Home / Jamiyat / BARNOMAI IMMUNOPROFILAKTIKA DAR TOJIKISTON 2016-2020

BARNOMAI IMMUNOPROFILAKTIKA DAR TOJIKISTON 2016-2020

Bo qarori Hukumati Jumhurii Tojikiston az 28 oktyabri soli 2016, № 456 tasdiq shudaast

BARNOMAI MILLII IMMUNOPROFILAKTIKA DAR JUMHURII TOJIKISTON  BAROI SOLHOI 2016-2020

1. MUQADDIMA

  1. Barnomai millii immunoprofilaktika dar Jumhurii Tojikiston baroi solhoi 2016-2020 (minbad – Barnoma) mutobiqi moddai 17 Qonuni konstitutsionii Jumhurii Tojikisgon “Dar borai Hukumati Jumhurii Tojikiston” va qarori Hukumati Jumhurii Tojikiston az 4 marti soli 2002, № 94 “Dar borai tasdiq namudani Konsepsiyai islohoti tandurustii Jumhurii Tojikiston” tahiya gardida, baroi andeshidani choraho jihati peshgiri va muboriza bar ziddi bemorihoi siroyatii ba vositai immunizatsiya idorashavanda dar miqyosi jumhuri ravona karda shudaast.
  2. Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” yake az qismhoi muhimi tarkibii sohai tandurusti mahsub yofta, maqsadi on immunizatsiyakunoni az rui ehtiyojoti aholi meboshad. Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” Barnomaro ba vositai sokhtori khud, ki az shash filial (filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” dar Viloyati Mukhtori Kuhistoni Badakhshon, filiali Muassisai davlatii “Markazi jumhuriyavin immunoprofilaktika” dar viloyati Sugd, filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” dar mintaqai Qurgonteppa, filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” dar mintaqai Kulob, filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” dar mintaqai Rasht, filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” dar shahri Dushanbe) va 65 markazhoi immunoprofilaktika dar shahru nohiyahoi jumhuri iborat meboshad, amali megardonad. Barnoma khususiyati strategii umumidavlati doshta, ba masalahoi amniyati aholii davlat dakhl dorad.
  3. Dar Barnomai mazkur mafhum va ikhtisoroti asosii zerin istifoda meshavand:

– immunoprofilaktika – usuli muhofizati infirodi yo ommavii aholi az bemorihoi siroyati bo rohi tashakkuli masuniyati suni;

imunoprofilaktika

– immunizatsiya – in ravande meboshad, ki tavassuti on shakhs masuniyatro bar ziddi bemorihoi siroyati bo rohi guzaronidani vaksina paydo mekunad;

– sessiyai immunizatsioni – jarayoni guzaronidani immunizatsiya;

– immunizatsiyai naqshavi – guzaronidani immunizatsiya tibqi taqvimi millii immunizatsiya;

– vaksina – mavodi tibbii immunobiologie meboshad, ki baroi paydo namudani masuniyat bar ziddi bemorihoi siroyati istifoda burda meshavad;

– voya – miqdori muayyani vaksina meboshad, ki baroi immunizatsiya istifoda burda meshavad;

– zanjiri khunukitaminkunanda – in sistemai taminkunandai sharoiti zaruri baroi nigohdori va intiqoli mavodi immunobiologi az muassisai istehsolkunanda to immunizatsiyagiranda meboshad;

– eliminatsiya – qat namudani gardishi virusi mahalli yo ba sifr rasonidani miqdori hodisahoi muayyani bemorihoi siroyati dar yagon mintaqai muayyani geografi;

– qobiliyati immunogeni – qobiliyati paydo namudani masuniyat bar ziddi bemorihoi siroyati;

– verifikatsiya – rasman tasdiq namudan;

– hodisai endemiki – hodisai bemorii siroyatie, ki bo tariqi ozmoishgohi tasdiq shudaast yo aloqamandii epidemiologi dorad va dar natijai intiqoli siroyati mahalli ba amal meoyad;

– intiqoli endemiki – intiqoli muntazami siroyat dar mintaqai muayyani geografi;

– nazorati epidemiologi – shakli tashkili chorabinihoi ziddi epidemikie meboshad, ki dar asosi tahlili malumot imkoniyati muayyan namudani sabab va sharoiti tashakkulyobii bemorihoro bo maqsadi tahiyai chorabiniho oid ba peshgiri, past va mahv namudani bemorihoi siroyatii ba vositai immunizatsiya idorashavanda faroham meovarad;

– falaj – bemorii shadidi siroyatshavanda buda, barangezandai on se namudi virusi bemorii falaj ba hisob meravad va az odami bemor yo homili barangezanda ba vositai khurok, ob, guftuguy ba shakhsi sihat meguzarad. Ba on illatnok namudani sistemai asab va paydoshavii falaj khos ast;

– guluzindonak – bemorii shadidi nihoyat khatarnoki siroyatshavanda buda, ba on gazaki gulu va rohhoi nafaskashi bo paydo shudani pardai zardobdor dar mavqei halq va zahroludshavii badan khos ast. Favt az in bemori ziyod meboshad;

– kabudsulfa – bemorii shadidi siroyatshavanda buda, oseb dodani rohhoi boloii sistemai nafaskashi, khuruji sulfai davomnoki ikhtiloji khosi on ast;

– kuzoz – bemorii shadadi siroyatshavanda buda, ba on illatnok namudani sistemai asab, khuruji larzishi beikhtiyoronai mushakhoi badan khos ast. Kuzozi navzodon odatan bo favti kudak anjom meyobad;

– surkhcha – bemorii shadidi siroyatshavanda buda, aslan balandshavii harorati badan, gazaki rohhoi nafas, gazaki milkhoi chashm va kholhoi populyozi dar badan khosiyathoi on meboshand. Bemorii surkhcha ba nuqson meovarad va khele khatarnok buda, ba favt merasonad;

– gulafshon – bemorii shadidi siroyati buda, ba vositai virusho meguzarad. Asosan baroi homiladoron nihoyat khatarnok ast. Agar zani homilador ba in bemori giriftor shavad, kudaki navzodi u bo nuqsonhoi ziyod – karshavi, nobinoi, nuqsoni modarzodii dil ba dunyo meoyad. CHunin nishonahoi segonaro – aloimi gulafshoni modarzodi menomand;

– sil – bemorii siroyatshavanda buda, odatan ba illatnok shudani shush, ustukhonho, sistemai asab, uzvhoi tanosul, rohhoi peshobbaror va uzvhoi ziyodi digar ovarda merasonad. Dar Jumhurii Tojikiston yake az bemorihoi pahnshuda ba hisob meravad;

– gepatiti V – bemorii siroyatshavanda buda, asosan jigarro illatnok mekunad. Ba vositai virusho az odami bemor, homili barangezandai in bemori bo rohi suzanguzaroni, khunguzaroni, dandonkani, aloqai jinsi ba odami sihat meguzarad;

– bemorii gemofilii tipi b – bemorii siroyati buda, barangezandaash chubchai tipi b, ki asosan sababgori bemorihoi gazaki shush va gazaki pardai magzi sar meboshad, ba hisob meravad;

– siroyati rotavirusi – yake az namudhoi bemorihoi pahnshudai shikamravi kudakon buda, nihoyat khatarnok meboshad, ki asosan dar fasli tobiston avj megirad. Makhsusan, kudakoni to 2 – sola beshtar bemor meshavand va be tabobati favri ba halokat merasand;

– vaksinai pentavalenti – vaksina bar ziddi bemorihoi guluzindonak, kabudsulfa, kuzoz, siroyati gemofilii tipi b va gepatiti V;

– vaksinai pnevmokokki – vaksina bar ziddi bemorii iltihobi shushe, ki barangezandaash bakteriyai pnevmokokk meboshad;

– VDBF – vaksinai ziddi bemorii falaj, ki bo tariqi dahon guzaronida meshavad;

– VsDBF – vaksinai sevalentai ziddi bemorii falaj, ki bo tariqi dahon guzaronida meshavad;

– VdDBF – vaksinai duvalentai ziddi bemorii falaj, ki bo tariqi dahon guzaronida meshavad;

– VGBF – vaksinai gayrifaolkardashudai ziddi bemorii falaj, ki bo tariqi suzandoru guzaronida meshavad;

– SG – vaksinai ziddi bemorihoi surkhcha va gulafshon;

– Gepatiti V – vaksinai ziddi bemorii gepatiti V;

– Hib – vaksinai ziddi siroyatii gemofilii tipi b;

– VJTGK – vaksinai ziddi bemorihoi guluzindonak, kabudsulfa va kuzoz;

– VJGK – vaksinai ziddi bemorihoi guluzindonak va kuzoz;

– VJGKk – vaksinai ziddi bemorihoi guluzindonak va kuzoz bo mikdori kamtarini antigenho;

– AK – anatoksin bar ziddi bemorii kuzoz;

– SMM – Sozmoni Milali Muttahid;

– BMA/SUT – Byuroi mintaqavii avrupoii Sozmoni umumijahonii tandurusti;

– SUT – Sozmoni umumijahonii tandurusti;

– HKSMM – Hazinai kudakoni Sozmoni Milali Muttahid;

– AGVI – Alyansi globalii vaksinaho va immunizatsiya;

– ARB IMA – Agentii rushdi baynalmilalii Iyoloti Muttahidai Amriko;

– AHBJ – Agentii hamkorii baynalmilalii Jopon;

– BMI – Barnomai millii immunoprofilaktika;

– VTHIA JT – Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston;

– MD MJTTHS – Muassisai davlatii “Markazi jumhuriyavii tashakkuli tarzi hayoti solim”;

– FMD MJI – filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika”;

– MI – markazi immunoprofilaktika;

– KATS – kumaki avvaliyai tibbiyu sanitari;

– BVI – barnomai vasei immunizatsiya;

– HNBI – holathoi nomatlubi badi immunizatsiya;

– KHBI – Kumitai hamohangsozii baynisohavi oid ba masalahoi immunoprofilaktika;

– VAO – vositahoi akhbori omma;

– AGM – aloimi gulafshoni modarzodi – in siroyatyobii kudak ba gulafshon az modari siroyatyofta;

– FSHS – falaji shadidi sust;

– TAS – tartibi amaliyothoi standarti;

– ISV – idorakunii samaranoki vaksinaho;

– MDM – majmui daromadi milli;

– BSJ – vaksinai ziddi bemorii sil.

