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

General information

Post-vaccination complications are pathological conditions that have a causal relationship with preventive vaccination, disrupting the health and development of the child. Prophylactic vaccination in pediatrics is aimed at the formation of protective immunity, which does not allow the development of an infectious process when a child re-contacts with a pathogenic one. In addition to individual type-specific immunity, mass vaccination of children is aimed at creating collective (population) immunity, designed to stop the circulation of the pathogen and the development of epidemics in society. For this purpose, Russia has adopted the National Calendar of Preventive Vaccinations, which regulates the list, timing and procedure for compulsory and additional vaccination of children from birth to adulthood.

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

Causes of post-vaccination complications

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

Reactogenic properties of a particular vaccine, that is, the ability, when introduced into the body, to cause post-vaccination reactions and complications, depend on its components (bacterial toxins, preservatives, stabilizers, solvents, adjuvants, antibiotics, etc.); immunological activity of the drug; tropism of vaccine strains to body tissues; possible change (reversion) of the properties of the vaccine strain; contamination (contamination) of the vaccine with foreign substances. Different vaccines differ significantly in the number and severity of adverse reactions; the most rectogenic of them are BCG and DPT vaccines, the least "heavy" are drugs for vaccination against poliomyelitis, against hepatitis B, against mumps, against rubella, etc.

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

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

Classification of post-vaccination complications

The pathological conditions accompanying the vaccination process include:

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

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

Vaccination reactions include various unstable disorders that arise after vaccination, which persist for a short time and do not disrupt the vital functions of the body. Post-vaccination reactions are of the same type in terms of clinical manifestations, usually do not violate the general condition of the child and go away on their own.

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

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

Characteristics of post-vaccination complications

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

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

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

Postvaccinal complications with an autoimmune mechanism of development include lesions of the central and peripheral nervous system (postvaccinal encephalitis, encephalomyelitis, polyneuritis, Guillain-Barré syndrome), myocarditis, juvenile rheumatoid arthritis, autoimmune hemolytic anemia, dermatoma erythematosus.

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

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

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

Diagnostics of post-vaccination complications

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

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

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

Treatment of post-vaccination complications

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

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

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

Prevention of post-vaccination complications

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

For children who have had a post-vaccination complication, the vaccine that caused the reaction is no longer administered, but in general, routine and emergency immunization is not contraindicated.

Zyna is injected into the anterolateral region of the upper thigh, for children over 18 months - into the region of the deltoid muscle.

The refusal to inject the vaccine into the buttock, in addition to the possibility of damage to the nerves and blood vessels passing in the buttock, is also motivated by the fact that in young children the gluteal region consists mainly of adipose tissue, and the quadriceps femoris muscle is well developed from the first months of life. In addition, there are no important nerves or blood vessels in the anterolateral region of the upper thigh.

In children over the age of 2 - 3 years, it is preferable to inject the vaccine into the deltoid muscle (in the middle between the lateral end of the scapula spine and the deltoid tuberosity). Injections into the triceps muscle should be avoided due to the possibility of injury to the radial, brachial, and ulnar nerves, as well as to the deep artery of the shoulder.

Contraindications to vaccination. Contraindications to vaccination of the nation are divided into permanent (absolute) and temporary (relative). Absolutely contraindicated:

all vaccines - in case of excessively strong reactions or other post-vaccination complications to the previous administration;

all live vaccines - to persons with immunodeficiency conditions (primary); immunosuppression, malignant neoplasms; pregnant women;

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

DPT vaccine - for progressive diseases of the nervous system, afebrile seizures in history;

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

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

With temporary contraindications, routine vaccination is not given until the end of acute and exacerbations of chronic diseases; the vaccine is administered no earlier than 4 weeks after recovery.

