General reactions after the introduction of inactivated vaccines appear. Adverse reactions and complications to vaccinations

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

Local and general post-vaccination reactions

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

Local post-vaccination reactions

Local reactions include all kinds of manifestations that occur at the injection site. Almost all non-specific local reactions appear during the first day after the administration of the drug. They can be represented by localized redness (hyperemia), the diameter of which does not exceed eight centimeters. Swelling is also possible, and in some cases, soreness at the injection site. If adsorbed drugs were administered (especially subcutaneously), an infiltrate may form.

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

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

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

Common post-vaccination reactions

Such reactions are represented by changes in the state and behavior of the patient. In most cases, they include an increase in body temperature. With the introduction of inactivated vaccines, such reactions appear a couple of hours after vaccination and do not last more than two days. In parallel, the patient may be disturbed by sleep disturbances, anxiety, myalgia and anorexia.

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

Post-vaccination complications

Such pathological conditions are represented by persistent changes in the human body that have developed due to the introduction of vaccination. Post-vaccination complications are long-term and go beyond the physiological norms. Such changes significantly impair the health of the patient.

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

Post-vaccination complications may include:

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

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

Folk remedies

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

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

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 a 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 doctor 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 (suspicion of a 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 a complication of it). However, doctors, taking into account the temporal 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 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 and summer, 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

The reduction in 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 DPT 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 society and improves medical care. This, first of all, increases the coverage of the population with immunization, which leads to a decrease in morbidity. Even if the cause cannot be established or the disease 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, as well as those due to 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

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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.

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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 1,500 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.

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. With pneumococcal vaccination with PCV7 and PCV13 vaccines, rare and very rare severe events have not been identified, 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 for 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. On 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.

", 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 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.

– these are severe and / or persistent health problems due to preventive vaccination.

The disease can be considered as a post-vaccination complication if:

• the temporal relationship of development with the height of the vaccination process has been proven;
• there is a dose-dependent relationship;
• this state can be reproduced in an experiment;
• the account of alternative reasons is made and their inconsistency is proved statistically;
• the strength of association of the disease with vaccination was calculated by the method of determining the relative risk;
• when the vaccine is discontinued, PVO is not recorded.

All diseases in the post-vaccination period are divided into:

1. Post-vaccination complications(conditions that arise as a result of vaccination have an obvious or proven connection with vaccination, but are not characteristic of the usual course of the vaccination process):

• allergic (local and general);
• involving the nervous system;
• rare forms.

1. Complicated course of the post-vaccination period(various diseases that coincided with vaccination in time, but do not have an etiological and pathogenetic connection with it).

Allergic complications

Local allergic complications

Local allergic complications are more often recorded after the introduction of non-live vaccines containing aluminum hydroxide as a sorbent: DTP, Tetracoca, toxoids, recombinant vaccines. When using live vaccines, they are observed less frequently and are associated with additional substances (proteins, stabilizers) included in the preparation.

Local complications are characterized by the appearance of hyperemia, edema, compaction of more than 8 cm in diameter at the injection site of the vaccine preparation, or soreness, hyperemia, edema (regardless of size), which persist for more than 3 days. In rare cases, when using vaccines containing aluminum hydroxide, aseptic abscess formation is possible. The term for the appearance of local allergic complications for non-live and live vaccines is the first 1-3 days after immunization.

Common allergic complications

Rare and most severe complications of vaccination include anaphylactic shock and anaphylactoid reaction.

Anaphylactic shock, which occurs more often after repeated administration of the vaccine, is the most dangerous, although extremely rare complication. It develops more often 30-60 minutes after vaccination, less often - after 3-4 hours (up to 5-6 hours). If the medical staff is not ready to provide adequate medical care, this complication can be fatal.

Anaphylactoid reaction develops acutely, but more delayed in time than anaphylactic shock, during the first 2-12 hours after the introduction of all vaccines and is manifested by acute circulatory decompensation, acute respiratory failure as a result of obstruction. Additional clinical manifestations are skin lesions (common urticaria, Quincke's edema or generalized angioedema) and gastrointestinal tract (colic, vomiting, diarrhea).

