Adverse events after vaccination in children

Immunization is one of the most effective ways to protect population from vaccine-preventable diseases. Immunization against infectious diseases has saved millions of lives. Modern vaccines are safe and effective. However, like every medicine, vaccines are not free from adverse reactions. The benefits of immunization are often not visible, particularly if the target disease incidence is low. In contrast, adverse effects that follow immunization are promptly noticeable, especially when the vaccinated person was apparently healthy at the time of immunization.

Fear of vaccine reactions, real or perceived, deters many people from undergoing vaccination. The problems of vaccine reaction and reluctance to be vaccinated have been known for many years in industrialized countries. These problems are usually paid attention to after most of the benefits from immunization have been obtained.

 

 

According to WHO Adverse event following immunization (AEFI) is defined as any untoward medical occurrence which follows immunization and which does not necessarily have a causal relationship with the use of the vaccine. The adverse event may be any unfavourable or unintended sign, an abnormal laboratory finding, a symptom or a disease.

Adverse events are classified as:

1. Having a specific causal relationship with the administration of the vaccine (there are statistical and biological data to support such a link),

2. Having a possible link with vaccination (available data are consistent with a causal relationship, but not sufficient),

3. With an uncertain relationship to the vaccine (not sufficient evidence for a causal relationship),

4. Non-grafting (available evidence suggests no association of the disease with vaccination).

Frequency of reactions is classified as:

· Very common            >10%

· Common                   1-10%

· Uncommon                1/100-1/1,000

· Rare                           1/1,000-1/10,000

· Very rare                   <1/10,000

Most vaccine reactions are minor and subside by their own. Severe reactions are very rare and, in general, do not result in death or long-term disability.

 

More Common                                               Less Common

(>1 in 100)                                                    (<1/100)

•Redness                                                        •Encephalitis

•Swelling, nodule                                           •Paralysis

•Pain                                                              •Arthritis

•Fever                                                            •Allergic reaction

•Irritability                                                     •Thrombocytopoenia

•Loss of appetite                                           •Febrile seizure

•Nausea                                                         •Fainting

•Narcolepsy

                                                                      •Death

 

The AEFI may be caused by the vaccine or immunization, but often the event is coincidental to vaccination, and we can’t control it.

 

Vaccine reaction is an event caused by the inherent properties of the vaccine, which was given correctly. Depending on the clinical relevance and severity, it can be classified as physiological and non-physiological. Physiological (or normal) reactions, reflecting natural reaction to the vaccine antigen, are common; they often include fever, muscle aches, local skin reactions, and usually have short duration.

Timing of vaccine reactions depends on the form of the vaccine, if we talk about inactivated vaccines, the time of developing reaction is within 72 hours. In live vaccines, time of reaction depends on the speed of virus replication but more often it is about 5-14 days.

Non-physiological (or postvaccinal complications) are less common, unexpected and more severe than physiological ones. The most severe complications are either allergic or neurological (encephalopathy, encephalitis, neuritis), and can lead to hospitalization or death.

Every year a number of those children who develop different clinical symptoms after immunization with different vaccines are hospitalized with a suspected diagnosis of post-vaccination complication. Then differential diagnosis and final diagnosis are made.

Causality assessment of AEFIs is very important for medical differential diagnosis. A good clinician does not diagnose diabetes or coronary artery disease on the basis of conflicting or vague information. In the same way, an AEFI should not be causally linked to a vaccine without adequate information.

 

Exercise 1

Parts of speech	Noun	Adjective	Verb	Participle I	Participle II
	vaccine
		differential
			to react
				replicating
					unexpected

Exercise 2

Answer the following questions:

1) Is immunization one of the most effective ways to protect population from vaccine-preventable diseases?

2) What are the advantages and disadvantages of immunization?

3) What is adverse event following immunization?

4) Why is the problem of adverse effects that follow immunization so frequently discussed nowadays?

5) What principles are used to classify adverse events following immunization?

6) What most common reactions caused by immunization can occur?

7) What severe reactions caused by immunization can occur?

8) Why is the assessment of AEFIs very important for medical differential diagnosis?

Exercise 3

Find the text sentences that are contrary to the following statements:

1) The benefits of immunization are often not visible.

2) The manifestations of adverse effects are not evident.

3) Children who develop different clinical symptoms after immunization are not hospitalized.

 

PART II

TEST YOURSELF

Самостоятельная работа № 1

Speaking on Infections

Exercise 1A. Read, translate and speak about each infection using the information given further in the texts in general.

Exercise 1B. Play parts of parents curious to know about common infections and a group of doctors giving an educational talk on them using the following texts from a reference book for parents.