4.6. Vaccinal reactions and complications

4.6.1. Vaccinal reactions

Normal vaccine reaction. The vaccination process is usually asymptomatic, but in vaccinated persons it is possible

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

Pathological conditions during the vaccination process. In addition to the normal vaccine response, the administration of vaccines may have side effects. Pathological conditions arising in the post-vaccination period are subdivided into three groups: 1) the addition of an acute intercurrent infection or exacerbation of chronic diseases; 2) post-vaccination reactions; 3) post-vaccination complications (discussed in subsection 4.6.2).

Nonspecific infectious diseases. After the administration of vaccines, children may develop nonspecific (in relation to the vaccine) infectious diseases: acute respiratory viral infections (ARVI) (often with manifestations of neurotoxicosis, croup syndrome, obstructive bronchitis), pneumonia, urinary tract infection, neuroinfection, etc. As a rule, the increased infectious morbidity in the post-vaccination period is explained by a simple coincidence in the time of vaccination and illness. However, it can also be associated with changes in the immune system after the administration of vaccines. This is due to the fact that when vaccines are administered, the same type of biphasic changes occur in the immune system.

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

The second phase - transient immunodeficiency - develops 2 - 3 weeks after vaccine administration and is characterized by a decrease in the number of all subpopulations of lymphocytes and their functional activity, including the ability to respond to mitogens and synthesize antibodies. This phase is necessary to limit the immune response to vaccine antigens. In addition, vaccination causes changes in the innate immunity system: interferon hyporeactivity (starting from the 1st day after vaccination), inhibition of the activity of complement, lysozyme, and phagocytic activity of leukocytes. This limitation, however, applies to unrelated antigens in relation to the vaccine.

Pathogenetically, post-vaccination immunodeficiency is indistinguishable from secondary immunodeficiencies arising in the course of viral or bacterial infections, and it is this that underlies

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

TO the same group includes complications developing

v as a result of a violation of the vaccination technique. Violation of the sterility of vaccines is extremely dangerous. This is the reason for the development purulent-septic complications, in some cases culminating in the development of infectious-toxic shock and death.

Pathological post-vaccination reactions. Some children develop cli

nic disorders that are unusual for the usual course of the vaccinal process. Such pathological vaccine reactions are divided into local and general.

All reactions that occur at the injection site are referred to as local pathogens. vaccine

us. Nonspecific local reactions appear on the 1st day after vaccination in the form of hyperemia and edema, which persist for 24 - 48 hours. When using adsorbed drugs, especially under the skin, an infiltrate may form at the injection site. With repeated administration of toxoid, excessive local allergic reactions may develop, extending to the entire buttock, and sometimes involving the lower back and thigh.

There are three degrees of severity of local reactions. A weak reaction is considered to be hyperemia without infiltration or infiltration with a diameter of up to 2.5 cm; an average reaction - an infiltrate up to 5 cm, a strong reaction - an infiltrate over 5 cm, as well as an infiltrate with lymphangitis and lymphadenitis. The appearance of such reactions is based on an increase in vascular permeability, as well as the development of basophilic infiltration under the action of an adjuvant. When they occur, antihistamines and compresses are prescribed.

With the introduction of live bacterial vaccines, specific local reactions develop, due to the infectious process at the site of application of the drug. Thus, during intradermal immunization with BCG vaccine, a specific reaction develops at the injection site after 6–8 weeks in the form of an infiltrate 5–10 mm in diameter with a small nodule in the center and the formation of a crust; in some cases, pustules appear at the injection site. The reverse development of changes takes 2 - 4 months. A superficial scar of 3 - 10 mm remains at the site of the reaction. If a local atypical reaction occurs, the child needs the advice of a phthisiatrician.

General reactions and are accompanied by changes in the state and behavior of the child. They often express

are fever, anxiety, sleep disturbance, anorexia, myalgia.

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

In children with perinatal damage to the nervous system, an encephalic reaction may develop after vaccination, accompanied by an increase in body temperature and short-term seizures. A manifestation of such a reaction to the introduction of the pertussis vaccine is also a continuous high-pitched cry of the child for several hours. The mechanism of development of an encephalic reaction is due to increased permeability of the vascular wall, which results in an increase in intracranial pressure and the development of edema-swelling of the brain.

