Types of pathological vaccination reactions. Post-vaccination reactions and complications: how to protect the child. Characteristics of post-vaccination complications

We must not forget that the vaccine is an immunobiological preparation that is introduced into the body in order to form a stable immunity to certain, potentially dangerous infectious diseases. It is precisely because of their properties and purpose that vaccinations can cause certain reactions from the body. The whole set of such reactions is divided into two categories:

Post-vaccination reactions (PVR).
Post-vaccination complications (PVO).

Expert opinion

N. I. Briko

Academician of the Russian Academy of Sciences, Professor, Doctor of Medical Sciences, Head of the Department of Epidemiology and Evidence-Based Medicine of the First Moscow State Medical University. THEM. Sechenov, President of NASKI

Post-vaccination reactions are various changes in the condition of the child that develop after the introduction vaccines and pass on their own within a short period of time. They do not pose a threat and do not lead to permanent impairment of health.

Post-vaccination complications- persistent changes in the human body that have occurred after the introduction of the vaccine. In this case, the violations are long-term, significantly go beyond the physiological norm and entail a variety of human health disorders. Let us consider in more detail the possible complications of vaccinations.

Unfortunately, none of the vaccines is completely safe. All of them have a certain degree of reactogenicity, which is limited by the regulatory documentation for drugs.

Side effects that can occur with the introduction of vaccines are very diverse. Factors contributing to the occurrence of adverse reactions and complications can be divided into 4 groups:

ignoring contraindications for use;
violation of the vaccination procedure;
individual characteristics of the state of the body of the vaccinated;
violation of production conditions, rules for transportation and storage of vaccines, poor quality of the vaccine preparation.

But even despite the possible complications of vaccines, modern medicine recognizes the significant advantage of their beneficial properties in reducing the possible consequences of the disease compared to the possible natural infection.

Relative risk of complications after vaccinations and related infections

Vaccine	Post-vaccination complications	Complications in the course of the disease	Mortality in the disease
smallpox	Vaccinal meningoencephalitis - 1/500,000	Meningoencephalitis - 1/500 Complications of chickenpox are recorded with a frequency of 5-6%. 30% of complications are neurological, 20% are pneumonia and bronchitis, 45% are local complications, accompanied by the formation of scars on the skin. In 10-20% of those who have been ill, the varicella-zoster virus remains for life in the nerve ganglia and subsequently causes another disease that can manifest itself at an older age - shingles or herpes.	0,001%
Measles-mumps-rubella	Thrombocytopenia - 1/40,000. Aseptic (mumps) meningitis (Jeryl Lynn strain) - less than 1/100,000.	Thrombocytopenia - up to 1/300. Aseptic (mumps) meningitis (Jeryl Lynn strain) - up to 1/300. In 20-30% of teenage boys and adult men with mumps, the testicles become inflamed (orchitis), in girls and women, in 5% of cases, the mumps virus affects the ovaries (oophoritis). Both of these complications can lead to infertility. In pregnant women, rubella leads to spontaneous abortion (10-40%), stillbirth (20%), death of the newborn (10-20%).	Rubella 0.01-1%. Mumps - 0.5-1.5%.
Measles	Thrombocytopenia - 1/40,000. Encephalopathy - 1/100,000.	Thrombocytopenia - up to 1/300. Encephalopathy - up to 1/300.	The disease is responsible for 20% of all childhood deaths. Mortality up to 1/500.
Whooping cough-diphtheria-tetanus	Encephalopathy - up to 1/300,000.	Encephalopathy - up to 1/1200. Diphtheria. Infectious-toxic shock, myocarditis, mono- and polyneuritis, including lesions of the cranial and peripheral nerves, polyradiculoneuropathy, lesions of the adrenal glands, toxic nephrosis - depending on the form in 20-100% of cases. Tetanus. Asphyxia, pneumonia, muscle ruptures, bone fractures, compression deformities of the spine, myocardial infarction, cardiac arrest, muscle contractures and paralysis of III, VI and VII pairs of cranial nerves. Whooping cough. The frequency of complications of the disease: 1/10 - pneumonia, 20/1000 - convulsions, 4/1000 - brain damage (encephalopathy).	Diphtheria - 20% adults, 10% children. Tetanus - 17 - 25% (with modern methods of treatment), 95% - in newborns. Whooping cough - 0.3%
papillomavirus infections	Severe allergic reaction - 1/500,000.	Cervical cancer - up to 1/4000.	52%
Hepatitis B	Severe allergic reaction - 1/600,000.	Chronic infections develop in 80-90% of children infected during the first year of life. Chronic infections develop in 30-50% of children infected before the age of six.	0,5-1%
Tuberculosis	Disseminated BCG infection - up to 1/300,000. BCG-osteitis - up to 1/100,000	Tuberculous meningitis, pulmonary hemorrhage, tuberculous pleurisy, tuberculous pneumonia, spread of tuberculosis infection to other organs and systems (miliary tuberculosis) in young children, development of pulmonary heart failure.	38% (The second leading cause of death from an infectious agent (after HIV infection). 2 billion people, a third of the population of our planet, are infected with the causative agent of tuberculosis.
Polio	Vaccine-associated flaccid paralysis - up to 1/160,000.	Paralysis - up to 1/100	5 - 10%

