Vaccinations are the most reliable way to protect your baby from various deadly diseases. But the opponents of the vaccination of children are no less than the supporters. No matter how much the doctors assure that there is no other more reliable way to protect the baby from polio, tetanus, tuberculosis, the enemy will insist on his own. On the net and in newspapers, you can read numerous reviews about the terrible, and sometimes even fatal consequences after vaccinations. But is the reaction to the vaccine as dangerous as opponents say? Consider what the consequences of vaccination are and what to expect for parents.

How does the baby's body react to vaccination?

Any reactions after the introduction of the vaccine in a child are not desirable and harmless. If the body has reacted to the vaccine, then the immune system has formed a defense, and this is the main purpose of vaccinations. In some cases, the vaccine is designed to protect not only the vaccinated baby, but also his children, for example, from rubella.

By their nature, all reactions of the child's body to the administered drug are conventionally divided into two groups:

• Post-vaccination - a normal reaction of a healthy immune system to the administered compounds.
• Complications - various unforeseen reactions of the body.

Complications after vaccination appear as a percentage no less than after taking any other medication. And complications after past diseases are many times worse than after immunovaccination. According to the statistics of the Ministry of Health, complications after the administered drug during vaccination appear in 1 out of 15,000 cases. And if the drug was properly stored, the child was carefully examined before the procedure, and the injection was given at the right time, then this ratio will increase by 50-60%.

Therefore, do not be afraid of reactions, it is better to understand them and take preventive and auxiliary methods in time. A prepared baby will more easily tolerate the drug and his immunity will form better.

Normal body behavior after vaccination

After vaccination, normal reactions develop, which are divided into general and local. Local occur directly at the injection site. Vaccination against various diseases causes local reactions that differ:

• Whooping cough, diphtheria, tetanus - a painful infiltrate on the skin, with redness.
• Measles, Rubella, Mumps - redness with swelling.
• Mantoux test - seal with swelling and redness around the infiltrate.
• Droplets poliomyelitis - conjunctivitis, swelling of the nasopharyngeal mucosa.

A local reaction manifests itself and does not cause great concern among specialists. The symptoms go away on their own after 3-4 days and they do not need to be treated additionally. But if the swelling and itching of the tissues bother the baby, then you can lubricate the skin with antihistamine ointments and give an anti-allergic drug.

Common reactions include:

• allergic reaction (redness, itching of the skin on any part of the body);
• a slight increase in temperature (up to 38 degrees, easily knocked down by antipyretic drugs and disappears after 2-3 days);
• in some cases, a slight malaise (the child feels weak, eats poorly and sleeps more).

The biggest reactions are caused by BCG vaccination, which a child with reduced immunity does not tolerate well. By themselves, local reactions are not dangerous for a baby with high immunity, but if the baby is sick in a latent form, then local reactions will turn into exacerbated complications.

Complications after immunovaccination

The most dangerous reactions after vaccination are complications. The body of the crumbs does not tolerate the administered drug and the child has symptoms:

• From the side of the psyche of the crumbs: irritability, tearfulness, increased fatigue.
• From the side of the stomach: liquefaction of the stool, nausea, vomiting, pain.
• Hyperthermia, the temperature rises above 38.5 and lasts for several days.
• Allergic reaction: skin rashes, swelling of the nasopharynx, face.

Any of the adverse reactions is dangerous for the baby. Therefore, when the first signs appear, it is better to inform specialists.

What is dangerous allergy after vaccination

Among the most dangerous symptoms, an allergic reaction in an acute form stands out. It can appear both on the first day and within a few days after the administration of the medication. The main reason for a violent allergic reaction is the composition of the drug. Almost all vaccines used in Russia are made on the basis of chicken protein. In allergic children, the reaction can cause anaphylactic shock or Quincke's edema. Specialists carefully monitor children with a tendency to allergies and in some cases less aggressive drug analogues are used.

Before vaccinations with DTP and BCG, you need to prepare the body of the crumbs. Three days before the injection, the child is given antihistamines. Their reception is canceled 3-4 days after immunization.

Even if the child did not have allergies after the first vaccination, mothers should not relax. After the procedure, you should not leave the clinic immediately. Take a walk with the baby for 30-40 minutes around the hospital yard. If a severe allergic reaction occurs, then doctors will be able to provide first aid in time.

Hyperthermia after administration of the drug

High temperatures are dangerous for young children. If the thermometer shows above 38.5 degrees for more than 3 hours, then the likelihood of developing febrile seizures increases. Children of any age are prone to seizures, but seizures are more likely to occur in a child under 2 years of age. Parents should control hyperthermia and prevent it from rising above 38.5.

When vaccinated with BCG, an increase in temperature to 38 degrees for the first three days before vaccination is considered the norm. The symptoms will go away on their own in 3-4 days.

You can alleviate the child's condition with the help of antipyretic suppositories and drugs: feralgon, nurofen, ibuklin, paracetamol. We do not recommend bringing down the temperature after vaccination with aspirin and analgin. Drugs affect the functioning of the cardiovascular system and you will only harm the baby.

A high fever that lasts for several hours can cause nausea, headache, and general malaise in the child. If the symptoms are aggravated by a local reaction in the form of an abscess or a bump that pulsates, then you should immediately contact an ambulance.

Any reactions, expected or complications, are better than the consequences after the illness. It is possible to prevent unpleasant symptoms after vaccination, but it will be difficult to correct a crippled child's body. Therefore, we recommend immunization, but before each procedure, the child's body must be prepared.

post-vaccination reactions.