BRONCHITIS. Bronchitis may be mild or severe. It simply means that the cold has spread to the air passages. There may or may not be fever, but the cough may be severe and it may interfere with feeds and sleep. If there is fever and the child coughs frequently, a doctor should be consulted. Even without fever, if the cough persists you should consult a doctor. Till such time as a doctor is available, the child should be given steam-inhalations to soothe the cough and ease breathing. Aspirin may be given to bring down his fever.

CHICKENPOX. The illness begins with fever, slight headache and listlessness. Within a day or two spots appear on the chest or back, which soon look like small blisters. Such new “crops” keep appearing for 2—3 days and older ones get scabbed over. There is a lot of itching and the child may scratch some of the blisters. Chlckenpox is usually a mild disease, and there is no particular treatment, except to keep the skin clean and use some soothening lotion for itching. The itching can also be relieved by bathing the child with a small quantity of bicarbonate of soda (baking soda) 2—3 times a day. Antihistamine syrup to relieve itching should only be given under medical advice.

As in the case of measles, there is no point keeping the other children in the family away, as they have been exposed to the disease already and it is just as well for them to get it over with.

COMMON COLD. The commonest viral infection is the common cold, and everyone is only too familiar with it. The baby is irritable and restless because he cannot breathe through his mouth. As soon as he tries to suck the breast or bottle, his breathing difficulty increases because his.mouth also gets blocked, and so he stops sucking in order to breathe. The baby not only has the problem of breathing, but also gives up feeding. He finds it difficult to go off to sleep and wakes up again and again. Because of the necessity of breathing through the mouth, many babies who suck their thumb give up this habit, as they have to breathe through their mouths. A cold may also cause pain in the ear and go down the air passages into the lungs.

There is no special medicine for the common cold, except to make the child comfortable by helping to keep his nose open with nose drops, and giving him baby aspirin for fever. Steam inhalations help a great deal. This can be done by the mother sitting with the baby in her lap and covering the head with a towel or a sheet. A steaming kettle is kept nearby and the baby inhales the steam. Be careful not to let the baby touch the hot kettle or to take the baby too near the steam, as it might cause skin burn. Inhalation can be given for about 5 —10 minutes 2—3 times a day. In warm weather it will not be possible to give steam inhalation.

CROUP. Croup is the word commonly used for infection of the air passage or larynx. There is a hoarse, barking cough and difficulty in breathing. It comes on suddenly during the evening. The child may have had a cold and some cough, but suddenly wakes up coughing and breathless. His voice is hoarse and he seems to be fighting for breath. It looks frightening, but it is not so serious as it looks. Breathing improves by increasing the humidity of the room. This can be done by keeping basins of water in the room, hanging wet sheets or towels around the child’s bed, by a room cooler or khas-khas chicks. In winter a steaming kettle can be kept in the room. Breathing improves in a moist room, and the cough also becomes loose and less dry.

Croup with fever. This is a more severe form of croup.There is difficulty in breathing, a feeling of tightness in the chest, and cough. A doctor should be consulted immediately or the child should be taken to the hospital.

DIPHTHERIA. Diphtheria is a highly contagious disease, which mainly effects the throat. The symptoms are sore throat, fever and headache. There is difficulty in swallowing. There is a whitish patch in the throat and if it spreads to the windpipe, there is difficulty in breathing. The child looks ill and toxic. The disease can lead to many complications of nerves, heart and kidneys, and sometimes an emergency operation (tracheostomy) may have to be done if the windpipe gets blocked with the membrane and the child has difficulty in breathing. The child will have to be hospitalized in an infectious disease hospital for 3—4 weeks, and then convalescence proceeds at home for a few weeks more. This disease can be prevented by immunizing the child.

GERMAN MEASLES (Rubella). This is a mild disease with low-grade fever, some pain behind ears due to enlargement of glands, and a mild pinkish rash, which only lasts for a day or two. The whole illness lasts 2—3 days and needs no treatment at all. If, however, a pregnant mother gets German measles during the first three months of her pregnancy, there is great danger of the baby being born with some congenital malformation. Under doctor’s advice it is permissible to have an abortion induced for such an eventuality. Fortunately, most mothers would have already had the infection in their childhood.

One attack of German measles usually gives a lifelong immunity, although, rarely, a second attack may occur. A vaccine has now been developed to prevent German measles but it is not yet available in all developing countries.

HEPATITIS. This is quite a common disease and every now and then one hears of someone who has jaundice. The disease is acquired by drinking, or eating anything contaminated by the hepatitis virus, which is passed in the infected person’s stool. The presence of hepatitis is a pointer to the inadequqte arrangements of safe water supply and sewage disposal in a locality. The virus is very resistant and even boiling does not destroy it.

