Skin post-vaccination reactions. Post-vaccination reactions and complications, local and general. Causes of complications

“Vaccines can cause dangerous complications" - this is precisely the argument of the opponents official medicine bring first. The stage for fear is prepared, and when, after vaccination, even a slight inflammation develops at the injection site, many patients begin to sound the alarm. Meanwhile, the overwhelming majority of post-vaccination reactions, as explained, are absolutely natural and do not pose any danger.

Adverse reactions during vaccination

Local reactions

After vaccination, redness of the skin, soreness, the appearance of an allergic rash, swelling, and enlargement of neighboring lymph nodes may be observed at the injection site. Based on information received from the Internet, people are beginning to sound the alarm. And absolutely in vain.

As is known from school biology textbooks, when the skin is damaged and foreign substances enter this area, inflammation occurs. But it passes quickly even without any special measures.

Practice shows that the body can react in this way even to completely neutral substances. Yes, during clinical trials vaccines, participants in control groups are given ordinary water for injection, and various local reactions occur even to this “drug”! Moreover, with approximately the same frequency as in the experimental groups where real vaccines are administered. That is, the cause of inflammation may be the injection itself.

At the same time, some vaccines are created in such a way as to deliberately provoke inflammation at the injection site. Manufacturers add special substances to such preparations - adjuvants (usually aluminum hydroxide or its salts). This is done in order to strengthen the body’s immune response: due to inflammation, there are many more cells immune system“get to know” the vaccine antigen. Examples of such vaccines are DTP (diphtheria, whooping cough, tetanus), ADS (diphtheria and tetanus), and against hepatitis A and B. Adjuvants are usually used in, since the immune response to live vaccines is already quite strong.

General reactions

Sometimes, as a result of vaccinations, a mild rash occurs not only in the area of ​​the injection, but covers quite large areas of the body. The main reasons are the effect of the vaccine virus or an allergic reaction. But these symptoms are not something beyond the norm, and they are observed for a fairly short time. Thus, a quickly passing rash is a common consequence of vaccination with live viral vaccines against measles, mumps, rubella.

In general, when live vaccines are administered, it is possible to reproduce a natural infection in a weakened form: the temperature rises, headache, sleep and appetite are disturbed. Case in point– “vaccinated measles”: 5-10 days after vaccination, a rash sometimes appears, and typical symptoms of acute respiratory infections are observed. And again, the “disease” goes away on its own.

It is important to understand that unpleasant symptoms after vaccination are temporary, while immunity to dangerous disease remains for life.

Post-vaccination complications

Adverse reactions from vaccination can be unpleasant, but they are not life-threatening. Only rarely do vaccinations cause truly serious conditions. But in fact, the vast majority of such cases are caused by medical errors.

Main causes of complications:

• violation of vaccine storage conditions;
• violation of instructions for administering the vaccine (for example, intradermal vaccine administration intramuscularly);
• non-compliance with contraindications (in particular, vaccination of a patient during an exacerbation of the disease);
• individual characteristics of the body (unexpectedly strong allergic reaction to repeated administration of the vaccine, development of the disease for which vaccination is being carried out).

Only last reason cannot be excluded. Everything else is the notorious “human factor”. And you can reduce the chances of developing complications to a minimum by choosing a proven one for vaccination.

Unlike adverse reactions, post-vaccination complications are extremely rare. Encephalitis as a result of measles vaccine occurs in one case per 5-10 million vaccinations. The likelihood of a generalized BCG infection is one in a million. Only one in 1.5 million OPV administered causes vaccine-associated polio. But we must understand that in the absence of vaccinations, the likelihood of catching a severe and extremely dangerous infection– many orders of magnitude higher.

Contraindications to vaccination

Before vaccinating a patient, the doctor simply must make sure that to this patient you can do it at this time. Fortunately, the instructions for any drug certainly contain a list of all possible contraindications.

Most of them are temporary, they are not grounds for completely canceling the procedure, but only for postponing it to a later late dates. For example, any infectious disease excludes vaccination - it is possible only after the patient has fully recovered. Certain restrictions apply during pregnancy and breastfeeding: expectant mothers are not vaccinated with live vaccines, although the use of others is quite acceptable.

But sometimes a person’s health condition can become the basis for permanent exemption from vaccinations. So, patients with primary immunodeficiency In principle, vaccination is not carried out. Certain diseases preclude the use of specific types of vaccines (for example, the pertussis component of the DTP vaccine is incompatible with some neurological diseases).

However, sometimes doctors may insist on vaccination even despite the presence of contraindications. For example, flu shots are not normally given to people with protein allergies. chicken eggs. But if the next type of influenza causes serious complications, and the risk of disease is high, in many Western countries doctors neglect this contraindication. Of course, vaccination must be combined with special measures for.

