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Anti-infective vaccines are the most effective public health measure taken to fight infectious diseases[i]. Vaccines and their constituents may give rise to side effects but which remain rare. In the United States, the number of moderate or severe reactions after vaccination with common vaccines (influenza, hepatitis B, measles-mumps-rubella, diphtheria-tetanus-polio) between 1991 and 2001 remained relatively stable: 7.2 reactions per 100 000 doses administered in 1991 against 5.8 per 100 000 doses administered in 2001[ii]. The most common side effects are local. Systemic reactions do exist but are most often benign.
RISKS ASSOCIATED WITH THE MAIN CONSTITUENTS OF VACCINES
Vaccines are made up of different constituents:
– culture media: generally made up of proteins or peptides (horse serum, mouse or monkey cells, etc.);
– additives including: antibiotics (neomycin, gentamycin, polymyxin B, etc.), preservatives (formaldehyde, thiomersal, aluminium, 2-phenoxy-ethanol, etc.), stabilisers (gelatin, lactose, polygelines, polysorbate 80/20);
– contaminants (latex);
– and the infective agent (anatoxins, attenuated or modified pathogen, etc.).
MAIN TYPES OF REACTIONS TO VACCINES
Local inflammation and sensitivity lasting 24 to 36 hours is common and unremarkable.
Various systemic reactions have been described following vaccination:
– Reactions implicating the cells of the immune system (immunoglobulin E, T cells, immune complexes, etc.);
– Reactions frequently referred to as "pseudo-allergic", most often in previously immunized patients (having either been vaccinated or having already been in contact with the infectious agent);
– Inflammatory autoimmune reactions, most often unmasking an underlying disease; vaccination is probably only an additional factor;
– Systemic reactions with fever, body aches, chills and fatigue occurring in the days following vaccination without specific gravity.
To limit this type of reaction, it is recommended to postpone any vaccination in case of fever, acute disease or progressive chronic disease.
Over the past few years, numerous diseases have been reported to be related to anti-infective vaccines (asthma, atopy, autism, multiple sclerosis, Guillain-Barré syndrome, etc.). Currently, there is no formal proof of the link between vaccination and these diseases [i] [ii] [iii] [iv].
Allergic reactions to vaccines are rare. The rate of reactions presumed to be allergic is between 1-10 per million doses of vaccine administered; the most commonly implicated vaccines are those containing anatoxins [v] [vi].
Mucocutaneous reactions to vaccines are not unusual; local reactions occurring at the injection sites are far the most common reactions and are benign in most cases. Allergic reactions to vaccines are rare; in case of suspicion of such a reaction, an allergy assessment is required.
[i] G Ada, "Vaccines and vaccination", The New England journal of medicine 345, No. 14 (October 4, 2001): 1042‑1053, doi:10.1056/NEJMra011223.
[ii] A Patja et al., "Risk of Guillain-Barré syndrome after measles-mumps-rubella vaccination", The Journal of pediatrics 138, No. 2 (February 2001): 250‑254, doi:10.1067/mpd.2001.111165.
[iii] Lynn Eaton, "New research on autism and measles “proves nothing”", BMJ (Clinical research ed.) 324, No. 7333 (February 9, 2002): 315.
[iv] F Zipp, J G Weil, et K M Einhäupl, "No increase in demyelinating diseases after hepatitis B vaccination", Nature medicine 5, No. 9 (September 1999): 964‑965, doi:10.1038/12376; C Confavreux et al., "Vaccinations and the risk of relapse in multiple sclerosis. Vaccines in Multiple Sclerosis Study Group", The New England journal of medicine 344, No. 5 (February 1, 2001): 319‑326, doi:10.1056/NEJM200102013440501; B Taylor et al., "Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association », Lancet 353, no 9169 (June 12, 1999): 2026‑2029; Annamari Mäkelä, J Pekka Nuorti, et Heikki Peltola, "Neurologic disorders after measles-mumps-rubella vaccination", Pediatrics 110, No. 5 (November 2002): 957‑963; C E Kuehni et al., "Are all wheezing disorders in very young (preschool) children increasing in prevalence?", Lancet 357, No. 9271 (June 9, 2001): 1821‑1825, doi:10.1016/S0140-6736(00)04958-8.
[v] C Ponvert, "[Allergic and non-allergic hypersensitivity reactions to toxoid-containing vaccines]", Archives de pédiatrie: organe officiel de la Sociéte française de pédiatrie 16, No. 4 (April 2009): 391‑395, doi:10.1016/j.arcped.2009.01.002.
[vi] Kari Bohlke et al., "Risk of anaphylaxis after vaccination of children and adolescents", Pediatrics 112, No. 4 (October 2003): 815‑820.
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