In current conditions, the most effective method of preventing pneumococcal infections (PI) is vaccination, which can significantly reduce the incidence and mortality from pneumococcus and reduce the level of antibiotic resistance. The use of pneumococcal conjugate vaccines has reduced the incidence of invasive PIs in vaccinated children and unvaccinated populations. This is especially true for children with severe somatic pathology, including those with various forms of heart failure (HF). The data show that vaccination of sick HF children can be a clinically effective intervention to improve the treatment results of circulatory failure and improve patients’ quality of life. However, questions regarding the optimal timing of vaccination of sick children with heart failure, dose, frequency and strategies of vaccine introduction still need to be resolved. Data on the pathophysiology of cardioprotection provision during effective vaccination against PI, influenza and COVID-19 in cardiac pathology are summarized. The authors recommend providing conditions for effective vaccine prevention of PI in children with heart failure.

Introduction. Vaccination is the primary method of preventing hepatitis B (HBV). Immunization performed according to the standard schedule often provides protective level of antibodies against HBV. However, the frequency deviation of the immunization schedule in children due to unjustified medical contraindication is the current problem in Russia. At the same time, there is currently no clear strategy for patients with significant deviations of the vaccination schedule, especially regarding extending the interval between the first and third administration of the HBV vaccine. The aim is to evaluate the immunological effects of vaccination against hepatitis B in the vaccination schedule deviation in healthy children and children with chronic diseases. Materials and methods. Eighty-one 0.7-11.7 year child with a disrupted schedule of vaccination against HBV was observed. The children were divided into two groups: children vaccinated within 12-35 months (group 1, n = 48) and children immunized more than 36 months after the first vaccination (group 2, n = 33). Children with chronic forms of pathology were included in both study groups. Blood tests for HBV antibodies after vaccination were performed 1-3 months after the third vaccination. Results. The average concentration of antibodies in the range of 10-1000 mMEd/ml in children of group 1 was significantly higher than in children of group 2 (p = 0.037). In addition, children with chronic diseases were significantly more likely to have an anti-HBs titer higher than 1000 mMEd/ml after the third vaccination than healthy children (p = 0.012). Conclusion. An increase in the interval between the first and third administration of the hepatitis B vaccine leads to a rise in the number of children who are not immune to hepatitis B. Chronic diseases fail to affect the immune response due to the introduction of the hepatitis B vaccine, even if the immunization schedule is disrupted.

Background. Immunological potency of 13-valent pneumococcal vaccine (PCV-13) in children with systemic juvenile idiopathic arthritis (SJIA) is still unstudied. Estimates of the genetically engineered biologic drugs (GEBD) effects on pneumococcal vaccination results also remain controversial.Objective. The aim of the study was to explore the PCV-13 efficacy in patients with SJIA and who is on treatment with monoclonal antibodies against interleukin 6 receptor (tocilizumab) and interleukin 8 receptor beta (canakinumab).Methods. The study included patients under the age of 18 with SJIA in remission or active form of disease vaccinated with PCV-13. The vaccine was administered in single dose of 0.5 ml intramuscularly in patients on treatment with GEBD or 3 weeks before GEBD administration for the first time (for patients with active disease). Vaccination was considered effective at achievement of the minimum protective level of antibodies to capsular polysaccharide of pneumococcus (anti-SPP IgG; ≥ 7 U/ml) or increase of anti-SPP IgG level ≥ 2 times in 4 weeks after vaccination. The anti-SPP IgG levels were measured with enzyme immunoassay.Results. The study included 53 patients (27 girls) in remission of SJIA and 25 (16 girls) in active disease. Median age was 13.3 and 10.8 years respectively. Tocilizumab/canakinumab was administrated in 43/10 and 18/7 patients respectively. Minimum significant anti-SPP IgG level and two-fold increase in anti-SPP IgG level were recorded in 49/53 (92%) and 32/53 (60%) patients with SJIA in remission, as well as in 22/25 (88%) and 18/25 (72%) patients in active disease respectively. PCV-13 immunological potency in patients with SJIA in remission and in active disease (in those who were initially administrated and who did not receive GEBD) did not differ.Conclusion. PCV-13 vaccination allows to achieve protective antibodies level in most of the patients with SJIA in children population regardless of the disease stage and the history of GEBD administration.

