Vaccination against hepatitis A (Avaxim 80, Avaxim 160, Havrix 1440, Vaqta)

Vaccine options

There are several hepatitis A vaccines available on the international market. They are all similar in terms of how well they protect people from the virus and the side effects.
There are no licensed vaccines for children under one year of age. The following vaccines are used in Russia: Avaxim, Avaxim 80, Vakta, GEP-A-in-VAK, Havrix 720, Havrix 1440. Mortality from hepatitis A ranges from 1% to 30%, with a clear increase in mortality with age, which is associated with an increased likelihood of infection layering on chronic liver disease.

Publications in the media

Introduction: Hepatitis A Hepatitis A is a widespread, highly contagious disease caused by the hepatitis A virus (HAV or, in English, HAV for hepatitis A virus) (Fig. 1). In Russia, from 50 thousand (data for 1998) to 183 thousand (data for 1995) cases of the disease are registered annually, but since 1995, thanks to various preventive measures, including vaccination of the population, according to the Ministry of Health and Social Development of the Russian Federation, the incidence rate has decreased by almost four times. Unlike hepatitis B and C, hepatitis A never occurs in a latent, asymptomatic form and does not become chronic, and the vast majority of its cases end in complete recovery. At the same time, publications devoted to this disease regularly appear in the scientific and popular medical literature, and interest in its prevention and therapy does not wane. Rice. 1. Prevalence of hepatitis A (data for 2003 from the website travelhealth.gov.hk), areas unfavorable for this disease are marked in blue. Hepatitis A: epidemiology Epidemic jaundice was first described in ancient times, but the hypothesis of an infectious nature was first formulated by Botkin only in 1888. Further research led in the 1960s to the distinction between fecal-oral viral hepatitis (A) and serum hepatitis (B). Later, other viral hepatitis were identified - C, D, E, etc. Outbreaks of hepatitis A were first described in the 17th-18th centuries. Non-epidemic, isolated cases of viral hepatitis A have been described as catarrhal jaundice - that is, jaundice accompanied by cold symptoms. A century later, it was proven that epidemic and non-epidemic forms of jaundice are a manifestation of the same infection. The mechanism of spread of the virus was discovered only during the Second World War. In 1941-42 Jaundice became a problem for British troops during the war in the Middle East, when the virus put out about 10% of the personnel. From that moment on, in 1943, in-depth research into the problem began in Great Britain and the USA. The fact of lifelong immunity to infection in those who have once recovered from it has led researchers to the idea that the serum of those who have recovered from hepatitis A can be used for prevention. The effectiveness of using human immunoglobulin (the serum of all adults is believed to contain antibodies to the hepatitis A virus) was demonstrated already in 1945, when the result of immunization of 2.7 thousand American soldiers was an 86% reduction in morbidity (data from the website privivka.ru). The hepatitis A virus is considered the most resistant to external influences: when boiled, its inactivation occurs only after 5 minutes, when treated with chlorine - after 30 minutes, formaldehyde - within 72 hours, 20% ethyl alcohol and strong acids do not lead to inactivation of the virus. Most often, the virus enters the body through the fecal-oral route, that is, by eating contaminated water and food. Usually these are products that cannot be cooked - greens and fruits, either already contaminated with the virus, or washed with water of dubious origin. Less common is the transmission of the virus through contaminated blood and its products, which occurs among drug addicts who share syringes, those who receive blood products or come into contact with blood. This route of transmission is rarely taken into account, although a purely speculative comparison with viral hepatitis B may give an idea of ​​the possible underestimation of the prevalence of hepatitis A. The source of infection is the sick person in the last week of the incubation period (which lasts from 14 to 28 days) and in the first week of the disease . Thus, an apparently healthy person can serve as a source of danger to his environment. The average duration of disability is 35 days. Most cases of the disease begin with symptoms reminiscent of a cold - loss of appetite, general weakness, nausea, vomiting, fever. These symptoms usually do not bother patients much; they continue to work and do not go to doctors. The first symptom that alarms patients is darkening of the urine, which is one of the signs of jaundice. The color of the urine changes from normal straw yellow to the color of dark beer. Another sign of jaundice, which is the first to be noticed by those close to the patient, is the yellowing of the whites of the eyes. The third classic sign of jaundice is discoloration