ARVI, as you know, make up the majority of cases of visiting doctors during the cold season, and the pandemic of the new coronavirus infection only aggravates the situation. Infection most often occurs by airborne droplets. Viruses enter the body through the nasopharynx, which is why it is often called the “gate” of infection. Pathogens scattered in the environment, when inhaling air, settle on the mucous membrane of the nasal cavity, and it is there that they are introduced into the body, as a result of which respiratory diseases can develop. That is why it is important to prevent direct contact of viruses with the mucous membrane and their subsequent penetration into the respiratory tract. By resorting to antiviral agents that are applied directly to the mucous membrane of the nasal passages, we prevent their reproduction and further spread of the virus.
- How to choose an ointment for a child
- Mechanism of transmission of ARVI
- Colds in childhood
- Nasal antiviral for children
- Adults taking antiviral drugs into the nose (intranasally)
- Viferon Gel
- Viferon ointment
- Application diagram
- The mechanism of immunity
How to choose antiviral ointments for children
Many people understand that the most “winning” tactic in confronting colds is preventing the disease. Therefore, many parents are wondering: what antiviral nasal ointment for children will work to help local immunity? However, not all products are suitable for your baby. The fact is that most drugs have restrictions based on the patient’s age; you should carefully read the instructions and not use inappropriate drugs that can upset the delicate balance of the baby’s immune system or damage organs that are not yet strong. Currently, the number of specific antiviral agents approved for use in pediatrics is limited.
Viferon
The domestic drug Viferon is one of the proteins of the human immune system - recombinant interferon alpha-2b. The drug has an immunomodulatory, antiproliferative (preventing cell proliferation) and antiviral effect. The scope of its application is quite extensive: these include viral and bacterial infections of a wide variety of etiologies and localizations. Infectious diseases most often plague a person throughout his life. The fight against them is carried out on all fronts using a wide variety of pharmacological “weapons”, the most serious of which are rightly considered to be antibiotics and chemotherapy drugs. However, antiviral and antibacterial therapy often turns into attempts to kill a fly with a jackhammer: it is no secret that the same antibiotics, in addition to their deadly effect on microorganisms, undermine the body’s defenses and deplete its immune resources. In this regard, it was proposed to use interferon preparations as part of the complex treatment of viral and bacterial infections. These proteins from the family of cytokine mediators are an important link in the formation of immunity. A prominent representative of this group of medicines is the Russian drug Viferon, produced in three dosage forms: ointment, gel and suppositories. The combination of ingredients included in Viferon brings a number of additional and by no means unnecessary pharmacological effects to its collection. Thus, antioxidants acting as auxiliary substances - tocopherol acetate and ascorbic acid (the latter is present only in suppositories) - increase the antiviral potential of interferon alpha-2b. With their active participation, the immunomodulatory effect of Viferon on T- and B-lymphocytes is enhanced, the concentration of secretory immunoglobulins (antibodies) of class A increases, the concentration of immunoglobulin E is normalized, and the work of the internal interferon alpha-2b system is restored.
Alpha tocopherol and ascorbic acid alone can suppress inflammation, stabilize cell membranes and repair damaged tissue. Thus, Viferon allows you to get by with smaller doses of antibacterial and hormonal drugs, and therefore reduce the likelihood of developing adverse reactions as part of antiviral and antibacterial therapy.
This is what is called the official program. Now - about the urgent matter, namely: Viferon, and this is no secret, is the subject of heated discussions in the medical and paramedical world. The fact is that a number of respected experts express objective doubts about its effectiveness, considering it almost a placebo. One of the arguments here is its instability in the gastrointestinal tract, where it enters when administered rectally. And the only way to keep the drug intact is subcutaneous or intramuscular administration, and, as you know, the manufacturer does not provide such dosage forms of Viferon. On the other hand, in the MEDLINE databases (the world's largest database of medical information, combining about 75% of medical publications published on the globe) there are more than 40 mentions of Viferon. Yes, the main subject of research was not the domestic Viferon, but its pharmacologically active substance - interferon alpha-2. However, even with such an assumption, Viferon certainly cannot be called a dummy that does not have the slightest evidence of its effectiveness. In any case, while all these heated debates are going on, the drug itself feels very comfortable on pharmacy shelves and absolutely does not complain about the lack of attention from doctors and patients.
