CHIEF STATE SANITARY DOCTOR OF THE RUSSIAN FEDERATION

RESOLUTION

On the approval of the sanitary and epidemiological rules of SP 3.1.3542-18 "Prevention of meningococcal infection"

In accordance with the Federal Law of 30.03.1999 N 52-FZ "On the sanitary and epidemiological well-being of the population" (Collected Legislation of the Russian Federation, 1999, N 14, Article 1650; 2002, N 1, (Part I), Article 2 ; 2003, No. 2, article 167; No. 27 (part I), article 2700; 2004, No. 35, article 3607; 2005, No. 19, article 1752; 2006, No. 1, article 10; No. 52 (part I), article 5498; 2007, No. 1 (part I), article 21; No. 1 (part I), article 29; No. 27, article 3213; No. 46, article 5554 ; N 49, Art. 6070; 2008, N 29 (Part I), Art. 3418; N 30 (Part II), Art. 3616; 2009, N 1, Art. 17; 2010, N 40, Art. 4969; 2011, No. 1, article 6; No. 30 (part I), article 4563, article 4590, article 4591, article 4596; No. 50, article 7359; 2012, No. 24, article 3069 ; No. 26, Article 3446; 2013, No. 27, Article 3477; No. 30 (part I), Article 4079; No. 48, Article 6165; 2014, No. 26 (part I), Article 3366, Article 3377; 2015, No. 1 (part I), Article 11; No. 27, Article 3951, No. 29 (part I), Article 4339; No. 29 (Part I), Article 4359; No. 48 (part I), art. 6724; 2016, N 27 (part I), art. 4160; N 27 (part II), art. 4238; 2017, N 27, art. 3932; N 27, art. 3938; No. 31 (part I), article 4765; No. 31 (part I), article 4770; 2018, No. 17, article 2430; No. 18, article 2571; No. 30, article 4543; N 32 ( Part II), Article 5135) and the Decree of the Government of the Russian Federation of July 24, 2000 N 554 "On approval of the Regulations on the State Sanitary and Epidemiological Service of the Russian Federation and the Regulations on State Sanitary and Epidemiological Standards" (Collected Legislation of the Russian Federation, 2000, N 31, article 3295; 2004, No. 8, art. 663; 47, Article 4666; 2005, N 39, Art. 3953)

i decree:

1. To approve the sanitary and epidemiological rules of SP 3.1.3542-18 "Prevention of meningococcal infection" (Appendix).

2. To recognize as invalid the sanitary and epidemiological rules of SP 3.1.2.2512-09 "Prevention of meningococcal infection", approved by the decree of the Chief State Sanitary Doctor of the Russian Federation of 05/18/2009 N 33 (registered by the Ministry of Justice of Russia on 06/29/2009, registration number 14148).

3. To establish the validity period of the sanitary and epidemiological rules of the joint venture 3.1.3542-18 "Prevention of meningococcal infection" until 15.12.2028.

A.Yu. Popova

Registered

at the Ministry of Justice

Russian Federation

registration N 53254

Application. Sanitary and Epidemiological Rules SP 3.1.3542-18. Prevention of meningococcal infection

application

APPROVED BY
by the Chief
state sanitary doctor
Russian Federation
dated December 20, 2018 N 52

Sanitary and Epidemiological Rules
SP 3.1.3542-18

I. Scope

1.1. These sanitary and epidemiological rules (hereinafter referred to as the Sanitary Rules) establish mandatory requirements for sanitary and anti-epidemic (preventive) measures taken to prevent the occurrence and spread of diseases of meningococcal infection.

1.2. Compliance with sanitary rules is mandatory for citizens, individual entrepreneurs and legal entities.

1.3. Control over the implementation of the Sanitary Rules by the bodies authorized to carry out federal state sanitary and epidemiological supervision, in accordance with the legislation of the Russian Federation.
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II. General Provisions

2.1. Meningococcal infection is an acute infectious disease, anthroponosis, with an aerosol transmission mechanism, characterized by various forms of the infectious process: from the local form (nasopharyngitis) to generalized forms (hereinafter referred to as GFMI) in the form of general intoxication (meningococccemia) and lesions of the pia mater of the brain with the development of meningitis, as well as the asymptomatic form (carrier of bacteria).
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Code A39 - meningococcal infection according to the International Classification of Diseases ICD-10.

2.2. The causative agent of meningococcal infection - meningococcus (Neisseria meningitidis) is unstable to various environmental factors: at a temperature of + 50 ° С it dies after 5 minutes, at + 100 ° С - after 30 seconds; at temperatures below + 22 ° C, as well as when dried, meningococcus dies within a few hours. The average survival rate on environmental objects is 7.5-8.5 hours at a microbial load density of 10 per 1 cm. Disinfectants have a bactericidal effect on meningococcus (dies instantly).
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Unified sanitary and epidemiological and hygienic requirements for products (goods) subject to sanitary and epidemiological supervision (control), approved by the Decision of the Customs Union Commission dated May 28, 2010 N 299 "On the application of sanitary measures in the Eurasian Economic Union" (official website of the Customs Union Commission http : //www.tsouz.ru/, 28.06.2010) as amended by the decisions of the Customs Union Commission dated 17.08.2010 N 341 (official website of the Customs Union Commission http://www.tsouz.ru/, 23.08.2010), from 18.11.2010 N 456 (official website of the Customs Union Commission http://www.tsouz.ru/, 22.11.2010), dated 02.03.2011 N 571 (official website of the Commission of the Customs Union http://www.tsouz.ru/ , 09.03.2011), dated 07.04.2011 N 622 (official website of the Commission of the Customs Union http://www.tsouz.ru/, 26.04.2011), dated 18.10.2011 N 829 (official website of the Commission of the Customs Union http: // www.tsouz.ru/, 21.10.2011), dated 09.12.2011 N 889 (official website of the Customs Union Commission http: //www.t souz.ru/, 15.12.2011), decisions of the Board of the Eurasian Economic Commission dated 04.19.2012 N 34 (official website of the Customs Union Commission http://www.tsouz.ru/, 29.04.2012), dated 16.08.2012 N 125 ( the official website of the Eurasian Economic Commission http://www.tsouz.ru/, 16.08.2012), dated 06.11.2012 N 208 (the official website of the Eurasian Economic Commission http://www.tsouz.ru/, 07.11.2012), dated 15.01.2013 N 6 (official website of the Eurasian Economic Commission http://www.tsouz.ru/, 18.01.2013), dated 10.11.2015 N 149 (official website of the Eurasian Economic Union http://www.eaeunion.org/, 16.11.2015), dated 23.01.2018 N 12 (official website of the Eurasian Economic Union http://www.eaeunion.org/, 26.01.2018), dated 10.05.2018 N 76 (official website of the Eurasian Economic Union http: // www .eaeunion.org /, 05/14/2018).