Most often, encephalic reactions develop after vaccination with whole-cell pertussis vaccine, which is associated with its sensitizing effect, the presence of antigens that cross-react with the brain tissue. At the same time, the incidence of seizures after the DPT vaccine is lower than that of foreign analogues.

Therapy for encephalic post-vaccination reactions is similar to therapy for neurotoxicosis (see Chapter 6). Common reactions to vaccination include allergic rashes. When it occurs, antihistamines are indicated.

4.6.2. Post-vaccination complications

No. 157-FZ "On immunization of infectious diseases"

To Post-vaccination complications include severe and (or) persistent health disorders that develop as a result of prophylactic vaccinations (Table 4.3). Postvaccinal complications are divided into specific, depending on the type of microorganism contained in the vaccine, and nonspecific

Cases of post-vaccination complications and suspicions of them, presented in table. 4.3 are investigated by commissions (pediatrician, therapist, immunologist, epidemiologist, etc.) appointed by the chief physician of the State Sanitary and Epidemiological Surveillance Center in the constituent entity of the Russian Federation.

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

Table 4. 3

The main diseases in the post-vaccination period, subject to registration and investigation

	Clinical form
				appearances
	Anaphylactic shock,		Everything except BCG and oral
	anaphylactoid		Noah polio
	reaction, collapse
	Heavy general		Everything except BCG and
	lized allergies		oral poliomy
	ic reactions		molten vaccine
	Serum Syndrome		Everything except BCG and
			oral poliomy
			molten vaccine
	Encephalitis, encepha		Inactivated
	scapathy, myelitis, ence
	phalomyelitis, neuritis,
	polyradiculoneuritis,
	Guillain-Barré syndrome
	Serous meningitis
	Afebrile seizures		Inactivated
		myocarditis,
		hypoplastic
	cican anemia, agranu
		Thrombocyto
	singing, collagenosis
	Vaccine-associated		Live polio
	polio
	Chronic arthritis		Rubella
	Cold abscess			During
		lymphadenitis,
	BCGinfection
	Sudden death and others
	lethal outcomes

Persistent and generalized BCG infection the development of osteitis (proceeding as bone tuberculosis), lymphadenitis (two or more localizations), subcutaneous infiltrate is manifested. In generalized infection, polymorphic clinical manifestations are observed. In persons with primary combined immunodeficiency, a lethal outcome is possible.

With the development of BCG infection, etiotropic therapy is performed. With generalized BCG infection, isoniazid or pyrazinamide is prescribed for 2 to 3 months. With purulent lymphadenitis, puncture of the affected lymph node is performed with removal of caseous masses and streptomycin or other anti-tuberculosis drugs are injected at a dose appropriate for age. The same therapy is indicated for cold abscesses that develop as a result of a violation of the vaccination technique and subcutaneous administration of the BCG vaccine.

Complications after BCG vaccination are rare. So, regional BCG lymphadenitis is recorded with a frequency of 1: 1 0 OOO, generalized BCG infection - 1: 1 OOO OOO.

The diagnosis of "vaccine-associated poliomyelitis" is put on the basis of the criteria proposed by WHO:

a) the occurrence in the period from 4 to 30 days in vaccinated, up to 60 days in contact;

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

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

type-specific antibodies at least 4 times.

In countries with wide vaccination coverage, most cases of poliomyelitis in modern conditions can be regarded as vaccine associated. Vaccine-associated poliomyelitis occurs in one in 500,000 children vaccinated with oral poliomyelitis vaccine. In Russia, since 1997, from 2 to 11 cases of vaccine-associated poliomyelitis have been reported annually, which on average does not go beyond international statistics (OV Sharapova, 2003).

