Prevention of post-vaccination complications in children. Reactions to previous vaccine doses

Unusual (pathological) reactions (post-vaccination complications) are pathological processes that developed within a certain period of time after vaccination. They are associated (etiologically and pathogenetically) with vaccination, differ from the clinical manifestations of ordinary vaccine reactions and occur in rare cases.

Classification of post-vaccination complications:

• I. Unusual (pathological) reactions (complications) to various vaccines:
  
  
  • Toxic (excessively strong).
  • Neurological.
  • Allergic (local and general).
• II. Complicated course of the vaccination process:
  
  
  • Layering of intercurrent diseases.
  • Exacerbation of latent chronic foci of infection.

Post-vaccination complications after administration of the BCG vaccine

According to the WHO classification, complications after tuberculosis vaccination are divided into four categories.

Subcutaneous cold abscess (aseptic infiltrate) can occur after 1-8 months. after vaccination (re-vaccination), more often when the vaccine administration technique is violated. A swelling with fluctuation gradually forms, and then a fistula or ulcer may appear. The course of the process is long: in the absence of treatment - 1-1.5 years, with treatment - 6-7 months. Healing occurs with the formation of a star-shaped scar.

Superficial and deep ulcers - appear 3-4 weeks after vaccination (re-vaccination).

Regional lymphadenitis - enlargement of the axillary and cervical lymph nodes after 2-3 months. after vaccination the course is sluggish and long-lasting. It resolves within 1-2 years, sometimes fistulas form.

Calcification in a lymph node more than 10 mm in diameter.

Keloid scars - develop within 1-2 months, more often after revaccination of BCG in pre- and puberty girls. The scar is dense, smooth, round or ellipsoidal in shape, with smooth edges. A vascular network develops in its thickness.

Osteitis occurs after 7-35 months. after vaccination. Clinically they occur as bone tuberculosis.

Lymphadenitis of two or more localizations. The clinical picture is the same as for regional lymphadenitis, but intoxication phenomena develop earlier and more often.

Rare complications in the form of allergic vasculitis, lupus erythematosus, etc.

Third category- generalized BCG infection with polymorphic clinical symptoms caused by damage to various organs. Occurs in children with T-cell immunodeficiency; the outcome is often fatal. The incidence is 4.29 per 1 million vaccinated people.

Post-vaccination complications after administration of oral polio vaccine

There are no toxic complications.

Neurological complications. The most serious is vaccine-associated polio (VAP), which is caused by a reversion of the vaccine strain of the virus and occurs, as a rule, in children with immunodeficiency conditions (with a frequency of 1 case per 2.5-3 million vaccine doses). VAP can occur in both vaccinated people and their contacts.

The diagnosis of vaccine-associated polio is made in a hospital by a commission based on the following criteria defined by WHO:

a) occurrence in vaccinated people from 4-30 days, in contacts of vaccinated people - up to 60 days;

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

c) absence of disease progression;

d) isolation of the vaccine strain of the virus and at least a 4-fold increase in the titer of type-specific antibodies.

Allergic reactions (urticaria, angioedema) are rare, usually in children predisposed to allergies in the first 4 days after vaccination.

Post-vaccination complications after administration of DTP vaccine

Toxic reactions - excessively strong (hyperthermia, severe intoxication) develop in the first two days after vaccination.

Neurological complications:

a) persistent high-pitched cry on the 1st day after vaccination. Caused by an acute increase in intracranial pressure. It is observed in children during the first 6 months. life, more often after the 1st and 2nd vaccination;

b) convulsive seizures without hyperthermia in the form of extensive seizures and “small” convulsive seizures (nodding, pecking, twitching). Occurs on the 4th day after vaccination and later. Afebrile seizures indicate previous organic brain damage;

c) convulsive syndrome against the background of hyperthermia (febrile convulsions - tonic or clonic-tonic) develop during the first 48 hours after vaccination;

d) post-vaccination encephalitis - a rare complication (1 case per 1 million vaccinated) occurs on the 3-8th day after vaccination. It occurs with convulsions, prolonged loss of consciousness, hyperkinesis, paresis with gross residual effects.

Allergic reactions (general):

a) anaphylactic shock, develops in the first 5-6 hours after vaccination;

b) collaptoid state in children under 1 year of age (sharp pallor, lethargy, cyanosis, drop in blood pressure, appearance of cold sweat, sometimes accompanied by loss of consciousness), occurs within 1 week after vaccination;

c) allergic rashes, Quincke's edema;

d) asthmatic syndrome, hemorrhagic syndrome, hemolyticouremic syndrome, croup syndrome, toxicoallergic condition (very rare).

Allergic reactions (local): skin hyperemia and soft tissue swelling at the site of drug administration (more than 8.0 cm in diameter).

Post-vaccination complications after administration of live measles vaccine

Toxic reactions (hyperthermia, severe discomfort, vomiting, nosebleeds, abdominal syndrome) occur from the 6th to the 11th day after vaccination. These clinical manifestations persist for 2-5 days and then disappear.

Neurological complications:

a) convulsive syndrome - febrile tonic-clonic convulsions with loss of consciousness and other cerebral symptoms, lasting 1-2 minutes, can be repeated 2-3 times. Develop on the 5-15th day after vaccination;

b) post-vaccination encephalitis is a rare complication (1 case per 1 million vaccinated people, with the disease - 1 case per 4 thousand sick people, according to WHO).

Allergic reactions are extremely rare (hemorrhagic rash with thrombocytopenia and nasal, vaginal, and intestinal bleeding; asthmatic syndrome; urticaria; Quincke's edema; arthralgia). Occurs from the 1st to the 15th day after vaccination.

Post-vaccination complications after administration of live mumps vaccine

Toxic reactions (fever, vomiting, abdominal pain) occur 7-15 days after vaccination.

Neurological complications:

a) convulsive syndrome - febrile convulsions;

b) serous meningitis is an extremely rare complication, occurs on the 5-30th day after vaccination, and is characterized by a benign course.

Alperhygienic reactions (rashes, Quincke's edema, anaphylactic shock) occur on the 1st-16th day after vaccination, more often in children with an unfavorable allergic history.

Rare complications: Reye's syndrome, development of acute parotitis and diabetes mellitus.

Post-vaccination complications after administration of hepatitis B vaccine

Toxic and neurological reactions are usually absent.

Alperhyges reactions (anaphylactic shock, urticaria, exanthema, arthralgia, myalgia, erythema nodosum) are rare.

