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

This is a Russian language translation of the ICMJE Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals. Updated in December 2016. This translation was prepared by V. Dengin with support from Media Sphera Publishing Group (academic editor Saygitov R.T., technical editors Solovova M.N., Shoshina M.N.). The ICMJE has not endorsed nor approved the contents of this translation. The official version of the Recommendations for the Conduct, Reporting, Editing and Publication of Scholarly Work in Medical Journals is located at www.icmje.org. Users should cite this official version when citing the document.

After switching to general diet, children aged over 1 year lack vitamins D, B12, C, as well as folates, calcium, iodine, iron, zinc, and docosahexaenoic acid. High prevalence of multi-micronutrient deficiency among toddlers and preschoolers constitutes grounds for administration of food products rich in micronutrients, including beverages made on different bases (juices, cow's milk, etc.). Baby food products for young children as well as micronutrient-enriched milk drinks have advantages over other dietary dishes because the vitamins and minerals contained in them correspond to the child's age requirement. The article discusses disagreements in the name of milk drinks for children over 1 year. The article also considers conformity of the quality of such drinks with the regulatory framework in force in the Russian Federation. The analysis of scientific literature on the effectiveness of inclusion of micronutrientenriched beverages in the diet of toddlers and preschoolers was carried out. Children whose diet includes only cow's milk with excessive intake of protein and saturated fats have a risk of developing deficiency of alpha-linolenic and docosahexaenoic acids, iron, vitamins C and D. Inclusion of milk drinks in the general diet guarantees adequate consumption of micronutrients, provides the body with vitamins and microelements, reduces disease incidence, improves cognitive functions of children.

Congenital heart diseases (CHD) — one of the most common malformations in children — remains the leading cause of death in the younger age group. The review presents the world statistics of incidence and mortality due to CHD; the reasons for variability of epidemiological data are considered. The association of CHD with defects of other organs and systems is discussed. The role of various risk factors in formation of CHD in fetus is showed.

Determining risk groups for the development of vitamin-deficient conditions in infants is important for the timely appointment of preventive doses of the necessary vitamins and vitamin complexes by a practicing pediatrician. The article contains information on the causes of vitamin deficiency and the biological value of vitamins D, C, A. The data of real clinical practice allowing the doctor to decide on the appointment of a complex of vitamins for hypovitaminosis prevention in infants is highlighted.

Juvenile idiopathic arthritis (JIA) is one of the most frequent and most disabling rheumatic diseases in children. Children with JIA receiving immunosuppressive and genetically engineered biologic drugs belong to the high-risk group for the development of bacterial and viral infections, including those administered by preventive vaccines.

Objective: Our aim was to evaluate the efficacy and safety of 13-valent pneumococcal polysaccharide vaccine (PPV) in children with JIA.

Methods. In a prospective open-label comparative study, the efficacy of vaccination was determined by the level of specific anti-pneumococcal antibodies (anti-SPP)IgG to Streptococcus pneumonia in the blood serum in patients with JIA. The safety of vaccination was assessed by determining a high-sensitivity C-reactive protein and S-100 protein as well as by the number of adverse events, by recording the number of infections of the upper respiratory tract and pneumonias, by the number of joints with active arthritis. Vaccination with 13-valent PPV was performed subcutaneously with one dose of 0.5 ml during therapy of the main disease with methotrexate or etanercept or 3 weeks before the appointment of methotrexate or etanercept. Patients were followed up for 1 year.

Results. The study included 42 children with JIA: 21 with JIA in the active phase of the disease, 21 in remission of the disease. As a result of vaccination, the level of anti-pneumococcal antibodies (antiSPP)IgG increased in the group of children with JIA in the active phase from 26.1 (14.3; 52.1) to 73.0 (52.5; 156.0) mg/l (p = 0.001), with JIA in remission — from 27.4 (18.2; 59.1) to 54.6 (35.3; 96.0) mg/l (p = 0.029). The concentration of the predictor of S-100 protein high activity after vaccination was not increased (p = 0.192). JIA aggravation episodes were not fixed in any patient. Serious adverse events were not observed during the trial.

Conclusion. The vaccination of children with JIA with 13-valent PPV is highly effective, not accompanied by exacerbation/increase in the activity of the disease and the development of serious adverse events. 

The issue of a therapy of children with juvenile idiopathic arthritis (JIA) with intolerance or insufficient effectiveness of methotrexate remains actual.

Objective: Our aim was to study the efficacy and safety of tocilizumab in patients with polyarticular JIA.

Methods. In a retrospective study, we studied the results of the use of tocilizumab in patients with active polyarticular JIA ( 5 active joints) resistant to prior therapy with methotrexate or a combination of methotrexate with other nonbiologic disease-modifying antiinflammatory drugs.