Meningococcus, according to the structure of the polysaccharide capsule, is divided into 12 serogroups: A, B, C, X, Y, Z, W, E, K, H, L, I.

2.3. Meningococcal infection is characterized by periodicity. Periodic increases in morbidity occur on average after long interepidemic periods from 10 to 30 years. Epidemics, simultaneously covering several dozen countries of the world, were caused by meningococcus serogroup A, and local epidemic rises within the borders of one country were caused by meningococcus serogroup B and C.

Sporadic incidence of the interepidemic period is formed by different serogroups, of which the main ones are A, B, C, W, Y, X.

The incidence rate of meningococcal infection in developed countries in modern conditions is 0.1-5.0 per 100 thousand population. In the Russian Federation, the incidence rate for the last decade (2006-2017) does not exceed 2 per 100 thousand of the population, and the average mortality rate is determined at 15%.

In the Russian Federation, the serogroup characteristics of meningococcal strains isolated from persons diagnosed with HFMI is represented mainly by serogroups A, B, C in equal proportions, and an increase in the heterogeneity of the meningococcal population is noted, due to the growth of strains of rare serogroups (W, Y).

2.4. During an epidemic rise, in 86% -98% of foci there is one case of HFMI, in 2% -14% of foci - from 2 cases of HFMI or more. The lowest percentage of secondary (sequential) diseases of GFMI (2-3%) occurs in families, the highest (12% -14%) - in preschool educational institutions and in hostels.

With a sporadic level of morbidity in the foci, 1 case of HFMI is recorded (in exceptional cases - 2 cases of HFMI or more).

2.5. The source of meningococcal infection is an infected person.

The causative agent of meningococcal infection is transmitted from person to person by airborne droplets (within a radius of up to 1 m from the infected person). Infection with the causative agent of meningococcal infection is also possible through household items (for example, shared cups and spoons) while eating.

2.6. There are 3 groups of sources of meningococcal infection:

patients with GFMI (meningococcemia, meningitis, meningoencephalitis, mixed form);

patients with acute meningococcal nasopharyngitis;

meningococcal bacteria carriers - persons without clinical manifestations, which are detected only during bacteriological examination.

The carriage rate of meningococcus in the human population with active detection is on average 4-10%. The duration of meningococcal carriage is on average 2-3 weeks (in 2% -3% of individuals it can last up to 6 weeks or more).

2.7. Meningococcal infection is characterized by winter-spring seasonality. An increase in the incidence of meningococcal infection is noted during the formation of teams of educational organizations (preschool, general education, vocational, higher education), including after summer holidays, of teams of persons called up for military service.

2.8. The risk groups for infection and meningococcal disease are:

persons subject to conscription for military service;

people traveling to areas endemic for meningococcal infection (for example, pilgrims, military personnel, tourists, athletes, geologists, biologists);

medical workers of structural divisions providing specialized medical care in the "infectious diseases" profile;

medical workers and laboratory staff working with the living culture of meningococcus;

inmates and staff of inpatient social service institutions with round-the-clock stay (children's homes, orphanages, boarding schools);

persons living in hostels;

persons taking part in massive international sports and cultural events;

children under 5 years of age inclusive (due to the high incidence in this age group);

adolescents aged 13-17 years (due to the increased level of carriage of the pathogen in this age group);

persons over 60 years old;

persons with primary and secondary immunodeficiency conditions, including HIV-infected;

persons who have undergone cochlear implantation;

persons with liquorrhea.

2.9. The incubation period for meningococcal infection is from 1 to 10 days, on average up to 4 days.

III. Identification, registration and registration of patients with GFMI, persons with suspected of this disease, patients with acute nasopharyngitis

3.2. The identification of patients with GFMI, as well as persons with suspected GFMI, should be carried out when providing the population with medical care on an outpatient and inpatient basis (including in a day hospital), including the provision of medical care in educational and health-improving organizations, as well as outside medical organizations.

3.3. Medical workers are obliged to inform about each case of GFMI disease, as well as if they suspect GFMI, by phone within 2 hours, and then within 12 hours send an emergency notification to the territorial body (organization) of the federal executive body authorized to implement the federal state sanitary -epidemiological surveillance, at the place of detection of the patient (regardless of the place of residence and temporary stay of the patient). Transmission of messages and emergency notifications can be carried out using electronic means of communication and specialized information systems.

3.4. A medical organization that has changed or clarified the diagnosis of GFMI, within 12 hours, submits a new emergency notification to the territorial body (organization) of the federal executive body authorized to carry out federal state sanitary and epidemiological surveillance at the place of detection of the patient, indicating the initial diagnosis, modified (updated) diagnosis and date of establishment of the specified diagnosis.

3.5. Each case of GFMI is subject to registration and accounting in the register of infectious diseases at the place of their detection, as well as in the territorial bodies (organizations) of the federal executive body authorized to exercise federal state sanitary and epidemiological supervision.
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3.6. The identification of patients with acute nasopharyngitis is carried out in the focus for the purpose of treatment. Patients with acute nasopharyngitis in the focus of the GFMI are not subject to registration and accounting.

3.7. Responsible for the completeness, reliability and timeliness of registration of diseases of the State Medical Institute, as well as prompt and complete reporting about it to the territorial body (organization) of the federal executive body authorized to carry out federal state sanitary and epidemiological supervision, are individual entrepreneurs engaged in medical activities, heads of medical , health, educational and other organizations that identified the patient.
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SP 3.1 / 3.2.3146-13 dated 16.12.2013 N 65.

3.8. Information on the registration of cases of GFMI on the basis of final diagnoses is entered into the forms of federal state statistical observation in accordance with sanitary and epidemiological requirements.
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SP 3.1 / 3.2.3146-13 dated 16.12.2013 N 65.

3.9. In the territorial bodies (organizations) of the federal executive body authorized to carry out federal state sanitary and epidemiological surveillance, the available data on registered cases of GFMI are analyzed by specialists as part of the epidemiological surveillance of meningococcal infection in order to draw up an epidemiological forecast and increase the effectiveness of preventive and anti-epidemic measures.

IV. Laboratory diagnostics of GFMI

4.1. For laboratory diagnostics of GFMI, bacteriological, molecular genetic and serological research methods are used. The priority is the use of cerebrospinal fluid (hereinafter - CSF) and blood as biological material.

