> Post-vaccination reaction

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What is a post-vaccination reaction?

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

Local post-vaccination reactions and their clinical manifestations

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

Signs of the body’s general reaction to vaccination

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

Diagnosis and treatment

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

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

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

Zin is injected into the anterolateral area of ​​the upper thigh, and for children over 18 months - into the deltoid muscle area.

The refusal to administer the vaccine into the buttock, in addition to the possibility of damage to the nerves and vessels passing in the buttock area, is also motivated by the fact that in children early age The gluteal region consists predominantly of adipose tissue, and the quadriceps femoris muscle is well developed from the first months of life. In addition, the anterolateral region of the upper thigh lacks important nerves and blood vessels.

In children over 2 to 3 years of age, it is preferable to administer the vaccine into the deltoid muscle (midway 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 brachial artery.

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 - to persons with immunodeficiency conditions (primary); immunosuppression, malignant tumors; pregnant women;

BCG vaccine - if the child’s body weight at birth is less than 2,000 g; keloid scars, including after administration of the previous dose;

DPT vaccine - for progressive diseases of the nervous system, and febrile seizures ah in the anamnesis;

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

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

In case of temporary contraindications, routine vaccination is postponed until the end of acute and exacerbation 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 in vaccinated individuals there may be

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

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

Nonspecific infectious diseases. In children, after the administration 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 timing of vaccination and illness. However, it may also be associated with changes in the immune system after the administration of vaccines. This is due to the fact that when vaccines are administered, the same type of two-phase changes occur in the immune system.

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

The second phase - transient immunodeficiency - develops 2-3 weeks after vaccine administration 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 also causes changes in the innate immune system: interferon hyporeactivity (starting from the 1st day after vaccination), inhibition of the activity of complement, lysozyme, and phagocytic activity of leukocytes. This restriction, however, applies to antigens that are foreign to the vaccine and unrelated.

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

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

TO this group also includes complications that develop

V as a result of violation of vaccination technique. 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 resulting in the development of infectious-toxic shock and death.

Pathological post-accinal reactions. Some children experience climatic symptoms during preventive vaccinations.

nic disorders unusual for the normal 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 to 48 hours. When using adsorbed drugs, especially subcutaneously, an infiltrate may form at the injection site. With repeated administration of toxoids, excessively strong local allergic reactions may 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 considered to be hyperemia without infiltrate or infiltrate with a diameter of up to 2.5 cm; an average reaction is an infiltrate of up to 5 cm, a strong reaction is an infiltrate of more than 5 cm, as well as an infiltrate with lymphangitis and lymphadenitis. The occurrence of such reactions is based on an increase in vascular permeability, as well as the development of basophilic infiltration under the influence of an adjuvant. If they occur, antihistamines and compresses are prescribed.

When live bacterial vaccines are administered, specific local reactions develop due to the infectious process at the site of application of the drug. Thus, with intradermal immunization with the BCG vaccine, after 6-8 weeks at the injection site, 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 changes in the child’s condition and behavior. They often express

are caused by increased body temperature, anxiety, sleep disturbance, anorexia, and myalgia.

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

In children with perinatal lesion 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 administration of pertussis vaccine is also the child’s continuous high-pitched scream for several hours. The mechanism of development of the encephalic reaction is due to increased permeability vascular wall, the consequence of which is an increase in intracranial pressure and the development of edema-swelling of the brain.

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

Therapy for encephalic post-vaccination reactions is similar to therapy for neurotoxicosis (see Chapter 6). Manifestations of general reactions to vaccination include an allergic rash. 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 problems 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, therapist, immunologist, epidemiologist, etc.) appointed by the chief physician of the State Sanitary and Epidemiological Supervision center in a constituent entity of the Russian Federation.

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

Table 4. 3

Major diseases in the post-vaccination period that are 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
	lysed allergies		oral polio
	logical reactions		cast vaccine
	Serum syndrome		All except BCG and
			oral polio
			cast vaccine
	Encephalitis, encephalitis		Inactivated
	lopatia, myelitis, ence
	phalomyelitis, neuritis,
	polyradiculoneuritis,
	Guillain-Barré syndrome
	Serous meningitis
	Afebrile seizures		Inactivated
		myocarditis,
		hypoplastic
	anemia, agranus
		Thrombocyto
	singing, collagenosis
	Vaccine-associated		Live polio
	polio
	Chronic arthritis		Rubella
	Cold abscess			During
		lymphadenitis,
	BCinfection
	Sudden death and others
	deaths

Persistent and generalized BCG infection This is the development of osteitis (proceeding as bone tuberculosis), lymphadenitis (two or more localizations), subcutaneous infiltrates. With a generalized infection, lymphatic clinical manifestations are observed. In persons with primary combined immunodeficiencies, death is possible.

With the development of BCG infection, etiotropic therapy is carried out. For generalized BCG infection, isoniazid or pyrazinamide is prescribed for 2 to 3 months. For purulent lymphadenitis, a puncture of the affected lymph node with the removal of caseous masses and streptomycin or other anti-tuberculosis drugs are administered in a dose appropriate to the 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 rarely develop. Thus, regional BCG lymphadenitis is recorded with a frequency of 1:1000, generalized BCG infection - 1:1000.

