An unusual local reaction to vaccines is: Complications after vaccination - causes in children and adults, diagnosis, treatment methods and prevention. Complications after vaccinations

The vast majority of civilized society are vaccinated at some point in their lives. In most cases, the introduction of necessary vaccines occurs in infancy - children are most vulnerable to dangerous diseases. Often the unformed organisms of children experience negative reactions for the administration of vaccines. So is it worth using vaccines if their use can lead to unpleasant consequences?

According to medical classification, the vaccine is an immunobiological preparation. This means that by introducing a weakened strain of the virus into the patient’s body, a strong immunity to the viral disease is developed. This is achieved by the formation of antibodies in the blood, which subsequently destroy the real virus that has entered the body. By itself, even a weakened strain of the virus cannot be beneficial to the body - which means that mild post-vaccination complications and reactions are inevitable.

Consequences of vaccinations

The consequences of vaccinations can be very diverse, especially in children. In medicine, they are not strictly divided into two types: reactions to vaccinations or complications. The former always represent a short-term change in the child’s condition, often only external; post-vaccination complications are long-term and serious side effects, the consequences of which are often irreversible. The good news is that even susceptible to disease In children, post-vaccination complications occur extremely rarely. The approximate chances of a particular complication occurring in a child can be compared in the table below.

Vaccine	Possible reaction	Chance of occurrence (case per count - in vaccinated people)
Tetanus	Anaphylactic shock, brachial neuritis	2/100000
DPT	Convulsions, decreased blood pressure, loss of consciousness, anaphylactic shock, encephalopathy	4/27000
Measles, rubella	Allergy, anaphylactic shock, encephalopathy, convulsions, fever, decreased platelets in the blood	5/43000
Hepatitis B	Anaphylactic shock	less than 1/600000
Polio vaccine (drops)	Vaccine-associated polio	1/2000000
BCG	Inflammation of lymph vessels, osteitis, BCG infection	1/11000

The table uses average values ​​from the late 90s to the present. As can be seen from the data, the chance of developing any complications after vaccination is quite insignificant. Minor reactions common to this type of medical procedure were not taken into account. It is important to remember that children’s exposure to any viral disease is tens or hundreds of times higher than the likelihood of developing a complication from this vaccination.

Vaccination is reliable protection against viral disease!

The main principle of a parent is not to risk the health of their children and not to avoid vaccinations at the right time! But it is important to approach the procedure responsibly. All vaccines are given under the strict supervision of a supervising physician and mandatory consultation. Vaccination technology must be followed - in 80% of cases, complications are observed precisely because of the negligence or insufficient qualifications of the personnel administering the vaccinations. Most probable cause- violation of storage conditions of the drug. Incorrect injection site, failure to identify contraindications and allergic reactions, improper care for children after vaccination, illness of the child at the time of vaccination, etc. Individual characteristics of the body play almost the last role in development post-vaccination complications- the chance is so insignificant. It is in the interests of parents to provide for all this in order to minimize risks and not cause harm to the child.

When to expect reactions

Post-vaccination complications can be easily calculated by the time of onset of symptoms relative to the date of vaccination - if the ailment does not fit into the time interval for the reaction to the vaccine, it means that there is no connection with the vaccination and you need to consult a doctor! Vaccination is a great stress for the body of children, and against the backdrop of a weakened immune system, the child can easily catch another disease. The average time for reactions to vaccination to appear is from 8 to 48 hours, but symptoms can last up to several months (minor and harmless). Let's look at how and how long reactions should occur from certain types of vaccinations. How and when a reaction to a vaccine may occur:

• The body’s general reaction to the vaccine or toxoids most noticeably manifests itself 8–12 hours after administration and completely disappears after 1–2 days;
• local reactions reach their maximum after a day and can last up to four days;
• Subcutaneous vaccination from sorbed preparations proceeds rather slowly and the first reaction can occur only one and a half to two days after vaccination. After the changes in the body, they can pass passively for up to a week, and the subcutaneous “bump” after vaccination will resolve within 20–30 days;
• complex antiviral drugs, consisting of 2-4 vaccinations, always give a reaction to the first vaccination - the rest can only slightly strengthen it, or cause an allergy.

