What is considered a post-vaccination complication, why most reactions to vaccinations are not post-vaccination complications, what should be the actions of doctors in case of detection of post-vaccination complications. Official regulations set out the fundamental provisions on these issues.

Post-vaccination complications. Registration, accounting and notification

In accordance with the Federal Law of the Russian Federation "On Immunoprophylaxis of Infectious Diseases", post-vaccination complications (PVO) include severe and (or) persistent health disorders due to preventive vaccinations, namely:

• anaphylactic shock and other immediate allergic reactions; serum sickness syndrome;
• encephalitis, encephalomyelitis, myelitis, mono(poly)neuritis, polyradiculoneuritis, encephalopathy, serous meningitis, afebrile convulsions absent before vaccination and recurring within 12 months after vaccination;
• acute myocarditis, acute nephritis, thrombocytopenic purpura, agranulocytosis, hypoplastic anemia, systemic connective tissue diseases, chronic arthritis;
• various forms of generalized BCG infection.

Information about post-vaccination complications is subject to state statistical records. When establishing the diagnosis of PVO, suspicion of PVO, as well as an unusual vaccine reaction during active observation during the vaccination period or when seeking medical help, the doctor (paramedic) must:

• provide the patient with medical care, if necessary, ensure timely hospitalization in a hospital where specialized medical care can be provided;
• register this case in a special accounting form or in the register of infectious diseases on specially marked sheets of the journal. Subsequently, the necessary clarifications and additions are made to the journal.

All information about the patient is recorded in detail in the relevant medical documentation. Namely: the history of the development of the newborn, the history of the development of the child, the child's medical record, the outpatient's medical record, the inpatient's medical record, as well as the emergency call card, the card that applied for anti-rabies help and the certificate of preventive vaccinations.

About uncomplicated single cases of strong local reactions (including edema, hyperemia > 8 cm in diameter) and strong general reactions (including temperature > 40 C, febrile convulsions) to vaccination, as well as mild manifestations of skin and respiratory Allergies are not reported to higher health authorities. These reactions are recorded in the child's developmental history, the child's or outpatient's medical record, the vaccination certificate, and in the clinic's vaccination record book.

When establishing a diagnosis of PVO or suspecting it, the doctor (paramedic) is obliged to immediately inform the head physician of the health facility. The latter, within 6 hours after establishing a preliminary or final diagnosis, sends information to the city (district) center of the state sanitary and epidemiological supervision. The head of the medical facility is responsible for the completeness, reliability and timeliness of accounting for diseases suspected of air defense, as well as for the prompt reporting of them.

The territorial center of the State Sanitary and Epidemiological Surveillance, which has received an emergency notification of the development of air defense (or suspicion of air defense), after registering the information received, transfers it to the center of the State Sanitary and Epidemiological Surveillance in the subject of the Russian Federation on the day the information is received. The Center for State Sanitary and Epidemiological Surveillance also transmits information about the series, in the application of which the frequency of development of strong local and / or general reactions exceeds the limits established by the instructions for the use of drugs.

Investigation of post-vaccination complications

Each case of complication (suspected complication) that required hospitalization, as well as resulting in a fatal outcome, must be investigated by a commission of specialists (pediatrician, internist, immunologist, epidemiologist, etc.) appointed by the chief physician of the regional state sanitary and epidemiological supervision in the subject of the Russian Federation. When investigating complications after BCG vaccination, a TB doctor should be included in the commission.

When conducting an investigation, it should be borne in mind that there are no pathognomonic symptoms that would unambiguously consider each specific case as a post-vaccination complication or unusual reaction. And such clinical symptoms as high fever, intoxication, neurological symptoms, various types of allergic reactions, incl. immediate type, may not be caused by vaccination, but by a disease that coincided in time with the vaccination. Therefore, each case of the disease that frolic in the post-vaccination period, and treated as a post-vaccination complication, requires careful differential diagnosis with both infectious (SARS, pneumonia, meningococcal and intestinal infections, urinary tract infections, etc.) and non-infectious diseases (spasmophilia, appendicitis, invagination, ileus, brain tumor, subdural hematoma, etc.) using instrumental (radiography, EchoEG, EEG) and laboratory (blood biochemistry with the determination of electrolytes, including calcium, CSF cytology, etc.) research methods, based on the clinical symptoms of the disease.