4.2. The collection, transportation and delivery time to the laboratory for the study of clinical material are carried out taking into account the conditions that ensure the preservation of the pathogen unstable to environmental factors in the clinical material.

4.3. Bacteriological examination is an obligatory stage of laboratory diagnostics of GFMI and consists in obtaining a culture of the causative agent of meningococcal infection, its identification to the species, determination of the serogroup by identifying the group-specific antigen (capsular polysaccharide) and sensitivity to antibacterial drugs.

4.4. The most important component of laboratory diagnostics of HFMI is the use of an express method (latex agglutination reaction) to detect a specific antigen directly in the CSF and (or) blood in patients with a clinical diagnosis of HFMI or suspected HFMI. The positive result of the express method allows in the shortest possible time (15-20 minutes) to establish the presence in the material of the causative agent of meningococcal infection and its serogroup.

4.5. Molecular genetic research to identify specific fragments of meningococcal DNA in clinical material (for example, cerebrospinal fluid) is carried out by laboratories equipped for this type of research. Test systems registered in the Russian Federation are used.
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Resolution of the Government of the Russian Federation of December 27, 2012 N 1416 "On Approval of the Rules for State Registration of Medical Devices" (Collected Legislation of the Russian Federation, 2013, N 1, Article 14; 2018, N 24, Article 3523) (hereinafter referred to as the Resolution of the Government of the Russian Federation 2012 N 1416); Order of the Ministry of Health of Russia dated 06.06.2012 N 4n "On approval of the nomenclature classification of medical devices" (registered by the Ministry of Justice of Russia on 09.07.2012, registration number 24852), as amended by order of the Ministry of Health of Russia dated 25.09.2014 N 557n (registered by the Ministry of Justice of Russia on 17.12.2014 , registration number 35201) (hereinafter - order of the Ministry of Health of Russia dated 06.06.2012 N 4n).


In the complex diagnosis of the disease, the molecular genetic method is used to increase the efficiency of laboratory diagnostics. In case of a negative result of the bacteriological method and the express method, a positive result of a molecular genetic study is taken into account only if there are clinical signs of HFMI.

4.6. Serological research method for detecting specific antibodies in blood serum to meningococcal polysaccharides of various serogroups (direct hemagglutination reaction (hereinafter - RPHA) is carried out using diagnostic kits registered in the Russian Federation.
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Decree of the Government of the Russian Federation of December 27, 2012 N 1416; order of the Ministry of Health of Russia dated 06.06.2012 N 4n.


RPHA is a retrospective adjunct method to increase the percentage of laboratory confirmation by GFMI.

4.7. The laboratory criteria for confirming the clinical diagnosis of a HFMI case are:

detection in clinical material (cerebrospinal fluid, blood) of diplococci with characteristic morphological signs;

characteristic growth of culture only on highly nutritious media;

typical morphology of a Gram culture smear;

saccharolytic activity of culture in relation to glucose and maltose;

identification of the serogroup in the culture of meningococcus;

detection of specific antigens in the cerebrospinal fluid and (or) blood serum in the reaction of latex agglutination;

detection of an increase in the titer of specific antibodies 4 or more times within 10-12 days (paired sera method) in the RPHA;

identification of meningococcal DNA using polymerase chain reaction (PCR) in clinical material (cerebrospinal fluid, blood, autopsy material).

V. Activities in the outbreak of GFMI

5.1. After receiving an emergency notification in the case of GFMI or if GFMI is suspected, specialists of the territorial body of the federal executive body authorized to carry out federal state sanitary and epidemiological supervision, within 24 hours, conduct an epidemiological investigation with the definition of the outbreak boundaries (the circle of people who communicated with the patient), and organize the implementation of anti-epidemic and preventive measures in order to localize and eliminate the focus.

5.2. The circle of people who communicated with the patient who were at risk of infection include everyone who was within a radius of 1 meter from the patient with HFMI (for example, people living in the same apartment with the sick person, neighbors in the apartment or dorm room, students (pupils) and staff of the group, class , branch of the educational organization visited by the sick person (the list of such persons can be expanded based on the results of an epidemiological investigation).

In the outbreak of the GFMI, the doctor (paramedic) examines the persons who communicated with the patient in order to identify persons with signs of GFMI and acute nasopharyngitis.

5.3. When individuals with suspected GFMI are identified, the medical worker conducting the examination organizes their immediate hospitalization to a medical organization that provides specialized medical care in the "infectious diseases" profile.

The medical organization informs the territorial body of the federal executive body authorized to carry out federal state sanitary and epidemiological supervision, at the place where the patient is identified ( regardless of the patient's place of residence).

Identified persons with signs of acute nasopharyngitis are subject to hospitalization in a medical organization providing specialized medical care in the "infectious diseases" profile for treatment (according to clinical indications). It is allowed to treat them at home, provided that regular medical supervision is organized for them, as well as in the absence of preschool children and persons working in preschool educational organizations, institutions of inpatient social services with round-the-clock stay in the family or apartment (children's homes, orphanages, boarding schools) providing medical care to children on an outpatient and inpatient basis.

5.4. After hospitalization of a patient with GFMI or suspicion of GFMI, on the basis of an order of the territorial body of the federal executive body authorized to carry out federal state sanitary and epidemiological surveillance, quarantine is imposed in the outbreak for a period of 10 days. For the period of quarantine, a medical worker (doctor, paramedic, nurse) daily conducts medical observation of persons who communicated with a patient with GFMI, with thermometry, examination of the nasopharynx and skin. In preschool educational organizations, general educational organizations, inpatient social services with round-the-clock stay (children's homes, orphanages, boarding schools), in the organization of recreation and health improvement of children, it is not allowed to accept new and temporarily absent children at the time of detection of a sick person, transfer of staff and children from groups (class, department) to other groups (class, department).

5.5. For persons who have communicated with a patient with GFMI who do not have inflammatory changes in the nasopharynx, a medical worker (doctor, paramedic, nurse) conducts emergency chemoprophylaxis with one of the antibiotics, taking into account contraindications (Appendix to the Sanitary Rules). Refusal from chemoprophylaxis is made out by an entry in the medical documentation, signed by the person who refused chemoprophylaxis, by the parent or other legal representative of minors, and by the medical worker in accordance with the legislation of the Russian Federation.
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Order of the Ministry of Health of Russia of 20.12.2012 N 1177n "On approval of the procedure for giving informed voluntary consent to medical intervention and refusal of medical intervention in relation to certain types of medical interventions, forms of informed voluntary consent to medical intervention and forms of refusal to medical intervention" (registered by the Ministry of Justice of Russia 06/28/2013, registration number 28924), as amended by order of the Ministry of Health of Russia dated 08/10/2015 N 549n (registered by the Ministry of Justice of Russia 09/03/2015, registration number 38783).

