How are complications from immunizations treated?

Local post-vaccination reactions

Minor redness, soreness and swelling at the injection site usually do not require active treatment. "Cold" subcutaneous infiltrates flow slowly, their resorption is sometimes accelerated by local procedures ("honey cakes", balsamic ointments). Abscesses and suppurations require antibacterial therapy (oxacillin, cefazolin, etc.), and, if indicated, surgical intervention.

Hyperthermia

An increase in temperature can be easily prevented by paracetamol or ibuprofen - administered before the inactivated vaccine is administered.

At a temperature of 38-39°, paracetamol is prescribed in a single dose of 15 mg/kg orally, the dose of ibuprofen is 5-7 mg/kg. In case of persistent hyperthermia above 40°, 50% Analgin is administered intramuscularly (0.015 ml/kg); it is not used orally at all, like nimesulide (Nise, Nimulid), due to toxicity. Against the background of antipyretics, with good blood supply (reddening of the skin), the child is uncovered, a fan stream is directed at him, and he is wiped with water at room temperature.

In case of hyperthermia with severe pallor of the skin, chills to eliminate spasm of peripheral vessels, rub the skin with warm water, 40% alcohol, vinegar solution (1 tablespoon per glass of water), give euphyllin (0.008-0.05), nicotinic acid (0.015-0.025) orally. The child should drink - 80-120 ml / kg / day - glucose-salt solution (Regidron, Oralit) in half with other liquids - sweet tea, juices, fruit drinks.

Acute flaccid paralysis

The diagnosis of vaccine-associated poliomyelitis (VAP) is probable if it develops from the 4th to the 36th day after OPV, up to the 60th day (rarely more) in contacts with a vaccinated person, and up to 6 months or more in immunocompromised contacts. VAP criteria: residual paresis after 60 days, no contact with a polio patient, vaccine virus in 1 or 2 stool samples (taken as early as possible with an interval of 1 day) and a negative result of 2 tests for wild virus. Treatment is carried out in a hospital.

Isolated facial nerve paresis (Bell's palsy) is not registered as an acute respiratory failure. Traumatic injuries of the sciatic nerve with injection into the buttock resolve spontaneously within a few days and do not require treatment.

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Cramps

Short-term seizures usually do not require therapy. In case of persistent or repeated seizures, lumbar puncture is indicated. To stop seizures, diazepam 0.5% solution is used intramuscularly or intravenously at 0.2-0.4 mg/kg per injection (not faster than 2 mg/min) or rectally - 0.5 mg/kg, but not more than 10 mg. If there is no effect, a repeat dose of diazepam can be administered (max. 0.6 mg/kg over 8 hours) or intravenous sodium oxybutyrate (GHB) 20% solution (in 5% glucose solution) 100 mg/kg, or general anesthesia is given.

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Encephalopathy

Encephalopathy (encephalic syndrome) is not just seizures (although they are common in encephalopathy), but also other disorders of the central nervous system, including disorders of consciousness (>6 hours). Treatment options: dehydration: 15-20% mannitol solution intravenously (1-1.5 g/kg dry matter), diuretics intramuscularly or intravenously - furosemide (1-3 mg/kg/day in 2-3 doses) with a transition to acetazolamide (Diacarb orally 0.05-0.25 g/day in 1 dose), which acts more slowly. In case of more persistent changes in the central nervous system - steroids.

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Allergic reactions

In children prone to allergic reactions, they are prevented by administering antihistamines before and after vaccination. In the first year of life, only Zyrtec is used from the new generations.

In severe cases of allergic complications, prednisolone is prescribed orally (at a dose of 1-2 mg/kg/day) or parenterally - 2-5 mg/kg/day, dexamethasone orally (0.15-0.3 mg/kg/day) or parenterally (0.3-0.6 mg/kg/day). In terms of effectiveness, 0.5 mg of dexamethasone (1 tablet) is approximately equivalent to 3.5 mg of prednisolone or 15 mg of hydrocortisone.