Routes of transmission of acute respiratory infections to adults and children
The prevalence of ARVI is associated both with a variety of pathogens and with the fact that specific immunity against past infections does not persist for a long period of time. Pathogens are easily transmitted in the environment. The need to be in a common space with other people (public transport, preschool and educational institutions, etc.) increases the risk of infection. In some cases, the carrier of the infection, without even knowing about his danger to others, can transmit the virus several days before the manifestation of clinical symptoms. The maximum danger of infection usually occurs 1-3 days from the onset of the disease. The minimum social distance, which is often recalled during the coronavirus pandemic, is 1.5 - 2 meters, but this distance, unfortunately, does not take into account factors such as air turbulence, the speed at which particles are released when coughing and sneezing.
Colds in childhood
Children easily exchange infections by contacting each other. Only the first months of life are relatively safe, when the child retains the passive immunity received from the mother. The baby is somewhat isolated: contact is often limited to family members. Unfortunately, the possibility of infection cannot be completely excluded even in infancy. Among preschoolers under five years of age, the highest incidence is observed, which is obviously associated with increased social contacts and visits to children's groups. “Sadovsky” children can get ARVI up to 10-15 times during the first year, then the frequency decreases by about half, but in subsequent years it remains quite high - 3-5 times a year. Repeated colds can deplete a child’s body, reduce defenses, delay normal development, contribute to the formation of “smoldering” foci of infection and allergies, and interfere with preventive vaccinations. Specific methods of prevention include vaccination. However, the vaccine works against a specific pathogen, for example, the influenza virus, but does not work against other infections, of which there are several hundred, as we know. Non-specific methods include hardening and the use of antiviral drugs according to the scheme proposed by your pediatrician.
Viferon gel for local and external use 36000 IU/g 12 g in Tambov
Gel, externally and locally.
In the complex therapy of ARVI, including influenza, long-term and frequent ARVI, incl. complicated by bacterial infection
:
a strip of gel no more than 0.5 cm long is applied to the pre-dried surface of the nasal mucosa and/or to the surface of the tonsils 3-5 times a day using a spatula or a cotton swab/cotton swab (see Note
). The course of treatment is 5 days; if necessary, the course can be extended.
Prevention of acute respiratory viral infections, including influenza
:
during the period of rising incidence, a strip of gel no more than 0.5 cm long is applied to the previously dried surface of the nasal mucosa and/or to the surface of the tonsils 2 times a day for 2–4 weeks.
In complex therapy of recurrent stenotic laryngotracheobronchitis
:
a strip of gel no more than 0.5 cm long is applied to the surface of the tonsils using a spatula or a cotton swab/cotton swab in the acute period of the disease 5 times a day, for 5–7 days, then 3 times a day for the next 3 weeks .
Prevention of recurrent stenosing laryngotracheobronchitis
:
a strip of gel no more than 0.5 cm long is applied to the surface of the tonsils using a spatula or a cotton swab/cotton swab 2 times a day for 3-4 weeks, the courses are repeated 2 times a year.
In complex therapy of acute and chronic recurrent herpetic infection (at the first signs of the disease or during the period of warning signs):
a strip of gel no more than 0.5 cm long is applied using a spatula or a cotton swab/cotton swab to a previously dried affected surface 3-5 times a day for 5-6 days, if necessary, the duration of the course is increased until the clinical manifestations disappear.
In complex therapy of herpetic cervicitis
:
1 ml of gel is applied with a cotton swab to the surface of the cervix, previously cleared of mucus, 2 times a day for 7 days, if necessary, the duration of the course can be increased to 14 days.
Note
.
The gel is applied to the mucous membrane of the nasal cavity after cleansing the nasal passages, and to the surface of the palatine tonsils - 30 minutes after eating.
When applying the gel to the tonsils, do not touch the tonsils with a cotton swab, but only with the gel; the gel flows down on its own along the surface of the tonsil. When applying the gel to the cervix, you should first remove mucus and discharge from the vaginal vaults and cervix with a cotton or gauze swab. When applying the gel to the affected areas of the skin and mucous membranes, after 30–40 minutes a thin film is formed, onto which the drug is again applied. If desired, the film can be peeled off or washed off with water before reapplying the drug.