Local reactions- in the form of hyperemia with soft tissue edema at the injection site up to 3 cm in diameter.

General reactions- in the form of an increase in temperature to 39.5ºС.

allergic reactions- in children with allergies, the skin syndrome may worsen, exudative manifestations may increase.

Neurological reactions- in children with neurological pathology, motor disinhibition, tearfulness, and restless sleep are manifested.

Post-vaccination reactions are quite common (1-5%), do not pose a threat to life and health, do not require urgent measures, are registered only in the territorial center of Rospotrebnadzor. The nature of the reactions is noted in the card of preventive vaccinations (form No. 063 / y) and the history of development (form No. 112 / y).

Post-vaccination complications.

Heavy local manifestations in the form of dense infiltrates more than 8 cm in diameter.

Overly strong general reactions in the form of a fever of 39.6ºС or more, febrile convulsions.

allergic complications: acute urticaria, angioedema, anaphylactic shock. In children of the first year of life, the equivalent of anaphylactic shock is a collaptoid state: blanching, cyanosis, severe lethargy, a drop in blood pressure, the appearance of sticky sweat, and sometimes loss of consciousness.

neurological complications:

continuous piercing "brain" scream (squeal), lasting for several hours, associated with an increase in intracranial pressure;

afebrile convulsions with loss of consciousness, sometimes in the form of “nods”, “pecks”, “absences”, gaze stops;

encephalitis occurring with convulsions, prolonged loss of consciousness, fever, vomiting, development of focal symptoms.

Specific complications:

vaccine-associated poliomyelitis (after OPV)

generalization of BCG, BCG-itis, regional abscess, osteomyelitis, keloid scar.

Post-vaccination complications are very rare (1:70000 - 1:5000000). A medical institution that has made a diagnosis of a post-vaccination complication must send an emergency notification to the local territorial center of Rospotrebnadzor and to the State Research Institute for Standardization and Control of Medical Biological Preparations. L.A. Tarasevich (119002, Moscow, lane Sivtsev Vrazhek, 41). Each case is subject to an internal investigation.

Causes of post-vaccination complications

Complications associated with violation vaccination techniques, are few. Violations of sterility lead to the development of suppuration at the injection site; Exceeding the dose of the drug can cause severe toxic-allergic reactions.

Complications associated with vaccine quality: local (non-sterile) or general (toxic) - appear in several children vaccinated with the same series of vaccine.

Complications due to individual reaction.

Emergency care for post-vaccination complications at the prehospital stage.

Hyperthermia

The child should be lightly dressed, be in a well-ventilated room and receive a plentiful fractional drink in the amount of 80-120 ml / kg / day.

With hyperthermia with pallor, "marble" skin color, chills and cool extremities caused by spasm of peripheral vessels, antipyretics are prescribed:

healthy children - upon reaching a body temperature > 38.5ºС;

children with neurological pathology and a history of seizures - temperatures >38.0ºС.

Enter paracetamol 10 mg/kg inside or in suppositories, in the absence of effect - lytic mixtures intramuscularly:

Metamizole sodium 50% solution: up to 1 year - 0.01 ml / kg, over 1 year - 0.1 ml / year of life;

Diphenhydramine 1% solution (diphenhydramine): up to 1 year - 0.01 ml / kg, over 1 year - 0.1 ml / year of life;

Papaverine hydrochloride 2% - up to 1 year - 0.01 ml / kg; 0.1 ml/year of life;

30-40 minutes after taking or administering antipyretics, the "pale" fever should turn into "pink", the peripheral vessels will dilate, the skin will become pink, the limbs will be hot, sweating may begin. At this stage, increased heat transfer occurs, so most often it is enough to undress the child, providing fresh air.

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

They are usually due to the following reasons:

- the 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, formalin, growth medium residues and other "ballast" substances.

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

General reactions: fever, feeling unwell, headache, sleep disorders, appetite, muscle and joint pain, nausea and other changes that can be detected using clinical and laboratory examination methods.

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

With the oral (oral) method of vaccination, possible reactions (in the form of nausea, vomiting, abdominal pain, stool disorders) can be attributed to both general and local reactions.

Local reactions can be manifested as individual of these symptoms, or all of the above. Particularly high local reactogenicity is characteristic of vaccines containing a sorbent when they are administered by the needleless method. Pronounced local reactions largely determine the intensity of the overall reaction of the body.

General reactions with the introduction of 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 . With the use of sorbed preparations administered subcutaneously, the development of local reactions is slower, the maximum reactions are observed 36-48 hours after vaccination, then the process passes into a subacute phase, which lasts up to 7 days and ends with the formation of a subcutaneous painless seal ("vaccine depot") , absorbable in 30 days or more.

During immunization 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. Re-immunization with other types of drugs may be accompanied by more pronounced reactions of an allergic nature. Therefore, if severe general or local reactions appear during the initial administration of the drug in a child, this fact must be registered in his vaccination card and subsequently this vaccination should not be carried out.

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

The 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 ° С;

- a strong reaction - with an increase in body temperature to 38.6 ° C and above.

Local reactions are assessed by the intensity of the development of inflammatory-infiltrative changes at the injection site:

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

- from 2.5 to 5 cm - a reaction of an average degree;

- more than 5 cm - a strong local reaction.