Many people sometimes refuse vaccinations for absolutely far-fetched reasons. “My child is sick, he already has a reduced immune system”, “he has a bad reaction to vaccinations” - these are typical false contraindications. This kind of logic is not only wrong, it is extremely dangerous. After all, if a child does not tolerate vaccines containing weakened strains of the virus, then the consequences of a full-fledged pathogen entering his body will most likely be simply fatal.

Fast vaccine reactions(PVR)- these are side, clinical and laboratory signs of unstable, unwanted, pathological (functional) changes in the body that arise in connection with vaccination (last 3-5 days and go away on their own).

Post-vaccination reactions are divided into local And are common.

Local post-vaccination reactions compaction tissue compaction; hyperemia not exceeding 80 mm in diameter; slight soreness at the site of vaccine administration.

TO common post-vaccination reactions include reactions not tied to the location of the injection and affecting the entire body: generalized rash; increased body temperature; sleep disturbances, anxiety; headache; dizziness, short-term loss of consciousness; in children - prolonged unusual crying; cyanosis, cold extremities; lymphadenopathy; anorexia, nausea, abdominal pain, dyspepsia, diarrhea; catarrhal phenomena not associated with acute respiratory infections that began before or immediately after vaccination; myalgia, arthralgia.

In general, common adverse reactions are in most cases the body’s reaction to the introduction of a foreign antigen and in most cases reflect the process of developing immunity. For example, the reason for the increase in body temperature that occurs after vaccination is the release of special “intermediaries” into the blood immune reaction proinflammatory interleukins. If the adverse reactions are not severe, then in general this is even a favorable sign in terms of developing immunity. For example, a small lump that appears at the site of vaccination with the hepatitis B vaccine indicates the activity of the process of developing immunity, which means that the vaccinated person will actually be protected from infection.

According to the severity of the course, post-vaccination reactions are divided into ordinary and severe (strong). TO severe reactions include local: at the site of drug administration, soft tissue swelling more than 50 mm in diameter, infiltration more than 20 mm, hyperemia more than 80 mm in diameter and are common: increased body temperature over 39 °C.

Local reactions develop immediately after administration of the drug and are mainly caused by vaccine ballast substances.

Time frame for the appearance of general vaccine reactions:

For non-live vaccines, 1-3 days after immunization (in 80-90% of cases, 1st day),

For live vaccines - from 5-6 to 12-14 days, with a peak of manifestations from 8 to 11 days after vaccination.

Post-vaccination reactions are not a contraindication
for subsequent vaccinations with this vaccine.

Post-vaccination complications(PVO) are persistent functional and morphological changes in the body that go beyond physiological fluctuations and lead to significant health problems

Post-vaccination complications do not contribute to the development of immunity. Complications do not include events that coincide in time with the vaccination (for example, an intercurrent disease in the post-vaccination period). Post-vaccination complications prevent repeated administration of the same vaccine.

Possible reasons post-vaccination complications: non-compliance with contraindications; individual characteristics of the vaccinated person; “program error” (violation of vaccination rules and techniques); inadequate quality of the vaccine, incl. arising from transportation and storage violations.

Generally accepted criteria for linking an event in the post-vaccination period with vaccination:

Pathological processes that occur after vaccination (“adverse events” or “side effects” in WHO terminology) should not be considered post-vaccination complications until their possible cause-and-effect, and not just a temporary relationship with vaccination, has been established;

Epidemiological (higher frequency in vaccinated people than in unvaccinated people);

Clinical (similarity of the post-vaccination complication with the complication of the corresponding infection, time of appearance after vaccination);

Virological (eg, absence of wild poliovirus in vaccine-associated polio).

Clinical forms post-vaccination complications:

Local post-vaccination complications - abscesses; subcutaneous cold abscess; superficial ulcer more than 10 mm; regional lymphadenitis(s); keloid scar.

Common post-vaccination complications from the nervous system are febrile convulsions; afebrile seizures; vaccine-associated meningitis/encephalitis; anesthesia/paresthesia; acute flaccid paralysis; vaccine-associated paralytic poliomyelitis; Guillain-Barré syndrome (polyradiculoneuritis); subacute sclerosing panencephalitis.

Other post-vaccination complications - anaphylactic shock and anaphylactoid reactions; allergic reactions(Quincke's edema, urticaria-type rash, Stevens-Johnson syndrome, Lyell); hypotensive-hyporesponsive syndrome (acute cardiovascular failure, hypotension, decreased muscle tone, short-term impairment or loss of consciousness, history of vascular disorders); arthritis (but not as a symptom of serum sickness); continuous high-pitched scream (lasting 3 hours or more); mumps, orchitis; thrombocytopenia; generalized BCG infection, osteomyelitis, osteitis, thrombocytopenic purpura.

Table 6 presents the main post-vaccination reactions and complications depending on the type of vaccine used.