of the stool. However, viral hepatitis A can occur without jaundice, when the only signs of ongoing infection may be nausea, loss of appetite and possibly abdominal pain. The frequency of icteric forms increases with age; jaundice is rare in children under 5 years of age and is an almost obligatory companion to hepatitis A in adults. The most severe clinical forms of viral hepatitis A are cholestatic (literally “stagnation of bile”) and fulminant (fulminant). With the first, the dominant symptoms are severe jaundice, significant enlargement of the liver and severe skin itching, the cause of which is irritation of the nerve receptors of the skin by bile components. Stagnation of bile in this form of viral hepatitis A is caused by significant inflammation of the walls of the bile ducts and the liver as a whole. Despite the more severe course, the prognosis for the cholestatic form of hepatitis A remains favorable. This cannot be said about the fulminate form of hepatitis A, which, fortunately, is quite rare among children and young adults (frequency is a fraction of a percent), but not uncommon in elderly patients (several percent of cases). Death occurs within a few days due to acute liver failure. Countries with moderate endemicity are characterized by a special type of incidence distribution. In rural areas, exposure to the hepatitis A virus occurs in childhood, and immunity is acquired at a younger age. In cities where it is easier to comply with hygienic requirements, a person remains susceptible longer, which, paradoxically, leads to a higher incidence of icteric and sometimes severe forms of hepatitis A in city residents. Thus, city residents traveling to the countryside are also a risk group. Other risk groups are people traveling on business trips and vacations to regions unaffected by hepatitis A; sewer and water supply workers; workers of trade and food enterprises and risk groups for complications and mortality due to hepatitis A: carriers of the hepatitis B and C virus, patients with chronic liver diseases. The situation in the Russian Federation The territory of the Russian Federation is considered unfavorable in terms of the situation with hepatitis A; recently, in 2000 and 2001, another increase in incidence was noted both in the country as a whole and in individual territories, and in general the number of newly registered cases increased by 83 ,5 %. Then a decline in incidence was observed again. This is partly due to the fact that hepatitis A is characterized by wave-like incidence cycles with a period of 5 to 7 years. Large outbreaks of hepatitis A have been reported in various countries. So, in 1988 in Shanghai, this disease affected more than 300 thousand people. The cause was eating raw shellfish. Such a wide spread at once in Russia is impossible, however, outbreaks of hepatitis A occur in various regions of the country. In 2000, nine outbreaks were reported, with a total of approximately 1,000 people affected. In August-September 2001, reports appeared in the media about an outbreak of hepatitis A in several regions of the Russian Federation. Moreover, when assessing the breadth of distribution, it is necessary to remember that for one case of the disease occurring with jaundice, there are at least five cases occurring without jaundice, which are usually not registered and which can be called a “latent form” of hepatitis A (from an interview with M. I. Mikhailov , Doctor of Medical Sciences, Professor of the N. F. Gamaleya Research Institute of Epidemiology and Microbiology of the Russian Academy of Medical Sciences, Moscow and I. V. Shakhgildyan, Doctor of Medical Sciences, Professor of the D. I. Ivanovsky Research Institute of Virology of the Russian Academy of Medical Sciences, Moscow, to the journal “Treating Doctor” No. 8, 2001) Hepatitis A: vaccination The question of possible lethality with hepatitis A still remains open. Some researchers completely deny this possibility. According to the website privivka.ru, mortality from hepatitis A ranges from 1% to 30%, with a clear increase in mortality with age, which is associated with an increased likelihood of infection layering on chronic liver disease. A significant proportion of deaths are recorded in patients who are chronic carriers of the hepatitis B virus. There is also a fairly large number of publications describing cases of fulminant hepatitis A (Tabor et al., 1984; Gust et al, 1992). More often, fulminant hepatitis A is registered as a concomitant infection in patients with chronic hepatitis B, C, AIDS, and drug addiction. In addition, the trigger role of the hepatitis A virus in the development of autoimmune hepatitis cannot be ruled out. Superinfection with viral hepatitis A in patients with chronic hepatitis B and C is of particular concern. The fact is that the registered increase in the incidence of hepatitis B, C and HIV infection, occurring in Russia in parallel with the increase in hepatitis A, will lead to an increase in cases of mixed hepatitis and an increase in the number of severe forms of these