Strong local reactions include the development of a massive edema of more than 10 cm in diameter, which is sometimes formed with the introduction of sorbed drugs, especially with the help of a needleless injector. Post-vaccination development of the infiltrate, accompanied by lymphangitis and lymphadenitis, is also regarded as a strong reaction.

Data on the reactogenicity of the applied vaccine are entered in the appropriate column of the medical book of the vaccinated. After each vaccination, after a strictly prescribed time, the doctor should evaluate the reaction of the vaccinated drug to the injection, record the post-vaccination reaction or its absence. Such marks are strictly required when using live vaccines, the reactions to the introduction of which are an indicator of the grafting of the drug (for example, when vaccinating against tularemia).

Given that the severity of vaccination reactions is largely determined by the intensity and duration of fever, modern methods of preventing and treating post-vaccination reactions are used. For this, antipyretic drugs are used (paracetamol, acetylsalicylic acid, brufen (ibuprofen), orthofen (voltaren), indomethacin and other drugs from the class of non-steroidal anti-inflammatory drugs). Of these, Voltaren and Indomethacin are the most effective.

Prescribing drugs in the post-vaccination period can significantly reduce the severity of vaccination reactions when using highly reactogenic drugs.
or completely prevent their development when immunized with weakly reactogenic vaccines. At the same time, the functional state of the body is significantly improved and the working capacity of vaccinated individuals is maintained. The immunological efficacy 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 of vaccination reactions, but for a period of at least 2 days. It is also extremely important to observe the regularity of taking medications (3 times a day).

Irregular use of pharmacological agents or their appointment with a delay (more than 1 hour after vaccination) is fraught with aggravation of the clinical course of the post-vaccination reaction.

Therefore, if it is impossible to simultaneously use the vaccine and the drug, they should be prescribed only to persons with already developed reactions, i.e., treatment of vaccination reactions should be carried out, which should last 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 violations of body functions. 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 reactivity of the body may be reduced due to the following reasons:

- due to the peculiarities of the constitutional nature;

- due to the peculiarities of the allergic history;

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

- in connection with an acute illness or injury;

- in connection with other pathological conditions that weaken the body and contribute to its increased sensitivity to allergens.

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

A prophylactic drug during the procedure for its administration can be a direct cause of a post-vaccination complication in case of violation of the vaccination technique (incorrect dose (volume), method (place) of administration, violation of asepsis rules) or when using a drug that was stored in violation of the established regimen. So, for example, an increase in the dose of an administered vaccine, in addition to gross errors, can occur with poor mixing of sorbed preparations, when people immunized with the last portions receive an excess amount of sorbent, and hence antigens.

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

Anaphylactic shock

The reasons for the acute development of endotoxic, or anaphylactic, shock may be sensitization of the body, violations of the rules for 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 introduction of such drugs is accompanied by a rapid entry into the circulatory system of an excess amount of toxic products that have appeared due to cell decay, and modified allergens.

The most reliable and effective way to prevent post-vaccination complications is the obligatory observance of the vaccination rules at all stages, starting with the control of vaccine preparations, competent selection of individuals,
to be vaccinated, examining them immediately before the procedure and ending with the observation of those vaccinated in the post-vaccination period.

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

An extremely rare, but the 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; sharp general weakness, anxiety, fear, sudden redness, and then pallor of the face, cold sweat, pain in the chest or abdomen, weakening and increased heart rate, a sharp decrease in blood pressure, sometimes nausea and vomiting, loss and confusion, dilated pupils.

Treatment

If signs of shock appear, the following actions should be taken urgently:

- immediately stop the administration of the drug;

- put a tourniquet on the arm (if the drug was injected into it, this will prevent the spread of the drug throughout the body);

- put the patient on the couch, give a pose with a low head;

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

- provide him with access to fresh air;

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

In a very serious condition, intravenous drip 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 drug (diphenhydramine, diazolin, tavegil, clemastine, etc.) is administered intramuscularly, calcium chloride intravenously, cordiamine, caffeine or ephedrine subcutaneously. In acute heart failure - intravenously 0.05% strophanthin from 0.1 to 1 ml in 10-20 ml of a 20% glucose solution, slowly. The patient needs to be given oxygen.

If there is no result from these measures, hormonal preparations are used intravenously (3% prednisolone or hydrocortisone in a 20% glucose solution).

Persons with developed anaphylactic shock at the first opportunity are hospitalized in a hospital with special resuscitation transport. If such a patient is not provided with timely medical 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 introduction of antipyretic, cardiac, detoxifying and other agents is indicated. The patient needs immediate hospitalization.

Allergic reactions from the skin are more often observed with the introduction of live vaccines and manifest as extensive hyperemia, massive edema and infiltration. A varied rash appears, swelling of the mucous membranes of the larynx, gastrointestinal tract and statutes may occur. These phenomena occur shortly after vaccination and, as a rule, quickly pass.

Treatment

Treatment consists in the appointment of antihistamines and drugs that soothe itching. The use of vitamins A and group B is shown.

Neurological post-vaccination complications

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

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

Local post-vaccination complications include changes that are observed with subcutaneous administration of sorbed preparations, especially when using a needleless injector, and proceed as a cold aseptic abscess. Treatment of such infiltrates is reduced to physiotherapeutic procedures or surgical intervention.

In addition to the listed complications, there may be other types of post-vaccination pathology associated with an exacerbation of the underlying disease that the vaccinated person suffered in a latent form.

qina is injected into the anterolateral region of the upper thigh, for children older than 18 months - into the region of the deltoid muscle.