It is often difficult to determine whether a condition that develops after vaccination is a pathological reaction to vaccination or is caused by a layer of intercurrent diseases. An increase in body temperature or deterioration in general condition later than the 2nd day after vaccination with inactivated drugs (DTP, ADS, ADS-M), as well as within 4-5 days after vaccination or 15 days after the administration of live viral vaccines (measles, mumps, rubella), as a rule, is caused by the addition of acute infectious diseases. In unclear cases, hospitalization in a hospital is recommended to clarify the diagnosis.

Treatment of post-vaccination complications

Post-vaccination complications are registered in the city epidemiological bureau. Treatment is carried out taking into account the leading clinical syndrome. Children with hyperthermia are prescribed antipyretic and desensitizing drugs. Patients with convulsive syndrome are subject to mandatory hospitalization. To relieve seizures, Relanium (intravenously or intramuscularly), GHB, and dehydration therapy are used. If allergic reactions develop, antihistamines are prescribed, which are advisable to be administered parenterally; glucocorticoid hormones are used according to indications.

All children with post-vaccination complications are subject to dispensary observation.

Post-vaccination complications and adverse reactions to vaccination in children - this issue worries all mothers who vaccinate their babies. After vaccination, both adverse reactions to vaccination and post-vaccination complications may occur.

Typically, adverse reactions to vaccinations with inactivated vaccines (DPT, DPT, hepatitis B) occur 1-2 days after vaccination.

A vaccine is a preparation containing killed or weakened microorganisms that cause an infectious disease. This is an immunobiological active drug that causes certain changes in the body - desirable, with the goal of creating immunity of the vaccinated person to a given infection, and undesirable, that is, adverse reactions.

Medical immunology centers of the Russian Federation advise vaccinating children from an early age. The very first vaccination (against hepatitis) is carried out in the first 12 hours of a child’s life, and then vaccination occurs according to the schedule of the vaccination certificate that each person has.

In 1996, the world celebrated the 200th anniversary of the first vaccination, performed in 1796 by the English doctor Ed. Jenner. Today, the idea of ​​vaccination in our country, in addition to sincere supporters, has a fairly large number of convinced opponents. The controversy surrounding the mass use of vaccines does not subside not only in our country. Already in the 18th and 19th centuries, doctors noted that mass smallpox vaccination shortens people’s lives, testifying to the imaginary benefits and real harms of vaccines. To date, a huge amount of material has been accumulated about the negative consequences - side effects of vaccines

The lack of safe vaccines, as well as a sharp deterioration in the health of Russian children, has led to an abundance of post-vaccination complications. If we proceed only from the “abundance of post-vaccination complications,” then there is not a single area of ​​medicine where vaccinations have not introduced iatrogenic pathology.

What are adverse reactions to vaccines?

The term “adverse reaction” refers to the occurrence of undesirable reactions of the body that were not the purpose of vaccination. In general, adverse reactions to vaccination are a normal reaction of the body to the introduction of a foreign antigen, and in most cases such a reaction reflects the process of developing immunity.

Adverse reactions are usually divided into local ones, i.e. occurring at the injection site (redness, soreness, thickening), and general, that is, those that affect the entire body as a whole - increased body temperature, malaise, etc.

In general, adverse reactions are a normal reaction of the body to the introduction of a foreign antigen and in most cases reflect the process of developing immunity. For example, the reason for the increase in body temperature that occurs after vaccination is the release of special “intermediaries” of the immune reaction into the blood. If the adverse reactions are not severe, then in general this is even a favorable sign in terms of developing immunity. For example, a small lump that appears at the site of vaccination with the hepatitis B vaccine indicates the activity of the process of developing immunity, which means that the vaccinated person will actually be protected from infection.

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

Typically, adverse reactions to vaccinations with inactivated vaccines (DPT, DPT, hepatitis B) occur 1-2 days after vaccination and go away on their own, without treatment, within 1-2 days. After vaccination with live vaccines, reactions may appear later, on days 2-10, and also go away within 1-2 days without treatment.

Most vaccines have been used for decades, so the typicality of reactions should also be taken into account. For example, the rubella vaccine cannot cause gastritis, but at the same time it can cause short-term swelling of the joints.

The incidence of adverse reactions has also been well studied. It is no secret that the rubella vaccine, which has been used abroad for more than 30 years, causes approximately 5% of general reactions, and that the hepatitis B vaccine, which has been used for more than 15 years, causes about 7% of local reactions.

Local reactions after vaccination

Local adverse reactions include redness, induration, soreness, swelling, which are significant and significant. Local reactions also include urticaria (an allergic rash, reminiscent of a nettle burn), and enlargement of the lymph nodes close to the injection site.
Why do local reactions occur? As is known from biology textbooks for elementary school, when the skin is damaged and foreign substances enter the body, inflammation occurs at the site of entry. It is quite natural to assume that the greater the volume of foreign substances, the greater the severity of inflammation. Numerous clinical trials of vaccines involving control groups, when participants were given ordinary water for injection as a control drug, have shown that even to this “drug” local reactions occur, and with a frequency close to that for the experimental group where the vaccines were administered. That is, the cause of local reactions to a certain extent is the injection itself.
Sometimes vaccines are designed to deliberately cause local reactions. We are talking about the inclusion in vaccines of special substances (usually aluminum hydroxide and its salts) or adjuvants, which are designed to cause inflammation so that more cells of the immune system “get acquainted” with the vaccine antigen, so that the strength of the immune response is higher. Examples of such vaccines are the DTP, ADS, and hepatitis A and B vaccines. Adjuvants are usually used in inactivated vaccines, since the immune response to live vaccines is already quite strong.
The method of vaccine administration also affects the number of local reactions. All injectable vaccines are best administered intramuscularly, and not into the buttock (you can get into the sciatic nerve or subcutaneous fatty tissue). The muscles are much better supplied with blood, the vaccine is better absorbed, and the strength of the immune response is greater. In children under 2 years of age, the best place for vaccination is the anterolateral surface of the thigh in its middle third. For children over two years of age and adults, it is best to inject into the deltoid muscle of the shoulder, that same muscular thickening on the shoulder - the injection is done from the side, at an angle of 90 degrees to the surface of the skin. With subcutaneous administration of vaccines, the frequency of local reactions (redness, thickening) will obviously be higher, and the absorption of vaccines and, as a consequence, the immune response may be lower than with intramuscular administration.

