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

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

Classification of post-vaccination complications:

• I. Unusual (pathological) reactions (complications) to various vaccines:
  
  
  • Toxic (too 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 the introduction of the BCG vaccine

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

Subcutaneous cold abscess (aseptic infiltrate) may occur after 1-8 months. after vaccination (revaccination), more often in violation of the technique of administering the vaccine. 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 the use of treatment - 6-7 months. Healing occurs with the formation of a star-shaped scar.

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

Regional lymphadenitis - an increase in axillary, cervical lymph nodes after 2-3 months. after vaccination - for a sluggish, long. It resolves within 1-2 years, fistulas are sometimes formed.

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

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

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

Lymphadenitis of two or more localizations. The clinic is the same as with regional lymphadenitis, however, the phenomena of intoxication 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 frequency of occurrence is 4.29 per 1 million vaccinated.

Post-vaccination complications after administration of oral polio vaccine

There are no toxic complications.

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

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

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

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

c) no progression of the disease;

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, Quincke's edema) are rare, usually in children predisposed to allergies in the first 4 days from vaccination.

Post-vaccination complications after administration of DPT vaccine

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

Neurological complications:

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

b) convulsive seizures without hyperthermia in the form of extended seizures and "small" convulsive seizures (nods, pecks, twitches). Occur on the 4th day after vaccination and later. Afebrile convulsions indicate a previous organic brain lesion;

c) convulsive syndrome on 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 3-8 days after vaccination. It proceeds 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 old (sharp pallor, lethargy, cyanosis, drop in blood pressure, the appearance of cold sweat, sometimes accompanied by loss of consciousness), occurs within 1 week after vaccination;

c) allergic rashes, angioedema;

d) asthmatic syndrome, hemorrhagic syndrome, hemolytic uremic syndrome, croup syndrome, toxic-allergic condition (very rare).

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

Post-vaccination complications after the introduction of live measles vaccine

Toxic reactions (hyperthermia, pronounced disturbance of health, vomiting, epistaxis, abdominal syndrome) occur from the 6th to the 11th day after vaccination. These clinical manifestations persist for 2-5 days, then disappear.

Neurological complications:

a) convulsive syndrome - febrile tonic-clonic convulsions with loss of consciousness and other cerebral symptoms, last 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, with illness - 1 case per 4 thousand cases, according to WHO).

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

Post-vaccination complications after the introduction 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 - an extremely rare complication, occurs on the 5-30th day after vaccination, is characterized by a benign course.

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

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

Post-vaccination complications after the introduction of the hepatitis B vaccine

Toxic and neurological reactions are usually absent.

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

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

Treatment of post-vaccination complications

Post-vaccination complications are registered in the epidemiological bureau of the city. 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. Relanium (intravenously or intramuscularly), GHB, and dehydration therapy are used to stop seizures. With the development of allergic reactions, antihistamines are prescribed, which are advisable to be administered parenterally, according to indications, glucocorticoid hormones are used.

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.

Usually, adverse reactions to vaccinations with inactivated vaccines (DPT, DTP, 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 aim of forming the immunity of the vaccinated to this infection, and undesirable, that is, side reactions.

Medical Immunology Centers of the Russian Federation advise to vaccinate 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 the vaccination takes place according to the schedule of the vaccination certificate that each person has.

In 1996, the world celebrated the 200th anniversary of the first vaccination, carried out in 1796 by the English physician Ed. Jenner. Today, the idea of ​​vaccination in our country, in addition to sincere supporters, has a fairly large number of staunch opponents. Disputes around the mass use of vaccines do not subside not only in our country. Already in the 18th and 19th centuries, doctors noted that mass smallpox vaccination shortens people's lives, testified to the imaginary benefits and real harms of vaccines. To date, a huge amount of material has been accumulated on the negative consequences - side effects of vaccines.

The lack of safe vaccines, as well as a sharp deterioration in the health of Russian children, 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 field of medicine where vaccinations have not introduced iatrogenic pathology.