diseases. For this reason, combined vaccines against hepatitis A and B are very widespread (for example, the Twinrix ™ vaccine, registered in Russia). Hepatitis A virus has low antigenic variability, which is reflected in the existence of only one serotype (Hollinger et al., 2001) (Fig. 2). Some variability of individual antigens of the virus determines its resistance to various antibodies (Nainan et al., 1992; Ping et al., 1992), but does not prevent the creation of highly effective vaccines. Rice. 2. Protein capsid of the hepatitis A virus: green, pink and blue colors indicate variable domains (VP3, VP2 and VP1, respectively). Highly conserved antigenic sites are marked in yellow (from Sanchez et al., 2003). Several vaccines obtained using similar technology and containing an inactivated strain of the virus are approved for use in Russia against hepatitis A itself. This is the Havrix-1440 vaccine, developed in the 90s by GlaxoSmithKline (USA), Vakta (manufactured by Aventis, France) and Hep-A-in-Vac, a domestic drug developed in 1986. 1993 at the M. P. Chumakov Institute of Poliomyelitis and Viral Encephalitis of the Russian Academy of Medical Sciences and the industrially produced NP "Vector" (Fig. 3). All these vaccines have passed the necessary tests and can be used for the prevention of hepatitis A ("Treating Doctor" No. 8 for 2001). All vaccines approved for use, as noted by clinicians, are quite effective and have low reactogenicity. Sometimes people who have been vaccinated experience pain and redness at the injection site, less often - a slight increase in temperature and mild malaise; a transient increase in activity liver enzymes are observed extremely rarely.At the same time, drugs against hepatitis A remain very expensive: the price of one dose of the vaccine ranges from 800 to 1000 rubles (Table 1, data for 2008).Fig. 3. Vaccines registered in the Russian Federation against hepatitis A. Table 1. Average prices for vaccines against hepatitis A registered in the Russian Federation. Preventive vaccination is the most effective. During an outbreak of hepatitis A, timely use of vaccines helps limit the spread of infection and is the most effective method of combating hepatitis A. Positive experience in this regard was obtained with the use of the Havrix vaccine to eliminate large outbreaks in Slovakia (Prikazsky et al., 1994); in Alaska (McMahon et al., 1996) and other regions. In response to a single injection of the Havrix vaccine, after one month, antibodies at a protective level are produced in 94-98% of vaccinated people. Repeated vaccine administration provides 99–100% anti-HAV coverage (Hollinger et al., 2007). Data on the duration of post-vaccination immunity indicate that it may persist for at least 10-20 years. Other vaccines containing inactivated hepatitis A virus, used in the world and not used in the Russian Federation, have also been demonstrated to be effective in preventing outbreaks of this disease. An example is the American-made Healive® vaccine, which underwent final testing in 2008 (Shen et al., 2008). Assessment of immunogenic activity is an important step in understanding vaccine prevention. When conducting research, it is necessary to remember the importance of using highly sensitive and specific diagnostic drugs. Thus, in a parallel study of 77 adolescent blood sera 20 days and 1.5 months after a single dose of the Havrix-720 vaccine, anti-HAV in concentrations exceeding 20 mIU/ml were detected in 83.8 and 67.5 % of cases with a domestically produced drug, and with the diagnosticum HAV Total from BIO-RAD, France - in 97.3 and 93.5% of cases (data from the website lvrach.ru). In addition to vaccination with an inactivated virus, vaccination directly with antibodies to hepatitis A, or prophylaxis with immunoglobulin, is also used. When carrying out routine prevention with vaccines, it must be taken into account that the development of immunity after vaccination takes a minimum of two and a maximum of four weeks. Immunization with immunoglobulin can be used for emergency prevention purposes, as it provides immediate protection against infection. At the same time, immunoglobulin does not provide long-term protection, so immunoglobulin is often administered simultaneously with the vaccine. WHO position on hepatitis A vaccines “All currently available hepatitis A vaccines are of good quality and comply with the above WHO recommendations. However, they are not licensed for use in children under one year of age. The effectiveness of vaccines in children under one year of age varies due to the effects of maternal antibodies. Although available vaccines induce long-term protection when given in two doses 6-18 months apart, a high degree of immunity is acquired after the first dose. Studies aimed at studying the duration of immunity after one dose of the vaccine are strongly encouraged. Planning for large-scale hepatitis A immunization programs should include careful analysis of the cost-effectiveness and sustainability of different hepatitis A prevention strategies, as