How are the complications after vaccinations treated?

Local post-vaccination reactions

Small redness, tenderness and swelling at the injection site usually do not require active treatment. Cold "subcutaneous infiltrates flow torpid, their resorption is sometimes accelerated by local procedures (" honey cakes ", balsamic ointments). Abscesses and suppuration require antibacterial therapy (oxacillin, cefazolin, etc.), and according to indications - surgical intervention.

Hyperthermia

The increase in temperature can easily be prevented by paracetamol or ibuprofen - enter them before the introduction of the inactivated vaccine.

At a temperature of 38-39 °, paracetamol is prescribed in a single dose of 15 mg / kg inwards, the dose of ibuprofen is 5-7 mg / kg. With persistent hyperthermia above 40 °, 50% Analginum IM is injected (0.015 ml / kg); inside it, like nimesulide (Naise, Nimulide) do not use at all because of toxicity. Against the background of antipyretics with good blood supply (redness of the skin), open the child, direct the stream of the fan to it, wipe it with water at room temperature.

When hyperthermia with a sharp pallor of the skin, chill to eliminate the spasm of peripheral blood vessels, rub the skin with warm water, 40% alcohol, vinegar (1 tablespoon per glass of water), give inside aufillin (0.008-0.05), nicotinic acid (0.015- 0.025). The child should drink 80-120 ml / kg / day - a glucose-saline solution (Regidron, Oralit) in half with other liquids - sweet tea, juices, mors.

Acute flaccid paralysis

The diagnosis of vaccine-associated poliomyelitis (VAP) is likely when it develops from the 4th to the 36th day after OPV, until the 60th day (rarely more) in the contact with the vaccinated and up to 6 months. And more in immunodeficient contact. VAP criteria: residual paresis after 60 days, absence of contact with a patient with poliomyelitis, vaccine virus in 1 or 2 stool samples (taken as soon as possible at intervals of 1 day) and a negative result of 2 samples for wild virus. Treatment is carried out in a hospital.

Isolated paresis of the facial nerve (Bell's paralysis) as an ORP is not recorded. Traumatic injuries of the sciatic nerve when injected into the buttock pass spontaneously for several days and do not require treatment.

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

Convulsions

Short-term convulsions, as a rule, do not require therapy. With incessant and repeated seizures, a lumbar puncture is indicated. For the cramping of seizures, diazepam 0.5% rr in / m or iv in 0.2-0.4 mg / kg per injection (no faster than 2 mg / min) or rectally - 0.5 mg / kg, but not more than 10 mg. If there is no effect, you can enter a repeated dose of diazepam (max 0.6 mg / kg for 8 hours) or iv sodium oxybutyrate (GHB) 20% rp (5% glucose) 100 mg / kg or give anesthesia.

[5], [6], [7], [8], [9], [10],

Encephalopathy

Encephalopathy (encephalic syndrome) is not just convulsions (although they are common in encephalopathy), but other disorders of the central nervous system, including disorders of consciousness (> 6 hours). Treatment options: dehydration: 15-20% rn mannitol iv in (1-1.5 g / kg dry matter), diuretic in / m or / in - furosemide (1-3 mg / kg / day in 2-3 admission) with the transition to acetazolamide (Diakarb inside 0.05-0.25 g / day in 1 reception), acting more slowly. With more persistent changes from the side of the central nervous system, steroids.

[11], [12], [13], [14], [15], [16], [17]

Allergic reactions

In children prone to allergic reactions, they are warned by the administration of anti-histamine agents before and after vaccination. In the first year of life, only Zirtek is used from the new generations.

In severe cases of allergic complications, prednisolone is administered orally (1-2 mg / kg / day) or parenterally 2-5 mg / kg / day, dexamethasone inside (0.15-0.3 mg / kg / day) or parenterally (0.3-0.6 mg / kg / day). The effectiveness of 0.5 mg dexamethasone (1 table) corresponds to approximately 3.5 mg of prednisolone or 15 mg of hydrocortisone.