  1. Dastovardhoi nazarrasi tandurustii jahoniro dar samti peshgirii bemorihoi siroyatii ba vositai immunizatsiya idorashavanda be istifoda az vaksinahoi hayotan muhim tasavvur kardan dushvor ast. Kashfiyoti vaksina yake az kashfiyothoi muhim va az jihati iqtisodi samaranoki sohai tandurusti dar asri XXI ba hisob meravad, zero bo istifoda az vaksinaho jomeai muosiri jahoni tavonist khudro az shumorai ziyodi bemorihoi siroyatie, ki dar asrhoi guzashta sababi asosii mayubi va margi millionho nafar aholi budand, emin nigoh dorad.
  2. Baroi bomuvaffaqiyat tatbiq namudani barnomai milli, taminoti purra va doimii vaksinaho, inchunin digar mavodi immunizatsioni zarur ast. Baroi qone gardonidani talaboti aholii jumhuri ba vaksinahoi hayotan muhim vaksinaho tavassuti SHubai taminoti Hazinai kudakoni Sozmoni Milali Muttahid kharidori va dastras karda meshavand. Tamomi vaksinahoe, ki baroi immunizatsiya istifoda burda meshavand, boyad bezarar va qobiliyati immunogenii baland doshta boshand, inchunin sertifikati sifat va bekhatarii Sozmoni umumijahonii tandurustiro doro boshand.
  3. Tamin namudani nigohdorii vaksinaho bo rioyai sharoiti zanjiri khunukitaminkunanda hangomi nigohdori va intiqoldihii vaksinaho dar sathi jumhuriyavi, viloyati, nohiyavi va dar sathi muassisahoi kumaki avvaliyai tibbiyu sanitari tajhizoti muosiri zanjiri khunukitaminkunandaro talab menamoyad.
  4. Arzyobii idorakunii samaranoki vaksinaho dar jumhuri, ki az jonibi Hazinai kudakoni Sozmoni Milali Muttahid bo dastgirii Sozmoni umumijahonii tandurusti dar soli 2012 guzaronida shuda bud, nishon dod, ki idorakunii vaksinaho va monitoringi zakhiraho dar mamlakat muvofiqi talabot anjom doda meshavand.
  5. Dar mintaqai Avrupoii Sozmoni umumijahonii tandurusti, ki Jumhurii Tojikiston niz ba on dokhil ast, barnomahoi samaranok hamchun qismi muhimi tashakkuli tandurustii jamiyatiro dar dahsolahoi okhir tashkil medihand.
  6. Dar natijai amaligardonii chunin barnomaho soli 1970 dar miqyosi jahoni nagzaki tabii mahv karda shud va dar soli 2002 mintaqai Avrupoii Sozmoni umumijahonii tandurusti hamchun mintaqai ozod az bemorii falaj elon gardid. Jumhurii Tojikiston niz dar qatori digar davlathoi mintaqai Avrupoii Sozmoni umumijahonii tandurusti sertifikati hamchun davlati ozod az bemorii falajro ba dast ovard.

2. TAHLILI VAZIYAT

  1. Bo maqsadi peshgirii bemorihoi ba vositai immunizatsiya idorashavanda, dar jumhuri bo qarori Hukumati Jumhurii Tojikiston az 30 apreli soli 2011, № 205 Barnomai millii immunoprofilaktika dar Jumhurii Tojikiston baroi solhoi 2011-2015 tasdiq karda shud.
  2. Dar doirai amalisozii Barnomai mazkur sharoit faroham omad, ki omilhoi tasirrasonanda dar samti past shudani sathi farogiri dar shahru nohiyaho muayyan karda shavand.
  3. Maqsadi asosii in Barnoma ba dast ovardani sathi balandi farogirii immunizatsiya, tashkil namudani dastrasii barobar ba immunizatsiya, inchunin behtar namudani istifodai vaksinahoi mavjudbuda va vaksinahoi nav, ba monandi vaksinai ziddi bemorii siroyatii gepatiti V, vaksinai pentavalenti, vaksinai rotavirusi, vaksinai gayrifaolkardashudai ziddi bemorii falaj, ki bo tariqi suzandoru guzaronida meshavad, meboshad.
  4. Az rui hujjathoi rasmii hisoboti omori oid ba immunizatsiya dar Jumhurii Tojikiston davomi dah soli guzashta sathi balandi farogirii immunizatsiya bar ziddi bemorihoi guluzindonak, kabudsulfa, kuzoz, falaj, surkhcha, gulafshon, sil ba dast ovarda shud.
  5. Dar mohi marti soli 2010 virusi yoboii falaj ba Jumhurii Tojikiston vorid gasht, ki sababi khuruji bemorii falaj dar jumhuri gardid. Dar natijai guzaronidani chorabinihoi favri oid ba peshgiri namudani pahnshavii virusi voridshudai falaji yoboi az shimoli Hinduston khuruji bemorii falaj dar mohi iyuli soli 2010 qat gardid. Soli 2011 Jumhurii Tojikiston sertifikati hamchun davlati ozod az bemorii falajro takroran ba dast ovard.
  6. Dar solhoi okhir hodisahoi bemorii falaj ba qayd girifta nashudaast, ki in bevosita sobit menamoyad, ki chorabiniho baroi tasdiqi maqomi jumhuri hamchun davlati ozod az bemorii falaj durust ba roh monda shudaast. Dar barobari in, khatari vorid shudani virusi falaji yoboi ba jumhuri to hol vujud dorad. Gardishi virusi falaji yoboi dar mamlakathoi endemiki, ba monandi Afgoniston, Pokiston va Nigeriya davom dorad.
  7. Dar jumhuri nishondodi indikatorii nazorati epidemiologi az boloi bemorii falaj >2 hodisahoi falaji shadidi sust ba 100000 kudakoni sinni to 15-sola ba dast ovarda shudaast.
  8. Soli 2011 badi se soli ba qayd nagiriftani hodisahoi bemorii surkhcha dar jumhuri hodisai mahallii bemorii surkhcha ba tavri ozmoishgohi tasdiq gardida, ba qayd girifta shud. Dar soli 2012 hamagi 14 hodisahoi bemorii surkhcha ba qayd girifta shuda budand, ki az onho 12 hodisa ba vorid shudani virus az Federatsiyai Rossiya ba mahallahoi lulinishin vobastagi doshtand. Bo sharofati sari vaqt guzaronidani chorabinihoi samaranoki ziddiepidemiki dar mahallahoi lulinishin hangomi vorid shudani hodisahoi surkhcha az Federatsiyai Rossiya, pahnshavii hodisahoi bemori ba digar mintaqahoi jumhuri peshgiri karda shud.
  9. Soli 2013 yak hodisai bemorii surkhcha dar kudaki to 1-solae, ki immunizatsiyaro bar ziddi bemorii surkhcha nagirifta bud, ba tavri ozmoishgohi tasdiq karda shud. Dar soli 2014 hodisai bemorii surkhcha ba qayd girifta nashudaast.
  10. Bo khulosai Komissiyai mintaqavii verifikatsionii Byuroi mintaqavii avrupoii Sozmoni umumijahonii tandurusti soli 2013 dar Jumhurii Tojikiston eliminatsiyai surkhcha ba dast ovarda shud, vale ba in dastovard nigoh nakarda, muassisahoi tibbii jumhuri bo maqsadi ba dast ovardani dalelhoi tasdiqi eliminatsiyai surkhcha boyad hamai tadbirhoro baroi tashkil va guzaronidani sifati balandi sistemai nazorati epidemiologi ba roh monand:

– daryofti ? 2 hodisai ba tavri ozmoishgohi manfi ba bemorii surkhcha dar mintaqahoi bo 100000 nafar aholi, inchunin dar mintaqahoi aholinishini bo shumorai kamtari aholi muvofiqi nishondodhoi ba on munosib;

– farogirii immunizatsiya bo 2 voyai vaksinai surkhcha – gulafshon ? 95% dar hamai sathho (jumhuriyavi, viloyati, shahri, nohiyavi, muassisahoi tibbi va mintaqahoi tibbi).