The results of a long-term analysis of deaths that developed in the post-vaccination period, conducted by the GISK named after. L.A. Tarasevich, indicate that the vast majority of them were due to intercurrent diseases (a disease detected against the background of an existing underlying disease and not being its complication). However, doctors, taking into account the temporary connection with the vaccination, made a diagnosis of "post-vaccination complication", in connection with which etiotropic therapy was not prescribed, which in some cases led to a tragic outcome.

Information indicating the possibility of a connection between post-vaccination complications and the quality of the administered vaccine:

• the development of complications is recorded in persons vaccinated by different medical workers after the introduction of a vaccine of one series or a vaccine of one manufacturer,
• a violation of the temperature regime of storage and / or transportation of the vaccine was revealed.

Information indicating technical errors:

• PVO develop only in patients vaccinated by a single healthcare worker;

Technical errors are caused by a violation of the rules for storage, preparation and administration of medical immunobiological preparations, in particular: the wrong choice of place and violation of the technique for administering the vaccine; violation of the rules for preparing the drug before its administration: using other drugs instead of a solvent; diluting the vaccine with the wrong volume of diluent; contamination of the vaccine or diluent; improper storage of the vaccine - long-term storage of the drug in a diluted form, freezing adsorbed vaccines; violation of the recommended dose and immunization schedule; using non-sterile syringes and needles.

If a technical error is suspected, it is necessary to check the quality of work of the medical worker performing vaccination, conduct additional training for him, and also evaluate the sufficiency and results of the metrological examination of the material and technical base: it may be necessary to replace refrigerators, not enough disposable syringes, etc.

Information indicating the characteristics of the patient's health:

• the appearance of stereotypical clinical manifestations after the introduction of different series of the vaccine in patients vaccinated by different medical workers with a general history and clinical signs of the disease:
• the presence of hypersensitivity to the components of the vaccine in the form of allergic reactions in history;
• immunodeficiency state (in the case of vaccine-associated diseases after the introduction of live vaccines);
• history of decompensated and progressive lesions of the central nervous system, convulsive syndrome (in case of development of neurological reactions to DPT)
• the presence of chronic diseases that can worsen in the post-vaccination period.

Information indicating that the disease is not related to vaccination:

• identification of the same symptoms of the disease in vaccinated and unvaccinated people;
• unfavorable epidemic situation in the environment of the vaccinated - close contact with infectious patients before or after vaccination can lead to the development of an acute disease, which coincides in time with the post-vaccination process, but is not associated with it.

Below are some clinical criteria that can be used in the differential diagnosis of post-vaccination complications:

• general reactions with fever, febrile convulsions to the introduction of DPT and ADS-M appear no later than 48 hours after vaccination;
• reactions to live vaccines (except for immediate-type allergic reactions in the first few hours after vaccination) cannot appear earlier than the 4th day and more than 12-14 days after the administration of measles and 30 days after the administration of OPV and mumps vaccines;
• meningeal phenomena are not typical for complications after the introduction of DTP vaccine, toxoids and live vaccines (with the exception of the mumps vaccine);
• encephalopathy is not typical for reactions to the introduction of mumps and polio vaccines and toxoids; it is extremely rare after DTP vaccination; the possibility of developing post-vaccinal encephalitis after vaccination with DTP vaccine is currently disputed;
• the diagnosis of post-vaccination encephalitis requires, first of all, the exclusion of other diseases that can occur with cerebral symptoms;
• neuritis of the facial nerve (Bell's palsy) is not a complication of OPV and other vaccines;
• allergic reactions of the immediate type develop no later than 24 hours after any type of immunization, and anaphylactic shock - no later than 4 hours;
• intestinal, renal symptoms, heart and respiratory failure are not typical for complications of vaccination and are signs of concomitant diseases;
• catarrhal syndrome may be a specific reaction to measles vaccination if it occurs no earlier than 5 days and no later than 14 days after vaccination; it is not characteristic of other vaccines;
• arthralgia and arthritis are characteristic only for rubella vaccination;
• The disease with vaccine-associated poliomyelitis develops within 4-30 days after immunization in vaccinated and up to 60 days in contacts. 80% of all cases of the disease are associated with the first vaccination, while the risk of developing the disease in immunodeficient individuals is 3-6 thousand times higher than that in healthy people. VAP is necessarily accompanied by residual effects (flaccid peripheral paresis and / or paralysis and muscle atrophy);
• lymphadenitis caused by the BCG vaccine strain usually develops on the side of the vaccine. The process usually involves axillary, much less often sub- and supraclavicular lymph nodes. A hallmark of the complication is the absence of soreness of the lymph node during palpation; the color of the skin over the lymph node is usually not changed;
• The criteria for suggesting BCG-etiology of osteitis are the age of the child from 6 months to 1 year, the primary localization of the lesion at the border of the epiphysis and diaphysis, a local increase in skin temperature without hyperemia - a "white tumor", the presence of swelling of the nearest joint, stiffness and muscle atrophy limbs (with appropriate localization of the lesion).