The refusal to administer the vaccine into the buttock, in addition to the possibility of damaging the nerves and blood vessels passing in the buttock area, is also motivated by the fact that in young children the gluteal region consists mainly of adipose tissue, and the quadriceps femoris muscle is well developed from the first months of life. In addition, there are no important nerves and blood vessels in the anterolateral region of the upper thigh.

In children over the age of 2-3 years, it is preferable to administer the vaccine into the deltoid muscle (in the middle between the lateral end of the spine of the scapula and the deltoid tuberosity). Injections into the triceps muscle should be avoided due to the possibility of injury to the radial, brachial, and ulnar nerves, as well as the deep artery of the shoulder.

Contraindications to vaccination. Contraindications to vaccination are divided into permanent (absolute) and temporary (relative). Absolutely contraindicated:

all vaccines - in case of excessively strong reactions or other post-vaccination complications to the previous administration;

all live vaccines - for persons with immunodeficiency states (primary); immunosuppression, malignant neoplasms; pregnant women;

BCG vaccine - with a child's body weight at birth less than 2,000 g; keloid scars, including after the introduction of the previous dose;

DTP vaccine - with progressive diseases of the nervous system, afebrile convulsions in history;

live measles, mumps, rubella vaccines - in severe forms of allergic reactions to aminoglycosides; anaphylactic reactions to egg white (except rubella vaccine);

hepatitis B vaccine - for allergic reactions to baker's yeast.

With temporary contraindications, scheduled vaccination is delayed until the end of acute and exacerbations of chronic diseases; the vaccine is administered no earlier than 4 weeks after recovery.

4.6. Vaccine reactions and complications

4.6.1. Vaccine reactions

Normal vaccine reaction. The vaccination process is usually asymptomatic, but vaccinated individuals may

manifestations of a normal vaccine reaction, which is understood as clinical and laboratory changes associated with the specific action of a particular vaccine. Clinical manifestations and the frequency of their occurrence are described in the instructions for each medical immunobiological preparation. Thus, vaccine reactions are a complex of clinical and paraclinical manifestations that stereotypically develops after the introduction of a specific antigen and is determined by the reactogenicity of the vaccine.

Pathological conditions during the vaccination process. Along with the normal vaccinal response, the administration of vaccines may be accompanied by side effects. Pathological conditions that occur in the post-vaccination period are divided into three groups: 1) the addition of an acute intercurrent infection or exacerbation of chronic diseases; 2) post-vaccination reactions; 3) post-vaccination complications (discussed in subsection 4.6.2).

Nonspecific infectious diseases. In children after the introduction of vaccines, nonspecific (in relation to the vaccine) infectious diseases may occur: acute respiratory viral infections (ARVI) (often with manifestations of neurotoxicosis, croup syndrome, obstructive bronchitis), pneumonia, urinary tract infection, neuroinfection, etc. As a rule, the increased infectious morbidity in the post-vaccination period is explained by a simple coincidence in the time of vaccination and illness. However, it may also be associated with changes in the immune system after the introduction of vaccines. This is due to the fact that the introduction of vaccines in the immune system results in the same type of biphasic changes.

The first phase - immunostimulation - is accompanied by an increase in the number of circulating lymphocytes, including T-helpers and B-lymphocytes.

The second phase - transient immunodeficiency - develops 2-3 weeks after the introduction of the vaccine and is characterized by a decrease in the number of all subpopulations of lymphocytes and their functional activity, including the ability to respond to mitogens and synthesize antibodies. This phase is necessary to limit the immune response to vaccine antigens. In addition, vaccination causes changes in the innate immune system: interferon hyporeactivity (starting from the 1st day after vaccination), inhibition of complement activity, lysozyme, and phagocytic activity of leukocytes. This limitation, however, extends to non-vaccinal, unrelated antigens.

Pathogenetically, post-vaccination immunodeficiency is indistinguishable from secondary immunodeficiencies that occur during viral or bacterial infections, and it is this that underlies

increased infectious morbidity with non-specific (in relation to the vaccine) infections. In the post-vaccination period in children, various acute infections are recorded more often than at other times, with two peaks being noted: in the first 3 days and on the 10-30th day after vaccination.

To This group also includes complications that develop

in as a result of a violation of the technique of vaccination. Violation of the sterility of vaccines is one of the extremely dangerous ones. This is the reason for the development purulent-septic complications, in some cases culminating in the development of infectious-toxic shock and death.

Pathological postaccinal reactions. Some children experience climacteric during prophylactic vaccination.

nic disorders, unusual for the usual course of the vaccination process. Such pathological vaccine reactions are divided into local and general.

Local pathological vaccine reactions include all reactions that occur at the injection site vaccines

us. Nonspecific local reactions appear on the 1st day after vaccination in the form of hyperemia and edema, which persist for 24-48 hours. When using adsorbed drugs, especially under the skin, an infiltrate may form at the injection site. With repeated administration of toxoids, excessively strong local allergic reactions can develop, spreading to the entire buttock, and sometimes involving the lower back and thigh.

There are three degrees of severity of the local reaction. A weak reaction is hyperemia without infiltrate or infiltrate with a diameter of up to 2.5 cm; an average reaction - an infiltrate up to 5 cm, a strong reaction - an infiltrate over 5 cm, as well as an infiltrate with lymphangitis and lymphadenitis. The appearance of such reactions is based on an increase in vascular permeability, as well as the development of basophilic infiltration under the action of an adjuvant. When they occur, antihistamines and compresses are prescribed.