Table 6. Post-vaccination reactions and complications depending on the type of vaccine used

Vaccination is definitely not the cause of symptoms (fever, skin rashes etc.), even if they appear within a time period typical for post-vaccination complications, if they persist for more than 2-3 days and/or if they are accompanied by new symptoms (vomiting, diarrhea, meningeal signs, etc.).

Clinical criteria differential diagnosis of air defense:

Reactions to live vaccines (except for immediate allergic reactions in the first few hours after vaccination) cannot appear earlier than the 4th day and more than 12-14 days after measles and 30 days after OPV and mumps vaccines;

Allergic reactions immediate type develop no later than after 24 hours after any type of immunization, and anaphylactic shock no later than in 4 hours;

Intestinal, kidney symptoms, heart and respiratory failure are not typical for complications of vaccination and are signs concomitant diseases;

Catarrhal syndrome may be a specific reaction to measles vaccination if it occurs no earlier than 5 days and no later than 14 days after vaccination; it is not typical for other vaccines;

Arthralgia and arthritis are characteristic only of rubella vaccination;

The disease vaccine-associated poliomyelitis (VAP) develops within 4-30 days after immunization in vaccinated people and up to 60 days in contact people; 80% of all cases of the disease are associated with the first vaccination, while the risk of the disease in immunodeficient individuals is 3-6 thousand times higher than that in healthy people. VAP is necessarily accompanied by residual effects (flaccid peripheral paresis and/or paralysis and muscle atrophy).

Features of diagnosing post-vaccination complications:

With the development of severe forms of neurological diseases (encephalitis, myelitis, polyradiculoneuritis, meningitis, etc.), in order to exclude intercurrent diseases, it is necessary to study paired sera.

The first serum should be taken as soon as possible early dates from the onset of the disease, and the second – after 14-21 days.

In sera, antibody titers to influenza, parainfluenza, herpes, coxsackie, ECHO, and adenovirus viruses should be determined. In this case, titration of the first and second sera should be carried out simultaneously. List of carried out serological studies may be expanded according to indications.

If a lumbar puncture is performed, it is necessary to conduct a virological study cerebrospinal fluid for the purpose of indicating both vaccine viruses (when vaccinated with live vaccines) and viruses of possible causative agents of intercurrent diseases.

The material should be delivered to the virology laboratory either frozen or at the temperature of melting ice. In the cells of the cerebrospinal fluid sediment obtained by centrifugation, indication of viral antigens in the immunofluorescence reaction is possible.

In case of serous meningitis that developed after mumps vaccination, and if VAP is suspected, their enteroviral etiology should be excluded.

When making a clinical diagnosis of BCGitis, its verification bacteriological methods involves isolating a culture of the pathogen with subsequent proof of its belonging to Mycobacterium bovis BCG.

Monitoring post-vaccination reactions and complications is a system of constant monitoring of the safety of medical immunobiological drugs in their conditions practical application. According to WHO: “Identification of post-vaccination complications with their subsequent investigation and measures taken increases public acceptance of immunization and improves health care. This primarily increases immunization coverage of the population, which leads to a decrease in morbidity.

Even if the cause cannot be determined or the disease was caused by a vaccine, the fact that the case is investigated by medical professionals increases public confidence in vaccinations.”

Air defense monitoring is carried out at all levels of medical care for the population: primary district, city, regional, republican. Its goal: to improve the system of measures to prevent complications after the use of medical immunobiological drugs.

Objectives: identification of PVO, determination of the nature and frequency of PVO for each drug, identification of risk factors contributing to the development of PVO, including climatic-geographical, socio-economic and environmental, as well as conditioned individual characteristics vaccinated.

Detection of post-vaccination reactions and complications is carried out by workers at all levels of medical care and observation. : medical workers who carry out vaccinations; medical workers who provide treatment for PVR and PVO in all medical institutions(both state and non-state forms of ownership); parents who were previously informed about possible reactions after vaccination.

If unusual PVR develops or PVR is suspected, it is necessary to immediately inform the head of the medical institution or a person involved in private medical practice, and send an emergency notification of an unusual PVR or suspected PVR - according to the forms of medical records approved by the Ministry of Health of Ukraine - to the territorial SES within 24 hours after their detection.

Each case of post-vaccination complication (suspected complication) that required hospitalization, as well as completed fatal is investigated by a commission of specialists (pediatrician, therapist, immunologist, epidemiologist, etc.) appointed by the chief physician of the regional (city) SES. Complications after BCG vaccination are investigated with the mandatory participation of a TB doctor.