5.6. In the outbreak, persons who have communicated with a patient with GFMI are given urgent specific prophylaxis with a topical vaccine (in accordance with the serogroup of meningococcus isolated from the cerebrospinal fluid and (or) blood of the patient with GFMI). In the absence of the possibility of determining the serogroup of meningococcus, emergency immunoprophylaxis is carried out without its establishment with multicomponent vaccines. Immunization of contact persons is carried out in accordance with the instructions for use of the vaccine. Chemoprophylaxis is not a contraindication for immunization.

5.7. During the period of an epidemic rise in the incidence of meningococcal infection in the foci of GFMI, emergency immunoprophylaxis is carried out without identifying the serogroup of the pathogen with multicomponent vaccines.

5.8. In preschool educational institutions, general educational organizations, in organizations with round-the-clock stay of children, including non-infectious medical organizations, organizations for recreation and health improvement of children, in professional educational organizations and educational institutions of higher education, medical supervision of persons who communicated with the patient, chemoprophylaxis and Immunoprophylaxis for persons in contact with the patient is provided by medical workers of these organizations. In the absence of medical workers in these organizations, these activities are provided (organized) by the heads (administration) of medical organizations on the territory of which the above organizations are located.

5.9. In the outbreak of GFMI, after hospitalization of a patient or suspected of GFMI, final disinfection is not carried out.

In the premises in which there are persons who are in contact with the patient, wet cleaning of the premises with the use of detergents is carried out twice a day; soft toys are excluded from everyday life, toys made of other materials are washed daily at the end of the day with hot water and detergent, airing is carried out (8-10 minutes at least four times a day).
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Sanitary and Epidemiological Rules SP 3.5.1378-03 "Sanitary and Epidemiological Requirements for the Organization and Implementation of Disinfection Activities", approved by the Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 09.06.2003 N 131 (registered by the Ministry of Justice of Russia on 19.06.2003, registration number 4757).


In order to reduce the risk of transmission of the causative agent of meningococcal infection in the sleeping quarters of preschool educational organizations, the number of beds must comply with sanitary and epidemiological requirements.
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Sanitary and Epidemiological Rules and Standards SanPiN 2.4.1.3049-13 "Sanitary and Epidemiological Requirements for the Design, Maintenance and Organization of the Mode of Operation of Preschool Educational Organizations", approved by the Resolution of the Chief State Sanitary Doctor of the Russian Federation dated 05.15.2013 N 26 (registered by the Ministry of Justice of Russia on 05.29. 2013, registration number 28564), as amended by the resolutions of the Chief State Sanitary Doctor of the Russian Federation dated 20.07.2015 N 28 (registered by the Ministry of Justice of Russia on 03.08.2015, registration number 38312); from 27.08.2015 N 41 (registered by the Ministry of Justice of Russia on 04.09.2015, registration number 38824); by the decision of the Supreme Court of the Russian Federation of 04.04.2014 N AKPI14-281 (Bulletin of the Supreme Court of the Russian Federation, 2015, N 1).

5.10. An extract from the hospital for convalescents of the State Medical Institute and acute nasopharyngitis and their admission to preschool educational organizations, general educational organizations, organizations with round-the-clock stay of children, organization of recreation and health improvement of children, to professional educational organizations and educational organizations of higher education are carried out after complete clinical recovery.

Vi. Organization of immunoprophylaxis of meningococcal infection in the interepidemic period and with the threat of an epidemic rise in the incidence of meningococcal infection

6.1. Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations for epidemic indications.
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"On immunization of infectious diseases" (Collected Legislation of the Russian Federation, 09.21.1998, N 38, Art.4736; 2018, N 11, Art.1591) (hereinafter - Federal Law of 09.17.1998 N 157-FZ); Order of the Ministry of Health of Russia dated 03.21.2014 N 125n "On the approval of the national calendar of preventive vaccinations and the calendar of preventive vaccinations for epidemic indications" (registered by the Ministry of Justice of Russia on 04.25.2014, registration number 32115), as amended by orders of the Ministry of Health of Russia dated 06.16.2016 N 370n (registered by the Ministry of Justice of Russia on July 4, 2016, registration number 42728), dated April 13, 2017 N 175n (registered by the Ministry of Justice of Russia on May 17, 2017, registration number 46745) (hereinafter - the order of the Ministry of Health of Russia dated March 21, 2014 N 125n).

6.2. Vaccination against meningococcal infection is carried out with vaccines approved in the territory of the Russian Federation in accordance with the instructions for their use. When carrying out vaccination, vaccines are used with the largest set of serogroups of the pathogen, which allows to ensure the maximum efficiency of immunization and the formation of population immunity.
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Federal Law of 17.09.1998 N 157-FZ; sanitary and epidemiological rules SP 3.3.2367-08 "Organization of immunoprophylaxis of infectious diseases", approved by the order of the Chief State Sanitary Doctor of the Russian Federation dated 04.06.2008 N 34 (registered by the Ministry of Justice of Russia on 25.06.2008, registration number 11881) (hereinafter - SP 3.3.2367 -08 dated 04.06.2008 N 34).

6.3. Vaccinations during the interepidemic period are routinely subject to persons from groups at high risk of infection in accordance with clause 2.8 of the Sanitary Rules, as well as for epidemic indications - persons who have been in contact with the patient in the outbreaks of the GFMI, in accordance with clauses 5.6-5.8 of the Sanitary Rules.

6.4. The harbingers of complications of the epidemiological situation are:

an increase in the incidence of GFMI by 2 times compared with the previous year;

an increase in the proportion of older children, adolescents and persons aged 18-25 years in the general age structure of cases by 2 times;

a pronounced (2 or more times) increase in cases of diseases in preschool educational, general educational organizations, among first-year students of professional educational organizations and educational institutions of higher education (for example, among visiting students living in hostels);

the appearance of foci with two or more cases of GFMI diseases;

a gradual change in the serogroup characteristics of meningococcal strains isolated from the cerebrospinal fluid and (or) blood of patients with HFMI and the formation of a landscape of meningococcal strains monoprofile in terms of serogroup characteristics, with a simultaneous increase in morbidity rates.