The risk of complications after vaccination is hundreds and thousands of times less than the risk of complications after previous diseases. So, for example, if vaccinations against pertussis-diphtheria-tetanus can cause encephalopathy (brain damage) in only one case per 300 thousand vaccinated children, then in the natural course of this disease, one child per 1200 sick children is at risk of such a complication. At the same time, the risk of mortality in unvaccinated children with these diseases is high: diphtheria - 1 in 20 cases, tetanus - 2 in 10, whooping cough - 1 in 800. The polio vaccine causes flaccid paralysis in less than one case per 160 thousand vaccinated children, while while the risk of death in the disease is 5 - 10%. Thus, the protective functions of vaccinations greatly reduce the possibility of complications that can be obtained during the natural course of the disease. Any vaccine is hundreds of times safer than the disease it protects against.

Most often, local reactions occur after vaccination, which have nothing to do with complications. Local reactions (pain, swelling) at the vaccination site do not require special treatment. The highest rate of development of local reactions is in the BCG vaccine - 90-95%. Approximately 50% of cases have local reactions to the whole cell DPT vaccine, while only about 10% to the acellular vaccine. The hepatitis B vaccine, which is given first in the hospital, causes local reactions in less than 5% of babies. It can also cause an increase in temperature above 38 0 С g (from 1 to 6% of cases). Fever, irritability, and malaise are non-specific systemic reactions to vaccines. Only the whole-cell DTP vaccine causes systemic non-specific vaccine reactions in 50% of cases. For other vaccines, this figure is less than 20%, in many cases (for example, when vaccinated against Haemophilus influenzae) - less than 10%. And the possibility of non-specific systemic reactions when taking oral polio vaccine is less than 1%.

Currently, the number of adverse events (AEs) of severe severity after vaccinations are minimized. So, when vaccinated with BCG, 0.000019-0.000159% of the development of disseminated tuberculosis is recorded. And even with such minimal values, the cause of this complication is not in the vaccine itself, but in negligence during vaccination, congenital immunodeficiencies. When vaccinated against measles, encephalitis develops no more than in 1 case per 1 million doses. When vaccinated against pneumococcal infection with PCV7 and PCV13 vaccines, rare and very rare severe events were not detected, although more than 600 million doses of these vaccines have already been administered worldwide.

In Russia, official registration and control of the number of complications as a result of vaccination has been carried out only since 1998. And it should be noted that due to the improvement of vaccination procedures and the vaccines themselves, the number of complications is significantly reduced. According to Rospotrebnadzor, the number of registered post-vaccination complications decreased from 323 cases in January-December 2013 to 232 cases over the same period in 2014 (for all vaccinations in aggregate).

Ask a question to a specialist

A question for vaccine experts

Questions and answers

The child is now 1 year old, we have to do 3 DTP.

At 1 DTP, the temperature was 38. The doctor said that before 2 DTP, take suprastin for 3 days. And 3 days after. But the temperature was a little higher than 39. I had to shoot down every three hours. And so for three days.

I read that suprastin should not be given before vaccination, but only after, because. it lowers the immune system.

Tell me, please, how to be in our case. To give suprastin in advance or still not? I know that each subsequent DTP is more difficult to tolerate. I'm very afraid of the consequences.

