<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3.dtd">
<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">medalphabet</journal-id><journal-title-group><journal-title xml:lang="ru">Медицинский алфавит</journal-title><trans-title-group xml:lang="en"><trans-title>Medical alphabet</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">2078-5631</issn><issn pub-type="epub">2949-2807</issn><publisher><publisher-name>ООО «Альфмед»</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="doi">10.33667/2078-5631-2023-31-15-20</article-id><article-id custom-type="elpub" pub-id-type="custom">medalphabet-3461</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>Статьи</subject></subj-group></article-categories><title-group><article-title>Опыт применения 23-валентной пневмококковой полисахаридной вакцины у больных анкилозирующим спондилитом и псориатическим артритом</article-title><trans-title-group xml:lang="en"><trans-title>Experience with 23-valent pneumococcal polysaccharide vaccine in patients with ankylosing spondylitis and psoriatic arthritis</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-5264-337X</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Баранова</surname><given-names>М. М.</given-names></name><name name-style="western" xml:lang="en"><surname>Baranova</surname><given-names>M. M.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Баранова Марина Михайловна - м.н.с. лаборатории коморбидных инфекций и вакцинопрофилактики.</p><p>Москва</p></bio><bio xml:lang="en"><p>Marina M. Baranova - Researcher at Laboratory for Studying Comorbid Infections and Vaccination Prevention.</p><p>Moscow</p></bio><email xlink:type="simple">baranovamarina103@gmail.com</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4327-6720</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Муравьева</surname><given-names>Н. В.</given-names></name><name name-style="western" xml:lang="en"><surname>Muravyeva</surname><given-names>N. V.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Муравьева Наталья Валерьевна - к.м.н., с.н.с. лаборатории коморбидных инфекций и вакцинопрофилактики.</p><p>Москва</p></bio><bio xml:lang="en"><p>Natalia V. Muravyeva - PhD Med., senior researcher at Laboratory for Studying Comorbid Infections and Vaccination Prevention.</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7091-2054</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Белов</surname><given-names>Б. С.</given-names></name><name name-style="western" xml:lang="en"><surname>Belov</surname><given-names>B. S.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Белов Борис Сергеевич - д.м.н., зав. лабораторией коморбидных инфекций и вакцинопрофилактики.</p><p>Москва</p></bio><bio xml:lang="en"><p>Boris S. Belov - DM Sci (habil.), head of Laboratory for Studying Comorbid Infections and Vaccination Prevention.</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4829-5210</contrib-id><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Верижникова</surname><given-names>Ж. Г.</given-names></name><name name-style="western" xml:lang="en"><surname>Verizhnikova</surname><given-names>Zh. G.</given-names></name></name-alternatives><bio xml:lang="ru"><p>Верижникова Жанна Григорьевна - м.н.с. лаборатории иммунологии и молекулярной биологии ревматических заболеваний.</p><p>Москва</p></bio><bio xml:lang="en"><p>Zhanna G. Verizhnikova - researcher at Laboratory of Immunology and Molecular Biology of Rheumatic Diseases.</p><p>Moscow</p></bio><xref ref-type="aff" rid="aff-1"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>ФГБНУ «Научно-исследовательский институт ревматологии имени В.А. Насоновой»</institution><country>Россия</country></aff><aff xml:lang="en"><institution>V.A. Nasonova Research Institute of Rheumatology</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2023</year></pub-date><pub-date pub-type="epub"><day>13</day><month>01</month><year>2024</year></pub-date><volume>0</volume><issue>31</issue><issue-title>Ревматология в общей врачебной практике (2)</issue-title><fpage>15</fpage><lpage>20</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Баранова М.