General reactions after vaccinations

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

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

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

When live vaccines are administered, it is sometimes possible to almost completely reproduce a natural infection in a weakened form. An indicative example is vaccination against measles, when 5-10 days after vaccination a specific post-vaccination reaction is possible, characterized by an increase in body temperature, symptoms of acute respiratory infections, a peculiar rash - all this is classified as “vaccinated measles”.

Post-vaccination complications

Unlike adverse reactions, vaccination complications are unwanted and quite severe conditions that occur after vaccination. For example, a sharp drop in blood pressure (anaphylactic shock), as a manifestation of an immediate allergic reaction to any component of the vaccine, cannot be called either a normal adverse reaction or even a severe adverse reaction, since anaphylactic shock and collapse require resuscitation measures. Other examples of complications are seizures, neurological disorders, allergic reactions of varying severity, etc.

To be fair, it should be noted that, unlike adverse reactions, post-vaccination complications are extremely rare - the frequency of complications such as encephalitis due to measles vaccine is 1 in 5-10 million vaccinations, generalized BCG infection, which occurs when BCG is administered incorrectly, is 1 in 1 million vaccinations, vaccine-associated polio - 1 per 1-1.5 million OPV doses administered. With the infections themselves that vaccinations protect against, these same complications occur with an order of magnitude greater frequency (see adverse reactions and complications to specific types of vaccines).

Unlike post-vaccination reactions, complications rarely depend on the composition of vaccines and their main cause is considered to be:

• violation of vaccine storage conditions (overheating for a long time, hypothermia and freezing of vaccines that cannot be frozen);
• violation of the vaccine administration technique (especially important for BCG, which must be administered strictly intradermally);
• violation of instructions for administering the vaccine (from non-compliance with contraindications to the administration of an oral vaccine intramuscularly);
• individual characteristics of the body (unexpectedly strong allergic reaction to repeated administration of the vaccine);
• addition of infection - purulent inflammation at the injection site and infection during the incubation period of which the vaccination was carried out.

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

Common complications of vaccinations (vaccine):

• Excessively strong general reactions with high temperature rise (more than 40ºС), general intoxication
• Damage to the central nervous system: persistent high-pitched crying of the child, convulsions without and with fever; encephalopathy (appearance of neurological “signs”); post-vaccination serous meningitis (short-term, non-leaving “irritation” of the meninges caused by the vaccine virus);
• Generalized infection with a vaccine microorganism;
• Damage to various organs (kidneys, joints, heart, gastrointestinal tract, etc.);
• Allergic reactions: local allergic reactions (Quincke's edema), allergic rashes, croup, suffocation, temporary increased bleeding, toxic-allergic condition; fainting, anaphylactic shock.
• The combined course of the vaccination process and an associated acute infection, with or without complications;

Description of some complications

Anaphylactic shock after vaccination

Anaphylactic shock- an allergic reaction of immediate type, a state of sharply increased sensitivity of the body that develops upon repeated introduction of an allergen. Usually to vaccine components (failure to comply with contraindications, undiagnosed allergies), it is characterized by a sharp drop in blood pressure and impaired cardiac activity. It usually occurs in the first 30 minutes after vaccination and requires resuscitation measures. In children, an analogue of anaphylaxis is collapse (fainting). It is an extremely rare complication. Anaphylactic shock often develops in children suffering from allergies and diathesis.

Afebrile seizures

Convulsions without fever(afebrile convulsions) - occur during vaccination with DTP vaccines (1 per 30-40 thousand vaccinations). In contrast, febrile seizures (i.e., against the background of an increase in temperature) are caused by irritation of certain areas of the brain and meninges by vaccine antigens or a reaction to them. In some cases, seizures first detected after vaccination are a consequence of epilepsy.

Serous meningitis

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

Table: Incidence of serious adverse reactions to vaccination (according to the World Health Organization)

Graft	Possible complications	Complication rate
Against hepatitis B
Against tuberculosis	Regional lymphadenitis, cold abscess Tuberculous osteitis Generalized BCG infection (with immunodeficiency)
Against polio	Vaccine-associated poliomyelitis with the introduction of live attenuated vaccine (for the first, second and third vaccinations)
Against tetanus	Brachial neuritis at the site of vaccine administration
DTP (against diphtheria, whooping cough and tetanus)	A high-pitched loud scream during the first hours after vaccination Episode of seizures associated with high fever Short-term decrease in blood pressure and muscle tone with impaired consciousness (fainting) Encephalopathy Allergic reaction to vaccine components
Against measles, rubella and mumps	Episode of seizures associated with high fever Decreased platelet count in the blood Allergic reaction to vaccine components Encephalopathy

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Post-vaccination complications and adverse reactions to vaccination in children - this issue worries all mothers who do. After vaccination, both adverse reactions to vaccination and post-vaccination complications may occur.

First, let’s figure out what an “adverse reaction” to a vaccine means and how it differs from post-vaccination complications.

The term “adverse reaction” refers to the occurrence of undesirable reactions organisms that were not the target of vaccination. In general, adverse reactions to vaccination are a normal reaction of the body to the introduction of a foreign antigen, and in most cases such a reaction reflects the process of developing immunity. For example, the reason after vaccination is the release of special “intermediaries” of the immune reaction into the blood. If the adverse reactions are not severe, then this is even beneficial for the formation of immunity to this antigen. For example, a slight thickening of the skin in the injection area after vaccination against hepatitis B indicates that the process of developing immunity is active, and means that the baby is actually protected from infection.

Adverse reactions to vaccination are usually divided into 2 groups: local and general.. Local reactions include redness, soreness and hardness at the site of vaccine administration. General reactions include increased body temperature and malaise.

Severe adverse reactions (increased body temperature over 39.5C°, large infiltrate in the area of ​​vaccine administration) are not favorable signs. Such reactions are subject to strict reporting and must be reported to vaccine quality control agencies. If there are many such reactions to a given batch of vaccine, then this batch is withdrawn from use and quality control is repeated for it.

Adverse reactions to vaccination usually occur 1-2 days after vaccination, and go away on their own within a few days. After vaccination with live vaccines (for example, rubella), reactions may appear later - on days 2-10.

Since most vaccines have been used for decades, adverse reactions to them are already typical. For example, the rubella vaccine can cause swelling in the joints, but it cannot cause gastritis.