– various persistent or severe health disorders that have developed as a result of preventive vaccination. Post-vaccination complications can be local (abscess at the injection site, purulent lymphadenitis, keloid scar, etc.) or general (anaphylactic shock, BCG infection, encephalitis, meningitis, sepsis, vaccine-associated polio, etc.). Diagnosis of post-vaccination complications is based on the analysis of clinical data and their connection with the recent vaccination. Treatment of post-vaccination complications should include etiotropic, pathogenetic and symptomatic general and local therapy.

General information

Post-vaccination complications are pathological conditions that have a causal relationship with preventive vaccination and impair the health and development of the child. Carrying out preventive vaccination in pediatrics is aimed at the formation of protective immunity that does not allow the development of infectious process upon repeated contact of the child with the pathogen. In addition to individual type-specific immunity, mass vaccination of children pursues the goal of creating collective (population) immunity, designed to stop the circulation of the pathogen and the development of epidemics in society. For this purpose, Russia has adopted National calendar preventive vaccinations regulating the list, timing and procedure for mandatory and additional vaccination of children from birth to adulthood.

In some cases, a child experiences an unexpected, pathological response of the body to vaccination, which is regarded as a post-vaccination complication. The incidence of post-vaccination complications varies greatly depending on the type of vaccination, the vaccines used and their reactogenicity. According to the data available in the literature, the “leader” in the development of post-vaccination complications is vaccination against whooping cough, diphtheria and tetanus - the frequency of complications is 0.2-0.6 cases per 100 thousand vaccinated people. When vaccinated against polio, against measles, against mumps undesirable consequences occur in 1 or less cases per 1 million vaccinated people.

Causes of post-vaccination complications

The occurrence of post-vaccination complications may be associated with the reactogenicity of the drug, the individual characteristics of the child’s body, and iatrogenic factors (technical errors and errors during immunization).

The reactogenic properties of a particular vaccine, that is, the ability, when introduced into the body, to cause post-vaccination reactions and complications, depend on its components (bacterial toxins, preservatives, stabilizers, solvents, adjuvants, antibiotics, etc.); immunological activity of the drug; tropism of vaccine strains to body tissues; possible change (reversion) of the properties of the vaccine strain; contamination (contamination) of the vaccine with foreign substances. Different vaccines vary significantly in the number and severity of adverse reactions; The most rectogenic of them are considered to be BCG and DTP vaccines, the least “heavy” are preparations for vaccinations against polio, against hepatitis B, against mumps, against rubella, etc.

The individual characteristics of the child’s body, which determine the frequency and severity of post-vaccination complications, may include background pathology that worsens in the post-vaccination period; sensitization and changes in immune reactivity; genetic predisposition to allergic reactions, autoimmune pathology, convulsive syndrome, etc.

As practice shows, common cause post-vaccination complications are errors medical personnel, violating the grafting technique. These may include subcutaneous (instead of intradermal) administration of the vaccine and vice versa, incorrect dilution and dosage of the drug, violation of asepsis and antisepsis during injection, erroneous use of other solvents medicinal substances etc.

Classification of post-vaccination complications

Pathological conditions accompanying the vaccination process include:

• intercurrent infections or chronic diseases that occurred or worsened in the post-vaccination period;
• vaccine reactions;
• post-vaccination complications.

Increased infectious morbidity in the post-vaccination period may be due to the coincidence of the disease and vaccination in time or to transient immunodeficiency developing after vaccination. During this period, the child may experience ARVI, obstructive bronchitis, pneumonia, urinary tract infections, etc.

Vaccine reactions include various unstable disorders that occur after vaccination, persist for a short time and do not interfere with the vital functions of the body. Post-vaccination reactions are of the same type in clinical manifestations, usually do not affect the general condition of the child and go away on their own.

Local vaccine reactions may include hyperemia, swelling, infiltration at the injection site, etc. General vaccine reactions may be accompanied by fever, myalgia, catarrhal symptoms, measles-like rash (after vaccination against measles), enlargement of the salivary glands (after vaccination against mumps), lymphadenitis ( after vaccination against rubella).

Post-vaccination complications are divided into specific (vaccine-associated diseases) and non-specific (excessively toxic, allergic, autoimmune, immune complex). By severity pathological process post-vaccination complications can be local and general.

Characteristics of post-vaccination complications

Excessive in strength toxic reactions are regarded as post-vaccination complications if they develop in the first three days after vaccination, are characterized by a pronounced disturbance in the child’s condition (temperature rise above 39.5°C, chills, lethargy, sleep disturbance, anorexia, possibly vomiting, nosebleeds, etc.) and persist within 1-3 days. Typically, such post-vaccination complications develop after the administration of DTP, Tetracoc, live measles vaccine, influenza split vaccines, etc. In some cases, hyperthermia may be accompanied by short-term febrile convulsions and hallucinatory syndrome.