well as an assessment of the likely long-term epidemiological consequences of vaccination at different coverage levels. In countries with high endemicity, exposure to HAV is almost universal before the age of 10 years. In such countries, clinical hepatitis A is usually a minor public health problem and large-scale immunization efforts against the disease should not be undertaken. In developed countries with low endemicity and high incidence in selected high-risk populations, immunization of such populations against hepatitis A may be recommended. High-risk groups include injecting drug users, homosexuals, people traveling to high-risk areas, and certain ethnic or religious groups. However, it should be noted that immunization programs targeting selected high-risk groups may have little impact on national hepatitis A incidence rates. In areas of moderate endemicity, where transmission is predominantly person-to-person (often with periodic outbreaks), hepatitis A can be controlled through large-scale immunization programs. Recommendations for immunization against hepatitis A in an outbreak setting depend on the epidemiology of hepatitis A in a given community and the ability to quickly implement a large-scale immunization program. The use of hepatitis A vaccine to control large outbreaks has been most successful in small, dense communities when vaccination is initiated early in the outbreak and high coverage is achieved across a wide age group. Vaccination efforts must be accompanied by health education and improved sanitation. Although the disease burden associated with hepatitis A is significant in many countries, the decision to include hepatitis A vaccine in routine childhood immunization programs must be made in the context of the full range of available immunization inputs. This includes vaccines against hepatitis B, Haemophilus influenzae b, rubella and yellow fever, and, in the near future, pneumococcal vaccines, which together are likely to lead to more significant results in addressing public health problems.” Conclusion In conclusion, it can be said that hepatitis A cannot currently be considered a serious clinical problem. As a result of many years of work of researchers and clinicians around the world, the strategies for prevention and combating this disease are finally clear, and numerous modern vaccines are very effective. Nevertheless, it should be noted the need to develop cheaper methods for the production of vaccines against hepatitis A, since some authors note the economic inefficiency of universal preventive vaccination (Anonychuk et al., 2008; Bauch et al., 2007). In particular, this statement can be attributed to the Russian Federation, where only one vaccine of domestic production is applied. Literature: 1. Anonychuk AM, Tricco AC, Bauch CT, Pham B., Gilca V., Duval B., John-Baptiste A., Wo G., Krahn M. Cost-Effectivens of Hepatitis a Vaccine: A Systematic Revie Revie W. To Explore The Effect of Methodological Quality On the Economic Attractivence of Vaccination Strategies. Pharmacoeconomics. 2008; 26 (1): 17 - 32. 2. Bauch CT, Anonychuk am, Pham Bz, Gilca V, Duval B, Krahn MD. COST-UTILITY OF UNIVERSAL HEPATITIS A Vaccination in Canada. Vaccine. 2007; 25 (51): 8536-8548. 3. Blaine Hollinger F., Bell B., Levy-Bruhl D., Shouval D., Wiersma S., Van Damme P. Hepatitis a and B Vaccination and Public Health. J. viral. Hepat. 2007; 14 SUPPL 1: 1-5. 4. Gist ID Epidemiological Patterns of Hepatitis a in Different Parts of the World. Vaccine, Volume 10, Supplement 1, 1992; S56-S58. 5. Hollinger, FB, and SU Emerson. 2001. Hepatis a virus, p. 799–840. In DM KNIPE, PM Howley, De Griffin, Ra Lamb, Ma Martin, B. Roizman, and Se Straus (Ed.), Fields Virology, 4th Ed., Vol. 1. Lippincott Williams & Wilkins, Philadelphia, PA. 6. McMahon BJ, BELLER M., Williams J., Schloss M., Tanttila H., Bulkow L. A Program to Control An outbreak of hepatitis a in alska by using an inactted hepatitis a var. Arch. Pediatr. Adolesc. Med. 1996; 150 (7): 733 - 739. 7. Nainan OV, Brinton Ma, Margolis HS Identification of Amino Acids Located in the Antibody Sites of Human Hepatitis a Virus. Virology 1992; 191: 984-987. 8. Príkazskutch v, Oleár v, Cernoch a, Safary a, André Fe. Interruption of an outbreak of hepatitis a in two villages by vaccination. J. Med. Virol. 1994; 44 (4): 457-459. 9. Ping L.-H., Lemon SM Antigenic Structure of Human Hepatis a Virus Defined by Analysis of Escape Mutants Selected Murine Monoclonal Antibodies. J. Virol. 1992 66: 2208-2216. 10. Sanchez G., Bosch A., Pinto Rm Genome VariaBility and Capsid Structural Constraints of Hepatitis a Virus. Journal of Virology 2003; 452-459. 11. Shen yg, gu xj, zhou jh Protective Effect of Inactivated Hepatis a Vaccine Against the outbreak of hepatitis a in an open rural community. World J. Gastroenterol 2008; 14 (17): 2771-2775. 12. Tabor E., Snoy P., Jackson DR, Schaff Z., Blatt PM, Gerety RJ Additional Evience FORE THE ONE AGENT OF HUMAN Non-A, Non-B Hepatitis. Transmission and Passage Studies in Chimpanzees. Transfusion 1984; 24 (3): 224 - 230.

