Pathological reactions and complications to prophylactic vaccinations. Vaccination reactions

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 specific allergens (plant pollen, house dust, animal dander, etc.) are ingested 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 can cause dangerous complications” - this is the argument that opponents of official medicine cite in the first place. The ground for fear is set, and when even a slight inflammation develops at the injection site after vaccination, many patients begin to sound the alarm. Meanwhile, the vast majority of post-vaccination reactions, as they explain, are absolutely natural and pose no danger.

Adverse reactions with vaccination

Local reactions

As is known from school biology textbooks, when the skin is damaged and foreign substances get into this place, inflammation occurs. But it quickly passes even without any special measures.

Practice shows that the body can thus react even to absolutely neutral substances. So, in the course of clinical trials of vaccines, participants in the control groups are given ordinary water for injection, and various local reactions occur even to this “drug”! Moreover, with approximately the same frequency as in the experimental groups, where real vaccines are administered. That is, the injection itself can be the cause of inflammation.

At the same time, some vaccines are designed in such a way as to deliberately provoke inflammation at the injection site. Manufacturers add special substances to such preparations - adjuvants (usually aluminum hydroxide or its salts). This is done in order to strengthen the body's immune response: thanks to inflammation, many more cells of the immune system "get acquainted" with the vaccine antigen. Examples of such vaccines are DPT (diphtheria, whooping cough, tetanus), DTP (diphtheria and tetanus), against hepatitis A and B. Adjuvants are usually used in, since the immune response to live vaccines is already strong enough.

General reactions

In general, with the introduction of live vaccines, it is possible to reproduce a natural infection in a weakened form: the temperature rises, headache appears, sleep and appetite are disturbed. An illustrative example is “vaccinated measles”: on the 5-10th day after vaccination, a rash sometimes appears, typical symptoms of acute respiratory infections are observed. And again, the "disease" goes away on its own.

It is important to understand that unpleasant symptoms after vaccination are temporary, while immunity to a dangerous disease remains for life.

Post-vaccination complications

Adverse reactions from vaccination may be unpleasant, but they do not pose a danger to life. Only occasionally do vaccinations cause really serious conditions. But in fact, the vast majority of such cases are caused by medical errors.

The main causes of complications:

• violation of vaccine storage conditions;
• violation of the instructions for administering the vaccine (for example, the introduction of an intradermal vaccine intramuscularly);
• non-compliance with contraindications (in particular, vaccination of the patient during an exacerbation of the disease);
• individual characteristics of the body (unexpectedly strong allergic reaction to the repeated administration of the vaccine, the development of the disease against which vaccination is carried out).

Only the last reason cannot be ruled out. Everything else is the notorious "human factor". And you can minimize the chances of developing complications by choosing a proven one for vaccination.

Unlike adverse reactions, post-vaccination complications are extremely rare. Encephalitis as a result of measles vaccine develops in one case in 5-10 million vaccinations. The chance of a generalized BCG infection is one in a million. Only one in 1.5 million doses of OPV administered causes vaccine-associated poliomyelitis. But we must understand that in the absence of vaccinations, the probability of catching a severe and extremely dangerous infection is many orders of magnitude higher.

Contraindications to vaccination

Most of them - temporary, they are the basis not for the complete cancellation of the procedure, but only for postponing it to a later date. For example, any infectious disease excludes vaccination - it is possible only after the patient has fully recovered. Certain restrictions apply during pregnancy and lactation: expectant mothers are not vaccinated with live vaccines, although the use of others is quite acceptable.

But sometimes the state of human health can be the basis for permanent withdrawal from vaccinations. So, in principle, vaccination is not carried out for patients with primary immunodeficiency. Certain diseases exclude the use of certain types of vaccines (for example, the pertussis component of the DTP vaccine is incompatible with some neurological diseases).

However, sometimes doctors may insist on vaccination even despite the presence of contraindications. For example, under normal circumstances, flu shots are not given to people who are allergic to egg protein. But if the next type of flu causes serious complications, and the risk of the disease is high, in many Western countries, doctors neglect such a contraindication. Of course, vaccination must be combined with special measures for.