Post-vaccination complications that occur in the form of allergic reactions are divided into local and general. The criteria for a local post-vaccination complication are hyperemia and swelling of tissues that extend beyond the area of ​​the nearest joint or to an area of ​​more than 1/2 of the anatomical zone at the site of vaccine administration, as well as hyperemia, swelling and pain that persist for more than 3 days, regardless of size. Most often, local allergic reactions develop after the administration of vaccines containing aluminum hydroxide sorbent (DTP, Tetrakok, anatoksins).

Among post-vaccination complications, there are also common allergic reactions: anaphylactic shock, urticaria, Quincke's edema, Lyell's syndrome, Stevens-Johnson syndrome, erythema multiforme exudative, manifestation and exacerbation of bronchial asthma and atopic dermatitis in children. Immunization can cause the initiation of immune complex post-vaccination complications - serum sickness, hemorrhagic vasculitis, periarteritis nodosa, glomerulonephritis, thrombocytopenic purpura, etc.

Post-vaccination complications with an autoimmune mechanism of development include lesions of the central and peripheral nervous system (post-vaccination encephalitis, encephalomyelitis, polyneuritis, Guillain-Barre syndrome), myocarditis, juvenile rheumatoid arthritis, autoimmune hemolytic anemia, systemic lupus erythematosus, dermatomyositis, scleroderma, etc.

A peculiar post-vaccination complication in children in the first six months of life is a shrill cry, which is persistent (from 3 to 5 hours) and monotonous. Typically, a high-pitched cry develops after the administration of pertussis vaccine and is caused by associated changes in microcirculation in the brain and acute attack intracranial hypertension.

The most severe post-vaccination complications in terms of their course and consequences are the so-called vaccine-associated diseases - paralytic poliomyelitis, meningitis, encephalitis, the clinical symptoms of which do not differ from those diseases with a different mechanism of occurrence. Vaccine-associated encephalitis can develop after vaccination against measles, rubella, and DPT. The likelihood of developing vaccine-associated meningitis after receiving the mumps vaccine has been proven.

Post-vaccination complications after administration of the BCG vaccine include local lesions, persistent and disseminated BCG infection. Among the local complications, the most common are axillary and cervical lymphadenitis, superficial or deep ulcers, cold abscesses, and keloid scars. Among the disseminated forms of BCG infection, osteitis (ostitis, osteomyelitis), phlyctenular conjunctivitis, iridocyclitis, and keratitis have been described. Severe generalized post-vaccination complications usually occur in children with immunodeficiency and are often fatal.

Diagnosis of post-vaccination complications

A post-vaccination complication can be suspected by a pediatrician based on the appearance of certain typical clinical signs at the height of the vaccination process.

Mandatory for the differential diagnosis of post-vaccination complications and complicated course of the vaccination period is laboratory examination child: general analysis urine and blood, virological and bacteriological studies of blood, urine, feces. To exclude intrauterine infections (. Differential diagnosis post-vaccination complications in these cases are carried out with epilepsy, hydrocephalus, etc.

The diagnosis of a post-vaccination complication is established only after all other possible causes of the child’s condition have been excluded.

Treatment of post-vaccination complications

As part of the complex treatment of post-vaccination complications, etiotropic and pathogenetic treatment is carried out; a gentle regime, careful care and rational diet. In order to treat local infiltrates, local ointment dressings and physiotherapy (UHF, ultrasound therapy) are prescribed.

In case of severe hyperthermia it is indicated drinking plenty of fluids, physical cooling (rubbing, ice on the head), antipyretic drugs (ibuprofen, paracematol), parenteral administration glucose-salt solutions. For allergic post-vaccination complications, the amount of assistance is dictated by the severity of the allergic reaction (administration of antihistamines, corticosteroids, adrenergic agonists, cardiac glycosides, etc.).

In case of post-vaccination complications from the nervous system, syndromic therapy (anticonvulsant, dehydration, anti-inflammatory, etc.) is prescribed. Treatment of post-BCG vaccination complications is carried out with the participation of a pediatric TB specialist.

Prevention of post-vaccination complications

Prevention of post-vaccination complications involves a set of measures, among which the first place is occupied by the correct selection of children to be vaccinated and the identification of contraindications. For this purpose, a pre-vaccination examination of the child is carried out by a pediatrician, and, if necessary, consultations with pediatric specialists who monitor the child for the underlying disease (pediatric allergist-immunologist, pediatric neurologist, pediatric cardiologist, pediatric nephrologist, pediatric pulmonologist, etc.). In the post-vaccination period, vaccinated children should be monitored. Compliance with immunization techniques is important: only experienced, specially trained medical personnel should be allowed to vaccinate children.

For children who have suffered a post-vaccination complication, the vaccine that caused the reaction is no longer administered, but in general routine and emergency immunization are not contraindicated.

Post-vaccination reactions are those that occur after a preventive or therapeutic vaccination.