With the threat of an epidemic rise in the incidence (the appearance of harbingers of complications of the epidemiological situation), the following are additionally subject to vaccination in a planned manner:

children under 8 years old inclusive;

first-year students of professional educational organizations and educational institutions of higher education, first of all, in teams (groups), staffed by students from different regions of the country and foreign countries.

With the continued increase in the incidence of meningococcal infection, in order to strengthen population immunity, the following are additionally subject to vaccination in a planned manner:

students of general education organizations from grades 3 to 11;

adult population (when contacting medical organizations).

6.5. Vaccination against the threat of an epidemic rise in the incidence of meningococcal disease is carried out by decision of the Chief State Sanitary Doctor of the Russian Federation, chief state sanitary doctors of the constituent entities of the Russian Federation.
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Federal Law of 30.03.1999 N 52-FZ "On the sanitary and epidemiological welfare of the population"; Federal Law of 17.09.1998 N 157-FZ; order of the Ministry of Health of Russia dated 03.21.2014 N 125n.

6.6. Planning, organization, implementation, completeness of coverage with preventive vaccinations, reliability of accounting and timeliness of reporting on preventive vaccinations are provided by the heads (administration) of medical organizations.
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Federal Law of 17.09.1998 N 157-FZ; SP 3.3.2367-08 dated 04.06.2008 N 34.

Vii. Epidemiological surveillance of meningococcal infection

7.1. Epidemiological surveillance of meningococcal infection is organized and carried out by the bodies exercising federal state sanitary and epidemiological surveillance, in accordance with the legislation of the Russian Federation.
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and 50 of the Federal Law of 30.03.1999 N 52-FZ "On the sanitary and epidemiological welfare of the population."

7.2. Measures to ensure federal state sanitary and epidemiological surveillance include:

monitoring the epidemiological situation (morbidity, mortality, focus);

analysis of the morbidity structure (age and contingents of cases);

tracking the circulation of pathogens secreted from patients with HFMI, their serogroup affiliation;

control of the organization and implementation of preventive vaccinations;

assessment of the timeliness and effectiveness of preventive and anti-epidemic measures;

timely management decisions and morbidity forecasting.

VIII. Hygienic education and training of citizens on the prevention of meningococcal infection

8.1. Hygienic education of the population is one of the methods of prevention of meningococcal infection, including: providing the population with information about meningococcal infection, the main symptoms of the disease and preventive measures using the media, leaflets, posters, bulletins, individual interviews.

8.2. Measures for sanitary and educational work among the population on measures to prevent meningococcal infection, including vaccine prophylaxis, are carried out by bodies exercising federal state sanitary and epidemiological supervision, executive authorities in the field of health protection, medical organizations.

Application. Drugs recommended by the World Health Organization for chemoprophylaxis in foci of meningococcal infection

application
to the sanitary rules
SP 3.1.3542-18

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* Official website of the World Health Organization: http://www.who.int/wer.

	Drug name	Drug dosage
		Adults 600 mg every 12 hours for 2 days Children from 12 months, 10 mg / kg body weight every 12 hours for 2 days Children under one year old, 5 mg / kg every 12 hours for 2 days
	Ciprofloxacin ***	Persons over 18 years of age 500 mg 1 dose
		Adults 0.5 mg / kg 4 times a day for 4 days Children in the age dosage - 4 times a day for 4 days

Treatment of nasopharyngitis is carried out with drugs Rifampicin **, Ciprofloxacin ***, Ampicillin in accordance with the instructions for their use.
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** Not recommended for pregnant women.

*** Not recommended for persons under the age of 18, pregnant and lactating mothers.

Electronic text of the document

After receiving an emergency, the specialists of the territorial bodies of sanitary and epidemiological supervision within 24 hours conduct an epidemiological investigation to determine the boundaries of the outbreak, the circle of contact persons and organize anti-epidemic and preventive measures in order to localize and eliminate the outbreak.

After the patient is hospitalized, the contact persons are quarantined for a period of 10 days from the moment of separation from the patient. Anti-epidemic measures are limited to the circle of persons from the immediate environment of the patient. These include people who live in the same apartment with the sick person, and close friends, with whom they constantly communicate. The list of persons subject to quarantine can be expanded by the epidemiologist depending on the specific situation in the outbreak.

Final disinfection in the focus of meningococcal infection after hospitalization of the patient is not carried out. The premises are cleaned daily, with frequent ventilation, maximum decompaction in the sleeping quarters.

Medical supervision in the outbreak consists in daily thermometry, examination of the nasopharynx and skin. The identified patients with acute nasopharyngitis are subject to bacteriological examination.

Chemoprophylaxis

All persons without inflammatory changes in the nasopharynx undergo chemoprophylaxis with one of the antibiotics, taking into account contraindications. Refusal from chemoprophylaxis is made out by an entry in the medical documentation and signed by the responsible person and the medical worker.

Ciprofloxacin. For persons over 18 years of age, 750 mg orally once. Not recommended for persons under 18 years of age, pregnant women (safety and efficacy of use in women during pregnancy has not been established) and lactating mothers.

Rifampicin. Adults 600 mg every 12 hours for 2 days. Not recommended for pregnant women (contraindicated in the first trimester of pregnancy, in the second and third trimesters - only for strict indications, after comparing the intended benefits to the mother and the potential risk to the fetus).

Elimination of nasopharyngeal carriage of meningococci occurs in 85% of patients who received rifampicin, and 95% who received ciprofloxacin.

Reserve drug ceftriaxone (250 mg intramuscularly once) is more effective against group A meningococci than rifampicin. In addition, ceftriaxone can be used during pregnancy, since the expected effect of therapy outweighs the potential harm to the fetus.

Vaccine prophylaxis

Vaccines have been developed that protect against one (type A or type B), two (A + C), or four (A, C, Y, W-135) meningococcal serotypes. Vaccination provides protection 10-14 days after injection.

In Russia, routine vaccination against meningococcal infection is not carried out. Vaccinations are included in the National calendar of preventive vaccinations according to epidemiological indications (from 1 year of age, revaccination after 3 years) - emergency vaccination is used in the focus of meningococcal infection among contact persons.

In the United States, routine vaccinations are carried out for children aged 11-12; adolescents aged 15 years attending educational institutions; college students. In addition, the CDC recommends revaccination at 3 to 5-year intervals if there is a high risk (impaired spleen function, military recruits, travel to countries with a high risk of epidemic disease).

Document expired or canceled

Resolution of the Chief State Sanitary Doctor of the Russian Federation of 05/18/2009 N 33 "On the approval of sanitary and epidemiological rules SP 3.1.2.2512-09" (together with "SP 3.1.2.2512-09. Prevention of meningococcal infection. Sanitary and epidemiological ...