Diagnosis of vaccine-associated polio is placed on the basis of criteria proposed by WHO:

a) occurrence within a period of 4 to 30 days in vaccinated people, up to 60 days in contact people;

b) development of flaccid paralysis or paresis without sensory impairment and with residual effects after 2 months of illness;

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

type-specific antibodies by at least 4 times.

In countries with high vaccination coverage, the majority of polio cases are modern conditions may be regarded as vaccine-associated. Vaccine-associated poliomyelitis occurs in one child out of 500,000 children vaccinated with oral polio vaccine. In Russia, since 1997, from 2 to 11 cases of vaccine-associated liomyelitis have been reported annually, which on average does not exceed the scope of international statistics (O. V. Sharapova, 2003).

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

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

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

Arthritis and arthralgia may occur after administration of red

nushny vaccine; congenital rubella syndrome, termination of pregnancy - 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 person, and post-vaccination complications themselves in young children are predictors of the subsequent development of immunopathological diseases. According to the leading mechanism of occurrence, these complications can be divided into three groups: allergic (atopic), immune complex, 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.

Allergies that occur during vaccination are associated with 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 severe local (including edema, hyperemia more than 8 cm in diameter) and general (including temperature more than 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 health authorities.

The most severe complication of the group is anaphylactic shock. When a vaccine allergen is ingested parenterally, skin hyperemia and itching (primarily of the hands, feet, groin area), sneezing, abdominal pain, urticarial rash, angioedema. Laryngeal edema, broncho- and laryngeal obstruction may also occur. Blood pressure decreases, muscle hypotension, loss of consciousness, severe pallor of the skin, heavy sweating, foam at the mouth, incontinence of urine and feces, convulsions, coma appear. When anaphylactic shock develops, death can occur within a few minutes. The following steps need to be taken very quickly:

1) immediately stop administering the vaccine that caused the reaction and place the child on his side to avoid asphyxia as a result of aspiration of vomit and retraction of the tongue. If there is no vomiting, the patient is placed on his back and the lower part of the body is raised. The patient is covered with heating pads, access to fresh air is provided, patency respiratory tract, carry out oxygen therapy;

2) immediately administer adrenaline 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%

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

With to slow down the distribution of vaccine antigen;

3) parenterally administer GCS (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 very serious condition can be given 2-3 single doses. If necessary, injections are repeated;

4) parenterally administer antihistamines (diphenhydramine, chloropyramine, clemastine), but only with a clear tendency to normalize blood pressure. In this case single dose 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 chlorpyr-

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 prescribed 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 colloid and (or) crystalloid is carried out.

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

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

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

Post-vaccination complications - disorders in the human body that developed after using the vaccine for preventive purposes. They can be local or general, and the consequences can be diagnosed based on clinical data, linking them with a recent vaccination. In this case, treatment is carried out in a complex, which includes etiotropic, symptomatic and local therapy.

Post-vaccination complications after vaccination

Such consequences caused by the vaccine can greatly affect the child’s health. Preventive vaccination in pediatrics is specifically aimed at creating immunity to certain pathogens. Also, the use of vaccines in a large number of the population helps to avoid epidemics and the spread of the disease.

Therefore, the country has a special vaccination calendar, which contains a list necessary vaccinations, and the time of their holding, including for children. Harm after injection may occur in some cases as an abnormal response to the drug. Such reactions occur after certain vaccines, often the whooping cough, diphtheria and tetanus vaccinations. To this list in last years Vaccines against polio, measles and mumps have been added.

Causes of complications

Negative consequences can arise for the following reasons:

• reactogenicity of the drug;
• characteristics of the body;
• technical errors and errors during drug administration.

Reactogenicity of a drug implies the body’s reaction to the components of the drug (bacterial toxins, preservatives, stabilizers, solvents, antibiotics). Different vaccines have different degrees of complications and the number of adverse reactions. The most reactogenic are considered to be: BCG, DTP vaccine, the least severe: vaccination against polio, hepatitis B, vaccine against rubella.

Post-vaccination reactions and complications, which are determined by individual characteristics, include background pathology, changes in reaction immune system, genetic feature, the presence of autoimmune pathologies. Nevertheless, doctors still talk about the reasons that may influence the occurrence of undesirable consequences.

Errors during vaccination very often cause post-vaccination complications in children; this occurs due to poor vaccination technique. This includes the most common mistakes medical personnel: incorrect administration of the drug, incorrect dilution of the vaccine and incorrect dosage, violation of asepsis during injection, use by mistake of others medicines, instead of what is required.

Classification of complications after vaccination

Diseases that are accompanied by the vaccine process include:

1. Infections and chronic diseases that arose during the post-vaccination period;
2. Interaction with the body after using the vaccine;
3. Complications that occurred after the vaccine.

The occurrence of infections in the post-vaccination period can occur due to vaccination or due to immunodeficiency that occurs after vaccination. Most often, during this period, a child develops ARVI, influenza, pneumonia, and infections with disorders of the genitourinary system.

Local reactions that occur after the vaccine: hyperemia, swelling, infiltration. Common reactions include: fever, catarrhal symptoms, rashes (especially after measles vaccination), lymphadenitis. Post-vaccination complications are divided into: specific and nonspecific. They can also be general and local and depend on the severity of the disease.

When might a reaction occur?

