Complications during preventive vaccinations in children

In early childhood, especially in the first year of life, the largest number of vaccinations is carried out. Vaccines are administered to the child's body, differing in immunogenic, allergenic, and mutagenic properties. This inertness was explained by the sterile conditions of the fetus in the intrauterine period, excluding the possibility of exogenous antigenic stimulation. In recent years, views on the immunological reactivity of children at an early age have been subject to significant revision. These data served as the basis for revising immunological contraindications. Hyperdiagnosis of post-vaccination complications often leads to the fact that various intercurrent diseases occurring in children in the post-vaccination period are taken for them, especially if they appeared in the first days after vaccination. Coincidences of various diseases with vaccinations can often occur, since the modern vaccination calendar for children of the first 2 years of life is very saturated, with vaccinations following one after another with short intervals. The main mandatory vaccinations (against tuberculosis, polio, whooping cough, diphtheria, tetanus, measles) are done at an early age, when the body's immune system is not yet perfect. Therefore, properly planned immunization schemes can contribute to the child's immunological maturation, and excessive ones can suppress it. When deciding whether to vaccinate at an early age with a particular vaccine, the following should be taken into account:

a) clinical and epidemiological indications;

b) the child's ability to fully develop immunity to a given specific antigen;

c) the tendency to develop severe reactions and complications during vaccination;

d) the influence of each previous vaccine on the body's corresponding response to the next immunization with other antigens.

The complication after immunization with the DTP vaccine came in first place among post-vaccination complications. The number of patients with post-vaccination complications after measles vaccination has significantly decreased.

Time frame for development of post-vaccination reactions and complications:

BCG vaccine – local reaction, infiltrate 5-10 mm, h-z 4-6 t. after vaccination, severe local reaction: soft tissue edema more than 20 mm, infiltrate more than 10 mm 5-7 days after revaccination.

General reaction – fever without pronounced impairment of the child’s general condition, first 2 days.

Complications:

Subcutaneous cold abscesses (impaired injection technique).

Superficial ulcer (impaired injection technique).

Regional lymphadenitis, colloid scar, osteomyelitis, generalized BCG – infection.

ADP, ADP

Local reaction – hyperemia of the skin, infiltrate.

Severe reaction – soft tissue edema more than 5 cm in diameter, infiltrate more than 2 cm.

General reaction: fever without pronounced impairment of the child’s general condition.

Severe reaction: fever above 38.60C. First two days.

Allergic complications: Kvitka-type edema, urticaria-type rash, exacerbation of allergic diseases (up to 10 days). In some cases, anaphylactic shock-type reactions (up to 24 hours).

Collaptoid state - decreased muscle tone, sharp pallor, dizziness, drowsiness, cardiovascular or respiratory failure (7 days).

Encephalopathy - impaired brain function, increased intracranial pressure (in children, continuous shrill cry), impaired consciousness, convulsions, pathological reflexes, limb paresis. In some cases, encephalitis (up to 7 days).

Residual state - the occurrence of convulsions at a temperature below 390C, acute nephritis, acute myocarditis, serous meningitis (up to 30 days).

Live polio vaccine

Reaction - intestinal dysfunction for no more than 2-3 days.

Complications - frail paresis of the extremities (most often lower) (7-30 days), rash, angioedema (up to 10 days).

Vaccination against rubella

Local reaction - hyperemia (1-3 days)

General reaction - fever, rash, enlarged lymph nodes (7-14 days, duration no more than 1-2 days).

Complications:

Urticaria-like rash (10 days) anaphylactic shock (24 hours).

Encephalopathy: convulsions associated with fever. Acute arthralgia, acute polyarthritis (for 14-30 days), transient polyneuropathy (14-30 days).

Hepatitis B vaccine.

Local: pain, hyperemia, swelling, itching, redness, hardening at the injection site (1-4 days).

General: short-term deterioration of well-being, low-grade fever (1-3 days).

Complications: Quincke's edema, serum sickness-like reaction with the development of arthritis and skin manifestations (erythema, ecchymoses, erythema nodosum (up to 30 days). Anaphylactic reactions (24 hours). In some cases, myalgia, peripheral neuropathy, facial nerve paralysis, Guillain-Barré syndrome, optic nerve neuritis (up to 30 days).

Vaginal diseases

Local: hyperemia and edema of tissues (1-3 days).

General: fever 38°C, catarrhal phenomena from the upper respiratory tract and eyes, decreased appetite, weakness, headache, rarely - rash. (6-12 days).

Complications: allergic complications, polymorphic rash, Quincke's edema, arthralgia (12 days), anaphylactic shock (24 hours).

Encephalopathy: convulsions, impaired consciousness, increased intracranial pressure, in some cases encephalitis (10-15 days).