They are usually due to the following reasons:

– introduction of a foreign biological substance into the body;

– the traumatic effect of vaccination;

– exposure to vaccine components that are not important in the formation of a specific immune response: preservative, sorbent, formaldehyde, residues of the growing medium and other “ballast” substances.

Responders develop characteristic syndrome in the form of general and local reactions. In heavy and moderate severity In cases, performance may be reduced or temporarily lost.

General reactions: increased body temperature, feeling unwell, headache, sleep disturbances, appetite, pain in muscles and joints, nausea and other changes that can be detected using clinical and laboratory examination methods.

Local reactions can manifest themselves in the form of pain at the injection site, hyperemia, edema, infiltration, lymphangitis, as well as regional lymphadenitis. With aerosol and intranasal methods of drug administration, local reactions can develop in the form catarrhal manifestations from the upper respiratory tract and conjunctivitis.

With the oral (by mouth) method of vaccination possible reactions(in the form of nausea, vomiting, abdominal pain, stool upset) can be classified as both general and local reactions.

Local reactions can manifest themselves as individual of these symptoms, or all of them. Particularly high local reactogenicity is characteristic of vaccines containing sorbent when administered using the needle-free method. Pronounced local reactions largely determine the intensity of the body’s overall reaction.

General reactions when administered with killed vaccines or toxoids reach their maximum development 8-12 hours after vaccination and disappear after 24 hours, less often - after 48 hours. Local reactions reach their maximum development after 24 hours and usually last no more than 2-4 days . When using sorbed drugs administered subcutaneously, the development of local reactions proceeds more slowly, maximum reactions are observed 36-48 hours after vaccination, then the process enters the subacute phase, which lasts up to 7 days and ends with the formation of a subcutaneous painless compaction (“vaccine depot”) , dissolving in 30 days or more.

When immunizing with toxoids, the scheme of which consists of 3 vaccinations, the most intense general and local reactions of a toxic nature are observed during the first vaccination. Repeated immunization with drugs of a different type may be accompanied by more severe reactions of an allergic nature. Therefore, if severe general or local reactions occur during the initial administration of the drug in a child, it is necessary to register this fact in his vaccination card and subsequently not carry out this vaccination.

General and local reactions during the administration of live vaccines appear in parallel with the dynamics of the vaccination process, while the severity, nature and time of occurrence of reactions depend on the characteristics of the development of the vaccine strain and the immunological status of the vaccinee.

General reactions of the body are assessed mainly by the degree of increase in body temperature as the most objective and easily recorded indicator.

The following scale for assessing general reactions has been established:

– a weak reaction is recorded at a body temperature of 37.1-37.5 ° C;

– average reaction - at 37.6-38.5 °C;

– strong reaction - when body temperature rises to 38.6 ° C and above.

Local reactions are assessed by the intensity of development of inflammatory and infiltrative changes at the site of drug administration:

– an infiltrate with a diameter of less than 2.5 cm is a weak reaction;

– from 2.5 to 5 cm - reaction medium degree;

– more than 5 cm - strong local reaction.

Strong local reactions include the development of massive edema more than 10 cm in diameter, which sometimes forms when sorbed drugs are administered, especially using a needle-free injector. Post-vaccination development infiltrate, accompanied by lymphangitis and lymphadenitis, is also regarded as a strong reaction.

Data on the reactogenicity of the vaccine used are entered in the appropriate column of the vaccinated person’s medical record. After each vaccination, strictly set time The doctor should evaluate the reaction of the vaccinated person to the injection of the drug, and record the post-vaccination reaction or its absence. Such marks are strictly required when using live vaccines, reactions to the introduction of which are an indicator of the vaccine’s effectiveness (for example, when vaccination against tularemia).

Considering that the severity vaccination reactions largely determined by the intensity and duration of the fever, use modern methods prevention and treatment of post-vaccination reactions. For this purpose, antipyretic drugs are used (paracetamol, acetylsalicylic acid, brufen (ibuprofen), ortofen (voltaren), indomethacin and other drugs from the class of non-steroidal anti-inflammatory drugs). Of these, the most effective are voltaren and indomethacin.

Prescribing medications in the post-vaccination period can significantly reduce the severity of vaccination reactions when using highly reactogenic drugs
or completely prevent their development during immunization with weakly reactogenic vaccines. At the same time, it improves significantly functional state the body and the performance of vaccinated individuals is maintained. The immunological effectiveness of vaccination is not reduced.

The drugs should be prescribed in therapeutic doses, simultaneously with vaccination and until the disappearance of the main clinical symptoms vaccination reactions, but for a period of at least 2 days. It is also extremely important to take medications regularly (3 times a day).

Irregular use of pharmacological agents or their administration late (more than 1 hour after vaccination) is fraught with complications clinical course post-vaccination reaction.