Nasal antiviral ointments as a way to protect children from colds
Most often, a “cold” refers to a mild illness of the upper respiratory tract, which is caused by a viral infection. The entry point for ARVI pathogens is the mucous membrane of the upper respiratory tract, where inflammation is localized in most ARVIs. A severe course of acute respiratory viral infection with damage to the lower respiratory tract with the development of bronchitis and pneumonia may be associated with reduced levels of the child’s immunity. It is known that up to the age of 7 years, a child’s immunity undergoes changes about 4-5 times. For ARVI in the acute period, etiotropic therapy is usually used using antiviral drugs of both local and general action. The role of antiviral drugs is that they prevent the reproduction of viruses and help reduce the viral load on the body. In addition, antiviral therapy facilitates the course of the disease, reduces the likelihood of complications and reduces the risk of infection to those around the patient. For the treatment of ARVI and influenza, VIFERON Ointment can be used in children over 1 year of age. Pediatricians recommend VIFERON Gel for the youngest children, which is approved from 0 years.
Anti-inflammatory and symptomatic drugs are also used in the treatment of ARVI to relieve symptoms. Patients are prescribed bed rest, drinking rest, diet, and vitamin supplements. But antibiotics are used strictly according to indications and doctor’s prescription.
The effectiveness of Viferon ointment in the rehabilitation of frequently ill children
The interferon system carries out a multifunctional effect in the body in three main directions: antiviral, antiproliferative, immunomodulatory. Imperfect functioning of the interferon system can cause increased sensitivity of children to infectious diseases and aggravate the severity of their course.
Studies devoted to the formation of the interferon system in ontogenesis have revealed some age-related features [3]. In newborn children, compared with adult donors, there is a significant decrease in the ability of leukocytes to produce α-interferon (α-IFN), as well as γ-interferon (γ-IFN). Moreover, the lower the gestational age of the newborn child, the more these indicators are reduced [1]. In premature newborns, the concentration of endogenous interferon in the blood serum exceeds that in full-term infants, young children and adults. Circulating interferon is currently considered as “early” interferon, which has a physiological orientation, reflecting the state of the interferon system of the developing fetus [3].
The action of “early” interferon is aimed not so much at protection, but at the development and differentiation of fetal cells. A relationship has been established between a decrease in the level of production of “early” interferon and deviations from the norm of fetal development in pregnant women [5]. It has also been revealed that the pathology of the ante- and perinatal periods of ontogenesis, leading to the development of perinatal hypoxia, fetaplacental insufficiency, provokes the development of immunological disorders in the mother-placenta-fetus system and deviations in the development of the immune system in postnatal ontogenesis [6].
The objective of this study was to develop methods for the rehabilitation of frequently ill children using Viferon ointment and analyze their effectiveness.
A child was considered to be frequently ill if he suffered 4 or more acute respiratory diseases during the year or if his resistance index (RI) was 0.33 or higher [4]:
RI = (number of acute respiratory diseases suffered by the child)/ (number of months of observation)
The work used clinical methods, the study of interferon status (serum, α-IFN, γ-IFN), according to the method proposed by S. S. Grigoryan and co-authors (1988), and the study of the cellular component of immunity. For isolated subpopulations of T-lymphocytes, the amount of acid phosphatase was determined by the azo-coupling method, according to Goldberg and Barka (1978).
Interferon preparations are characterized by a combination of antiviral, antibacterial and immunomodulatory activity. In recent years, new generation interferon preparations (reaferon, realdiron, as well as foreign ones - intron A, roferon A) have been obtained using genetic engineering methods, which eliminates the use of donor blood as a raw material. Among them, we should highlight the domestic complex drug Viferon, which includes human recombinant interferon α-2b, membrane-stabilizing components (vitamins E and C) and a base. The drug is available in two dosage forms: ointment and rectal suppositories. The complex composition of Viferon causes a number of new effects: in combination with membrane-stabilizing components, the antiviral activity of recombinant interferon α-2b increases 10–14 times, its immunomodulatory effect on T- and B-lymphocytes is enhanced, the content of immunoglobulin E is normalized, phagocytosis is enhanced, and there are no side effects symptoms that occur with parenteral administration of interferon drugs (flu-like phenomena, severe headaches, arthralgia, hallucinations, hair loss, diarrhea). It has been established that with long-term use of Viferon for 2 years, antibodies are not formed that neutralize the antiviral activity of recombinant interferon α-2b.
The listed properties of Viferon, in particular interferon- and immunocorrective effects, served as the basis for its use in the rehabilitation of this category of children. Viferon ointment, containing 40 thousand IU of interferon per 1 g, was used as a dosage form.
The drug was used in three main areas: during courses of immuno- and interferon rehabilitation; during the period of adaptation to a preschool institution; for preventive purposes during the period of rising incidence of ARVI.