Many people sometimes refuse vaccinations for absolutely far-fetched reasons. “My child is sickly, his immunity is already reduced”, “he has a bad reaction to vaccinations”, these are typical false contraindications. Such logic is not only wrong, it is extremely dangerous. After all, if a child does not tolerate vaccines containing attenuated strains of the virus, then the consequences of getting a full-fledged pathogen into his body are likely to be simply fatal.

Content

A vaccine is the introduction of inactivated (weakened) or non-living microbes into the human body. This contributes to the production of antigens, forms type-specific immunity against a certain type of pathological bacteria. No one can predict the reaction of both the child and the adult organism to an unknown drug, therefore, in some cases, post-vaccination complications (PVO) occur.

Why do vaccine complications occur?

Vaccination is aimed at the formation of protective immunity, which will prevent the development of an infectious process when a person comes into contact with a pathogen. A vaccine is a biological serum that is injected into a patient's body to wake up the immune system. It is prepared from killed or greatly weakened microbes and antigens. Different preparations for immunization may contain a different composition:

• waste products of pathogens of viral infections;
• synthetic compounds (adjuvants);
• modified infectious agents;
• live viruses;
• inactivated microorganisms;
• combined substances.

Vaccination is considered a "training exercise" of the body against dangerous pathologies. If the immunization is successful, then re-infection is impossible, but sometimes there are serious complications after vaccination. A child and an adult patient may develop an unexpected pathological response to vaccination, which the medical staff regards as a post-vaccination complication.

The frequency of these processes varies depending on the type of vaccines used and their reactogenicity. For example, a reaction to a DPT vaccination (against tetanus, diphtheria and whooping cough) has negative consequences for a child's body in 0.2-0.6 cases per 100,000 vaccinated children. When vaccinated against MMR (against mumps, measles and rubella), complications occur in 1 case per 1 million vaccinated.

Causes

The occurrence of complications after vaccination may occur due to the individual characteristics of the human body, due to the reactogenicity of the drug, the tropism of vaccine strains to tissues or the reversion of their properties. Also, the pathological response of the body to vaccination occurs due to staff errors in violation of the technique for administering serum. Iatrogenic factors include:

• incorrect dosage or microbial contamination of the drug;
• unsuccessful administration (subcutaneous instead of intradermal);
• violation of antiseptics during injection;
• erroneous use of medicinal substances as solvents.

The individual characteristics of the human body, which determine the severity and frequency of post-vaccination complications, include:

• genetic predisposition to allergic reactions;
• background pathology, aggravated after vaccination;
• change and sensitization of immune reactivity;
• convulsive syndrome;
• autoimmune pathologies.

Classification

The vaccination process is accompanied by the following pathological conditions:

• Chronic diseases or intercurrent infections, exacerbated or joined after vaccination. The development of the disease in the post-vaccination period is sometimes caused by the coincidence of the onset of the disease and the administration of serum, or by a developed immunodeficiency. During this period, you can get sick with obstructive bronchitis, SARS, infectious pathologies of the urinary tract, pneumonia and other ailments.
• vaccine reactions. These include non-persistent disorders that have arisen after vaccination and persist for a short time. They do not disturb the general condition of the vaccinated and quickly pass on their own.
• Post-vaccination complications. They are divided into specific and non-specific. The former are vaccine-associated diseases (poliomyelitis, meningitis, encephalitis, and others), and the latter are immunocomplex, autoimmune, allergic, and overly toxic. According to the severity of symptoms, post-vaccination reactions are divided into local and general.

What are post-vaccination reactions and complications

After vaccination, the body may react with the following local or general symptoms:

• Local reactions: soreness at the site of serum injection, edema, hyperemia, regional lymphadenitis, conjunctivitis, nosebleeds, catarrhal manifestations from the respiratory tract (with intranasal and aerosol administration of drugs).
• General reactions: malaise, sleep disturbance, loss of appetite, fever, headache, nausea, pain in the joints and muscles.