The incidence of adverse reactions to vaccines is also known. For example, the hepatitis B vaccine (used abroad for more than 15 years) causes about 7% of local reactions. And the rubella vaccine causes about 5% of overall adverse reactions.

Local adverse reactions

Local reactions to vaccination include redness, induration, swelling and pain. at the site of vaccine administration (if they are essential). Urticaria (allergic rash) and enlargement of the lymph nodes closest to the injection site (lymphadenitis) are also considered local adverse reactions.

The cause of local reactions is the injection itself; at the site where the foreign agent enters the body, a response occurs in the form of inflammation. Some vaccines are specially formulated to cause local reactions specifically (they contain aluminum hydroxide). For example, the DTP vaccine contains substances to cause inflammation at the injection site, and thus, as many body cells as possible become familiar with the vaccine antigens. Typically, inactivated vaccines (those without a live component) use aluminum hydroxide to boost the immune response.

The incidence of local adverse reactions is also affected by the location of vaccine administration.. All injectable vaccines are administered intramuscularly or subcutaneously. With subcutaneous administration of the vaccine, adverse local reactions are much higher, and the immune response may be less than with intramuscular administration (since absorption is less).

Vaccines are administered intramuscularly into the middle third of the anterolateral thigh area(in children under 2 years of age), or in the area of ​​the deltoid muscle of the shoulder (in children over 2 years of age and in adults). Vaccines are not administered to the buttock area, as there is a possibility of getting into the subcutaneous fat and damaging the sciatic nerve.

Common adverse reactions to vaccinations

Common post-vaccination reactions include– rash (spread over large areas of the body), increased body temperature, sleep and appetite disturbances, anxiety, headache, dizziness. Young children may have a reaction such as prolonged crying.

Rash after vaccination due to several reasons. Firstly, the cause may be the multiplication of the vaccine virus in the skin; such a rash goes away quickly and is mild in nature. This rash usually appears after the administration of live vaccines (rubella, measles, mumps). The second cause of a rash is an allergic reaction.

Sometimes the rash is pinpoint in nature, and its cause is the resulting increased bleeding of the capillaries. This rash is usually short-lived and reflects a temporary disorder of the clotting system (for example, after vaccination against rubella, the number of platelets in the blood may decrease).

After vaccination with live vaccines A viral infection may occur in a very mild form. For example, after vaccination against measles, on days 5-10, a specific post-vaccination reaction may occur in the form of increased body temperature, symptoms of acute respiratory infections and a typical rash. This reaction is called “vaccinated measles” and indicates the formation of immunity against this infection.

Post-vaccination complications

Post-vaccination complications these are unwanted and serious conditions that arose after vaccination. The line between post-vaccination complications and adverse reactions is quite blurred. Severe post-vaccination complications are very rare (less than 0.1% of all vaccinations). Complications such as:

• Anaphylactic reaction (shock);
• The occurrence of encephalitis, myelitis, polyneuritis (mononeuritis), serous meningitis, afebrile convulsions (not associated with fever), which persist for a year after vaccination;
• Acute myocarditis, nephritis, systemic diseases (for example, hemorrhagic vasculitis), hypoplastic anemia, agranulocytosis, chronic arthritis;
• Generalized form of BCG infection.

In addition to these complications, there are milder complications, for example, febrile convulsions due to an increase in temperature after vaccination, and the development of an abscess in the injection area. Such complications are also recorded and analyzed.

The first place in the frequency of post-vaccination complications is occupied by the DTP vaccine.(almost 60% of all complications). Currently, imported vaccines are used (Pentaxim, Infanrix), which do not contain the whole pertussis component, which reduces the incidence of complications and adverse reactions.

The causes of post-vaccination complications are:

• Violation of vaccine storage conditions (overheating, hypothermia, freezing);
• Violations of the instructions for administering the vaccine (exceeding the dose, erroneous administration of another drug, failure to comply with contraindications, another route of vaccine administration);
• Individual characteristics of the body.

Sometimes the appearance of symptoms after the introduction of a vaccine does not at all mean the development of complications, but is the result of an infection (against the background of weakened immunity). Secondary infection complicates the body’s response to vaccination and can lead to complications.

What are the complications after vaccinations?

Thank you

Graft is an immunobiological drug that is introduced into the body with the aim of forming 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 entire set of such reactions is divided into two categories:
1. Post-vaccination reactions (PVR).
2. Post-vaccination complications (PVC).

Post-vaccination reactions represent various changes in the child’s condition that develop after administration vaccines, and go away on their own within a short period of time. Changes in the body that qualify as post-vaccination reactions are unstable, purely functional, do not pose a threat and do not lead to permanent health problems.

Post-vaccination complications are permanent changes in the human body that occurred after the introduction of vaccination. In this case, the violations are long-term, significantly exceed the physiological norm and entail various problems with human health. Let's take a closer look at the possible complications of vaccinations.

Post-vaccination complications can be toxic (unusually strong), allergic, with symptoms of disorders of the nervous system and rare forms. A post-vaccination complication should be distinguished from the complicated course of the post-vaccination period, when various pathologies are identified that occur simultaneously with the vaccination, but are in no way related to it.

Complications after vaccinations in children

Each vaccination can cause its own version of complications. But there are also complications common to all vaccines that children can develop. These include the following conditions:

• anaphylactic shock, which develops within 24 hours after the vaccine is administered;
• allergic reactions involving the entire body - Quincke's edema, Steven-Johnson syndrome, Lyell's syndrome, etc.;
• serum sickness;
• meningitis;
• neuritis;
• polyneuritis – Guillain-Barré syndrome;
• convulsions that develop against the background of low body temperature - less than 38.5 o C, which are recorded throughout the year after vaccination;
• sensory disturbance;
• vaccine-associated polio;
• thrombotic thrombocytopenic purpura;
• hypoplastic anemia;
• collagenoses;
• decrease in the number of leukocytes in the blood;
• abscess or ulcer at the injection site;
• lymphadenitis – inflammation of the lymphatic ducts;
• Osteitis – inflammation of the bones;
• keloid scar;
• baby screaming for at least 3 hours straight;
• sudden death.

These complications can develop after various vaccinations. Their appearance, as a result of vaccination, is possible only in a limited period of time, which is carefully verified and regulated by the World Health Organization. The appearance of the above pathologies outside the specified time period means that they are in no way related to the vaccine.