М., Муравьева Н.В., Белов Б.С., Верижникова Ж.Г., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Баранова М.М., Муравьева Н.В., Белов Б.С., Верижникова Ж.Г.</copyright-holder><copyright-holder xml:lang="en">Baranova M.M., Muravyeva N.V., Belov B.S., Verizhnikova Z.G.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://www.med-alphabet.com/jour/article/view/3461">https://www.med-alphabet.com/jour/article/view/3461</self-uri><abstract><p>Пневмококк играет первостепенную роль в качествевозбудителя пневмонии как у населения в целом, так иубольных иммуновоспалительными ревматическими заболеваниями (ИВРЗ), в том числе спондилоартритами (СпА). Однако данные по иммуногенности, эффективности и безопасности пневмококковых вакцин у больных СпА ограничены.</p><sec><title>Цель исследования</title><p>Цель исследования. Изучить иммуногенность, эффективность и безопасность 23-валентной пневмококковой полисахаридной вакцины (ППВ-23) у больных анкилозирующим спондилитом (АС) и псориатическим артритом (ПсА), наблюдавшихся в ФГБНУ «НИИР им. В.А. Насоновой» (Москва).</p></sec><sec><title>Материалы и методы</title><p>Материалы и методы. В исследование включено 145 человек: 51 больной АС, 25 – ПсА, 69 лиц контрольной группы (КГ) без ИВРЗ. Большинство (65,8%) пациентов получали иммуносупрессивную терапию. ППВ-23 вводили в количестве 1 дозы (0,5 мл) подкожно на фоне проводимой антиревматической терапии независимо от активности основного ИВРЗ. Уровень антител (АТ) к пневмококковому капсульному полисахариду определяли с помощью набора EIA PCP IgG (TestLine Clinical Diagnostics, Чешская Республика) перед вакцинацией и через 1, 3 и 12 месяцев после нее. Также оценивали клиническую эффективность и безопасность ППВ-23, в том числе влияние на активность АС и ПсА по динамике индексов BASDAI и DAPSA.</p></sec><sec><title>Результаты</title><p>Результаты. Через 1, 3 и 12 месяцев после вакцинации концентрация пневмококковых АТ была значимо выше по сравнению с исходными показателями, что свидетельствует о достаточной иммуногенности ППВ-23. Клиническая эффективность ППВ-23 у больных АС и ПсА составила 98,7%. В целом негативного влияния вакцинации на активность основного заболевания не отмечено. Частота поствакцинальных реакций у больных и в КГ была сопоставима.</p></sec><sec><title>Выводы</title><p>Выводы. Полученные результаты исследования свидетельствуют о достаточной иммуногенности, клинической эффективности и безопасности ППВ-23 у больных АС и Пс А.</p></sec></abstract><trans-abstract xml:lang="en"><p>Pneumococcus plays a primary role as a causative agent of pneumonia both in the general population and in patients with immuno-inflammatory rheumatic diseases (IVRS), including spondylarthritis (SpA). However, data on the immunogenicity, efficacy and safety of pneumococcal vaccines in patients with SpA are limited.</p><sec><title>The aim of the study</title><p>The aim of the study. To study the immunogenicity, efficacy and safety of the 23-valent pneumococcal polysaccharide vaccine (PPV-23) in patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA), observed at the V.A. Nasonova Research Institute (Moscow, Russia).</p></sec><sec><title>Materials and methods</title><p>Materials and methods. 145 people were included in the study: 51 patients with AS, 25 with PsA, 69 in control group (СG) without IVR. The majority of patients (65.8%) received immunosuppressive therapy. PPV-23 was administered in an amount of one dose (0.5 ml) subcutaneously against the background of antirheumatic therapy, regardless of the activity of the main IVR. The level of antibodies (AT) to pneumococcal capsular polysaccharide was determined using the EIA PCP IgG kit (TestLine Clinical Diagnostics, Czech Republic) before vaccination and 1, 3 and 12 months after it. The clinical efficacy and safety of PPV-23 were also evaluated, including the effect on the activity of AS and PsA according to the dynamics of BASDAI and DAPSA indices.