Immunization Reaction

Dear Lisa,

My daughter got her 4 month vaccines the other day and the next day she had hard bumps at the site of the injections. Was I supposed to rub the area after she got the vaccines? At this point I can't rub them because she cried but at least I will know for next time.

I assumed if I needed to rub it out her doctor would have told me but now I'm questioning myself. Please help!

“Bumps at the site of Injection”

Dear “Bumps at the site of Injection”,

Tenderness and swelling at the site of an injection is a common side effect from vaccine administration. (1) This reaction can occur whenever a child receives any injection, whether it be a vaccine or a medication. There is nothing that you as a parent could have done to prevent this common side effect. To answer your question, parents are not supposed to rub or massage the injection site after a vaccine is administered. In some cases a nurse may put pressure on an injection site after an injection is administered. The purpose of this is to stop the brief bleeding that normally occurs after an injection. Bleeding at an injection site is treated with gentle pressure to the area for a few minutes. (2) The best thing that a parent can do after your baby gets a shot is to pick her up and hug her!

The DPT vaccine, which is a routinely given at the 4 month visit, may cause a localized reaction. (3) Signs of a localized reaction include redness, induration or nodule formation at the injection site. (4). Many times this nodule formation can be felt under the skin for a few weeks or even months after an immunization is given. This nodule will gradually disappear on its own. (5)

In some cases redness and swelling occurs at a vaccine injection site because of a Hypersensitivity reaction or allergy to a hidden ingredient in the vaccine. Some vaccines have trace amounts of antibiotics which may cause a reaction in susceptible individuals. The Polio vaccine, which is routinely given at the 4 month visit may contain trace amounts of the antibiotics; Streptomycin, Neomycin and Polymyxin B. (2)

Some children allergic to Neomycin may experience a delayed-type, local reaction reaction 48 to 96 hours after administration of the Polio Vaccine (IPV), MMR or Varicella. The signs of this type of reaction include a raised red and itchy area on the skin. (2) This type of reaction is not a contraindication for future immunizations. Other vaccine components, such as gelatin may also cause a reaction in a sensitive child.

If your child develops signs of a hypersensitivity reaction to a vaccine, you should contact your Doctor. At the time of vaccine administration the staff at the doctor’s office documents the site of injection for each vaccine. It is a good idea to take note which vaccine was given at the site where a reaction occurs. Knowing this information, your doctor can monitor your child during future immunization administration. If your child develops a minor reaction, this does not prevent her from receiving the vaccine in the future. (2) These minor hypersensitivity reactions are commonly treated with an anti-histamine such as Benadryl.

On the other hand if a child has a history of an Anaphylactic reaction to Neomycin; Neomycin –containing vaccines should not be used. An immediate severe allergic reaction or anaphylaxis to a vaccine is a contraindication to future immunizations with that product. (2)

Serious complications of Intramuscular injections are rare. (2) Some of these rare reactions include cellulitis (skin infection), sterile abscess, bacterial abscess and skin pigmentation. Sterile abscesses or bacterial abscesses are estimated to occur once per 100,000 to 166,000 doses of DPT.(2) Signs of an abscess include redness, warmth, induration, pain, and fever. If a child develops signs of an abscess she should be evaluated by her Pediatrician so that treatment can be initiated with an antibiotic if necessary.

The description of your daughter’s symptoms sound like normal swelling that occurs after an injection. The only way to be sure what type of reaction your daughter is having is to have her evaluated by your Physician. Whenever there is a reaction to an immunization, no matter how mild, it is a good idea to contact your Pediatrician’s office so that the information can be documented.

Many times the pain reliever Tylenol is recommended to treat the discomfort from vaccine administration. I found that in most cases the discomfort subsides within 48 hours. During this time it is a good idea to watch the injection site for signs of an infection. This can be best done by keeping the site clear from bandages or band-aides. A band-aide can mask signs of an infection. This is the reason why band-aides are typically not used after giving an immunization. If a band-aide is used it should be left on the site for no more than 1 to 2 hours. (2) Signs to watch for include increased swelling at the injection site, redness that spreads, induration, warmth at the injection site, discoloration at the injection site, limitation in movement, prolonged crying or excessive irritability and fever. If any of these signs occur your child should be evaluated by your Physician.


For more information about Vaccines and the potential side effects log onto:

The Children’s Hospital of Philadelphia

References:
(1)Bates B. A Guide to Physical Examination and History Taking. Fifth Ed. Philadelphia, PA:J.B.Lippincott Company. 1991:403.
(2)American Academy of Pediatrics. Active and Passive Immunization. In: Peter G, ed. 1997. Red Book: Report of the Committee on Infectious Disease. 24th ed. Elk Grove Village, IL: American Academy of Pediatrics; 1997:15,32-34.
(3)The Children’s Hospital of Philadelphia Website. A Look at each vaccine: Diphtheria, Tetanus, Pertussis Vaccines. Available at: http://www.chop.edu/consumer/jsp/division/generic.jsp?id=75701. Accessed Oct 2006.
(4) Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984: 58.
(5)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:403.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Keeping Children Healthy