IV. Activities in the outbreak of generalized form

meningococcal infection in the interepidemic period

4.1. The interepidemic period is characterized by a sporadic incidence of generalized forms caused by various serogroups of meningococcus. The overwhelming number of foci (up to 100%) is limited to one case of the disease.

4.2. After receiving an emergency notification in the event of a generalized form of infection or suspicion of this disease, specialists of the territorial bodies of Rospotrebnadzor within 24 hours conduct an epidemiological investigation to determine the boundaries of the focus and the circle of people who communicated with the patient, and organize anti-epidemic and preventive measures in order to localize and eliminate the focus ...

4.3 Anti-epidemic measures in the outbreaks are aimed at eliminating possible secondary diseases and excluding the spread of infection beyond the outbreak. They are limited to the circle of persons from the immediate environment of the patient in a generalized form. These include relatives living in the same apartment with the sick person, close friends (with whom they constantly communicate), pupils and staff of the children's organization group, neighbors in the apartment and the dorm room.

The list of the circle of close contacts can be expanded by the epidemiologist, depending on the specific situation in the outbreak.

4.4. In the outbreak, after hospitalization of a patient with a generalized form or suspicion of it, quarantine is imposed for a period of 10 days. During the first 24 hours, the otolaryngologist examines the persons who communicated with the patient in order to identify patients with acute nasopharyngitis. The identified patients with acute nasopharyngitis are subject to bacteriological examination prior to the appointment of appropriate treatment. After bacteriological examination, persons with symptoms of acute nasopharyngitis are hospitalized in a hospital (according to clinical indications) or left at home for appropriate treatment in the absence of children under the age of 3 years in the immediate environment. All persons without inflammatory changes in the nasopharynx undergo chemoprophylaxis with one of the antibiotics (Appendix), taking into account contraindications. Refusal from chemoprophylaxis is made out by an entry in the medical documentation and signed by the responsible person and the medical worker.

4.5. For the period of quarantine, medical supervision is established for the outbreak with daily thermometry, examination of the nasopharynx and skin. It is not allowed to admit new and temporarily absent children to preschool organizations, children's homes, orphanages, schools, boarding schools, children's health organizations, transfer of personnel from groups (class, department) to other groups.

4.6. The appearance in the interepidemic period of foci with secondary diseases of generalized forms of meningococcal infection within one month is an alarming sign of a possible increase in the incidence. In such foci, with an established meningococcal serogroup that has formed a lesion, an emergency vaccination with a meningococcal vaccine is performed, which contains an antigen corresponding to the serogroup detected in patients.

Vaccination is carried out in accordance with the instructions for use of the vaccine.

Children over 1 - 2 years old, adolescents and adults are subject to vaccination:

In a children's preschool educational organization, a child's home, an orphanage, a school, a boarding school, a family, an apartment - all persons who communicated with the patient;

Persons who communicated with the patient in hostels, in the event of a disease in teams staffed by foreign citizens.

The presence in the vaccinated disease of nasopharyngitis without a temperature reaction is not a contraindication for vaccination.

Methodical instructions
on anti-epidemic measures for meningococcal infection

The source of meningococcal infection is a sick person or a carrier of bacteria, infection occurs by droplets (aerosol).

There are 3 groups of sources of infection:

1. Patients with generalized forms - GFMI (about 1% of the total number of infected persons).

2. Patients with acute meningococcal nasopharyngitis (10-20% of the total number of infected persons).

3. "Healthy" carriers - persons who excrete meningococci and do not have inflammatory changes in the nasopharynx.

The most dangerous source of infection is a patient with a generalized form - GMFI (meningitis, meningococcemia, meningoencephalitis, etc.) in the prodromal period, which lasts an average of 4-6 days.

A certain epidemiological significance belongs to patients with meningococcal nasopharyngitis, the duration of the infectious period is about two weeks.

A "healthy" host has a significantly lower infectivity. At the same time, the number of carriers is hundreds of times higher than the number of patients: the epidemic process in meningococcal infection is supported by a consistent state of carriage. The duration of meningococcal carriage is on average 2-3 weeks, in 2-3% of individuals, carriage can last for 6 or more weeks. There is some information about a longer carrier, especially in the presence of a chronic inflammatory condition of the nasopharynx.

The focus of meningococcal infection is characterized by the appearance in the family, child care center, school and other groups of a patient with GFMI. The border of the focus is determined by the epidemiologist in each case, all those who have communicated with the sick person are identified for a more complete diagnosis of patients with meningococcal nasopharyngitis and carriers.

In epidemiological practice, the foci are divided into two categories: with a small number of people communicating with each other and clearly delineated boundaries (family foci, foci in groups of children's groups, school classes) or foci where the determination of boundaries is difficult due to the significant number of people who are in close communication (students of various schools, employees of enterprises and institutions, etc.).

Overconsolidation, high humidity in the room, violation of the sanitary and hygienic regime contribute to the spread of infection and the emergence of group diseases of meningococcal infection. Outbreaks occur more frequently in organized groups of children and adolescents, as a rule, during the first weeks after their formation or during a seasonal increase in the incidence. At the same time, the greatest risk of infection is exposed to persons newly enrolled in collectives, especially those who arrived from other settlements.

Anti-epidemic measures in the focus of meningococcal infection

Cases of the generalized form of meningococcal infection (GFMI) are subject to mandatory registration and submission of emergency notification to the sanitary-epidemiological station: meningococcal (epidemic cerebrospinal) meningitis, meningococccemia (sepsis, without damage to the meninges) and their associated bacteriological forms, as well as their combined forms In the presence of group diseases of the GFMI with the number of 5 or more cases, an extraordinary report is submitted to the Ministry of Health of the Union republic in accordance with the established procedure.

Patients with a generalized form of meningococcal infection or, if it is suspected, are immediately hospitalized in specialized departments of infectious diseases hospitals, and in their absence - in boxes or semi-boxes.

Patients with bacteriologically confirmed meningococcal nasopharyngitis identified in the foci of infection, depending on the severity of the clinical course, are placed in infectious diseases hospitals or in special deployed hospitals. They can be isolated at home if there are no more preschool children and persons working in preschool institutions in the family or apartment, as well as subject to regular medical supervision and treatment.

Contact with a sick person left at home, children attending preschool institutions and persons working in these institutions are allowed into the team only after a medical examination and a single bacteriological examination with a negative result.