What are adverse reactions to vaccines?

The term "adverse reaction" refers to the occurrence of unwanted reactions of the body, which 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, i.e. arising at the injection site (redness, soreness, induration), and general, that is, those that affect the entire body as a whole - fever, 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 cause of an increase in body temperature that occurs after vaccination is the release of special "mediators" of the immune reaction into the blood. If adverse reactions are not severe, then in general it is even a sign that is favorable in terms of developing immunity. For example, a small induration that occurs at the site of vaccination with a hepatitis B vaccine indicates the activity of the process of developing immunity, which means that the vaccinated person will be really protected from infection.

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

Usually, adverse reactions to vaccinations with inactivated vaccines (DTP, ATP, hepatitis B) occur 1-2 days after vaccination and disappear on their own, without treatment, within 1-2 days. After inoculation with live vaccines, reactions may appear later, on days 2-10, and also pass without treatment within 1-2 days.

Most vaccines have been in use 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 frequency of adverse reactions is also well studied. It is no secret that the rubella vaccine, which has been used abroad for more than 30 years, causes about 5% of general reactions, 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 side reactions include redness, induration, soreness, swelling, which are significant and significant. Also, local reactions include urticaria (an allergic rash resembling that of a nettle burn), an increase in lymph nodes adjacent 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 contact. It is quite natural to assume that the greater the volume of foreign substances, the greater the strength of inflammation. Numerous clinical trials of vaccines involving control groups, when ordinary water for injection was administered as a control drug, showed that even this “drug” causes local reactions, and at a frequency close to that of the experimental group where the vaccines were administered. That is, the injection itself is the cause of local reactions to a certain extent.
Sometimes vaccines are designed to cause local reactions on purpose. We are talking about the inclusion in the composition of vaccines of special substances (usually aluminum hydroxide and its salts) or adjuvants that 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 DTP, DTP, hepatitis A and B. Usually adjuvants are used in inactivated vaccines, since the immune response to live vaccines is already quite strong.
The way vaccines are administered also affects the number of local reactions. All injectable vaccines are best administered intramuscularly, and not in the buttock (you can get into the sciatic nerve or subcutaneous fat). Muscles are much better supplied with blood, the vaccine is better absorbed, the strength of the immune response is greater. In children under 2 years of age, the best place for vaccination is the anterior-lateral surface of the thigh in its middle third. Children older than two years and adults are best grafted into the deltoid muscle of the shoulder, the very muscular thickening on the shoulder - the injection is made from the side, at an angle of 90 degrees to the skin surface. With subcutaneous administration of vaccines, the frequency of local reactions (redness, induration) will obviously be higher, and the absorption of vaccines and, as a result, the immune response may be lower than with intramuscular administration.

Common reactions after vaccinations

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

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

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

With the introduction of live vaccines, almost complete reproduction of a natural infection in a weakened form is sometimes possible. An illustrative example of vaccination against measles, when on the 5th - 10th day after vaccination, a specific post-vaccination reaction is possible, characterized by an increase in body temperature, symptoms of acute respiratory infections, a kind of rash - all this is classified as "vaccinated measles".

Post-vaccination complications

In contrast to adverse reactions, vaccination complications are undesirable and rather 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 convulsions, neurological disorders, allergic reactions of varying severity, etc.

In fairness, it should be noted that, unlike adverse reactions, post-vaccination complications are extremely rare - the frequency of complications such as encephalitis for measles vaccine is 1 in 5-10 million vaccinations, generalized BCG infection that occurs when BCG is administered incorrectly is 1 per 1 million vaccinations, vaccine-associated poliomyelitis - 1 per 1-1.5 million doses of OPV administered. In the infections that vaccines protect against, these same complications occur at an order of magnitude higher 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 the instructions for administering the vaccine (from non-compliance with contraindications up to the introduction of an oral vaccine intramuscularly);
• individual characteristics of the body (unexpectedly strong allergic reaction to the repeated administration of the vaccine);
• accession of infection - purulent inflammation at the injection site and infection, in the incubation period of which vaccination was carried out.