A cause for concern should be considered if the body's reaction does not fit into the standard time frame for changes. This means either serious post-vaccination complications or a disease of another kind - in this case, you should immediately take the child to the doctor for a detailed examination.

If there are any significant deviations from the normal course of the reaction after vaccination, you should immediately consult a doctor. Ask in medical institution Information brochures to monitor your child's condition at home.

Severity of the leak

An indicator of the severity of post-vaccination changes is considered to be an increase in the body temperature of children relative to normal for general reactions, and the size and inflammation (infiltrate) at the site of drug administration for local ones. Both are conventionally divided into three groups, depending on the severity of the post-vaccination complication.

General reactions to vaccination:

• minor reaction - temperature does not exceed 37.6 °C;
• moderate reaction - from 37.6 °C to 38.5 °C;
• severe reaction - from 38.5 °C or more.

Local (local) reactions to vaccination:

• a weak reaction is an infiltrate or lump no larger than 2.5 cm in diameter;
• moderate reaction - compaction measuring from 2.5 to 5 cm in diameter;
• severe reaction - the size of the infiltrate is more than 5 cm.

It is imperative to monitor changes in the condition of children in the first few days after vaccination and immediately consult a doctor at the first manifestations of moderate or severe post-vaccination complications. If children quickly develop one or more signs of a severe reaction to a vaccine, resuscitation procedures may be required. Mild and moderate reactions can be alleviated with proper care and special medicines, antipyretic or restorative, the use of which must be consulted with the supervising physician immediately before vaccination. It is absolutely prohibited to use in these cases traditional methods self-medication, questionable remedies or incorrect medications. The health of children can be undermined for a long time if, against the background of a general post-vaccination weakening, we also use chemicals, which are not necessary.

Fast vaccine reactions and complications occur in medical practice hundreds of times less common than cases of infection with viral diseases.

How to avoid

Despite the large amount of contradictory and frightening information about vaccination, especially for children, it should be remembered: a correctly administered vaccine and proper care will reduce the risk of even the most minor complications to an absolute minimum. The main reason for such troubles can always be indicated:

• low quality of the administered drug, incorrectly selected vaccine;
• inattention or lack of professionalism medical personnel, which can often be found in conditions of conveyor belt free medicine;
• improper care, self-medication;
• infection with a bacteriological disease against the background of weakened immunity of children;
• unaccounted for individual intolerance or allergic reaction.

It's not worth saving. It would be very reasonable to use the services of a paid institution if your clinic clearly does not meet the standards of medical care.

All these factors are easy for an attentive and caring parent to track, which means that the risk of serious post-vaccination complications for their children is several times lower. Quantity viral diseases per hundred thousand children grows annually by 1.2–4% according to State statistics and represents hundreds of times more cases than post-vaccination reactions are observed. And of course, the vast majority of those sick did not receive the necessary vaccination.

Live vaccines - vaccination from weakened viruses

– 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 – pathological conditions, having a causal relationship with preventive vaccination, disrupting the health and development of the child. Carrying out preventive vaccination in pediatrics is aimed at the formation of protective immunity, which does not allow the development of an infectious process when the child comes into repeated contact 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 the National Calendar of Preventive Vaccinations, which regulates the list, timing and procedure for compulsory 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, individual characteristics the child’s body, 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 of medical personnel who violate the vaccination 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, added 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, edema, infiltration at the injection site, etc. General vaccine reactions may be accompanied by fever, myalgia, catarrhal symptoms, measles-like rash (after vaccination against measles), increased 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). Depending on the severity of the pathological process, post-vaccination complications are 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 DPT, 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 soreness 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 administration of the pertussis vaccine and is caused by an associated change in microcirculation in the brain and an acute attack of 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, clinical symptoms which are no different from those diseases with a different mechanism of occurrence. Vaccine-associated encephalitis can develop after vaccination against measles, rubella, and DTP. 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 often end in 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 differential diagnosis post-vaccination complications and complicated course of the vaccine period is laboratory examination child: general analysis of urine and blood, virological and bacteriological research blood, urine, feces. To exclude intrauterine infections(Differential diagnosis of post-vaccination complications in these cases is carried out with epilepsy, hydrocephalus, etc.