With the introduction of live bacterial vaccines, specific local reactions develop due to the infectious process at the site of application of the drug. So, with intradermal immunization with BCG vaccine at the injection site, after 6-8 weeks, a specific reaction develops 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; in some cases, pustules appear at the injection site. The reverse development of changes takes 2-4 months. A superficial scar of 3–10 mm remains at the site of the reaction. If a local atypical reaction occurs, the child needs to consult a phthisiatrician.

General vaccinal reactions are accompanied by a change in the state and behavior of the child. They often express

are caused by fever, anxiety, sleep disturbance, anorexia, myalgia.

After administration of inactivated vaccines, general reactions develop after several hours; their duration usually does not exceed 48 hours. The severity of the reaction is estimated by the height of the body temperature, with which other manifestations are directly correlated. The reaction is considered weak when the body temperature rises to 37.5 °C, medium - at a temperature from 37.6 to 38.5 °C, strong - when the body temperature rises above 38.5 °C. These manifestations are based on the development of the acute phase response.

In children with perinatal lesions of the nervous system, after vaccination, an encephalic reaction may develop, accompanied by an increase in body temperature and short-term convulsions. A manifestation of such a reaction to the introduction of pertussis vaccine is also a continuous shrill cry of the child for several hours. The mechanism of development of the encephalic reaction is due to the increased permeability of the vascular wall, resulting in an increase in intracranial pressure and the development of edema-swelling of the brain.

Most often, encephalic reactions develop after vaccination with a whole cell pertussis vaccine, which is associated with its sensitizing effect, the presence of antigens that cross-react with the brain tissue. At the same time, the frequency of seizures after the DTP vaccine is lower than that of foreign analogues.

The therapy for encephalic post-vaccination reactions is similar to that for neurotoxicosis (see Chapter 6). An allergic rash is also a manifestation of common reactions to vaccination. When it occurs, antihistamines are indicated.

4.6.2. Post-vaccination complications

No. 157-FZ "On immunoprophylaxis of infectious diseases"

to Post-vaccination complications include severe and (or) persistent health disorders that develop as a result of preventive vaccinations (Table 4.3). Post-vaccination complications are divided into specific, depending on the type of microorganism contained in the vaccine, and non-specific.

Cases of post-vaccination complications and suspicions of them, presented in Table. 4.3 are investigated by commissions (pediatrician, internist, immunologist, epidemiologist, etc.) appointed by the chief doctor of the center of the State Sanitary and Epidemiological Surveillance in the constituent entity of the Russian Federation.

Specific post-vaccination complications. These complications include vaccine-associated infections caused by the residual virulence of the vaccine strain, the reversion of its pathogenic properties, and disturbances in the immune system (primary immunodeficiencies).

Table 4. 3

The main diseases in the post-vaccination period, subject to registration and investigation

	Clinical form
				appearance
	Anaphylactic shock,		Everything except BCG and oral
	anaphylactoid		polio
	reaction, collapse
	Heavy generators		All except BCG and
	licked allergy		oral polio
	cal reactions		cast vaccine
	Serum syndrome		All except BCG and
			oral polio
			cast vaccine
	encephalitis, encephalitis		Inactivated
	shovel, myelitis, ence
	phalomyelitis, neuritis,
	polyradiculoneuritis,
	Guillain-Barré syndrome
	Serous meningitis
	Afebrile convulsions		Inactivated
		myocarditis,
		hypoplasti-
	chesky anemia, agranu
		Thrombocyto
	singing, collagenosis
	Vaccine-associated		Live polio
	poliomyelitis
	chronic arthritis		rubella
	cold abscess,			During
		lymphadenitis,
	BCG infection
	Sudden death and others
	deaths

Persistent and generalized BCG infection manifests itself in the development of osteitis (flowing as bone tuberculosis), lymphadenitis (two or more localizations), subcutaneous infiltrates. With a generalized infection, polymorphic clinical manifestations are observed. In individuals with primary combined immunodeficiencies, a lethal outcome is possible.

With the development of BCG infection, etiotropic therapy is carried out. With generalized BCG infection, isoniazid or pyrazinamide is prescribed for 2-3 months. With purulent lymphadenitis, a puncture of the affected lymph node is made with the removal of caseous masses and streptomycin or other anti-tuberculosis drugs are administered at a dose appropriate for age. The same therapy is indicated for cold abscesses that have developed as a result of a violation of the vaccination technique and subcutaneous administration of the BCG vaccine.

Complications after BCG vaccination are rare. So, regional BCG lymphadenitis is registered with a frequency of 1: 1 0 LLC, generalized BCG infection - 1: 1 LLC LLC.

Diagnosis of vaccine-associated poliomyelitis is based on the criteria proposed by WHO:

a) occurrence in terms from 4 to 30 days in vaccinated, up to 60 days in contact;

b) the development of flaccid paralysis or paresis without impaired sensitivity and with residual effects after 2 months of illness;

c) absence of disease progression; d) isolation of the vaccine strain of the virus and an increase in titer

type-specific antibodies at least 4 times.

In countries with high vaccination coverage, most cases of poliomyelitis can now be classified as vaccine-associated. Vaccine-associated poliomyelitis occurs in 1 in 500,000 children vaccinated with oral polio vaccine. In Russia, since 1997, from 2 to 11 cases of vaccine-associated poliomyelitis have been reported annually, which, on average, does not go beyond international statistics (O. V. Sharapova, 2003).