Therefore, if it is impossible simultaneous use vaccines and medicine They should be prescribed only to persons with already developed reactions, i.e., treatment of vaccination reactions should be carried out, which should last for at least 2 days.

Possible post-vaccination complications, their prevention and treatment

Post-vaccination complications are pathological reactions that are not characteristic of the normal course of the vaccination process, causing pronounced, sometimes severe, dysfunctions of the body. Post-vaccination complications are extremely rare.

The main cause of post-vaccination complications is the altered (or perverted) reactivity of the body prior to vaccination. The body's reactivity may be reduced due to the following reasons:

– due to constitutional features;

- due to the characteristics allergy history;

– due to the presence of chronic foci of infection in the body;

– in connection with an acute illness or injury;

- in connection with others pathological conditions, weakening the body and contributing to its increased sensitivity to allergens.

A standard vaccine preparation introduced into the body, as a rule, cannot cause post-vaccination complications, since it is subject to reliable multi-stage control before release.

A prophylactic drug during the procedure for its administration can be the direct cause of a post-vaccination complication if the vaccination technique is violated (incorrect dose (volume), method (place) of administration, violation of asepsis rules) or when using a drug that was stored in violation of the established regime. For example, an increase in the dose of the administered vaccine, in addition to gross errors, can occur when the sorbed drugs are poorly mixed, when people immunized with the last portions receive an excess amount of sorbent, and therefore antigens.

Severe reactions in the nature of post-vaccination complications can occur when a number of live vaccines are administered to people who are sensitized to this infection (tularemia, brucellosis, tuberculosis) and have not been examined with skin tests allergic status.

Anaphylactic shock

The causes of the acute development of endotoxic or anaphylactic shock may be sensitization of the body, violations of the rules of storage and transportation of a number of vaccines, which lead to increased decay of bacterial cells of live vaccines and desorption of components in sorbed preparations. The administration of such drugs is accompanied by rapid entry into circulatory system excess amounts of toxic products resulting from cell breakdown and modified allergens.

The most reliable and effective way prevention of post-vaccination complications is mandatory compliance with the rules of vaccination at all stages, starting with control of vaccine preparations, competent selection of persons,
subject to vaccination, examining them immediately before the procedure and ending with monitoring the vaccinated in the post-vaccination period.

The medical service must be ready to provide emergency care in the event of acute post-vaccination complications, fainting or collapsed reactions not related to the effect of the vaccine. To do this, in the room where vaccinations are carried out, the medications and instruments necessary to assist with anaphylactic shock (adrenaline, ephedrine, caffeine, antihistamines, glucose, etc.).

An extremely rare, but most severe post-vaccination reaction is anaphylactic shock, which develops as an immediate allergic reaction.

Clinic

The clinical picture of anaphylactic shock is characterized by rapidly developing disorders of the central nervous system, progressive acute vascular insufficiency (collapse, then shock), respiratory disorders, and sometimes convulsions.

The main symptoms of shock are; severe general weakness, anxiety, fear, sudden redness, and then paleness of the face, cold sweat, pain in the chest or abdomen, weakening and increased heart rate, a sharp decline blood pressure, sometimes nausea and vomiting, loss and confusion, dilated pupils.

Treatment

If signs of shock appear, it is necessary to urgently perform the following actions:

– immediately stop administering the drug;

– apply a tourniquet to your arm (if the drug was injected into it, this will prevent the drug from spreading throughout the body);

– put the patient on the couch, give a pose with his head bowed low;

– vigorously warm the patient (cover with a blanket, apply heating pads, give hot tea);

- provide him with access fresh air;

– inject 0.3-0.5 ml of adrenaline (in 2-5 ml isotonic solution) at the injection site and 0.3-1.0 ml additionally subcutaneously (in severe cases - intravenously, slowly).

In very severe conditions, intravenous drip administration of a 0.2% solution of norepinephrine in 200-500 ml of a 5% glucose solution is indicated at the rate of 3-5 ml of the drug per 1 liter. At the same time, an antihistamine (diphenhydramine, diazolin, tavegil, clemastine, etc.), calcium chloride is administered intramuscularly, cordiamine, caffeine or ephedrine is administered subcutaneously. In acute heart failure - intravenously 0.05% strophanthin from 0.1 to 1 ml in 10-20 ml of 20% glucose solution, slowly. The patient must be given oxygen.

If there is no result from these measures, apply hormonal drugs intravenous drip (3% prednisolone or hydrocortisone in 20% glucose solution).

Persons with developed anaphylactic shock are hospitalized at the first opportunity in a hospital using special intensive care transport. If such a patient is not provided with timely health care, anaphylactic shock can be fatal.

Endotoxic shock

Clinic

Endotoxic shock is extremely rare with the introduction of live, killed and chemical vaccines. Its clinical picture resembles anaphylactic shock, but it develops more slowly. Sometimes hyperemia with severe intoxication can quickly develop. In these cases, the administration of antipyretic, cardiac, detoxification and other drugs is indicated. Immediate hospitalization of the patient is necessary.