The diagnosis of a post-vaccination complication is established only after all other complications have been excluded. possible reasons violations of the child's condition.

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.

Vaccination reactions are divided into local and general. The first develop directly at the site of drug administration. A local reaction to the DTP vaccine is expressed in redness and a small thickening (about 2.5 cm in diameter) at the injection site. Local reaction to measles vaccine, which occurs only occasionally: hyperemia, slight tissue swelling at the site of vaccine administration for 1-2 days. A possible local reaction to the rubella vaccine is hyperemia at the site of vaccine administration, and occasionally lymphadenitis.

So, local reaction manifests itself as local pain, swelling, hyperemia, infiltration, inflammation. With the aerosol method of vaccine administration, local reactions such as conjunctivitis and catarrhal phenomena of the upper respiratory tract may be observed.

TO common post-vaccination reactions include: fever, general malaise, headache, joint pain, abdominal pain, vomiting, nausea, sleep disturbance, etc. Temperature is the most objective indicator of the general reaction. It is by the degree of temperature rise that general reactions are divided into weak (37-37.5 °C), medium (37.6-38.5 °C) and strong (over 38.5 °C).

The timing of the onset of a general reaction varies for different vaccines. Thus, the temperature reaction after administration DTP vaccines occurs mainly in the first day after vaccination and passes quickly. Temperature response to injection measles vaccine may appear from the 6th to the 12th day after vaccination. At the same time, hyperemia of the pharynx, runny nose, slight cough, sometimes conjunctivitis. Less common are general malaise, loss of appetite, nosebleeds, and measles-like rash.

From the 8th to the 16th day after vaccination against mumps, an increase in temperature, hyperemia of the pharynx, rhinitis, and a short-term (1-3 days) increase in the parotid salivary glands are occasionally observed. Prolonged manifestations of catarrhal phenomena or a more pronounced enlargement of the salivary glands are a reason to consult a doctor.

The presence of general and local reactions, as well as the degree of their manifestation, largely depend on the type of vaccine. When live vaccines are administered, symptoms associated with characteristic properties strains themselves and the emergence of a vaccine infectious process.

When introducing killed and chemically adsorbed vaccines, as well as toxoids, local reactions usually develop within a day and, as a rule, disappear after 2-7 days. Fever and other signs of a general reaction last a day or two.

With repeated vaccination, allergic reactions to the vaccine may occur, which are expressed by the appearance of edema and hyperemia at the site of vaccine administration, as well as complications of general reactions such as fever, low blood pressure, the appearance of a rash, etc. Allergic reactions may occur immediately after administration of the drug, but may also appear later, a day or two after vaccination. The fact is that vaccines contain a variety of allergenic substances, some of which cause an immediate allergic reaction, and some - increased sensitivity, the consequences of which may appear over time. For example, a certain number of children are allergic to egg white, bovine albumin, bovine whey and other heterologous proteins. It has been proven that not all of these children have allergic reactions to a vaccine containing this protein, and that such children, in principle, can be vaccinated with this drug. However, the introduction of a vaccine containing a foreign protein still poses a danger to these children.

It lies in the fact that the introduction of a small dose of a heterologous protein creates increased sensitivity, which can subsequently manifest itself when a large dose of the protein is administered and even when taken with food in persons predisposed to allergies.

Some vaccines can cause immediate allergies to unrelated antigens, such as the DPT vaccine, especially its pertussis component. The DTP vaccine can contribute to the occurrence of allergic reactions to house dust, pollen, etc. Vaccination of allergic children with the DPT-M toxoid, as a rule, is not accompanied by the appearance of signs of allergy.