Evaluation of the safety profile of vaccines in patients with rheumatic diseases requires an assessment of their impact on disease activity. The effect of antipneumococcal vaccination on the activity of systemic juvenile idiopathic arthritis (sJIA) has not been studied so far. Objective. To evaluate the dynamics of sJIA activity after immunization with pneumococcal 13-valent conjugate vaccine (PCV13) of patients receiving biologicals. Patients and methods. This study included patients with sJIA in remission or active disease receiving biologicals during inpatient treatment and vaccinated with PCV13. To evaluate the effect of immunization on sJIA activity, we measured serum levels of high-sensitivity C-reactive protein (hs-CRP) and calprotectin. In addition to that, we assessed the number of new cases, when concentration of these markers was above the upper limit (UL) 4 weeks after PCV13 administration. Results. In 18 out of 53 patients in remission (34%) and 3 out of 25 patients with active sJIA (12%), hs-CRP levels were undetectable (0.1 mg/L) at both time-points (baseline and after 4 weeks). Among those with detectable hs-CRP levels in at least one time-point 4 weeks after vaccination, patients in remission (n = 35) had no significant changes in hs-CRP (median -0.17 mg/mL; 95% CI -0.84…0.41), whereas patients with active sJIA (n = 22) demonstrated a 3-fold decrease in hs-CRP level (median -0.94 mg/mL (95% CI -3.93…0.05). We observed no significant difference in calprotectin levels in the groups. Concentration of hs-CRP above the UL 4 weeks after vaccination was detected in 2 out of 53 sJIA patients in remission (4%) and none of the patients with active sJIA. Сoncentration of calprotectin above the UL 4 weeks after vaccination was detected in 8 out 53 (15%) and 5 out 25 (20%) sJIA patients in remission and with active disease, respectively. Conclusion. Vaccination against pneumococcal infection in patients with sJIA led to an increase in the level of highly sensitive laboratory markers of sJIA activity in 4–20% of patients. Key words: disease activity, safety, high-sensitivity C-reactive protein, biological drugs, calprotectin, juvenile idiopathic arthritis, pneumococcal 13-valent conjugate vaccine

International practice of immunization against pneumococcus in patients with systemic juvenile idiopathic arthritis (SJIA) receiving biological therapy is generalized in this review. High efficiency and safety of pneumococcal vaccines in children with SJIA is presented. Numerous researches show the adequate immune response after vaccination as well as alongside with genetically engineered biologic drugs therapy. Prevention of pneumococcal disease in patients with SJIA reduces the risk of development of pneumococcal diseases severe complications.

Background. Vaccination coverage in patients with rheumatic diseases remains extremely low. Moreover, infections are the leading cause of death in such patients. Respiratory infections mortality is 2–5 times higher in adults with rheumatoid arthritis than in overall population. The most frequent infectious complications in patients receiving Tocilizumab (first-line drug for treatment of patients with systemic juvenile idiopathic arthritis (SJIA)) are pneumonia and acute sinusitis. Their clinical course differs: slight clinical presentation, reference ranges of laboratory tests of disease activity (ESR, C-reactive protein), significant changes in lungs and paranasal sinuses according to the computer tomography. Infectious complications development can cause aggravation of prior disease itself or due to temporary immunosuppressive therapy cessation. Clinical Case Description. The experience of immunization with 13-valent pneumococcal conjugate vaccine (PCV13) and haemophilus influenzae-tetanus toxoid conjugate vaccine in the 1,5 years old boy with SJIA receiving interleukin-6 receptor monoclonal antibody Tocilizumab is presented. The result of such vaccination was increase of pneumococcal and haemophilus influenzae antibodies levels by more than two times. Meanwhile vaccination had no negative impact on the prior disease course: the levels of predictors of prior disease aggravation such as protein S100 and highly sensitive C-reactive protein did not increase significantly in comparison with the period before vaccination. Conclusion. The efficiency and safety of immunization with PCV13 and haemophilus influenzae-tetanus toxoid conjugate vaccine in the child with SJIA receiving Tocilizumab is presented.