In principle, suprastin has no effect on fever during vaccination. Your situation fits into the picture of a normal vaccination process. I can advise 3-5 hours after vaccination to give an antipyretic in advance before the temperature appears. Another option is also possible - try to inoculate with Pentaxim, Infanrix or Infanrix Hexa.

The child is 18 months old, yesterday they were vaccinated with pneumococcus, the temperature rose in the evening, weakness in the morning, my leg hurts, I am very worried.

Harit Susanna Mikhailovna answers

If the fever has lasted for several days without the appearance of catarrhal symptoms (runny nose, cough, etc.), then this is a normal vaccine reaction. Lethargy or, on the contrary, anxiety also fit into a normal vaccine reaction and should pass in a few days. Later on the day of vaccination, a few hours after vaccination, give an antipyretic in advance, even at normal temperature. If there is pain at the injection site and the child spares the leg when walking, then this is probably a myalgic syndrome, with the use of an antipyretic (eg Nurofen) these symptoms should disappear. If there is a local reaction, you can use 0.1% hydrocortisone eye ointment and troxevasin gel (alternate them) several times a day, applying to the injection site.

My baby is 4.5 months old. From 2.5 months we have been diagnosed with atopic dermatitis. Vaccinations up to 3 months were done according to the plan. Now in remission, we plan to do DTP. We categorically do not want to do a domestic one, because we are afraid of very poor tolerance + from Prevenar there was swelling at the injection site. Now we are waiting for the decision of the immunological commission on the approval of a free (imported) vaccination. Please tell me, are there any positive solutions with such a diagnosis? Given that dad is allergic yet.

Harit Susanna Mikhailovna answers

In the presence of a local pathological reaction - edema and hyperemia at the injection site of more than 8 cm, the question of introducing another vaccine is decided. If the local reaction is less, then this is considered the norm and you can continue to be vaccinated against the background of taking antihistamines.

The presence of a local reaction to Prevenar 13 does not mean that the child will have an allergic reaction to another vaccine. In such cases, it is recommended to take antihistamines on the day of vaccination and possibly for the first three days after vaccination. The most important thing in the presence of food allergies is not to introduce new foods before and after vaccination (within a week).

As for resolving the issue of acellular vaccines, there are no general rules; in each region, the issue of free use of these vaccines is resolved in its own way. It should only be understood that switching to cell-free vaccines does not guarantee the absence of an allergic reaction after vaccination, it is less common, but also possible.

Should I get the Prevenar vaccine at 6 months? And if so, is it compatible with DTP?

Harit Susanna Mikhailovna answers

It is vital for young children to be vaccinated against pneumococcal infection, since children die from diseases caused by this infection (meningitis, pneumonia, sepsis). At least 3 vaccinations are needed to protect against pneumococcal disease - so the sooner a child gets vaccinated, the better.

It is recommended to be vaccinated with DTP and Prevenar on the same day by the national vaccination schedule. Any vaccination can cause a fever in a child, one must remember this and give the child an antipyretic if the temperature rises.

We have encountered such a problem. My daughter is now 3 years old, 9 months old, she received 1 and 2 vaccines against poliomyelitis in the form of Pentaxim (at 5 and 8 months). We have not given the third vaccination so far, because there was a bad reaction to Pentaxim, after that we began every 6 months. donate blood from a vein for possible allergic reactions to vaccinations and for 3 years neither DTP, nor ads-m, nor Pentaxim, Infanrix, nor against measles-rubella, we were ever allowed to put on the basis of tests, from them an official medical withdrawal. But no one ever offered us the 3rd and 4th polio for these 3 years (even the head of the children's clinic, when she signed the card for the garden), and no one offered to be examined for it, and of course they didn’t explain that if someone in the garden then they will put the OPV, they will drop us out of the garden (in our garden, children eat in a common cafe, and not in groups). Now they called from the garden and said that because. our vaccination is not finished we are suspended from the kindergarten for 60 days and so every time someone is vaccinated, or we can put the 4th polio boost along with the rest of the children in the garden. Because 3 can be set only up to a year, and we have already missed it, and 4 can be set up to 4 years (daughter turns 4 in 3 months). At the moment, we now have a complete medical exemption for 2 months from any vaccinations. Now we are undergoing treatment due to the activity of the Epstein-bar virus. They answered in the garden because we have a medical tap, then we will not be dropped off. For me, the question is: to what extent do children vaccinated with OPV pose a danger to my child (in our kindergarten, children eat in a common cafe at the same time, and not in groups)? And up to 4 years, you can put the fourth one, skipping the third, with a gap between 2 and 4 vaccines of 3 years? We do not have tests for allergic reactions to vaccines in our city, which means we can only get them on vacation, but the child will already be 4 years old at that moment. How to act in our situation?

