Rus Articles Journal

Threefold protection: we do AKDS inoculation (against whooping cough, diphtheria and tetanus)

When to do an inoculation

the Schedule of vaccination in our country is defined by a national calendar of inoculations. Vaccination of AKDS (TETRAKOK, INFANRIKS) - triple is also carried out in 3, 4, 5 and in 6 months. Further one revaccination - in 18 months follows. If the child begins to take root not in 3 months, and later, then the vaccines containing a koklyushny component to it enter three times with an interval of 1,5 months, and the fourth time - in a year after the third introduction. The subsequent age revaccinations in our country are provided only against diphtheria and tetanus of ADS - M of ANATOKSINOM of 1 (the foreign, registered in Russia analogs - DT - SHOE-POLISHES and IMOVAKSDT - ADYuLT) and each 10 years during life are spent in 7, 14 and further.

of 1 Anatoksina with an additive contain the reduced amount of active ingredient in the name of the letter “m“.

of the Kind of anatoksin

To vaccination only against diphtheria are applied BY HELL or HELL - ANATOKSIN M, and separately against tetanus - ADS ANATOKSIN.

For immunization against diphtheria and tetanus of children under 6 years if they had whooping cough and does not need to impart them from this disease any more, or they have constant contraindications to application of a koklyushny component of a vaccine (afebrilny spasms, the progressing disease of nervous system) about which the speech will go later, use ADS ANATOKSIN. At primary immunization this vaccine is entered by two times with an interval of 1,5 months. In 12 months after the second introduction the single revaccination is necessary. Since 7 - summer age to children and adults enter only ADS - ANATOKSIN M. This preparation is used for planned revaccinations according to a calendar of inoculations (in 7, 14 and further each 10 years). If for any reasons the child till 6 years was not imparted against diphtheria and tetanus, then after this age he is imparted by ADS - ANATOKSINOM M twice with an interval of 1,5 months and a revaccination in 6 - 9 months, and then revaktsinirut according to a calendar of inoculations. ADS - M of ANATOKSIN use also for continuation of immunization against diphtheria and tetanus to children 6 years at which complications of AKDS - vaccination about which we will tell below were noted are younger.

At violation of the schedule of immunization are set off by all inoculations which are carried out earlier, and the child continue to impart, completing all introductions of preparations before end of primary complex: vaccination + the first revaccination, and then enter into the age schedule of revaccinations.

of AKDS, TETPAKOK, INFANRIKS and all anatoksina can be entered in one stage with any other vaccines, except for BTsZh.

As enters a vaccine


All preparations for prevention of whooping cough, diphtheria, tetanus represent rather turbid liquid which before introduction is well stirred up for receiving a uniform uniform (homogeneous) suspension. If in a preparation there are not developing lumps or flakes, it is impossible to enter it.


Besides the main active ingredients, are included 1 adsorbent in structure of vaccines and the 2 stabilizer . As adsorbent HYDROXIDE of ALUMINIUM which strengthens a vaccine immunogenicity, that is its ability to cause long protection against an illness is used. As the stabilizer TIOMERSAL which represents mercury salt in quantity to 25 mkg acts. This dose is not dangerous to the person - according to WHO data, per day with food, water and through lungs gets to our organism to 20 mkg of various compounds of mercury.

of 1 Adsorbent - the substance capable to absorb (to adsorb) other various substances on the surface. For example, this property can be used for removal of harmful connections from any environment.

of 2 the Stabilizer - the substance promoting long preservation of physical, chemical properties of a preparation (product).

are entered by

of AKDS (TETRAKOK, INFANRIKS) intramuscularly, to children till 18 months - into a perednenaruzhny surface of a hip, to children 18 months - in a deltoid muscle (the top third of a shoulder) are more senior. Introduction of a vaccine to a gluteus which widely practiced earlier is not recommended now as buttocks of the baby have a big layer of fatty tissue and the preparation can get to fatty cellulose. Absorption of a vaccine comes from fatty tissue more slowly, than from muscular that can lead to emergence of local vaktsinalny reactions. Anatoksina (ADS, ADS - M and HELL - M) to children of preschool age enter the same as AKDS - a vaccine, and school students can inject a drug also hypodermically to the subscapular area. The special needle for hypodermic manipulations, with sharper, than at a needle for intramuscular injections, a cut is for this purpose used.


What the organism

will answer

After introduction of all specified preparations, but is much more often - after introduction of tselnokletochny vaccines (AKDS, TETRAKOK), in the first 3 days the child can have a reciprocal vaktsinalny reaction (local or the general). In 80 - 90% of cases it is noticeable in several hours after an inoculation.

It is usual (normal) vaktsinalny reactions, but not complications.

