1. INFECTIOUS COMPLICATIONS AFTER VACCINATION Dr Alireza Nateghian Associate professor of Pediatrics and Pediatric infectious diseases NATIONAL COMMITTEE FOR AEFIs INVESTIGATION

2. Classification of AEFIs Vaccine reaction Program error Coincidental Injection reaction unknown

3. Vaccine reactions Due to vaccine nature Mild reactions Severe reactions

4. 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…

5. Rare(severe) reactions AREACTIONTIME TO PRESENTATION INCIDENC(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 BAnaphylaxisLess than 1 h1 MMR-FC -throbocytopenia -anaphylaxis -encepalopathy -encephalitis 6-12 d 15-35 d Less than 1 h 6-12 d Acute,subacute,SSPE 330 30 1 <1 ? OPVPARALYSIS4-30 d0.4(esp with first dose)

6. vaccinereactionTime to presentation INCIDENC(PER 1 MILLION DOSES) T/TD/Td-neural plexus injury -sterile abscess -anaphylaxis 2-28 d 1-6 w Less than 1 h 5-10 6-10 1 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 ?

7. Program errors Type of program errorcomplications Unstrile injectionsAbcsess,cellulitis,sepsis,osteomyelitis,sept ic arthritis,TSS,HIV,HBV,HCV VACCINE RECONSTITUTION PROBLEM, OTHER DRUGS INSTEAD OF VACCINE LOCAL REACTION,ABSCESS THEIR 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 contraindicationSevere reactions(pregnancy,immune defects,concurrent diseases…)

8. TSS