Toxic complications: temperature above 38.60C, manifestations of intoxication, pronounced catarrhal symptoms, rash (6-16 days).

Acute myocarditis

Vaginal diseases

Local: hyperemia (1-3 days).

General: temperature increase to 37.50C, mild hyperemia of the pharynx, runny nose, decreased appetite, abdominal pain (4-10 days).

Painless enlargement of the salivary glands.

Complications: urticaria-like rash, Quincke's edema (1-16 days), convulsions, impaired consciousness (7-15 days), high fever (more than 38.5), vomiting, abdominal pain.

Serious meningitis on the background of elevated temperature.

Therapy of post-vaccination complications is carried out with a review of their nature, severity of the course, the age of the child, and its individual characteristics.

From the timeliness and correctness of the prescription of therapeutic measures, especially in severe forms of complications, the outcome of the disease depends.

Comprehensive therapy of post-vaccination complications includes both specific (etiotropic) and non-specific treatment (pathogenetic). An important place in the treatment of these patients is occupied by the correct regimen, rational diet and good care.

In accordance with the Law of Ukraine “On ensuring the sanitary and epidemiological well-being of the population” and in order to improve the quality of immunization and implement scientifically based epidemiological surveillance of post-vaccination reactions and complications, a new order of the Ministry of Health of Ukraine dated 4.3.98 No. 49 was issued. This order speaks about separate points of epidemiological surveillance and registration of post-vaccination complications and their epidemiological investigation.

Detection of PVR and PVU is carried out by:

- medical workers performing vaccination.

- medical workers performing treatment of patients with PVR and PVU in various medical institutions.

- parents, previously informed about possible reactions after vaccination.

All cases of PVR and PVU are subject to registration, namely:

1. All abscesses at the site of vaccine administration.

2. All fatalities occurring within 30 days after immunization.

3. All cases of hospitalization related to immunization.

4. Other disorders related to immunization.

Usual and severe PVR and PVU are registered in the child's vaccination and developmental history card or outpatient card.

Lists of patients are recorded and submitted to epidemiological institutions once a month, as well as data on the total number of usual reactions.

In order to maximize children's adherence to preventive vaccinations and to prevent unusual reactions and complications, a large role will be played by the rational organization of the work of pediatricians and immunologists.

Vaccination in children's polyclinics only after examination by a district pediatrician and according to his prescription, because it is the district pediatrician who constantly supervises for the child and only he can give a correct assessment of his health status, and also conduct health measures before vaccination for children who are weakened and often sick.


