1 Национальный медицинский исследовательский центр здоровья детей, Москва, Российская Федерация 2 Российский национальный исследовательский медицинский университет им. Н.И. Пирогова, Москва, Российская Федерация 3 Первый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский Университет), Москва, Российская Федерация 4 Республиканский кожно-венерологический диспансер, Грозный, Российская Федерация

The article is devoted to the urgent problem of papillomavirus infection, the extremely high prevalence of which determines the key contribution to the structure of morbidity and mortality from oncological diseases. A chronic persistent course, resulting in benign and malignant tumors in the infection atrium, makes scientists seek new ways of treatment. A specific vaccinal prevention is recognized to be the only reliable protection method today. The article is an updated review of the clinical guidelines developed and approved by the professional association «Union of Pediatricians of Russia» in 2016 for a vaccinal prevention of the diseases caused by human papillomavirus, first published on pediatr-russia.ru. The widespread introduction of vaccines against human papillomavirus, which have confirmed the clinical efficacy and safety, can significantly reduce the global burden of diseases associated with papillomavirus infection.

The article is devoted to bronchiectases issue in children and reflects the most actual approaches to the diagnosis and management of patients with this pathology. Information on the true prevalence of bronchiectases both abroad and in Russia varies. Wherein, bronchiectases can be either an independent disease or a manifestation of another pathology, which necessitates an integrated multidisciplinary approach not only for diagnosis but also for patient management with this pathology. The material presented by the authors is based on clinical guidelines developed and approved by the profile association of the Union of Pediatricians of Russia and aimed at raising awareness of specialists providing medical care to children.

Methylmalonic acidemia (aciduria) is an inherited metabolic disturbance from the group of organic acidemias (acidurias). The article presents etiopathogenetic, epidemiological, diagnostic, and therapeutic aspects of the problem. The possibilities of laboratory and instrumental diagnostic methods the tactics of dietary correction of metabolic disorders in acute and interstitial periods of the disease are described in details; features of drug treatment are outlined. The necessary information for clinical practice and patients’ everyday life is given in the article.

This article describes the peculiarities of the National immunization programs for adolescents in the WHO Euro region. A comparative analysis of the groups was conducted based on economic development. The best and the worst performing states were identified in every group. It was demonstrated that economic development is not the leading factor that determines a country’s vaccination policy.

The article presents the detailed key provisions of the clinical recommendations on providing medical care to children with Kawasaki syndrome/illness, developed by the professional association of pediatric specialists — the Union of Pediatricians of Russia. The current data on the prevalence of pathology is presented, the characteristic diagnostic signs of the disease are given that allow to make a diagnosis as soon as possible and immediately appoint a specific treatment. Therapeutic measures carried out in the required volume determine the further prognosis. The comprehensive approach to the management of pediatric patients with this nosology presented in the article will ensure a high level of medical care quality provided to children with Kawasaki syndrome.

The article is devoted to the problem of timely diagnosis and current principles of management of children with bronchial asthma. Given the  increase in the prevalence of allergic pathology stated over the past  decades, the issues of differential diagnosis, integrated approach to the  treatment and management of children with allergies are extremely  relevant. Strategies of sequential therapy and monitoring of the  patient’s condition, adherence principles are key links in achieving and  maintaining control over bronchial asthma. The publication presents the  main provisions of national clinical guidelines developed and approved  by the professional association «Union of Pediatricians of Russia».

Hypophosphatasia is a rare genetic disorder caused by deficiency of tissue-specific  alkaline phosphatase as a result of mutations in the ALPL gene. Depending on the form and severity of the disease, pathology may spawn in utero, in childhood or in adult age. Given functions of alkaline phosphatase, patients experience multisystem disorders: primarily changes in bone (osteoporosis, rachitic deformations,  fractures),  lung  disease  (hypoplasia  with respiratory  failure)  and  central  nervous  system  (seizures),  hypercalcemia with development of nephrocalcinosis. Without timely treatment, the disease may be harmful to life in most cases. Patients required observation of a multidisciplinary team of physicians. The only effective treatment is enzyme replacement therapy with asfotase alpha. It is also necessary to carry out symptomatic treatment and rehabilitation of patients with the use of physiotherapy and therapeutic physical training complexes of exercises.

The article is devoted to one of the most urgent problems of pediatrics — rhinitis in children. The difficulty of nasal breathing, being one of the most frequent complaints to pediatricians, can be caused by a banal respiratory infection, as well as be one of the systemic pathology’s symptoms. The economic burden of rhinitis is great for any health budget, the total direct and indirect costs are huge. The article shows the main phenotypic characteristics of rhinitis depending on the etiological factor; gives the modern principles of differential diagnostic search; points studies, use of which is not recommended in routine practice. The authors reflect the key components of a complex therapy and discuss in detail the tactics and possible pharmacological treatment strategies.