  1. Jumhurii Tojikiston dar solhoi 2011, 2013 va 2014 az bemorii gulafshon ozod bud. Soli 2012 1 hodisai bemorii gulafshon ba tavri ozmoishgohi tasdiq karda shuda bud.
  2. Nishondodhoi indikatori (daryofti hodisaho bo istifoda az tahlilhoi ozmoishgohi na kamtar az ?2 hodisa dar 100000 aholi, baqaydgirii hodisahoi ba tavri ozmoishgohi manfi na kam az 80% dar mintaqahoi mamurii jumhuri bo 100000 nafar aholi) hamchun isboti eliminatsiyai virusi mahallii gulafshon ba dast ovarda nashud.
  3. Nazorati epidemiologi az boloi bemorii gulafshon dar yakjoyagi bo nazorati epidemiologi az boloi surkhcha guzaronida meshavad va chun peshina takmildihii minbadaro bo istifoda az tashkhisi ozmoishgohii tamomi bemorone, ki donachahoi ba bemorii gulafshon monandi dorand, talab mekunad. Nazorati epidemiologi az rui bemorii gulafshon pesh az hama baroi peshgirii aloimi gulafshoni modarzodi peshbini shudaast, ki on dar jumhuri az soli 2000 to in zamon umuman ba qayd girifta nashudaast.
  4. Az soli 2010 to soli 2014 har sol pastshavii daryofti shumorai gumonbarshudagon ba bemorii gulafshon ba nazar merasad. Hamagi dar solhoi 2010 – 56 hodisa, 2011-2012 – 20 hodisa, 2013 – 30 hodisa va 2014 – 6 hodisahoi gumonbarshuda ba bemorii gulafshon oshkor karda shudaast. Nishondodi hodisahoi ba tavri ozmoishgohi manfi ba bemorii gulafshon az 0,3 ziyod nameshavad, hol on, ki boyad 1 hodisa ba 100000 aholi barobar boshad.
  5. Jumhurii Tojikiston muvofiqi hisoboti rasmii omori “Dar borai baqaydgirii bemorihoi siroyati va paraziti” az soli 2008 to soli 2015 hamchun davlati ozod az bemorii guluzindonak ba hisob meravad.
  6. Ammo ba qayd nagiriftani hodisahoi bemorii guluzindonak ba isboti tasirnopazirii balandi aholi nisbat ba in bemori taqviyat doda nashudaast, chunki immunizatsiyai naqshavi dar bayni aholii sinnashon 16, 26, 36, 46 va 56 – sola bo sababi narasidani mablagho guzaronida nameshavad, ki in ba past shudani masuniyati aholi ba in bemori ovarda merasonad.
  7. Dar solhoi 2011-2015 yagon hodisai ehtimolii bemorii guluzindonak ba qayd girifta nashudast, ammo az ehtimol dur nest, ki yagon hodisahoi nishonahoi kliniki doshta ba guluzindonak ba nazar girifta nashuda boshad.
  8. Nazorati epidemiologi az boloi bemorii guluzindonak dar hambastagi bo nazorati epidemiologi az boloi falaji shadidi sust, surkhcha va gulafshon burda meshavad, ki in takmildihiro talab mekunad.
  9. Baroi nigoh doshtani dastovardho va amalisozii maqsadu vazifahoi dar pesh guzoshtashuda dar samti nigoh doshtani maqomi Jumhurii Tojikiston hamchun davlati ozod az bemoriii falaj, eliminatsiyai surkhcha, gulafshon va muboriza bar ziddi digar bemorihoi ba vositai immunizatsiya idorashavanda boyad tamomi quvvatro jihati mukammal namudani sistemai munazzami tandurusti dar majmu ba kor andokhta shavad, ki in zarurati tahiyai Barnomai navi millii immunoprofilaktikaro ba miyon meorad.

3. MAQSADI BARNOMA

  1. Barnomai mazkur baroi tamini amniyati sanitariyu epidemiologii aholii kishvar, peshgirii paydoish va pahnshavii bemorihoi siroyatii ba vositai immunizatsiya idorashavanda, az bayn burdani khatari takrorshavii khuruji bemorii falaj dar Jumhurii Tojikiston, ustuvor nigoh doshtani maqomi davlati ozod az bemorii falaj, baland bardoshtani dastrasi, sifatnoki va samaranokii khizmatrasonihoi tibbi, behtar namudani salomatii modar va kudak, purzur namudani kumaki avvaliyai tibbiyu sanitari dar jumhuri ravona karda shudaast.

4. VAZIFAHOI BARNOMA

  1. Vazifahoi Barnoma az inho iborat ast:

– nigoh doshtani maqomi Jumhurii Tojikiston hamchun davlati ozod az bemorii falaj (peshgirii vorid shudani virusi yoboii falaj az khoriji kishvar) to soli 2020;

– eliminatsiyai surkhcha (peshgirii gardishi virusi mahallii surkhcha) to soli 2020;

– eliminatsiyai gulafshon (peshgirii gardishi virusi mahallii gulafshon) to soli 2020;

– peshgirii aloimi gulafshoni modarzodi, ba dast ovardani nishondodi ?1 hodisa ba 100000 kudakoni zinda tavalludshuda to soli 2020;

– roh nadodan ba hodisahoi kuzozi navzodon to soli 2020;

– noil shudan ba nishondodi pahnshavii hodisahoi bemorii guluzindonak kamtar az 0,1 ba 100000 aholi to soli 2020;

– kabudsulfa kamtar az 1 hodisa ba 100000 aholi to soli 2020;

– nazorati epidemiologii siroyatyobii gepatiti V. Korkardi naqshai chorabiniho oid ba muboriza bar ziddi gepatiti V muvofiqi tavsiyai “Naqshai amalii Avrupoii Sozmoni umumijahonii tandurusti vobasta ba vaksina dar solhoi 2015-2020” to soli 2017;

– roh nadodan ba khatogihoi kormandoni tib, ki ba holathoi nomatlubi badi immunizatsiya ovarda merasonand, to soli 2020;

– vase namudani qismhoi immunologiya va immunoprofilaktika dar jumhuri, dar naqshahoi talimii tahsiloti tibbii muassisahoi davlatii talimii “Donishgohi davlatii tibbii Tojikiston ba nomi Abuali ibni Sino”, “Donishgohi davlatii tibbii Hatlon” va “Donishkadai tahsiloti badidiplomii kormandoni sohai tandurustii Jumhurii Tojikiston” to soli 2018;

– korkard va dar amal jori namudani barnomahoi talimi baroi kormandoni tib oid ba masalahoi immunoprofilaktika az soli 2017.

  1. Baroi noil shudan ba maqsad va vazifaho strategiyahoi asosi istifoda burda shavand:

– noil shudan ba sathi balandi masuliyati milli baroi tamini ehtiyojoti kishvar bo kormandoni balandikhtisosi tib va zakhirahoi moddii zaruri baroi halli masalahoi dar pesh guzoshtashuda;

– noil shudan ba balandshavi va ustuvor nigoh doshtani sathi balandi farogirii immunizatsiyai naqshavi (?95%) bo panj voyai vaksinai ziddi falaj, du voyai vaksinai surkhcha – gulafshon, chor voyai vaksinai gepatiti V dar muhlathoi muayyanshuda muvofiqi taqvimi millii immunizatsiya, ki az tarafi Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston tasdiq shudaast;

– immunizatsiyai nopurrai kudakoni sinni to 1-sola az soli 2016 to soli 2020 bo voyahoi vaksinai ziddi bemorihoi guluzindonak, kabudsulfa va kuzoz 1 – vaksinai ziddi bemorihoi guluzindonak, kabudsulfa va kuzoz 3, vaksinai dahonii bemorii falaj 1vaksinai dahonii bemorii falaj 3 boyad dar hamai shabakahoi muassisahoi kumaki avvaliyai tibbiyu sanitari na besh az 5 %-ro tashkil dihad;

– ustuvor namudani barnomahoi immunizatsiyai naqshavi bar ziddi bemorihoi ba vositai immunizatsiya idorashavanda, bo rohi taqviyati juzhoi asosii infrasokhtori mavjudbudai immunoprofilaktika;

– baland bardoshtani bekhatari va samaranokii immunizatsiya;

– korkardi sistemai monitoringi farogirii immunizatsiya bo maqsadi kam kardani shumorai kudakone, ki kursi purrai immunizatsiyaro ba anjom narasonidaand;

– kam kardani sathi imkoniyathoi az dast doda va shumorai ziddi nishondodhoi beasos baroi immunizatsiya;

– talimi ilovagii mutakhassison va rushdi sistemai ittilooti, inchunin korkardi mavodi talimi va robita bo jomea;

– istifodai chorabinihoi ilovagii immunizatsioni (immunizatsiyai mahdud dar manbahoi bemorihoi siroyati);

– taqviyati nizomi nazorati epidemiologi az rui bemorihoi ba vositai immunizatsiya idorashavanda bo rohi guzaronidani taftishoti mukammal va bo tasdiqi ozmoishgohii tamomi hodisahoi gumonbarshuda;

– vorid namudani nazorati epidemiologi az rui holathoi nomatlubi badi immunizatsiya dar barnomai talimii kormandoni shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari oid ba nazorati epidemiologi az boloi bemorihoi ba vositai immunizatsiya idorashavanda;

– behtar namudani dastrasi ba malumoti sifatnok va daqiq oid ba manfiat va khatarho, vobasta ba immunizatsiyai bemorihoi siroyatii ba vositai immunizatsiya idorashavanda, baroi kormandoni sohai tandurusti va aholi, dar yakjoyagi bo kormandoni sohai maorif, peshvoyoni din, vositahoi akhbori omma, shabakahoi ijtimoi, tabiboni oilavi, kormandoni miyonai tib va faoloni kasbii omuzonidashuda dar sohai tandurusti;

– guzaronidani monitoring va bahodihii samthoi asosii Barnoma.