Discharge from the hospital for patients with GFMI and nasopharyngitis is made after complete clinical recovery, without bacteriological examination for meningococcal carriage.

Reconvalences of meningococcal infection are admitted to kindergartens, schools, boarding schools, sanatoriums and educational institutions after one negative result of bacteriological examination, carried out no earlier than 5 days after discharge from the hospital or recovery of the patient with nasopharyngitis at home.

Various prophylactic vaccinations for convalescents who have undergone a generalized form of meningococcal infection are carried out 6 months after recovery, for those who have had meningococcal nasopharyngitis - after 2 months, for carriers - 1 month after release from the pathogen.

After hospitalization of a patient, GFMI carry out the following measures:

the boundaries of the focus are determined, persons in contact with patients are identified, taking into account the duration and proximity of communication;

in kindergartens, children's homes, boarding schools, children's sanatoriums, schools (classes), quarantine is established for a period of 10 days from the moment of isolation of the last patient. During this period, it is prohibited to admit new and temporarily absent children, as well as transfers of children and staff from one group (class) to another;

all persons who communicated with the patient in a team, family (apartment) undergo a medical examination (in teams, it is mandatory with the participation of an otolaryngologist). Particular attention is paid to identifying individuals with chronic inflammation in the nasopharynx and individuals with unclear "allergic" skin rashes. In the presence of pathological changes in the nasopharynx, patients are isolated from the team, and contacts in the family (apartment) are not allowed into children's groups and schools until a diagnosis is made. Individuals with suspicious skin rashes are hospitalized to rule out meningococcemia.

In the outbreak, clinical observation is carried out with an examination of the nasopharynx, skin and daily thermometry for 10 days (quarantine period).

Children under 1 year of age who have communicated with patients with a generalized form of meningococcal infection are injected with normal immunoglobulin at a dose of 1.5 ml for prophylactic purposes, and 3.0 ml at the age of 2 to 7 years inclusive. The drug is administered intramuscularly, once, no later than the seventh day after the registration of the first case of the disease.

Bacteriological examination is carried out:

a) in children's institutions - children who were in contact with patients, and the service personnel of the entire institution;

b) in schools - students and teachers of the class where the patient is registered;

c) in boarding schools (round-the-clock stay of children) - students who communicated with the patient in the classroom and in the bedroom, as well as teachers and educators of this class;

d) in families, apartments - all persons who communicated with patients;

e) in universities, secondary educational institutions, vocational schools, special schools in the event of a case of illness in the first year - teachers and students of the entire course; in senior courses - only those who communicated with the patient in the study group and the dorm room;

f) in other organized groups - persons living in a hostel.

In preschool institutions, bacteriological examinations of contact persons are carried out at least twice with an interval of 3-7 days, in other groups - once.

Carriers of meningococci identified during bacteriological examination in preschool groups, boarding schools and other children's institutions are removed from the group for the period of rehabilitation. The speakers are not isolated from the collective of adults, including educational institutions.

Carriers of meningococci - children and adults identified in family centers, in kindergartens, schools, boarding schools, sanatoriums, pioneer camps and other children's institutions are not allowed. Bacteriological examination of the groups that were visited by these carriers is not carried out.

If a carrier of meningococci is identified among patients in somatic hospitals, it should be isolated in a box or semi-box. The question of rehabilitation is decided depending on the underlying disease. In the absence of the possibility of isolating the carrier, the rehabilitation course is mandatory. The staff of the department undergoes a single bacteriological examination, the identified carriers are suspended from work for the duration of the rehabilitation.

Patients with acute nasopharyngitis (bacteriologically unconfirmed), identified in the focus of meningococcal infection, are subject to treatment as prescribed by the doctor who established the diagnosis. From preschool groups, these patients are isolated for the duration of treatment and are admitted to the collective only after the disappearance of acute phenomena.

The identified carriers of meningococci are sanitized at home or in departments specially deployed for these purposes: adults - ampicillin or levomycytin 0.5x4 times a day for 4 days. For children, these drugs are prescribed according to the same scheme in age-related dosages. For the rehabilitation of carriers in closed groups of adults, rifampicin 0.3 is recommended every 12 hours for 2 days.

3 days after the end of the sanitation course, the carriers, regardless of the drug used, are subjected to a single bacteriological examination and, if there is one negative bacteriological analysis, they are allowed into the collectives.

With prolonged carriage (over 1 month) and the absence of inflammatory changes in the nasopharynx, the carrier is admitted to the team where it was identified.

Final dysenfection # in the lesions is not performed. Transport for transportation of patients is not subject to disinfection. The room is subject to daily wet cleaning, maximum decompaction in sleeping rooms, frequent ventilation of the room, irradiation with ultraviolet and bactericidal lamps.

During the period of seasonal rise in morbidity, large gatherings of children at entertainment events are prohibited, and the breaks between screenings in cinemas are lengthened.

Among the population, a wide explanatory work is constantly being carried out on the need for an early visit to a doctor.

Specific prevention

Meningococcal vaccine of serogroups A and C (produced by the Moscow Research Institute of Electrodemotional Electronics named after G.N. Gabrichevsky) is weakly reactogenic, harmless, immunologically active, causes an increase in antibodies from day 5 after a single injection and after 2 weeks antibodies reach their maximum level. The vaccine is used for prophylactic purposes and for the purpose of emergency prophylaxis in foci of meningococcal infection.

1. For prophylactic purposes, vaccination is carried out in territories during a period of epidemic trouble, with an incidence rate of more than 2.0 per 100,000 population.

Vaccinations are subject to:

children from 1 to 7 years old inclusive;

first-year students of institutes, technical schools, vocational schools, temporary workers and other persons who came from different localities to organized groups and united by living together in hostels (preferably during the formation of groups);

children admitted to orphanages, students of the first grades of boarding schools.

With a sharp rise in morbidity and an indicator of over 20.0 per 100,000 population, mass vaccination of the entire population under the age of 20 is carried out.

2. For the purpose of emergency prevention (to prevent secondary diseases), the vaccine is administered at the site of infection in the first 5 days after the detection of the first case of the disease with a generalized form of meningococcal infection.

Vaccinations are subject to:

persons who were in contact with the patient in a child care institution, school class, family, apartment, dormitory dormitory and friendly contacts;

persons re-entering the collective - the focus of infection (the vaccine is administered to them a week before admission);

students of the entire first year of secondary and higher educational institutions in the event of diseases of the GFMI in the first year or in the senior years;

senior students who communicated with the patient in a group or dorm room;

children living in rural areas, schoolchildren, students of vocational schools, etc., as well as all persons who were in any degree of communication with the patient in the village, where no diseases have been registered for the last 3 years.