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

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

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

Arthritis and arthralgias can occur after the administration of red

nushy vaccine; congenital rubella syndrome, termination of pregnancy - when vaccinating pregnant women with rubella vaccine.

Nonspecific post-vaccination complications. Such complications are primarily associated with the individual reactivity of the inoculated. Vaccination can act as a factor in identifying the genetic predisposition of the vaccinated person, and the post-vaccination complications themselves in young children are predictors of the development of immunopathological diseases in the future. According to the leading mechanism of occurrence, these complications can be conditionally divided into three groups: allergic (atopic), immunocomplex, and autoimmune.

TO allergic complications include anaphylactic shock, severe generalized allergic reactions (Quincke's edema, Stevens-Johnson syndrome, Lyell's syndrome, polymorphic exudative erythema), the onset and exacerbation of atopic dermatitis, bronchial asthma.

Allergy that occurs during vaccination is associated with an increased production of general and specific IgE both to the protective antigens of the vaccine and to antigens that do not have a protective effect (egg protein, antibiotics, gelatin). Allergic reactions occur to a greater extent in persons predisposed to atopy. Isolated cases of strong local (including edema, hyperemia more than 8 cm in diameter) and general (including temperature over 40 ° C, febrile convulsions) reactions to vaccination, as well as mild manifestations of skin and respiratory allergies are subject to registration in accordance with the established procedure without informing higher health authorities.

The most severe complication of the group is anaphylactic shock. With parenteral ingestion of the vaccine allergen, a few seconds or minutes after a short period of precursors (weakness, fear, anxiety), skin flushing and itching (primarily of the hands, feet, groin), sneezing, abdominal pain, urticaria rash, angioedema appear. edema. Laryngeal edema, broncho- and laryngeal obstruction may also occur. Blood pressure decreases, muscle hypotension, loss of consciousness, severe pallor of the skin, pouring sweat, foam at the mouth, not holding urine and feces, convulsions, coma appear. With the development of anaphylactic shock, death can occur within a few minutes. The following activities must be carried out very quickly:

1) Immediately stop the administration of the vaccine that caused the reaction and lay the child on its side to avoid asphyxiation as a result of aspiration of vomit and retraction of the tongue. In the absence of vomiting, the patient is placed on his back and the lower part of the body is raised. The patient is covered with heating pads, fresh air is provided, airway patency, oxygen therapy is performed;

2) immediately inject adrenaline at the rate of 0.01 μg / kg, or 0.1 ml for a year of life up to 4 years, 0.4 ml for children 5 years old, 0.5 ml 0.1%

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

with the purpose of slowing down the distribution of the vaccine antigen;

3) parenteral administration of GCS (prednisolone 1 - 2 mg / kg or hydrocortisone 5 - 10 mg / kg), which reduce or prevent the development of later manifestations of anaphylactic shock (bronchospasm, edema). A child in a very serious condition can be administered 2 - 3 single doses. If necessary, injections are repeated;

4) parenterally administer antihistamines (diphenhydramine, chlorpyramine, clemastine), but only with a clear tendency to normalize blood pressure. In this case, a single dose of diphenhydramine in children from 1 month to 2 years is 2 - 5 mg, from 2 to 6 years - 5-15 mg, from 6 to 12 years old - 15 - 30 mg; single dose of chlorpyr

amine in children under 1 year old is 6.25 mg, from 1 year to 7 years old - 8.3 mg, from 7 to 14 years old - 12.5 mg; Clemastine is administered intramuscularly to children in a single dose of 0.0125 mg / kg (daily dose - 0.025 mg / kg).