Harit Susanna Mikhailovna answers

What was the bad reaction to Pentaxim? On the basis of what tests could a medical withdrawal be made? In our country, allergy tests to vaccine components are very rarely done. If you are not allergic to chicken or quail eggs, the child receives them for food, then you can be vaccinated against measles and mumps, and the rubella vaccine generally does not contain either chicken or quail eggs. Cases of measles are registered in the Russian Federation and your child is at risk because he has not been vaccinated against it.

You can get vaccinated against polio - the vaccine is well tolerated and rarely gives any allergic reactions. If oral polio vaccine is given to other children in kindergarten, you are at risk of developing vaccine-associated polio. You can be vaccinated against polio at any age, only pertussis vaccination in our country is done up to 4 years (in the summer of 2017, the whooping cough vaccine Adacel is expected to appear and it can be administered to children after 4 years).

Your child must already have 5 polio shots to be fully protected against this infection, you can get inactivated or oral polio vaccine and after 6 months the first booster, and after 2 months - 2 booster against polio.

Please explain the situation. In the morning they did revaccination of poliomyelitis. Two hours later, snot and sneezing began. Is it ORVI on the background of vaccination? And is there a risk of further manifestations of complications?

Harit Susanna Mikhailovna answers

You are most likely carrying a respiratory infection. The vaccination just coincided with the onset of your illness. If you hadn't been vaccinated, you would have gotten ARI in the same way. Now the incidence of respiratory infections is high. Therefore, you can continue to take root, this is not a complication.

On November 11, a child 6 years and 10 months old was vaccinated with ADSm in the thigh in kindergarten, the nurse gave 1 tab. suprastin. In the evening of that day, the child was capricious, and since November 12 there were complaints about a feeling of pressure at the injection site, he began to limp on his right leg, the temperature rose to 37.2. Mom gave her son ibuprofen and suprastin. At the injection site, edema and hyperemia 11 x 9 cm were found. On November 13 (3rd day), the complaints were the same, the temperature was 37.2, they also gave 1 table. suprastin and put fenistil at night. Fenistil reduced the feeling of pressure in the leg. In general, the boy's condition is normal, his appetite is normal, he plays and is sociable. Today, November 14, the hyperemia around the injection is the same size, but the swelling is less (the child was not given any drugs), he does not notice a feeling of pressure. But there was a slight runny nose, the child sneezes. Temperature at 21:00 36.6. Please tell me how we should deal with this unusual reaction to the vaccine. Will this reaction be a contraindication to the subsequent administration of ADSm? How to protect the child from diphtheria and tetanus in the future?

Harit Susanna Mikhailovna answers

It is possible that subfebrile fever and a runny nose are a manifestation of a respiratory disease. The presence of hyperemia and edema at the injection site, as well as myalgic syndrome (limping on the leg where the vaccine was given) is a manifestation of a local allergic reaction. Such reactions are more common with 3 vaccinations or revaccination of DTP (Pentaxim, infanrix, ADS, ADSm). The management tactics in this case was chosen correctly - non-steroidal anti-inflammatory drugs and antihistamines. Nurofen is prescribed in a planned manner 2 times a day for 2-3 days (while maintaining myalgic syndrome), antihistamines (Zodak) - up to 7 days. Locally applied hydrocortisone eye ointment 0.1% and troxevasin gel, ointments alternate, applied 2-3 times a day. In no case should the injection site be smeared with iodine or warm compresses should be done. If it was the 2nd revaccination against tetanus and diphtheria, then the next revaccination should be at 14 years of age. Before it, it is necessary to pass an analysis for diphtheria antibodies, if there is a protective level, vaccination is postponed.

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

Post-vaccination complications after vaccination

The effects that the vaccine provokes can greatly affect the health of the child. 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 the epidemic and the spread of the disease.