Such a complication as encephalitis, when vaccinated with both inactivated and live vaccines, occurs in a ratio of 1: 1,000,000.

Mitigated measles, post-vaccination measles encephalitis, subacute sclerosing panencephalitis, and measles pneumonia may occur after vaccination with measles vaccine.

Acute parotitis and mumps meningitis develop after vaccination with mumps vaccine.

Arthritis and arthralgia may occur after the administration of red-

stuffy vaccine; congenital rubella syndrome, abortion - when vaccinating pregnant women with rubella vaccine.

Nonspecific post-vaccination complications. Such complications are associated primarily with the individual reactivity of the vaccinated person. Vaccination can act as a factor in identifying the genetic predisposition of the vaccinated, and the post-vaccination complications themselves in young children are predictors of the development of immunopathological diseases in the future. According to the leading mechanism of occurrence, these complications can be conditionally divided into three groups: allergic (atopic), immunocomplex, autoimmune.

To allergic complications include anaphylactic shock, severe generalized allergic reactions (Quincke's edema, Stevens-Johnson syndrome, Lyell's syndrome, erythema multiforme exudative), onset and exacerbation of atopic dermatitis, bronchial asthma.

Allergy that occurs during vaccination is associated with an increased production of general and specific IgE both to the protective antigens of the vaccine and to antigens that do not have a protective effect (egg white, antibiotics, gelatin). Allergic reactions occur to a greater extent in individuals predisposed to atopy. Isolated cases of strong local (including edema, hyperemia more than 8 cm in diameter) and general (including temperature over 40 °C, febrile convulsions) reactions to vaccination, as well as mild manifestations of skin and respiratory allergies are subject to registration in the prescribed manner without informing higher authorities.

The most severe complication of the group is anaphylactic shock. In case of parenteral ingestion of the allergen of the vaccine, a few seconds or minutes after a short period of precursors (weakness, fear, anxiety), skin hyperemia and itching (primarily of the hands, feet, inguinal region), sneezing, abdominal pain, urticarial rash, angioedema edema. There may also be swelling of the larynx, broncho- and laryngo-obstruction. Blood pressure decreases, muscle hypotension, loss of consciousness, sharp pallor of the skin, pouring sweat, foam from the mouth, incontinence of urine and feces, convulsions, coma appear. With the development of anaphylactic shock, death can occur within a few minutes. The following steps need to be taken very quickly:

1) immediately stop the administration of the vaccine that caused the reaction, and lay the child on his side to avoid asphyxia as a result of aspiration of vomit, retraction of the tongue. In the absence of vomiting, the patient is placed on his back and the lower part of the body is raised. The patient is covered with heating pads, they provide access to fresh air, airway patency, oxygen therapy is carried out;

2) immediately inject epinephrine at the rate of 0.01 mcg / kg, or 0.1 ml per year of life up to 4 years, 0.4 ml for children 5 years old, 0.5 ml 0.1%

intravenous solution for children over 5 years of age (subcutaneous or intramuscular administration is possible). Injections are repeated every 10-15 minutes until the patient is removed from a serious condition. To reduce the absorption of the vaccine when it is administered subcutaneously, it is necessary to chop the injection site with an adrenaline solution (0.15 - 0.75 ml of a 0.1% solution). A tourniquet is applied above the injection site.

With the purpose of slowing down the distribution of the vaccine antigen;

3) parenterally introduce corticosteroids (prednisolone 1–2 mg/kg or hydrocortisone 5–10 mg/kg), which reduce or prevent the development of later manifestations of anaphylactic shock (bronchospasm, edema). A child in a very serious condition can be given 2 to 3 single doses. If necessary, injections are repeated;

4) parenterally introduce antihistamines (diphenhydramine, chlorpyramine, clemastine), but only with a clear trend towards normalization of blood pressure. In this case, a single dose of diphenhydramine in children from 1 month to 2 years is 2-5 mg, from 2 to 6 years - 5-15 mg, from 6 to 12 years - 15 - 30 mg; single dose of chloropyr-

amine in children under 1 year is 6.25 mg, from 1 year to 7 years - 8.3 mg, from 7 to 14 years - 12.5 mg; clemastine is administered intramuscularly to children in a single dose of 0.0125 mg/kg (daily dose - 0.025 mg/kg).

To restore the volume of circulating fluid, infusion therapy with colloidal and (or) crystalloid is carried out.

ny solutions (5 - 10 ml/kg). If breathing is difficult, bronchospasm is prescribed a solution of aminophylline at the rate of 1 mg / kg per 1 hour. In case of heart failure, cardiac glycosides are indicated. After emergency care, the patient is subject to mandatory hospitalization.

Vaccination may lead to the initiation and/or exacerbation of immunocomplex and autoimmune diseases. The first include hemorrhagic vasculitis, serum sickness, polyarteritis nodosa, glomerulonephritis, idiopathic thrombocytopenic purpura.