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Vaccines are administered to the child's body, differing in immunogenic, allergenic, and mutagenic properties. This inertness was explained by the sterile conditions of the fetus in the intrauterine period, excluding the possibility of exogenous antigenic stimulation. In recent years, views on the immunological reactivity of children at an early age have been subject to significant revision. These data served as the basis for revising immunological contraindications. Hyperdiagnosis of post-vaccination complications often leads to the fact that various intercurrent diseases occurring in children in the post-vaccination period are taken for them, especially if they appeared in the first days after vaccination. Coincidences of various diseases with vaccinations can often occur, since the modern vaccination calendar for children of the first 2 years of life is very saturated, with vaccinations following one after another with short intervals. The main mandatory vaccinations (against tuberculosis, polio, whooping cough, diphtheria, tetanus, measles) are done at an early age, when the body's immune system is not yet perfect. Therefore, properly planned immunization schemes can contribute to the child's immunological maturation, and excessive ones can suppress it. When deciding whether to vaccinate at an early age with a particular vaccine, the following should be taken into account: a) clinical and epidemiological indications; b) the child's ability to fully develop immunity to a given specific antigen; c) the tendency to develop severe reactions and complications during vaccination; d) the influence of each previous vaccine on the body's corresponding response to the next immunization with other antigens. The complication after immunization with the DTP vaccine came in first place among post-vaccination complications. The number of patients with post-vaccination complications after measles vaccination has significantly decreased. Time frame for development of post-vaccination reactions and complications: BCG vaccine – local reaction, infiltrate 5-10 mm, h-z 4-6 t. after vaccination, severe local reaction: soft tissue edema more than 20 mm, infiltrate more than 10 mm 5-7 days after revaccination. General reaction – fever without pronounced impairment of the child’s general condition, first 2 days. Complications: Subcutaneous cold abscesses (impaired injection technique). Superficial ulcer (impaired injection technique). Regional lymphadenitis, colloid scar, osteomyelitis, generalized BCG – infection. ADP, ADP Local reaction – hyperemia of the skin, infiltrate. Severe reaction – soft tissue edema more than 5 cm in diameter, infiltrate more than 2 cm. General reaction: fever without pronounced impairment of the child’s general condition. Severe reaction: fever above 38.60C. First two days. Allergic complications: Kvitka-type edema, urticaria-type rash, exacerbation of allergic diseases (up to 10 days). In some cases, anaphylactic shock-type reactions (up to 24 hours). Collaptoid state - decreased muscle tone, sharp pallor, dizziness, drowsiness, cardiovascular or respiratory failure (7 days). Encephalopathy - impaired brain function, increased intracranial pressure (in children, continuous shrill cry), impaired consciousness, convulsions, pathological reflexes, limb paresis. In some cases, encephalitis (up to 7 days). Residual state - the occurrence of convulsions at a temperature below 390C, acute nephritis, acute myocarditis, serous meningitis (up to 30 days). Live polio vaccine Reaction - intestinal dysfunction for no more than 2-3 days. Complications - frail paresis of the extremities (most often lower) (7-30 days), rash, angioedema (up to 10 days). Vaccination against rubella Local reaction - hyperemia (1-3 days) General reaction - fever, rash, enlarged lymph nodes (7-14 days, duration no more than 1-2 days). Complications: Urticaria-like rash (10 days) anaphylactic shock (24 hours). Encephalopathy: convulsions associated with fever. Acute arthralgia, acute polyarthritis (for 14-30 days), transient polyneuropathy (14-30 days). Hepatitis B vaccine. Local: pain, hyperemia, swelling, itching, redness, hardening at the injection site (1-4 days). General: short-term deterioration of well-being, low-grade fever (1-3 days). Complications: Quincke's edema, serum sickness-like reaction with the development of arthritis and skin manifestations (erythema, ecchymoses, erythema nodosum (up to 30 days). Anaphylactic reactions (24 hours). In some cases, myalgia, peripheral neuropathy, facial nerve paralysis, Guillain-Barré syndrome, optic nerve neuritis (up to 30 days). Vaginal diseases Local: hyperemia and edema of tissues (1-3 days). General: fever 38°C, catarrhal phenomena from the upper respiratory tract and eyes, decreased appetite, weakness, headache, rarely - rash. (6-12 days). Complications: allergic complications, polymorphic rash, Quincke's edema, arthralgia (12 days), anaphylactic shock (24 hours). Encephalopathy: convulsions, impaired consciousness, increased intracranial pressure, in some cases encephalitis (10-15 days). Toxic complications: temperature above 38.60C, manifestations of intoxication, pronounced catarrhal symptoms, rash (6-16 days). Acute myocarditis Vaginal diseases Local: hyperemia (1-3 days). General: temperature increase to 37.50C, mild hyperemia of the pharynx, runny nose, decreased appetite, abdominal pain (4-10 days). Painless enlargement of the salivary glands. Complications: urticaria-like rash, Quincke's edema (1-16 days), convulsions, impaired consciousness (7-15 days), high fever (more than 38.5), vomiting, abdominal pain. Serious meningitis on the background of elevated temperature. Therapy of post-vaccination complications is carried out with a review of their nature, severity of the course, the age of the child, and its individual characteristics. From the timeliness and correctness of the prescription of therapeutic measures, especially in severe forms of complications, the outcome of the disease depends. Comprehensive therapy of post-vaccination complications includes both specific (etiotropic) and non-specific treatment (pathogenetic). An important place in the treatment of these patients is occupied by the correct regimen, rational diet and good care. In accordance with the Law of Ukraine “On ensuring the sanitary and epidemiological well-being of the population” and in order to improve the quality of immunization and implement scientifically based epidemiological surveillance of post-vaccination reactions and complications, a new order of the Ministry of Health of Ukraine dated 4.3.98 No. 49 was issued. This order speaks about separate points of epidemiological surveillance and registration of post-vaccination complications and their epidemiological investigation. Detection of PVR and PVU is carried out by: - medical workers performing vaccination. - medical workers performing treatment of patients with PVR and PVU in various medical institutions. - parents, previously informed about possible reactions after vaccination. All cases of PVR and PVU are subject to registration, namely: 1. All abscesses at the site of vaccine administration. 2. All fatalities occurring within 30 days after immunization. 3. All cases of hospitalization related to immunization. 4. Other disorders related to immunization. Usual and severe PVR and PVU are registered in the child's vaccination and developmental history card or outpatient card. Lists of patients are recorded and submitted to epidemiological institutions once a month, as well as data on the total number of usual reactions. In order to maximize children's adherence to preventive vaccinations and to prevent unusual reactions and complications, a large role will be played by the rational organization of the work of pediatricians and immunologists. Vaccination in children's polyclinics only after examination by a district pediatrician and according to his prescription, because it is the district pediatrician who constantly supervises for the child and only he can give a correct assessment of his health status, and also conduct health measures before vaccination for children who are weakened and often sick.
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