Vaccination with abnormalities in health

Neurological diseases

Progressive neurological pathology - decompensated hydrocephalus, neuromuscular dystrophies, degenerative diseases and CNS lesions with congenital metabolic defects - are contraindications to the use of DTP because of the risk of seizures, but can be considered in terms of vaccination with Infanrix or ADS vaccine when the process is stabilized. Children with hydrocephalus can be vaccinated after 1 month. After compensation of the process (achieved conservatively or promptly). To determine the progression of the disease the child is sent to a neurologist at the age of 1-2 months, but the pediatrician decides whether to vaccinate. In case of doubt, the tap refers only to the pertussis component, IPV, ADS and HBV are administered in a timely manner. DTP is contraindicated in the case of afefril convulsions in the anamnesis; these children are examined for epilepsy, they are vaccinated after the diagnosis is clarified against the background of anticonvulsant therapy.

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

Children with febrile seizures in the anamnesis of DTP are administered concomitantly with paracetamol (15 mg / kg 3-4 times a day for 1-2 days). Children, whose condition is referred to as "convulsive alertness", is vaccinated as usual, possibly on the background of therapy with soothing agents and dehydration (see below).

Stable and regressive neurological symptoms (Down's disease, cerebral palsy, consequences of injuries, etc.): in the absence of aphybrid convulsions, children are vaccinated according to the calendar, incl. On the background of therapy prescribed by a neuropathologist. Children who received diuretics (triampur, diacarb) in occasion of so-called. Hypertension-hydronephalic syndrome, they can be reassigned 1 day before and 1-2 days after vaccination.

With a syndrome of increased nervous excitability for the period of vaccination, a sedative (valerian, potassium citrate) can be administered. Children who have undergone meningococcal meningitis are immunized no earlier than 6 months after recovery. Children with mental illness outside the acute period, with mental retardation, do not require medical preparation for vaccination.

Allergy

The opinion that vaccines "allergize" is illegal, they practically do not stimulate a persistent increase in the level of IgE and the production of specific IgE antibodies. All vaccines included in the Calendar contain far fewer antigens than 30-40 years ago because of their better purification. Individuals are allergic to vaccine components that are capable of triggering immediate reactions:

• Aminoglycosides - vaccines against measles, rubella, mumps;
• Protein of chicken egg - measles and mumps vaccines of foreign origin, influenza vaccines, vaccine against yellow fever;
• Gelatin - a vaccine against varicella;
• Baking yeast - vaccines against hepatitis B.

When collecting anamnesis, they clarify not only the presence of reactions, but also their nature; It is dangerous to vaccinate (with foreign measles and trivaccine, produced on cultures of chick embryo cells) only children giving an anaphylactic reaction, i.e. Almost instantaneous development of shock or angioedema of Quincke (for example, a child immediately after the first piece of egg-containing product develops shock, swelling of the lips or larynx). The remaining children with hypersensitivity to the egg are inoculated in the usual way, but only in the conditions of the polyclinic. Russian HCV and HPV are prepared on Japanese quail eggs, cross reactions with chicken protein are rare, although possible.

Measles, rubella and mumps vaccines are not administered to persons with severe allergic reactions to aminoglycosides, which should be consulted before vaccination, despite the rarity of these reactions.

Children with allergies to vaccine components should be vaccinated, if possible, with vaccines without a causative allergen. Children without an anaphylactic reaction are prescribed antihistamines; At the 1st year of life, only Zirtek (cetirizine) is used from preparations of 2-3 generations. Persons with a tendency to such reactions (for example, HBV to a child with an allergy to baker's yeast) are vaccinated against a background of steroid therapy (inside prednisolone 1.5-2 mg / kg / day).

In children with allergies, the danger of allergic reactions and serum sickness is higher for the administration of tetanus antitetanus or antidiphtheria serum (up to 15%) than for active immunization with anatoxins, which is a significant argument in favor of timely active immunization.