There is fever, loss of appetite, vomiting and pain in the upper abdomen. Loss of appetite and a feeling of being ill is out of proportion to the fever. Even the smell or sight of food may make the child sick. In 4—5 days the urine becomes dark in colour, and later the eyes and skin become yellow. Gradually the appetite returns and the fever comes down.

The child should remain in bed as long as he has fever and feels ill. Once his appetite returns he can play about in the house, but should not go to nursery school till jaundice has disappeared and he feels quite well.

In the acute stage the child should be encouraged to drink sweet drinks such as orange juice, or sweet lemon drinks or any sherbet. Sugarcane juice is excellent. Sugar is good for the recovery of the liver. As the appetite returns, ordinary household food can be given, but you should cut down on butter, oil and fried food. There is no need to give only boiled food, as was advised earlier.

INFECTIONS (Protection against). The baby has to be protected against all diseases possible. Cooking the food hygienically and protecting it from dust and flies is helpful in preventing diarrhoea. Do not expose a child to sudden chill, like giving him a bath in a draughty place or changing him in a cold room if he has wet his clothes at night. This can lead to a cold and chill, which may even lead to congestion of the chest. If he gets wet in the rain, change his clothes as soon as you can. Make sure you do not take the baby with you while visiting a friend or relative who has an illness such as fever, cough or a rash. The baby may catch the infection easily. As far as possible protect the baby from being in contact with other children who suffer from coughs and colds measles, chickenpox, mumps or any other infectious disease. This is not always possible, because someone or the other either at home or in the neighbourhood has a cough or a cold.

INFLUENZA. Influenza is also commonly called flu. It starts as a heavy cold, with fever and cough. There is headache and bodyache and extreme weakness and malaise. It spreads rapidly from one person to the other. The incubation period is only from 1 to 2 days. The management consists of bed rest, general management for fever with aspirin, and for cough with steam inhalation or a cough linctus. There is a variety of vapourubs which, when rubbed on the chest and neck, also seem to give relief. There is no specific treatment.

MUMPS. Mumps is a communicable virus disease, that usually attacks one or both parotid glands located near the angle of the jaw. It commonly occurs between 5 and 15 years of age. The incubation period, i.e. the period between acquiring the infection and the first symptoms, is usually three weeks. One attack gives immunity.

There is pain on opening the mouth or chewing, a moderate degree of fever, loss of appetite, headache and body pain. Both sides of the face may swell at the same time or there may be a gap of a few days between one side and the other. The swelling lasts about 6—7 days.

Mumps may affect testicles in boys and ovaries in girls, resulting in sterility. This is rare before puberty, and so it is best if children acquire the disease at a younger age. Treatment consists of bed rest during fever, mouthwashes to keep the mouth clean and aspirin for fever and pain.

Mumps can now be prevented by immunizing the child with mumps vaccine, but it is not yet available in all developing countries.

PNEUMONIA. Pneumonia is an acute inflamation of the lung. It may be caused by bacteria or viruses. It may follow a cold and bronchitis, or may come on suddenly. It may also be a complication of measles or whooping cough. The child looks ill, has fever, cough, and very rapid breathing. He may also complain of pain in the chest. An X-ray examination will confirm the presence of pneumonia. A doctor should be consulted, and depending on the severity the child may be treated at home or admitted to a hospital. If his breathing is very rapid, he may need oxygen. Most pneumonias can be treated with antibiotics and the disease rs not as dangerous as it used to be some years ago. Pneumonia can be dangerous in a malnourished child, or in very young children, especially if it is due to an organism called staphylococcus. Viral pneumonia cures gradually. The child should be kept in bed, given plenty of fluids and a highly nourishing diet.

POLIOMYELITIS. Poliomyelitis is a contagious disease caused by a virus, which enters the body with food and contaminated water. The virus is passed in the stools of the infected person and if hygienic measures are poor and the disposal of faeces is not done properly, the infection spreads to water and food. The illness begins as common cold, with aches and pains and stiffness of the back and neck, and the child recovers in a few days without anyone realizing that he had poliomyelitis. In some cases, however, the nerves get affected and the child develops paralysis of any part of the body, usually a limb. Sometimes the whole body gets affected and the child may have difficulty in breathing because of the involvement of chest muscles.

It is a frightening disease but one should remember that with proper management, there is considerable or even complete recovery and the child is able to lead a perfectly normal life.