5. TASHKILI KORGUZORII HIZMATRASONII IMMUNIZATSIONi VA UHDADORIHO

  1. Barnomaro dar jumhuri vaziri tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston sarvari mekunad. Tamini hamohangsozii Barnoma dar sathi jumhuriyavi ba zimmai muovini yakumi vazir, muovini vazir – sardukhturi davlatii sanitari guzoshta shudaast. Idorakunii barnomai immunizatsiyaro rayosathoi tashkili khizmatrasonii tibbi ba modaronu kudak va tanzimi oila, islohot, kumaki avvaliyai tibbiyu sanitari va robitahoi baynalmilali, amniyati sanitariyu epidemiologi, holathoi favquloda va kumaki favrii tibbi amali menamoyand.
  2. Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” masuli asosi baroi amalisozii tamomi samthoi Barnoma ba hisob rafta, vazifahoi zerinro ijro menamoyad: yorii tashkiliyu dasturi, khamohangsozii amalhoi khizmatrasonihoi tibbi oid ba banaqshagiri, tashkilkuni, amalisozii chorabinihoi Barnoma, jamovari va tahlili malumot doir ba samthoi asosii Barnoma. Dar sathi viloyati idorakunii Barnoma ba zimmai sardoroni rayosathoi tandurustii viloyati va dar sathhoi shahrivu nohiyavi ba zimmai menejeroni shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari va sartabiboni bemorkhonahoi markazi guzoshta meshavad.
  3. Dar Viloyati Mukhtori Kuhistoni Badakhshon, mintaqahoi Qurgonteppa va Kulobi viloyati Hatlon, viloyati Sugd, shahri Dushanbe va nohiyahoi vodii Rasht, idorakunii tashkili – dasturi ba zimmai filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” va dar shahru nohiyahoi tobei jumhuri ba zimmai Markazi immunoprofilaktika guzoshta shudaand.
  4. Baroi amalisozii Barnoma, shabakai mavjudbudai Markazi immunoprofilaktika, markazhoi nazorati davlatii sanitariyu epidemiologi, shabakahoi muassisahoi kumaki avvaliyai tibbiyu sanitari, tavalludkhonaho va shubahoi tavalludi shahru nohiyaho istifoda burda meshavand. Dar jumhuri, dar majmu ziyoda az 3000 muassisahoi tibbi, az jumla tavalludkhonaho va shubahoi tavallud bo immunizatsiya mashguland. Dar tavalludkhonaho va shubahoi tavallud bar ziddi bemorihoi falaj, sil va gepatiti V immunizatsiya guzaronida meshavad.
  5. Immunizatsiya yake az khizmatrasonihoi asosii shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari ba hisob rafta, majmui asosii faoliyati khudro dar samti immunizatsiyai kudakon, navrason va kalonsolon amali megardonad. Dar shahrho immunizatsiya az jonibi markazhoi salomatii shahri, markazhoi tibbi oilavi, tavalludkhonaho va shubahoi tavallud, dar dehot az jonibi markazhoi salomatii dehot va bungohhoi salomati guzaronda meshavad. Baroi immunizatsiyai mintaqahoi durdasti aholinishin guruhhoi sayyor va mobili az hisobi kormandoni tibbi shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari va bemorkhonahoi markazii nohiyavi tashkil karda meshavand.
  6. Ba muassisahoi dar bolo qaydgardida uhdadorihoi zerin guzoshta meshavand:

– tartibdihii naqshai immunizatsiyai kudakon muvofiqi farmoishi tasdiqshudai Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston az 7 avgusti soli 2014, № 643 “Dar borai takmildihii sistemai peshgirii bemorihoi bo vaksina idorashavanda”;

– bahisobgirii miqdori zarurii tamomi namudi vaksinahoi baroi farogirii immunizatsiyai guruhi maqsadnok peshbinishuda bo darnazardoshti zakhirai onho;

– rioyai qatii usulhoi bekhatar guzaronidani immunizatsiya;

– bahisobgirii immunizatsiya (daftari qaydi immunizatsiya), tarikhi inkishofyobii kudak (shakli 112), korti qaydi immunizatsiyai kudak (shakli 63), shinosnomai immunizatsiyai kudak va tayyor namudani hujjathoi bahisobgiri – hisobot oid ba immunizatsiya va bahisobgirii vaksinaho (shakli 2);

– nazorat va bahisobgirii holathoi nomatlubi badi immunizatsiya;

– rioyai qatii tartibi amaliyothoi standarti oid ba zanjiri khunukitaminkunanda;

– istifodai oqilona, nazorati daromadu kharojoti vaksinaho, suzandoruho va quttiho baroi bekhavf mahv namudani mavodi tazriqii istifodashuda (daftari nazorati vaksinaho, suzandoruho va quttihoi mahvi bekhatar);

– tamini sistemai paygiri az rui kudakone, ki immunizatsiyaro ba purragi nagiriftaand (yane voyai vaksinai navbatiro sari vaqt qabul nakardaand);

– asosnokkunii ziddi nishondodho, guzaronidani immunizatsiyahoi peshgirikunanda va tahlili ziddi nishondodhoi mavjudbuda;

– farogirii balandi immunizatsiyai kudakon dar soli avvali hayotashon;

– guzaronidani tahlili harmohai ijroi naqshai immunizatsiyai solona, mohona, imkoniyathoi azdastdodashuda bo tartibdihii diagrammahoi monitoringi immunizatsiya va immunizatsiyai ba itmom norasonida;

– bahodihii muntazami sathi dastrasi (sathi farogirii immunizatsiyai kudakoni to 1-sola (?95%)) va samaranokii (immunizatsiyai ba itmom norasonida (?5%)) khizmatrasonii sohai immunoprofilaktika;

– muhokima namudani masalahoi immunoprofilaktika dar shuroi tibbii shahru nohiyahoi jumhuri.

  1. Tashkil kardan va baland bardoshtani sathi farogirii immunizatsiya:

a) vazifa – baland bardoshtani sathi dastrasi va samaranokii immunizatsiya baroi har yak kudak, past kardani imkoniyathoi azdastdoda va immunizatsiyai ba itmom norasonida, dar on khusus, ki yagon kudak be asos immunizatsiya nogirifta namonad;

b) strategiya – noil shudan va dar sathi baland nigoh doshtani farogirii immunizatsiya baroi kudakoni sinnu soli to 1-sola va immunizatsiyai takrori (?95%) muvofiqi vazifaho oid ba sathi farogirii immunizatsiya (zamimai 1);

v) guzarondani immunizatsiyai naqshavi bo istifoda az:

– sessiyahoi doimi;

– sessiyahoi sayyor;

– tashkil namudani brigadahoi mobili bo istifoda az manbahoi ilovagii mahalli baroi naqliyot va suzishvori;

g) taqvimi millii immunizatsiya – hujjatest, ki muhlat va tartiboti ba aholi guzarondani immunizatsiyaro muqarrar mekunad (zamimai 2);

g) baroi tashkili korguzorii immunizatsiya, ahamiyati avvalindaraja ba durust va purra baqaydgirii tamomi kudakone, ki dar in hudud zindagi mekunand, mavjudiyagi hujjatho baroi har yak kudak, baqaydgirii aniqi kudakone, ki immunizatsiya giriftaand va onhoe, ki immunizatsiyaro muvofiqi muhlathoi dar taqvim peshbinishuda nagiriftaand, doda meshavad. Hamai shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari boyad naqshai immunizatsiyai kudakonro doshta boshand;

d) dar naqsha malumoti raqami oid ba shumorai aholi, miqdori vaksinahoi zaruri, chorabiniho va manbahoi lozima baroi guzarondani immunizatsiyai naqshavi boyad nishon doda shavad. Diqqati makhsus boyad ba purragii sathi farogirii immunizatsiya dar bayni guruhhoi osebpazir (mahallahoi dushvorguzar, bo aqalliyathoi etniki, geografi, bo kormandoni tib tamin nabudani baze az muassisahoi tibbii durdast, mahallahoi lulinishin) doda shavad:

– taqviyat dodani siyosati Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston oid ba bartaraf namudani ziddi nishondodhoi beasos va kafolat dodani on, ki tanho kormandoni tibbi shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari metavonand khulosai okhironro oid ba nishondodhoi zid dihand;

– bo maqsadi daryofti mushkiloti vobasta ba dastrasi va past budani samaranokii khizmatrasonihoi immunizatsioni va muayyan namudani hududhoe, ki ba chorahoi avvalindaraja niyoz dorand, inchunin andeshidani choraho baroi bartaraf namudani onho, dar sathi har yak muassisai tibbii shahru nohiya, viloyat va jumhuri, “Tahlili miqdorii malumot” jori karda shavad.

