Time-tested system
"AiF. Health”: – Mikhail Petrovich, you can often hear talk that vaccinations do more harm than good, that they weaken the immune system, contribute to the development of allergic reactions... Is this true?
M.K.: – Not a single vaccine is 100% harmless. The body must react to the introduction of any antigen, and each reacts in its own way. The norm is a slight increase in temperature, mild discomfort, and redness at the site of vaccine administration. And the doctor should warn about this! The main thing is to understand that the result of vaccination will always be beneficial.
"AiF. Health”: – In our country there is a so-called National Calendar of Preventive Vaccinations. What vaccinations does it include and how mandatory are they?
M.K.: – There are eleven of them: against viral hepatitis B, tuberculosis, diphtheria, whooping cough, tetanus, against Haemophilus influenzae, polio, measles, rubella, mumps and, of course, against influenza. By the way, adults should undergo booster vaccination against diphtheria and tetanus every 10 years.
"AiF. Health”: – How obligatory is it to comply with all this, and are there any additional vaccinations?
M.K.: – This is a system verified over many years of work. Violation of the timing of vaccinations, and even more so, refusal of them, I would call a crime against the child, his health, and his entire future life.
I will say more: those who, for various reasons, were not vaccinated against hepatitis B on time, can receive it at the expense of the state at any age (up to 55 years), and those who have not been sick and have not been vaccinated against rubella - up to 25 years.
Mikhail Kostinov: “Self-medication is gaining momentum in modern society”
Doctor of Medical Sciences, Professor, Honored Scientist of the Russian Federation, Head of the Laboratory of Vaccine Prevention and Immunotherapy of Allergic Diseases of the Federal State Budgetary Institution Research Institute of Vaccines and Serums named after. I.I. Mechnikov" Mikhail Kostinov - about methods of preventing viral diseases, the characteristics of human immunity and antiviral drugs. Several books on vaccine prevention have been published under the editorship of Mikhail Petrovich. He is the author of numerous scientific articles and practical guidelines on vaccination, which are used by Russian doctors.
– It’s winter now, the period of spread of influenza and ARVI, new infectious diseases. How to better prepare and protect yourself? What preventive measures are most relevant?
– Preparation for the ARVI and influenza season should begin in the fall. Today, the most effective measure to prevent influenza is vaccination. Immunoprophylaxis is necessary to prevent morbidity, disease complications and mortality. As for emergency prevention, there are many drugs that are well known in Russia to both patients and doctors. However, their use must be justified. To prepare yourself for an infection, you should use only drugs approved for prevention. In some cases, they can be useful not only for people with reduced immunity, but also for healthy people. For example, according to one study conducted in the United States, children with chronic diseases and initially healthy children are equally likely to get the flu. But at the same time, it showed that among initially healthy children there were more deaths at the early stage of the disease. Such results once again emphasize the need for everyone, without exception, to be attentive to their health during the season of respiratory infections and take protective measures.
Russia has historically developed traditions of preventive medicine. This has led to the fact that our country ranks first in the number of immunotropic drugs developed. There is a lot of evidence in the scientific literature that these drugs are used in the complex treatment of many diseases of a viral, bacterial, fungal nature and varying degrees of severity - including respiratory infections and repeated exacerbations. Such drugs themselves do not have a direct antiviral or antibacterial effect. They must be combined with basic treatment. If a person is sick, for example, with tuberculosis, then we are talking, accordingly, about anti-tuberculosis therapy. To alleviate the course of serious diseases is the purpose for which immunomodulators were originally created at the end of the last century.
If a person suffers from any chronic diseases, then, as prescribed by his attending physician, he can also use immunotropic drugs in addition to the main therapy to prevent exacerbations.