Introduction. The only effective method of controlling rotavirus infection is vaccination, which has been mandatory in the Moscow Vaccination Schedule since 2014 and in the Epidemic Vaccinations Schedule. To evaluate the efficacy and safety of pentavalent vaccine immunization for the prevention of rotavirus infection in healthy children and children with chronic diseases there were comprehensively examined 182 children, including 83 healthy and 99 cases with problems of health. Vaccination was performed at the age of 6-32 weeks. All adverse events occurred within 42 days after vaccine administration were recorded. There was analyzed the incidence of intestinal infections within the next year since the moment of the first vaccination. There were no revealed any statistically significant differences in the frequency of adverse events between the group of healthy children and the group of cases with different chronic diseases. The most common post-vaccination adverse effects were diarrhea and subfebrile and febrile temperature. During a year follow-up period, a group of patients (n=9) did not have any symptoms of the disease after contacting patients with cases with acute intestinal infections. Conclusion The study shows the safety of rotavirus infection immunization in healthy children and children with chronic diseases. Rotavirus infection vaccination is effective in patients who have had contact with persons suffering from acute intestinal infections. Vaccination against rotavirus infection should be recommended not only for healthy infants but for those with chronic diseases also.

Prevention of exacerbations of bronchopulmonary dysplasia (BPD) directly affects the outcome of the disease and belongs to the priority areas of pulmonology of early childhood age. Seasonal immunoprophylaxis of the severe course of respiratory syncytial viral infection (RSVI) with palivizumab and vaccine prophylaxis of pneumococcal and hemophilic infections in children who have formed BPD has been established to allow to reduce the frequency of hospitalization, resuscitation and death. The authors present their own data on results of passive and active immunization of BPD children against pathogens of the respiratory spectrum.

Background. The problem of distrust of immunization is widespread not only in Russia but also all over the world. Many parents refuse to vaccinate their child reasoning that the vaccines can harm their health, the immune system may not cope with the body burden; and some doctors themselves discourage parents from vaccination. Our aim was to assess the attitude of doctors and parents towards vaccination whose children are vaccinated completely or partially; to study the most frequent reasons for refusals of vaccination by parents. Methods. We used the questionnaires for parents (n = 114) who brought their children for vaccination for the first time or repeatedly; and the questionnaires for students of 4–6 courses and interns of medical universities (n = 336) who expressed their sentiments towards vaccination and demonstrated the knowledge of the national and regional immunization schedules. AstonGroup also conducted studies among physicians of different specialties (n = 307) on the most frequent reasons for refusals of vaccination. Results. In most cases, the parents’ attitude towards vaccination was positive. One in three patient representatives considered that he was fully acquainted with immunization issues, and more than half wanted to be vaccinated only within the national immunization schedule. In almost 100% of cases, parents had trust in information about vaccination received from a doctor. The results of the AstonGroup survey showed that the most frequent medical exemptions were given by neurologists, immunologists, and surgeons. And the parents themselves, who brought their children to see doctors, reasoned their refusals of vaccination with fear of complications and also considered vaccination to be harmful and useless. The doctors participating in the survey offered methods for influencing the parents, namely: providing them with accessible information about vaccinations included in the national immunization schedule as well as about the experience of using vaccines, including other countries. Discussion. The survey revealed insufficient knowledge of the national immunization schedule among students as well as cautious attitude towards vaccination issues and the trust in vaccination myths among legally authorized representatives of patients. Conclusion. The effective measures to combat ‘anti-vaccination scepticism’ are lectures for parents; personal, social and health education at pediatric sites as well as continuing medical education.

Background. Patients with juvenile idiopathic arthritis (JIA) have an increased risk of being infected. Approximately half of all serious infections in children with JIA are associated with airway involvement.Objective. Our aim was to study the efficacy and safety of the pneumococcal 13-valent conjugate vaccine (PCV) in children with JIA.Methods. In a prospective cohort study, 5 groups were formed: children with JIA in the remission phase on methotrexate therapy (group 1) or etanercept (group 2), with JIA in the active phase prior to the appointment of methotrexate (group 3) or etanercept (group 4), control group (conditionally healthy children). 0.5 ml of the 13-valent PCV was administered once subcutaneously during therapy in patients in the remission phase or 3 weeks before the appointment of methotrexate or etanercept in patients in the active phase. The main study outcome was the proportion of patients with a protective ( 40 mg/L) level of specific anti-pneumococcal antibodies (anti-SPP) IgG to Streptococcus pneumoniae 4 weeks after vaccination. In addition, we assessed the incidence of infectious events before and after vaccination as well as changes in the content of a high-sensitivity C-reactive protein, S100 protein, and post-vaccination period.Results. The study included 125 children. Four weeks after vaccination, the protective level of anti-SPP IgG was established in 21 (84%) patients in the 1st, 23 (92%) in the 2nd, 22 (88%) in the 3rd, 24 (96%) in the 4th and 5th groups (p =1.0). Increase in the concentration of S100 protein and high-sensitivity C-reactive protein after vaccination was not noted. JIA exacerbation episodes were not recorded in any patient. After immunization, the total number of infectious events decreased in all observed groups (p 0.001). Serious adverse events were not registered during the study.Conclusion. Vaccination with the 13-valent PCV in children with JIA is highly effective and is not accompanied by the development of serious adverse events.