Internet sources: 1. World Health Organization 2. US Food and Drug Administration 3. EMedicineHealth 4. AboutHepatitis 5. Ministry of Health and Social Development of the Russian Federation 6. HepatituNET 7. Vaccination.RU 8. “Attending Doctor” 9. TravelHealth

Principles and purposes of vaccination

Hepatitis A infection does not cause chronic liver disease and is rarely fatal, but it can cause debilitating symptoms and fulminant hepatitis (acute liver failure), which is associated with high mortality and long recovery. Individual cases and epidemics of hepatitis A occur throughout the world and tend to be cyclical. There are an estimated 1.4 million cases of hepatitis A worldwide each year. In areas where the virus is widespread (high endemicity), the majority of hepatitis A infections occur among young children. The use of the vaccine provides long-term protection for children and people who did not have hepatitis A in childhood.

Whether or not a vaccine is included in routine childhood immunization depends on the local context, including the proportion of susceptible people in the population and the level of exposure to the virus. Some countries, including Argentina, Israel, China, Turkey and the United States, include this vaccine in routine childhood immunizations. Many countries use a two-dose schedule using inactivated hepatitis A vaccine, but other countries may include a single dose of inactivated hepatitis A vaccine in their immunization schedules. A.

In Russia, vaccination against this disease is carried out according to epidemic indications. For example, for persons living in regions disadvantaged by the incidence of hepatitis A, as well as persons at occupational risk of infection (medical workers, public service workers employed at food industry enterprises, as well as those servicing water supply and sewerage facilities, equipment and networks ). In addition, people traveling to disadvantaged countries (regions) where outbreaks of hepatitis A are registered are vaccinated.

1.What is hepatitis A and its symptoms?

Viral hepatitis, including hepatitis A, hepatitis B and hepatitis C

– various diseases that affect the liver. Each type of hepatitis has its own symptoms and causes. Treatment for hepatitis also depends on what type of hepatitis is diagnosed. In this article we will talk about one of the types of hepatitis – hepatitis A.

Hepatitis A is a serious disease caused by the virus of the same name and is an inflammation of the liver.

What are the symptoms of hepatitis A?

The main symptoms of hepatitis A may be:

• Jaundice (yellow tint to eyes and skin, dark urine);
• Abdominal pain;
• Loss of appetite;
• Nausea;
• Fever;
• Diarrhea;
• Fatigue and tiredness.

In children, hepatitis A often manifests itself with several symptoms at once.

A person infected with the hepatitis A virus can infect others for about a week before symptoms appear and for the first week after symptoms appear. It is also possible to transmit the virus from a person whose disease occurs in a latent form, without symptoms.

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Vaccine effectiveness

After vaccination, immunity against the hepatitis A virus is formed in 95% of individuals within 2 weeks after the first injection and in 100% after the second dose of the vaccine. Even if exposed to the virus, one dose of the vaccine has a protective effect for two weeks after exposure to the virus. However, manufacturers recommend two doses of the vaccine to provide longer-lasting protection—for approximately 5 to 8 years after vaccination.

The introduction of the vaccine leads to the appearance of protective antibodies to the hepatitis A virus 15-28 days after vaccination. The concentration of antibodies after vaccination is slightly lower than during infection, but is sufficient for reliable protection against the disease. The resulting protective immunity lasts for at least a year after vaccination. When a second dose of the vaccine is administered (6-12 months after primary immunization), it is possible to prolong immunity to hepatitis A for up to 10 years. The repeatedly proven effectiveness of vaccination of the population against hepatitis A makes the task of completely eliminating this infection quite realistic.