Post-vaccination complications with damage to the central and peripheral nervous system have an autoimmune mechanism. The defeat of the central nervous system is expressed in the development of encephalitis, encephalomyelitis. With damage to the peripheral nervous system, mononeuritis, polyneuritis, Guillain-Barré syndrome can occur. In addition, “second” diseases develop as vaccination complications: autoimmune hemolytic anemia, idiopathic and thrombotic thrombocytopenic purpura, myocarditis, glomerulonephritis, tubulointerstitial nephritis, systemic lupus erythematosus (SLE), dermatomyositis, systemic scleroderma, juvenile rheumatoid arthritis, disseminated sclerosis. The introduction of vaccines can stimulate the formation of autoantibodies, autoreactive lymphocytes, immune

Introduction	Vaccination of patients with burdened anamnesis. Recommended Vaccines	Vaccination reactions and complications
Immunological mechanisms anti-infective protection	Tactics of treatment of children with various pathologies before and after vaccination	Contraindications to vaccination
Vaccines, composition, vaccination technique, vaccine preparations. Development of new types of vaccines	Some aspects of immunization adults	Attachment 1 Appendix 2
Vaccination strategy in Russia and other countries of the world. Immunization schedules	Urgent therapeutic measures in the development of post-vaccination complications	Glossary of terms Bibliography

8. VACCINE REACTIONS AND COMPLICATIONS

To date, there are numerous definitions of the various reactions that can occur as a result of vaccination. In particular: "adverse reactions", "adverse reactions", "side effects", etc. Due to the lack of generally accepted definitions, discrepancies arise when evaluating such reactions in vaccinated people. This necessitates the selection of a criterion that allows differentiating reactions to the introduction of vaccines. In our opinion, such a criterion is the possibility of booster immunization or revaccination in a patient who had any manifestations after the introduction of the vaccine.

From this perspective, two types of reactions can be considered:

Vaccination reactions- these are reactions that occur as a result of vaccination, but are not an obstacle to subsequent administrations of the same vaccine.

Complications (adverse reactions) are reactions that occur as a result of vaccination and prevent the repeated administration of the same vaccine.

Undesirable reactions or complications caused by vaccination are changes in body functions that go beyond physiological fluctuations and do not contribute to the development of immunity.

From a legal point of view, "post-vaccination complications are severe and / or persistent health disorders due to preventive vaccinations" (see Appendix No. 2).

8.1. Probable Mechanisms of Adverse Immunization Reactions

Modern ideas about the mechanisms of adverse reactions to vaccines are summarized in the work of N.V. Medunicina, ( Russian J. of Immunology, Vol.2, N 1, 1997, p.11-14). The author identifies several mechanisms that play a leading role in this process.

1. Pharmacological action of vaccines.

2. Post-vaccination infection caused by:
- residual virulence of the vaccine strain;
- reversal of the pathogenic properties of the vaccine strain.

3. Tumorogenic effect of vaccines.

4. Induction of an allergic response to:
- exogenous allergens not associated with the vaccine;
- antigens present in the vaccine itself;
- stabilizers and adjuvants contained in the vaccine.

5. Formation of non-protective antibodies.

6. Immunomodulatory effect of vaccines, realized due to:
- antigens contained in vaccines;
- cytokines found in vaccines.

7. Induction of autoimmunity.

8. Induction of immunodeficiency.

9. Psychogenic effect of vaccination.

Pharmacological effects of vaccines. Some vaccines administered to humans can cause significant changes not only in the immune system, but in the endocrine, nervous, vascular, etc. Vaccines can cause functional changes in the heart, lungs, and kidneys. Thus, the reactivity of the DTP vaccine is mainly due to pertussis toxin and lipopolysaccharide. These substances are responsible for the development of fever, convulsions, encephalopathy, etc.

Vaccines induce the formation of various mediators of the immune system, some of which have a pharmacological effect. For example, interferon is the cause of fever, granulocytopenia, and IL-1 is one of the inflammatory mediators.

post-vaccination infections. Their occurrence is possible only with the introduction of live vaccines. So, lymphadenitis, osteomyelitis that occurs after the injection of BCG vaccine is an example of such an action. Another example is vaccine-associated poliomyelitis (live vaccine), which develops in vaccinated and exposed individuals.

tumorigenic effect. The presence of heterologous DNA in small concentrations in vaccine preparations (especially genetically engineered ones) is dangerous, because can induce inactivation of oncogene suppression or activation of proto-oncogenes after integration into the cellular genome. According to WHO requirements, the content of heterogeneous DNA in vaccines should be less than 100 pg/dose.

Induction of antibodies to non-protective antigens contained in vaccines. The immune system produces "useless antibodies" when the vaccine is multicomponent, and the main protective effect required by vaccination must be of the cell-mediated type.

Allergy. The vaccine contains various allergic substances. Thus, fractions of tetanus toxoid differ from each other in their ability to induce both HNT and DTH reactions. Most vaccines contain additives such as heterologous proteins (ovalbumin, bovine serum albumin), growth factors (DNA), stabilizers (formaldehyde, phenol), adsorbents (aluminum hydroxide), antibiotics (kanamycin, neomycin, gentamicin). All of them can cause allergies.

Some vaccines stimulate IgE synthesis, thus developing an immediate allergy. DTP vaccine promotes the development of IgE-dependent allergic reactions to plant pollen, house dust and other allergens (possibly responsible B. pertussis and pertussis toxin).

Some viruses, such as influenza A virus, increase the release of histamine when exposed to specific allergens (plant pollen, house dust, animal dander, etc.) in patients with these types of allergies. In addition, this phenomenon can provoke an exacerbation of asthma.

Aluminum hydroxide is the most commonly used adsorbent, however, it is not indifferent to humans. It can become a depot for antigens and enhance the adjuvant effect. On the other hand, aluminum hydroxide can cause allergies and autoimmunity.