The child should be kept at complete rest during the first few days while there is fever, pain and tenderness. No injection should be given at this stage. Once the acute stage has passed, physiotherapy (exercises and massage), should be started with the advice of the treating doctor. This is a long-drawn-out affair and you must be patient and keep up your morale as well as that of the child’s. If you are going to sit with a long face and tears in your eyes, the child is hot going to be encouraged. There are no drugs for the treatment of polio. В complex injections do not help. Physiotherapy is the only answer.

Since the virus is passed in the stools, during the illness, there should be proper disposals of stools in the flush, and disinfection of bedsheets and clothes if they get soiled with faeces.

The disease can be prevented by polio vaccine, as suggested in the immunization schedule.

RHEUMATIC FEVER. Rheumatic fever is an exceedingly variable disease and affects the joints, the heart and other parts of the body. The common age incidence is between 5 and 14 years. It is considered a reaction of the body to a streptococcal infection of the throat which has been inadequately treated, or not treated at all. The child has fever, pain or swelling in the joints which may be mild or severe. The pain and swelling travels from one joint to the other, and lasts 2—3 days, the usual joints affected are wrists, elbows, knees and ancles. The seriousness of the disease lies in the fact that it may affect the heart, in which case the child looks very ill and pale, has a rapid pulse and also breathes rapidly. He may develop puffiness in the face and swelling in his body. On the other hand the disease may be mild, passed off as “aches and pains”, but even a mild attack can affect the heart, which may be discovered later in a routine examination because of a “murmur” in the heart. Any child who has pain in the joints, slight fever and tiredness, should be examined to make sure about rheumatic fever. There is always a danger of serious sequelae, once the heart is involved.

Once the heart is affected, treatment is long and protracted and the child has to be under the careful observation of a pediatrician or a cardiologist. The attacks of rheumatic fever tend to recur, and may endanger the heart further, or the heart may get affected in a subsequent attack even if it was not affected earlier. Recurrence of rheumatic fever can be prevented by giving the child an injection of a special type of penicillin, once a month for several years. This will naturally have to be done under the supervision of a doctor.

Adequate treatment of tonsillitis will prevent rheumatic fever, and therefore it is a preventable disease.

A child with rheumatic fever needs a prolonged period of rest. Every effort must be made to keep him cheerful and well occupied with toys and reading material. Since he will miss school for several weeks, some thought should be given to teaching him at home during convalescence, so that he does not have problems when he gets back to school.

TONSILLITIS. Tonsils are pads of lymphoid tissue in the throat, on each side, and when the child opens his mouth wide, these can be seen as small, rounded projections in the throat. Tonsillitis means inflammation of the tonsils. This is also called “strep” throat because the commonest cause of infection is streptococcus. The child has high fever, malaise, headache, and may complain of pain in the throat. The tonsils look angry and red and there are whitish patches on one or more tonsil, referred to as follicles. This condition has to be distinguished from diphtheria. A smear examination from the patch will confirm the diagnosis. The child should be treated adequately (usually 10 days) with penicillin, or a substitute. This is important because if the condition is not treated adequately, the streptococcal infection can lead to rheumatic fever.

WHOOPING COUGH (Pertussis). A newborn baby has no immunity to this disease at all, and so he must be kept protected from children who have any kind of cough. Whooping cough seems like an ordinary cough for the first few days, but gradually the bouts become more and more prolonged and the child coughs continuously. His face becomes red and he very often vomits. At the end of the bout of cough, when he takes a deep breath, a croaky sound is heard which is called the whoop and which gives the disease its name. The disease is a prolonged one and the cough may last 2—3 months. It can lead to lung complications also.

The child loses weight because of repeated vomiting. Fortunately, it can be prevented by immunizing the child with triple antigen (DPT) injections.

A child with whooping cough should be kept separate from other children for the first 3—4 weeks, but it is very often difficult to do that because of shortage of space in the house. The disease is more severe in babies under 1 year of age, and every effort must be made to isolate them, at least.

Due to a severe bout of coughing there may be bleeding into the blood vessels of the eyes and the eyes will look as if someone has hit the child and produced a bruise (commonly called a black eye).

Самостоятельная работа № 2

Lexical Tests

1. Common Cold

All children catch 1.... It’s not unusual to them to have as many as eight a year and there is little you can do 2... them. But the good news is that by the time adulthood is reached, 3... people will have a certain 4... against them — which is why parents often 5... children through 6... colds with scarcely a sniffle themselves.

The 7... cold is 8... by a virus which enters the body through the nose. It is very 9... and can be passed by coughing or 10.... Symptoms start up to four days after catching the 11... and include a runny or blocked nose; sneezing and 12... throat. A cold is best 13... at home and there is some truth in the saying that if you treat 14... it will 15... seven days and if you don’t it will last a week (but feel like a fortnight!).