Immunization Reactions

IMMUNIZATION REACTIONS

DEFINITION

  • You believe your child is having a reaction to a recent immunization
  • Reactions to DTaP (Diphtheria, Tetanus, Pertussis), MMR (Measles, Mumps, Rubella), polio, Hemophilus influenzae type b, Hepatitis A, Hepatitis B, influenza, chickenpox (varicella), pneumococcal, meningococcal, Rotavirus and Human Papilloma virus and vaccines are covered

Symptoms

  • Most local pain and swelling at the injection site occur within 2 days.
  • Fever with most vaccines begins within 24 hours and lasts 2 to 3 days.
  • With live vaccines (MMR and chickenpox), fever and systemic reactions usually begin between 1 and 4 weeks.
  • Severe allergic reactions are very rare, but can occur with any vaccine.
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WHEN TO CALL YOUR DOCTOR

Call 911 now (your child may need an ambulance):

  • Difficulty with breathing or swallowing.
  • Not moving or very weak.  
  • Unresponsive or difficult to awaken .

Call your doctor now (night or day) if:

  • Your child looks or acts very sick.
  • Age less than 12 weeks with fever above 100.4°F (38°C) rectally.   (Caution: Do NOT give your baby any fever medicine before being seen.)
  • Fever above 105 F (40.6 C)
  • High-pitched, unusual cry present for more than 1 hour.
  • Crying continuously for more than 3 hours.
  • Redness or red streak around the injection site bigger than 1 inch.  
  • Redness around the injection site persists for more than 48 hours (2 days).

Call your doctor within 24 hours (between 9am and 4pm) if:

  • You think your child needs to be seen
  • Fever present for more than 3 days
  • Measles vaccine rash (onset day 6 to 12) persists for more than 3 days

Call your doctor during weekday office hours if:

  • You have other questions or concerns
  • Pain, tenderness, or swelling at the injection site persists for more than 3 days
  • Fussiness from vaccine persists for more than 3 days

Parent care at home if:

  • Normal immunization reaction and you don't think your child needs to be seen.
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HOME CARE ADVICE

Treatment for Common Immunization Reactions

  1. Pain: for initial pain or tenderness at the injection site with any vaccine
    • Apply a cold pack or ice in a wet washcloth to the area for 20 minutes once
    • Give acetaminophen (e.g., Tylenol) or ibuprofen by mouth. (See Dosage table)
  2. Fever: For fevers above 102 F (39 C), give acetaminophen (okay to use ibuprofen if over 6 months old).
  3. General Reaction:
    • All vaccines can cause mild fussiness, irritability and restless sleep. While this is usually due to a sore injection site, sometimes the cause is less clear.
    • Some children sleep more than usual. A decreased appetite and activity level are also common.
    • These symptoms do not need any treatment and will usually resolve in 24-48 hours.
  4. Call Your Doctor If:
    • Fever lasts over 3 days
    • Pain lasts over 3 days
    • Injection site starts to look infected
    • Your child becomes worse

