How to recognize complications after vaccination?

Complications after vaccination rarely occur in children in the first six months of their lives, the more they can be masked by other diseases of this age. However, it is tactically correct to think first about other types of pathology, only by excluding which it is possible to raise the question of the connection of complications after vaccination. It is especially important to exclude meningitis, pneumonia and emergency surgical pathology, since the delay in their treatment is life threatening.

To address this issue, it is important to consider the time of development of the disease.

“Complications after vaccination” does not always mean “from vaccination”. So, the temperature rise later than the 2nd day after inoculation with inactivated drugs or before the 5th or after the 15th day from the administration of live vaccines is usually not associated with its implementation (after the injection of HPV, the development of meningitis occurs until the 25th day, and orchita - up to the 42nd day). But even in cases of temperature, rash within a specified time, their preservation for more than 2-3 days and / or the addition of new symptoms (vomiting, diarrhea, meningeal signs), makes their connection with its implementation unlikely. Such situations require hospitalization, and the history should be carefully collected, especially with regard to the child’s contacts, who are ill with the environment, or with allergens.

There are no pathognomonic symptoms that would allow to unequivocally consider the event of a complication after vaccination, so this is always a probabilistic statement even after the exclusion of all other possible causes.

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Infectious diseases

SARS is most often mistaken for complications after vaccination, including after DTP, although catarrhal syndrome is not typical for complications of DTP.

Fever without visible focus of infection (LBOI) and without catarrhal phenomena in an infant carries a 10-15% risk of bacteremia with the risk of meningitis, pneumonia, etc. These symptoms very much resemble complications after vaccination. In the presence of leukocytosis above 15x10 ⁹ / l, neutrophilia above 10x10 ⁹ / l, CRP above 70 g / l - administration of ceftriaxone is shown (iv / 80 mg / kg / day).

Urinary tract infection is a common cause of complications after vaccination, the diagnosis is difficult if there is no dysuria. Urinalysis (better seeding) - mandatory for fever of unknown origin.

Enterovirus infection is a common cause of LBOI, sometimes with meningism and convulsions. It is easily recognized in the presence of herpangina, characterized by maculopapular rash (ECNO exanthema) against the background of a decrease in temperature after 4-5 days.

Infection with herpes viruses type 6 and type 7 also occurs with high fever. A rash (sudden rash) appears in 3-4 days, in the first days a diagnosis of complications after vaccination.

Acute pneumonia is taken as a “reaction to the vaccine” due to the scarcity of physical symptoms due to underreporting of common symptoms (febrileitis> 3 days, shortness of breath in the absence of bronchial obstruction); X-ray confirms the diagnosis of complications after vaccination.

Meningitis in the first 3-5 days from the introduction of dead vaccines is often mistaken for post-vaccination encephalitis or encephalopathy. The appearance after convulsions of convulsions, meningeal signs, especially against the background of febrile and repeated vomiting, requires the immediate holding of lumbar puncture to exclude meningitis. Purulent meningitis as a complication after vaccination is not typical; serous meningitis with a good prognosis rarely occurs after ZHPV (usually after 10-25 days).

Intestinal infections: diarrhea and other intestinal symptoms are not characteristic of the vaccination pathology.

Among other bacterial infections in the post-vaccination period, one should point to angina and scarlet fever caused by hemolytic streptococcus.

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Noncommunicable diseases

Febrile seizures often accompany fever after DTP, live vaccines, however, they are not considered as complications after vaccination, warning, especially in children prone to them, by the introduction of antipyretic.

Spasmophilia on the background of active rickets with hypocalcemia can cause afebrile seizures, as complications after vaccination, especially in children 3-6 months. In the spring. Suspect spasmophilia allows overweight child, the prevalence in his diet porridge. The ECG gives an orientation about hypocalcemia - a pointed isosceles tooth of T.

Epilepsy is a common cause of afebrile seizures as a complication after vaccination, which is established with the help of EEG. Sometimes in the 1st episode of convulsions, in the absence of epilepsy in the family history and unclear EEG data, the episode has to be recognized as a complication, and only observation allows you to make the correct diagnosis.

A brain tumor (astrocytoma, ependymoma) can also be the cause of neurological disorders after vaccination. A gradual increase in symptoms, signs of intracranial hypertension should be alarming.

Leukodystrophies - a group of hereditary diseases that have been genetically deciphered lately - can manifest themselves at the age of 3-4 months. Their coincidence with the introduction of DTP and the similarity of their symptoms with encephalitis was, apparently, a reason to talk about post-vaccination encephalitis.

Traumatic injury to the sciatic nerve occurs when injected into the buttock. His signs (the child is restless, does not rely on the foot on the side of the injection) appear immediately as complications after vaccination, which distinguishes them from neuritis (transient weakness of the limb with hyporeflexia) that occurs after a few days and is the result of a suspected enteroviral infection; they require differential diagnosis with VAP, patients should be examined by the program for AFP. Unlike VAP and poliomyelitis caused by the wild virus, these neuritis do not leave any consequences during the examination after 2 months.

Polyradiculoneuritis (Guillain-Barre syndrome) is considered as a complication after vaccination with DPT and influenza vaccine; however, its course is no different from the classic, non-vaccine-related disease. Children who have had Guillain-Barre syndrome outside of vaccination can be vaccinated safely (DTP + OPV) after 6 months. After recovery. All patients are examined under the program of AFP.

Thrombocytopenic purpura is often observed on the 3-4th day after the administration of DTP, and complications are considered after vaccination; downstream and favorable outcome is not different from that of children of the same age who did not receive vaccine preparations, which confirms the presence of only a temporary association. Recurrences have been described with the subsequent introduction of LBV, which is evidence of its likely connection with measles vaccination.

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