Category: Vaccine Side Effects

DTaP Vaccine Reactions – Is This Normal?

Vaccines are very safe.

They are not 100% safe though and they can have some side effects.

Fortunately, most of these side effects are harmless and don’t have any long term risks. And of course, the great benefits of vaccines outweigh those risks.

Common DTaP Vaccine Reactions

Although 75% of kids don’t have any reactions at all, some do have mild reactions.

Among the vaccine reactions or side effects that can occur most commonly include:

Vaccine Information Statements from the CDC highlight the risks of each vaccine.
The DTaP Vaccine Information Statement from the CDC highlight all of the vaccine’s possible risks.
  • fussiness
  • fever
  • redness or swelling at the injection site
  • soreness or tenderness at the injection site
  • tiredness
  • poor appetite
  • vomiting

How commonly do they occur?

They range from 1 in 3 kids for some fussiness all the way down to 1 in 50 kids for vomiting.

And they begin 1 to 3 days after the vaccine was given and last for 1 to 7 days.  Fortunately, fever and fussiness don’t last that long, typically going away after just a day or two.

Treatment is symptomatic, with a cold pack or cool cloth/compress and pain reliever

What About More Extensive Swelling and Redness?

Sometimes the swelling and redness after a DTaP vaccine can be more than you expect though. It might even make you think your child has developed a skin infection.

“Sometimes the 4th or 5th dose of DTaP vaccine is followed by swelling of the entire arm or leg in which the shot was given, lasting 1–7 days (up to about 1 child in 30).”

DTaP Vaccine Vaccine Information Statement

This more extensive local reaction, while scary looking, is not dangerous, and will also go away without long term effects.

It is also not an allergic reaction, so your child can finish the DTaP series if he or she still needs another dose.

Call your pediatrician or seek medical attention if you think your child has developed a skin infection after a vaccination, but keep in mind that bacterial cellulitis after getting a vaccine is an extremely rare, almost unheard of, complication.

Other more moderate and severe DTaP vaccine reactions are uncommon or rare.

“A hypotonic-hyporesponsive episode (HHE) is the sudden onset of hypotonia, hyporesponsiveness, and pallor or cyanosis that occurs within 48 hours after childhood immunizations.”

DuVernoy et al on Hypotonic-hyporesponsive episodes reported to the Vaccine Adverse Event Reporting System (VAERS), 1996-1998

What about hypotonic-hyporesponsive episodes (HHE) and seizures? These were removed as table injuries after DTP back in 1995. It is not that HHE can’t occur after DTP, DTaP, or other vaccines, but rather that HHE doesn’t then cause any permanent neurological damage to the child.

And remember that some so-called vaccine induced diseases are simply made up.

Most of these reactions, as well as the risks of getting natural diphtheria, tetanus, and pertussis infections, are listed in the DTaP VIS.

What to Know About Common DTaP Vaccine Reactions

While most kids don’t have any reactions at all after their DTaP vaccines, those that do typically have mild reactions, including some fever, soreness, or swelling at the injection site.

More About Common DTaP Vaccine Reactions

 

cVDPV

Circulating vaccine-derived polio virus or cVDPV are outbreaks of polio that are actually caused by the polio vaccine.

Very rarely, the attenuated (weakened) virus in the oral polio vaccine can revert to a form that can cause the person who was vaccinated or their close contact to actually develop polio.

It should not be confused with VAPP or vaccine-associated paralytic polio. With VAPP, the original strain of attenuated vaccine virus reverts to a form that can cause polio, but it does spread from one person to another, so does not lead to outbreaks.

cVDPV Outbreaks

Fortunately, both VAPP and cVDPV are rare.

How rare? VAPP only occurs in about 1 in every 1.27 million children receiving their first dose of OPV.

And according to the WHO, there had only been about 24 outbreaks of cVDPV over the past 10 years. Tragically, this has resulted in at least 750 cases of paralytic polio in 21 countries.

An outbreak of cVDPV in Syria will be controlled by 355 vaccination teams that will vaccinate up to 328,000 children.
The WHO reports that an outbreak of cVDPV in Syria will be controlled by 355 vaccination teams that will vaccinate up to 328,000 children.

A new outbreak of cVDPV in Syria adds to those numbers though.

After being polio free for 15 years, since 1999, Syria began having cases of wild type polio again in 2013 (35 cases) and 2014 (1 case). Those polio cases and the emergence of an outbreak of cVDPV2 (there are three strains of polio virus – this outbreak was caused by the type-2 strain) highlight the effects of years of poor immunization rates because of war.

While there are many challenges to getting kids vaccinated in Syria, up to 355 vaccination teams with 61 supervisors will be working out of five vaccine distribution centers to vaccinate 328,000 children to control the outbreak and get kids vaccinated.

Circulating Vaccine-Derived Polio Virus

Just like wild type polio, we can stop cVDPV by increasing vaccination rates and increasing access to improved sanitation facilities.

Why?

Although anti-vaccine folks routinely cry wolf about shedding, the oral polio vaccine really does shed – in the stool of people who have been recently vaccinated. You can then be exposed to the attenuated polio vaccine virus (which can help give immunity to others in the community by passive immunization) or a strain of cVDPV (which can, unfortunately, help give others, especially if they are not vaccinated, paralytic polio) if they are exposed to open sewage or can not practice proper hygiene, etc.

Can’t we just stop using the live, oral polio vaccine?