When conducting an investigation, information received from the sick person or his parents is of significant help in making a diagnosis. These include data from the patient's updated medical history, his state of health before vaccination, the time of appearance and nature of the first symptoms of the disease, the dynamics of the disease, pre-medical treatment, the presence and nature of reactions to previous vaccinations, etc.

When investigating any case of a post-vaccination complication (suspicion of a complication), one should ask the places of distribution of the advertised series about possible unusual reactions after its use and the number of vaccinations (or doses used). In addition, the appeal for medical care of 80-100 vaccinated with this series should be actively analyzed (with inactivated vaccines - during the first three days, live viral vaccines administered parenterally - within 5-21 days).

With the development of neurological diseases (encephalitis, myelitis, polyradiculoneuritis, meningitis, etc.), in order to exclude intercurrent diseases, it is necessary to provide serological studies of paired sera. The first serum should be taken as soon as possible from the onset of the disease, and the second - after 14-21 days.

In sera, antibody titers to influenza, parainfluenza, herpes, coxsackie, ECHO, and adenoviruses should be determined. In this case, the titration of the first and second sera should be carried out simultaneously. The list of ongoing serological studies according to indications can be expanded. So, for example, in areas endemic for tick-borne encephalitis, with the development of neurological diseases after vaccination carried out in the spring-summer period, it is justified to determine antibodies to the tick-borne encephalitis virus.

In the case of a lumbar puncture, it is necessary to conduct a virological examination of the cerebrospinal fluid in order to isolate both vaccine viruses (when vaccinated with live vaccines) and viruses - possible causative agents of intercurrent disease. Material should be delivered to the virology laboratory either frozen or at melting ice temperature. In the cells of the CSF sediment obtained by centrifugation, the indication of viral antigens in the immunofluorescence reaction is possible.

In case of serous meningitis that has developed after mumps vaccination or suspected VAP, special attention should be paid to the indication of enteroviruses.

When making a clinical diagnosis of a generalized BCG infection, verification by bacteriological methods involves the isolation of a culture of the pathogen, followed by proof of its belonging to Mycobacterium bovis BCG.

A separate group consists of complications that have developed as a result of the so-called software errors. The latter include: violation of the dose and method of administration of the drug, erroneous administration of another drug, non-compliance with the general rules for vaccination. As a rule, such violations are committed by medical workers, primarily nurses who have not been trained in vaccination. A distinctive feature of this kind of complications is their development in persons vaccinated in the same institution or by the same medical worker.

The clinician in the treatment of a disease that has arisen in the post-vaccination period, and the pathologist in the case of a fatal outcome, should be focused on the possibility of developing a complex combined pathology during this period.

Prevention of post-vaccination complications. Vaccination of special groups

Reducing the number of contraindications to vaccination raises the question of developing rational tactics for vaccinating children with certain health problems that are not a contraindication to vaccination. The designation of such children as "risk groups" is unjustified, since we are not talking about the risk of vaccination, but about choosing the most appropriate time and method for its implementation, as well as methods for treating the underlying disease with the achievement of the most complete remission possible. The name "special or special groups" is more justified, requiring certain precautions when administering vaccinations.

