Contraindications to vaccination

Modern vaccines have a minimum of contraindications, they are released as much as possible from ballast substances, preservatives and allergens, so that they can be used in the vast majority of children and adults without any preliminary research or analysis. To all vaccines there are two interrelated contraindications - allergic reactions to vaccine components and a strong reaction or complication to the previous dose of this vaccine.

[1], [2], [3], [4], [5]

Relative (temporary) contraindications for vaccination

A relative (temporary) contraindication is the presence of a vaccinated acute or exacerbation of a chronic disease, since in the case of development of its complication or adverse outcome, the vaccine can be put forward as their cause. Experience has shown that during vaccination according to epidemics of children with acute pathology, the number of reactions and complications does not increase, and the immune response is adequate. Vaccination of pregnant women is also undesirable: although the teratogenic effect of vaccines, including live vaccines, is not proven, vaccination can be associated with the complication or birth of a defective child.

For each vaccine, there are a number of contraindications, the strict adherence to which ensures the maximum effectiveness and safety of vaccine prophylaxis.

Reducing the number of contraindications was made possible by improving the quality of vaccines and increasing knowledge about the causes of complications. Most chronic diseases are excluded from the list, only a few pathologies that increase the risk of complications are left. Compliance with contraindications protects not only the vaccinated, but also the medical worker from possible charges. But an expanded interpretation of contraindications is unacceptable, an increase in the number of unreasonable offtakes reduces immunization coverage and, as the experience of the USSR and other countries has shown, is fraught with an epidemic of controlled infections.

Despite the reduction in the number of contraindications and the increase in immunization coverage, we observe a reduction in the frequency of severe reactions and complications, the bulk of them being of an individual nature that can not be foreseen, i.e. To associate with the previous state of the vaccinated. This is facilitated by the following rules for vaccinating special groups with health problems that require special treatment.

List of medical contraindications for immunization of the National Immunization Calendar *

Vaccine	Contraindications
All vaccines	Strong reaction or complication to previous vaccine administration
All live vaccines	Immunodeficiency status (primary) Immunosuppression; malignant neoplasms Pregnancy
BCG	Weight of child at birth less than 2000 g Keloid scar
DTP	Progressive diseases of the nervous system Afebra Cramps in history
Live vaccines: measles (LCV), mumps (HPV), rubella, as well as combined di- and trivaccines	Severe forms of allergic reactions to aminoglycosides (gentamicin, kanamycin, etc.) For foreign-made vaccines prepared on chick embryos: anaphylactic reaction to egg hen protein
Hepatitis B vaccine (HBV)	Allergic reaction to baker's yeast
Flu	Allergic reaction to egg white protein, aminoglycosides, a strong reaction to the previous of any influenza vaccine. Contraindications for live vaccines - see Instructions for Use.

* Acute infectious and non-infectious diseases, exacerbation of chronic diseases are temporary contraindications for vaccination. Scheduled vaccinations are carried out 2-4 weeks after recovery or during the period of convalescence or remission. With mild ARVI, acute intestinal diseases and other vaccinations are carried out immediately after the normalization of temperature.

False contraindications to vaccination

In practice, there are often cases of "withdrawal" from vaccination of children who do not have any contraindications. The main unjustified reasons for the withdrawals and delays of vaccination are "perinatal encephalopathy", "dysbacteriosis", "thymomegalia", allergy and anemia. Refusal of parents, although referred to, occurs in less than 1% of cases, and it can be significantly reduced by persistent explanatory work.

"Perinatal encephalopathy" (PEP) as a diagnosis is excluded by a new classification, CNS pathology should be indicated by specific terms. The acute period of perinatal damage ends within the first month of life, after which stable or regressing residual disorders may occur - in the form of muscular dystonia, delay in the formation of mental and motor functions, disturbance of the periodicity of sleep and wakefulness. Usually they were considered anxiety (most often associated with colic), a Gref symptom (variant of the norm) or a chin tremor (a hereditary dominant trait). Not surprisingly, the "diagnosis" of PEP has recently had 80-90% of all children of the 1st year at the polyclinic site!

In such children, the neurologist should only confirm the absence of a progressive pathology, which gives the pediatrician the grounds to instill the child on time; withdrawal of a neurologist is legitimate only if the child has afebrile seizures, hydrocephalus or other progressive CNS disease.

Dysbacteriosis as a diagnosis is justified only in a patient with a stool disorder against a background of massive antibiotic therapy, when the question of vaccination usually does not arise. In other cases, this diagnosis is not legitimate: a violation of the intestinal biocenosis is secondary for any intestinal disease: intestinal infection, food intolerance, impaired absorption of lactose and other carbohydrates, celiac disease, irritable bowel syndrome. Analyzes "on a dysbacteriosis" in these cases (and furthermore at a normal chair) are not necessary, since. Do not clarify the true cause of the disorder, besides they are expensive. In any case, changes in the microbial flora of the stool are not an excuse for withdrawing from vaccination or delaying it.

An increase in the shade of the thymus on the roentgenogram is usually detected by chance, it is either an anatomical variant or a result of its post-stress hyperplasia, in both cases the diagnosis of thymomegaly is illegal. Such children respond normally to vaccination and should be vaccinated on time.

Allergies in the child is not an excuse for not taking vaccinations, the rules for their implementation are outlined below. The use of ointments with steroids (as well as with pimecrolimus - Elidel), steroids in the form of sprays or inhalations does not prevent vaccination.

Anemia of alimentary genesis should not be the reason for withdrawing from vaccination; after it is carried out, the child should be prescribed an iron preparation. Severe anemia requires clarification of its cause, followed by a decision on the nature of therapy and the timing of vaccination.

There can be no contraindication to maintenance treatment (antibiotics, endocrine, cardiac, etc.), as well as anamnestic data on serious diseases in the absence of their active manifestations. Indication of family history of epilepsy, complications of vaccine administration, allergy of any form, death of siblings in the post-vaccination period should not serve as a diversion from vaccinations. Exception - the presence in the family of a patient with immunodeficiency - requires a newborn before the introduction of BCG and the replacement of OPV with IPV.

[6], [7], [8], [9],