Complications and side effects of vaccinations in children - video

Main causes of complications after vaccination

Complications after vaccination can be caused by one of the following reasons:

• administration of the vaccine if there are contraindications;
• improper vaccination;
• poor quality of the vaccine product;
• individual properties and reactions of the human body.

As you can see, the main factors causing the formation of post-vaccination complications are various safety violations, neglect of the rules for administering drugs, ignoring contraindications or not actively identifying them, as well as unsatisfactory quality of vaccines. Individual properties of a person can only overlap with the listed factors, contributing to the development of complications.

That is why the basis for the prevention of vaccination complications is the careful identification of contraindications, adherence to the technique of using vaccines, quality control of drugs, compliance with the rules of their storage, transportation and transportation. The poor quality of vaccines is not necessarily inherent in them initially. The pharmaceutical plant could produce normal, high-quality drugs. But they were transported and then stored incorrectly, as a result of which they acquired negative properties.

Complications after vaccination with DTP, ADS-m

DTP vaccination is done to create immunity to whooping cough, diphtheria and tetanus. In this case, K is a component against whooping cough, AD - against diphtheria, AS - against tetanus. There are also similar vaccines: Tetracok and Infanrix. The vaccine is given to children, three doses are administered, and the fourth one a year after the third. Then children are revaccinated only against diphtheria and tetanus at the age of 6–7, and at 14 years old with the ADS-m vaccine.

The DTP vaccine provokes the formation of various complications in 1 child per 15,000 - 50,000 vaccinated. And the Infanrix vaccine has a significantly lower risk of complications - only 1 child per 100,000 - 2,500,000 vaccinated. The ADS-m vaccine almost never leads to complications, since it lacks the most reactogenic pertussis component.

All complications from the DTP vaccine are usually divided into local and systemic. The table shows all possible complications of DTP and ADS-m and the time of their development after vaccination:

Type of complications DPT, ADS-m	Type of complications	Type of complications
Significant enlargement and hardening at the injection site	Local	24 – 48 hours
Swelling of the injection site greater than 8 cm in diameter	Local	24 – 48 hours
Allergy	Local	24 – 48 hours
Skin redness	Local	24 – 48 hours
Screaming continuously for 3 or more hours	Systemic	Up to two days
Increase in body temperature above 39.0 o C	Systemic	Up to 72 hours
Febrile seizures (at a temperature of 38.0 o C and above)	Systemic	24 – 72 hours
Afebrile seizures (at normal temperature)	Systemic	1 year after vaccination
Anaphylactic shock	Systemic	Up to 24 hours
Lymphadenopathy	Systemic	Up to 7 days
Headache	Systemic	Up to 48 hours
Irritability	Systemic	Up to 48 hours
Digestive disorder	Systemic	Up to 72 hours
Severe allergic reactions (Quincke's edema, urticaria, etc.)	Systemic	Up to 72 hours
Reduced blood pressure and muscle tone	Systemic	Up to 72 hours
Loss of consciousness	Systemic	Up to 72 hours
Meningitis or encephalitis	Systemic	Up to 1 month
Sensory impairment	Systemic	Up to 1 month
Polyradiculoneuritis	Systemic	Up to 1 month
Decreased platelet count	Systemic	Up to 1 month

Local complications of DPT and DPT-m vaccinations usually resolve on their own within a few days. To alleviate the child’s condition, you can lubricate the injection site with Troxevasin ointment. If the baby develops complications after DTP vaccination, then the next time only anti-diphtheria and anti-tetanus components are administered, without whooping cough, since it is this that provokes most of the complications.

Complications after tetanus vaccination

Tetanus vaccination can lead to the development of the following complications within the specified time frame:

• increase in body temperature for 3 days;
• redness at the injection site – up to 2 days;
• enlargement and pain of lymph nodes – up to a week;
• sleep disturbance – up to 2 days;
• headaches – up to 2 days;
• digestive and appetite disorders – up to 3 days;
• allergic rash;
• long, incessant screaming – up to 3 days;
• convulsions due to elevated temperature – up to 3 days;
• meningitis or encephalitis – up to 1 month;
• neuritis of the auditory and optic nerve – up to 1 month.

To reduce the risk of complications to the minimum possible level, it is necessary to follow the rules of vaccination, take into account contraindications and not use drugs that were stored in violation of established standards.

Complications after diphtheria vaccination

Vaccination only against diphtheria is not very reactogenic, so it is relatively easily tolerated. Complications can develop in the form of anaphylactic shock, allergies at the injection site, pain at the injection site and the entire limb as a whole, and neurological disorders.

Complications after vaccination with Pentaxim

The Pentaxim vaccine is a combination vaccine, it is administered against five diseases - diphtheria, whooping cough, tetanus, polio and Hib infection, which is caused by Haemophilus influenzae. According to observations of children who received all 4 doses of the Pentaxim vaccine, complications developed in only 0.6%. These complications required qualified medical care, but not a single death was recorded. Since Pentaxim contains a component against polio, there is no risk of contracting this infection, but it does occur when using the oral vaccine.

Pentaxim, despite its five components, rarely causes reactions and complications, which mainly manifest themselves in the form of high fever, irritability, prolonged crying, thickening and a lump at the injection site. In rare cases, seizures, mild neurological symptoms, digestive disorders, and severe pain at the injection site and the entire limb may develop. The most severe reaction usually occurs on the second dose, while the first and third are easier.

Complications after hepatitis B vaccination

Vaccination against hepatitis B can cause the following complications, which develop within the specified time frame:

• Increase in body temperature – up to 3 days.
• Severe reaction at the site of vaccine administration (pain, swelling more than 5 cm, redness more than 8 cm, induration more than 2 cm) – up to 2 days.
• Headaches, irritability, poor sleep – up to 3 days.
• Digestive disorders – up to 5 days.
• Runny nose – up to 3 days.
• Pain in muscles and joints – up to 3 days.
• Anaphylactic shock – up to 1 day.
• Allergies (Quincke's edema, urticaria, etc.) - up to 3 days.
• Decreased blood pressure, muscle tone, loss of consciousness – up to 3 days.
• Arthritis – from day 5 for 1 month.
• Convulsions against a background of normal or elevated temperature – up to 3 days.
• Meningitis, encephalitis, sensitivity disorders – up to 15 days.
• Polyradiculoneuritis – up to 1 month.

