INFECTIOUS COMPLICATIONS AFTER VACCINATION

Dr Alireza NateghianAssociate professor of Pediatrics and Pediatric

infectious diseasesNATIONAL COMMITTEE FOR AEFIs INVESTIGATION

Classification of AEFIs

• Vaccine reaction• Program error• Coincidental• Injection reaction• unknown

Vaccine reactions

• Due to vaccine nature

• Mild reactions• Severe reactions

MILD(USUAL) REACTIONS

1.immunologic response to vaccine: - local reaction(BCG:90%,HEPATITIS B:5-15%, MMR:10% ,T/DT/Td:10% ,Pertussis:50%),

increases with repeated dose up to 50-85%

- systemic response:• FEVER (Hepetitis B:1-6% ,MMR:5-15% ,OPV:1%,T/TD/Td:10%,Pertussis:50%)

• Systemic reactions:irritability,fatigue,loss of appetite,headache,diarrhea,body pain,mild measles,mumps,rubella artralgia) (MMR:5% ,OPV:<1%,T/TD/Td:25%,pertussis:50-60%)

2.adjuants,perservatives…

Rare(severe) reactionsA REACTION TIME TO

PRESENTATIONINCIDENC(PER 1 MILLION DOSES)

BCG -local adenitis

-osteitis

-BCG dessimination

After 2 month up to?

1-12 months

After 1 month up to?

100-1000?

Up to 300

1

Hepatitis B Anaphylaxis Less than 1 h 1

MMR -FC-throbocytopenia-anaphylaxis-encepalopathy-encephalitis

6-12 d15-35 dLess than 1 h6-12 dAcute,subacute,SSPE

330301<1?

OPV PARALYSIS 4-30 d 0.4(esp with first dose)

vaccine reaction Time to presentation

INCIDENC(PER 1 MILLION DOSES)

T/TD/Td -neural plexus injury

-sterile abscess-anaphylaxis

2-28 d

1-6 wLess than 1 h

5-10

6-101

Pertussis -high pitch crying >3h-convulsion-hypotonia-hyporeflexia

-anaphylaxis

-encephalitis

First 24h

Up to 2 days

Usually up to 1 d

Less than 1h

Usually up to 2 d

1000-60000

80-570

20-990

20

?

Program errorsType of program error complications

Unstrile injections Abcsess,cellulitis,sepsis,osteomyelitis,septic arthritis,TSS,HIV,HBV,HCV

VACCINE RECONSTITUTION PROBLEM,OTHER DRUGS INSTEAD OF VACCINE

LOCAL REACTION,ABSCESSTHEIR REACTIONS

INJECTION IN WRONG PLACE -BCG local reaction-Superficial injection of DTP:NERVE INJ-BUTTOCK INJ FOR Hepatitis B:NO effect

Error in transportation -freezed vaccine:local reaction-heated vaccine: no effect

No attention to contraindication Severe reactions(pregnancy,immune defects,concurrent diseases…)

TSS