Therefore, the country has a special vaccination calendar, which contains a list of necessary vaccinations, and the time of their implementation, including for children. Harm after injection may occur in some cases as an abnormal response to the drug. These reactions occur after certain vaccines, often the pertussis, diphtheria, and tetanus vaccines. In recent years, vaccines have been added to this list for: polio, measles and mumps.

Causes of complications

Negative consequences can arise for the following reasons:

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

The reactogenicity of the drug implies the reactions of the body to the components of the drug (bacterial toxins, preservatives, stabilizers, solvents, antibiotics). Different vaccines have a different degree of complications and the number of adverse reactions. The most reactogenic are: BCG, DPT vaccine, the least severe: vaccination against polio, hepatitis B, rubella vaccine.

Post-vaccination reactions and complications that are due to individual characteristics include background pathology, changes in the immune system response, genetic features, and the presence of autoimmune pathologies. Nevertheless, doctors are still talking about the reasons that may affect the occurrence of undesirable consequences.

Errors in vaccination very often cause post-vaccination complications in children, this occurs due to impaired vaccination technique. This includes the most common mistakes of medical personnel: incorrect administration of the drug, incorrect dilution of the vaccine and incorrect dosage, violation of asepsis during injection, use of other drugs by mistake, instead of the necessary one.

Classification of complications after vaccination

Diseases that are accompanied by the vaccination process include:

Infections and chronic diseases that arose in the post-vaccination period;
Interaction with the body after the use of the vaccine;
Aggravations that arose after the vaccine.

The occurrence of infections in the post-vaccination period may occur due to vaccination or due to immunodeficiency that occurred after vaccination. Most often, a child during this period develops SARS, influenza, pneumonia, infections with a violation of the genitourinary system.

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

When can a reaction occur?

The post-vaccination period and the moment when complications may occur is easily calculated in time, taking into account the symptoms and the timing of the vaccination behavior. Since vaccination greatly affects the protective functions of the body, a child during this period can easily get sick with another disease. Since weakened immunity is subject to the process. Usually, the reaction to vaccinations appears within the period from 8 to 48 hours, and the symptoms can be observed for several months (minor and not dangerous).
Interaction with the vaccine:

the general one, which is provoked by toxoids, is considered highly noticeable and appears after 8-12 hours, while such a reaction disappears after 1-2 days;
local, appears during the day, but can last up to 4 days;
vaccination, where the injection is given subcutaneously, may also 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, the rest increase the reaction.

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

The course of post-vaccination changes

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

General microreaction:

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

Local microreactions:

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

After vaccination during the first day, the child needs constant monitoring. Even with small, minor reactions, you need to see a doctor. Sometimes a child may need resuscitation. It is forbidden to use traditional methods of treatment.

Reactions that can be attributed to post-vaccination are rare. Most often, complications arise due to infection with viral infections.

Post-vaccination reaction mcb 10

An allergic reaction, which is called microbial 10, has its own code T78. In microbial 10 may include such 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 rubrics;
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 find the pathogen, eliminate the symptoms and start recovery will be much easier. Symptoms such as angioedema or anaphylactic shock may require immediate resuscitation of the patient.

ICD 10 reaction to vaccination is very rare. Since with natural contacts it is very difficult to become infected with a large number of infectious diseases at once. 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 show only a decline in strength and activity, but no complications. But, there is no specific reaction to microbial 10, because everyone can individually respond to a particular vaccine. Doctors say that a stronger reaction may occur in those who have an exacerbation of chronic diseases, so vaccination should not be carried out during these periods.

Timely diagnosis

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

By conducting a biochemical blood test, it is possible to exclude the occurrence of seizures, which may indicate rickets or spasmophilia, the initial stage of 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 violation of the nervous system), an electroencephalogram, an MRI of the brain may be prescribed. This is because some of the symptoms are very similar to those that occur with epilepsy, a brain tumor, or hydrocephalus. It is difficult to diagnose a post-vaccination complication, because a lot of time is spent on 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 obligatory to have a sparing regimen, as well as a proper diet, which includes a balanced intake of vegetables and fruits, as well as cereals and dairy products. If it is necessary to treat the infiltrate, it is possible to apply ointments and dressings, as well as the obligatory use of physiotherapy for a quick recovery: UHF, ultrasound therapy.