Complications after polio vaccination

There are two types of polio vaccine: oral live and inactivated. The oral one is administered as drops into the mouth, and the inactivated one is given as an injection. Complications of both types of polio vaccine and the timing of their development are reflected in the table:

Complications after BCG vaccination

It is necessary to understand that BCG is given not with the goal of making the body immune to tuberculosis, but to reduce the severity of the disease in case of infection. This is especially true for children under 1 year of age, in whom tuberculosis infection does not affect the lungs, but results in generalized blood poisoning or meningitis. However, BCG itself is a low-reactogenic vaccine, which can cause a rise in temperature within 2 days, an abscess under the skin at the injection site or an ulcer of more than 1 cm after 1.5 - 6 months, as well as a keloid scar after 6 - 12 months. In addition, the following are registered as complications of BCG:

• generalized BCG infection – after 2-18 months;
• osteomyelitis – after 2-18 months;
• osteitis – after 2-18 months;
• inflammation of the lymphatic ducts – after 2 – 6 months.

Complications after influenza vaccination

In Russia, domestic and imported flu vaccines are available, and they all have approximately the same properties and can cause similar complications. In general, the flu vaccine is extremely rarely accompanied by complications, the spectrum of which is very narrow. Most often, complications appear in the form of allergies, especially in people who have allergies to the drug Neomycin or chicken egg white. Several cases of hemorrhagic vasculitis have been reported, but the connection between this pathology and the influenza vaccine has not been established for certain.

Complications after vaccination against chickenpox, measles, rubella, combined
MMR and Priorix vaccines

Priorix is ​​a variant of the combined measles, mumps and rubella vaccine. Vaccinations against these infections cause almost identical reactions and complications. Thus, a rise in temperature can be observed only on days 4–15 after vaccination, and a strong local reaction is observed in the first two days, and is expressed in the formation of severe swelling of more than 5 cm, redness of more than 8 cm, and thickening of more than 2 cm. In addition, Vaccinations against chickenpox, measles, rubella and combined MMR can cause the following complications in the appropriate time frame:

• lymphadenopathy – from 4 to 30 days;
• headache, irritability and sleep disturbance – on days 4–15;
• non-allergic rash – after 4 – 15 days;
• indigestion – after 4 – 15 days;
• runny nose – from 4 to 15 days;
• pain in joints and muscles – from 4 to 15 days;
• anaphylactic shock - the first day after injection;
• allergic reactions (for example, Quincke's edema, urticaria, Stevens-Johnson or Lyell syndrome) - up to 3 days;
• decreased blood pressure and muscle tone, loss of consciousness – up to 3 days;
• arthritis – from 4 to 30 days;
• convulsions due to fever - from 4 to 15 days;
• meningitis, encephalitis, sensory impairment – ​​from 4 to 42 days;
• polyradiculoneuritis – up to 1 month;
• mumps, inflammation of the testicles in boys (orchitis) - from 4 to 42 days;
• decrease in the number of platelets - from 4 to 15 days.

These complications develop quite rarely, and they can be prevented by following the rules for vaccination, storage and transportation of drugs.

Complications after rabies vaccination

Rabies vaccination very rarely provokes the development of complications, and they are mainly manifested by allergies, especially in people suffering from reactions to chicken egg white. Neurological symptoms were also noted, such as neuralgia, attacks of dizziness, neuropathy, which, however, after a short period of time pass on their own and without a trace.

Complications after the Mantoux test

Mantoux is a biological test that is necessary to detect whether a child is infected with the causative agent of tuberculosis - Koch's bacillus. The Mantoux test is used in children instead of fluorography, which is done for adults. As complications, the Mantoux test may be accompanied by inflammation of the lymph nodes and ducts, as well as malaise, headache, weakness or fever. The severity of reactions to the Mantoux test depends on the individual characteristics of the human body. For example, some children have severe arm pain or vomiting.

Statistics of complications after vaccinations

Today in Russia, official recording and control over the number of complications as a result of vaccination has been carried out only since 1998. Such work is carried out by national specialized scientific institutes and experts from the World Health Organization, but they are able to study the situation only in a limited number of settlements, mainly in large cities. According to US statistics, every year 50 children suffer from severe neurological symptoms and central nervous system dysfunction as a result of vaccination complications. The table shows various severe post-vaccination complications from various vaccinations according to the World Health Organization:

Vaccine	Complication	Frequency of development complications
BCG	Inflammation of lymph vessels	1 in 1000 – 10,000
	Osteitis	1 in 3000 – 100,000,000
	Generalized BCG infection	1 in 1000,000
Hepatitis B	Anaphylactic shock	1 in 600,000 – 900,000
Measles, mumps, rubella	Cramps due to fever	1 in 3000
	Decreased platelet count in the blood	1 in 30,000
	Severe allergies	1 in 100,000
	Anaphylactic shock	1 in 1000,000
	Encephalopathy	Less than 1 in 1,000,000
Oral vaccine against polio (mouth drops)	Vaccine-associated polio	1 in 2000,000
Tetanus	Brachial neuritis	1 in 100,000
	Anaphylactic shock	1 in 100,000
DPT	Long continuous scream	1 in 1000
	Convulsions	1 per 1750 – 12500
	Decreased blood pressure, muscle tone, loss of consciousness	1 in 1000 – 33,000
	Anaphylactic shock	1 in 50,000
	Encephalopathy	1 in 1000,000

The variation in frequent complications is due to differences between countries. A greater number of complications are caused by neglect of vaccination rules, ignoring contraindications, improper storage and transportation of vaccines, the use of spoiled batches of drugs and other similar factors.

Before use, you should consult a specialist.

Chapter 2 Post-vaccination reactions and complications

When carrying out mass immunization of adults and children, the safety of vaccines and a differential approach to the selection of persons to be vaccinated are of great importance.

Correct organization of vaccination work requires strict consideration of vaccination reactions and post-vaccination complications. Vaccinations should be carried out only by medical workers in special vaccination rooms.

Reactions to vaccinations are an expected state of the body, which may be characterized by deviations in the nature of its functioning. Often, local and general reactions may occur during parenteral administration of the vaccine.

Local reactions develop in the area of ​​vaccine administration in the form of redness or infiltration. They appear more often in older children and adults. In most cases, prolonged local reactions occur when using adsorbed vaccines.

The general reaction is manifested by increased temperature, headache and joint pain, general malaise, and dyspeptic symptoms.

The response to the vaccine depends on the individual characteristics of the organism and the reactogenicity of the vaccine. In case of severe reactions in more than 7%, the vaccine used is withdrawn.