  1. Vaksinaho:

a) dar majmu, tamomi khizmatrasonihoi immunoprofilaktika dar hududi jumhuri dar doirai barnomahoi davlati roygon guzaronida meshavand:

– tashkil namudani taminot bo vaksinaho va mavodi immunizatsioni, bartariyati muhimi barnoma ba hisob meravad;

– dastraskunii vaksinahoe, ki baroi amaligardonii barnomai milli lozimand, Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” ba vositai filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” va Markazi immunoprofilaktika dar shahru nohiyahoi tobei jumhuri buda, tamomi muassisahoi tibbii jumhuriro tamin menamoyad. Tamomi vaksinaho az jonibi SHubai taminoti Hazinai kudakoni Sozmoni Milali Muttahid dar shahri Kopengageni SHohigarii Daniya joygir buda, baroi Jumhurii Tojikiston bo darkhosti Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” kharidori karda meshavand;

– baroi bomuvaffaqiyat amalisozii Barnoma, taminoti purra va doimii vaksinaho va digar mavodi immunizatsioni lozim ast;

b) talabot ba vaksinaho – tamomi vaksinahoe, ki baroi immunizatsiya istifoda burda meshavand, boyad bezarar, qobiliyati immunogenii baland doshta, doroi sertifikati sifati mutobiqati talaboti baynalmilali ba mavodi immunobiologiro doshta boshand:

– vaksinahoe, ki az jonibi SHubai taminoti Hazinai kudakoni Sozmoni Milali Muttahid baroi ijroi maqsadhoi barnomai vasei immunizatsiya dar Tojikiston kharidori karda meshavand, sifati bovarii komilro doro meboshand. Tamomi vaksinahoe, ki tavassuti sistemai Sozmoni Milali Muttahid kharidori karda meshavand, doroi sertifikati Sozmoni umumijahonii tandurusti meboshand;

– ba tamomi vaksinahoe, ki ba jumhuri vorid meshavand, az tarafi Hadamoti nazorati davlatii faoliyati farmasevti sertifikati mutobiqat doda meshavad;

– arzyobii idorakunii samaranoki vaksinaho dar jumhuri, ki az jonibi Hazinai kudakoni Sozmoni Milali Muttahid bo dastgirii Sozmoni umumijahonii tandurusti dar soli 2012 guzaronida shuda bud, nishon dod, ki idorakunii vaksinaho va monitoringi zakhiraho dar jumhuri muvofiqi talabot amali karda meshavad;

v) vazifa – baland bardoshtani idorakunii samaranoki vaksinaho va idorakunii sifat;

g) qismi asosii sistemai idorakunii samaranoki vaksinaho va idorakunii sifatro tartibi amaliyothoi standarti tashkil medihad, ki az tarafi Sozmoni umumijahonii tandurusti tavsiya karda shudaast;

g) bo maqsadi tamin namudani idorakunii samaranoki vaksinaho va nazorati sifat dar soli 2015 Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika” dar yakjoyagi bo Hazinai kudakoni Sozmoni Milali Muttahid, tartibi amaliyothoi standartiro korkard namudand, ki dar nuh meyor (qabuli vaksinaho, monitoringi harorat, hajmi nigohdori, bino, tajhizot va naqliyot, khizmatrasonii tekhniki va tamir, nazorati zakhiraho, taqsimot, borbandii yakhdonhoi sayyor, idorakunii vaksinaho va idorakunii barnomavii umumi) ba sharoiti milli mutobiq karda, ba filiali Muassisai davlatii “Markazi jumhuriyavii immunoprofilaktika”, Markazi immunoprofilaktika, shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari, bemorkhonaho va rohbaroni sohai immunoprofilaktika baroi dar amal tatbiq namudan peshnihod karda shudand.

  1. Zanjiri khunukitaminkunanda juzi muhimi immunoprofilaktika ba hisob meravad, zero hamai vaksinaho bo mururi vaqt, makhsusan hangomi tasiri garmi va bazei onho bo sababi tasiri yakhbandi, faoliyati khudro gum mekunand:

a) vazifa – rioyai qatii talaboti vaksinaho dar hama marhilaho, hangomi intiqoldihi, nigohdori dar yakhdon yo dar khonayakhdon, inchunin hangomi istifodabarii on dar vaqti guzarondani immunizatsiya dar muassisahoi tibbi;

b) strategiyaho – tashkil namudani zanjiri khunukitaminkunanda, ki se juzi muhimro dar bar megirad:

– mutakhassisi omuzonidashuda, ki bevosita bo tajhizoti khunukitaminkunanda kor mekunad;

– taminot bo tajhizoti khunukitaminkunanda baroi nigohdori va intiqoldikhii vaksinaho;

– amali namudani tartibi nazorat az rui taqsimot va istifodabarii vaksinaho;

v) baroi tamin namudani zanjiri khunukitaminkunanda dar solhoi 2016-2020:

– idoma dodani bozomuzii mutakhassison dar tamomi sathho oid ba tartibi amaliyothoi standarti doir ba tajhizoti zanjiri khunukitaminkunanda;

– dar sathi anbori markazi va anborhoi viloyati vaksinai dahonii ziddi bemorii falaj (VDBF) dar harorati -15 -25 S°  nigoh doshta meshavand (harorati muvofiq baroi nigohdorii vaksinahoi digar +2+8 S° );

– dar markazhoi immunoprofilaktikai shahru nohiyaho va muassisahoi tibbiyu profilaktiki nigohdori va intiqoli tamomi vaksinaho dar harorati +2 +8  S°  tamin karda shavad;

– muqarrar namudani hisoboti muntazam oid ba mavjudiyat va holati tekhnikii tajhizoti khunukitaminkunanda;

– banaqshagirii khizmatrasonii tekhnikii tajhizoti khunukitaminkunanda va tamiri onho, dastur dodani mutakhassisone, ki bo in tajhizot kor mekunand;

– vobasta namudani maqomoti ijroiyai mahallii hokimiyati davlatii shahru nohiyahoi jumhuri baroi dastgirii ilovagii kharidorii tajhizoti zanjiri khunukitaminkunanda ba muassisahoi tibbii dakhldor (zamimai 3);

– tamin namudani ijroi tartibi amaliyothoi standarti oid ba tajhizoti zanjiri khunukitaminkunanda;

– dar tamomi muassisahoi tibbie, ki vaksinaho nigoh doshta meshavand, “Naqshai chorabinihoi favri dar holati rukh dodani holathoi favqulodda”, ki metavonad ba bekhatarii vaksinaho tasir rasonand, tartib doda shavad.

  1. Immunizatsiyai bekhatar boyad dar hama jo, tibqi siyosati milli va peshnihodhoi Sozmoni umumijahonii tandurusti, bo rioyai qoidahoi asosii bekhatari, guzaronida shavad:

– dar joi tozai makhsus judokardashuda (aqallan dar mizi alohida);

– dar jarayoni omodashavi va guzaronidani immunizatsiya ba suzan boyad dast narasonand, inchunin ba ruypushhoi tamyiznabuda suzan boyad narasad;

– baroi toza kardani joi immunizatsiya, tanho pakhtai tamyizyofta istifoda burda shavad;

– vaksinaro tanho hamon vaqte, ki kudak ba immunizatsiya tayyor meboshad ba suzandoru giriftan lozim ast;

– dar davomi sessiyai immunizatsioni vaksina boyad dar zeri qabati porolonii juzvdoni harorati (termosumka) nigoh doshta shavad;

– vaksinahoi zinda boyad tanho bo halkunandahoi hamon istehsolkunandai vaksina hal karda shavand;

– vaksinahoi zinda (vaksinai ziddi bemorii sil (BSJ), surkhchagulafshon) badi halkuniashon tanho dar davomi shash soat boyad istifoda burda shavand;

– zarfhoi bo vaksinahoi halshuda az nurhoi oftob himoya karda shavand;

– voyai purrai vaksinaro boyad ba joyi muayyanshuda va ba tavri durust vorid kard (kitf, roni poy, zeri pust, dokhili pust, dokhili mushak);

– talafi vaksinaho muvofiqi tavsiyahoi Sozmoni umumijahonii tandurusti boyad ba inobat girifta shavad (zamimai 4).