Viferon ointment was administered intranasally according to the method we developed (RF patent No. 2214272 dated October 20, 2003) 2 times a day in a daily dose of 1 g. The drug was used daily for the first 2 weeks, and 3 times a week for the next 2–4 weeks. Frequently ill children attending preschool institutions and raised in an orphanage were under observation. The age of the children ranged from 3 months to 5.5 years. Of these, more than half (61.6%) were young children. All frequently ill children had deviations in the ante- and perinatal periods of development. 73 children (main group) received Viferon ointment. The comparison group, in which children did not receive the drug, as well as other immunomodulatory drugs, consisted of 34 children of the same age who had an unfavorable course of early ontogenesis and suffered from frequent respiratory infections. In both groups, general health activities were carried out (massage, vitamin therapy, physical therapy, etc.).
Analysis of the clinical effectiveness of the ointment form of Viferon shows its pronounced effect on the incidence of children during the period of adaptation to a preschool institution. Among the children who received Viferonorehabilitation, 41% did not get sick in the first 3.5 months after entering a preschool institution. In the comparison group, all observed children recovered from the disease during this period. The number of days missed due to illness in the group receiving Viferon was 2.2 times lower than in the comparison group (p < 0.01), and the number of episodes of acute respiratory infections suffered by one child was almost 2 times lower (p < 0 ,01).
Along with the positive clinical effect, there was an improvement in immunological parameters. This was expressed in a significant (p < 0.01) increase in the helper subpopulation of lymphocytes (38.2 ± 0.45% and 41.73 ± 0.67%, respectively), in a decrease in T-suppressors (22.98 ± 0.52% and 21.27 ± 0.62%, respectively, p < 0.05), in the normalization of the immunoregulatory index (1.68 ± 0.06 and 1.96 ± 0.09, respectively, p < 0.01). There were no significant differences in the dynamics of immunological parameters in children of the comparison group during the same time (p > 0.05). Subsequent observations over the course of a year showed that the effect of Viferonorehabilitation carried out during the period of adaptation to a preschool institution on the incidence of children's illnesses gradually decreases over time. Thus, if the incidence of children in the first 3.5 months after taking the drug was 2 times lower than in the comparison group, then in 6 months it was 1.5 times lower, and in 8 months it was 1.4 times lower than in the group of children who did not receive the drug. This necessitates repeated courses of viferonorehabilitation for frequently ill children admitted to preschool institutions every 3–4 months until a lasting clinical effect is achieved.
Viferonorehabilitation, along with a decrease in morbidity, facilitated adaptation to a preschool institution and by reducing emotional and behavioral disorders. This is due to the longer stay of children in a group and the possibility of carrying out psychological and pedagogical influences.
Viferon ointment was also included in the rehabilitation complex for frequently ill children, which is usually carried out 2 times a year. Clinical observations conducted over the course of a year showed that Viferon rehabilitation leads to a reduction in the incidence of respiratory infections by 2.0–1.7–2.1 times. The most pronounced effect is observed in young children.
The use of Viferon ointment contributes to a significant (p < 0.01) increase in the synthesis of γ-interferon in frequently ill children, both in the first year of life and in older age. There is a significant decrease in circulating “early” interferon in children of the second and third year of life. If before Viferonorehabilitation it was detected in 66.67% of those examined, then after its completion - in 28.27% of frequently ill children (p < 0.05). In frequently ill children in the first year of life, there is no significant decrease in circulating “early” interferon (p > 0.05). After a course of Viferon rehabilitation, its circulation remains in the vast majority (85.71%) of children, which indicates the need for longer use of the drug in children of this age. A significant increase in the ability to produce α-IFN was not detected in all children examined without exception (p > 0.05). It can be argued that, in parallel with the increase in the synthesis of γ-IFN after a course of viferon rehabilitation, frequently ill children experience significant positive dynamics in cellular immunity indicators; the helper subpopulation of T-lymphocytes increases (p < 0.01), the number of T-suppressors decreases (p < 0.01), and the immunoregulatory index increases (p < 0.01). There were no significant changes in the studied indicators of cellular immunity in the group of children who did not receive Viferon during this time (p > 0.05).
Thus, the use of Viferon ointment for the purpose of rehabilitation of disorders in the interferon system in frequently ill children with a history of dysontogenetic abnormalities has a significant interferon-correcting and immunomodulatory effect. It manifests itself in the stimulation of γ-interferonogenesis, a decrease in circulating “early” interferon, an increase in the helper activity of the cellular immune system, and a normalization of the ratio of T-lymphocyte subpopulations. Clinically, this process correlates with a decrease in the number of episodes of respiratory infections, an increase in the resistance of children, and an alleviation of the adaptation syndrome during the period of adaptation to a preschool institution.