</p></sec><sec><title>Results</title><p>Results. After 1, 3 and 12 months after vaccination, the concentration of pneumococcal AT was significantly higher compared to baseline values, which indicates sufficient immunogenicity of PPV-23. The clinical efficacy of PPV-23 in patients with AS and PsA was 98.7%. In general, there was no negative effect of vaccination on the activity of the underlying disease. The frequency of postvaccinal reactions in patients and in СG was comparable.</p></sec><sec><title>Conclusions</title><p>Conclusions. The obtained results of the study indicate sufficient immunogenicity, clinical efficacy and safety of PPV-23 in patients with AS and Ps A.</p></sec></trans-abstract><kwd-group xml:lang="ru"><kwd>пневмококковые инфекции</kwd><kwd>пневмония</kwd><kwd>анкилозирующий спондилит</kwd><kwd>псориатический артрит</kwd><kwd>вакцинация</kwd><kwd>эффективность</kwd><kwd>иммуногенность</kwd><kwd>безопасность</kwd></kwd-group><kwd-group xml:lang="en"><kwd>pneumococcal infections</kwd><kwd>pneumonia</kwd><kwd>ankylosing spondylitis</kwd><kwd>psoriatic arthritis</kwd><kwd>vaccination</kwd><kwd>efficacy</kwd><kwd>immunogenicity</kwd><kwd>safety</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Чучалин А. Г., Брико Н. И., Авдеев С. Н. и др. Федеральные клинические рекомендации по вакцинопрофилактике пневмококковой инфекции у взрослых. Пульмонология. 2019; 29 (1): 19–34. DOI: 10.18093/0869–0189–2019–29–1–19–34.</mixed-citation><mixed-citation xml:lang="en">Chuchalin AG, Briko NI, Avdeev SN, et al. Federal clinical guidelines on preventive vaccination against pneumococcal infections in adults. Pulmonology. 2019; 29 (1): 19–34. (In Russ.) DOI: 10.18093/0869–0189–2019–29–1–19–34.</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Chung HY, Tam LS, Chan SCW, et al. Risk of community-acquired pneumonia requiring hospitalization in patients with spondyloarthritis. Ther Adv Musculoskelet Dis. 2020 Oct 13; 12: 1759720x20962618. DOI: 10.1177/1759720x20962618. PMID: 33133244; PMCID: PMC7576917.</mixed-citation><mixed-citation xml:lang="en">Chung HY, Tam LS, Chan SCW, et al. Risk of community-acquired pneumonia requiring hospitalization in patients with spondyloarthritis. Ther Adv Musculoskelet Dis. 2020 Oct 13; 12: 1759720x20962618. DOI: 10.1177/1759720x20962618. PMID: 33133244; PMCID: PMC7576917.</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Quartuccio L, Zabotti A, Del Zotto S, et al. Risk of serious infection among patients receiving biologics for chronic inflammatory diseases: Usefulness of administrative data. J Adv Res. 2018 Sep 19; 15: 87–93. DOI: 10.1016/j.jare.2018.09.003. PMID: 30581616; PMCID: PMC 6300460.</mixed-citation><mixed-citation xml:lang="en">Quartuccio L, Zabotti A, Del Zotto S, et al. Risk of serious infection among patients receiving biologics for chronic inflammatory diseases: Usefulness of administrative data. J Adv Res. 2018 Sep 19; 15: 87–93. DOI: 10.1016/j.jare.2018.09.003. PMID: 30581616; PMCID: PMC 6300460.</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Wotton CJ, Goldacre MJ. Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health. 2012 Dec; 66 (12): 1177–81. DOI: 10.1136/jech-2011–200168. Epub 2012 Apr 6. PMID: 22493476.</mixed-citation><mixed-citation xml:lang="en">Wotton CJ, Goldacre MJ. Risk of invasive pneumococcal disease in people admitted to hospital with selected immune-mediated diseases: record linkage cohort analyses. J Epidemiol Community Health. 2012 Dec; 66 (12): 1177–81. DOI: 10.1136/jech-2011–200168. Epub 2012 Apr 6. PMID: 22493476.