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

True eczema. Vaccination is performed during remission after the elimination of acute rashes, wetness and skin infection. To achieve remission - complete or partial - sometimes takes several months, nevertheless, these children can be vaccinated completely, often already at the first year of life. Preservation of lichenization sites (neurodermatitis) does not prevent the introduction of vaccines (except for some dermal). 3-4 days before the vaccination prescribed antihistamines, enhance local treatment (including steroid ointments) for 5-7 days after vaccination. The same tactics of vaccination of older children with inactive neurodermatitis.

Children with urticaria, Quinck's edema are inoculated 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. With preservation of easy obstruction in 2-4 weeks. Vaccination is carried out against the background of beta-agonists (eg, metered-dose inhalations of salbutamol or Beroduala 1 dose 2-3 times a day) or euphillin inside at 4 mg / kg 3 times a day. Children with 2-3 episodes of obstruction in the anamnesis, especially in the presence of allergies in the parents, are vaccinated as having bronchial asthma.

Bronchial asthma. Vaccinations are carried out in remission, in this case it is important not the prescription of the attack or the degree of violation of HPV, but the stability of the condition. Basic therapy (including inhalation steroids) and beta-agonists or theophyllines can be increased by 30-50%, for the period of vaccination, children receiving systemic steroids are vaccinated according to the rules set out below.

Patients with pollinosis are well tolerated inoculations, carrying out a specific hyposensitization after them does not affect the level of specific antibodies.

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

Cardiopathies and connective tissue diseases

Children with congenital heart diseases and arrhythmias are vaccinated after reaching a minimum of hemodynamic disturbances, incl. On the background of cardiac funds, children with rheumatism and other acquired cardiopathies - in the period of remission.

Vaccination of children with systemic connective tissue diseases during remission is recommended to be performed 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 are particularly in need of vaccinations against pneumococcal infection and influenza, which they tolerate well, despite concerns about the introduction of the vaccine Grippol with polyoxidonium.

[5], [6], [7],

Chronic hepatitis

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

[8], [9], [10], [11], [12],

Kidney Diseases

Children with pyelonephritis are vaccinated in the period of remission on the background of maintenance antibiotic therapy. With a remission period 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 (considering the timing of immunosuppression), even at a low dose of steroids (1 mg / kg / day of prednisolone). With a remission duration of 6 months. There were no signs of exacerbation after ADS-M, and the immune response was adequate. HBV even at an earlier time is highly desirable, which allows, if necessary, to secure the conduct of hemodialysis. In these children, the smooth course of SARS helps in determining the possibility of vaccination. The experience of vaccinations in children with congenital renal pathology is small, it follows, first of all, to focus on the degree of compensation of renal functions. Inoculations of children with renal pathology against pneumococcal infection and influenza give good results, WHO also recommends their vaccination against Hib infection and chicken pox.

Cystic fibrosis, chronic inflammatory lung diseases

Vaccination of these children is carried out under the full program in a period free from exacerbations, including against a background of prolonged antibacterial and other therapy (except for immunosuppressive). These patients are especially shown vaccinations against measles and influenza.

[13], [14], [15], [16], [17], [18], [19]

Endocrine pathology

Diabetes patients are more susceptible to infections and a number of immunological features. Those vaccinated before the manifestation of diabetes show a higher percentage of seronegativity to poliovirus type 3, a faster decrease in titers to diphtheria, low titers of antibodies to measles, mumps. Even in patients with measles, antibodies are not detected in 11% of cases. The ban on vaccination of patients with diabetes, which existed before the beginning of the 1990s (due to isolated cases of necrosis and infection at the injection site and the development of ketoacidosis in the case of exchange instability) is removed, In the phase of diabetes compensation, vaccination was effective and safe.

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

• satisfactory state, blood sugar on an empty stomach is not higher than 10 mmol / l;
• minimum daily glycosuria (no more than 10-20 g day);
• normal diuresis, the absence of ketone bodies in the urine;
• control over the parameters of sugar metabolism in the post-vaccination period.

In diabetics, prevention of epidpidotitis, as well as, hepatitis A, influenza and pneumococcal infection, which are particularly difficult, is especially important.