Local vaktsinalny reaction represents reddening and consolidation in the place of introduction of a preparation, most often the small size, however there are cases when manifestations of local reaction have 8 cm a diameter (but no more) that too is norm. It arises, as a rule, in the first day after an inoculation and remains within 2 - 3 days.

the General vaktsinalny reaction is shown by

most often in several hours after introduction of a vaccine and expressed by an indisposition and temperature increase of a body, but, as a rule, takes place by the end of third day. Distinguish weak vaktsinalny reaction with rise in temperature to 37,5 °C and insignificant violation of the general state; average vaktsinalny reaction with a temperature not above 38,5 °C and more expressed violations of the general state and strong vaktsinalny reaction with a temperature above 38,6 °C and the expressed violation of the general state. At very strong reaction with temperature increase of a body - in the first two days to 40,0 °C and above - introduction of AKDS - a vaccine stop, and diphtheria and tetanus inoculations continue ADS (ADS - M) by ANATOKSINOM .

Number of average and strong reactions to a vaccine the Tetracook can reach 30% of number of the imparted children. Frequency of strong reactions to introduction of a vaccine of AKDS does not exceed 1% of number of all imparted. Emergence of reactions is connected both with features of an organism of the child, and with a reaktogennost of a vaccine which is noted in a varying degree at all preparations and can differ depending on the used vaccine series. On acellular vaccines and anatoksina strong reactions practically do not meet. Development of usual (normal) vaktsinalny reactions does not depend on what dose of a vaccine is received by the child. Such reactions with an identical frequency arise both after 1, and after 3 or 4 introductions of AKDS, and can be even slightly more often on 1 - e introduction since 3 - the monthly child to whom introduce AKDS for the first time faces rather active alien agent. Actually with frequency rate of introduction of AKDS - vaccines increase only allergic, most often local reactions is possible (hypostasis, consolidation, redness in the place of an injection). It is connected with the fact that at repeated introduction to a vaccine organism, besides antibodies against the concrete activator or its toxins can be formed and antibodies which define emergence of allergic reactions, belonging to the class so-called, immunoglobulins E. Their increased quantity most often hereditarily is caused. When the child predisposed to an allergy receives the 1 and 2 dose of AKDS, in its organism antibodies of this class to a vaccine begin to be formed, and at the 3 and 4 introduction of AKDS there is an allergic reaction. Therefore recommend to the children who earlier already had allergic reactions to some substances when carrying out inoculations, especially at repeated introduction of the same vaccine, to preventively accept antiallergic means. However these drugs do not prevent temperature increase therefore their appointment to all children in a row that became wide to extend recently, senselessly.

Rise in temperature after an inoculation is a natural reaction of an organism, it is caused by actively going responses, in particular synthesis of some factors stimulating the active specific answer to a vaccine. Not for nothing in due time considered that the higher at the child temperature after an inoculation, the is more active immunity, the better it is protected from an infection.

How to help the kid

At temperature increase more than 38,5 °C (at the children predisposed to spasms, this “threshold“ should not exceed 37,6 °C) needs to use febrifuges (PARATSETAMOL, NUROFEN, NIMULID). If high temperature remains also after administration of drugs or other violations in health of the child were shown, it is necessary to call the doctor.

does not need “to Train“ for

the healthy kid for an inoculation. it is important to p to remember

that the child can get sick with any infection which incidentally coincided on time with the carried-out inoculation. If except temperature it has a cough, cold, violations of a chair, and fever remains longer than 3 days or begins 3 days later after an inoculation, it has no relation to it. It is necessary to find out in due time with what disease it can be connected and begin to treat the kid.

Often parents complain that after an inoculation the child had allergic rashes on skin (diathesis), and before nothing similar happened. As a rule, diathesis develops at children with hereditary predisposition to allergic reactions and various violations of work of intestines. The vaccine is capable to raise an allergic mood and if at the child the contributing factors take place, then after an inoculation, especially, if new food are entered into the same time in a diet of the nursing mother or the kid, the allergy can be shown for the first time. Therefore there is a rule - to enter new products or to change mix not later than a week to an inoculation or not earlier than in 7 - 10 days after it. As for children of more advanced age, does not follow adults, “feeling sorry“ for them after a prick, to treat with candies chocolate and other products - allergens, and also to drive in the popular enterprises of a public catering.

Possible complications

Of course, do not have absolutely safe vaccines, and the vaccine very seldom, but can cause complication. Parents have to know it, as well as the fact that it is one hundred times more dangerous than a consequence of infections. Besides, according to WHO data, vaccine-challenged complications register with a frequency of 1 on 15000 - 50000 doses of tselnokletochny vaccines (AKDS, TETRAKOK) and isolated cases - on acellular vaccines and anatoksina (1 100000 - 2,5000000).

are Distinguished by local and general complications.

to local complications refer education in the place of a prick of the site of fabric increased in volume To and the increased density (infiltrate), and also allergic reaction with reddening of skin and considerable hypostasis - more than 80 mm in the diameter. These changes remain within 1 - 2 days and take place independently. It is possible to use ointment, for example troksevazinovy which is put on all area of hypostasis of 3 - 5 times a day before disappearance of symptoms.

