Contraindications to vaccination

Modern vaccines have a minimum of contraindications, they are maximally free of ballast substances, preservatives and allergens, so they can be used in the vast majority of children and adults without any preliminary studies or tests. All vaccines have two interrelated contraindications - allergic reactions to vaccine components and a strong reaction or complication to a previous dose of this vaccine.

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Relative (temporary) contraindications to vaccination

A relative (temporary) contraindication is the presence of an acute or exacerbation of a chronic disease in the person being vaccinated, since in the event of the development of complications or an unfavorable outcome, the vaccination may be put forward as their cause. Experience has shown that when vaccinating children with acute pathology according to epidemiological indications, the number of reactions and complications does not increase, and the immune response is adequate. Vaccination of pregnant women is also undesirable: although the teratogenic effect of vaccines, including live ones, has not been proven, complications or the birth of a defective child may be associated with vaccination.

Each vaccine has a certain number of contraindications, strict adherence to which ensures maximum effectiveness and safety of vaccination.

The reduction in the number of contraindications has become possible due to the improvement of the quality of vaccines and the expansion of knowledge about the causes of complications. Most chronic diseases have been excluded from the list, only a few types of pathology that increase the risk of complications have been left. Compliance with contraindications protects not only the vaccinated person, but also the medical worker from possible accusations. However, an expanded interpretation of contraindications is unacceptable, the increase in the number of unjustified exemptions reduces vaccination coverage and, as the experience of the USSR and other countries has shown, is fraught with an epidemic of controlled infections.

Despite the reduction in the number of contraindications and the increase in vaccination coverage, we are seeing a reduction in the frequency of severe reactions and complications, most of which are individual in nature and cannot be predicted, i.e. associated with the previous condition of the person being vaccinated. This is also facilitated by the rules for vaccinating special groups with health problems that require a special approach, as outlined below.

List of medical contraindications to vaccinations of the National Immunoprophylaxis Calendar*

Vaccine	Contraindications
All vaccines	Severe reaction or complication to a previous vaccine administration
All live vaccines	Immunodeficiency state (primary) Immunosuppression; malignancies Pregnancy
BCG	The baby's birth weight is less than 2000 g Keloid scar
DPT	Progressive diseases of the nervous system History of afebrile seizures
Live vaccines: measles (MSV), mumps (MPV), rubella, as well as combined di- and tri-vaccines	Severe forms of allergic reactions to aminoglycosides (gentamicin, kanamycin, etc.) For foreign-made vaccines prepared on chicken embryos: anaphylactic reaction to chicken egg protein
Hepatitis B vaccine (HBV)	Allergic reaction to baker's yeast
Flu	Allergic reaction to chicken egg protein, aminoglycosides, severe reaction to any previous flu vaccine. Contraindications for live vaccines - see Instructions for Use.

* Acute infectious and non-infectious diseases, exacerbation of chronic diseases are temporary contraindications for vaccination. Scheduled vaccinations are carried out 2-4 weeks after recovery or during the period of convalescence or remission. In case of mild acute respiratory viral infections, acute intestinal diseases, etc., vaccinations are carried out immediately after the temperature has returned to normal.

False contraindications to vaccination

In practice, there are often cases of "exemption" from vaccination of children who do not have any contraindications. The main unjustified reasons for exemptions and delays in vaccination are "perinatal encephalopathy", "dysbacteriosis", "thymomegaly", allergies and anemia. Parental refusal, although it is referred to, occurs in less than 1% of cases, and it can be significantly reduced by persistent explanatory work.

"Perinatal encephalopathy" (PEP) as a diagnosis is excluded by the new classification, CNS pathology should be designated by specific terms. The acute period of perinatal damage ends within the first month of life, after which stable or regressing residual disorders may occur - in the form of muscle dystonia, delayed development of mental and motor functions, disturbances in the periodicity of sleep and wakefulness. Usually, they also included anxiety (most often associated with colic), Graefe's symptom (a normal variant) or chin tremor (hereditary dominant trait). It is not surprising that until recently 80-90% of all children of the first year in the polyclinic area had the "diagnosis" of PEP!

In such children, the neurologist must only confirm the absence of progressive pathology, which gives the pediatrician grounds to vaccinate the child on time; the neurologist's refusal is only legitimate if the child is diagnosed with afebrile seizures, hydrocephalus, or another progressive CNS disease.

Dysbacteriosis as a diagnosis is justified only in a patient with a bowel disorder against the background of massive antibiotic therapy, when the question of vaccination usually does not arise. In other cases, this diagnosis is not valid: a violation of the intestinal biocenosis is secondary to any intestinal disease: intestinal infection, food intolerance, impaired absorption of lactose and other carbohydrates, celiac disease, irritable bowel syndrome. Tests "for dysbacteriosis" in these cases (and especially with normal stool) are not needed, since they do not clarify the true cause of the disorder, and they are also expensive. In any case, changes in the microbial flora of feces are not a reason to refuse vaccination or postpone it.

An enlarged thymus shadow on an X-ray is usually detected by chance; it is either an anatomical variant or a result of its post-stress hyperplasia; in both cases, the diagnosis of "thymomegaly" is incorrect. Such children respond normally to vaccination and should be vaccinated on time.

Allergy in a child is not a reason to refuse vaccinations, the rules for their implementation are set out below. The use of ointments with steroids (as well as with pimecrolimus - Elidel), steroids in the form of sprays or inhalations does not interfere with vaccination.

Anemia of alimentary genesis should not be a reason for refusal from vaccination; after vaccination, the child should be prescribed an iron preparation. Severe anemia requires clarification of its cause with a subsequent decision on the nature of therapy and the time of vaccination.

Supportive treatment (antibiotics, endocrine, cardiac, etc.) cannot be a contraindication, as well as anamnestic data on severe diseases in the absence of their active manifestations. Indications of the presence of epilepsy in the child's family history, complications from the introduction of the vaccine, allergies of any form, cases of death of a sibling in the post-vaccination period should not serve as an exemption from vaccination. The exception - the presence of a patient with immunodeficiency in the family - requires examination of the newborn before the introduction of BCG and replacement of OPV with IPV.

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