In addition, reactions to the introduction of vaccines differ in the time of their occurrence. An immediate reaction can occur after any vaccine.

It is often observed in people who previously had damage to the respiratory system, nervous system, or who had influenza or adenoviral infection before vaccination. This reaction occurs within the first 2 hours after vaccination.

An accelerated reaction develops in the first day after administration of the vaccine and is expressed in local and general manifestations: hyperemia at the injection site, tissue swelling and infiltration. There are weak (diameter of hyperemia and induration up to 2.5 cm), medium (up to 5 cm) and strong (more than 5 cm) accelerated reactions.

A vaccine reaction, manifested by symptoms of general severe intoxication or damage to individual organs and systems, is regarded as a post-vaccination complication.

Post-vaccination complications are rare. Certain local reactions are subject to registration during vaccinations (Table 19).

Table 19. Post-vaccination local reactions

Post-vaccination complications are divided into several groups.

Complications associated with violation of vaccination technique, which are rare, include suppuration at the injection site.

In the case of subcutaneous administration of adsorbed vaccines, aseptic infiltrates are formed. Subcutaneous administration of the BCG vaccine can lead to the development of an abscess accompanied by lymph node involvement.

Complications related to the quality of the vaccine can be local or general.

In addition, complications can develop in cases of exceeding the dosage of the drug used, subcutaneous administration of vaccines used to prevent particularly dangerous infections, as well as those intended for skin vaccinations.

Such errors during vaccinations can cause severe reactions with a possible fatal outcome.

If the dose of inactivated and live bacterial vaccines is exceeded by more than 2 times, the administration of antihistamines is recommended; if the condition worsens, prednisolone is prescribed parenterally or orally.

If an overdose of mumps, measles and polio vaccines is administered, treatment is not required. Special training of medical personnel performing vaccination prevents these complications, which are not always a pathological condition.

To decide whether the process that arose in the post-vaccination period is a complication of the vaccination, it is necessary to take into account the time of its development (Table 20). This is also important for determining the criterion for insurance liability.

Table 20. Possible post-vaccination complications (V.K. Tatochenko, 2007)

During the vaccination period (both on the day of vaccination and in the days following immunization), a vaccinated person, especially a child, may experience various diseases that are mistaken for post-vaccination complications.

But the occurrence of disease symptoms after vaccination is not always a consequence of vaccination.

Deterioration of the condition 2–3 or 12–14 days after vaccination with inactivated drugs, as well as live viral vaccines, is often associated with the appearance of various infectious diseases (ARVI, enterovirus infection, urinary tract infection, intestinal infections, acute pneumonia, etc.).

In these cases, urgent hospitalization of the patient is necessary to clarify the diagnosis.

Non-infectious diseases (various diseases of the digestive tract, renal pathology, respiratory diseases) occur in only 10% of the total number of such cases.

Indicative criteria are the timing of the appearance of individual symptoms after vaccination.

General severe reactions, accompanied by fever and convulsions, occur no later than 2 days after vaccination (DPT, ADS, ADS-M), and with the introduction of live vaccines (measles, mumps) no earlier than 5 days.

A response to live vaccines, with the exception of immediate reactions, can be detected immediately after vaccination in the first 4 days, after measles - more than 12-14 days, mumps - after 21 days, after polio vaccine - 30 days.

Meningeal symptoms may appear 3–4 weeks after administration of the mumps vaccine.

The phenomena of encephalopathy as a reaction to the administration of a vaccine (DTP) are rare.

Catarrhal symptoms may occur after the measles vaccine is administered - after 5 days, but no later than 14 days. Other vaccines do not have this reaction.

Arthralgia and isolated arthritis are characteristic of rubella vaccination.

Vaccine-associated poliomyelitis develops on days 4–30 after immunization in vaccinated people and up to 60 days in contact people.

Anaphylactic shock

Anaphylactic shock is a severe generalized immediate reaction caused by an antigen-antibody reaction occurring on the membranes of mast cells with fixed antibodies (JgE). The reaction is accompanied by the appearance of biologically active substances.

Anaphylactic shock usually occurs 1–15 minutes after parenteral administration of vaccines and serums, as well as during allergy testing and allergen immunotherapy. It develops more often with subsequent vaccinations.

Initial clinical manifestations occur immediately after administration of the vaccine: anxiety, palpitations, paresthesia, itching, cough, and difficulty breathing.

Usually, with shock, hypoexcitement develops due to a sharp expansion of the vascular bed due to vasomotor paralysis.

In this case, the permeability of membranes is impaired, interstitial edema of the brain and lungs develops. Oxygen starvation sets in.

Anaphylactic shock is accompanied by dysfunction of the central nervous system, the appearance of a thread-like pulse, pallor of the skin, and a decrease in body temperature. Anaphylactic shock can often be fatal.

In the development of anaphylactic shock, 4 stages are observed: the stage of sensitization, immunokinetic, pathochemical and pathophysiological.

Cases of death within 1 hour are usually associated with collapse, within 4–12 hours - with secondary circulatory arrest; on the second day and later - with progression of vasculitis, renal or liver failure, cerebral edema, damage to the blood coagulation system.

Clinical variants of anaphylactic shock can be different. Treatment measures are associated with their manifestations.

At hemodylactic option Treatment is aimed at maintaining blood pressure; vasopressors, plasma replacement fluids, and corticosteroids are prescribed.

Asphyxial variant requires the administration of bronchodilators, corticosteroids, sputum suction, elimination of respiratory disorders (elimination of tongue retraction, tracheostonia). Oxygen therapy is also prescribed.

Cerebral variant involves the prescription of diuretics, anticonvulsants and antihistamines.

Abdominal option requires repeated administration of sympathomimetics, corticosteroids, antihistamines and diuretics.

List of medications and medical equipment needed to assist with anaphylactic shock

1. 0.1% solution of adrenaline hydrochloride – 10 ampoules.

2. 0.2% solution of norepinephrine hydrotartate – 10 ampoules.

3. 1% mesatone solution – 10 ampoules.

4. 3% prednisolone solution – 10 ampoules.

5. 2.4% aminophylline solution – 10 ampoules.

6. 10% glucose solution – 10 ampoules.

7. 5% glucose solution – 1 bottle (500 ml).

8. 0.9% sodium chloride solution – 10 ampoules.

9. 0.1% solution of atropine sulfate – 10 ampoules.

10. 10% calcium chloride solution – 10 ampoules.

