Is it possible to vaccinate with DTP and ADS? Side effects in children after vaccination

Diphtheria

Diphtheria is a bacterial infection characterized by specific changes in the oropharynx and a pronounced toxic syndrome. Diphtheria is transmitted by airborne droplets (from a patient or a carrier during breathing), less often by contact (from contaminated objects). Infection occurs approximately 2-10 days from the moment of contact.

Diphtheria is characterized by pronounced changes in the oropharynx. The throat turns red, then becomes covered with a dense fibrin film, which is difficult to separate from the mucous membranes, and sometimes makes breathing difficult. Diphtheria of the larynx is accompanied by hoarseness and loss of voice, difficulty breathing, and in some cases bleeding.

The diphtheria bacillus is an infectious agent that can produce a toxin. Under its influence, a toxic syndrome develops in the body - swelling of the upper respiratory tract and subcutaneous fat. At the same time, patients feel clearly unwell: high fever, difficulty breathing, headaches. In addition, the disease is often complicated by myocarditis and pathology of the nervous system (encephalitis). To treat diphtheria, antibiotics are used, as well as antitoxic serum or immunoglobulin.

Diphtheria is now rare. It's not very contagious. But this disease is serious, and in the pre-vaccination era it was in first place as the cause of child mortality.

Whooping cough

Whooping cough is an infectious disease transmitted by airborne droplets. It manifests itself as a prolonged, intense, obsessive cough. The incubation period for whooping cough lasts from 1 to 2 weeks. After the disease develops, the patient can be a source of infection for up to a month. In addition, asymptomatic carriage is possible.

In children under one year of age, whooping cough infection often leads to attacks of respiratory arrest. And against this background, complications develop from the nervous and cardiovascular systems. In older children, the disease begins with the symptoms of a common cold: fever, runny nose, cough, redness of the throat. Then a long, painful paroxysmal cough develops. Attacks are sometimes accompanied by vomiting, hemorrhages in the skin of the face and conjunctiva, saliva and lacrimation, and swelling of the veins of the neck. This cough can last up to six months.

Antibacterial drugs are used to treat whooping cough. However, they can be effective only in the initial period, when whooping cough is almost impossible to distinguish from other acute respiratory viral infections. During the period of paroxysmal cough, antibiotic therapy is not effective. Treatment is carried out symptomatically and has virtually no effect on the duration of the cough.

Whooping cough is extremely contagious. It affects up to 95% of unvaccinated contacts. Even now, against the backdrop of universal vaccination, cases of whooping cough are not uncommon. The disease is especially dangerous in children who have not yet had time to get vaccinated for some reason.

What to do if you missed a vaccination?

If a vaccination was missed, it is recommended to resume immunoprophylaxis at a time as close as possible to the vaccination schedule. It is better to take the fourth dose with ADS or ADS-M. These products do not contain a whole-cell pertussis component, so they are better tolerated by children.

If the child has not had whooping cough and the parents want to fully vaccinate the baby against this infectious pathology, then the fourth dose of DPT should be given six months after the third injection.

Tetanus

Tetanus is a severe bacterial infection with a contact transmission mechanism, which is characterized by damage to the nervous system with the development of convulsions and tonic muscle tension. The infection is transmitted by contact. The microbe is widespread in nature, especially in agricultural areas. It is found in soil, water, and house dust. Often it is an inhabitant of the intestines of animals, sometimes humans. Tetanus bacillus can form spores that are resistant to high and low temperatures and antiseptic solutions.

The tetanus bacillus acquires its pathogenic properties in the absence of oxygen (anaerobic environment). Getting into the wound from contaminated surfaces, the microbe begins to multiply and release a toxin. The toxin enters the nervous system through the blood. The clinical picture is developing. From infection to the first symptoms it takes approximately 1 to 3 weeks. Initially, the muscles of the face and head are affected - a sharp muscle spasm occurs. Then the changes spread to the trunk and limbs, and convulsions appear. Muscle contractions can be so intense that they injure joints and ligaments. Damage to the muscles of the heart and respiratory tract is common.