Over many centuries of existence, man has managed to invent many effective methods for preventing certain health problems. And one of the most effective ways prevention is worth recognizing vaccination. Vaccinations really help to avoid many serious diseases, including those that pose a serious threat to human life. But such medical procedure, like all others, can cause unwanted reactions body. And the topic of our conversation today will be post-vaccination reactions and complications.

Local and general post-vaccination reactions

Such reactions represent various changes in the baby’s condition that occur after the vaccine is administered and go away on their own within a fairly limited period of time. Those changes in the body that qualify as post-vaccination reactions are considered unstable, purely functional and cannot threaten the health and life of the patient.

Local post-vaccination reactions

Local reactions include all kinds of manifestations that occur at the site of vaccine administration. Almost all nonspecific local reactions appear during the first day after administration of the drug. They may present as localized redness (hyperemia), the diameter of which does not exceed eight centimeters. Swelling and, in some cases, pain at the injection site are also possible. If adsorbed drugs were administered (especially subcutaneously), an infiltrate may form.

The described reactions last no longer than a couple of days and do not require any specific treatment.

However, if the local reaction is particularly severe (redness more than eight centimeters and swelling more than five centimeters in diameter), this drug cannot be used in the future.

The introduction of live bacterial vaccines can lead to the development of specific local reactions caused by the infectious vaccine process that develops at the site of application of the product. Such reactions are considered as an indispensable condition for the development of immunity. For example, when the BCG vaccine is administered to a newborn, one and a half to two months after vaccination, an infiltrate of 0.5-1 cm in size (in diameter) appears on the skin. It has a small nodule in the center, becomes crusty, and pustulation is also possible. Over time, a small scar forms at the site of the reaction.

Common post-vaccination reactions

Such reactions are represented by changes in the patient's condition and behavior. In most cases, these include increases in body temperature. When inactivated vaccines are administered, such reactions appear a couple of hours after vaccination and do not last more than two days. In parallel, the patient may experience sleep disturbances, anxiety, myalgia and anorexia.

When immunized with live vaccines, general reactions occur approximately eight to twelve days after vaccination. They are also manifested by an increase in temperature, but in parallel, catarrhal symptoms may occur (when using measles, mumps and rubella vaccines), measles-like skin rashes (when using measles vaccine), unilateral or bilateral inflammation of the salivary glands under the tongue (when using mumps vaccine) , as well as lymphadenitis of the posterior cervical and/or occipital nodes (when using the rubella vaccine). Such symptoms are not associated with post-vaccination complications and are explained by the replication of the vaccine virus. They usually go away within a few days with the use of symptomatic remedies.

Post-vaccination complications

Such pathological conditions are represented by persistent changes in the human body that have developed due to the introduction of vaccinations. Post-vaccination complications are long-lasting and greatly exceed the scope of physiological norms. Such changes significantly impair the patient's health.

They can be toxic (unusually strong), allergic (with manifestations of disturbances in the functioning of the nervous system) and rare forms of complications. Most often, such conditions are explained by the administration of the vaccine when the patient has some contraindications, insufficiently correct implementation of vaccination, poor quality of the vaccine preparation and individual properties and reactions human body.

Post-vaccination complications can be presented:

Anaphylactic shock that developed within 24 hours after vaccination;
- allergic reactions that affect the entire body;
- serum sickness;
- encephalitis;
- encephalopathy;
- meningitis;
- neuritis;
- polyneuritis, Guillain-Barré syndrome;
- convulsions that occur against the background of low body temperature (less than 38.5C) and are recorded within a year after vaccination;
- paralysis;
- sensitivity disorders;
- vaccine-associated polio;
- myocarditis;
- hypoplastic anemia;
- collagenoses;
- decrease in the number of leukocytes in the blood;
- an abscess or ulcer at the injection site;
- lymphadenitis – inflammation of the lymphatic ducts;
- osteitis – inflammation of the bones;
- keloid scar;
- screaming of a child for at least three hours in a row;
- sudden death.
- disease thrombotic thrombocytopenic purpura;

Similar conditions can occur after various vaccinations. Their therapy is carried out exclusively under the supervision of several qualified specialists and is comprehensive.

