Vaccination with health conditions

Neurological diseases

Progressive neurological pathology - decompensated hydrocephalus, neuromuscular dystrophies, degenerative diseases and CNS lesions in congenital metabolic defects - are contraindications to the use of DPT due to the risk of seizures, but can be considered in terms of vaccination with Infanrix or ADS when the process is stabilized. Children with hydrocephalus can be vaccinated 1 month after compensation of the process (achieved conservatively or surgically). To determine the progression of the disease, a child is referred to a neurologist at 1-2 months of life, but the question of vaccination is decided by the pediatrician. In doubtful cases, the exemption concerns only the pertussis component, IPV, ADS and HBV are administered in a timely manner. DPT is also contraindicated in case of a history of afebrile seizures; These children are examined to detect epilepsy, and vaccinations are given to them after the diagnosis has been clarified against the background of anticonvulsant therapy.

Patients with multiple sclerosis are vaccinated during the period of remission with inactivated vaccines (except for the hepatitis B vaccine).

Children with a history of febrile seizures are given DPT simultaneously with paracetamol (15 mg/kg 3-4 times a day for 1-2 days). Children whose condition is designated as “convulsive readiness” are vaccinated as usual, possibly against the background of therapy with sedatives and dehydration (see below).

Stable and regressing neurological symptoms (Down's syndrome, cerebral palsy, consequences of injuries, etc.): in the absence of afebrile seizures, children are vaccinated according to the calendar, including against the background of therapy prescribed by a neurologist. Children who received diuretics (Triampur, Diacarb) for the so-called hypertensive-hydronephic syndrome can be prescribed them again 1 day before and 1-2 days after vaccination.

In case of increased nervous excitability syndrome, a sedative (valerian, mixture with citral) can be prescribed during the vaccination period. Children who have had meningococcal meningitis are vaccinated no earlier than 6 months after recovery. Children with mental illnesses outside the acute period, with mental retardation do not require drug preparation for vaccination.

Allergy

The opinion that vaccines "allergenize" is wrong, they practically do not stimulate a stable increase in the level of IgE and the production of specific IgE antibodies. All vaccines included in the Calendar contain much less antigens than 30-40 years ago due to their better purification. Some people have an allergy to vaccine components that can cause immediate reactions:

• Aminoglycosides - vaccines against measles, rubella, mumps;
• Chicken egg white - measles and mumps vaccines of foreign manufacture, influenza vaccines, yellow fever vaccine;
• Gelatin - chickenpox vaccine;
• Baker's yeast - vaccines against hepatitis B.

When collecting anamnesis, not only the presence of reactions is clarified, but also their nature; it is dangerous to vaccinate (with foreign measles and trivacine, produced on chicken embryo cell cultures) only children who give an anaphylactic reaction, i.e. almost immediate development of shock or Quincke's angioedema (for example, a child develops shock, swelling of the lip or larynx immediately after the first bite of a product containing egg). Other children with hypersensitivity to eggs are vaccinated in the usual manner, but only in a polyclinic setting. Russian ZIV and ZPV are prepared on Japanese quail eggs, cross-reactions with chicken protein are rare, although possible.

Measles, mumps and rubella vaccines are not given to people with severe allergic reactions to aminoglycosides, which should be discussed before vaccination, although these reactions are rare.

Children with allergies to vaccine components should be vaccinated, if possible, with vaccines without the causative allergen. Children without anaphylactic reactions are prescribed antihistamines; in the first year of life, only Zyrtec (cetirizine) is used from drugs of the 2nd-3rd generation. Persons with a tendency to such reactions (for example, HBV in a child with an allergy to baker's yeast) are vaccinated against the background of steroid therapy (oral prednisolone 1.5-2 mg/kg/day).

In children with allergies, the risk of allergic reactions and serum sickness to the administration of anti-tetanus or anti-diphtheria serums is much higher (up to 15%) than to active immunization with anatoxins, which is a significant argument in favor of timely active immunization.

Atopic dermatitis (milk crust, nummular or intertriginous rash, diaper dermatitis, as well as seborrheic dermatitis, gneiss) - vaccination is carried out in the period of remission (complete or partial), in the subacute course of the process. The introduction of vaccines causes a transient increase in allergic manifestations in 7-15%, easily removed by antihistamines. Often, the appearance of a rash after vaccination is associated with dietary errors. Vaccination of these children is carried out in full against the background of a hypoallergenic (usually dairy-free) diet, local treatment (including ointments with steroids or pimecrolimus - Elidel) and antihistamines 1-2 days before and 3-4 days after vaccination.