In modern conditions, the patient dies from tetanus in approximately 20% of cases. The infection is especially dangerous in children of the first year of life. Mortality reaches 90-95%. Timely treatment can reduce mortality and reduce the manifestations of the disease. However, even with its use, recovery occurs only after 2-4 months; some consequences remain irreversible for the nervous system.

Tetanus is a very dangerous infection. It is still not uncommon to encounter tetanus bacillus spores in nature.

What vaccinations are there for whooping cough, diphtheria and tetanus?

1. DTP is the most widely used vaccine in our country. It includes toxoid (neutralized toxin) of tetanus and diphtheria, as well as killed pertussis bacteria. In addition to the main components, the vaccine includes adjuvants, antiseptics and preservatives, as well as the main medium - a diluent.
2. ADS and ADS-M are vaccines without a pertussis component. The ADS-M vaccine contains a reduced amount of diphtheria toxoid. These vaccines are used for revaccination in children after 7 years of age and in adults when whooping cough vaccination is no longer indicated.
3. “Bubo-Kok” - in addition to the DTP components, this vaccine contains part of the hepatitis B viral protein. This is done in order to avoid giving the baby two injections at the same time, because Vaccinations according to the calendar are done together.
4. "Bubo-M" is a vaccine without a pertussis component.
5. "Pentaxim" - contains tetanus, diphtheria and pertussis toxoids, particles of the pertussis microbe. Additionally, polio has been added to this vaccine for ease of use. According to the vaccination calendar, the DTP and polio vaccination schedules coincide. A component against Haemophilus influenzae can be added to this vaccine from a separate vial. The decision about the need to administer it is made by the doctor. The vaccine is distinguished by the absence of whole pertussis cells - this causes fewer side effects.
6. "Infanrix" is identical in composition to "Pentaxim", with the exception of the polio component - it is absent in it.
7. "Infanrix hexa" - in addition to the components of "Infanrix", includes inactivated polio viruses and part of the hepatitis B virus protein.
8. "Adasel" - includes: diphtheria, tetanus, pertussis toxoids and fragments of pertussis bacteria.

How 4 DPTs are tolerated: normal reaction and complications

As you get older, the likelihood of developing side effects and their severity increases. Poor tolerance can also be explained by the fact that the child already has a certain amount of antibodies in his blood, which, with the next injection of antigenic material, begin to become active, causing a number of changes in well-being.

Weak and allergy-prone individuals are especially susceptible to adverse reactions. All reactions to DTP can be divided into normal and pathological. The former indicate the correct formation of immunity, and the latter indicate the development of complications.

After the fourth dose of DTP, the following changes in health status may occur:

• hyperthermia;
• small rash on the body;
• soreness, redness, pastiness in the puncture area;
• dizziness and weakness;
• drowsiness;
• loss of appetite;
• prolonged and unnatural crying;
• nausea, single vomiting;
• disorder in the intestinal tract.

These symptoms are short-term and disappear after a few days. Such conditions do not require drug therapy.

Complications of DTP include the following conditions:

• allergies in the form of angioedema, urticaria, Stevens-Johnson syndrome, anaphylaxis;
• abscess at the injection site;
• toxic shock;
• fever;
• seizures;
• inflammation of the brain;
• lameness;
• addition of a concomitant infection.

For better tolerability of the fourth dose of DPT, doctors recommend giving antipyretics and antihistamines for several days after the injection.
Also, to minimize the risk of negative consequences of vaccination, you should not vaccinate a child if he has the following conditions:

• general malaise;
• the appearance of severe adverse reactions to a previous DPT injection;
• reduced immunity;
• exacerbation of chronic pathology;
• cancer;
• hyperthermia;
• rash on the body.

As a rule, most children after the fourth DPT experience a local reaction and a rise in temperature. Moreover, the first three vaccinations may not produce any changes in well-being in the post-vaccination period.