Folk remedies

The medicinal properties of lemon balm herb will help reduce the severity of unpleasant symptoms during post-vaccination reactions.

So, to improve the condition of anxiety, sleep disturbances and fever after vaccination, you can make tea. Brew a tablespoon of dried herb with half a liter of boiling water. Infuse the drink for an hour, then strain. Adults should drink a couple of glasses a day, sweetened with honey, and children can be given this medicine two or three tablespoons at a time (if there are no allergies).

", 2011 O.V. Shamsheva, Head of the Department of Infectious Diseases in Children, Moscow Faculty of the State Educational Institution of Higher Professional Education "Russian State medical University them. N.I. Pirogov" Ministry of Health and Social Development of the Russian Federation, Professor, Dr. med. sciences

Any vaccine can cause a response in the body, which usually does not lead to serious impairment. Vaccine reactions for inactivated vaccines are usually of the same type, while for live vaccines they are type specific. In cases where vaccine reactions manifest themselves as excessively strong (toxic), they move into the category of post-vaccination complications.

VACCINAL REACTIONS

They are divided into local and general. Local reactions include all manifestations that occur at the site of administration of the drug. Nonspecific local reactions appear during the first day after vaccination in the form of hyperemia not exceeding 8 cm in diameter, swelling, and sometimes pain at the injection site. When administering adsorbed drugs, especially subcutaneously, an infiltrate may form at the injection site. Local reactions develop on the day of vaccine administration (both live and inactivated), last no more than 2–3 days and, as a rule, do not require treatment.
Severe local reaction (hyperemia more than 8 cm, edema more than 5 cm in diameter) is a contraindication for subsequent use this drug. With repeated administration of toxoids, excessively strong local reactions may develop, spreading to the entire buttock, and sometimes involving the lower back and thigh. Apparently, these reactions are allergic in nature. Wherein general state the child is not disturbed.
When live bacterial vaccines are administered, specific local reactions develop, which are caused by the infectious vaccine process at the site of application of the drug. They appear after a certain period of time after vaccination, and their presence is an indispensable condition for the development of immunity. Thus, with intradermal immunization of newborns with the BCG vaccine, a specific reaction develops at the injection site after 6–8 weeks in the form of an infiltrate with a diameter of 5–10 mm with a small nodule in the center and the formation of a crust, and in some cases pustulation is noted. This reaction is caused by the intracellular reproduction of living attenuated mycobacteria with residual virulence. The reverse development of changes occurs within 2–4 months, and sometimes over a longer period. A superficial scar measuring 3–10 mm remains at the site of the reaction. If the local reaction is of a different nature, the child should be consulted by a phthisiatrician.
The local reaction after cutaneous immunization with tularemia vaccine has a different picture. In almost all vaccinated people, from the 4th–5th day (less often until the 10th day), hyperemia and swelling with a diameter of up to 15 mm develop at the site of scarification; vesicles the size of millet grains appear along the incisions; from the 10th–15th day on the site vaccination forms a crust, after peeling it off a scar remains on the skin.
General reactions include a change in the child’s condition and behavior, usually accompanied by an increase in temperature. To the administration of inactivated vaccines, general reactions develop several hours after vaccination, their duration usually does not exceed 48 hours. Moreover, when the temperature rises to 38° C and above, they may be accompanied by anxiety, sleep disturbance, anorexia, and myalgia.
General vaccine reactions are divided into: weak – low-grade fever up to 37.5° C, in the absence of symptoms of intoxication;
medium strength – temperature from 37.6° C to 38.5° C, moderate intoxication; With
severe – fever above 38.6° C, severe manifestations of intoxication.

General reactions after immunization with live vaccines develop at the height of the vaccine infectious process, usually on the 8th–12th day after vaccination, with fluctuations from the 4th to the 15th day. Moreover, in addition to the above symptoms, they may be accompanied by the appearance of catarrhal symptoms(measles, mumps, rubella vaccine), measles-like rash (measles vaccine), one- or bilateral inflammation of the salivary glands (mumps vaccine), lymphadenitis of the posterior cervical and occipital nodes (rubella vaccine).