In children of the first year of life, the equivalent of anaphylactic shock is a collaptoid state: a sharp pallor, lethargy, adynamia, a drop in blood pressure, less often - cyanosis, cold sweat, loss of consciousness. The most common manifestations of general allergic complications are skin rashes - rashes, including urticaria, Quincke's edema, which appear with the introduction of non-live vaccines in the first 1-3 days after vaccination, with the introduction of live vaccines - from 4-5 to 14 days (in peak period of vaccination).

Quincke's edema and serum sickness, occur mainly in children after repeated DPT vaccinations, more often in children who had similar reactions to the introduction of previous doses. Rare, severe variants of an allergic reaction are toxic-allergic dermatitis (Stevens-Johnson, Lyell syndromes), the timing of their appearance coincides with the height of the vaccination process.

Complications involving the nervous system

The most common manifestation of post-vaccination complications from the nervous system are convulsive seizures.

convulsive syndrome against the background of hyperthermia (febrile convulsions) proceeds in the form of: generalized tonic, clonic-tonic, clonic seizures, single or repeated, usually short-term. Febrile seizures can develop after all vaccines. The term of occurrence when using non-live vaccines is 1-3 days after vaccination, when vaccinated with live vaccines - at the height of the vaccine reaction - 5-12 days after vaccination. In older children, the hallucinatory syndrome is the equivalent of seizures. Some authors do not consider febrile convulsions to be a post-vaccination complication. Because children in the first three years of life are predisposed to convulsive states with fever due to various causes, these researchers consider febrile convulsions after vaccination as a reaction of such children to

rise in temperature.

Convulsive syndrome against the background of normal or subfebrile body temperature (up to 38.0C), with impaired consciousness and behavior. Afebrile convulsive seizures are characterized by polymorphism of manifestations from generalized to small seizures (“absences”, “nods”, “pecks”, “fades”, twitching of individual muscle groups, stopping the gaze). Small seizures are usually repeated (serial), develop when the child falls asleep and wakes up. Afebrile convulsions are detected more often after the introduction of a whole-cell pertussis vaccine (DTP, Tetracoccus). The timing of their appearance may be more distant - 1-2 weeks after vaccination. The development of afebrile convulsions indicates the presence of an organic lesion of the nervous system in the child, which was not detected in a timely manner, and vaccination serves as a provoking factor for an already latent CNS disease. In the WHO system, afebrile seizures are not considered etiologically related to vaccination.

piercing scream. Persistent monotonous cry in children of the first six months of life, which occurs a few hours after vaccination and lasts from 3 to 5 hours.

encephalopathy

Encephalitis

Vaccine-associated diseases

The most severe lesions of the nervous system are vaccine-associated diseases. They develop extremely rarely and only when using live vaccines.

Vaccine-associated paralytic poliomyelitis(VAPP). The disease is caused by damage to the anterior horns of the spinal cord, usually occurs in the form of a lesion of one limb, with typical neurological disorders, lasts at least 2 months, leaves behind pronounced consequences.

Vaccine-associated encephalitis- encephalitis caused by viruses of live vaccines, tropic to the nervous tissue (anti-measles, anti-rubella).

Treatment of post-vaccination pathology

Post-vaccination reactions in most cases do not require special treatment and disappear on their own within a few hours or days. When the temperature rises to high numbers, an abundant fractional drink, physical methods of cooling and antipyretic drugs (panadol, Tylenol, paracetamol, brufen syrup, etc.) are prescribed. If an allergic rash occurs after vaccination, you can use one of the antimediator drugs (fencarol, tavegil, , diazolin) 3 times a day at an age dosage for 2-3 days. Post-vaccination complications requiring the appointment of etiotropic therapy include some forms of complications after the administration of the BCG vaccine. The most severe complications during immunization with the BCG vaccine include a generalized infection with mycobacteria of the vaccine strain, which developed against the background of a violation of cellular immunity. Treatment is usually carried out in a specialized hospital, while 2-3 anti-tuberculosis drugs are prescribed for a period of at least 2-3 months.