When is DTP vaccination given?

According to the national calendar, DPT vaccination is given at 3 months, 4.5 months and 6 months. Revaccination is done at 18 months. The second revaccination at 6-7 years is carried out without the pertussis component. The third - at the age of 14, and then every 10 years - also without adding the whooping cough component.

What to do if the DPT vaccination was not done on time?

If vaccinations are not completed, the calendar is continued at the same intervals indicated in the calendar. The second vaccine is given no less than 1.5 months after the first. The third is no less than 1.5 months from the second. Revaccination at least 12 months after the last vaccination.

DTP vaccination is given up to 4 years of age. After 4 doses, DTaP is given (in this case, the interval between the third vaccination and revaccination can be reduced to 6 months).

"Infanrix hexa", according to the instructions, is only done up to 36 months.

"Infanrix" and "Pentaxim" can be done up to 6 years.

"Adasel" is used only for revaccination at 6-7 years of age and for vaccination in adults every 10 years.

Children over 6 years of age are vaccinated only with pertussis-free vaccines (ADS, ADS-M, Bubo-M) or the Adasel vaccine. They receive two vaccinations 1.5 - 2 months apart. Revaccination after 9-12 months. And the second revaccination after 2 years.

Is it necessary to do 4 DPTs?

Some parents think that after three vaccinations the child becomes completely and permanently protected from infection with diphtheria, tetanus and whooping cough bacilli. On the Internet on forums you can read that the fourth DTP vaccination can be tolerated by the child’s body worse than the previous ones.

Revaccination with DTP is considered mandatory.
But every parent has the right to write a refusal based on the provisions of the law. Doctors give the following arguments in favor of the fourth vaccination:

• DTP forms temporary immunity. After the third vaccine, antibodies are present in sufficient concentration in the body for 5 years. Closer to 6-7 years, the baby becomes more susceptible to infection with tetanus, whooping cough and diphtheria bacilli;
• at 6-7 years old, a child usually begins to go to school. There the baby actively contacts other children and teachers. Accordingly, his risk of contracting infectious viral pathologies increases;
• diphtheria and tetanus are dangerous diseases. Children are especially susceptible to them due to weak immunity. There are still no effective drugs for tetanus bacillus. Therefore, the risk of mortality from this disease is very high;
• In 15-20% of children vaccinated with three doses of DPT, a sufficient amount of antibodies in the blood is not detected after a year. This is due to the individual characteristics of the body. The fourth vaccination can determine the concentration of antibodies at 6 years of age by donating blood for analysis. As a rule, by this age, most children's defenses against diphtheria, tetanus and whooping cough have already been reduced. Therefore, the fourth DPT vaccination is recommended for everyone.

Komarovsky recommends not ignoring immunoprophylaxis if the child has no contraindications. The doctor notes that the consequences of infectious viral pathologies develop much more often and they are more dangerous than adverse reactions to vaccination, which can be quickly eliminated with medication.

What complications can occur after DPT vaccination?

DTP is one of the most reactogenic vaccinations in the calendar. Should we be afraid of it and refuse it?

Indeed, after the administration of DTP, adverse reactions often occur:

1. An increase in body temperature to 38.5*C occurs in approximately half of the cases after injection of the DPT vaccine. When using acellular vaccines (Prevenar, Infanrix or Adasel), it occurs approximately 2-3 times less often. Less common is an increase in temperature to 39*C (about 10% of cases). Extremely rare - up to 40*C (less than 0.5% of all vaccinated people). This increase in temperature goes away 1-3 days after vaccination on its own and only requires the use of an antipyretic drug in an age-appropriate dose to improve the child’s well-being.
2. Irritability and prolonged crying. Also quite common. For DPT, approximately 40% of all vaccinations. For acellular vaccines, this percentage drops to about 15%. It goes away on its own in 1-2 days. Requires only observation and care of the baby.
3. Local reactions in the form of swelling, redness and pain at the injection site occur with varying intensity in approximately half of those vaccinated. Local reactions are observed much less frequently in those vaccinated with acellular vaccine. Pain in the first days after vaccination can be reduced with the help of the same medications that are used to bring down a high fever. If redness, swelling and pain increase, and the drugs turn out to be ineffective, it makes sense to show the baby to the doctor in order not to miss complications associated with infection of the injection site, or violation of the drug administration technique.
4. Sometimes, for several days after vaccination, the baby is worried about loss of appetite and, as a result, weight loss. This phenomenon is temporary and does not require correction.
5. Vomiting occurs in approximately 15% of vaccinated children. It is never painful, repeated or long lasting. Does not require treatment. But you should notify your doctor about such a reaction.
6. Rarely (approximately 0.02% for DTP and even lower for acellular vaccines) febrile seizures occur in children after vaccination. Such convulsions occur at elevated temperatures. More often, children have a congenital predisposition to the development of such seizures. Vaccination in such situations serves only as a provoking factor. In most cases, febrile seizures are not dangerous for the baby, although they are very frightening for parents. After a seizure, a child must be seen by a doctor. And warn your doctor about previous cases of such an adverse reaction.

Severe and rare complications after vaccination include:

1. Acute allergic reactions. Immediately after vaccination, mother and baby are recommended to spend about half an hour within the walls of a medical institution.
2. Hypotensive-hyporesponsive syndrome. The risk is present approximately in the first 12 hours after vaccination. The child suddenly turns pale, becomes lethargic and lethargic. This complication does not require treatment, it goes away on its own, but it requires medical supervision. Hypotensive-hyporesponsive syndrome after DPT vaccination raises the question of further vaccination.

To reduce the risk of severe adverse reactions, examination before vaccination is recommended. Before vaccination, the child should not be sick with an acute respiratory infection. Chronic diseases must be in remission. If necessary, the attending physician can prescribe treatment for a child with a chronic disease during vaccination.

It must be said that the subsequent vaccination is more difficult to tolerate than the previous one. In children with severe reactions, it is advisable to replace the vaccine with an acellular one or one that does not contain the pertussis component.

Luga Interdistrict Hospital

What to do before vaccination

Before vaccination

• Before the first vaccination with DTP vaccine, it is necessary to do a general blood and urine test, and also obtain permission from a neurologist for vaccination.
• If your child has allergic disorders (diathesis, etc.), discuss with your doctor in advance a plan for preventing exacerbation of allergies . Usually it consists of taking antihistamines (suprastin, fenistil) for 2 days before vaccination and 2 days after.
• If you haven't already, buy children's antipyretics with paracetamol. It is better to buy candles, since flavorings in syrups themselves can cause adverse reactions. Buy analgin.

On the day of vaccination

• Do not introduce new complementary foods or new types of food . If your child is breastfed, do not introduce new foods into your diet.
• Don't forget to take antihistamines and other medications prescribed by your doctor.
• Make sure that you have analgin at home (especially in the case of DTP vaccines) and baby suppositories with paracetamol (Efferalgan, Panadol). Do not rely solely on homeopathic medicines - they can be used, but they will not help if you have severe reactions to vaccinations.
• If the child is old enough, never, even as a joke, scare the child with vaccination .
• If your child asks about the injection, be honest and say that it may be a little painful, but it’s only for a few seconds.

Before leaving home

• If you have a vaccination certificate showing your vaccinations, take it with you.
• favorite toy or diaper with you

At the time of vaccination

Just before the vaccination

• Make sure with your doctor that your child does not have a fever at the time of vaccination. This is the only universal contraindication to vaccination.
• Ask your doctor what and what kind of vaccine your child will be vaccinated against today.
• Don't hesitate to ask your doctor if you have any doubts about the vaccine.