The post-vaccination period and the moment when complications may occur can be easily calculated in time, taking into account the symptoms and timing of vaccination behavior. Since vaccination has a very strong effect on protective functions body, a child during this period can easily become ill with another disease. Since weakened immunity is susceptible to the process. Typically, a reaction to vaccinations appears within 8 to 48 hours, and symptoms can last for several months (minor and not dangerous).
Interaction with the vaccine:

• general, which is provoked by toxoids, is considered very noticeable and appears after 8-12 hours, while this reaction disappears after 1-2 days;
• local, appears throughout the day, but can last up to 4 days;
• vaccination, where the injection is given subcutaneously, may appear on the second day, and symptoms appear gradually as the drug spreads throughout the body. The lump that forms at the injection site resolves within 30 days;
• complex vaccines can cause an allergic reaction to one of the drugs, while the others intensify the reaction.

If the reaction does not fit within a certain framework, you should consult a doctor. Symptoms may be post-vaccination complications or indicate the onset of another disease.
Do not self-medicate or give your child medications that may complicate the situation. Only a doctor can quickly eliminate all symptoms.

The course of post-vaccination changes

The severity of changes after vaccination can be expressed in an increase in body temperature, an increase and change in the size of the infiltrate. There are several classifications that help quickly identify deviations and changes:

1. General microreaction:

• a slight increase in temperature within 37.6 degrees;
• average severity – up to 38.5;
• severe reaction - above 38.5 degrees.

1. Local microreactions:

• the formation of a small lump, the diameter of which is 2.5 cm;
• medium compaction, size from 2.5 to 5 cm;
• severe reaction - when the lump is more than 5 centimeters in diameter.

After vaccination during the first day, the child needs constant monitoring. Even with small, insignificant reactions, you should consult a doctor. Sometimes the child may need resuscitation. It is prohibited to use traditional methods treatment.

Reactions that can be classified as post-vaccination are rare. Most often, complications arise due to viral infections.

Post-vaccination reaction microbial 10

Allergic reaction, which is called ICD 10, has its own code T78. ICD 10 may include the following allergic reactions:

• Anaphylactic shock to food;
• Allergic reactions to food;
• Anaphylactic shock without a specific etiology;
• Quincke's edema;
• Unexplained reactive response of the body;
• Reactions that do not have a clear classification in other categories;
• Unfavorable response to various external factors.

To accurately diagnose the cause and manifestation of the disease, you need to take samples with allergens or use other diagnostic methods. If you quickly detect the pathogen, it will be much easier to eliminate the symptoms and begin recovery. Symptoms such as angioedema or anaphylactic shock may require immediate resuscitation of the patient.

ICD 10 reaction to vaccination is very rare. Since during natural contacts it is very difficult to become infected with a large number of infectious diseases. DTP vaccination is carried out at the age of 3 months, where the disease of whooping cough or diphtheria or tetanus is significantly increased, vaccination can be carried out immediately after birth.

In this case, the child may only experience a loss of strength and activity, but no complications. But, there is no specific reaction to ICD 10, because everyone can react individually to a particular vaccine. Doctors say that the reaction may be stronger in those who have an exacerbation of chronic diseases, so during these periods you should not vaccinate.

Timely diagnosis

A post-vaccination complication or negative reaction to a vaccine can be diagnosed by a pediatrician based on the symptoms that appeared in the period after vaccination.
A mandatory diagnostic method is a full examination and certain tests: a general urine test, a blood test, a blood test for viruses and bacteria, and a stool test. Diagnostics allows us to exclude intrauterine infections, which include herpes, toxoplasmosis, rubella. For children under 1 year of age, ELISA and PCR diagnostics are most often used.

By performing a biochemical blood test, it is possible to exclude the occurrence of seizures, which may indicate rickets or spasmophilia, the initial stage diabetes mellitus. This is due to the fact that only a biochemical analysis can indicate a lack of calcium in the body.

If there are indications (for example, a disorder of the nervous system), an electroencephalogram or MRI of the brain may be prescribed. This is because some symptoms are very similar to those that occur with epilepsy, brain tumors or hydrocephalus. Diagnose post-vaccination complication it's difficult, because a large number of time is spent collecting tests and excluding other diseases that cause similar symptoms.

How to treat complications after vaccination

Treatment involves complex therapy, which includes etiotropic and pathogenetic measures. It is mandatory to have a gentle regimen, as well as a proper diet, which includes a balanced consumption of vegetables and fruits, as well as cereals and dairy products. If treatment of the infiltrate is necessary, it is possible to apply ointments and bandages, as well as the mandatory use of physiotherapy for a quick recovery: UHF, ultrasound therapy.

If hyperemia is pronounced, you need to drink a large amount of water (it is important that the water is not cold), cool the body (wraps, ice on the head), use drugs to reduce fever (ibuprofen), and administer a glucose-salt solution. If post-vaccination complications cause a severe allergy on the body, doctors prescribe a number of antihistamines, corticosteroids and glycosides.

If complications affect the central nervous system, medications are used that can eliminate seizures and also prevent inflammation. Treatment must be carried out by a phthisiatrician. Each individual case of treatment of post-vaccination complications is considered individually, and treatment may depend on individual characteristics, complexity of the disease and the presence of chronic diseases.