True eczema. Vaccination is carried out during remission after the elimination of acute rashes, oozing and skin infection. Sometimes it takes several months to achieve remission - complete or partial, however, such children can be fully vaccinated, often already in the 1st year of life. The preservation of lichenification areas (neurodermatitis) does not prevent the introduction of vaccines (except for some skin ones). Antihistamines are prescribed 3-4 days before vaccination, local treatment is intensified (including steroid ointments) for 5-7 days after vaccination. The same tactics for vaccinating older children with inactive neurodermatitis.

Children with urticaria and Quincke's edema are vaccinated during the period of remission.

Respiratory allergy in children of the first months of life is masked by bronchiolitis or obstructive bronchitis against the background of ARVI, they are vaccinated as after any acute disease in full. If mild obstruction persists after 2-4 weeks, vaccination is carried out against the background of beta-agonists (for example, dosed inhalations of salbutamol or Berodual 1 dose 2-3 times a day) or euphyllin orally at 4 mg / kg 3 times a day. Children with 2-3 episodes of obstruction in the anamnesis, especially if the parents have allergies, are vaccinated as patients with bronchial asthma.

Bronchial asthma. Vaccinations are given in remission, and the stability of the condition is important, not the duration of the attack or the degree of impairment of the respiratory function. Basic therapy (including inhaled steroids) and beta-agonists or theophyllines can be increased by 30-50% during the vaccination period; children receiving systemic steroids are vaccinated according to the rules set out below.

Patients with hay fever tolerate vaccinations well; specific hyposensitization after them does not affect the level of specific antibodies.

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Cardiopathies and connective tissue diseases

Children with congenital heart defects and arrhythmias are vaccinated when the minimum of hemodynamic disturbances is reached, including against the background of cardiac drugs, children with rheumatism and other acquired cardiopathies - during the period of remission.

Vaccination of children with systemic connective tissue diseases in remission is recommended to be carried out against the background of NSAID therapy (2 weeks before and 6 weeks after vaccination). Children on maintenance doses of cytostatics, as well as children with remission for more than 1 year, are vaccinated without NSAIDs. Children in this category especially need vaccinations against pneumococcal infection and influenza, which they tolerate well, despite concerns about the introduction of the Grippol vaccine with polyoxidonium.

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Chronic hepatitis

Patients with chronic hepatitis, including those with incipient cirrhosis, are vaccinated in remission or low activity (minimum achievable aminotransferase activity). Even with short remission (1-6 months), they tolerate DPT or ADS-M well, and an increase in liver enzymes, if observed, is insignificant and short-lived. Vaccination of these patients is immunologically effective. It is important to vaccinate patients with CHB and CHC against hepatitis A, and with CHC - also against hepatitis B.

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Kidney diseases

Children with pyelonephritis are vaccinated during the remission period against the background of maintenance antibacterial therapy. With a remission duration of 4 months, ADS-M did not cause adverse reactions, and the immune response was adequate.

Children with chronic glomerulonephritis should be vaccinated against the background of remission with minimal activity of the process (taking into account the terms of immunosuppression), even on a low dose of steroids (1 mg / kg / day of prednisolone). With a remission duration of 6 months. No signs of exacerbation were observed after the administration of ADS-M, and the immune response was adequate. HBV even at an earlier stage is highly desirable, which allows, if necessary, to secure hemodialysis. In these children, a smooth course of ARVI helps in determining the possibility of vaccination. Experience in vaccinating children with congenital renal pathology is small, it is necessary, first of all, to focus on the degree of compensation of renal functions. Vaccinations of children with renal pathology against pneumococcal infection and influenza give good results, WHO also recommends vaccinating them against Hib infection and chickenpox.

Cystic fibrosis, chronic inflammatory lung diseases

Vaccination of these children is carried out according to the full program in a period free from exacerbations, including against the background of long-term antibacterial and other therapy (except immunosuppressive). These patients are especially recommended to be vaccinated against measles and influenza.

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Endocrine pathology

Diabetic patients are more susceptible to infections and have a number of immunological features. Those vaccinated before the manifestation of diabetes have a higher percentage of seronegativity to poliovirus type 3, a faster decrease in titers to diphtheria, low titers of antibodies to measles and mumps. Even in patients who have had measles, antibodies are not detected in 11% of cases. The ban on vaccination of diabetic patients, which existed until the early 90s (due to individual cases of necrosis and infection at the injection site and the development of ketoacidosis with metabolic instability) has been lifted, since vaccination has proven effective and safe in the compensation phase of diabetes.