Allergic reactions from the skin are more often observed with the introduction of live vaccines and manifest themselves in the form of extensive hyperemia, massive edema and infiltration. A variety of rashes appear, swelling of the mucous membranes of the larynx, gastrointestinal tract and mouth may occur. These phenomena occur soon after vaccination and, as a rule, pass quickly.

Treatment

Treatment consists of prescribing antihistamines and anti-itch medications. The use of vitamins A and group B is indicated.

Neurological post-vaccination complications

Neurological post-vaccination complications can occur in the form of lesions of the central (encephalitis, meningoencephalitis) and peripheral (polyneuritis) nervous system.

Post-vaccination encephalitis is an extremely rare phenomenon and is most often observed in children who are vaccinated with live viral vaccines. Previously, they most often occurred during immunization with the smallpox vaccine.

Local post-vaccination complications include changes that are observed during subcutaneous administration of sorbed drugs, especially when using a needle-free injector, and occur as a cold aseptic abscess. Treatment of such infiltrates comes down to physiotherapeutic procedures or surgery.

In addition to the complications listed above, other types may also occur. post-vaccination pathology, associated with an exacerbation of the underlying disease that the vaccinated person suffered from, which occurred in a latent form.

> Post-vaccination reaction

This information cannot be used for self-medication!
Consultation with a specialist is required!

What is a post-vaccination reaction?

A post-vaccination reaction is a condition that sometimes develops after vaccination, has a short-term course and usually does not cause harm to health. Since the vaccine is a foreign antigen for the body, in most cases the post-vaccination reaction indicates that the body has begun the process of forming immunity to the disease against which the vaccine was given. Absolutely any vaccine can cause such a reaction.

Local post-vaccination reactions and their clinical manifestations

There are local and general post-vaccination reactions. Local manifestations include those that occur at the site of vaccine administration. This may include swelling, redness, thickening, and soreness. Local reactions are also considered an increase in nearby lymph nodes and urticaria ( allergic rash, similar to a nettle burn). Some vaccines deliberately contain substances that cause inflammation. This is done in order to increase the strength of the immune response. An example of such a vaccine would be combination vaccine against diphtheria, whooping cough and tetanus (DTP). Local reactions develop on the day the vaccine is given and last no longer than 2–3 days. Some live vaccines cause specific local reaction, the presence of which is a prerequisite for the development of immunity. For example, at the site of injection of the BCG vaccine against tuberculosis, 6 weeks after vaccination, an infiltrate with a small nodule in the center forms, then a crust and after 2-4 months a scar. The tularemia vaccine causes redness, swelling, and blistering around the injection site 4–5 days after administration. And after 10–15 days, a crust forms at the grafting site and then a scar.

Signs of the body’s general reaction to vaccination

The general post-vaccination reaction is a deterioration in the patient’s general condition, manifested by malaise, dizziness, appetite and sleep disturbances, headache, muscle pain, and in children - anxiety and prolonged crying. As a rule, these symptoms are accompanied by an increase in temperature. According to the degree of its increase, general reactions are divided into weak (up to 37.5°), moderate (37.6°–38.5°) and pronounced (over 38.6°). General reactions develop a few hours after vaccination and last no more than two days. After the administration of some live vaccines, a symptom complex may develop in the form of an erased clinical picture the disease for which the vaccine was given. So, 5–10 days after administration measles vaccine The temperature may rise and a peculiar measles-like rash may appear on the skin. The mumps vaccine sometimes causes inflammation of the salivary glands, and the rubella vaccine sometimes causes enlargement of the occipital lymph nodes, which is characteristic of this disease.

Diagnosis and treatment

Post-vaccination reactions must be distinguished from post-vaccination complications. That's what they're called severe conditions health hazards that occur after vaccination. These include anaphylactic shock, serum sickness, Quincke's edema, broncho-obstructive syndrome, meningitis, encephalitis, etc. Fortunately, post-vaccination complications are extremely rare (less than one case per million vaccinations).

Local and mild general post-vaccination reactions do not require treatment. At temperatures above 38°, it is advisable to take antipyretics and drink plenty of fluids; for extensive skin rashes, antihistamines should be taken. Do not apply ointments or compresses to the injection site.

A post-vaccination reaction is an expected and reversible condition that does not require prevention. To avoid post-vaccination complications, vaccinations should be done no earlier than one month after suffering an acute or exacerbation of a chronic disease. For some time after vaccination, foods that often cause allergic reactions (chocolate, eggs, citrus fruits, caviar) should be excluded from the diet. Within 0.5 hours after the vaccine is administered, you need to stay in the clinic premises in order to quickly receive qualified help in case of a severe allergic reaction.