The course of viferon prophylaxis was carried out in the spring season, taking into account the seasonal rhythms of interferonogenesis identified and described by us earlier. To compare the data obtained, the incidence of respiratory infections was analyzed 2 months before viferon prophylaxis and within 2 months after its completion. A study of the clinical effectiveness of the drug showed its difference in children of early and preschool age. There were no cases of illness in young children during viferon prophylaxis. Over the next 2 months, compared with the same time period preceding the prevention, there was a decrease in the incidence of ARVI by 4 times in the number of cases and by 6.6 times in the number of days missed by one child (p < 0.01). There were no significant differences in the incidence of preschool children before and after viferon prophylaxis.
The more pronounced effectiveness of viferon prophylaxis in children of the first 3 years of life may be due to the optimally selected dose of the drug and its administration schedule, the plastic abilities of the body of young children, and in particular their immune system, which determine a high immunomodulatory effect.
A study of the interferon status of children before and after viferon prophylaxis shows its positive effect on the state of the interferon system. The examined children showed a significant increase in the production of γ-IFN (p < 0.01) and a decrease in circulating “early” interferon (p < 0.01). The number of children in whom “early” interferon is detected decreases by 2.7 times. In the comparison group, studies conducted at the same time did not reveal significant changes in interferon status (p > 0.05).
It should be noted that there were no side effects, including allergic reactions, negative changes in laboratory parameters, when using Viferon ointment in all observed children.
Thus, the use of the ointment form of the domestic drug Viferon in frequently ill children has an interferon-corrective and immunomodulatory effect, promoting an increase in the production of γ-IFN, the helper subpopulation of T-lymphocytes, a decrease in circulating “early” interferon, normalization of the immunoregulatory index, a decrease in the incidence of acute respiratory viral infections, and easier adaptation to period of adaptation to new microsocial conditions.
For questions regarding literature, please contact the editor.
Z. S. Makarova , Doctor of Medical Sciences, Professor V. A. Doskin , Doctor of Medical Sciences, Professor V. V. Malinovskaya , Doctor of Biological Sciences, Professor RMAPO, State Research Institute of Epidemiology and Microbiology named after. N. F. Gamaleyi RAMS, Moscow
Mechanism of action of immunity in the nose
Most infectious agents enter the body from the surface of the mucous membranes, which are the initial portal of entry for most respiratory viruses. The immune system uses various mechanisms to fight infections. – In addition to increasing the activity of general systemic immunity, local immunity plays an important role in protecting against pathogenic viruses. It is this that helps to cope with those pathogens that have settled on the surface of the mucous membranes of the nasopharynx and prevents the further spread of infection inside.
Secretory A-type immunoglobulins are special protein substances - they play a major role in the prevention of disease or recovery. Specific prevention of viral infections involves the immune system of the mucous membranes. The IgA present on them, the action of which is aimed at neutralizing the infection, can come from blood serum or be secreted by cells of submucosal tissue.
An effective measure to protect the upper respiratory tract is the induction of immunoglobulins precisely at the sites of virus replication - the nasopharynx. Stimulating the production of high titer whey proteins is more effective for the lower respiratory tract.
Strengthening the activity of local immunity plays an important role in preventing infection of the body by certain viruses, especially influenza. Knowledge of the mechanism of formation of local immunity makes the search for means that provide protection of mucous membranes from infectious agents a solvable task. Thus, at the beginning of the last century, the theory of local immunity was formulated, and subsequently data was accumulated indicating the important role of local protective factors in a number of viral infections. With the discovery of immunoglobulin A and evidence of its secretion by mucosal cells, a new era in the development of applied immunology began.
In particular, it was found that IgA is the most important immunoglobulin, the main biological function of which is to protect the mucous membranes from infectious agents. The most likely mechanism of IgA neutralization of the virus is to prevent the virus from binding to target mucosal cells, although others are possible.
It was found that IgA can not only prevent the virus from attaching to cellular receptors, but also inhibit its penetration into the cell or replication. Studies of the mechanism of intracellular neutralization of the virus allow us to conclude that IgA can contribute not only to protection against viral infection of the mucous membranes, but also to its terminationii.
The drug VIFERON Gel, for example, has a pronounced local immunomodulatory effect and helps to increase locally formed antibodies of the secretory IgA class, which prevent the fixation and proliferation of pathogenic microorganisms on the mucous membranes, which provides a preventive effect of the drug for the prevention of viral and other diseases.