11. 2% solution of suprastin – 10 ampoules.

12. 2.5% solution of pipalfen – 10 ampoules.

13. 0.05% solution of strophanthin – 10 ampoules.

14. 2% solution of furaselide (Lasix) – 10 ampoules.

15. Ethyl alcohol 70% – 100 ml.

16. Oxygen cylinder with reducer.

17. Oxygen cushion.

18. System for intravenous infusion – 2 pcs.

19. Disposable syringes (1, 2, 5, 10 and 20 ml).

20. Rubber bands – 2 pcs.

21. Electric suction – 1 pc.

22. Mouth retractor – 1 pc.

23. Device for measuring blood pressure.

Measures taken during anaphylactic shock

1. The patient must be positioned so that his head is below the level of his legs and turned to the side to prevent aspiration of vomit.

2. Using a mouth expander, the lower jaw is advanced.

3. Immediately administer adrenaline hydrochloride 0.1% or norepinephrine hydrotartrate in an age-specific dosage (children 0.01, 0.1% solution per 1 kg of weight, 0.3–0.5 ml) subcutaneously or intramuscularly, and also carry out injections or local injections.

4. Blood pressure is measured before the administration of adrenaline and 15–20 minutes after administration. If necessary, the injection of adrenaline (0.3–0.5) is repeated and then administered every 4 hours.

5. If the patient’s condition does not improve, intravenous administration of adrenaline (epinephrine) is prescribed: 1 ml of 0.1% solution in 100 ml of 0.9% sodium chloride. Inject slowly - 1 ml per minute, under the control of counting heart rate and blood pressure.

6. Bradycardia is stopped by administering atropine at a dose of 0.3–0.5 mg subcutaneously. According to indications in case of severe condition, the administration is repeated after 10 minutes.

7. To maintain blood pressure and replenish the volume of circulating fluid, dopamine is prescribed - 400 mg per 500 ml of 5% glucose solution, with further administration of norepinephrine - 0.2-2 ml per 500 ml of 5% glucose solution after replenishing the circulating volume liquids.

8. If there is no effect from infusion therapy, it is recommended to administer glucagon (1–5 mg) intravenously as a bolus, and then as a bolus (5–15 mcg/min).

9. To reduce the intake of antigen, a tourniquet is applied to the limb above the injection site for 25 minutes, loosening every 10 minutes for 1–2 minutes.

10. Antiallergic drugs are administered intravenously or intramuscularly: half the daily dose of prednisolone (3–6 mg/kg per day for children); according to indications, this dose is repeated or dexamethasone is prescribed (0.4–0.8 mg/day).

11. The administration of glucocorticoids is combined with the administration of antihistamines intramuscularly or new generation drugs orally.

12. In case of laryngeal edema, intubation or tracheostomy is indicated.

13. In case of cyanosis and dyspnea, oxygen is given.

14. In a terminal condition, resuscitation is carried out by means of indirect massage, intracardial administration of adrenaline, as well as artificial ventilation, intravenous administration of atropine and calcium chloride.

15. Patients with anaphylactic shock are subject to immediate hospitalization in the intensive care unit.

Feverish reaction

Hyperthermic syndrome

A reaction without a visible focus of infection can be observed 2–3 days after DPT administration and 5–8 days after measles vaccination. An increase in temperature should be alarming if the condition worsens and signs of bacterial inflammation appear.

As a result, the course of the vaccination reaction is stimulated by the production of pyrogenic cytokines, such as interferon gamma, interleukin, prostaglandin E, etc., which act on the pituitary gland and thereby lead to a decrease in heat transfer.

At the same time, specific antibodies of class G and memory cells are produced. Fever that occurs after vaccinations is usually well tolerated.

Indications for prescribing medications are a body temperature of 39 °C in children over 3 months, as well as convulsions, diseases of the central nervous system, cardiac decompensation at a body temperature of more than 38 °C. In the presence of muscle pain and headaches, the prescription of antipyretics is 0.5 lower than indicated.

Among antipyretics, it is recommended to prescribe paracetamol in a single dose of 15 mg/kg body weight, 60 mg/kg/day. Typically, its effect occurs within 30 minutes and lasts up to 4 hours. In addition to prescriptions in solution, you can use it in suppositories (15–20 mg/kg).

To quickly reduce the temperature, the introduction of a lytic mixture consisting of 0.5–1 ml of 2.5% aminazine (chlorpromazine), pipolfen is used. It is also possible to administer analgin (metamizole sodium) at 0.1–0.2 ml of a 50% solution per 10 kg of body weight.

In case of hyperthermia, the child is placed in a well-ventilated room, a constant supply of fresh cool air is ensured, and plenty of fluids are prescribed (80–120 ml/kg/day) in the form of a glucose-saline solution, sweet tea, and fruit juices. The child is given frequent and frequent drinks.

In case of hyperthermia, physical cooling methods are used - the child is uncovered and an ice pack is suspended above the head.

These procedures are indicated for hyperthermia, which occurs with redness of the skin, in which case increased heat transfer occurs.

For hyperthermia, accompanied by pallor of the skin, chills, vasospasm, the skin is rubbed with 50% alcohol, papaverine, aminophylline, no-shpu are given.

Encephalic syndrome

This syndrome is accompanied by impaired cerebral circulation, agitation, and single short-term convulsions. Usually does not require active therapy.

If the convulsive syndrome persists, urgent hospitalization is indicated.

Diazepam is urgently administered (0.5% solution intramuscularly or intravenously at 0.2 or 0.4 mg/kg per injection).

If the convulsions do not stop, repeated administration is made (0.6 mg/kg after 8 hours) or diphenine is administered at a rate of 20 mg/kg. For persistent convulsive syndrome, other drugs are also used (sodium hydroxybutyrate, valproic acid, etc.).

Collapse

Collapse is an acute vascular failure, which is accompanied by a sharp decrease in vascular tone and symptoms of brain hypoxia. Collapse develops in the first hours after vaccination. Characteristic symptoms are lethargy, adynamia, pallor with marbling, severe acrocyanosis, a rapid decrease in blood pressure, and a weak pulse.

Emergency assistance consists of immediately taking the following measures. The patient lies on his back, with his head thrown back to ensure an influx of fresh air. The airway is ensured and the oral cavity is inspected. The patient is administered a 0.1% solution of adrenaline (0.01 ml/kg), prednisolone (5–10 mg/kg/day) intravenously or intramuscularly.

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