Background. The primary serological status of children with bronchopulmonary dysplasia (BPD) with respect to respiratory significant pathogens remains unstudied. Wherein, the efficacy of vaccination of children with BPD against Streptococcus pneumoniae and Haemophilus influenzae type b (Hib) has been studied in a small number of studies which results are contradictory.Objective. Our aim was to study the pre-vaccinal serological status with regard to S. pneumoniae and Hib and the immunological efficacy of vaccination against these infections in children with BPD.Methods. The study included children with BPD without exacerbation. The immunological efficacy of conjugate vaccines — pneumococcal 13-valent and against Haemophilus influenza type b — was assessed by the level of IgG against S. pneumoniae and Hib using the ELISA method. The level of antibodies was determined before vaccination and 1 or 3–6 months afterwards.Results. The study included 32 children with BPD, mean age at the time of determining primary serological status was 13.3±1.3 months, at the time of vaccination — 15.2±1.5 months. The mean gestational age was 28.7±0.8 weeks, the body weight at birth was 1225±180 g. Before vaccination, all children with BPD had no protective antibody titre against S. pneumoniae and Hib averaging 0.2±0.034 and 0.13±0.0106 mg/L, respectively. One month after vaccination, the level of antibodies to S. pneumoniae reached 12.9±2.34 mg/L to Hib — 3.34±0.769 mg/L.Conclusion. After immunization with a pneumococcal 13-valent conjugate vaccine and a conjugate vaccine against Haemophilus influenzae type b, the concentration of IgG against S. pneumoniae exceeded the protective level in all examined patients (100%), the concentration to Hib — in 29 (90.6%).

Background. After inclusion of pneumococcal vaccination in the National Vaccination Schedule, it is very important to evaluate the efficacy of routine immunisation of the child population for more than 3 years. The obtained results provide opportunity to analyse the problems in achieving the goal, determine their causes, and suggest the ways of overcoming. Our aim was to study the results of a three-year period of pneumococcal vaccination of children. Methods. The quality of immunoprophylaxis of pneumococcal infection in the territory of the Russian Federation were assessed by analysing the coverage of vaccination and timeliness of its conduct after the inclusion of pneumococcal vaccine in the National Vaccination Schedule. The actual epidemiological efficacy of pneumococcal vaccination was assessed based on morbidity and mortality due to community-acquired pneumonia, incidence of acute otitis media among children. By questioning parents (n = 352) who applied to the Federal State Autonomous Institution of the Russian Federation Ministry of Health ‘National Medical Research Centre for Children’s Health, the timeliness of pneumococcal vaccination for infants was established. Results. In most regions, a high level of pneumococcal vaccination coverage was reached (87% of children). Despite the fact that the majority of children (73%) were vaccinated untimely. In particular, the results of a questionnaire survey conducted in the Moscow vaccination centre indicate insufficient awareness of parents for the need to vaccinate infants against pneumococcal infection by primary care professionals and, as a consequence, a low level of timely initiated vaccine introduction (40.1%). The introduction of routine prophylactic pneumococcal vaccination in Russia resulted in a 35% reduction in the death rate of children from community-acquired pneumonia, led to a decrease in the incidence of acute otitis media. Conclusion. The introduction of routine prophylactic vaccination of children against Streptococcus pneumoniae helps to reduce morbidity and mortality from pneumococcal infections. The surveillance system for community-acquired pneumonia requires further improvement. It is advisable to conduct an additional analysis on the reasons for refusals and medical exemptions to vaccination. It is important to increase the professional level of paediatricians in prophylactic vaccination.