Reactions to previous doses of vaccine

Continuing to give the vaccine is contraindicated in children who have had a severe reaction or complication after receiving this drug.

Severe reactions include the following: temperature 40 C and above; local reaction 8 cm in diameter or more.

Complications include: encephalopathy; convulsions; pronounced immediate reactions of the anaphylactic type (shock, Quincke's edema); hives; prolonged piercing cry; collaptoid states (hypotensive-hypodynamic reactions).

If the occurrence of these complications is associated with the introduction of DTP vaccine, subsequent vaccination is carried out with DTP toxoid.

In rare cases of such reactions to ADS or ADS-M, completion of vaccination according to epidemiological indications can be carried out with the same vaccines against the background of administration (one day before and 2-3 days after vaccination) of steroids (oral prednisolone 1.5-2 mg / kg / day or another drug in an equivalent dose). The same method can be used when administering DTP to children who have given a pronounced reaction to the DTP vaccine.

Live vaccines (OPV, ZhIV, ZhPV) are administered to children with a reaction to DPT as usual.

If a child has given an anaphylactic reaction to antibiotics contained in live vaccines or culture substrate antigens (chicken egg protein in influenza vaccines, as well as in foreign measles and mumps vaccines), the subsequent administration of these and similar vaccines is contraindicated. In Russia, Japanese quail eggs are used for the production of ZhIV and ZhPV, so the presence of hypersensitivity to chicken egg protein is not a contraindication for their administration. Contraindications to revaccination of BCG and OPV are also specific complications that have developed after the previous administration of the drug.

After completion of the investigation of the case of PVO, the commission draws up an act of epidemiological investigation in accordance with the guidelines of the "Monitoring of post-vaccination complications".

Monitoring of post-vaccination complications

Monitoring of post-vaccination complications is a system for continuous monitoring of the safety of medical immunobiological preparations (MIBP) in the context of their practical use.

Purpose of monitoring– obtaining materials indicating the safety of MIBP and improving the system of measures to prevent post-vaccination complications (PVO) after their use.

According to the WHO: “Identification of post-vaccination complications with their subsequent investigation and action increases the perception of immunization by the society and improves medical care. This, first of all, increases the coverage of the population with immunization, which leads to a decrease in morbidity. was caused by the vaccine, the mere fact that a case of a post-vaccination complication was investigated by medical professionals increases public confidence in vaccinations.

Monitoring tasks include:

• MIBP safety supervision;
• identification of post-vaccination complications after the use of domestic and imported MIBP;
• determination of the nature and frequency of air defense for each drug;
• determination of factors contributing to the development of air defense, including demographic, climatic-geographical, socio-economic and environmental factors, as well as those determined by the individual characteristics of the vaccinated.

Monitoring of post-vaccination complications is carried out at all levels of medical care for the population: district, city, regional, regional, republican. It applies to federal, municipal and private healthcare organizations, as well as citizens engaged in private medical practice with licenses for relevant activities in the field of immunoprophylaxis.

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.

Other news

The Ministry of Health of the Russian Federation approved the use of the domestic quadrivalent vaccine for the prevention of influenza "Ultrix Quadri" in children from 6 years of age. Now the drug, which is produced in the Ryazan region by the FORT company (part of the Marathon Group and Nacimbio of the Rostec State Corporation), is available for seasonal immunization against influenza of the population of the age group from 6 to 60 years. On February 13, 2020, changes were made to the instructions for use of the medicinal product.

The Nacimbio holding of the Rostec State Corporation is launching the first domestic combined vaccine for the prevention of measles, rubella and mumps in children. The drug, acting on the principle of "three injections in one" will allow you to get the effect of immune protection from three infections at once. Serial production of the vaccine will begin in 2020.