If the hyperemia is pronounced, you need to drink plenty of water (it is important that the water is not cold), cooling for the body (wraps, ice on the head), the use of drugs to reduce fever (ibuprofen), the introduction of a glucose-salt solution. If post-vaccination complications have a strong allergy on the body, doctors prescribe a number of antihistamines, corticosteroids and glycosides.

If complications affect the central nervous system, drugs are used that can eliminate convulsions 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, the 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 follow. It is for this purpose that a preliminary examination is carried out, all children are treated by a pediatrician. If necessary, it is worth contacting other specialists for advice. It can be a dermatologist, immunologist, neurologist, cardiologist and pulmonologist.

A mandatory event in the post-vaccination period is the 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 the rest and quickly give medical help. Children who had complications after a particular vaccine do not re-do it. But, the planned prophylactic use of other vaccines is not prohibited.

A separate item 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 schedule. The same applies to the time after vaccination - the child should not be in crowded places for several days, not communicate with people who may have infectious diseases. The approach may reduce the possibility of getting complications. For additional insurance, you can record all the reactions of the child's body that appear after the administration of the drug. Even a slight reddening or an increase in temperature within the normal range should be controlled.

Complications that may occur after vaccination can have consequences and affect the functioning of the whole organism. It is important to get tested beforehand and get permission from a doctor to carry out immunizations. Different types of vaccines have different effects and may cause different complications. This may be a slight redness at the injection site, or it may provoke 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 often non-compliance with safety rules during the injection causes complications and the appearance of diseases.

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.

Usually, adverse reactions to vaccinations with inactivated vaccines (DPT, DTP, 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 aim of forming the immunity of the vaccinated to this infection, and undesirable, that is, side reactions.

Medical Immunology Centers of the Russian Federation advise to vaccinate 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 the vaccination takes place according to the schedule of the vaccination certificate that each person has.

In 1996, the world celebrated the 200th anniversary of the first vaccination, carried out in 1796 by the English physician Ed. Jenner. Today, the idea of vaccination in our country, in addition to sincere supporters, has a fairly large number of staunch opponents. Disputes around the mass use of vaccines do not subside not only in our country. Already in the 18th and 19th centuries, doctors noted that mass smallpox vaccination shortens people's lives, testified to the imaginary benefits and real harms of vaccines. To date, a huge amount of material has been accumulated on the negative consequences - side effects of vaccines.

The lack of safe vaccines, as well as a sharp deterioration in the health of Russian children, 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 field of medicine where vaccinations have not introduced iatrogenic pathology.

What are adverse reactions to vaccines?

The term "adverse reaction" refers to the occurrence of unwanted reactions of the body, which were not the purpose 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, i.e. arising at the injection site (redness, soreness, induration), and general, that is, those that affect the entire body as a whole - fever, 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 cause of an increase in body temperature that occurs after vaccination is the release of special "mediators" of the immune reaction into the blood. If adverse reactions are not severe, then in general it is even a sign that is favorable in terms of developing immunity. For example, a small induration that occurs at the site of vaccination with a hepatitis B vaccine indicates the activity of the process of developing immunity, which means that the vaccinated person will be really protected from infection.

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

Usually, adverse reactions to vaccinations with inactivated vaccines (DTP, ATP, hepatitis B) occur 1-2 days after vaccination and disappear on their own, without treatment, within 1-2 days. After inoculation with live vaccines, reactions may appear later, on days 2-10, and also pass without treatment within 1-2 days.

