collaborators have well equipped laboratories for state of the art immunological and biochemical analyses and we have already collected blood samples throughout the period of these adverse reactions. We therefore, have unique samples to begin to scientifically pinpoint the reasons for the adverse reactions. We have significant preliminary evidence that may explain these responses and we will continue to seek funding to continue these studies. We have obtained some limited funding from private sources but as yet there are no government funds allocated for studying adverse reactions to this vaccine, so the progress of these studies is slow.
It is apparent that the Hepatitis B virus (and vaccine developed from the Hepatitis B surface antigen) is very unique from many other viruses and vaccines. New theories and experiments (i.e. molecular mimicry and anti-idiotypic antibodies) have been developed which could explain reasons for autoimmune reactions caused by this virus or the viral protein used in the vaccine. (The December 26, 1996, New York Time’s article which summarizes studies on «molecular mimicry» theories for viruses causing autoimmune diseases may be right on point.) The fact that there are dozens of publications on the correlation of this virus as well as the vaccine with autoimmune and other connective tissue disorders provides strong evidence for the correlation of this viral antigen causing autoimmune diseases.
In summary, no one, especially myself, would ever assert that the Hepatitis B virus is not causing serious health problems in the world. However, if this, or any other vaccine, by nature of the protein or parts of the protein (native or produced from a cDNA as a recombinant protein), has the ability to adversely effect the immune system of large numbers of individuals resulting in severe adverse reactions (even if restricted to some genetic populations), then the public reaction to ALL vaccines, including those that clearly DON’T have related adverse reactions will be doomed in the public’s eye. That includes the development of vaccines to evolving airborne viruses that might become a serious threat to the world population. Thanks to the success of the Government funded Human Genome Project and advances in computer programs, it may soon be possible to evaluate potential molecular structure to predict these problems with vaccine in advance or early in vaccine development.
I will conclude by relating an observation. In my research on vaccines that have been used for the humane control of animal populations, I have had the opportunity to observe first hand African elephant family behavior. Whenever a baby cries, the entire herd of up to a hundred will immediately trumpet, and charge with great flurry to surround the infant elephant. When it is apparent that there is no danger, they will one by one touch trunks with that infant, ensuring that he is okay before going about their business. They would certainly never allow a single baby or family member to be exposed to unknown danger.
I ask you in your task of investigating our public health system that as do our friends the elephants, listen to the cries of babies (and family members) that might have been adversely affected by this vaccine or who may be at risk. Please demand adequate scientific documentation and medical information to make responsible decisions concerning mandating vaccines for children. In addition to your investigation on the adverse reactions of this vaccine I would urge you to help to provide research funds which are currently not available to study the serious adverse reactions of this vaccine as well as other vaccines.
Thank you for the opportunity to appear before this distinguished subcommittee. I will be glad to answer any of your questions or provide you with additional information you may request.
Sincerely,
Bonnie S. Dunbar, PhD, Professor
Department of Cell Biology
Baylor College of Medicine, One Baylor Plaza
Houston, Texas 77030
http://www.house.gov/reform/cj/hearings/5.18.99/Dunbar.htm
http://www.homeoint.org/kotok/vaccines/dunbar.htm

Ñåé÷àñ ìíîãî ãîâîðèòñÿ î âðåäå ïîòðåáëåíèÿ ïðîäóêòîâ ÃÌÎ (ãåííîìîäèôèöèðîâàííûå), ëþäè ñòàðàþòñÿ íå ïîêóïàòü è íå ïîòðåáëÿòü òàêèå ïðîäóêòû… Íî ÷òî òîãäà ãîâîðèòü î íåîáõîäèìîñòè óæåñòî÷åíèÿ ïðîâåðîê âñåãî ñâÿçàííîãî ñ âàêöèíàöèåé íîâîðîæäåííûõ, åñëè ðå÷ü èä¸ò î âíåäðåíèè âíóòðü âàêöèí, ïðîèçâåä¸ííûõ ãåííîèíæåíåðíûì ñïîñîáîì?

Ïîäðîáíåå ñì. íà àâòîðñêîé ñòðàíèöå  www.proza.ru/2007/12/01/275 ðàññëåäîâàíèå äåÿòåëüíîñòè ÔÂÐ (Ôîíä Âèøíåâñêàÿ-Ðîñòðîïîâè÷) â Ðîññèè…

