What are the long-term, possibly systemic consequences, of extensive swelling which can last up to 14 days? - SM
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Vaccine 2001 Sep 14;19(32):4720-4726 |
Assessment of injection site reactions to an
acellular pertussis-based combination vaccine, including novel use of skin
tests with vaccine antigens.
Scheifele DW, Halperin SA, Ferguson AC.
Vaccine Evaluation Center, BC's Children's Hospital, 4500 Oak Street and the
University of British Columbia, BC, V6H 3V4, Vancouver, Canada
Recent reports indicate that children receiving a fifth consecutive dose of
DTPa vaccine have a moderate likelihood of developing a large injection site
reaction, the etiology of which remains unknown. We assessed the frequency,
severity and outcome of local reactions in 205 children who had participated in
earlier studies of DTPa-based vaccines and were due for a fifth dose at 4-6
years. DTPa.IPV vaccine was given intramuscularly in the deltoid. To explore
the role of cell-mediated immunity in local reactions we applied epicutaneous
(patch) tests at the same visit, using code-labeled solutions of DTPa.IPV, DT,
Pa, IPV, alum solution and saline, leaving them in place for 48 h. Subjects
were assessed by research staff on the following day. Injection site redness or
swelling >/=50 mm diameter was present in 24.4 and 20.5%, respectively, but
none of the subjects had fever or persistent limitation of arm movement. Large
local reactions were more common in bigger children (P<0.01) but not in
those with allergy/atopy. Large reactions resolved within 14 days. Positive
skin tests (erythema) occurred at 85 test sites in 51 of 187 evaluable
children, principally with DTPa.IPV, IPV and alum solutions. However, only DT
and Pa solutions caused positive tests significantly more often in children
with injection site redness >/=50 mm than in non-reactors (P<0.05, odds
ratios 5.2 and 6.1, respectively). Presence of alum in most test solutions might
have confounded the results as it caused non-specific inflammation when applied
alone. We conclude that local reactions to a fifth dose of DTPa-type vaccine
are frequent and sometimes extensive but not incapacitating and that concurrent
skin testing has potential to identify the vaccine antigens and immune
mechanism contributing to local reactions with more refinement of the method.
PMID: 11535322 [PubMed - in process]
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