Most vaccines have been in use 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 frequency of adverse reactions is also well studied. It is no secret that the rubella vaccine, which has been used abroad for more than 30 years, causes about 5% of general reactions, 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 side reactions include redness, induration, soreness, swelling, which are significant and significant. Also, local reactions include urticaria (an allergic rash resembling that of a nettle burn), an increase in lymph nodes adjacent 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 contact. It is quite natural to assume that the greater the volume of foreign substances, the greater the strength of inflammation. Numerous clinical trials of vaccines involving control groups, when ordinary water for injection was administered as a control drug, showed that even this “drug” causes local reactions, and at a frequency close to that of the experimental group where the vaccines were administered. That is, the injection itself is the cause of local reactions to a certain extent.
Sometimes vaccines are designed to cause local reactions on purpose. We are talking about the inclusion in the composition of vaccines of special substances (usually aluminum hydroxide and its salts) or adjuvants that 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 DTP, DTP, hepatitis A and B. Usually adjuvants are used in inactivated vaccines, since the immune response to live vaccines is already quite strong.
The way vaccines are administered also affects the number of local reactions. All injectable vaccines are best administered intramuscularly, and not in the buttock (you can get into the sciatic nerve or subcutaneous fat). Muscles are much better supplied with blood, the vaccine is better absorbed, the strength of the immune response is greater. In children under 2 years of age, the best place for vaccination is the anterior-lateral surface of the thigh in its middle third. Children older than two years and adults are best grafted into the deltoid muscle of the shoulder, the very muscular thickening on the shoulder - the injection is made from the side, at an angle of 90 degrees to the skin surface. With subcutaneous administration of vaccines, the frequency of local reactions (redness, induration) will obviously be higher, and the absorption of vaccines and, as a result, the immune response may be lower than with intramuscular administration.

Common reactions after vaccinations

Common post-vaccination reactions include a rash covering large areas of the body, fever, anxiety, sleep and appetite disorders, headache, dizziness, short-term loss of consciousness, cyanosis, cold extremities. In children, there is such a reaction as prolonged unusual crying.

Why does a rash appear after vaccination? There are three possible reasons - the reproduction of the vaccine virus in the skin, an allergic reaction, increased bleeding that occurred after vaccination. A mild, transient rash (caused by the replication of the vaccine virus in the skin) is a normal consequence of vaccination with live virus vaccines such as those against measles, mumps, and rubella.

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

With the introduction of live vaccines, almost complete reproduction of a natural infection in a weakened form is sometimes possible. An illustrative example of vaccination against measles, when on the 5th - 10th day after vaccination, a specific post-vaccination reaction is possible, characterized by an increase in body temperature, symptoms of acute respiratory infections, a kind of rash - all this is classified as "vaccinated measles".

Post-vaccination complications

In contrast to adverse reactions, vaccination complications are undesirable and rather 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 are convulsions, neurological disorders, allergic reactions of varying severity, etc.

In fairness, it should be noted that, unlike adverse reactions, post-vaccination complications are extremely rare - the frequency of complications such as encephalitis for measles vaccine is 1 in 5-10 million vaccinations, generalized BCG infection that occurs when BCG is administered incorrectly is 1 per 1 million vaccinations, vaccine-associated poliomyelitis - 1 per 1-1.5 million doses of OPV administered. In the infections that vaccines protect against, these same complications occur at an order of magnitude higher 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 the instructions for administering the vaccine (from non-compliance with contraindications up to the introduction of an oral vaccine intramuscularly);
individual characteristics of the body (unexpectedly strong allergic reaction to the repeated administration of the vaccine);
accession of infection - purulent inflammation at the injection site and infection, in the incubation period of which vaccination was carried out.

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

Common complications for vaccinations (vaccine):

Excessively strong general reactions with a high temperature increase (more than 40ºС), general intoxication
Damage to the central nervous system: persistent piercing crying of the child, convulsions without and with an increase in body temperature; encephalopathy (the appearance of neurological "signs"); post-vaccination serous meningitis (short-term, leaving no consequences "irritation" of the meninges caused by the vaccine virus);
Generalized infection with a vaccine microorganism;
Damage to various organs (kidneys, joints, heart, gastrointestinal tract, etc.);
Allergic reactions: local reactions of an allergic type (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 associated acute infection, with and without complications;

Description of some complications

Anaphylactic shock after vaccination

Anaphylactic shock- an allergic reaction of an immediate type, a state of sharply increased sensitivity of the body that develops with the repeated introduction of an allergen. Usually, vaccine components (non-compliance with contraindications, undetected allergies) are characterized by a sharp drop in blood pressure and impaired cardiac activity. Occurs usually in the first 30 minutes after vaccination, requires resuscitation. 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 convulsions

Seizures without fever(afebrile convulsions) - occur when vaccinated 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 parts of the brain and meninges with vaccine antigens or a reaction to them. In some cases, seizures first detected after vaccination are the result of epilepsy.