In my opinion, Russia occupies one of the leading places in the world in self-medication for respiratory infections. People learn about a particular medicine from the Internet or advertising sources and make decisions about its purchase without the participation of a doctor. Self-medication is often harmful to health, and this affects the quality of life in the future. Of course, anyone has the right to buy an over-the-counter drug at a pharmacy and take it at their own discretion, for example, as a preventive measure. But at the same time, it is important to be confident in the diagnosis and not waste time if we are talking about a serious disease that only a doctor can diagnose and treat. Having carefully examined the patient, specialists can also, in accordance with the established diagnosis, recommend medications to strengthen the immune system.
– It is known that scientists distinguish between two types of immunity: innate and acquired. What is the difference? What are the basic mechanisms of both?
– Innate immunity is genetically transmitted from mother to child at birth. This is the first line of defense against germs. When we get sick, the innate immune system immediately programs the body to fight. Many different mediators begin to work against the disease. They are released within the first few minutes after the virus enters the body and work for about a week. After this, acquired or adaptive immunity is activated: the body produces antibodies. Sometimes adaptive immunity is created through vaccination. Key cells of the immune response, so-called dendritic cells, are involved in this process. Innate immunity can last a lifetime, but acquired immunity does not always.
– You mentioned dendritic cells. Tell us a little more.
– Dendritic cells got their name due to their branched processes, with the help of which they explore the body’s environment and promptly identify intruders - pathogens. They help immune cells begin to fight the pathogen, triggering cascades of immune reactions. This is how, for example, during vaccination, antibodies are formed. And the completeness and duration of the immune response will depend on how active dendritic cells are.
– What else does the duration of the immune response depend on?
– It depends on whether memory cells have been formed, and if so, in what quantity. Now the main goal in vaccinology is to teach the body to produce these same “memory cells.” Scientists have been creating drugs capable of this for the last 15-20 years. Thus, if previously vaccines worked for about five years, now, thanks to the addition of special compounds (adjuvants, conjugates), they can help people for 10-15.
– If we talk about vaccine prevention, how does the immunization process affect the human body and how is immune defense formed? How can natural immunity mechanisms be used to create vaccines?
– It’s very good if the vaccine works, for example, like a virus. If a person is seriously ill with any viral infection, then after recovery he cannot become infected with this virus for many years. The mechanism of action of modern vaccines is aimed at ensuring that the immunity that is developed to the vaccine is as powerful as during a viral infection. Adjuvants have been developed to support this mechanism. These are substances that are used to enhance the effect of vaccines and quickly develop immunity and help form memory cells. Adjuvants began to be created in the middle of the last century and are used to this day. The most common of them is aluminum hydroxide. It was used in the development of vaccines against diphtheria and tetanus, thanks to which the acquired immunity worked longer and more efficiently.
Today, adjuvant technologies in vaccine production are among the most modern. They allow you to reduce the amount of antigen and create lasting immunity to infectious diseases. There are people who respond poorly to vaccination. These are mainly children, elderly people and people with weakened immune systems. It is especially important for them to use the safest adjuvanted vaccines that have the ability to create post-vaccination immunity even in conditions of immunodeficiency. Scientists paid special attention to the potential of the adjuvant when the need for a pandemic vaccine arose. The fact is that in a pandemic, it is important to produce more vaccine from the same amount of antigens and vaccinate more people in a short time. If we recall history, in Russia in the period 2009-2010 an adjuvanted vaccine (azoximer bromide adjuvant) was created in the shortest possible time, which was used to combat the H1N1 influenza. Adjuvanted and conjugate vaccines are widespread outside the Russian Federation and are used to prevent not only influenza, but also other infections, for example, hepatitis B, diphtheria, pneumococcus, meningococcus, tetanus, etc.
It should be noted that in Russia over the past five to six years they have been actively studying the cellular mechanisms of innate and adaptive immunity when administering vaccines against influenza, pneumococcus and other infections. With the help of vaccination, we are trying to form immunity similar to natural, but without the development of possible undesirable effects that a viral infection causes. We learn from nature.
– Are there other means of prevention besides vaccines? What is their action based on?