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Anaphylactic shock

Anaphylactic shock is the main form of preventable mortality associated with vaccination, and the willingness to provide assistance is critical in its treatment. An anti-shock kit should be available in the vaccination room (or vaccination kit). In case of shock, immediately administer a dose of adrenaline (epinephrine) hydrochloride (0.1%) or noradrenaline hydrotartrate (0.2%) subcutaneously or intramuscularly 0.01 ml/kg, maximum 0.3 ml, repeated if necessary every 20 minutes until the patient is no longer in a serious condition. If a reaction to subcutaneous administration develops, a second dose of adrenaline is administered at the injection site to constrict the subcutaneous vessels. If the drug was administered intramuscularly, sympathomimetics should not be administered at the injection site, as they dilate skeletal muscle vessels. If possible, a tourniquet (on the shoulder) is applied to reduce the intake of antigen.

If the patient's condition does not improve, the sympathomimetic is administered intravenously in 10 ml of 0.9% sodium chloride solution (0.01 ml/kg of 0.1% adrenaline solution, or 0.2% norepinephrine solution, or 0.1-0.3 ml of 1% mesaton solution). At the same time, an antihistamine is administered intramuscularly in an age-appropriate dose.

More effective is intravenous drip administration of these agents, which also helps to correct hypovolemia. For this, 1 ml of 0.1% adrenaline solution is diluted in 250 ml of 5% glucose solution, which gives its concentration of 4 mcg/ml. Infusion begins with 0.1 mcg/kg/min and is brought to the required level to maintain blood pressure - no more than 1.5 mcg/kg/min. In some cases, an inotropic agent is required to maintain blood pressure, for example, intravenous dopamine at a dose of 5-20 mcg/kg/min.

The child is placed on his side (vomiting!), covered with heating pads, older children are given hot tea or coffee with sugar and provided with access to fresh air; according to indications - O2 _through a mask; caffeine subcutaneously or intramuscularly; intravenously corglycon or strophanthin.

If bronchospasm develops, beta ₂ -mimetic is inhaled through a metered-dose inhaler or through a nebulizer, or euphyllin is administered intravenously at a dose of 4 mg/kg in 10-20 ml of saline. In case of collapse, plasma or its substitutes are transfused. Intubation or tracheotomy is indicated in case of acute laryngeal edema. In case of respiratory failure, artificial ventilation is used.

Corticosteroids to combat the first manifestations of shock do not replace adrenaline, but their administration can reduce the severity of later manifestations over the next 12-24 hours - bronchospasm, urticaria, edema, intestinal spasm and other smooth muscle spasm. Half of the daily dose of prednisolone solution (3-6 mg/kg/day) or dexamethasone (0.4-0.8 mg/kg/day) is administered intravenously or intramuscularly, and this dose is repeated if necessary. Further treatment, if necessary, is carried out with oral drugs (prednisolone 1-2 mg/kg/day, dexamethasone 0.15-0.3 mg/kg/day). It is advisable to prescribe a combination of H1 _and H2 _blockers (Zyrtec 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 has been given to them and they have been brought out of a life-threatening condition, should be urgently hospitalized, preferably by special transport, since their condition may worsen on the way and require urgent medical measures.

In case of collaptoid (hypotensive-hyporesponsive) reactions, adrenaline and steroids are administered. Milder forms of anaphylactoid reactions - itching, rashes, Quincke's edema, urticaria require the administration of adrenaline subcutaneously (1-2 injections) or H1 _blocker 24 hours - better in combination with H2 _blockers orally (cimetidine 15-30 mg/kg/day, ranitidine 2-6 mg/kg/day).

Instructions for treating shock should be available in every vaccination room.

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Treatment for incorrectly administered vaccines

An erroneous subcutaneous or intramuscular administration of BCG requires specific chemotherapy (see below) and observation at a tuberculosis dispensary. Increasing the dose of ZPV, ZHCV, OPV, parenteral administration of the latter, as well as dilution of live inactivated measles vaccine (DPT, ADS) usually does not produce clinical manifestations and does not require therapy. In case of erroneous subcutaneous administration of live vaccines against plague and tularemia, diluted for cutaneous application, a 3-day course of antibiotics is indicated. When increasing the dose of DPT, ADS and AS, HAV and HBV, other inactivated vaccines, antipyretics and antihistamines are indicated for the first 48 hours. When increasing the dose of live bacterial vaccines, the corresponding antibiotics are indicated for 5-7 days at a therapeutic dose.