Immunization is carried out in accordance with the instructions for the use of polysaccharide meningococcal vaccine, not earlier than 2 months after the introduction of other vaccines, and in the foci of infection - regardless of the time of their introduction.

Repeated vaccination for the same persons is carried out no more than once every 3 years.

In immunized collectives, quarantine is not established, bacteriological examination and immunoglobulin prophylaxis for contacts older than 1 year are not carried out.

Meningococcal infection is an anthroponous disease caused by meningococcus and proceeding in various clinical forms. The causative agent is Neisseria meningitidis (meningococci - gram-negative cocci). Depending on the structure of the polysaccharide, 12 serogroups are distinguished: A, B, C, X, Y, Z, W-135, 29E, K, H, L, I. Meningococci serogroups A, B, C are the most dangerous and can often cause diseases , outbreaks and epidemics. Intragroup genetic subgrouping of meningococci and determination of enzyme types allows identifying hypervirulent strains of meningococci (meningococci of serogroup A - genetic subgroup III-1, meningococci of serogroup B - enzyme types ET-5, ET-37), which is important in predicting epidemiological distress.

There are three categories of sources of infection: patients with a generalized form of meningococcal infection, patients with meningococcal nasopharyngitis, carriers of meningococci. The pathogen is transmitted from person to person by airborne droplets. More often they become infected from asymptomatic carriers and less often through direct contact with a patient with a generalized form of meningococcal infection. The risk of developing the disease in children is higher than in adults. All individuals are susceptible to the disease, but the risk of infection is higher in people with terminal complement deficiency and in people with splenectomy.

The incubation period is 1 to 10 days, usually less than 4 days.

Activities in the focus of meningococcal infection.

In the focus of meningococcal infection, after hospitalization of a patient or suspected of this disease, final disinfection is not carried out, and in the rooms where the patient or suspected of the disease previously stayed, they carry out wet cleaning, ventilation and ultraviolet irradiation of the room.

In preschool educational institutions, children's homes, orphanages, schools, boarding schools, health organizations, children's sanatoriums and hospitals, quarantine is established for 10 days from the moment of isolation of the last person who fell ill with a generalized form of meningococcal infection. During this period, it is not allowed to admit new and temporarily absent children to these organizations, as well as transfers of children and staff from a group (class, department) to other groups.

In collectives with a wide range of people communicating with each other (higher educational institutions, secondary specialized educational institutions, colleges, etc.), if several diseases occur simultaneously with a generalized form of meningococcal infection or consecutively 1 - 2 diseases per week, the educational process is interrupted for a period of at least than 10 days.

Specific prevention of meningococcal infection.

The airborne mechanism of transmission in meningococcal infection and the widespread nasopharyngeal carriage of meningococci (4 - 8%) in the population restrain the effectiveness of anti-epidemic measures against the source of infection and the causative agent of the disease. A radical measure to prevent the spread of the disease is specific vaccine prophylaxis.

The procedure for carrying out preventive vaccinations against meningococcal infection, the definition of population groups and the timing of preventive vaccinations are determined by the bodies exercising state sanitary and epidemiological supervision. I

Organization of immunoprophylaxis against meningococcal infection.

Preventive vaccinations against meningococcal infection are included in the calendar of preventive vaccinations for epidemic indications. Preventive vaccination begins when there is a threat of the development of an epidemic rise: the identification of obvious signs of epidemiological trouble in accordance with clause 7.3, an increase in the incidence of urban residents twice compared to the previous year, or with a sharp rise in the incidence of more than 20.0 per 100,000 population.

Planning, organization, implementation, completeness of coverage and reliability of accounting for preventive vaccinations, as well as timely submission of reports to the authorities exercising state sanitary and epidemiological supervision, are provided by the heads of medical and preventive institutions.

The plan of preventive vaccinations and the need of medical and preventive organizations for medical immunobiological preparations for their implementation is agreed with the authorities exercising state sanitary and epidemiological supervision.

Immunization of the population.

With the threat of an epidemic rise of meningococcal infection, vaccine prophylaxis, first of all, should be:

Children from 1.5 years old to 8 years old inclusive;

First-year students of secondary and higher educational institutions, as well as persons who arrived from different territories of the Russian Federation, countries of near and far abroad and united by joint living in hostels.

With a sharp rise in the incidence (over 20 per 100,000 population), mass vaccination of the entire population is carried out with coverage of at least 85%.

Prophylactic vaccinations for children are carried out with the consent of parents or other legal representatives of minors after receiving full and objective information from medical workers about the need for preventive vaccinations, the consequences of refusing them, and possible post-vaccination complications.

Health workers inform adults and parents of children about the required prophylactic vaccinations, the timing of their implementation, as well as the need for immunization and possible reactions of the body to the administration of drugs. Vaccination is carried out only after obtaining their consent.

In case of refusal of vaccination, the citizen or his legal representative is explained in a form accessible to him the possible consequences.

Refusal to carry out preventive vaccination is made out by an entry in medical documents and signed by the parent or his legal representative.

Immunization is carried out by medical personnel trained in immunization.

To carry out preventive vaccinations in medical and preventive organizations, vaccination rooms are allocated and equipped with the necessary equipment.

In the absence of a vaccination room in a medical and prophylactic organization serving the adult population, preventive vaccinations may be carried out in medical rooms that meet sanitary and hygienic requirements.

Children attending preschool educational institutions, schools and boarding schools, as well as children in closed institutions (orphanages, orphanages) receive preventive vaccinations in the vaccination rooms of these organizations, equipped with the necessary equipment and materials.

Vaccinations at home are allowed when organizing mass immunization by vaccination teams provided with appropriate means.

Medical personnel with acute respiratory diseases, tonsillitis, injuries to the hands, purulent lesions of the skin and mucous membranes, regardless of their location, are removed from preventive vaccinations.

Storage and transportation of medical immunobiological preparations is carried out in accordance with the requirements of regulatory documents.

Preventive vaccinations against meningococcal infection are carried out with medical immunobiological preparations registered in the territory of the Russian Federation in accordance with the established procedure in accordance with the instructions for their use.

Meningococcal polysaccharide vaccine can be administered simultaneously in different syringes with other types of vaccines and toxoids, in addition to BCG vaccine and yellow fever vaccine.

Immunization is carried out with disposable syringes.

Vaccines:

· Meningo A + C vaccine (Sanofi-Pasteur, France) for the prevention of meningococcal infection.