The triumphal march of vaccine prevention in the fight against infections for over 220 years has defined immunization today as a strategic investment in protecting health, the well-being of the family and the nation as a whole. In modern conditions, its tasks have noticeably expanded - this is not only a decrease in morbidity and mortality, but also the provision of active longevity. The elevation of vaccination to the rank of state policy allows us to consider it as a tool for implementing the demographic policy of our country and ensuring biological safety. Great hopes are placed on vaccine prophylaxis and in the fight against antibiotic resistance. All this is happening against the backdrop of an intensification of the anti-vaccination movement, a decrease in the population's commitment to vaccination, and the emergence of a number of strategic WHO programs on immunization.

In Russia, there is a National calendar of preventive vaccinations, within which vaccinations are carried out at a certain age for children and adults. Citizens of Russia are entitled to receive the vaccinations included in the calendar free of charge. Why are vaccinations needed and when should they be given?

Nacimbio holding (part of Rostec) has started shipping 34.5 million doses of influenza vaccines to the regions of the Russian Federation. At the first stage, which will be completed by early September, it is planned to supply 11% more doses compared to 2018, the Rostec press service reported.

The Microgen company, which is managed by Nacimbio JSC of the Rostec State Corporation, promptly delivered bacteriophage preparations for emergency prevention of intestinal infections to flood zones in the regions of the Far East. In particular, more than 1.5 thousand packages of the polyvalent Intesti-bacteriophage were sent to the Jewish Autonomous Region by air; situations in the flood zone.

On July 9, the American MSD and the Fort plant, which is part of the Marathon Group, came to an agreement to localize the production of vaccines against chicken pox, rotavirus infection and human papillomavirus (HPV) in Russia at the plant's facilities in the Ryazan region. Partners will invest 7 billion rubles in localization.

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.

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

How does the baby's body react to vaccination?

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

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

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

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

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

Normal body behavior after vaccination

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

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

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

Common reactions include:

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

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

Complications after immunovaccination

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

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

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

What is dangerous allergy after vaccination

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

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

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

Hyperthermia after administration of the drug

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

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

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

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

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

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

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 has 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 whooping cough 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 an 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.

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

General information

Post-vaccination complications are pathological conditions that have a causal relationship with prophylactic vaccination, disrupting the health and development of the child. Carrying out preventive vaccination in pediatrics is aimed at the formation of protective immunity, which does not allow the development of an infectious process upon repeated contact of a child with a pathogen. In addition to individual type-specific immunity, mass vaccination of children aims to create collective (population) immunity, designed to stop the circulation of the pathogen and the development of epidemics in society. To this end, Russia has adopted the National Calendar of Preventive Immunizations, which regulates the list, timing and procedure for mandatory and additional vaccination of children from birth to adulthood.

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

Causes of post-vaccination complications

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

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

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

As practice shows, a frequent cause of post-vaccination complications are the mistakes of medical personnel who violate the vaccination technique. These may include subcutaneous (instead of intradermal) administration of the vaccine and vice versa, improper dilution and dosage of the drug, violation of asepsis and antisepsis during injection, erroneous use of other medicinal substances as solvents, etc.

Classification of post-vaccination complications

Among the pathological conditions that accompany the vaccination process include:

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

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

Vaccine reactions include various unstable disorders that occur after vaccination, which persist for a short time and do not disrupt the vital activity of the organism. Post-vaccination reactions are of the same type in terms of clinical manifestations, usually do not disturb the general condition of the child and pass on their own.

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

Post-vaccination complications are divided into specific (vaccine-associated diseases) and non-specific (excessively strong toxic, allergic, autoimmune, immunocomplex). According to the severity of the pathological process, post-vaccination complications are local and general.

Characteristics of post-vaccination complications

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

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

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

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

A peculiar post-vaccination complication in children of the first six months of life is a piercing cry, which has a persistent (from 3 to 5 hours) and monotonous character. Usually, a piercing cry develops after the administration of pertussis vaccine and is due to the associated change in the microcirculation in the brain and an acute attack of intracranial hypertension.

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

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

Diagnosis of post-vaccination complications

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

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

The diagnosis of a post-vaccination complication is established only after all other possible causes of the violation of the child's condition are excluded.

Treatment of post-vaccination complications

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

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

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

Prevention of post-vaccination complications

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

Children who have had a post-vaccination complication are no longer given the vaccine that caused the reaction, but in general, routine and emergency immunizations are not contraindicated.