Äëÿ ñïðàâêè.
Ãåïàòèò B. Ïóòè çàðàæåíèÿ.
 îòëè÷èå îò Ãåïàòèòà À, ê êîòîðîìó îáñóæäàåìàÿ ãåïàòèò-ïðèâèâêà Ýíäæåðèêñ íå èìååò íèêàêîãî îòíîøåíèÿ, Ãåïàòèò B ïåðåäà¸òñÿ èñêëþ÷èòåëüíî ïàðåíòåðàëüíûì ïóò¸ì, èëè åñëè ïðîùå — ÷åðåç êðîâü, àíàëîãè÷íî ÑÏÈÄó. Çàðàçèòüñÿ ìîæíî ëèøü óïîòðåáëÿÿ íàðêîòèêè ÷åðåç íåñòåðèëüíóþ èãëó, ïåðåëèâàÿ íåïðîâåðåííóþ êðîâü, à òàêæå îò ñåêñóàëüíîãî ïàðòí¸ðà, è, ïðåæäå âñåãî ãîìîñåêñóàëèñòàì. È ëèøü êðàéíå íåçíà÷èòåëüíàÿ ÷àñòü çàáîëåâøèõ íàñëåäóåò ãåïàòèò B îò áîëüíîé ìàòåðè. Ýòè äàííûå ïîëíîñòüþ ïîäòâåðæäàþòñÿ ñòàòèñòèêîé, â òîì ÷èñëå è ðîññèéñêîé. Òàê, â 1999ãîäó îêîëî 52% çàðàçèëèñü ïîëîâûì ïóò¸ì, 30% — îò øïðèöà íàðêîìàíà, 3% — îò ìåäèêîâ è ëèøü 0,1% — «âåðòèêàëüíî» (îò áîëüíîé ìàòåðè). Äàëåå, â òîì æå 1999 ãîäó â Ìîñêâå (3) ëèøü 1,6% çàáîëåâøèõ ñîñòàâëÿëè äåòè äî 14ëåò, è èç íèõ âíîâü òå æå 0,1% — äåòè 0-2ëåò. Çàïîìíèòå ýòó öèôðó, îíà íàì åù¸ ïðèãîäèòñÿ!

Çàìå÷ó åù¸ ðàç, ÷òî íèêòî èç ñåðü¸çíûõ ìåäèêîâ íå îñïàðèâàåò ýòèõ ïðîïèñíûõ èñòèí. Íî â òàêîì ñëó÷àå, êàêîâ ñìûñë (êðîìå ôèíàíñîâîãî) ïðèâèâàòü ìëàäåíöà â ïåðâûå äíè æèçíè, âåäü îí åù¸ ìíîãî ëåò íå áóäåò âåñòè ïîëîâóþ æèçíü ñî ñëó÷àéíûìè ïàðòí¸ðàìè è ïðèíèìàòü íàðêîòèêè? À êîãäà íà÷í¸ò (åñëè äàæå íà÷í¸ò!) ýòî äåëàòü, ïðèâèâî÷íûé èììóíèòåò óæå îñëàáíåò (äàæå åñëè ñ÷èòàòü ÷òî îí ðàáîòàåò), èáî åñòü ìíîãî÷èñëåííûå äàííûå î äëèòåëüíîñòè çàùèòíîãî òèòðà â 5-10ëåò (1), è ÷åì áîëüøå âûõîäèò ðàáîò, òåì ìåíüøå ñòàíîâèòñÿ ýòà öèôðà. Ìîæåò áûòü â áîëåå ñòàðøåì âîçðàñòå ýíäæåðèêñ ïðîòèâîïîêàçàí è âåä¸ò ê áîëåå âûñîêîìó ïðîöåíòó îñëîæíåíèé? Íåò, îá ýòîì íåò ÍÈ ÅÄÈÍÎÉ ïóáëèêàöèè. Ìîæåò áûòü â çðåëîì âîçðàñòå ýíäæåðèêñ ìåíåå ýôôåêòèâåí? Íåò, âñå èññëåäîâàíèÿ ïåñòðÿò ñîîáùåíèÿìè î õîðîøèõ ðåçóëüòàòàõ èìåííî íà ãðóïïàõ ðèñêà òèïà òåõ æå ãîìîñåêñóàëèñòîâ è âðà÷åé. Äëÿ ÷åãî æå òîãäà òàêàÿ ñïåøêà, çà÷åì ïðèâèâàòü îò áîëåçíè çà ÏßÒÍÀÄÖÀÒÜ ëåò äî òîãî, êàê åé ìîæíî ðåàëüíî çàðàçèòüñÿ?

Åäèíñòâåííûé îòâåò îò äîëæíîñòíûõ ëèö âåñüìà öèíè÷åí — «äåòè äîñòóïíåå». Ò.å. çà íàðêîìàíîì è ãîìîñåêñóàëèñòîì åù¸ íàäî ïîáåãàòü, îíè íå ïîíèìàþò ñâîåãî ñ÷àñòüÿ è íå ñòàíîâÿòñÿ â î÷åðåäü íà ïðèâèâêó, à ïðèáûëü óïëûâàåò èç ðóê… Ïîýòîìó ñðî÷íî íàäî âêîëîòü ìèëëèîíû äîç õîòü êîìó-íèáóäü, æåëàòåëüíî ñàìîìó áåççàùèòíîìó («äîñòóïíîìó» â òåðìèíîëîãèè ôàðìàäåëüöîâ) — è òóò óæ ëó÷øå íîâîðîæä¸ííûõ íèêîãî íå ïðèäóìàòü.

Ñì.
http://www.afanas.ru/privivki/engerix.htm



Источник: www.proza.ru


Добавить комментарий