Preventive measures to avoid post-vaccination complications

Preventive measures for complications after vaccination have a certain complex, which indicates the correct selection of children for vaccination. This is the most important point to adhere to. It is for this purpose that a preliminary examination of all children is carried out by the treating pediatrician. If necessary, you should contact other specialists for advice. This could be a dermatologist, immunologist, neurologist, cardiologist and pulmonologist.

A mandatory activity in the post-vaccination period is constant monitoring of children who have been vaccinated. At the same time, only medical personnel should do this. It is the person who can recognize the symptoms before others and quickly provide medical assistance. Children who have had complications after a particular vaccine are not given it again. However, the planned preventive use of other vaccines is not prohibited.

A separate point in preventive measures should be the attention of parents. Only a caring parent will be able to control the quality of the vaccine and its correctness, according to the vaccination calendar. The same applies to the time after vaccination - the child should not be in crowded places for several days and not communicate with people who may have infectious diseases. The approach may reduce the possibility of complications. For additional insurance, you can write down all the reactions of the child’s body that appear after the administration of the drug. Even slight redness or an increase in temperature within normal limits should be controlled.

Complications that may arise after vaccination can have consequences and affect the functioning of the entire body. It is important to get tested first and get your doctor’s permission to get immunized. Different kinds vaccines have different effects and can cause different complications. This may be slight redness at the injection site, or it may cause swelling and anaphylactic shock. For any reactions of the body, it is better to visit a doctor and not self-medicate. It is important to follow all the rules for vaccination, since failure to comply with safety rules during injection often causes complications and the appearance of diseases.

Chapter 2 Post-vaccination reactions and complications

When carrying out mass immunization of adults and children, the safety of vaccines and a differential approach to the selection of persons to be vaccinated are of great importance.

Correct organization of vaccination work requires strict consideration of vaccination reactions and post-vaccination complications. Vaccinations should only be carried out medical workers in special vaccination rooms.

Reactions to vaccinations are an expected state of the body, which may be characterized by deviations in the nature of its functioning. Often, local and general reactions may occur during parenteral administration of the vaccine.

Local reactions develop in the area of ​​vaccine administration in the form of redness or infiltration. They appear more often in older children and adults. In most cases, prolonged local reactions occur when using adsorbed vaccines.

The general reaction is manifested by increased temperature, headache and joint pain, general malaise, and dyspeptic symptoms.

The response to the vaccine depends on the individual characteristics of the organism and the reactogenicity of the vaccine. In case of severe reactions in more than 7%, the vaccine used is withdrawn.

In addition, reactions to the introduction of vaccines differ in the time of their occurrence. An immediate reaction can occur after any vaccine.

Often observed in people who previously had damage to the respiratory system, nervous system, had the flu or adenovirus infection before vaccinations. This reaction occurs within the first 2 hours after vaccination.

An accelerated reaction develops in the first day after administration of the vaccine and is expressed in local and general manifestations: hyperemia at the injection site, tissue swelling and infiltration. There are weak (diameter of hyperemia and induration up to 2.5 cm), medium (up to 5 cm) and strong (more than 5 cm) accelerated reactions.

Vaccination reaction, manifested by symptoms of general severe intoxication or lesions individual organs and systems, is regarded as a post-vaccination complication.

Post-vaccination complications are rare. Certain local reactions are subject to registration during vaccinations (Table 19).

Table 19. Post-vaccination local reactions

Post-vaccination complications are divided into several groups.

Complications associated with violation of vaccination technique, which are rare, include suppuration at the injection site.

In the case of subcutaneous administration of adsorbed vaccines, aseptic infiltrates are formed. Subcutaneous administration of the BCG vaccine can lead to the development of an abscess accompanied by lymph node involvement.

Complications related to the quality of the vaccine can be local or general.

In addition, complications can develop in cases of exceeding the dosage of the drug used, subcutaneous administration of vaccines used for the prevention of especially dangerous infections, as well as those intended for skin vaccinations.

Such errors during vaccinations can cause severe reactions with a possible fatal outcome.

If the dose of inactivated and live bacterial vaccines is exceeded by more than 2 times, the administration of antihistamines is recommended; if the condition worsens, prednisolone is prescribed parenterally or orally.

If an overdose of mumps, measles and polio vaccines is administered, treatment is not required. Special training of medical personnel performing vaccination prevents these complications, which are not always a pathological condition.

To decide whether the process that arose in the post-vaccination period is a complication of the vaccination, it is necessary to take into account the time of its development (Table 20). This is also important for determining the criterion for insurance liability.

Table 20. Possible post-vaccination complications (V.K. Tatochenko, 2007)

During the vaccination period (both on the day of vaccination and in the days following immunization), a vaccinated person, especially a child, may experience various diseases that are mistaken for post-vaccination complications.

But the occurrence of disease symptoms after vaccination is not always a consequence of vaccination.

Deterioration of the condition 2–3 or 12–14 days after vaccination with inactivated drugs, as well as live viral vaccines, is often associated with the appearance of various infectious diseases (ARVI, enterovirus infection, urinary tract infection, intestinal infections, acute pneumonia and etc.).

In these cases, urgent hospitalization of the patient is necessary to clarify the diagnosis.

Non-communicable diseases (various diseases digestive tract, renal pathology, respiratory diseases) occur in only 10% of the total number of such cases.

Approximate criteria are the timing of appearance individual symptoms after vaccinations.