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

Common complications for vaccinations (vaccine):

• Excessively strong general reactions with a high temperature increase (more than 40ºС), general intoxication
• Damage to the central nervous system: persistent piercing crying of the child, convulsions without and with an increase in body temperature; encephalopathy (the appearance of neurological "signs"); post-vaccination serous meningitis (short-term, leaving no consequences "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 reactions of an allergic type (Quincke's edema), allergic rashes, croup, suffocation, temporary increased bleeding, toxic-allergic condition; fainting, anaphylactic shock.
• The combined course of the vaccination process and the associated acute infection, with and without complications;

Description of some complications

Anaphylactic shock after vaccination

Anaphylactic shock- an allergic reaction of an immediate type, a state of sharply increased sensitivity of the body that develops with the repeated introduction of an allergen. Usually, vaccine components (non-compliance with contraindications, undetected allergies) are characterized by a sharp drop in blood pressure and impaired cardiac activity. Occurs usually in the first 30 minutes after vaccination, requires resuscitation. 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 convulsions

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

Serous meningitis

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

Table: Frequency of occurrence 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 a live attenuated vaccine (for the first, second and third vaccinations)
Against tetanus	Neuritis of the brachial nerve at the injection site
DTP (against diphtheria, whooping cough and tetanus)	High-pitched, loud cry during the first hours after vaccination Episode of convulsions against the background of high temperature 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 convulsions against the background of high temperature Decrease in the number of platelets 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.

To begin with, 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 unwanted 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 cause after vaccination is the release into the blood of special "mediators" of the immune reaction. If adverse reactions are not severe, then this is even favorable for the formation of immunity to this antigen. For example, a slight tightening of the skin in the injection area after a hepatitis B vaccination indicates that the process of developing immunity is active, and means that this 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 induration at the injection site. Common reactions include fever, malaise.

Severe adverse reactions (fever over 39.5°C, large infiltrate in the area of ​​vaccine administration) are not favorable signs. Such reactions are subject to strict reporting and must be reported to institutions that control the quality of vaccines. If there are many such reactions to a given vaccine series, then this series is withdrawn from use and re-quality control is carried out for it.

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

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

The frequency 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 the total adverse reactions.

Local adverse reactions

Local reactions to vaccination include redness, induration, swelling, and soreness. at the injection site (if they are significant). Urticaria (allergic rash) and swollen lymph nodes near the injection site (lymphadenitis) are also listed as local side effects.

The cause of local reactions is the injection itself, at the site of entry of a foreign agent into the body, a response occurs in the form of inflammation. Some vaccines are specially made to cause local reactions on purpose (aluminum hydroxide is included in their composition). For example, the DPT vaccine contains such substances to cause inflammation at the injection site, and in this way, as many body cells as possible "get acquainted" with the antigens of the vaccine. Typically, inactivated vaccines (which do not have a live component) use aluminum hydroxide to enhance the immune response.

The place of administration of the vaccine also affects the frequency of occurrence of local adverse reactions.. All injectable vaccines are administered intramuscularly or subcutaneously. Subcutaneous injection of the vaccine has much higher adverse local reactions, and the immune response may be less than with intramuscular injection (because absorption is less).

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

Common adverse reactions to vaccination

Common post-vaccination reactions include- rash (spread to large areas of the body), fever, sleep and appetite disturbances, anxiety, headache, dizziness. Young children may have this kind of reaction, such as crying for a long time.

Rash after vaccination due to several reasons. Firstly, the cause may be the reproduction of the vaccine virus in the skin, such a rash passes quickly and is mild. Such a rash usually appears after the introduction of live vaccines (rubella, measles, mumps). The second cause of a rash is an allergic reaction.