  1. Monitoring va bahodihi:

– monitoring – in nazorati muntazam az rui nishondodhoi “indikatori”-i az tarafi Sozmoni umumijahonii tandurusti tavsiyadodashuda meboshad, ki imkoniyati bahodihii sifat va samaranokii ijroi samthoi asosii Barnomaro amali megardonad;

– monitoringi muntazam va bahodihii samthoi asosii Barnoma baroi oshkor namudani on qismhoe, ki ba takmildihi niyoz dorand, zarur meboshad, inchunin baroi dastras namudani malumote, ki muvofiq va sifatnok budani malumoti peshnihodgardidaro tasdiq mekunad;

– in makhsusan baroi bahodihii maqsad va vazifahoi dar Barnoma guzoshtashuda oid ba past va mahv namudani bemorihoi siroyatii peshgirishavanda to soli 2020 muhim ast;

– monitoring, tahlili farogirii immunizatsiya va nazorati epidemiologi az rui bemorihoi ba vositai immunizatsiya idorashavanda, boyad dar sathi hamai mintaqahoi mamuri va muassisahoi tibbi amali gardonida shavad (kumaki avvaliyai tibbiyu sanitari, sokhtori gospitali, rayosathoi tandurustii viloyatho, shahrho va dar sathi jumhuri). Sistemai monitoringi boetimod dar bar megirad: farogirii immunizatsiya, sifat va bekhatarii vaksinaho, tazriqhoi bekhatar, zanjiri khunukitaminkunanda va nazorati epidemiologi az boloi holathoi nomatlubi badi immunizatsiya;

– ilova ba monitoringi naqshavi, meboyad tahlili amiqi davrii sistemai immunoprofilaktika va nazorati epidemiologiro az rui bemorihoi siroyatii ba vositai immunizatsiya idorashavanda guzarond, ki in imkoniyati bahodihii sifatnoki, purragi, qobili istifoda budan va samaranokii onro faroham meovarad;

– maqomoti ijroiyai mahallii hokimiyati davlatii shahru nohiyahoi jumhuri guruhhoi monitoringiro baroi guzaronidani monitoringhoi muntazami faoliyati sohai immunoprofilaktika dar muassisahoi tibbii dakhldor, bo vositahoi naqliyot va suzishvori tamin namoyand.

6. NAZORATI EPIDEMIOLOGi

  1. Dar jumhuri ba sistemai nazorati epidemiologi az rui bemorihoi ba vositai immunizatsiya idorashavanda hamai muassisahoi tibbii ambulatori va statsionarie, ki aholi metavonad murojiat kunad, vorid shudaand. Baroi faoliyati bosamari in sistema, hamohangii daqiqi doimii bayni onho boyad ba roh monda shuda boshad.
  2. Maqsadi faoliyati sistemai nazorati epidemiologi dar marhilai mahv namudani bemorii falaj, eliminatsiyai surkhcha, gulafshon, kuzozi navzodon – in baqaydgirii har yak hodisa meboshad.
  3. Ayni zamon dar Jumhurii Tojikiston bo maqsadi az dast nadodani yagon hodisai bemori, justujui faoli hodisaho bo rohi tashrifi harhaftaina ba muassisahoi tibbii tahti nazoratbuda, ki aksar vaqt bemoron baroi muoina va muayyan namudani bemorihoe, ki alomathoi monand dorand, murojiat mekunand, nazorati epidemiologi burda meshavad.
  4. Nazorati epidemiologi az rui surkhcha, gulafshon, aloimi gulafshoni modarzodi, guluzindonak, holathoi nomatlubi badi immunizatsiya dar hambastagi bo nazorati epidemiologii falaji shadidi sust burda meshavad.
  5. Nazorati faoli epidemiologi – in strategiyae meboshad, ki baroi “faolona oshkor namudani hodisahoi bemorihoi bo vositai immunizatsiya idorashavanda va jam namudani malumot az tarafi kormandoni tibbe, ki muntazam ba muassisahoi tibbi tashrif meorand” (ba joi “gayrifaolona” intizor shudani hisoboti chunin hodisaho) ba roh monda shudaast.
  6. Faoliyati sistemai nazorati epidemiologi:

– istifodabarii muqarraroti standartii muayyan namudani hodisaho, ki az tarafi Byuroi mintaqavii avrupoii Sozmoni umumijahonii tandurusti korkard shudaast;

– oshkor kardani hodisaho;

– baqaydgiri va bahisobgiri;

– rasonidani khabarnoma oid ba daryofti hodisaho ba idorahoi bolomaqom dar muddati ?24 soat;

– guzaronidani taftishoti epidemiologii daqiq dar muddati ?48 soat az lahzai daryoft bo pur namudani shakli taftishoti;

– giriftani mavod baroi tashkhisi ozmoishgohi va intiqoli on ba tashkhisgoh;

– guzaronidani tahlili ozmoishgohi dar ozmoishgohhoi bovaribakhshi Sozmoni umumijahonii tandurusti;

– tahti nazorat giriftani bemoron bo falaji shadidi sust, surkhcha, gulafshon, guluzindonak, holathoi nomatlubi badi immunizatsiya; – chorabinihoi ziddiepidemiki dar manbai bemori, immunizatsiyai mahdud dar mahallahoi aholinishin;

– purragi va sarivaqtii khabarnomahoi “sifri”-i haftaina bo hisoboti mohona;

– farogirii immunizatsiya sol ba sol, dar mintaqahoi mamuri, muassisahoi tibbi;

– immunizatsiyai ba itmom norasida dar mintaqahoi mamuri, muassisahoi tibbi, sol ba sol;

– shumorai hodisaho va nishondodhoi bemoriho muvofiqi sinnu sol, jins va vazi immunizatsioni;

– nazorat va tahlili nishondodhoi standartii sifatnokii nazorati epidemiologi, ki az tarafi Sozmoni umumijahonii tandurusti tavsiya shudaast, bo qabul namudani qarorhoi mushakhass;

– omuzonidani kormandoni tamomi sathho oid ba masalahoi nazorati epidemiologi;

– nigoh doshtani aloqa bo mutakhassisone, ki malumoti avvalaro peshnihod menamoyand.

7. VORIDKUNII VAKSINAHOI NAV

  1. Az davrai tashkilyobii barnomai vasei immunizatsiya dar soli 1974 millionho hodisahoi favt, mayubi, ki sababgorashon shash adad bemorihoi maqsadnoki barnomai vasei immunizatsiya budand, peshgiri karda shudaand (sil, guluzindonak, kuzoz, kabudsulfa, falaj va surkhcha). Ayni hol, vaksinaho bar ziddi digar bemorihoi siroyati niz istehsol meshavand, ki baroi tandurustii jamiyati dar miqyosi jahoni yo dar yak qator mintaqahoi jahon afzaliyatnok ba hisob meravand.
  2. Dar Jumhurii Tojikiston az soli 2002 sar karda vaksinai gepatiti V, soli 2008 – vaksinai pentavalenti, soli 2009 – vaksinai surkhcha-gulafshon va az soli 2015 vaksinai rotavirusi ba Taqvimi millii immunoprofilaktika vorid karda shudand.
  3. Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston bo maqsadi amali gardonidani strategiyai Sozmoni Milali Muttahid “Hadafhoi rushdi hazorsola” dar davomi solhoi 2016-2020 dar qatori vaksinahoi mavjudbuda maqsadi vorid namudani digar vaksinahoi navro dorad:

a) az soli 2017 dar jumhuri az nav jori namudani immunizatsiya dar bayni:

– navrason va kalonsolon bar ziddi guluzindonak va kuzoz bo anatoksini vaksinai ziddi bemorihoi guluzindonak va kuzoz bo miqdori kamtarini antigenho;

– zanhoi homila bar ziddi kuzoz bo anatoksini bar ziddi bemorii kuzoz;

b) ivaz namudani vaksinai surkhcha – gulafshon ba vaksinai surkhchaparotit-gulafshon;

v) az soli 2017-um vorid namudani vaksinai gayrifaolkardashudai ziddi bemorii falaj, ki bo tariqi suzandoru guzaronida meshavad;

g) vorid namudani vaksinai pnevmokokki az soli 2018;

g) vorid namudani vaksinai ziddi saratoni gardanaki bachadon az soli 2020.

8. SAFARBARKUNII IJTIMOi

  1. Strategiyahoi asosi – in tahiyai mavodi ittilootiyu talimi baroi kormandoni tib va aholi meboshand.
  2. Baroi noil shudan ba strategiyaho:

– behtar namudani dastrasi ba ittilooti etimodnok oid ba bartariho va khatarhoi immunizatsiya bar ziddi bemorihoi siroyatii ba vositai immunizatsiya idorashavanda baroi kormandoni tib va aholi;

– davom dodani omuzishi kormandoni tib oid ba muoshirati bayni shakhsiyatho;

– vase istifoda burdani iqtidori ruznomanigoron baroi bayon namudani masalahoi immunizatsiyai naqshavi;

– vorid namudani darshoi omuzishi dar sathi kumaki avvaliyai tibbiyu sanitari va tamin namudani vaqti kofi baroi fahmondadihii oilahoe, ki kudakonashonro ba immunizatsiya meorand;

– Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston boyad chorahoro oid ba ziyod namudani barnomahoi targiboti dar borai mohiyati immunizatsiya va bekhatarii vaksinaho bo istifoda az vositahoi akhbori omma (televizion, radio va internet) biandeshad;

– Muassisai davlatii “Markazi jumhuriyavii tashakkuli tarzi hayoti solim” – peshgirii bemorihoi siroyatii ba vositai immunizatsiya idorashavandaro dar faoliyati khud hamchun yake az afzaliyati asosii kori khud dokhil namoyad.