To restore the volume of the circulating fluid, infusion therapy with colloidal and (or) crystalloid

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

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

Postvaccinal complications with damage to the central and peripheral nervous systems have an autoimmune mechanism. The defeat of the central nervous system is expressed in the development of encephalitis, encephalomyelitis. With damage to the peripheral nervous system, mononeuritis, polyneuritis, Guillain-Barré syndrome can occur. In addition, “second” diseases develop as complications of vaccination: autoimmune hemolytic anemia, idiopathic and thrombotic thrombocytopenic purpura, myocarditis, glomerulonephritis, tubulointerstitial nephritis, systemic lupus erythematosus (SLE), dermatomyositis, syrhematic rheumatoid arthritis, rheumatoid arthritis sclerosis. The introduction of vaccines can stimulate the formation of autoantibodies, autoreactive lymphocytes, immune cells.

Biological preparations used for preventive vaccinations cause general and local responses from the body. The essence of these reactions lies in the mobilization of the protective physiological functions of the body associated with the emergence of a vaccinal infectious process and the formation of specific immunity.

Post-vaccination reactions in persons who do not have clinical contraindications to vaccination, if preventive vaccinations are carried out correctly, are not pathological in nature and do not require therapeutic intervention.

The severity and duration of post-vaccination reactions depend not only on the reactogenic properties of the drug, but also, to no less extent, on individual sensitivity and other physiological characteristics of the organism.

The most reactogenic are killed vaccines administered subcutaneously, the least reactogenic are oral live polio vaccine and live cutaneous vaccines.

To assess the intensity of general reactions, it is customary to apply the following criteria: the reaction is considered weak when the temperature rises to 37.5 ° C, medium - from 37.6 to 38.5 ° C, strong - over 38.5 ° C. In addition, subjective and objective clinical symptoms: general malaise, headaches, dizziness, short-term fainting, nausea, vomiting, catarrhal phenomena in the nasopharynx, conjunctivitis, rashes, etc.

To assess the degree of intensity of local reactions that occur after the administration of killed and chemical bacterial vaccines, toxoids and serum preparations, the following criteria are adopted: a weak reaction is considered to be hyperemia without an infiltrate or an infiltrate with a diameter of up to 2.5 cm, an average - an infiltrate with a diameter of 2.6 to 5 cm, strong - an infiltrate with a diameter of more than 5 cm, as well as that with lymphangitis and lymphadenitis.

Local reactions that occur after the introduction of live bacterial and viral vaccines have no generally accepted estimates of intensity.

General reactions with an increase in temperature after the introduction of killed and chemical bacterial vaccines and toxoids occur only in a part of the vaccinated and reach their maximum development after 9-12 hours, after which, within 36-48, the temperature gradually decreases to normal and at the same time the disorders of the general state of the body are restored.

Local reactions appear 1-2 days after vaccination and are observed within 2-8 days. In a small part of those vaccinated with preparations adsorbed on aluminum hydroxide, a painless seal may remain at the injection site, slowly dissolving within 15 to 30-40 days.

Table 3 presents a general description and assessment of the general and local response to vaccinations.

After vaccination and revaccination against smallpox, brucellosis and tularemia, the time of onset, the nature of the reactions and their intensity have specific characteristics, depending on the individual sensitivity, and the immunological state of the vaccinated.

In the manuals for the use of biological preparations, the permissible degree of their reactogenicity is determined. In the event that the frequency of pronounced (strong) reactions among the vaccinated exceeds the percentage allowed by the instruction, further vaccinations with this series of the drug are terminated. So, for example, vaccinations against measles with this series of vaccines are stopped if among the vaccinated there are more than 4% of persons with a pronounced general reaction, with a temperature above 38.6 ° C. The DPT vaccine is allowed for use if the number of strong reactions does not exceed 1%.

Before carrying out mass inoculations with drugs with increased reactogenicity (typhoid, cholera, measles, DPT vaccines, etc.), it is recommended that vaccinations be carried out in a limited group of people (50-100 people) of the appropriate age in order to identify the reactogenicity of this series of the drug.

Before the introduction of heterogeneous serum preparations, a preliminary determination of the individual sensitivity of the organism to horse serum proteins is made by means of an intradermal test, the technique of setting which and the assessment of reactions are described in the corresponding instructions.