Sometimes the rash is punctate, and its cause is the resulting increased bleeding of 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 the appearance of a viral infection in a very mild form can be noted. For example, after vaccination against measles, a specific post-vaccination reaction may occur on days 5-10 in the form of an increase in 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 have arisen after vaccination. The boundary 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 (eg, hemorrhagic vasculitis), hypoplastic anemia, agranulocytosis, chronic arthritis;
• Generalized form of BCG infection.

In addition to these complications, there are milder ones, for example, febrile convulsions against the background of fever after vaccination, 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 DTP vaccine(almost 60% of all complications). Currently, imported vaccines (Pentaxim, Infanrix) are used, which do not contain a whole pertussis component, which reduces the frequency 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, non-compliance with contraindications, another way of administering the vaccine);
• Individual characteristics of the organism.

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 a weakened immune system). Secondary infection aggravates the body's response to vaccination and can lead to complications.

What are the complications after vaccinations?

Thank you

Graft is an immunobiological preparation that is introduced into the body in order to form a stable immunity to certain, potentially dangerous infectious diseases. It is precisely because of their properties and purpose that vaccinations can cause certain reactions from the body. The whole set of such reactions is divided into two categories:
1. Post-vaccination reactions (PVR).
2. Post-vaccination complications (PVO).

Post-vaccination reactions are various changes in the condition of the child that develop after the introduction vaccines, and pass on their own within a short period of time. Changes in the body, qualified as post-vaccination reactions, are unstable, purely functional, do not pose a threat and do not lead to a permanent health disorder.

Post-vaccination complications are persistent changes in the human body that have occurred after the introduction of the vaccine. In this case, the violations are long-term, significantly go beyond the physiological norm and entail a variety of human health disorders. Let us consider in more detail the possible complications of vaccinations.

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 a complicated course of the post-vaccination period, when various pathologies are detected that occur simultaneously with vaccination, but are in no way associated with it.

Complications after vaccinations in children

Each vaccine can cause its own variant of the complication. But there are also complications common to all vaccines that can develop in children. These include the following states:

• anaphylactic shock, which develops within a day after the introduction of the vaccine;
• 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 a background of low body temperature - less than 38.5 o C, fixed for a year after the vaccination;
• violation of sensitivity;
• vaccine-associated poliomyelitis;
• 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;
• the cry of the child for at least 3 hours in a row;
• 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 associated with vaccination.

Complications and side effects of vaccinations in children - video

The main causes of complications after vaccination

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

• the introduction of the vaccine in the presence of contraindications;
• improper vaccination;
• poor quality of the vaccine preparation;
• individual properties and reactions of the human body.

As can be seen, the main factors causing the formation of post-vaccination complications are various safety violations, neglect of the rules for administering drugs, ignoring contraindications or their insufficiently active identification, as well as the poor quality of vaccines. Individual properties of a person can only be superimposed on the listed factors, contributing to the development of complications.

That is why the basis for the prevention of complications of vaccinations is the careful identification of contraindications, compliance with the technique of using vaccines, quality control of drugs, compliance with the rules for their storage, transportation and transportation. The poor quality of vaccines, however, 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 DPT, ADS-m

DTP vaccination is done to develop immunity to whooping cough, diphtheria and tetanus. At the same time, K is a component against whooping cough, AD is against diphtheria, AC is against tetanus. Similar vaccines are also available: Tetracoccus and Infanrix. The vaccine is given to children, three doses are administered, and the fourth - 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 in 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 ATP-m and the time of their development after vaccination:

Type of complications DPT, ADS-m	Type of complications	Type of complications
Significant enlargement and induration 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
Scream continuous for 3 or more hours	Systemic	Up to two days
An increase in body temperature above 39.0 o C	Systemic	Up to 72 hours
Febrile convulsions (at a temperature of 38.0 o C and above)	Systemic	24 – 72 hours
Seizures are afebrile (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
indigestion	Systemic	Up to 72 hours
Severe allergic reactions (Quincke's edema, urticaria, etc.)	Systemic	Up to 72 hours
Decreased blood pressure, muscle tone	Systemic	Up to 72 hours
Loss of consciousness	Systemic	Up to 72 hours
Meningitis or encephalitis	Systemic	Up to 1 month
Sensory disturbance	Systemic	Up to 1 month
Polyradiculoneuritis	Systemic	Up to 1 month
Decreased platelet count	Systemic	Up to 1 month

Local complications of DTP and ATP-m vaccinations usually go away on their own within a few days. To alleviate the condition of the child, you can lubricate the injection site with Troxevasin ointment. If the baby has developed complications after DTP vaccination, then the next time only anti-diphtheria and anti-tetanus components are administered, without whooping cough, since it is he who provokes most of the complications.

Complications after tetanus vaccination

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

• increase in body temperature within 3 days;
• redness at the injection site - up to 2 days;
• enlargement and soreness of the lymph nodes - up to a week;
• sleep disturbance - up to 2 days;
• headaches - up to 2 days;
• digestive disorders and appetite - up to 3 days;
• allergic rash;
• long incessant cry - up to 3 days;
• convulsions against the background of 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 lowest possible level, it is necessary to follow the rules of vaccination, take into account contraindications and not use drugs that have been stored in violation of established standards.

Complications after vaccination against diphtheria

Vaccination against diphtheria alone is not too reactogenic, so it is relatively easy to tolerate. 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 Pentaxim vaccination

The Pentaxim vaccine is a combined one, 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, only 0.6% developed complications. 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 occurs when using an oral vaccine.

Pentaxim, despite the five components, rarely causes reactions and complications, which are mainly manifested in the form of high fever, irritability, prolonged crying, hardening and bumps at the injection site. In rare cases, seizures, mild neurological symptoms, digestive disorders, severe pain at the injection site and the entire limb may develop. The most severe reaction, as a rule, develops on the second dose, and the first and third are easier.

Complications after hepatitis B vaccination

Hepatitis B vaccination can cause the following complications that develop within the specified time frame:

• Increase in body temperature - up to 3 days.
• A pronounced reaction at the injection site (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.
• Decrease in pressure, muscle tone, loss of consciousness - up to 3 days.
• Arthritis - from 5 days for 1 month.
• Convulsions against the background of normal or elevated temperature - up to 3 days.
• Meningitis, encephalitis, sensory disturbances - up to 15 days.
• Polyradiculoneuritis - up to 1 month.

Complications after polio vaccination

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

Complications after BCG vaccination

It must be understood that BCG is not put in order to make 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 gives generalized blood poisoning or meningitis. However, BCG itself is a low-reactive vaccine that can provoke 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, and 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 flu vaccination

Domestic and imported influenza vaccines are available in Russia, and all of them have approximately the same properties and are capable of causing similar complications. In general, the flu vaccine is extremely rarely accompanied by complications, the spectrum of which is very narrow. Most often, complications in the form of allergies appear, especially in people who have one on the drug Neomycin or chicken egg protein. Several cases of the formation of hemorrhagic vasculitis have been registered, however, the relationship of this pathology with the flu shot has not been established for certain.

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

Priorix is ​​a combination measles, mumps and rubella vaccine. Vaccinations against these infections cause almost the same reactions and complications. Thus, a rise in temperature can be observed only on the 4th - 15th day after vaccination, and a strong local reaction is observed in the first two days, and is expressed in the formation of severe edema of more than 5 cm, redness of more than 8 cm, and compaction of more than 2 cm. In addition, vaccinations against chickenpox, measles, rubella and combined MMR can cause the following complications at the appropriate time:

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

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

Complications after rabies vaccination

The rabies vaccine very rarely provokes the development of complications, and they are mainly manifested by allergies, especially in people suffering from reactions to hen's egg protein. Neurological symptoms were also noted, such as neuralgia, dizziness attacks, 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 the infection of a child with the causative agent of tuberculosis - Koch's bacillus. The Mantoux test is used in children instead of fluorography, which is done in 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

