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Immunization Reactions

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Does this describe your child's symptoms?

 

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 vaccines are covered

Symptoms

  • Most local swelling, redness and pain at the injection site begins within 24 hours of the shot. It usually lasts 2 to 3 days, but with DTaP can last 7 days.

  • Fever with most vaccines begins within 24 hours and lasts 1 to 2 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

Call 911 Now (your child may need an ambulance) If

  • Difficulty with breathing or swallowing

  • Not moving or very weak

  • Unresponsive or difficult to awaken

call now

Call Your Doctor Now (night or day) If

  • Your child looks or acts very sick

  • Age under 12 weeks with fever above 100.4° F (38.0° C) rectally (Caution: Do NOT give your baby any fever medicine before being seen.)

  • Fever over 104° F (40° C) and not improved 2 hours after fever medicine

  • High-pitched, unusual crying present over 1 hour

  • Crying continuously for over 3 hours

  • Redness or red streaking around the injection site begins over 48 hours (2 days) after the shot

  • Redness or red streak around the injection site becomes larger than 1 inch (2.5 cm) (over 2 inches (5 cm) for 4th DTaP and over 3 inches (7.5 cm) for 5th DTaP)

  • You think your child needs to be seen urgently

call within 24 hours

Call Your Doctor Within 24 Hours (between 9 am and 4 pm) If

  • You think your child needs to be seen, but not urgently

  • Fever present for more than 3 days

  • Fever returns after gone for over 24 hours

  • Measles vaccine rash (onset day 6 to 12) persists over 4 days

call within 24 hours

Call Your Doctor During Weekday Office Hours If

  • You have other questions or concerns

  • Redness, swelling or pain at the injection site persists over 3 days and is getting worse

  • Fussiness from vaccine persists over 3 days

home care

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 FOR IMMUNIZATION REACTIONS

Treatment for Common Immunization Reactions

  1. Reassurance:

    • Immunizations (vaccines) protect your child against serious diseases.

    • All of these reactions mean the vaccine is working.

    • Your child's body is producing new antibodies to protect against the real disease.

    • Most of these symptoms will only last 2 or 3 days.

    • There is no need to see your child's doctor for normal reactions.

  2. Local Reaction at Injection Site:

    • Cold Pack: 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 as needed.

    • Pain Medicine: Give acetaminophen (e.g., Tylenol) or ibuprofen. (See Dosage table)

    • Localized Hives: If itchy, can apply 1% hydrocortisone cream (no prescription needed) once or twice.

  3. Fever:

    • Fever with most vaccines begins within 12 hours and lasts 2 to 3 days. This is normal and harmless.

    • For fevers above 102° F (39° C), give acetaminophen (If over 6 months old, okay to give ibuprofen) (See Dosage table)

    • For all fevers: Give extra fluids. Avoid excessive clothing or blankets (bundling).

  4. 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.

  5. Call Your Doctor If:

    • Redness becomes larger than 1 inch (2.5 cm) (over 2 inches (5 cm) with 4th DTaP or over 3 inches (7.5 cm) with 5th DTaP)

    • Pain, swelling or redness gets worse after 3 days (or lasts over 7 days)

    • Fever starts after 2 days (or lasts over 3 days)

    • 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 102° F (39°C).

    • 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 child 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 2 to 7 days.

    • 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 large swelling over 4 inches (10 cm) arm can follow the 4th or 5th dose of DTaP occurs in 5% of children. Most children can still move the leg or arm normally. The area of redness is smaller.

    • The large thigh or upper arm swelling resolves without treatment by day 3 (60%) to day 7 (90%). This is not an allergy and future DTaP vaccines are safe to give.

  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 usually 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 2 months with a fever following the Hep B 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: Congested or runny nose, mild fever.

  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 (39.5°C) 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. 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%.

    • Headache in 30%

  11. Pneumococcal 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

  12. Polio Vaccine:

    • Polio vaccine by injection occasionally causes some muscle soreness.

    • Oral vaccine no longer used in the U.S.

  13. Rotavirus Vaccine:

    • No serious reactions to this oral vaccine

    • Mild diarrhea or vomiting for 1 to 2 days in 3%

    • No fever

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

Online Medical Reviewer: Louise Akin, RN, BSN
Online Medical Reviewer: Daphne Pierce-Smith, RN, MSN, FNP, CCRC
Last Review Date: 2/21/2012
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