– To prevent respiratory infections of various natures, immunomodulators are used. They have different origins. There are synthetic, genetically engineered, bacterial, plant-based and others. Some can work only on the links of cellular immunity, others - on humoral immunity cells, and others - on phagocytosis-complement or interferon status. The immunomodulator, to a greater or lesser extent, affects all parts of the immune system. When a doctor prescribes a medicine for prevention, he, depending on the disease, its pathogenesis, and changes in the immune status, selects the appropriate drug. For example, azoximer bromide - the drug Polyoxidonium in tablets (there are contraindications, you must consult a specialist before use) - increases the body's resistance to local and generalized infections of bacterial, fungal and viral etiology.
There are immunomodulators that act locally. They are used in the form of drops or ointments, sprays. And there are systemic ones - they affect the immune system as a whole. At this time, special attention should be paid to the prevention of respiratory infections, especially for those who have not had a flu shot and want to protect themselves from viral infections, including coronavirus. In addition to a number of preventive measures related to hand washing, wearing masks, etc., it is necessary to keep in mind the drugs that are approved for the prevention of complications from respiratory infections.
– Should we pay attention to whether drugs have mechanisms of influence on innate immunity when choosing a prophylactic agent?
– Of course, both on innate and adaptive immunity. However, the doctor needs this more in order to competently and expediently prescribe an immunotropic drug. The main thing here is to evaluate whether there is a need to prescribe it at all. I recommend always paying attention to the instructions: the longer they are, the better the drug has been studied. If you use poorly studied medications that have had few clinical studies, you can harm the body. You need to be confident in the safety and effectiveness of the drug used.
– Nowadays there are quite a lot of antiviral drugs in pharmacies, including Russian ones. How can a consumer figure out whether they need to be used in general? What should you pay attention to when choosing?
– First of all, you need to pay attention to the evidence base, geography, experience of use and, of course, the doctor’s recommendations. Each drug must be used specifically in certain situations.
"Gap" in the calendar
"AiF. Health”: – What other vaccinations, in your opinion, should be in the National Calendar?
M.K.: – The time has come to make vaccination against pneumococcal infection mandatory.
"AiF. Health”: – Why from her?
M.K.: – No other infection kills so many people in the world – 1.7 million annually! Moreover, the worst thing is that the majority are children in the first two years of life.
"AiF. Health”: – How is this virus transmitted?
M.K.: – By airborne droplets from person to person. Moreover, the carrier may not be sick, and may not even know about the presence of the virus in his body. The consequences for the sick person, especially if it is a small child, are irreversible. He either dies after 1-2 weeks, or “acquires” chronic pathologies, such as pneumonia, inflammation of the middle ear... There is also a danger such as blood poisoning and meningitis.
"AiF. Health”: – To what extent do people perceive the threat of pneumococcal infection? Where can I find out about this?
Notes
- ↑ 12
[kremlin.ru/acts/bank/21545 Decree of the President of the Russian Federation dated October 18, 2004. No. 1324]. President of Russia. Retrieved November 2, 2015. - [www.instmech.ru/ob-institutie/struktura Scientific divisions of the institute]. www.instmech.ru. Retrieved November 2, 2015.
- [www.epidemvac.ru/redaction Editorial Board]. www.epidemvac.ru. Retrieved November 2, 2015.
- [www.mma.ru/person/51927/ Kostinov Mikhail Petrovich - First Moscow State Medical University named after I.M. Sechenov]. www.mma.ru. Retrieved November 2, 2015.
- [cyberleninka.ru/article/n/vliyanie-kompleksnoy-vaktsinatsii-protiv-pnevmokokkovoy-gemofilnoy-tipa-b-infektsiy-i-grippa-na-klinicheskoe-techenie-hronicheskoy INFLUENCE OF COMPLEX VACCINATION AGAINST PNEUMOCOCCAL, HEMOPHILICA TYPE B INFECTIONS AND FLU ON THE CLINICAL COURSE OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE]. Cyberleninka. Retrieved November 2, 2015.