With hyperthermic reactions in some children, it is possible to develop febrile seizures, which, as a rule, are short-term. The frequency of development of convulsive (encephalitic) reactions, according to long-term observations of domestic pediatricians, for the DTP vaccine is 4:100,000, which is a significantly lower figure than when using foreign drugs containing pertussis microbial cells. Administration of DTP vaccine may also cause a high-pitched scream that lasts for several hours and appears to be associated with the development of intracranial hypertension. If strong general reactions occur, symptomatic therapy is prescribed.

POST-VACCINATION COMPLICATIONS

As for post-vaccination complications, pathological processes such as vaccine-associated poliomyelitis (VAP), generalized BCG infection, encephalitis after measles vaccination, meningitis after live mumps vaccine, occur in one case or less per million vaccinated people. The table shows complications that have a causal relationship with vaccination.

The very fact of the extremely rare development of post-vaccination complications indicates the importance of the individual reactivity of the vaccinated organism in the implementation of side effect one vaccine or another. This is especially evident when analyzing complications after the use of live vaccines. Thus, the frequency of vaccine-associated poliomyelitis in children of the first year of life with primary immunodeficiency is more than 2000 times higher than that in immunocompetent children of the same age (16.216 and 7.6 cases per 10 million vaccinated, respectively). Vaccination against polio inactivated vaccine(IPV) at 3 and 4.5 months of life (according to the Russian vaccination calendar) solved the problem of VAP. This severe complication, as a generalized BCG infection, occurring with a frequency of less than 1 case per 1 million primary vaccinated people, usually develops in children with severe disorders of cellular immunity (combined immunodeficiencies, cellular immune deficiency syndrome, chronic granulomatous disease). Therefore, all primary immunodeficiencies are a contraindication to the administration of live vaccines.
Vaccine-associated meningitis after vaccination with the mumps vaccine usually occurs from the 10th to the 40th day after vaccination and is not much different from the disease serous meningitis caused by the mumps virus. In addition to the general cerebral syndrome (headache, vomiting), mild meningeal symptoms (stiff neck, Kernig's, Brudzinski's symptoms) can be detected. In analyzes cerebrospinal fluid contains normal or slightly increased amount protein, lymphocytic pleocytosis. For differential diagnosis with meningitis of other etiologies, virological and serological research. Treatment consists of prescribing antiviral, detoxification and dehydration agents.

When injected into the buttock area, traumatic injury may occur sciatic nerve, Clinical signs which in the form of restlessness and sparing of the leg on the side of which the injection was given has been observed since the first day. These same signs after OPV administration may be a manifestation of vaccine-associated poliomyelitis.

Thrombocytopenia is one of the possible complications of rubella vaccine administration. A cause-and-effect relationship between thrombocytopenia and the administration of vaccine preparations containing the measles virus has been proven.

Table

Complications that are causally related to vaccination

ADVERSE REACTIONS It is necessary to highlight adverse reactions, occurring after the administration of live viral vaccines (measles, mumps, rubella, yellow fever). They are associated with the replication of the vaccine virus, develop from the 4th to the 15th day after vaccination and have nothing to do with post-vaccination complications. In this case, fever, malaise, as well as a rash (with the introduction of measles vaccine), swelling of the parotid glands (in children vaccinated against mumps), arthralgia and lymphadenopathy (with immunization with rubella vaccine) may be observed. As a rule, these reactions disappear within a few days after the administration of symptomatic therapy.