With a careful preliminary medical examination of the contingents of the population to be immunized and the removal from vaccinations of persons with clinical contraindications, unusual pronounced post-vaccination reactions and complications are observed in extremely rare cases. The most important role in their occurrence is played by the state of increased allergic sensitivity of the body, which is not always detected during a medical examination.

The reason for the increased reactivity of the body may be the previous sensitization with medicinal, bacterial, serum, food and other allergens, as well as a change in reactivity in persons with chronic dormant infectious foci, exudative diathesis, in persons who have suffered acute infectious diseases shortly before vaccination and in vaccinated repeatedly without observing the prescribed intervals between vaccinations against individual infections or between vaccination and revaccination. Defects and errors in the vaccination technique, violations of the hygienic regime after vaccinations: fatigue, overheating, hypothermia, drifts of a secondary infection, transfer of the vaccinia virus during scratching, etc. - also complicate the course of the vaccination process.

The main clinical forms of post-vaccination complications are:

1) serum sickness and anaphylactic shock, most often occurring with repeated, but sometimes with the initial administration of heterogeneous serum preparations;

2) allergic skin reactions - rashes, local and general edema, urticaria, etc., which may occur after the administration of smallpox, measles, rabies and DTP vaccines;

3) lesions of the central or peripheral nervous system - encephalitis, meningoencephalitis, mononeuritis, polyneuritis, etc., in extremely rare cases arising after vaccinations against smallpox and pertussis.

Although post-vaccination complications are extremely rare, the medical personnel conducting the vaccinations must have an appropriate set of medicines and instruments necessary for emergency care: epinephrine, caffeine, ephedrine, cordiamine, diphenhydramine, glucose, calcium preparations, etc. in ampoules, sterile syringes, needles, bandages, alcohol, etc. After the introduction of heterogeneous sera, the vaccinated should remain under medical supervision for one hour.

To prevent the possibility of unusual reactions and complications, it is necessary:

1) strict adherence to general rules, hygiene conditions and vaccination techniques;

2) prevention of violations of the timing of preventive vaccinations and the intervals between them, established by order of the Minister of Health of the USSR No. 322 of April 25, 1973;

3) careful preliminary medical examination and removal from vaccinations of persons with clinical contraindications;

4) medical examination and temperature measurement immediately before vaccinations.

"Vaccinations can cause dangerous complications" - this is the argument that opponents of official medicine cite in the first place. The ground for fear has been prepared, and when, after vaccination, at least a slight inflammation develops at the injection site, many patients begin to sound the alarm. Meanwhile, the overwhelming majority of post-vaccination reactions, as they explain, are absolutely natural and pose no danger.

Adverse reactions during vaccination

Local reactions

After vaccination at the injection site, there may be redness of the skin, soreness, the appearance of an allergic rash, edema, and an increase in neighboring lymph nodes. Based on the information received from the Internet, people start to sound the alarm. And absolutely in vain.

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

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

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

General reactions

Sometimes, as a result of vaccinations, a light rash occurs not only in the area of ​​the injection, but covers quite large areas of the body. The main reasons are the action of a vaccine virus or an allergic reaction. But these symptoms are not something outside the normal range, moreover, they are observed for a rather short time. So, a rapidly passing rash is a common consequence of vaccination with live viral vaccines against measles, mumps, rubella.

In general, with the introduction of live vaccines, it is possible to reproduce a natural infection in a weakened form: the temperature rises, a headache appears, sleep and appetite are disturbed. An illustrative example is "vaccinated measles": on the 5-10th day after vaccination, sometimes a rash 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 during vaccination can be unpleasant, but they are not life-threatening. Only occasionally do vaccinations cause really serious conditions. But in reality, the vast majority of such cases are caused by medical errors.

The main causes of complications:

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

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

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

Contraindications to vaccination

Before giving a patient a vaccination, the doctor is simply obliged to make sure that this patient can be vaccinated at this particular time. Fortunately, the instructions for any drug will certainly provide a list of all possible contraindications.