Background. Infections are the main cause of death for patients with autoimmune rheumatic diseases. In adult patients with rheumatoid arthritis (RA), mortality caused by respiratory infections is 2–5 times higher than in the population. One of the frequent infectious complications in the course of treatment with tocilizumab, the first-choice drug for treating systemic juvenile idiopathic arthritis (sJIA), is pneumonia characterized by a poor clinical picture, normal values of laboratory indices of the disease activity (ESR, C-reactive protein) with pronounced changes in the lungs revealed by computed tomography. In case of acute respiratory infection in children with systemic JIA, immunosuppressants and genetically engineered biological preparations (GEBP) are discontinued. This often leads to an exacerbation of the underlying disease and the progression of a pathological process. At present, vaccination against pneumococcal infection in Russia is not included in the standard for managing patients with rheumatic diseases. Studies of the safety and efficacy of vaccination with 13-valent pneumococcal conjugate vaccine (PCV) in patients with sJIA receiving genetically engineered biological preparations were not conducted. Clinical Case Description. The article shares the experience of vaccination of a girl aged 9 years with a 13-valent PCV that was conducted in the course of a scientific investigation, which studied the efficacy and safety of vaccination of children with systemic JIA prior to prescription of GEBP tocilizumab. Vaccination did not cause a deterioration in the course of the main disease (1 month), led to a reduction in the incidence of acute respiratory infections (from 4 to 1 time within 6 months before and after vaccination), and discontinuation of antibacterial drugs within 6 months after vaccination. Conclusion. The safety of a 13-valent PCV in a child with sJIA and a decrease of the incidence of respiratory diseases after vaccination, their complications, and the use of antibacterial drugs have been shown.

Background Juvenile Idiopathic Arthritis (JIA) is the most common rheumatologic disease in children, which development is influenced by the occurred infection along with the genetic factors. Vaccination of the patients with JIA should be considered an important measure to prevent comorbid infections, which influences the progression and outcomes of the rheumatologic disease. Objective to study vaccination status in patients with JIA. Materials and methods A cross-sectional retrospective study of 44 children aged 1,5–13 years with the confirmed JIA was conducted. Anamnesis was obtained via parents’ interviews. Personal medical documentation was analysed. Results It was observed that only 27% of patients with JIA were vaccinated according to the National Immunisation Program (NIP). Every 4th child (23% patients) was not vaccinated against main vaccine preventable diseases. Moreover, only 5% of children had vaccination against flu. One unvaccinated child had a manifestation of JIA soon after having measles infection. Before the onset of the autoimmune disease, 56% of children did not follow the NIP and 44% had their vaccination postponed due to the existing rheumatologic condition. Only non-significant number of mothers (9%) connect the manifestation of rheumatologic disease with the conducted vaccination. Moreover, the anamnestic data about the post-vaccination reactions were collected: 88% of children, vaccinated with live vaccines against measles, rubella, epidemic parotitis and polio had no post-vaccination reactions, whereas in 12% of cases a moderate short-lasting joint swelling was observed. Every second vaccination (48%) with an inactivated vaccine caused local or general mild and moderate adverse reactions. Conclusion The prevalent number of patients with JIA needs correction of the vaccination schedule.

The article presents the experience of vaccination with a pneumococcal 13-valent conjugate vaccine (PCV13) of a patient aged 5 years with oligoarticular juvenile idiopathic arthritis (JIA) receiving methotrexate at a dose of 15 mg/m2 per week subcutaneously. Treatment with methotrexate provided a remission of JIA, but was accompanied by frequent respiratory infections — up to 8 times a year. During infection progression, methotrexate injections were omitted. Gaps in the treatment with methotrexate were accompanied by an exacerbation of the underlying condition. Vaccination of the patient with PCV13 reduced the frequency of respiratory infections to 2 times a year, which was accompanied by the development of persistent remission of the disease. Adverse events and exacerbation of JIA in a child after vaccination with PCV13 were not registered.

Background. Pertussis is a highly contagious bacterial infection of airborne transmission type that still remains a serious problem in Russia and around the world. The only reliable means of specific prophylaxis of pertussis is vaccination. In Russia, only one revaccination from pertussis is provided at the age of one and a half years, which is done with whole-cell DTP vaccine, which is not used with children older than 4 years due to high reactogenicity. Imported acellular DTP vaccines are an alternative to whole-cell vaccines licensed for use with older children. Objective: Our aim was to study children’s tolerability of the vaccine containing acellular pertussis component. Methods. The safety of acellular DTP vaccines (DTaP, DTaP/IPV/Hib) has been analyzed in a retrospective study with children older than 4 years at the department of vaccinal prevention of Scientific Center of Children’s Health (Moscow) in the period from December 2014 to December 2015.Results. The results of 123 vaccinated children aged 4 to 9 have been studies. Among them, healthy children — 62, those having allergic disease — 30, those with other chronic diseases — 31. In the post-vaccination period (3–7 days), local reactions (weak and/or strong) were recorded with 19 (31%) healthy children, 11 (37%) with children having allergic diseases, 9 (29%) with children having other chronic diseases. General reactions to vaccination (weak and/or strong) occurred with 11 (18%), 6 (20%), and 8 (26%) children respectively. Conclusion. The compared groups did not differ in frequency of post-vaccination reactions and their intensity, with the exception of strong local reactions that occurred more frequently with children having allergic diseases.