ANAMNESIS

In order to find out whether the deterioration of the child’s condition was a consequence of the addition of an intercurrent disease or a complication of vaccination, it is necessary to carefully collect information about infectious diseases in the family and in the children's team. Simultaneously with the study of the medical history, it is necessary to pay attention to the epidemiological situation, i.e., the presence of infectious diseases in the child’s environment. This is of great importance, since the addition of intercurrent infections in the post-vaccination period aggravates its course and can cause various complications, and also reduces the development of specific immunity. In young children, these intercurrent diseases most often include acute respiratory infections (mono- and mixed infections): influenza, parainfluenza, respiratory syncytial, adenovirus, mycoplasma, pneumococcal, staphylococcal and other infections. If vaccination was carried out in incubation period these diseases, the latter can be complicated by sore throat, sinusitis, otitis, croup syndrome, obstructive bronchitis, bronchiolitis, pneumonia, etc.

DIFFERENTIAL DIAGNOSIS

In terms of differential diagnosis, one should remember the need to exclude intercurrent enterovirus infection(ECHO, Coxsackie), which is characterized by an acute onset with a rise in temperature to 39–40 ° C, accompanied by headache, pain in eyeballs, vomiting, dizziness, sleep disorder, herpetic sore throat, exanthema, symptoms of damage to the meningeal membranes and gastrointestinal tract. The disease has a pronounced spring-summer seasonality (“summer flu”) and can spread not only by airborne droplets, but also by the fecal-oral route.

In the post-vaccination period, it is possible that intestinal infections, which are characterized by a combination of general intoxication with vomiting, diarrhea and other manifestations of damage to the gastrointestinal tract. Severe anxiety, abdominal pain, vomiting, and lack of stool require a differential diagnosis with intussusception.

After vaccination, infection may be detected for the first time urinary tract, characterized by an acute onset, high fever and changes in urine tests. Thus, taking into account the possibility of complications arising from the administration of various vaccines, it should be borne in mind that the development of a pathological process in the post-vaccination period is not always associated with vaccination. Therefore, it is legitimate to make a diagnosis of a post-vaccination complication only after all other possible causes that led to the development of a particular pathology have been rejected.

PREVENTION

It is important to consider constant medical monitoring of vaccinated people in the post-vaccination period, to protect them from excessive physical and mental stress. It is also necessary to pay attention to the nutrition of children before and after vaccination. This is especially important for children suffering food allergies. During the vaccination period, they should not receive food that has previously caused allergic reactions, as well as foods that have not been consumed before and contain obligate allergens (eggs, chocolate, citrus fruits, caviar, fish, etc.).

Prevention of infectious diseases in the post-vaccination period is of decisive importance. Parents should not raise the question of immediate vaccinations before or immediately after the child’s admission to kindergarten or preschool. In a children's institution, a child finds himself in conditions of high microbial and viral contamination, his usual routine changes, emotional stress arises, all this adversely affects his health and is therefore incompatible with vaccination.

The choice of time of year for vaccination may have a certain significance. It has been shown that in the warm season, children tolerate the vaccination process more easily, since their body is more saturated with vitamins, which are so necessary in the immunization process. Autumn and winter are a time of high incidence of acute respiratory viral infections, the occurrence of which in the post-vaccination period is extremely undesirable.

It is better to vaccinate children who often suffer from acute respiratory infections in the warm season, while it is better to vaccinate children with allergies in winter; vaccinating them in spring and summer is undesirable, since pollen allergies are possible.

There is evidence that when vaccination is carried out for the purpose of prevention post-vaccination pathology daily allowance should be taken into account biological rhythms. It is recommended that vaccinations be carried out in the morning (before 12 o'clock).

Measures to prevent post-vaccination complications include a constant review of the vaccination calendar, which is carried out at the state level, using the latest scientific achievements in the field of immunoprophylaxis. Rationalization of the timing and sequence of immunization should be done by each pediatrician when drawing up an individual vaccination calendar. Immunoprophylaxis according to an individual calendar is carried out, as a rule, for children with a complicated medical history.

In conclusion, it should be said that in order to avoid the development of post-vaccination pathology, it is necessary to strictly follow the instructions for the vaccine, which provide recommendations regarding doses, regimens and contraindications for the administration of the drug.

Vaccination is not carried out during the acute period infectious disease. A contraindication to the administration of live vaccines is primary immunodeficiency. Pathological reaction caused by vaccination is a contraindication to the future use of this vaccine.