Most of them are temporary, they are not grounds for completely canceling 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 a person's health condition can become the basis for permanent withdrawal from vaccinations. So, patients with primary immunodeficiency are not vaccinated in principle. Certain diseases preclude the use of specific 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 though there are contraindications. For example, under normal circumstances, flu shots are not given to people who are allergic to chicken 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 this contraindication. Of course, the vaccination must be combined with special measures for.

Many people sometimes refuse vaccinations for completely far-fetched reasons. “My child is sickly, he already has a weakened immune system,” “he has a bad reaction to vaccinations,” these are typical false contraindications... This kind of logic is not only wrong, it is extremely dangerous. After all, if a child does not tolerate vaccines containing weakened strains of the virus, then the consequences of a full-fledged pathogen entering his body will most likely be simply fatal.

The vast majority of civilized society is vaccinated at some point in their lives. For most cases, the introduction of the necessary vaccines occurs in infancy - children are most vulnerable to dangerous diseases. Often, the unformed organisms of children experience negative reactions to the administration of vaccines. So is it worth using vaccines if their use can lead to unpleasant consequences?

According to the medical classification, the vaccine is an immunobiological preparation. This means that through the introduction of a weakened strain of the virus in the patient's body, a stable immunity to a viral disease is developed. This is achieved by the formation of antibodies in the blood, which will subsequently destroy the real virus that has entered the body. By itself, even a weakened strain of the virus cannot be useful for the body, which means that mild post-vaccination complications and reactions are inevitable.

The consequences of vaccinations

The consequences of vaccination can be very varied, especially in children. In medicine, they are not strictly divided into two types: reactions to vaccinations or complications. The former always represent a short-term change in the state of the child, often only external ones; Post-vaccination complications are long-term and serious side effects, the consequences of which are often irreversible. The good news is that even in children susceptible to illness, post-vaccination complications are extremely rare. The approximate chances of a complication in a child can be compared in the table below.

Vaccine	Possible reactions	Chance of occurrence (case per number - vaccinated)
Tetanus	Anaphylactic shock, brachial neuritis	2/100000
DTP	Convulsions, decreased pressure, loss of consciousness, anaphylactic shock, encephalopathy	4/27000
Measles, rubella	Allergy, anaphylactic shock, encephalopathy, convulsions, fever, decreased blood platelets	5/43000
Hepatitis B	Anaphylactic shock	less than 1/600000
Polio vaccine (drops)	Vaccine-associated poliomyelitis	1/2000000
BCG	Inflammation of the lymphatic vessels, osteitis, BCG infection	1/11000

The table uses averaged values ​​from the late 90s to the present. As you can see from the data, the chance of earning any complication after vaccination is rather small. Minor reactions common in this type of medical procedure were not taken into account. It is important to remember that the susceptibility of children to any viral disease is tens and hundreds of times higher than the likelihood of earning a complication from this vaccination.

Vaccination is a reliable protection against viral disease!

The main principle of a parent is not to risk the health of children and not to avoid vaccination at the right time! But it is important to take a responsible approach to the procedure. All vaccines are made under the strict supervision of a supervising physician and mandatory consultation. The vaccination technology must be followed - in 80% of cases, complications are observed precisely because of the negligence or insufficient qualifications of the personnel giving vaccinations. The most likely reason is a violation of the storage conditions of the drug. The wrong injection site, no identification of contraindications and allergic reactions, improper care of children after vaccination, the child's illness at the time of vaccination, etc. The individual characteristics of the body play almost the last role in the development of post-vaccination complications - the chance is so insignificant. It is in the interests of parents to provide for all this in order to minimize risks and not cause harm to the child.