Immunomodulatory effect of vaccines. Many varieties of bacteria such as M.tuberculosis, B.pertussis and bacterial preparations - peptidoglycans, lipopolysaccharides, protein A and others have nonspecific immunomodulatory activity. Pertussis bacteria increase the activity of macrophages, T-helpers, T-effectors and reduce the activity of T-suppressors.

In some cases, non-specific modulation plays a decisive role in the formation of immunity, moreover, it may be the main defense mechanism in chronic infections. Nonspecific cellular reactions are not only the result of a direct effect of microbial products on cells, but they can be induced by mediators secreted by lymphocytes or macrophages under the influence of microbial products.

A new development in the study of the various effects of vaccines was the discovery of different types of cytokines in preparations. Many cytokines such as IL-1, IL-6, granulocyte colony-stimulating factor, granulocyte-macrophage colony-stimulating factor can be contained in vaccines against polio, rubella, rabies, measles, mumps. Cytokines as biological substances act in small concentrations. They can cause complications of vaccination.

Induction of autoimmunity. It has been established that the pertussis vaccine causes a polyclonal effect and can induce or stimulate the formation of autoantibodies and specific clones of lymphocytes directed against the structures of one's own body. Antibodies such as anti-DNA antibodies are present in the sera of some individuals who do not show clinical signs of pathology. The introduction of vaccines can stimulate the synthesis of antibodies and the development of the pathological process.

Another possible reason for the post-immunization development of autoimmune disorders is the phenomenon of mimicry (vaccine and components of one's own body). For example, the similarity of the polysaccharide of meningococcus B and the glycoprotein of cell membranes.

induction of immunodeficiency. Suppression of the immune response may depend on the conditions of vaccine administration (time of administration, dose, etc.). Suppression depends on the ability of microbial antigens to activate suppressor mechanisms, causing the release of suppressor factors from these cells, including the secretion of prostaglandin E 2 from macrophages, and the like.

Suppression can be either specific or non-specific, depending on the type of activated suppressor cells. Vaccination can inhibit non-specific resistance to infections, and as a result, intercurrent infections are superimposed, exacerbation of the latent process and chronic infections is possible.

Psychogenic effect of vaccination. The psycho-emotional characteristics of the patient may enhance the local and systemic reactions caused by vaccines. Some authors, for example, recommend the use of fenozepam before vaccination, which will prevent the development of negative reactions during the post-vaccination period.

Knowledge of the above mechanisms of adverse immunization reactions allows the allergist-immunologist to develop individual vaccination schedules, taking into account the characteristics of the patient's immune system, as well as the quality of the vaccine.

8.2. Hypersensitivity to vaccine components

Vaccine components may cause allergic reactions in some recipients. These reactions may be local or systemic and may include anaphylactic or anaphylactoid reactions (generalized urticaria, swelling of the oral and laryngeal mucosa, difficulty breathing, hypotension, shock).

Vaccine components that can cause these reactions are: vaccine antigens, animal proteins, antibiotics, preservatives, stabilizers. The most commonly used animal proteins are egg proteins. They are present in vaccines such as influenza, yellow fever. Cell culture of chick embryos can be contained in measles and mumps vaccines. In this regard, persons who are allergic to chicken eggs should not be given these vaccines, or with great caution.

If there is a history of allergy to penicillin, neomycin, then such patients should not be given the MMR vaccine, since it contains traces of neomycin. At the same time, if a history of allergy to neomycin in the form of HRT (contact dermatitis) is indicated, this is not a contraindication for the introduction of this vaccine.

Some bacterial vaccines such as DTP, cholera, typhoid often cause local reactions such as hyperemia, soreness at the injection site, and fever. These reactions are difficult to associate with specific sensitivity to the components of the vaccine and are more likely to reflect toxic effects than hypersensitivity.

Urticaria or anaphylactic reactions to DTP, DTP, or AS are rarely described. In the event of such reactions, to decide on the further administration of the AU, skin tests should be performed to determine sensitivity to the vaccine. In addition, it is necessary to conduct a serological study to detect an antibody response to AS before continuing to use AS.

The literature describes allergic reactions to merthiolate (thimerosal) in 5.7% of immunized patients. The reactions were in the form of skin changes - dermatitis, exacerbation of atopic dermatitis, etc. .

Researchers in Japan have shown the possible role of thimerosal, which is part of vaccines, in the sensitization of vaccinated children. Skin tests were performed with 0.05% aqueous thimerosal in 141 patients and with 0.05% aqueous mercuric chloride in 222 patients, including 63 children. It turned out that the frequency of positive tests for thimerosal is 16.3%, and these were vaccinated children aged 3 to 48 months. Further studies were carried out on guinea pigs vaccinated with DTP and sensitization to thimerosal was obtained. Based on the above, the authors concluded that thimerosal may sensitize children.

An allergic reaction to the gelatin included in the MMR vaccine has also been described in the form of anaphylaxis.

There are rare cases of vaccine granulomas as a manifestation of an allergy to aluminum to vaccines containing aluminum hydroxide.

Other authors described 3 cases of subcutaneous nodules at the site of injection of vaccines containing tetanus toxoid. Biopsy and microscopic examination in all three cases showed granulomatous inflammation containing lymphoid follicles in the dermis and subcutaneous tissue, surrounded by an infiltration composed of lymphocytes, histiocytes, plasma cells, and eosinophils. It was concluded that there was an allergic reaction to the injected aluminum.

The admixture of a foreign protein (ovalbumin, bovine serum albumin, etc.) can have a sensitizing effect, which will subsequently manifest itself when this protein is administered with food.

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