How to get vaccinated

Vaccination against hepatitis A is carried out in private clinics and in some public health institutions. With us you can get vaccinated at any time. Sometimes it is advisable to test for the presence of antibodies to the virus. If they are detected, no vaccination is given.

You do not need to have any documents with you to get vaccinated. The serum is administered if the patient has no contraindications.

Price

It must be said that the vaccine contains tiny particles of the virus; it is not active. They are deposited on an existing carrier, namely aluminum hydroxide. This vaccination is given to adults and children at any age. Today, both mono-vaccines and combination-type formulations are widely used. There are types of drugs that can be given to children from the age of one year, some vaccinations are designed for ages after 3 years. Immunization is carried out in several stages, the interval between injections depends on the type of drug.

You must understand that this type of immunization protects not only you, but also your family and other people who are not vaccinated. If you work in certain industries, you are required to get vaccinated. These areas of activity include education, food industry, and medicine.

Contraindications

All vaccines, including the Botkin disease vaccine, have all sorts of contraindications. Sometimes the doctor may refuse if he decides that you should not get vaccinated. A medical exemption may be temporary or permanent. Among the temporary reasons:

• acute infection;
• any chronic diseases with their exacerbation.

Among the constant contraindications it is worth noting:

• presence of allergies to vaccine components;
• too negative reaction the previous time.

People with fever and malaise are not allowed to participate in such disease prevention. The instructions say that the serum is administered a month after complete recovery. When planning a pregnancy, doctors advise applying in advance and getting vaccinated. The vaccine is not given to people with immunodeficiency or cancer. The serum is never mixed with other drugs.

Side effects

In certain cases, immunization may cause an unpleasant reaction. They usually occur less frequently in children. Most often, all adverse reactions disappear after 2-3 days. May be observed:

• heat;
• the appearance of nausea and even vomiting;
• muscle weakness;
• indigestion, loss of appetite;
• drowsiness and general weakness;
• redness, as well as thickening where the drug was injected;
• migraine.

Remember, there is no need to tape the injection site. It is not recommended to get it wet. As a rule, there is no reaction at the next immunization. All symptoms go away within a few days and without medication. To avoid weakening your immune system, refrain from drinking alcohol before and after the procedure. Serious complications are rare and are the exception to the rule. Of course, only you can decide whether you need such protection, but remember that the disease itself is much more severe and can even lead to death.

Consequences of hepatitis A.

Hepatitis A is an acute, but relatively short-lasting infection. After infection, the liver recovers within several weeks or months. The virus usually does not cause any long-term problems or complications. However, according to statistics, from 10 to 15% of people who have had hepatitis A experience a prolonged course of the disease or a recurrence of its symptoms within six to nine months. In very rare cases, patients develop acute liver failure, which can be fatal or require complex treatment such as a liver transplant.

Treatment of hepatitis A

The peculiarity of hepatitis A is that there is no treatment for the disease as such. Doctors can only monitor the condition of the liver to make sure that the recovery process is going well.

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What complications may occur during hepatitis A vaccination?

Content:

• What complications may occur during hepatitis A vaccination?
• Who should be vaccinated against hepatitis A?
• How to get vaccinated against hepatitis A
• When can you get vaccinated against hepatitis A?

Vaccination, like taking certain medications, can cause serious complications. An allergic reaction is possible. Compared to other vaccines, it is much easier to tolerate. To date, isolated cases of death have been recorded. According to experts, it is easier for the human body to endure vaccination than to get hepatitis A.

As after any vaccination, a person may develop a fever during the day - this is normal. If the readings are above 38.5°C, then you need to take an antipyretic. Sometimes an inflammatory process may begin at the injection site, but often this is how an allergic reaction manifests itself. If you are prone to allergies, take an antihistamine before vaccination.

If itching and burning occurs at the injection site, you can lubricate it with any oil, baby cream, or buy a special medicinal ointment at the pharmacy that will effectively remove the irritation. In cases where the vaccine injection site is very itchy, try not to scratch it, as this will only worsen the situation.

If other reactions occur, please report them to your doctor immediately. Perhaps your body reacts differently to the vaccine.