</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">Баранова М. М., Муравьева Н. В., Белов Б. С., и др. Коморбидные инфекции у больных спондилоартритами: частота, структура, факторы риска. Современная ревматология. 2023; 17 (4): 64–70. https://doi.org/10.14412/1996–7012–2023–4–64–70</mixed-citation><mixed-citation xml:lang="en">Baranova M.M., Muravyeva N.V., Belov B.S., et al. Comorbid infections in patients with spondyloarthritis: Frequency, structure and risk factors. Modern Rheumatology Journal. 2023; 17 (4): 64–70. (In Russ.) https://doi.org/10.14412/1996–7012–2023–4–64–70</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Moltó A, Etcheto A, van der Heijde D, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: Results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016 Jun; 75 (6): 1016–23. DOI: 10.1136/annrheumdis-2015–208174. Epub 2015 Oct 21. PMID: 26489703.</mixed-citation><mixed-citation xml:lang="en">Moltó A, Etcheto A, van der Heijde D, et al. Prevalence of comorbidities and evaluation of their screening in spondyloarthritis: Results of the international cross-sectional ASAS-COMOSPA study. Ann Rheum Dis. 2016 Jun; 75 (6): 1016–23. DOI: 10.1136/annrheumdis-2015–208174. Epub 2015 Oct 21. PMID: 26489703.</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Molto A, Gossec L, Poiraudeau S, et al. Evaluation of the impact of a nurse-led program of systematic screening of comorbidities in patients with axial spondyloarthritis: The results of the COMEDSPA prospective, controlled, one-year randomized trial. Semin Arthritis Rheum. 2020 Aug; 50 (4): 701–708. DOI: 10.1016/j.semarthrit.2020.05.012. Epub 2020 May 27. PMID: 32521324.</mixed-citation><mixed-citation xml:lang="en">Molto A, Gossec L, Poiraudeau S, et al. Evaluation of the impact of a nurse-led program of systematic screening of comorbidities in patients with axial spondyloarthritis: The results of the COMEDSPA prospective, controlled, one-year randomized trial. Semin Arthritis Rheum. 2020 Aug; 50 (4): 701–708. DOI: 10.1016/j.semarthrit.2020.05.012. Epub 2020 May 27. PMID: 32521324.</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Дубинина Т. В., Гайдукова И. З., Годзенко А. А. и др. Рекомендации по оценке активности болезни и функционального состояния больных анкилозирующим спондилитом в клинической практике. Научно-практическая ревматология. 2017; 55 (4): 344–350. https://doi.org/10.14412/1995–4484–2017–344–350</mixed-citation><mixed-citation xml:lang="en">Dubinina T. V., Gaidukova I. Z., Godzenko A. A., et al. Guidelines for the assessment of disease activity and functional status in patients with ankylosing spondylitis in clinical practice. Rheumatology Science and Practice. 2017; 55 (4): 344–350. (In Russ.) https://doi.org/10.14412/1995–4484–2017–344–350</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Коротаева Т.В., Корсакова Ю.Л., Логинова Е.Ю., и др. Псориатический артрит. Клинические рекомендации по диагностике и лечению. Современная ревматология. 2018; 12 (2): 22–35. https://doi.org/10.14412/1996–7012–2018–2–22–35</mixed-citation><mixed-citation xml:lang="en">Korotaeva T. V., Korsakova Yu.L., Loginova E. Yu., et al. Psoriatic arthritis. Clinical guidelines for diagnosis and treatment. Modern Rheumatology Journal. 2018; 12 (2): 22–35. (In Russ.) https://doi.org/10.14412/1996–7012–2018–2–22–35</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Fischer L, Gerstel PF, Poncet A, et al. Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases – a longitudinal study. Arthritis Res Ther. 2015; 17 (1): 151. DOI: 10.1186/s13075–015–0663–9. PMID: 26048579; PMCID: PMC 4481118.</mixed-citation><mixed-citation xml:lang="en">Fischer L, Gerstel PF, Poncet A, et al. Pneumococcal polysaccharide vaccination in adults undergoing immunosuppressive treatment for inflammatory diseases – a longitudinal study. Arthritis Res Ther. 2015; 17 (1): 151. DOI: 10.1186/s13075–015–0663–9. PMID: 26048579; PMCID: PMC 4481118.