Specific Immunization Reactions

  1. Chickenpox Vaccine:
    • Pain or swelling at the injection site for 1 to 2 days (in 19% of children)
    • Mild fever lasting 1 to 3 days begins 17 to 28 days after the vaccine (in 14%). Give acetaminophen or ibuprofen for fever over 102F (39C).
    • Never give aspirin for fever, pain or within 6 weeks of receiving the vaccine (Reason: risk of Reye's syndrome - a rare but serious brain disease)
    • Chickenpox-like vaccine rash (usually 2 lesions) at the injection site (in 3%)
    • Chickenpox-like vaccine rash (usually 5 lesions) scattered over the body (in 4%)
    • This mild rash begins 5 to 26 days after the vaccine and usually lasts a few days.
    • Children with these vaccine rashes can go to day care or school. (Reason: for practical purposes, vaccine rashes are not contagious)
    • EXCEPTION: avoid school if widespread, weepy lesions (Reason: probably actual chickenpox).
    • Precaution: if vaccine rash contains fluid, cover it with clothing or Band-Aid.
  2. DTaP or DT Vaccine: The following harmless reactions to DTaP can occur:
    • Pain, tenderness, swelling or redness at the injection site (in 25% of children) and lasts for 24 to 48 hours. A swollen arm or leg following 4th or 5th DTaP occurs in 3% and is not serious.
    • Fever (in 25% of children) and lasts for 24 to 48 hours
    • Mild drowsiness (30%), fretfulness (30%) or poor appetite (10%) and lasts for 24 to 48 hours.
    • A painless lump (or nodule) at the DTaP injection site can occur 1 or 2 weeks later. It is harmless and usually will disappear in about 2 months.
    • Call Your Doctor If: It turns red or tender to the touch.
  3. Hemophilus Influenza Type B Vaccine (Hib):
    • No serious reactions reported
    • Sore injection site or mild fever only occurs in 1.5% of children
  4. Hepatitis A Vaccine:
    • No serious reactions reported
    • Sore injection occurs in 20% of children, loss of appetite in 10%, and headache in 5%.
    • Usually no fever.
    • If these symptoms occur, they begin 3-5 days after vaccine and last 1-2 days
  5. Hepatitis B Virus Vaccine (HBV):
    • No serious reactions reported
    • Sore injection site occurs in 30% of children and mild fever in 3% of children
    • Because fever from the vaccine is rare, any infant under 3 months with a fever following the vaccine should be examined.
  6. Influenza Virus Vaccine:
    • Pain, tenderness or swelling at the injection site occurs within 6 to 8 hours in 10% of children.
    • Mild fever under 103 F (39.5 C) occurs in 18% of children. Fevers mainly occur in young children.
    • Nasal Influenza Vaccine: No side effects, no fever or symptoms.
  7. Measles Vaccine:
    • The measles vaccine can cause a fever (10% of children) and rash (5% of children) about 6 to 12 days following the injection.
    • Mild fever under 103 F (39.5C) in 10% and lasts 2 or 3 days.
    • The mild pink rash is mainly on the trunk and lasts 2 or 3 days.
    • No treatment is necessary. Your child is not contagious.
    • Call Your Doctor If:
      • Rash becomes very itchy
      • Rash changes to purple spots
      • Rash lasts over 3 days
  8. Meningococcal Vaccine:
    • No serious reactions
    • Sore injection site for 1 to 2 days occurs in 50%, with limited use of the arm in 15%.
    • Mild fever occurs in 4%, headache in 40% and joint pain in 20%
    • The vaccine never causes meningitis.
  9. Mumps or Rubella Vaccine: There are no reactions except for an occasional sore injection site.
  10. Pneumococcus Vaccine:
    • No serious reactions
    • Pain, tenderness, swelling OR redness at the injection site in 15 - 30%
    • Mild fever under 102 F (39 C) in 15% for 1-2 days
  11. Polio Vaccine:
    • No serious reactions
    • Polio vaccine by injection occasionally causes some muscle soreness.
  12. Rotavirus Vaccine:
    • No serious reactions to this oral vaccine
    • Mild diarrhea or vomiting for 1 to 2 days in 3%
    • No fever
  13. Human Papillomavirus Vaccine:
    • No serious reactions reported
    • Sore injection site for few days in 80%
    • Mild redness and swelling at the injection site (in 25%)
    • Fever over 100.4 F (38.0 C) in 10% and fever over 102 F (39 C) in 1-2%.

And remember, contact your doctor if your child becomes worse or develops any of the "Call Your Doctor" symptoms.

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REFERENCES

  1. AAP Committee on Infectious Diseases. Prevention and control of meningococcal disease: recommendations for use of meningococcal vaccines in pediatric patients. Pediatrics. 2005;116(2): 496-505.
  2. American Academy of Pediatrics, Committee on Infectious Diseases. Immunization of preterm and low birth weight infants. Pediatrics. 2003; 112(1):193-198.
  3. American Academy of Pediatrics: Committee on Infectious Diseases. Immunization Reactions. In Pickering L, ed. 2006 Red Book. 27th ed. Elk Grove Village, IL: 2006.
  4. Feder HM, et al. Clinical varicella following varicella vaccination: Don't be fooled. Pediatrics. 1997;89:897-898.
  5. Puwada L, et al. Systemic reactions (anaphylaxis) to measles-mumps-rubella vaccine and skin testing. Pediatrics. 1993;91:835-836.
  6. Rennels MB, Deloria MA, Pichichero ME, Losonsky GA, et al. Extensive swelling after booster doses of acellular pertussis-tetanus-diptheria vaccines. Pediatrics. 2000;105(1). URL: http//www.pediatrics.org/cgi/content/full/105/1/e12
  7. Schuval S. Avoiding allergic reactions to childhood vaccines (and what to do when they occur). Contemp Pediatr. 2003;20(4):29-53.
  8. Skowronski DM, Remple VP, Macnabb J, et al. Injection-site reactions to booster doses of acellular pertussis vaccine:rate, severity and anticipated impact. Pediatrics. 2003;112:e453-e459.

Disclaimer: This information is not intended be a substitute for professional medical advice. It is provided for educational purposes only. You assume full responsibility for how you choose to use this information.

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