9. HAMKORIHOI BAYNALMILALi

  1. Bo maqsadi boz ham behtar namudani khizmatrasonii immunizatsiya, Kumitai hamohangsozii baynisohavi oid ba masalahoi immunoprofilaktika boyad tibqi tartibi muqarrargardida kori khudro bo tashkilothoi baynalmilali (Sozmoni umumijahonii tandurusti, Hazinai kudakoni Sozmoni Milali Muttahid, Alyansi globalii vaksinaho va immunizatsiya, Agentii hamkorii baynalmilalii Jopon, Agentii rushdi baynalmilalii Iyoloti Muttahidai Amriko va digar donorho) baroi dastgirii minbadai Barnoma tibqi muqarraroti qonunguzori davom dihad.
  2. Justujui sharikoni nav baroi musoidat namudan jihati amalisozii Barnoma.

10. MABLAGGUZORII BARNOMA

  1. Dar Jumhurii Tojikiston immunizatsiya hamchun Barnomai afzaliyatnoki sohai tandurusti ba hisob meravad. To soli 2005 jumhuri dar masalai taminot bo vaksinaho va mavodi immunizatsioni – hamchun davlati az donorho vobasta ba hisob meraft. Az soli 2005 Hukumati Jumhurii Tojikiston judo kardani mablagro baroi kharidi vaksinaho va digar mavodhoi immunizatsioni ogoz namud. Az on vaqt sar karda, hissai mablagguzorii Hukumati Jumhurii Tojikiston baroi sohai immunoprofilaktika harsola ziyod shuda istodaast.
  2. Barnoma dar doirai mablaghoe, ki dar bujeti sohai tandurusti baroi immunizatsiya peshbini shudaand va tashkilothoi baynalmilalie, ki dar samti peshgirii bemorihoi siroyatii bo vositai immunizatsiya idorashavanda faoliyat mekunand, mablagguzori karda meshavad: tamin namudani kharidorii vaksinaho va mavodi immunizatsioni, tajhizoti khunukitaminkunanda, nazorat az rui bemorihoi siroyati, omuzish va gayra. Baroi amali gardonidani Barnoma va qone gardonidani talaboti Jumhurii Tojikiston bo vaksinaho va mavodi immunizatsioni baroi solhoi 2016-2020 hamagi 34885327 (siyu chor millionu hashtsadu hashtodu panj hazoru sesadu bistu haft) dollari IMA zarur ast. Az miqdori umumii mablaghoi zaruri 19469735 (nuzdah millionu chorsadu shastu nuh hazoru haftsadu siyu panj) dollari IMA (56%) az hisobi Alyansi globalii vaksinaho va immunizatsiya, 3900000 (se millionu nuhsad hazor) dollari IMA (11%) az hisobi Agentii hamkorii baynalmilalii Jopon baroi solhoi 2016-2019 va 5000000 (panj million) dollari IMA (14%) az hisobi mablaghoi dar bujeti sohai tandurusti baroi kharidorii vaksinaho peshbinishuda, dastgiri karda meshavad. Mablagi norasoii amalisozii Barnoma boshad 6515592 (shash millionu panjsadu ponzdah hazoru panjsadu navadu du) dollari IMA (19%)-ro tashkil medihad, ki in mablagho ham az tashkilothoi baynalmilali va dar doirai mablaghoi hamasola baroi sohai tandurusti dar bujeti davlati peshbinishuda, amali karda meshavand (zamimai 5).
  3. Baroi amalisozii hamajonibai Barnoma zarur ast:

– Vazorati tandurusti va hifzi ijtimoii aholii Jumhurii Tojikiston hamkoriro bo Vazorati moliyai Jumhurii Tochikiston, maqomoti ijroiyai mahallii hokimiyati davlati, Sozmoni umumijahonii tandurusti, Hazinai kudakoni Sozmoni Milali Muttahid va digar sharikon davom doda, baroi rushdi strategiyaho va rasidan ba dastovardhoi mustaqilonai iqtisodii (khudmablagguzori) Barnoma va khizmatrasonii immunizatsiya boyad choraho andeshad;

– ba sardoroni rayosathoi tandurustii viloyatho, shahrho, menejeroni shabakai muassisahoi kumaki avvaliyai tibbiyu sanitari va sartabiboni bemorkhonahoi markazi bo darkhost baromadan ba maqomoti ijroiyai mahallii hokimiyati davlati baroi ziyod namudani sahmi onho dar mablagguzorii Barnoma (inchunin baroi kharidorii yakhdonho, khizmatrasonii tekhniki, omuzishho, fahmondadihi dar bayni aholi va digar kharojot).

Zamimahoi 1-5

               Zamimai 1

Vazifaho oid ba sathi farogirii immunizatsiya

Vaksinaho 2016 2017 2018 2019 2020
1) BSJ (vaksinai ziddi bemorii sil) 98% 98% 98% 98% 98%
2) VJTGK (vaksinai ziddi bemorihoi guluzindonak, kabudsulfa va kuzoz) 95% 95% 95% 95% 95%
3) Pentavalenti 95% 95% 95% 95% 95%
4) VJGK (vaksinai ziddi bemorihoi guluzindonak va kuzoz) 95% 95% 95% 95% 95%
5) Surkhcha/gulafshon 95% 95% 95% 95% 95%
6) VDBF (vaksinai ziddi bemorii falaj, ki bo tariqi dahon guzaronida meshavad) 95% 95% 95% 95% 95%
7) Rotavirusi 95% 95% 95% 95% 95%
8) VGBF (vaksinai gayrifaolkardashudai ziddi bemorii falaj, ki bo tariqi suzandoru guzaronida meshavad) 95% 95% 95% 95% 95%
9) Gepatiti V 98% 98% 98% 98% 98%

Zamimai 2

Taqvimi millii immunizatsiya dar Jumhurii Tojikiston

 

Vaksinaho

 

 

Sinnu sol
Immunizatsiya Immunizatsiyai takrori
*VDBF (vaksinai ziddi bemorii falaj, ki bo tariqi dahon guzaronida meshavad) 0-dar muddati 24 soati bad az tavallud, 2,3 va 4-mohagi 12 – moha
**Gepatiti V dar muddati 24 soati bad az tavallud
BSJ (vaksinai ziddi bemorii sil) 3-5 ruzi bad az tavallud 6,16 – sola
Pentavalenti (VJKGK, Hib, gepatiti V) 2-3-4 – moha
Surkhcha — gulafshon 12 – moha 6 – sola
VJKGK-4(vaksinai jabidashudai ziddi bemorihoi guluzindonak va kuzoz) 16-23-moha
Guluzindonak va kuzoz (VJGK) 6 – sola
Guluzindonak va kuzoz bo miqdori kamtarini antigenho (VJGK-M) 16-26-36-45-56 – sola
Rotavirusi 2-3 – moha
Gayrifaolkardashuda bar ziddi bemorii falaj

***(VGBF)

3 – moha

* Dar holate, ki agar tifl hangomi tavalludshavi voyai sifrii VDBF-ro nagirifta boshad, boyad u immunizatsiyaro dar davomi 14 ruzi bad az tavallud girad.

** Dar holate, ki agar tifl hangomi tavalludshavi voyai gepatiti V nagirifta boshad, boyad ba u dar davomi 7 ruzi badi tavallud immunizatoiya guzaronida shavad.