to the general complications treat :

  • persistent monotonous shrill shout (squeal) of the kid which appears in several hours after an inoculation and remains 3 hours and more and also is followed by concern of the child and sometimes - temperature increase of a body. All symptoms pass independently in several hours, but as therapy febrifugal preparations can be applied (see above). It does not exert negative impact on health of the child;
  • a convulsive syndrome (meets frequency of 1 on 50000 doses; it should be noted that at infection with a koklyushny infection this figure is much higher - 1 on 1000 diseased):
    • the febrilny spasms developing against high temperature (it is above 38,0 °C) in the first three days after an inoculation, is the most frequent - in the first day. Many foreign and domestic pediatricians and neurologists do not consider similar reaction of an organism as post-inoculative complications as nearly 15% of children till 2 years are inclined to such spasms at high temperature. Such is property of their brain fabric, their individual reaction to temperature, irrespective of its origin;
    • afebrilny spasms - spasms at a normal or subfebrilny temperature (to 38,0 °C). They arise very seldom. Their emergence demonstrates the previous organic defeat of nervous system which for any reasons was not installed to an inoculation. Emergence of such attacks is the indication for obligatory inspection of the child at the neurologist, with use of various tool methods.
  • allergic reactions: urticaria 1 , Quincke 2 and anaphylactic shock 3 - the most serious and most rare complication (less than 1 on 1000000 doses of a vaccine) which develops right after introduction of a vaccine or in 20 - 30 minutes swelled. Therefore within half an hour after vaccination the kid has to be under supervision of medical personnel and not leave policlinic or the inoculative center where carried out an inoculation. Unfortunately, in practice this rule is not always followed from - for haste of parents or medical staff. Treatment of complications is carried out by the doctor.

of 1 the Small tortoiseshell - the allergic disease which is characterized by skin rash in the form of blisters, an itch.

of 2 Quincke (the huge small tortoiseshell) - the allergic disease which is characterized by hypostasis of skin, hypodermic cellulose, and also mucous membranes of internals and systems Swelled (respiratory, digestive, urinary).


of 3 Anaphylactic shock - the state at which in response to introduction of any substance to an organism there is a sharp falling of arterial pressure that breaks activity of an organism in this case is required the immediate resuscitation help.

At introduction of an acellular koklyushny vaccine and anatoksin of complication arise much less than after introduction of AKDS - a vaccine, and monotonous shout and spasms do not meet.

to the Children who transferred complications to AKDS (TETRAKOK) a vaccine in the subsequent a koklyushny component is not entered, and diphtheria and tetanus inoculations carry out anatoksinam.

Risk of development of complications can be lowered to a minimum by means of regime and medicamentous measures. But even if complication did not manage to be prevented, at the child immunity to an infection is all the same developed and it is possible to continue inoculative process by other vaccine.

It is considered p that in AKDS - a vaccine of complication causes koklyushny component. If heavy reaction (for example, anaphylactic shock) was on DTsS or DTsS - M anatoksin, then to such children carry out Mand`s test (the French pediatrician who offered it). This test can be carried out only in the conditions of policlinic or a hospital. 0,1 ml of an anatoksin (diphtheritic or tetanic) part in 10 ml of physiological solution. From the received solution take 0,1 ml of the divorced anatoksin and enter vnutrikozhno on border of the lower and middle part of a forearm (as at reaction Manta). The result is estimated at once and in 24 hours. Test is considered negative if in the place of introduction there are no reactions and there is no general malaise. At negative test it is possible to enter given anatoksin.

of Contraindication to vaccination

Temporary contraindication to carrying out inoculations is sharp or an exacerbation of a chronic disease. In this case vaccination carry out later a vyzdorovleniye of the kid (in 2 - 3 weeks after a sharp illness and not earlier than in a month after an aggravation of chronic). To exclude vaccination of the unhealthy child, in day of an inoculation he is examined surely by the doctor or the paramedic (in rural areas) and takes temperature. The inoculation is done only to the healthy child, with normal body temperature, and specified whether there is no diseased in an environment of the kid. If those are, then it is better to postpone a planned inoculation for several days - before their recovery.

Constant contraindication to introduction of this or that vaccine are the heavy allergy to one of its components (Quincke, anaphylactic shock swelled), and also complication to the previous dose of a vaccine or rise in temperature more than 40,0 °C. Contraindication for introduction of a tselnokletochny koklyushny vaccine (AKDS, TETRAKOK) is the progressing defeat of nervous system and afebrilny spasms at the child.


about contraindications, it is necessary to tell that quite often doctors and parents unreasonably expand their “list“ and do not impart kids who have no direct contraindications to vaccination, for example of children - the allergic persons having bronchial asthma or children with not progressing defeat of nervous system. And meanwhile such kids surely it is necessary to impart against whooping cough as whooping cough causes the heaviest complications from lungs in children with bronchial asthma, and children with defeat of nervous system at a koklyushny infection have a long and serious damage of a brain.