Are common severe reactions, accompanied elevated temperature and convulsive syndrome, occur no later than 2 days after vaccination (DPT, ADS, ADS-M), and with the introduction of live vaccines (measles, mumps) no earlier than 5 days.

A response to live vaccines, with the exception of immediate reactions, can be detected immediately after vaccination in the first 4 days, after measles - more than 12-14 days, mumps - after 21 days, after polio vaccine - 30 days.

Meningeal symptoms may appear 3–4 weeks after administration of the mumps vaccine.

The phenomena of encephalopathy as a reaction to the administration of a vaccine (DPT) are rare.

Catarrhal symptoms may occur after the measles vaccine is administered - after 5 days, but no later than 14 days. Other vaccines do not have this reaction.

Arthralgia and isolated arthritis are characteristic of rubella vaccination.

Vaccine-associated poliomyelitis develops on days 4–30 after immunization in vaccinated people and up to 60 days in contact people.

Anaphylactic shock

Anaphylactic shock is a severe generalized immediate reaction caused by an antigen-antibody reaction occurring on the membranes of mast cells with fixed antibodies (JgE). The reaction is accompanied by the appearance of biologically active substances.

Anaphylactic shock usually occurs 1–15 minutes after parenteral administration of vaccines and serums, as well as during allergy testing and allergen immunotherapy. It develops more often with subsequent vaccinations.

Initial clinical manifestations occur immediately after administration of the vaccine: anxiety, palpitations, paresthesia, itching, cough, and difficulty breathing.

Usually, with shock, hypoexcitement develops due to a sharp expansion of the vascular bed due to vasomotor paralysis.

In this case, the permeability of membranes is impaired, interstitial edema of the brain and lungs develops. Oxygen starvation sets in.

Anaphylactic shock is accompanied by dysfunction of the central nervous system, the appearance of a thread-like pulse, pallor of the skin, and a decrease in body temperature. Anaphylactic shock can often be fatal.

In the development of anaphylactic shock, 4 stages are observed: the stage of sensitization, immunokinetic, pathochemical and pathophysiological.

Cases of death within 1 hour are usually associated with collapse, within 4–12 hours - with secondary circulatory arrest; on the second day and later - with progression of vasculitis, renal or liver failure, cerebral edema, damage to the blood coagulation system.

Clinical variants of anaphylactic shock can be different. Treatment measures are associated with their manifestations.

At hemodylactic option treatment is aimed at maintaining blood pressure, vasopressors, plasma replacement fluids, and corticosteroids are prescribed.

Asphyxial variant requires the administration of bronchodilators, corticosteroids, sputum suction, elimination of respiratory disorders (elimination of tongue retraction, tracheostonia). Oxygen therapy is also prescribed.

Cerebral variant involves the prescription of diuretics, anticonvulsants and antihistamines.

Abdominal option requires repeated administration of sympathomimetics, corticosteroids, antihistamines and diuretics.

List of medications and medical equipment needed to assist with anaphylactic shock

1. 0.1% solution of adrenaline hydrochloride – 10 ampoules.

2. 0.2% solution of norepinephrine hydrotartate – 10 ampoules.

3. 1% mesatone solution – 10 ampoules.

4. 3% prednisolone solution – 10 ampoules.

5. 2.4% aminophylline solution – 10 ampoules.

6. 10% glucose solution – 10 ampoules.

7. 5% glucose solution – 1 bottle (500 ml).

8. 0.9% sodium chloride solution – 10 ampoules.

9. 0.1% solution of atropine sulfate – 10 ampoules.

10. 10% calcium chloride solution – 10 ampoules.

11. 2% solution of suprastin – 10 ampoules.

12. 2.5% solution of pipalfen – 10 ampoules.

13. 0.05% solution of strophanthin – 10 ampoules.

14. 2% solution of furaselide (Lasix) – 10 ampoules.

15. Ethyl alcohol 70% – 100 ml.

16. Oxygen cylinder with reducer.

17. Oxygen cushion.

18. System for intravenous infusion- 2 pcs.

19. Disposable syringes (1, 2, 5, 10 and 20 ml).

20. Rubber bands – 2 pcs.

21. Electric suction – 1 pc.

22. Mouth retractor – 1 pc.

23. Device for measuring blood pressure.

Measures taken during anaphylactic shock

1. The patient must be positioned so that his head is below the level of his legs and turned to the side to prevent aspiration of vomit.

2. Using a mouth expander, the lower jaw is advanced.

3. Immediately administer adrenaline hydrochloride 0.1% or norepinephrine hydrotartrate in an age-specific dosage (children 0.01, 0.1% solution per 1 kg of weight, 0.3–0.5 ml) subcutaneously or intramuscularly, and also carry out injections or local injections.

4. Blood pressure is measured before the administration of adrenaline and 15–20 minutes after administration. If necessary, the injection of adrenaline (0.3–0.5) is repeated and then administered every 4 hours.

5. If the patient’s condition does not improve, a intravenous administration adrenaline (epinephrine): 1 ml of 0.1% solution in 100 ml of 0.9% sodium chloride. Inject slowly - 1 ml per minute, under the control of counting heart rate and blood pressure.

6. Bradycardia is stopped by administering atropine at a dose of 0.3–0.5 mg subcutaneously. According to indications in case of severe condition, the administration is repeated after 10 minutes.