Results. The data of 40 children (83% girls) with the onset median of polyarticular JIA of 4.8 (2.9, 8.1) years and the interval between the disease onset and the initiation of tocilizumab therapy of 5.7 (1.8, 8.5) years was analyzed. Tocilizumab was used as an intravenous infusion of 8 mg/kg (with a weight 30 kg) or 10 mg/kg (with a weight < 30 kg) every 4 weeks. The duration of tocilizumab monotherapy in 5 (13%) children was 1,109 days (452; 1,542). The stages of inactive disease (according to the criteria of C. Wallace, 2004) in 6 months of tocilizumab therapy reached 6 (15%) patients, in 42 months — 32 (80%) patients. In 3 patients, tocilizumab was canceled due to persistent remission. After 6 months of treatment, there was a marked decrease in erythrocyte sedimentation rate, C-reactive protein concentration, number of leukocytes and platelets (in all cases, p < 0.001) to normal values, which persisted throughout the whole period of drug administration. Predictors for achieving inactive disease were the initial (at the onset of tocilizumab therapy) number of peripheral blood leukocytes < 9.0X109/l [relative risk (RR) 1.92; 95% confidence interval (CI) 0.9–4.6)] and the absence of prior biological therapy (RR 1.92, 95% CI 0.9–4.6). The most frequent side effects of tocilizumab therapy were transient hypercholesterolemia (in 13), hypertriglyceridemia (in 4), transient grade II neutropenia (in 1).

Conclusion. The long-term efficacy and relative safety of tocilizumab in children with polyarticular JIA have been showed. 

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 brain activity of a newborn affects postnatal adaptation, the disorder of which can cause dysfunction of organs and systems of the immature organism and the development of diseases in more distant periods of maturation.

Objective: Our aim was to study the effect of levocarnitine on dynamics of the brain bioelectrical activity formation in term infants delivered by cesarean section.

Methods. The study included term infants (gestation period 38–40 weeks) delivered by cesarean section, with perinatal hypoxic lesion of the central nervous system (cerebral ischemia). Children were randomized into groups of standard (recommended) treatment and standard treatment enhanced with levocarnitine (plus levocarnitine) — 30% oral solution at a dose of 100 mg/kg per day for 3 weeks starting from the 7th day of life. The brain bioelectrical activity was assessed with electroencephalography (EEG) of the natural sleep period on the 3rd–6th day and then at 3, 6, and 12 months.

Results. 45 children were randomized into groups of standard treatment and standard treatment plus levocarnitine, of which 44 and 40 children completed the study, respectively. Initially, the delayed formation of age-related brain activity was detected in 16/40 (40%) children receiving levocarnitine and in 19/44 (43%) in the experimental group (p = 0.767), disturbances in the EEG sleep pattern with generation of background anomalies — in 17 (43%) and 16 (36%) (p = 0.565), pathological graph elements — in 1 (3%) and 2 (5%) children (p = 0.536), respectively. According to the dynamic EEG control results, it was found that after 1 year the cerebral dysfunction was registered less frequently in children receiving levocarnitine — in 32 (80%) vs. 42 (96%) children in the group of standard treatment (p = 0.028).

Conclusion. Adminisration of levocarnitine in the neonatal period reduces the risk of developing cerebral dysfunction by the end of the first year of life. 

The article presents the follow-up of a patient with severe systemic juvenile idiopathic arthritis (JIA) resistant to glucocorticosteroids, to the first genetically engineered biologic drug (GEBD) tocilizumab, a monoclonal antibody to the interleukin (IL) 6 receptor. Switching to the second GEBD — a monoclonal antibody to IL1β canakinumab — provided a remission of the disease. The first injection of the drug fully arrested the systemic symptoms of the disease, and the fourth one — the articular syndrome. The presented clinical example shows that switching to GEBD with a different mechanism of action — a monoclonal antibody to IL1β canakinumab — is highly effective and induces a remission of the disease in patients with systemic JIA resistant to tocilizumab. There were no adverse events under pressure of canakinumab therapy.

The key to effective treatment of a bacterial infection is a rapid and proper selection of antimicrobial therapy. WHO and UNICEF developed the Global Action Plan for the Prevention and Control of Pneumonia and Diarrhoea (GAPPD) aimed to elimination of the preventable causes of child death by 2025 by optimizing diagnosis and treatment. The main pneumonia agents are fastidious microorganisms that require special nutrient media and cultivation conditions that are absent in many laboratories. Due to low effectiveness of the etiological diagnosis, the choice of antibiotic therapy for pneumonia in the practice of a pediatrician is usually empirical. The article describes clinical cases of community-acquired pneumonia in children caused by strains of Streptococcus pneumoniae with a multiple antibiotic resistance. The above experience can be used by pediatricians in everyday practice.

Cryopyrin associated periodic syndromes (CAPS) are rare monogenic autoinflammatory diseases from the group of hereditary periodic syndromes caused by a regulation defect of inflammatory cytokines, in particular interleukin 1β. They include familial cold autoinflammatory syndrome (FCAS), Muckle–Wells syndrome (MWS), and neonatal-onset multisystem inflammatory disease (CINCA/NOMID). Previously, Muckle–Wells syndrome was considered as a triad of symptoms — urticaria, deafness, and reactive amyloidosis. Today, the spectrum of symptoms is constantly expanding: it includes fever, fatigue, conjunctivitis, arthralgia, arthritis, myalgia, irritability, headache, abdominal pain, mouth ulcers, pericarditis, which involves doctors of different specialties in the diagnostic and treatment process, who are not always familiar with this disease. In Russia, single observations of this disease have been described. We present the clinical case of Muckle–Wells syndrome in a 5-year-old child, whose first symptoms appeared at the age of 2 months. This observation underscores the complexity of diagnosing the syndrome in children.