Vaccination of patients with diabetes is carried out taking into account the risk of lipodystrophy in:

• satisfactory condition, fasting blood sugar no higher than 10 mmol/l;
• minimal daily glycosuria (no more than 10-20 g per day);
• normal diuresis, absence of ketone bodies in the urine;
• monitoring sugar metabolism parameters in the post-vaccination period.

For patients with diabetes, prevention of mumps is especially important, as well as hepatitis A, influenza and pneumococcal infection, which are particularly severe.

Adrenogenital syndrome. Replacement therapy with prednisolone, and in the salt-wasting form - also with deoxycorticosterone acetate, which these patients receive throughout their lives, does not induce immunosuppression and does not interfere with vaccination with any vaccines. If necessary, the dose of steroids is increased

Children with hypothyroidism, disorders of sexual development and other diseases of the endocrine glands, in the absence of signs of immunodeficiency, are vaccinated with all vaccines against the background of adequate compensation of endocrine functions.

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Diseases of the coagulation system

Hemophilia is not accompanied by defects of the immune system, the danger is associated with the possibility of bleeding with intramuscular injections. With regard to blood infections (hepatitis B), the risk of infection through blood products is many times higher. To reduce the risk of bleeding, they are given vaccines subcutaneously - in the back of the hand or foot, but for DPT, HBV, Hib vaccines this can lead to a decrease in the immune response. so they are given intramuscularly in the forearm; - in these places, the injection channel can be well mechanically compressed.

Intramuscular administration of vaccines to a patient with hemophilia is safe if it is administered shortly after the administration of the clotting factor. This, of course, only applies to inactivated vaccines, since live vaccines can be inactivated by the antibodies contained in these preparations. Live vaccines are administered 6 weeks or more after the next administration of the clotting factor.

Given the increased risk of hepatitis B infection via blood products, hemophiliacs should be vaccinated as soon as possible. Because HBV is less immunogenic when administered subcutaneously, it is preferable to administer it intramuscularly immediately after the first clotting factor administration.

Immune thrombocytopenic purpura (ITP) often develops in the first year of life, preventing the administration of the primary series of vaccinations; naturally, only in the stage of stable remission does the question of their admissibility arise.

Since more than 80% of children with immune thrombocytopenic purpura recover within 9-12 months and do not have subsequent relapses, they can be vaccinated with inactivated vaccines (ADS, ADS-M, VHBV) after stable normalization of the platelet count (the analysis should be repeated before vaccination). Although immune thrombocytopenic purpura is usually not listed as a contraindication for live vaccines, given the possibility of developing thrombocytopenia after their administration (including with the appearance of antiplatelet autoantibodies), vaccination with them should be carried out with greater caution (after a longer period of time) than with inactivated vaccines. In such cases, it is recommended to prescribe anti-inflammatory and membrane-stabilizing agents before and after vaccination. The possibility of recurrent thrombocytopenia after the administration of a measles monovalent vaccine (after MMC) makes it necessary to be cautious about repeated vaccinations with live vaccines in such individuals.

The question of vaccination of children with chronic immune thrombocytopenic purpura is decided individually.

Anticoagulant therapy carries a risk of bleeding, especially with intramuscular administration of vaccines, so the recommendations given for patients with hemophilia apply to these patients. Cholera and yellow fever vaccinations may be associated with decreased blood clotting, so they should be administered with caution in this category of patients.

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Vaccination and tuberculosis

Tuberculosis is not listed as a contraindication. Some domestic authors recommend vaccinating children with abnormal tuberculin tests and those infected after completing a course of chemoprophylaxis, and those with other forms of the disease - at the stage of sanatorium treatment against the background of anti-relapse therapy. Children infected with tuberculosis tolerate all calendar and pneumococcal vaccines well, so a delay in vaccination is justified only for the acute (initial) period of the disease. The following recommendations were approved:

• Hepatitis B vaccines and toxoids are low-reactogenic in tuberculosis-infected children and can be used even in cases of health problems.
• Revaccination against measles, mumps and rubella in tuberculosis-infected individuals after completion of chemotherapy is safe and effective.
• The administration of a booster dose of ADS-M toxoid to children during treatment in a tuberculosis sanatorium does not cause side effects and leads to the synthesis of antibodies in high titers.
• Vaccination against influenza with inactivated vaccines in tuberculosis-infected children is safe and can be carried out at any stage of treatment; their combined administration with the Pneumo 23 vaccine reduces the incidence of acute respiratory viral infections.
• Taking anti-tuberculosis drugs does not affect the development of a specific immune response and is not an obstacle to vaccination.