7. To maintain blood pressure and replenish the volume of circulating fluid, dopamine is prescribed - 400 mg per 500 ml of 5% glucose solution, with further administration of norepinephrine - 0.2–2 ml per 500 ml of 5% glucose solution after replenishing the circulating volume liquids.

8. If there is no effect from infusion therapy, it is recommended to administer glucagon (1–5 mg) intravenously as a bolus, and then as a bolus (5–15 mcg/min).

9. To reduce the intake of antigen, a tourniquet is applied to the limb above the injection site for 25 minutes, loosening every 10 minutes for 1–2 minutes.

10. Antiallergic drugs are administered intravenously or intramuscularly: half the daily dose of prednisolone (3–6 mg/kg per day for children); according to indications, this dose is repeated or dexamethasone is prescribed (0.4–0.8 mg/day).

11. The administration of glucocorticoids is combined with the administration of antihistamines intramuscularly or new generation drugs orally.

12. In case of laryngeal edema, intubation or tracheostomy is indicated.

13. In case of cyanosis and dyspnea, oxygen is given.

14. In case of terminal condition, resuscitation is carried out by means of indirect massage, intracardial injection of adrenaline, as well as artificial ventilation lungs, intravenous administration of atropine and calcium chloride.

15. Patients with anaphylactic shock are subject to immediate hospitalization in the intensive care unit.

Feverish reaction

Hyperthermic syndrome

A reaction without a visible focus of infection can be observed 2–3 days after DPT administration and 5–8 days after measles vaccination. An increase in temperature should be alarming if the condition worsens and signs of bacterial inflammation appear.

As a result, the course of the vaccination reaction is stimulated by the production of pyrogenic cytokines, such as interferon gamma, interleukin, prostaglandin E, etc., which act on the pituitary gland and thereby lead to a decrease in heat transfer.

At the same time, specific antibodies of class G and memory cells are produced. Fever that occurs after vaccinations is usually well tolerated.

Indications for use medications are a body temperature of 39 °C in children over 3 months old, as well as convulsive syndrome, diseases of the central nervous system, cardiac decompensation at a body temperature of more than 38 °C. In the presence of muscle pain and headaches, the prescription of antipyretics is 0.5 lower than indicated.

Among antipyretics, it is recommended to prescribe paracetamol in a single dose of 15 mg/kg body weight, 60 mg/kg/day. Typically, its effect occurs within 30 minutes and lasts up to 4 hours. In addition to prescriptions in solution, you can use it in suppositories (15–20 mg/kg).

To quickly reduce the temperature, administration is used lytic mixture, consisting of 0.5–1 ml of 2.5% aminazine (chlorpromazine), pipolfen. It is also possible to administer analgin (metamizole sodium) at 0.1–0.2 ml of a 50% solution per 10 kg of body weight.

In case of hyperthermia, the child is placed in a well-ventilated room, a constant supply of fresh cool air is ensured, and plenty of fluids are prescribed (80–120 ml/kg/day) in the form of a glucose-saline solution, sweet tea, and fruit juices. The child is given frequent and frequent drinks.

In case of hyperthermia, physical cooling methods are used - the child is uncovered and an ice pack is suspended above the head.

These procedures are indicated for hyperthermia, which occurs with redness of the skin, in which case increased heat transfer occurs.

For hyperthermia, accompanied by pallor of the skin, chills, vasospasm, the skin is rubbed with 50% alcohol, papaverine, aminophylline, no-shpu are given.

Encephalic syndrome

This syndrome is accompanied by impaired cerebral circulation, agitation, and single short-term convulsions. Usually does not require active therapy.

If the convulsive syndrome persists, urgent hospitalization is indicated.

Diazepam is urgently administered (0.5% solution intramuscularly or intravenously at 0.2 or 0.4 mg/kg per injection).

If the convulsions do not stop, repeated administration is made (0.6 mg/kg after 8 hours) or diphenine is administered at a rate of 20 mg/kg. With persistent convulsive syndrome Other agents are also used (sodium hydroxybutyrate, valproic acid, etc.).

Collapse

Collapse is an acute vascular failure, which is accompanied by sharp decline vascular tone, symptoms of brain hypoxia. Collapse develops in the first hours after vaccination. Characteristic symptoms are lethargy, adynamia, pallor with marbling, severe acrocyanosis, rapid decline blood pressure, weak pulse.

Urgent Care is to immediately carry out the following activities. The patient lies on his back, with his head thrown back to ensure an influx of fresh air. The airway is ensured and an audit is carried out oral cavity. The patient is administered a 0.1% solution of adrenaline (0.01 ml/kg), prednisolone (5–10 mg/kg/day) intravenously or intramuscularly. This text is an introductory fragment.

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Post-vaccination complications and adverse reactions to vaccination in children - this issue worries all mothers who vaccinate their babies. After vaccination, both adverse reactions to vaccination and post-vaccination complications may occur.

Typically, adverse reactions to vaccinations with inactivated vaccines (DPT, DPT, hepatitis B) occur 1-2 days after vaccination.

A vaccine is a preparation containing killed or weakened microorganisms that cause an infectious disease. This is an immunobiological active drug that causes certain changes in the body - desirable, with the goal of creating immunity of the vaccinated person to a given infection, and undesirable, that is, adverse reactions.