[18], [19], [20],

Anaphylactic shock

Anaphylactic shock is the main form of preventable lethality associated with vaccination, in its treatment the decisive is the willingness to provide help. In the vaccination room (or in the kit for vaccination) should be anti-shock kit. In shock, a dose of adrenaline (epinephrine) hydrochloride (0.1%) or norepinephrine hydrotartrate (0.2%) is injected immediately or shocked with 0.01 ml / kg, maximum 0.3 ml, repeatedly if necessary every 20 min until the patient is removed from a serious condition. When the reaction to subcutaneous injection develops, a second dose of epinephrine is injected at the injection site to narrow the subcutaneous vessels. If the drug was administered intramuscularly, then it is not possible to inject sympathomimetics at the injection site, since they dilate the vessels of skeletal muscles. To reduce the incidence of antigen, if possible, apply a tourniquet (on the shoulder).

If the patient's condition does not improve, sympathomimetic is administered intravenously in 10 ml of 0.9% sodium chloride solution (0.01 ml / kg 0.1% solution of epinephrine, or 0.2% noradrenaline solution, or 0.1-0.3 ml of a 1% solution of mezatone). At the same time, an antihistamine in the age group is administered in / m.

More effectively drip IV administration of these drugs, which contributes to the correction of hypovolemia. To do this, 1 ml of a 0.1% solution of epinephrine is diluted in 250 ml of a 5% glucose solution, which gives a concentration of 4 μg / ml. Infusion begins at 0.1 μg / kg / min and is adjusted to the required level to maintain blood pressure - no more than 1.5 μg / kg / min. In some cases, the maintenance of blood pressure requires the introduction of an inotropic agent, for example, dopamine IV in a dose of 5-20 μg / kg / min.

The child is laid on his side (vomit!), Overlaid with heating pads, the elders are given hot tea or coffee with sugar and provide access to fresh air; according to the indications - O ₂ through the mask; caffeine n / k or in / m; intravenously, korglikon or strophanthin.

With the development of bronchospasm inhaled beta ₂ -mimetik through a metered-dose inhaler or through a nebulizer or intravenously administered euphillin at a dose of 4 mg / kg in 10-20 ml of saline. When the collapse is poured plasma or its substitutes. In acute edema of the larynx, intubation or tracheotomy is indicated. When breathing is abnormal - ventilation.

Corticosteroid drugs to combat the first manifestations of shock are not for: they change epinephrine, their administration, however, can reduce during the next 12-24 hours the severity of later manifestations - bronchospasm, urticaria, edema, intestinal spasm and other smooth muscle organs. In / in or / m inject half the daily dose of a solution of prednisolone (3-6 mg / kg / day) or dexamethasone (0.4-0.8 mg / kg / day), if necessary, this dose is repeated. Further treatment, if necessary, is done with oral medications (prednisolone 1-2 mg / kg / day, dexamethasone 0.15-0.3 mg / kg / day). It is advisable to appoint a combination of H ₁ and H ₂ -blockers (Zirtek 2.5-10 mg / day or Suprastin 1-1.5 mg / kg / day in combination with cimetidine 15-30 mg / kg / day).

All patients after first aid and removal from a threatening state should be urgently hospitalized, preferably by special transport, since on the way their condition may worsen and require urgent medical measures.

In the case of collaptoid (hypotensive-hypo-responsive) reactions, adrenaline, steroids are administered. Lighter forms of anaphylactoid reactions - pruritus, rashes, Quincke's edema, urticaria require adrenaline injection subcutaneously (1-2 injections) or H ₁ blocker 24 hours - better in combination with H ₂ -blockers inside (cimetidine 15-30 mg / kg / day , ranitidine 2-6 mg / kg / day).

Instructions for the treatment of shock should be in each inoculum.

[21], [22], [23],

Therapy with improper administration of vaccines

Incorrect subcutaneous or intramuscular administration of BCG requires specific chemotherapy (see below), and monitoring of the tuberculosis dispensary. An increase in the dose of HPV, HCV, OPV, parenteral administration of the latter, and the dilution of live measles vaccine inactivated (DTP, ADS) usually does not give clinical manifestations and does not require therapy. In case of erroneous subcutaneous administration of live vaccines against plague and tularemia, divorced for cutaneous application shows a 3-day course of antibiotic. With increasing doses of DTP, ADP and AC, HAV and HBV, other inactivated vaccines, antipyretics and antihistamines are shown in the first 48 hours. When the dose of live bacterial vaccines is increased, the corresponding antibiotics are shown for 5-7 days in a therapeutic dose.