To date, in Russia, official registration 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 localities, mainly in large cities. According to US statistics, every year 50 children develop severe neurological symptoms and disorders of the central nervous system as a result of vaccination complications. The table reflects various severe post-vaccination complications from various vaccinations according to the World Health Organization:

Vaccine	Complication	Development frequency complications
BCG	Inflammation of the lymphatic 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	Convulsions against the background of temperature	1 in 3000
	Decrease in the number of platelets in the blood	1 in 30,000
	severe allergy	1 in 100,000
	Anaphylactic shock	1 in 1000,000
	Encephalopathy	Less than 1 in 1,000,000
oral vaccine against poliomyelitis (drops in the mouth)	Vaccine Associated Poliomyelitis	1 in 2000,000
Tetanus	Shoulder nerve neuritis	1 in 100,000
	Anaphylactic shock	1 in 100,000
DPT	Long incessant scream	1 in 1000
	convulsions	1 in 1750 - 12500
	Decreased pressure, muscle tone, loss of consciousness	1 in 1000 - 33,000
	Anaphylactic shock	1 in 50,000
	Encephalopathy	1 in 1000,000

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

Before use, you should consult with a specialist.

Chapter 2 Post-vaccination reactions and complications

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

Proper organization of vaccination work requires strict consideration of vaccination reactions and post-vaccination complications. Vaccinations should be carried out only by medical professionals 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. Frequently, local and systemic reactions may occur with parenteral administration of the vaccine.

Local reactions develop in the area of ​​​​vaccination in the form of redness or infiltration. They are more common in older children and adults. In most cases, prolonged local reactions appear with the use of adsorbed vaccines.

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

The response to the introduction of the vaccine depends on the individual characteristics of the organism and the reactogenicity of the vaccine. In the 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 may occur after any vaccine.

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

An accelerated reaction develops on the first day after the introduction 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 compaction up to 2.5 cm), medium (up to 5 cm) and strong (more than 5 cm) accelerated reactions.

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

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

Table 19. Post-vaccination local reactions

Post-vaccination complications are divided into several groups.

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

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

Complications related to the quality of the vaccine may 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 especially dangerous infections, as well as those intended for skin vaccinations.

Such mistakes during vaccination can cause severe reactions with a possible fatal outcome.

In case of exceeding the dose of inactivated and live bacterial vaccines by more than 2 times, the introduction of antihistamines is recommended; if the condition worsens, prednisolone is prescribed parenterally or orally.

With the introduction of an exceeded dose of mumps, measles and polio vaccines, 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 occurred 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). It is also important for determining the criterion of 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 following days after immunization), a vaccinated person, especially a child, may experience various diseases that are mistaken for post-vaccination complications.

But the occurrence of symptoms of the disease 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-communicable diseases (various diseases of the digestive tract, kidney pathology, respiratory diseases) occur only in 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 convulsive syndrome, 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.

Response to live vaccines, with the exception of reactions of an immediate type, 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 the introduction of the mumps vaccine.

The phenomena of encephalopathy as a reaction to the introduction of a vaccine (DPT) are rare.

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

Arthralgias and isolated arthritis are characteristic of rubella vaccination.

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

Anaphylactic shock

Anaphylactic shock is a severe generalized immediate type reaction caused by an antigen-antibody reaction occurring on mast cell membranes 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 sera, as well as during allergy testing and allergen immunotherapy. More often develops on subsequent vaccinations.

Clinical initial manifestations occur immediately after the introduction of the vaccine: there is anxiety, palpitations, paresthesia, itching, cough, shortness of breath.

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

At the same time, membrane permeability is disturbed, 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 thready pulse, pallor of the skin, and a decrease in body temperature. Often, anaphylactic shock can be fatal.