Medical immunology centers of the Russian Federation advise vaccinating children from an early age. The very first vaccination (against hepatitis) is carried out in the first 12 hours of a child’s life, and then vaccination occurs according to the schedule of the vaccination certificate that each person has.

In 1996, the world celebrated the 200th anniversary of the first vaccination, performed in 1796 by the English doctor Ed. Jenner. Today, the idea of ​​vaccination in our country, in addition to sincere supporters, has quite big number convinced opponents. The controversy surrounding the mass use of vaccines does not subside not only in our country. Already in the 18th and 19th centuries, doctors noted that mass smallpox vaccination shortens people’s lives, testifying to the imaginary benefits and real harms of vaccines. To date, a huge amount of material has been accumulated on the negative consequences - side effect vaccines

The lack of safe vaccines, as well as a sharp deterioration in the health of Russian children, has led to an abundance of post-vaccination complications. If we proceed only from the “abundance of post-vaccination complications,” then there is not a single area of ​​medicine where vaccinations have not introduced iatrogenic pathology.

What are adverse reactions to vaccines?

The term “adverse reaction” means the occurrence adverse reactions organisms that were not the target of vaccination. In general, adverse reactions to vaccination are a normal reaction of the body to the introduction of a foreign antigen, and in most cases such a reaction reflects the process of developing immunity.

Adverse reactions are usually divided into local ones, i.e. occurring at the injection site (redness, soreness, thickening), and general, that is, those that affect the entire body as a whole - increased body temperature, malaise, etc.

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

Naturally, an increase in body temperature to 40°C cannot be a favorable sign and such reactions are usually classified as a special type of severe adverse reactions. Such reactions, along with complications, are subject to strict reporting and must be reported to the authorities that control the quality of vaccines. If many such reactions occur to a given production batch of the vaccine, then such a batch is removed from use and is subject to repeated quality control.

Typically, adverse reactions to vaccinations with inactivated vaccines (DPT, DPT, hepatitis B) occur 1-2 days after vaccination and go away on their own, without treatment, within 1-2 days. After vaccination with live vaccines, reactions may appear later, on days 2-10, and also go away within 1-2 days without treatment.

Most vaccines have been used for decades, so the typicality of reactions should also be taken into account. For example, the rubella vaccine cannot cause gastritis, but at the same time it can cause short-term swelling of the joints.

The incidence of adverse reactions has also been well studied. It is no secret that the rubella vaccine, which has been used abroad for more than 30 years, causes approximately 5% of general reactions, and that the hepatitis B vaccine, which has been used for more than 15 years, causes about 7% of local reactions.

Local reactions after vaccination

Local adverse reactions include redness, induration, soreness, swelling, which are significant and significant. Local reactions also include urticaria (an allergic rash, reminiscent of a nettle burn), and enlargement of the lymph nodes close to the injection site.
Why do local reactions occur? As is known from biology textbooks for elementary school, when the skin is damaged and foreign substances enter the body, inflammation occurs at the site of entry. It is quite natural to assume that the greater the volume of foreign substances, the greater the severity of inflammation. Numerous clinical trials vaccines involving control groups, when participants were administered ordinary water for injection as a control drug, showed that even to this “drug” local reactions occur, and with a frequency close to that for the experimental group where the vaccines were administered. That is, the cause of local reactions to a certain extent is the injection itself.
Sometimes vaccines are designed to deliberately cause local reactions. We are talking about the inclusion in vaccines of special substances (usually aluminum hydroxide and its salts) or adjuvants, which are designed to cause inflammation so that more cells of the immune system “get acquainted” with the vaccine antigen, so that the strength of the immune response is higher. Examples of such vaccines are the DTP, ADS, and hepatitis A and B vaccines. Adjuvants are usually used in inactivated vaccines, since the immune response to live vaccines is already quite strong.
The method of vaccine administration also affects the number of local reactions. All injectable vaccines are best administered intramuscularly, and not into the buttock (you can get into the sciatic nerve or subcutaneous fatty tissue). The muscles are much better supplied with blood, the vaccine is better absorbed, and the strength of the immune response is greater. In children under 2 years of age, the best place for vaccination is the anterolateral surface of the thigh in its middle third. For children over two years of age and adults, it is best to inject into the deltoid muscle of the shoulder, that same muscular thickening on the shoulder - the injection is done from the side, at an angle of 90 degrees to the surface of the skin. With subcutaneous administration of vaccines, the frequency of local reactions (redness, thickening) will obviously be higher, and the absorption of vaccines and, as a consequence, the immune response may be lower than with intramuscular administration.

General reactions after vaccinations

Common post-vaccination reactions include a rash covering large areas of the body, increased body temperature, anxiety, sleep and appetite disturbances, headache, dizziness, short-term loss of consciousness, cyanosis, coldness of the extremities. In children, a reaction such as prolonged unusual crying occurs.

Why does a rash appear after vaccination? Possible reasons three - reproduction of the vaccine virus in the skin, an allergic reaction, increased bleeding that occurs after vaccination. A mild, quick rash (caused by vaccine virus multiplication in the skin) is a normal consequence of vaccination with live virus vaccines such as measles, mumps, and rubella.