Local reactions are manifested as individual symptoms, and all of the above. High reactogenicity is characteristic of vaccines containing a sorbent when they are administered in a needleless manner. Local reactions appear immediately after the introduction of the vaccine, reach a maximum in a day and persist from 2 to 40 days. General complications reach a maximum after 8-12 hours, and disappear after vaccination from 1 day to several months.

When using sorbed vaccines administered subcutaneously, local reactions proceed slowly, reaching their maximum after 36-38 hours. Further, the process passes into a subacute phase, which lasts about 7 days, ending with the formation of a subcutaneous seal, which resolves from 30 days or more. The most severe reactions occur during immunization with toxoids.

The main complications after vaccination:

Diagnostics

If complications arise after vaccination, the doctor directs the patient to laboratory tests. For differential diagnosis you need:

• general urine and blood tests;
• virological and bacteriological examination of feces, urine, blood to exclude convulsive conditions;
• methods of PCR, ELISA to exclude intrauterine infections in children of the first year of life;
• lumbar puncture with a study of the battleship (with lesions of the central nervous system);
• electroencephalography (according to indications);
• MRI of the brain (if necessary);
• neurosonography, electromyography (with post-vaccination complications).

Treatment

As part of the complex treatment of complications after vaccination, pathogenetic and etiotropic therapy is carried out. For a patient of any age, a rational diet, careful care, sparing regimen are organized.. To exclude local infiltrates, local dressings with Vishnevsky ointment and physiotherapy (ultrasound, UHF) are used. Some complications after DTP are treated with the help of a neurologist.

The body will more easily endure the post-vaccination period if the gastrointestinal tract is not loaded, therefore, on the day of vaccination and the day after it, it is better to observe a semi-starvation regimen. Fried foods, sweets, fast food and other foods containing stabilizers and preservatives should be avoided. It is better to cook vegetable soups, liquid cereals, drink plenty of water. It is not recommended to introduce complementary foods to a baby until a stable remission is achieved. Contact with other people should be limited in case of health problems after vaccination until the immunological activity is fully restored.

Preparations

In case of complications after vaccination from the nervous system, doctors prescribe post-syndrome therapy (anti-inflammatory, dehydration, anticonvulsant). Combination treatment involves taking the following medications

• antipyretic: Paracetamol, Brufen with an increase in body temperature above 38 ° C;
• antihistamines: Diazolin, Fenkarol in the event of an allergic rash;
• corticosteroids: Hydrocortisone, Prednisolone in the absence of the effect of antihistamines;
• antispasmodics: Eufillin, Papaverine for spasm of peripheral vessels;
• tranquilizers: Seduxen, Diazepam with strong excitement, motor restlessness, continuous piercing cry of the child.

Physiotherapy procedures

Post-vaccination complications are successfully eliminated with the help of physiotherapy procedures. The most effective:

• UHF. For treatment, electromagnetic fields of ultrahigh frequency are used. The procedure helps to reduce pain and inflammation, eliminate edema, and remove toxins from the body. With muscle spasms, UHF therapy quickly removes painful symptoms.
• ultrasound therapy. To eliminate the complications caused by vaccination, ultrasonic vibrations with a frequency of 800-900 kHz are used. The procedure has a thermal, mechanical, physical and chemical effect on the cells of the body, activating metabolic processes, and enhances immunity. Ultrasound therapy has an antispasmodic, analgesic, anti-inflammatory effect. Improves tissue trophism, promotes regenerative processes, stimulates lymph and blood circulation.

Prevention of post-vaccination complications

A contraindication to the introduction of live viruses is the presence of an immunodeficiency state, a malignant neoplasm and pregnancy. BCG should not be administered to an infant if birth weight is less than 2000 grams. A contraindication to DPT vaccination is the presence of a history of afebrile convulsions and pathologies of the nervous system. Immunoglobulin vaccination is not done in the first week of pregnancy. The Mantoux test is not performed for people with schizophrenia and various neurological diseases. Vaccination against mumps (mumps) can not be done with tuberculosis, HIV, oncology.

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 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).

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

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

Harit Susanna Mikhailovna answers

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

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

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

Harit Susanna Mikhailovna answers

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

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

Your child must already have 5 polio shots to be fully protected against this infection, you can get 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.