Adrenogenital syndrome. Substitution therapy with prednisolone, and with salt-losing form - also deoxycorticosterone acetate, which these patients receive for life, does not induce immunosuppression and does not interfere with vaccination with any vaccines. If necessary, increase the dose of steroids

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

[20]

Diseases of the clotting system

Hemophilia is not accompanied by defects in the immune system, the danger is associated with the possibility of bleeding with the / m injections. With regard to blood infections (hepatitis B), the risk of infection through blood products in them is many times higher. To reduce the risk of bleeding, they are injected subcutaneously - in the rear of the hand or foot, but for DTP, HBV, Hib vaccine this can lead to a decrease in the immune response. So that they are injected intramuscularly into the forearm - in these places the injection canal can be well mechanically compressed.

In / m administration of vaccines to a patient with hemophilia is safe if it is administered soon after the introduction of a factor of coagulation. This, of course, applies only to inactivated vaccines, since live vaccines can be inactivated by the antibodies contained in these preparations. Live vaccines after the next introduction of coagulation factor introduced after 6 weeks or more.

Given the increased risk of contracting hepatitis B through blood products, hemophiliacs should be vaccinated as soon as possible. Since HBV is less immunogenic with subcutaneous administration, it is preferably administered intramuscularly after the first administration of a coagulation factor.

Immune thrombocytopenic purpura (ITP) often develops at the 1 st year of life, preventing the primary series of vaccinations; naturally, only in the stage of persistent remission does the question of their admissibility arise.

Since more than 80% of children with immune thrombocytopenic purpura recuperate within 9-12 months and do not relapse afterwards, they can be vaccinated with inactivated vaccines (ADS, ADS-M, HBV) after stable normalization of the platelet count (the analysis should be repeated before vaccination) . Although immune thrombocytopenic purpura is usually not indicated as a contraindication for live vaccines, given the possibility of developing thrombocytopenia after their administration (including the appearance of antiplatelet autoantibodies), vaccination should be carried out with greater caution (after a longer period of time) than inactivated vaccines. In such cases, the appointment of anti-inflammatory and membrane stabilizing agents before and after vaccination is recommended. The possibility of re-development of thrombocytopenia in the introduction of measles monovaccine (after MMK) makes it necessary to be cautious about the re-vaccination with live vaccines of such persons.

The question of vaccinations of children with chronic immune thrombocytopenic purpura is solved individually.

Therapy with anticoagulants is accompanied by a risk of bleeding, especially with intramuscular injection of vaccines, so these recommendations are applicable to the recommendations given for patients with hemophilia. Inoculations against cholera and yellow fever may be accompanied by a decrease in blood clotting, so that they should be performed with caution in this category of patients.

[21], [22], [23]

Vaccination and tuberculosis

Tuberculosis is not listed in the list of contraindications. Children with a bend of tuberculin samples and infected ones are recommended by some Russian authors to be vaccinated at the end of chemoprophylaxis course, with other forms of the disease - at the stage of sanatorium treatment against the background of anti-relapse therapy. Infected with tuberculosis, children tolerate all calendar and pneumococcal vaccines well, so the delay with vaccination is justified only for an acute (initial) period of the disease. The following recommendations were approved:

• Hepatitis B vaccines and toxoins in tubinfected children are slightly reactogenic, and they can be used in case of abnormalities in health status.
• Revaccination against measles, epidarotitis and rubella infected with tuberculosis after the completion of the course of chemotherapy is safe and effective.
• The introduction of a booster dose of ADS-M toxoid to children against treatment in a tuberculosis sanatorium does not cause adverse reactions and leads to the synthesis of antibodies in high titers.
• Vaccination against influenza with inactivated vaccines in tubinfected children is safe and can be performed at any stage of treatment, combined with their administration with the Pneumo 23 vaccine reduces the incidence of ARVI.
• Admission of anti-TB drugs does not affect the development of a specific immune response and is not an obstacle to vaccination.