A pinpoint rash that occurs as a result of increased bleeding (for example, in rare cases, after a rubella vaccine there is a temporary decrease in the number of platelets) can reflect either a mild, temporary damage to the blood coagulation system, or be a reflection of a more serious pathology - for example, hemorrhagic vasculitis ( autoimmune lesion vascular walls) and can already be a post-vaccination complication.

When live vaccines are administered, it is sometimes possible to almost completely reproduce a natural infection in a weakened form. An indicative example is vaccination against measles, when 5-10 days after vaccination a specific post-vaccination reaction is possible, characterized by an increase in body temperature, symptoms of acute respiratory infections, a peculiar rash - all this is classified as “vaccinated measles”.

Post-vaccination complications

Unlike adverse reactions, vaccination complications are unwanted and quite severe conditions that occur after vaccination. For example, a sharp drop in blood pressure (anaphylactic shock), as a manifestation of an immediate allergic reaction to any component of the vaccine, cannot be called either a normal adverse reaction or even a severe adverse reaction, since anaphylactic shock and collapse require resuscitation measures. Other examples of complications include seizures, neurological disorders, allergic reactions varying degrees gravity, etc.

To be fair, it should be noted that, unlike adverse reactions, post-vaccination complications are extremely rare - the frequency of complications such as encephalitis due to measles vaccine is 1 in 5-10 million vaccinations, generalized BCG infection, which occurs when BCG is administered incorrectly, is 1 in 1 million vaccinations, vaccine-associated polio - 1 per 1-1.5 million OPV doses administered. With the infections themselves that vaccinations protect against, these same complications occur with an order of magnitude greater frequency (see adverse reactions and complications to specific types of vaccines).

Unlike post-vaccination reactions, complications rarely depend on the composition of vaccines and their main cause is considered to be:

• violation of vaccine storage conditions (overheating for a long time, hypothermia and freezing of vaccines that cannot be frozen);
• violation of the vaccine administration technique (especially important for BCG, which must be administered strictly intradermally);
• violation of instructions for administering the vaccine (from non-compliance with contraindications to the administration of an oral vaccine intramuscularly);
• individual characteristics of the body (unexpectedly strong allergic reaction to repeated administration of the vaccine);
• addition of infection - purulent inflammation at the site of injection and infection, in incubation period who were vaccinated.

TO local complications include compaction (over 3 cm in diameter or extending beyond the joint); purulent (in case of violation of vaccination rules) and “sterile” (incorrect administration of BCG) inflammation at the injection site.

Common complications of vaccinations (vaccine):

• Excessively strong general reactions with high temperature rise (more than 40ºС), general intoxication
• Damage to the central nervous system: persistent high-pitched crying of the child, convulsions without and with fever; encephalopathy (appearance of neurological “signs”); post-vaccination serous meningitis (short-term, non-leaving “irritation” of the meninges caused by the vaccine virus);
• Generalized infection with a vaccine microorganism;
• Damage to various organs (kidneys, joints, heart, gastrointestinal tract and etc.);
• Allergic reactions: local allergic type reactions (Quincke's edema), allergic rashes, croup, suffocation, temporary increased bleeding, toxic-allergic condition; fainting, anaphylactic shock.
• The combined course of the vaccination process and the attached acute infection, with and without complications;

Description of some complications

Anaphylactic shock after vaccination

Anaphylactic shock- an allergic reaction of immediate type, a state of sharply increased sensitivity of the body that develops upon repeated introduction of an allergen. Typically, vaccine components (non-compliance with contraindications, undiagnosed allergies) are characterized by sharp drop blood pressure and cardiac dysfunction. It usually occurs in the first 30 minutes after vaccination and requires resuscitation measures. In children, an analogue of anaphylaxis is collapse ( fainting). It is an extremely rare complication. Anaphylactic shock often develops in children suffering from allergies and diathesis.

Afebrile seizures

Convulsions without fever(afebrile convulsions) - occur during vaccination with DTP vaccines (1 per 30-40 thousand vaccinations). In contrast to febrile seizures (i.e., against the background of an increase in temperature), they are caused by irritation of certain areas of the brain and meninges vaccine antigens or reactions to them. In some cases, seizures first detected after vaccination are a consequence of epilepsy.

Serous meningitis

Encephalitic reaction(serous meningitis) is a complication of vaccination against measles and mumps that occurs with a frequency of 1 in 10 thousand vaccinations. Occurs as a result of irritation of the meninges by vaccine viruses. Manifested by headaches, other neurological symptoms. But, unlike similar manifestations during a natural infection, such a post-vaccination complication goes away without any consequences.

Table: Incidence of serious adverse reactions to vaccination (according to the World Health Organization)

Graft	Possible complications	Complication rate
Against hepatitis B
Against tuberculosis	Regional lymphadenitis, cold abscess Tuberculous osteitis Generalized BCG infection (with immunodeficiency)
Against polio	Vaccine-associated polio with the introduction of live attenuated vaccine (for the first, second and third vaccinations)
Against tetanus	Brachial neuritis at the site of vaccine administration
DTP (against diphtheria, whooping cough and tetanus)	A high-pitched loud scream during the first hours after vaccination Episode of seizures in the background high temperature Short-term decrease in blood pressure and muscle tone with impaired consciousness (fainting) Encephalopathy Allergic reaction to vaccine components
Against measles, rubella and mumps	Episode of seizures associated with high fever Decreased platelet count in the blood Allergic reaction to vaccine components Encephalopathy

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