When to expect reactions

Post-vaccination complications are easy to calculate by the time of the onset of symptoms relative to the date of vaccination - if the malaise does not fit into the time intervals for the occurrence of a reaction to the vaccine, then there is no connection with the vaccination and you need to consult a doctor! Vaccination is a great stress for the body of children, and against the background of a weakened immune system, a child can easily pick up another disease. The average time for the manifestation of reactions to the vaccine is from 8 to 48 hours, while the symptoms can last up to several months (minor and harmless). Let us analyze how and how much reactions should proceed from certain types of vaccinations. How and when a vaccine reaction can occur:

• The general reaction of the body to the vaccine or toxoids is most noticeable after 8–12 hours, after administration and completely disappears after 1–2 days;
• local reactions reach a maximum point in a day and can last up to four days;
• subcutaneous vaccination from sorbed preparations proceeds rather slowly and the first reaction can occur only one and a half to two days after vaccination. After changes in the body can passively proceed for up to a week, and the subcutaneous "lump" after vaccination will be absorbed for 20-30 days;
• complex antiviral drugs, consisting of 2–4 vaccinations, always give a reaction to the first vaccination - the rest can only slightly intensify it, or give an allergy.

It should be considered a cause for concern if the body's response does not fit into the standard time frame for change. This means either serious post-vaccination complications or a disease of another kind - in this case, you should immediately show the child to the doctor for a detailed examination.

In case of any significant deviations from the normal course of the reaction after vaccination, you should immediately consult a doctor. Ask the health care provider for information brochures to monitor your child at home.

The severity of the leak

An indicator of the severity for the course of post-vaccination changes is considered to be an increase in the body temperature of children relative to normal for general reactions, and the size and inflammation (infiltration) at the injection site for local ones. Both are conventionally divided into three groups, varying from the severity of post-vaccination complications.

Common vaccine reactions:

• slight reaction - the temperature does not exceed 37.6 ° C;
• moderate reaction - from 37.6 ° C to 38.5 ° C;
• severe reaction - from 38.5 ° C or more.

Local (local) reactions to vaccination:

• a weak reaction is an infiltration or lump no more than 2.5 cm in diameter;
• moderate reaction - a seal 2.5 to 5 cm in diameter;
• severe reaction - the size of the infiltrate is more than 5 cm.

It is imperative to monitor changes in the condition of children in the first few days after vaccination and immediately consult a doctor at the first manifestations of moderate or severe post-vaccination complications. If children quickly develop one or more signs of a severe reaction to the vaccine, resuscitation may be required. Weak and moderate reactions can be alleviated by proper care and special drugs, antipyretic or tonic, the use of which must be consulted with the observing doctor immediately before vaccination. It is absolutely forbidden in these cases to use folk methods of self-medication, dubious remedies or the wrong drugs. The health of children can be undermined for a long time if, against the background of general post-vaccination weakening, chemical preparations are also used, which are not necessary.

Post-vaccination reactions and complications are encountered in medical practice hundreds of times less often than cases of infection with viral diseases.

How to avoid

Despite the large amount of conflicting and frightening information about vaccination, especially for children, it should be remembered: a properly made vaccine and competent care will reduce the risk of even the smallest complications to an absolute minimum. As the main reason for such troubles, you can always indicate:

• poor quality of the injected drug, incorrectly selected vaccine;
• carelessness or lack of professionalism of medical personnel, which can often be found in the conditions of conveyor-based free medicine;
• improper care, self-medication;
• infection with a bacteriological disease against the background of weakened immunity of children;
• unaccounted for individual intolerance or allergic reaction.

Not worth saving. It would be very reasonable to use the services of a paid institution if your clinic clearly falls short of the standards of medical care.

All these factors can be easily tracked by an attentive and caring parent, which means that the risk of getting serious post-vaccination complications for their children is several times less. The number of viral diseases per one hundred thousand children is growing annually by 1.2-4% according to the State Statistics and is hundreds of times more cases than post-vaccination reactions are observed. And of course, the vast majority of the sick did not receive the required vaccinations.

Live vaccines - vaccination from attenuated viruses