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

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

Clinical variants of anaphylactic shock may be different. Their manifestations are associated with therapeutic measures.

At hemodilactic variant treatment is aimed at maintaining blood pressure, vasopressors, plasma-substituting fluids, and corticosteroids are prescribed.

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

cerebral variant provides for the appointment of diuretics, anticonvulsants and antihistamines.

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

List of drugs and medical equipment needed to help with anaphylactic shock

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

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

3. 1% mezaton solution - 10 ampoules.

4. 3% solution of prednisolone - 10 ampoules.

5. 2.4% solution of aminophylline - 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% suprastin solution - 10 ampoules.

12. 2.5% solution of pipalfen - 10 ampoules.

13. 0.05% solution of strophanthin - 10 ampoules.

14. 2% solution of furaselid (lasix) - 10 ampoules.

15. Ethyl alcohol 70% - 100 ml.

16. Oxygen cylinder with a 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 pump - 1 pc.

22. Mouth expander - 1 pc.

23. Apparatus for measuring blood pressure.

Activities carried out with anaphylactic shock

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

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

3. Adrenaline hydrochloride 0.1% or norepinephrine hydrotartrate is immediately administered at an age dosage (children 0.01, 0.1% solution per 1 kg of weight, 0.3-0.5 ml) subcutaneously or intramuscularly, and also carry out chipping 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 injected every 4 hours.

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

6. Bradycardia is stopped by the introduction of atropine at a dose of 0.3–0.5 mg subcutaneously. According to indications in case of a serious condition, the introduction 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 volume of circulating liquids.

8. In the absence of the effect of infusion therapy, it is recommended to administer glucagon (1–5 mg) intravenously in a stream, and then in a stream (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 (0.4-0.8 mg / day) is prescribed.

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

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

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

14. In the terminal state, resuscitation is carried out by indirect massage, the introduction of adrenaline intracardially, as well as artificial ventilation of the lungs, 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 DTP administration and 5–8 days after measles vaccination. An increase in temperature should be alarming in case of deterioration and the appearance of signs of bacterial inflammation.

As a result, the course of the grafting reaction is stimulated by the production of pyrogenic cytokines, such as gamma-interferon, 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 vaccination is usually well tolerated.

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

Of the antipyretics, it is recommended to prescribe paracetamol in a single dose of 15 mg/kg body weight, 60 mg/kg/day. Usually its action occurs after 30 minutes and lasts up to 4 hours. In addition to appointments in solution, you can use it in suppositories (15–20 mg / kg).

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

With hyperthermia, the child is placed in a well-ventilated room, a constant supply of fresh cool air is provided, and plenty of fluids (80-120 ml / kg / day) are prescribed in the form of a glucose-salt solution, sweet tea, fruit juices. The child is fed often and fractionally.

In case of hyperthermia, physical methods of cooling are used - the child is opened, an ice pack is hung over the head.

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

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

encephalic syndrome

This syndrome is accompanied by impaired cerebral circulation, agitation, 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 convulsions do not stop, re-introduction is made (0.6 mg / kg after 8 hours) or difenin is administered at the rate of 20 mg / kg. With persistent convulsive syndrome, other means are also used (sodium oxybutyrate, valproic acid, etc.).

Collapse

Collapse is an acute vascular insufficiency, which is accompanied by a sharp decrease in vascular tone, symptoms of cerebral hypoxia. The collapse develops in the first hours after vaccination. Characteristic symptoms are lethargy, weakness, pallor with marbling, pronounced acrocyanosis, a rapid decrease in blood pressure, and a weak pulse.

Emergency assistance consists in the immediate implementation of the following measures. The patient is laid on his back, while the head should be thrown back to ensure the flow of fresh air. Free airway patency is ensured, an audit of the oral cavity is carried out. The patient is injected with a 0.1% solution of adrenaline (0.01 ml / kg), prednisolone (5-10 mg / kg / day) intravenously or intramuscularly.

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