Catch up and overtake abroad
"AiF. Health”: – At one time, our country was, one might say, “ahead of the rest” in terms of preventive vaccinations. Suffice it to remember that we once defeated smallpox... And how do we look now compared to other countries?
M.K.: – Unfortunately, we currently do not carry out vaccinations against a number of serious diseases, although in other countries they are included in the National Vaccination Calendars.
First of all, it is chickenpox. It is generally accepted that a child should get sick from it, preferably at an early age. But do parents understand that in this way the child receives a virus from the herpes family, which will accompany him throughout his life? It remains in the nerve endings even during stress, and during injury it can develop into such a serious, incurable disease as herpes zoster. And this threatens almost a third of those who had chickenpox in childhood.
We do not have mandatory vaccination against human papillomavirus (HPV). And this, although not 100%, is still serious (doctors say about 75%) prevention of cervical cancer! I was recently at a conference where a terrible statistic was announced: out of 100 women registered with a diagnosis of cervical cancer, 25 die within a year.
"AiF. Health”: – We have regional programs on HPV, don’t we?
M.K.: – Yes, but they depend on the availability of funds in the region. Today there are funds and vaccination is taking place. Tomorrow - no, and everything stopped. This should be government policy.
It is also necessary to say about rotavirus infection - the scourge of all children in the first 3 years of life. If a child has been in a hospital at least once, he will definitely pick it up. The infection is accompanied by intestinal syndrome and dehydration. At the same time, it is very easy to prevent it: it is enough to take a few drops of the vaccine in the first year of life.
Unlike other countries, we need to vaccinate against hepatitis A due to the current epidemic situation in Russia.
In the future, vaccination against meningococcal infection is also needed for young children, which has long been accepted abroad. We currently recommend vaccinations only due to the epidemiological situation, and for children over 2 years old.
To the extent that broad social strata are concerned about the issue, the authorities will react. If the state understands that society cares about its own health and the health of future generations, funds will be found for vaccine prevention.
Personal experience
"AiF. Health”: – But let’s return to the so-called seasonal vaccinations, in particular against the flu. Who is at risk here?
M.K.: – These are children attending preschool institutions and primary school students, medical workers, employees of educational institutions, as well as adults over 60 years old, all with chronic diseases. And most importantly – pregnant women!
"AiF. Health”: – Is it possible for them to be vaccinated?
M.K.: – Not only is it possible, it is necessary! There are recommendations from WHO and the Ministry of Health. But here, unfortunately, this is not done - women, apparently out of ignorance, do not strive, and doctors do not insist.
"AiF. Health”: – What are you and your family vaccinated against?
M.K.: – My wife and children from the flu – every year. And I only do it when some new strain appears. For the rest I have a long-term immunity...
Professional activity
In 2001, Mikhail Petrovich, as a professor, worked at the Department of International Law at the First Medical School. Kostinov is known as an ardent supporter of vaccination. He promotes this method of protection not only in the media, but also on television.
Most actively, the immunologist encourages the population to get flu vaccinations. According to the expert, this type of disease is very insidious and a protected organism is less likely to get sick with its new varieties. This also applies to the global Covid-19 pandemic.
In 2021, Mikhail Kostinov took an active part in the development of a vaccine against Coronavirus. The man is convinced that only mass vaccinations will help cope with the disease. According to the immunologist’s forecasts, a working vaccine that can be used en masse will not be ready until 2021.
Not everyone agrees with Kostinov’s optimistic statements. Israeli scientist Yehuda Shenfeld, who specializes in autoimmune diseases, claims that such little-studied vaccines will cause a lot of diseases in the future.
In the interview, Mikhail Petrovich tells many interesting facts. The professor's reports and lectures are very popular in scientific circles. According to the doctor, Covid-19 will be a powerful impetus for the development of medicine. He is also convinced that a new era of vaccination will begin, without which humanity simply cannot survive.