</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Rasmussen S. L., Fuursted K., Nielsen K. A. et al. Pneumococcal Antibody Protection in Patients with Autoimmune Inflammatory Rheumatic Diseases with Varying Vac-cination Status. Scand J Rheumatol. 2020; 49 (5): 353–360. https://doi.org/10.1080/03009742.2020.1732459</mixed-citation><mixed-citation xml:lang="en">Rasmussen S. L., Fuursted K., Nielsen K. A. et al. Pneumococcal Antibody Protection in Patients with Autoimmune Inflammatory Rheumatic Diseases with Varying Vac-cination Status. Scand J Rheumatol. 2020; 49 (5): 353–360. https://doi.org/10.1080/03009742.2020.1732459</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">van Aalst M, Langedijk AC, Spijker R, et al. The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: A systematic review and meta-analysis. Vaccine. 2018; 36 (39): 5832–5845. DOI: 10.1016/j.vaccine.2018.07.039.</mixed-citation><mixed-citation xml:lang="en">van Aalst M, Langedijk AC, Spijker R, et al. The effect of immunosuppressive agents on immunogenicity of pneumococcal vaccination: A systematic review and meta-analysis. Vaccine. 2018; 36 (39): 5832–5845. DOI: 10.1016/j.vaccine.2018.07.039.</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Bass AR, Chakravarty E, Akl EA, et al. 2022 American College of Rheumatology Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases. Arthritis Care Res (Hoboken). 2023 Mar; 75 (3): 449–464. DOI: 10.1002/acr.25045. Epub 2023 Jan 4. PMID: 36597813; PMCID: PMC 10291822.</mixed-citation><mixed-citation xml:lang="en">Bass AR, Chakravarty E, Akl EA, et al. 2022 American College of Rheumatology Guideline for Vaccinations in Patients with Rheumatic and Musculoskeletal Diseases. Arthritis Care Res (Hoboken). 2023 Mar; 75 (3): 449–464. DOI: 10.1002/acr.25045. Epub 2023 Jan 4. PMID: 36597813; PMCID: PMC 10291822.</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Niederman MS, Folaranmi T, Buchwald UK, et al. Efficacy and effectiveness of a 23-valent polysaccharide vaccine against invasive and noninvasive pneumococcal disease and related outcomes: A review of available evidence. Expert Rev Vaccines. 2021; 20 (3): 243–256. DOI: 10.1080/14760584.2021.1880328.</mixed-citation><mixed-citation xml:lang="en">Niederman MS, Folaranmi T, Buchwald UK, et al. Efficacy and effectiveness of a 23-valent polysaccharide vaccine against invasive and noninvasive pneumococcal disease and related outcomes: A review of available evidence. Expert Rev Vaccines. 2021; 20 (3): 243–256. DOI: 10.1080/14760584.2021.1880328.</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Козлов РС. Современные возможности специфической профилактики пневмококковых инфекций. Клиническая микробиология и антимикробная химиотерапия. 2002; 4 (1): 61–9.</mixed-citation><mixed-citation xml:lang="en">Kozlov RS. Modern possibilities of specific prevention of pneumococcal infections. Clinical Microbiology and Antimicrobial Chemotherapy. 2002; 4 (1): 61–9. (In Russ.)</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Bühler S, Eperon G, Ribi C, et al. Vaccination recommendations for adult patients with autoimmune inflammatory rheumatic diseases. Swiss Med Wkly. 2015; 145: w14159. DOI: 10.4414/smw.2015.14159.</mixed-citation><mixed-citation xml:lang="en">Bühler S, Eperon G, Ribi C, et al. Vaccination recommendations for adult patients with autoimmune inflammatory rheumatic diseases. Swiss Med Wkly. 2015; 145: w14159. DOI: 10.4414/smw.2015.14159.</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Вакцины и вакцинация. Национальное руководство. Краткое издание. Под ред. В. В. Зверева, Р. М. Хаитова. М.: ГЭОТАР-Медиа, 2014. 640 с.</mixed-citation><mixed-citation xml:lang="en">Vaccines and vaccination. National Guidelines. Brief edition. Ed. V. V. Zverev, R. M. Khaitov. M.: GEOTAR-Media, 2014. 640 p.</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