*** Jorikunii vaksinai VGBF az soli 2017-um ba naqsha girifta shudaast.

Zamimai 3

Talabot ba yakhdonho baroi muassisahoi tibbii Jumhurii Tojikiston

Mintaqa Markazhoi salomatii dehoti (adad) Bungohhoi salomati (adad)
Viloyati Mukhtori Kuhistoni Badakhshon 20 159
Mintaqai Rasht 8 101
Mintaqai Kulob 7 84
Mintaqai Qurgonteshga 228
Viloyati Sugd 16 178
SHahru nohiyahoi tobei jumhuri, az jumla: 125
n. Rudaki 41
sh, Vahdat 31
n. Fayzobod 15
sh. Hisor 14
sh. Tursunzoda
n. Varzob 22
n. SHahrinav 2
Hamagi: 51 875

                                                                                                                                                                               Zamimai 4

Vazifaho oid ba nishondodi talafi vaksinaho

Vaksinaho 2016 2017 2018 2019 2020
1) BSJ (vaksinai ziddi bemorii sil) 25% 25% 25% 25% 25%
2) VJKGK (vaksinai jabidashudai ziddi bemorihoi guluzindonak va kuzoz) 20% 20% 20% 20% 20%
3) Pentavalenti 5% 5% 5% 5% 5%
4) VJGK (vaksinai ziddi bemorihoi guluzindonak va kuzoz) 20% 20% 20% 20% 20%
5) Surkhcha/gulafshon 20% 20% 20% 20% 20%
b) VDBF (vaksinai ziddi bemorii falaj, ki bo tariqi dahon guzaronida meshavad) 20% 20% 20% 20% 20%
7) Rotavirusi 5% 5% 5% 5% 5%
8) VGBF (vaksinai gayrifaolkardashudai ziddi bemorii falaj, ki bo tariqi suzandoru guzaronida meshavad) 20% 20% 20% 20% 20%
9) Gepatiti V 5% 5% 5% 5% 5%

                                                                                                                                                                                         Zamimai 5

Talabot ba vaksinaho va mavodi tazriqi baroi

immushazatsiyai naqshavi dar Jumhurii Tojikiston

Vaksinaho

 

 

Soli 2016 Soli 2017 Soli 2018 Soli 2019 Soli 2020
Guruhi maqsad-nok (nafar) Miqdori umumii voyaho bo hisobi nishondodi sarfiyot va 25% zakhirai ehtiyoti (voya) Ba mablagi umumi bo dollari IMA Guruhi maqsadnok (nafar) Miqdori umumii voyaho 6o hisobi

nishondodi

talaf (voya)

Ba mablagi umumi bo dollari IMA Guruhi maqsadnok (nafar) Miqdori umumii voyaho bo hisobi nishondodi talaf (voya) Ba mablagi umumi bo dollari IMA Guruhi maqsadnok (nafar) Miqdori umumii voyaho bo hisobi nishondodi talaf (voya) Ba mablagi umumi bo dollari IMA Guruhi maqsadnok (nafar) Miqdork umumii voyaho bo hisobi nishondodi talaf (voya) Ba mablagi umumi bo dollari IMA
BSJ

(20 – voyagi)

274000 455525 31887 282768 376081 26326 291817 388117 27168 301155 400536 28038 310792 413353 28935
Pentavalenti

(1 – voyagi)

274000 1078875 2805075 282768 890719 2315869 291817 919224 2389982 301155 948638 2466459 310792 978995 2545387
OPV

(20 – voyagi)

274000 1616600 339486 282768 1334665 280280 291817 1377376 289249 301155 1761251 369863 310792 1817610 381698
Gepatiti V

(1 – voyagi)

274000 359625 136658 282768 296906 112824 291817 306408 116435 301155 316213 120161 310792 326332 124006
Rotavirusi

(1 – voyagi)

274000 719250 14744″ 282768 593813 1217317 291817 612816 1256273 301155 632426 1188961 310792 652663 1227006
IPV

(10 – voyagi)

274000 404150 767885 282768 333666 633965 291817 344344 654254 301155 355363 675190 310792 366735 696797
Surhcha

gulafshon

(10 – voyagi)

262000 435575 252634 270384 359611 208574 279036 371118 215248 247298 711899 412901 297180 734681 426115
AKDS

(10 – voyagi)

262000 435575 87115 270384 359611 71   922 279036 37SH8 74224 287965 382993 76599 297180 395249 79050
ADS –

(10 – voyagi)

225000 374062 44887 232200 308826 37059 239360 318708 38245 247298 328906 39469 255212 339432 40732
Vaksinaho     6344326     5237873     5405495     5470955     5646026
Suzandoruho     223815     184780     190696     168666     174062
Frakht+khiz-matrasoni+ bufer     1323769     1092902     1127878     1128979     1165105
Mablagi umumi     7891910     6515 555     6724069     6768600     6985193

 Ba qarori Hukumati

Jumhurii Tojikiston

az 28 oktyabri soli 2016, № 456

tasdiq shudaast

Naqshai

chorabiniho oid ba tatbiqi Barnomai millii immunoprofilaktika

dar Jumhurii Tojikiston baroi solhoi 2016-2020

r/t CHorabiniho Ijrokunandagon Muhlati tatbiq Mablag bo dollari IMA Sarchashmai mablagguzori
1. Takmili sohai immunoprofilaktika dar Jumhurii Tojikiston bo rohi taqviyati bazai moddiyu tekhniki
1.1. Behtar namudani zaminai moddiyu tekhnikii markazhoi immunoprofilaktikai shahru nohiyaho Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 93750,00 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
1.2. Nigoh doshtani sathi balandi farogirii immunizatsiya muvofiqi Taqvimi millii immunizatsiya Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati
1.3. Nazorati faoli epidemiologi az rui bemorihoi ba vositai immunizatsiya idorashavanda Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati
1.4. Monitoring va bahodihii samthoi asosii Barnoma Vazorati tandurusti va khifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati
1.5. Tibqi tartibi muqarrargardida hamkori bo tashkilothoi baynalmilali oid ba justuju namudani sharikoni nav baroi rasonidani kumak dar amaligardonii Barnoma Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020
2. Takmili barnomahoi omuzishi dar sokhtori muassisahoi tahsiloti oli va inchunin baland bardoshtann sathi donishi mutakhassisoni soha, makhsusan tayyorii todiplomi va badmidiplomii mutakhassison
2.1. Vase namudani qismhoi immunologiya va immunoprofilaktika dar barnomahoi talimi Vazorati tandurusti va hifzi ijtimoii aholi, Muassisai davlatii talimii “Donishgohi davlatii tibbii Tojikiston ba nomi Abuali ibni Sino” 2016-2020 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
2.2. Vorid namudani sessiyahoi omuzishi oid ba qismhoi sohai immunoprofilaktika dar barnomahoi talimi Muassisai davlatii talimii “Donishkadai tahsiloti badidiplomii kormandoni sohai tandurustii Jumhurii Tojikiston” 2016-2020 Mablaghoi peshbinishudai bujeti davlati
2.3. Muntazam guzaronidani seminarhoi talimi oid ba nazorati epidemiologi az rui bemorihoi ba vositai immunizatsiya idorashavanda Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 15000,00 Mablaghoi peshbinishudai bujeti davlati

 

 

 

3. Haridori, intiqol va tamin namudani nigohdorii vaksinaho bo

rioyai sharoiti zanjiri khunukitaminkunanda

3.1. Tamini talaboti aholi bo vaksinahoi sifatnok Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 34, 885, 327 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
3.2. Behtar namudani sistemai zanjiri khunukitaminkunanda Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 6250,00 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
3.3. Tartib dodan va jori namudani “TAS oid ba ISV” Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghon peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
3.4. Barguzor namudani omuzishhoi talimi dar bayni kormandoni tib oid ba TAS Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati
3.5. Monitoringi muntazami ijroi TAS oid ba ISV Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
3.6. Guzaronidani bahodihii ISV va peshnihod namudani tavsiyaho baroi takmili on Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
4. Safarbarkunii ijtimoi
4.1. Tahiyai mavodi ittilootiyu talimi baroi kormandoni tib va aholi oid ba samaranokii immunizatsiya Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 500 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
4.2. Omuzipsh kormandoni tib oid ba tashviqot va safarbarkuni Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
4.3. Istifoda namudani ruznomaho, shabakahoi televizioni va somonahoi interneti baroi tashviqoti immunizatsiya Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 200 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
4.4 Behtar namudani dastrasnokii malumoti sifatnok va daqiq oid ba manfiathoi immunizatsiya dar bayni aholi Vazorati tandurusti va hifzi ijtimoii aholi 2016-2020 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
5. Vorid namudani vaksinahoi nav
5.1. Vorid namudani vaksinai gayrifaolkardashuda bar ziddi bemorii falaj (IPV) Vazorati tandurusti va hifzi ijtimoii aholi 2017 Kumaki tashkilothoi baynalmilali
5.2. Az nav amali gardonidani immunizatsiya dar jumhuri dar bayni navrason va kalonsolon bar ziddi guluzindonak va kuzoz bo vaksinai VJGKk Vazorati tandurusti va hifzi ijtimoii aholi 2017 Mablaghoi peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
5.3. Vorid namudani anatoksin bar ziddi kuzoz dar bayni zanoni homila (AK) Vazorati tandurusti va

hifzi ijtimoii aholi

2017 Mablaghoi peshbinishudai bujeti davlati
5.4. Ivaz namudani vaksinai surkhcha-gulafshon ba vaksinai surkhcha-parotit-gulafshon Vazorati tandurusti va hifzi ijtimoii aholi 2017 Mablagkhri peshbinishudai bujeti davlati va kumaki tashkilothoi baynalmilali
5.5 Vorid namudani vaksinai pnevmokokki ba taqvimi millii immunizatsiya Vazorati tandurusti va hifzi ijtimoii aholi 2018 Kumaki tashkilothoi baynalminali
5.6. Vorid namudani vaksinai ziddi saratoni gardanaki bachadon ba taqvimi millii immunizatsiya Vazorati tandurusti va hifzi ijtimoii aholi 2020

Kumaki tashkilothoi baynalmalali

 

Загрузка...

Dar boramon

Инчунин кобед

tttt

SHurishhoi gulomon bo sardorii N. Terner va J. Braun

Dar solhoi 30-yumi asri XIX masalai gulomdori dar hayoti jamiyatii IMA yake az masalahoi jiddie …