Serous meningitis

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

Table: Frequency of occurrence 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 poliomyelitis with the introduction of a live attenuated vaccine (for the first, second and third vaccinations)
Against tetanus	Neuritis of the brachial nerve at the injection site
DTP (against diphtheria, whooping cough and tetanus)	High-pitched, loud cry during the first hours after vaccination Episode of convulsions against the background of 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 convulsions against the background of high temperature Decrease in the number of platelets in the blood Allergic reaction to vaccine components Encephalopathy

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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	Annex 1 Annex 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.

2000-2007 NIIAH SGMA

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

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

VACCINATION REACTIONS

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

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

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

POST-VACCINATION COMPLICATIONS

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

The very fact of the extremely rare development of post-vaccination complications indicates the importance of the individual reactivity of the organism vaccinated in the implementation of the side effects of a particular vaccine. This is especially evident in the analysis of complications after the use of live vaccines. Thus, the frequency of vaccine-associated poliomyelitis in children of the first year of life with primary immunodeficiency is more than 2000 times higher than that in immunocompetent children of the same age (16.216 and 7.6 cases per 10 million vaccinated, respectively). Vaccination against poliomyelitis with an inactivated vaccine (IPV) at 3 and 4.5 months of life (according to the Russian vaccination calendar) solved the problem of VAP. Such a severe complication as generalized BCG infection, occurring with a frequency of less than 1 case per 1 million initially vaccinated, usually develops in children with severe disorders of cellular immunity (combined immunodeficiencies, cellular immune deficiency syndrome, chronic granulomatous disease). Therefore, all primary immunodeficiencies are a contraindication to the introduction of live vaccines.
Vaccine-associated meningitis after vaccination with the mumps vaccine usually occurs between the 10th and 40th day after vaccination and is not much different from the disease of serous meningitis caused by the mumps virus. At the same time, in addition to the cerebral syndrome (headache, vomiting), mild meningeal symptoms (stiff neck, symptoms of Kernig, Brudzinsky) can be determined. Cerebrospinal fluid tests show normal or slightly elevated protein, lymphocytic pleocytosis. To conduct a differential diagnosis with meningitis of a different etiology, virological and serological studies are carried out. Treatment consists in the appointment of antiviral, detoxification and dehydration agents.

When injected into the buttock area, traumatic damage to the sciatic nerve can be observed, the clinical signs of which in the form of anxiety and sparing of the leg on the side of which the injection was made, are observed from the first day. The same signs after the introduction of OPV may be a manifestation of vaccine-associated poliomyelitis.

Thrombocytopenia is one of the possible complications of the rubella vaccine. A causal relationship of thrombocytopenia with the introduction of vaccine preparations containing the measles virus has been proven.

Table

Complications with a causal relationship to vaccination

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

ANAMNESIS

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

DIFFERENTIAL DIAGNOSIS

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

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

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

PREVENTION

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

Prevention in the post-vaccination period of infectious diseases plays a decisive role. Parents should not be asked to immediately carry out vaccinations before admission or immediately after the child enters a childcare or preschool institution. In a children's institution, a child finds himself in conditions of high microbial and viral contamination, his usual routine changes, emotional stress arises, all this adversely affects his health and is therefore incompatible with vaccination.

The choice of time of year for vaccinations may be of some importance. It is shown that in the warm season, children tolerate the vaccination process more easily, since their body is more saturated with vitamins, which are so necessary in the process of immunization. Autumn and winter is a time of high incidence of acute respiratory viral infections, the addition of which in the post-vaccination period is highly undesirable.

Children who often suffer from acute respiratory infections are best vaccinated in the warm season, while allergic children are best vaccinated in winter, their vaccination in spring and summer is undesirable, since pollen allergies are possible.

There is evidence that when carrying out vaccination to prevent post-vaccination pathology, daily biological rhythms should be taken into account. It is recommended to carry out vaccinations in the morning (up to 12 hours).

Measures for the prevention of post-vaccination complications include the constant revision of the vaccination schedule, which is carried out at the state level, using the latest scientific achievements in the field of immunoprophylaxis. It is necessary for each pediatrician to rationalize the timing and sequence of immunization when compiling an individual vaccination schedule. Immunoprophylaxis according to an individual calendar is carried out, as a rule, for children with a aggravated anamnesis.

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

Vaccination is not carried out during an acute infectious disease. A contraindication to the introduction of live vaccines is primary immunodeficiency. A pathological reaction due to vaccination is a contraindication to the use of this vaccine in the future.