Background Pertussis is a highly contagious bacterial infection with a respiratory route of transmission. It remains an important public health problem in Russia and in the world. The only confirmed way of specific prevention of pertussis is vaccination. There is only one booster dose against pertussis at the age of 18 months with DTwP in Russia. This vaccine is not administered in children after 4 years of age due to its reactogenicity. The alternative way to the whole cell pertussis vaccination is the administration of DTaP, which can be used in older children. Aims to study tolerability of vaccines containing acellular pertussis after 4 years of age. Methods The retrospective study included the analysis of safety of DTaP vaccines in 123 children aged 4–9 years from 01.12.2014 to 31.12.2015. It included 62 healthy children, 30 with allergic diseases and 31 with other chronic diseases. Results In the post-vaccination period (3 days after the vaccination) local reactions were observed in 39 (32%) subjects, where 19 (31%) were healthy children, 11 (37%) – with allergic disease, 9 (29%) – with other pathology. Moreover, severe local reactions in the injection site occurred in 15% of subjects. Half of these children had different allergic diseases. Common reactions were observed in 25 (20%) children, where 11 (18%) were healthy, 6 (20%) – with allergic pathology and 8 (26%) children with other chronic diseases. Only 7% of the common reactions were considered severe. During the first week after the vaccination, no exacerbations of allergy or any other chronic diseases were observed. Conclusion A good tolerability of DTaP was demonstrated in children after 4 years of age in both healthy subjects and those having different chronic diseases. Apart from the children with allergic pathology who had severe local reactions more frequently, these two groups had no difference in the prevalence and severity of post-vaccination adverse reactions.

Meningococcal infection is an acute disease caused by Neisseria meningitidis, which proceeds with a diverse clinical aspect from nasopharyngitis to meningococcal meningitis and meningococcemia. Since 2014, a tetravalent meningococcal conjugate vaccine has been registered in Russia. This vaccine creates protection against serogroups A, C, W-135, Y and can be used from the age of nine months to 55 years. The actual issue is a vaccine tolerability, including when combined with other vaccine preparations.Objective: Our aim was to evaluate the safety of a tetravalent meningococcal conjugate vaccine against serogroups A, C, Y and W-135 when it is combined with other vaccine preparations.Methods. A prospective full-design study assessed the tolerability of immunization with a meningococcal conjugate vaccine, both in case of monovaccination and in combination with a pneumococcal 13-valent conjugate vaccine, measles-mumps-rubella, viral hepatitis A, influenza, and chicken pox vaccines.Results. 97 children aged from 9 months to 18 years were vaccinated, 20 of them were healthy and 77 had medical issues (with allergic pathology, ENT diseases, cardiovascular and nervous system diseases, lung diseases as well as orphan diseases). Among vaccinated children, general reactions were observed in 3/97 (3.1%) children, local reactions — in 5 (5.2%). The post-vaccination period passed asymptomatically and uneventfully in the prevailing majority of children vaccinated with a tetravalent meningococcal conjugate vaccine (in 91, 93.8%).Conclusion. The immunization with a tetravalent meningococcal conjugate vaccine against serogroups A, C, Y, W-135 is well tolerated, both in case of monovaccination and in combination with other vaccine preparations, in healthy children of different age groups and in patients with different health status.

The article presents the experience of vaccination with a pneumococcal 13-valent conjugate vaccine (PCV13) of a patient aged 5 years with oligoarticular juvenile idiopathic arthritis (JIA) receiving methotrexate at a dose of 15 mg/m2 per week subcutaneously. Treatment with methotrexate provided a remission of JIA, but was accompanied by frequent respiratory infections — up to 8 times a year. During infection progression, methotrexate injections were omitted. Gaps in the treatment with methotrexate were accompanied by an exacerbation of the underlying condition. Vaccination of the patient with PCV13 reduced the frequency of respiratory infections to 2 times a year, which was accompanied by the development of persistent remission of the disease. Adverse events and exacerbation of JIA in a child after vaccination with PCV13 were not registered.