Background: Omalizumab is the first and yet the only biopreparation for asthma which combines high efficiency and high cost. The clinical-economic expediency of using omalizumab in asthmatic children has not been previously studied in Russia. Objective: Our aim was to evaluate the clinical and economic expediency of using omalizumab as additive treatment (to basic or supporting therapy) in children with severe uncontrolled atopic asthma under the Russian economic conditions. Methods: We conducted a mathematical simulation of asthma treatment in children with an increased frequency of hospitalization (9 times per year) with an average monthly omalizumab requirement of 558 mg. The model is based on the Markov chain. The model includes direct and non-direct costs. The planning horizons were 2 and 5 years. We analyzed the efficiency and utility of the costs and their influence on the budget. The stability of received data is proven by sensitivity analyzis. Results: Over a 5-year planning horizon the cost of an additional year of quality life (due to using omalizumab) was 1,259,185 roubles, while the “society’s solvency” is 1 341 308 roubles (cost utility analizis). It takes 39,820 rubles to prevent one hospitalization with omalizumab over a 5-year planning horizon (cost efficiency analizis), which is comparable to the cost of hospitalization (43,141 rubles). Total costs for treating 100 children with asthma, 7 of which would be treated with omalizumab, were equal to the amount of money which is enough to treat 105 children without omalizumab (analysis of budgetary influence). Conclusion: The analyses of cost efficiency and utility have shown that the strategy of using omalizumab together with standard treatment is economically expedient. Budgetary influence analysis has not detected a significant burden on the budget.

Cow’s milk proteins (CMP) are the most often cause of allergy in young children. Despite the significant successes in laboratory diagnosis, which also cover allergy in children, food allergy is still a major discussion point in many cases. Successful CMP allergy treatment in children is largely dependant upon the early diagnosis and timely prescription of an eliminatory diet and is defined not only by the actions of specialists (allergologists and dietologists) but also of the primary level doctors. The minimal effective duration of the diet is established by evidence-based studies and is defined in consensus documents on treating children with CMP allergy. Further questions concerning diet duration are resolved according to each unique case. The continuation of a diet should be justified, therefore the necessity of eliminating certain products from a child’s diet is evaluated every 6–12 months. However, at the moment there are no clear ways to predict the duration after which tolerance would appear and thus the duration of a strict eliminatory diet for CMP allergic children. Until recently it was believed that 80–90% of CMP-allergic children form a tolerance over the first 3–5 years of life; however, according to the latest data, the body’s adaptation manifests later. In general, studies show that persisting CMP allergy is characterized by a severe family anamnesis concerning atopic diseases, a longer period between the beginning of CMP intake and the first allergy symptoms, a larger frequency of multiple food reactions and the presence of other allergies. With age a partial CMP tolerance may develop, when dairy products should be introduced in limited amounts. In such cases specialists recommend to introduce milk proteins in tolerable amounts (mainly as part of other products), which, as has been demonstrated, can contribute to the formation of tolerance, while retaining the diagnosis formulation.

The article is dedicated to allergic rhinitis (AR) in children. AR is widespread among children and adolescents; it negatively affects physical and psychological condition, social life and school performance and reduces life quality of both patients and members of their families. The authors consider the most modern approaches to diagnostics and control over the disease and present evidence-based recommendations. The authors offer the relevant classification; describe classic and additional disease symptoms and list the key nosological forms of differential diagnostic search. The complex of therapeutic measures to be taken at AR is aimed at relieving devastating symptoms of the disease and involves limitation of contacts with pathogenetically significant allergens, drug therapy, specific immunotherapy and education. Preventive measures are aimed at preventing development of sensitization/manifestation/aggravation of the AR course. The information given in the article is aimed at spreading the main principles of AR therapy and increasing accessibility of the modern methods of control over allergic diseases. Key words: allergic rhinitis; children; control; therapy

The article dwells upon modern principles of diagnostics and therapy of acute tonsillopharyngitis in children given Russian antibiotic resistance peculiarities of Streptococcus pyogenes. The rate of antibiotic prescription in the event of acute tonsillopharyngitis remains unreasonably high in Russia. The disease most often has viral etiology and antibiotic prescription in such a situation is unreasonable. Prescription of systemic antibiotics is indicated only in the event of the confirmed streptococcal etiology of acute tonsillopharyngitis. Use of the express test in routine practice allows confirming or ruling out streptococcal etiology of the disease quickly and effectively; this allows selecting therapy of acute tonsillopharyngitis timely and rationally.

In recent years, there has been a significant increase in the prevalence  of food allergies. Pathological conditions associated  with a food intolerance are becoming an increasingly urgent problem of pediatrics. According to different researchers, allergic lesions of the gastrointestinal tract occurs in 25–50% of patients with such common pathology as an allergy to cow's milk proteins. The severity of diseases  associated  with food allergies and their prognosis  depend largely on early diagnosis and adequate treatment. Difficulties and errors  in the diagnosis  of gastrointestinal  food allergies  are associated  with both subjective  and objective  reasons,  primarily due to the fact that gastrointestinal  reactions to food are often delayed and non-IgE-mediated. The article describes clinical forms of gastrointestinal food allergy according to the existing classification. Diagnostic algorithms and modern approaches  to differential diagnosis of disease based on evidence-based  medicine and corresponding to international consensus papers are given.