Vaccination L3Assist Prof. Dr.Raid K. DehiolUniversity of Thi-Qar/ College of medicine 2020
Adverse Reactions To Vaccination
Local reactions:-Immediate pain at the site of inoculation, it disappear after few minutes
- Sometimes this pain is replaced by tenderness lasting for hours or day ( e.g. DTP, TYPHOID vaccines).
- A painless nodule may develop at the injection site especially with adsorbed vaccines ( with adjuvant) and may turn into aseptic abscess.
- Local ulceration may occur in BCG vaccinated persons, and it is self limited and not need treatment.
Systemic reactions:-
fever, digestive symptoms as vomiting and loose bowel motion, this may last for 1-2 days.Skin reaction:-
urticaria rash especially with history of allergy.
- fine macular rash may seen one to few days after measles and rubella vaccines.
Renal :- simple proteinuria, hematuric nephritis, and some times even heavy proteinuria ( nephritic syndrome), all are transient.
Neurological reaction :-
the vaccine which is mostly involved by this reaction is pertusis vaccine, so there may be :-
- convulsions ( 1:10,000). - prolonged crying for 6-12 hours especially after the 1st injection.
- hypotonic hyporesponsive episodes.
- agitation that may disappear after few minutes.
- Pallor.
- cyanosis.
Paralytic reactions:- this occurs with OPV, and the overall risk of vaccine associated paralytic poliomyelitis ( VAPP) is about 1 case/750.000 doses. The risk of paralysis in the immunodeficient recipients may as much as 6,800 times that in normal subjects.
Encephalitis:- the risk of having panecephalitis following measles vaccine is about 12 times lower than if the child was affected by the disease itself and the prognosis is good.
Joint complications:- rubella vaccine may cause arthralgia and arthritis and it is more in adults.
Lymphadenopathy:-
• two vaccines could cause it, these are:-
• A- BCG vaccine:- 6-12 % of BCG vaccinated individuals develop regional inflammatory adenitis in the left axillary lymph nodes, often fistulation and suppuration occurs that will close after few days. Sometimes there is intermittent suppuration with a 6 weeks- 6 months , some times we need INH for treatment.
• B- Rubella vaccine: it may cause lymphadenopathy in 20% of cases and resolves spontaneously.
Teratogenic complications:- the vaccines are to be avoided during pregnancy, the only safe vaccines during pregnancy are ( tetanus toxoid, killed polio vaccine, cholera vaccine, HBV, and influenza vaccine).
Skeletal complication:- osteitis rarely follows BCG.
Hematological complications:-measles and rubella vaccines may cause thrombocytopenia
BCG vaccine ( Bacille Calmette-Guerin)
It is a live attenuated vaccine derived from mycobacterium bovis that has lost its virulence in humans by being specially cultured in an artificial medium for years, and given as a single intradermal injection at the left shoulder ( at the insertion of the deltoid muscle), in a dose of 0.05 ml in neonates and 0.1 ml > 1 year of age.WHO recommended that a single dose of BCG vaccine administered during infancy, including asymptomatic HIV infected children in population where the risk for tuberculosis is high. It is type 4 immune response and we should wait 6-8 weeks after injection for scar appearance.
BCG is extremely safe in usual dose, local ulcer and regional suppurative adenopathy may occur and usually mild not need treatment but chemotherapy is used occasionally and sometimes surgical excision of draining lymph node. Osteitis is a rare complication. Systemic complication also rare.
BCG is 50% effective in prevention of pulmonary TB and 50%-80% effective in prevention of disseminated or meningeal TB.
Measles vaccine
Is either monovalent or combined with Rubella (MR) or measles, mumps, rubella (MMR). It is a live attenuated vaccine given at 9th month, 15th month, and 4-6 years ( i.m. or s.c). Adverse events following MMR include fever ( usually 6-12 days following vaccination), rash about 5% and rarely transient thrombocytopenia.Post exposure prophylaxis by vaccination is effective in prevention or modification of measles if given within 72 hours postexposure.
Haemophilus influenzae vaccine
An effective vaccine to prevent Hemophilus influenza type b disease introduced in many countries has result in dramatic decrease in the incidence of infection caused by this organism(meningitis, epiglottitis, otitis media). It is given in 3 dose series at 2,4,6 months of age. It is type is polysaccharide capsule conjugated to carrier protein.Polio vaccine
two polio vaccines are used throughout the world to combat polio. The first was developed by Jonas Salk, in 1955,it consist of an injected dose of killed poliovirus. Thereafter, Albert Sabin produced an oral polio vaccine using live attenuated virus in 1962.The two vaccines have eradicate polio from most of the countries in the world and reduced the incidence from an estimated 350,000 case in 1988 to less than 2000 case in 2006.
• Salk’s polio vaccine
• Inactivated polio vaccine (IPV), killed polio vaccine. It confers IgG-mediated immunity in the blood stream which prevents polio infection from progress to viremia and protects the motor neurons, thus eliminating the risk of bulbar polio and post polio syndrome.• IPV has no adverse side effects.
• Because it offers no protection to the mucosal lining of the intestine, people vaccinated with IPV can still carry the disease and spread it to unvaccinated individuals.
Sabin polio vaccine
Oral polio vaccine (OPV) is a live attenuated vaccine.It replicates very efficiently in the gut, the primary site of infection and replication, but is unable to replicate efficiently within nervous system tissue.
The OPV proved superior in administration, and also provided longer lasting immunity than IPV.
Rota vaccine
Worldwide, rotavirus is estimated to cause more than 111 million cases of diarrhea annually in children younger than 5 year, with approximately 500,000 death per year.
A live attenuated, oral, pentavalent rotavirus vaccine was approved in 2006 for use in United states. It contains 5 reassortant rotaviruses isolated from human and bovine proteins.
It provides a 96% reduction in hospitalization for rotavirus gastroenteritis through the 1st 2 years after the 3rd dose. Its effective 98% against severe rotavirus gastroenteritis, and 74% against rotavirus gastroenteritis of any severity.
Another monovalent vaccine appear to be safe and effective. It is an attenuated monovalent human rotavirus and is administered as 2 oral doses at 2 and 4 months of age.
The vaccine has 85% efficacy against severe gastroenteritis, and reduce hospital admission for all diarrhea by 42%. Despite being monovalent, the vaccine is effective in prevention of all 4 common serotypes of human rotavirus.
Hepatitis B virus prevention
Hepatitis B vaccine and hepatitis B immunoglobulin (HBIG) are available for prevention of HBV infection. The safety profile of HBV vaccine is excellent. The most reported side effects are pain at the injection site (up to 29% of cases) and fever (up to 6% of cases).Household, sexual, and needle-sharing contacts should be identified and vaccinated if they are susceptible to HBV infection. HBV is not spread by breast-feeding, kissing, hugging, or sharing water or utensils.
Children with HBV should not be excluded from school, play, child care, or work, unless they are prone to biting.
Current HBV vaccination recommendations are as follows :-
• For all medically stable infants weighing ≥ 2,000 g at birth and born to HBsAg-negative mothers, the first dose of HBV vaccine should be administered before hospital discharge. Single-dose antigen HBV vaccine should be used for the birth dose. Subsequent doses to complete the series are given at 1-4 mo and at 6-18 mo of age.
• Preterm infants weighing <2,000 g at birth and born to HBsAg-negative mothers should have their initial dose delayed until 1 mo of age or before hospital discharge.
-if the mother had HBsAg +ve , both HBIG and vaccine should be administered within 12 hr of the infant's birth