At the moment of injection

• Don't worry . Your excitement and anxiety are transferred to the child. Be calm and confident - and the child will tolerate the vaccination much easier.
• Don't worry about the fact that you are still worried, just turn your anxiety into a constructive direction.
• To distract your child (and yourself) - communicate with him, play, sing songs, look at interior items, play with a toy taken from home.
• Smile and be affectionate to your child.
• During the injection, the child should be in your arms - this will make him and you more comfortable.
• Let your child cry after the injection. Don’t force your child to “be brave” or tell him that crying is a shame.
• If a child says that he is in pain, “blow out” the pain. Take a deep breath and slowly “blow out” the pain. Repeat this exercise several times.

After vaccination

In the first 30 minutes after vaccination

• Don't forget and hesitate to ask your doctor your questions . Be sure to ask about what and when reactions to the vaccine may occur and in what cases to seek medical help.
• Do not rush to leave the clinic or medical center. Sit for 20-30 minutes near the office. Firstly, this will help you calm down, and secondly, it will allow you to quickly provide help in case of immediate allergic reactions to the vaccine.
• If the child is breastfed, give him the breast , this will help him calm down.
• If the child is old enough, please him with some pleasant surprise, reward him with something, praise him . Tell him it's okay.

Upon returning home after vaccination

• In case of vaccination with DTP vaccine: unless otherwise prescribed by the doctor, give the child a dose (suppository or syrup) of an antipyretic. This will avoid unpleasant reactions that occur in the first hours after vaccination.
• If the child does not have a temperature, you can swim as usual. The presence of reactions at the injection site is not a contraindication to swimming, and even vice versa.

First night after vaccination

• Most often, temperature reactions to inactivated vaccines (DPT and others) occur on the first day after vaccination.
• In the case of DPT vaccines: prophylactically, be sure to give the child an antipyretic , even if the temperature is currently normal. Keep analgin on hand.
• If severe temperature reactions occur (38.5 ° C and above), give once . In children over 2 years of age, the dose can be increased to one third of the same tablet.
• In case of temperature reactions, do not neglect wiping your child with warm water. Do not use vodka for rubbing - it irritates and dries baby's skin.
• Do not forget that the daily dosage of paracetamol is not unlimited . In case of overdose, serious complications are possible. Carefully read the instructions for the drug you are using (Panadol, Efferalgan, Tylenol).
• Do not use aspirin under any circumstances . Its use in young children is fraught with serious complications.

The first two days after vaccination (DPT, DPT, hepatitis B, Hib vaccine, IPV)

• Take the medications prescribed by your doctor to prevent allergic disorders.
• Continue taking antipyretics according to the instructions for the medications if the temperature remains elevated.
• DTP vaccines. Monitor your child's body temperature . Try not to let it rise above 38.5°C (under the arm). In some children, against the background of an increase in temperature, the so-called so-called febrile seizures. Take antipyretics without waiting for the temperature to rise.
• You can and should walk with your child, you can and should bathe him. The exception is when the child has a fever due to or regardless of vaccination.
• If a Mantoux test was performed, when swimming, try not to let water get into the place where the test was taken. Don't forget that sweat is also a liquid, so make sure that your baby's hand doesn't sweat.
• Do not introduce new foods into your child’s diet (and yours, if the child is breastfed). This can be done on the 3rd day after vaccination and later.
• In the case of DPT, ADS, hepatitis B and ADS-M vaccines. If strong reactions occur at the injection site (swelling, thickening, redness), apply a warm compress or simply periodically apply a cloth moistened with water. If you are not already taking anti-inflammatory medications, start taking them.

5-12 days after vaccination

• In the case of vaccination with live vaccines (drops of polio vaccine OPV, measles, mumps, rubella), adverse reactions usually occur 5-12 days after vaccination.
• If any reaction occurs, but the vaccination was not done with a live vaccine, then vaccination with 99% probability has nothing to do with it. The most common cause of temperature and some other reactions in young children is teething, and in older children - colds.

Vaccination, Children, Reminders, Recommendations