Although a serious side effect of the vaccine, the vaccine’s benefits clearly outweigh the risk of both VAPP and cVDPV while polio is endemic (lots of cases) in a region, after all, without the vaccine, hundreds of thousands of children would get polio and would be paralyzed.

In polio-free countries, the risks of VAPP and cVDPV becomes greater than the risk of polio though, and they move to the inactivated polio vaccine. That helps prevent a situation in which the polio vaccines actually causes more cases of polio than wild type polio viruses.

Eventually, all countries will move to the IPV vaccine as we move closer to polio eradication. We came one step closer to that point in April 2016 when all countries that were still using the oral polio vaccine switched from trivalent OPV (three strains) to bivalent OPV (two strains) for their routine immunization programs. This could eliminate up to 90% of cases of cVDPV (most are caused by the type-2 strain which is not in bOPV)!

What To Know About cVDPV

Circulating vaccine-derived polio virus outbreaks are a rare side effect of the oral polio vaccine.

More Information About cVDPV

Vaccines and Seizures

A newborn baby getting an EEG.
A newborn baby getting an EEG.

Can vaccines cause seizures?

Unfortunately, they sometimes can.

Vaccines and Febrile Seizures

The CDC reports that “There is a small increased risk for febrile seizures after MMR and MMRV vaccines.”

We also know that:

  • there is a small increased risk for febrile seizures when the influenza vaccine is given at the same time as either the Prevnar13 vaccine or the DTaP vaccine, although “the risk of febrile seizure with any combination of these vaccines is small and CDC’s Advisory Committee on Immunization Practices (ACIP) does not recommend getting any of these vaccines on separate days.”
  • there is a small increased risk for febrile seizures if the combined MMR and chicken pox vaccine (ProQuad) is given to infants between the ages of 12 to 23 months vs their getting the shots separately.

But remember that febrile seizures, while scary for parents and other caregivers, are rarely dangerous.

It is also important to note that while febrile seizures are common, they are not commonly triggered by vaccines. A 2016 report in Pediatrics, “Vaccines and Febrile Seizures: Quantifying the Risk,” states that “The risk is 1 febrile seizure per pediatric practice every 5 to 10 years.”

Not surprisingly though, vaccines can likely prevent many febrile seizures, as chicken pox, flu, Hib, measles, mumps, rubella, pneumococcal infections and other vaccine-preventable diseases often cause fever and can trigger febrile seizures themselves.

Also, a study recently found that children who got sick with pertussis could be at increased risk for developing epilepsy, or recurrent seizures. That’s just another good reason to get vaccinated and protected against vaccine-preventable diseases.

Vaccines and Other Types of Seizures

While vaccines can sometimes trigger febrile seizures, they do not typically cause other types of seizures.

It was once thought that seizures were a common side effect of the DPT vaccine, but many studies have found that to not be true and seizures following DPT was even removed as a table injury from the NVICP. In fact, many of these children were instead found to have Dravet syndrome, which put them at increased risk for febrile seizures.

Long-term non-febrile seizures are still listed as side effects for the DTaP and MMR vaccine, but they “are so rare it is hard to tell if they are caused by the vaccine.”

A 2010 study in Pediatrics, “Lack of Association Between Acellular Pertussis Vaccine and Seizures in Early Childhood,” did not find any “increased risk for seizures after
DTaP vaccination among children who were aged 6 weeks to 23 months.”

Do report any reaction to VAERS if you think it was caused by a vaccine though.

Seizures After Getting Vaccines

If vaccines don’t usually cause seizures, then how do you explain a healthy infant developing seizures a few days, weeks, or months after getting his vaccines?

We’re always looking for reasons why something happened. The example I use is from my wife, who is a pediatrician. She was about to vaccinate a four-month-old baby, and while she was drawing the vaccine from the syringe, the baby had a seizure — and went onto have a permanent seizure disorder. Now, my wife hadn’t given the vaccine yet. But if she had given that vaccine five minutes earlier, there would have been no amount of statistical data in the world that would have convinced that mother that the vaccine hadn’t caused the baby’s seizure. You can do studies that show no increased risk with vaccines and seizure disorders, but that mother might still say “well, that’s true for the population but it’s not true for my child.”

Temporal associations are powerful, and they’re hard to defeat with statistics or studies.

Paul Offit, MD interview for The Thinking Persons Guide to Autism

There are many seizure disorders that begin in infancy.

Some even start in the newborn period, before a baby is a month old.

They are not triggered by vaccines though.

They include:

  • Infantile Spasms (first described in 1841) – typically begin when infants are about 4 months old, just when they get their second set of vaccines, which weren’t available when Dr. West described his own son’s repeated spasms
  • Benign Familial Neonatal Seizures – often genetic, seizures may begin on a baby’s third day of life
  • Benign Neonatal Convulsions – begin on the fifth day of life – the “fifth day fits,” and the seizures stop in about a month

If your child got her first hepatitis B vaccine when she was five days old and began having seizures, would you accept a diagnosis of Benign Neonatal Convulsions or would you blame the shot?

Would you remember the saying about correlation and causation?

For More Information on Vaccines and Seizures:

Fainting After Vaccines

Have you heard about children getting dizzy or fainting (syncope) after getting a vaccine?

“Fainting after getting a vaccine is most commonly reported after three vaccines given to adolescents: HPV, MCV4, and Tdap. Because the ingredients of these three vaccines are different, yet fainting is seen with all of them, scientists think that fainting is due to the vaccination process and not to the vaccines themselves.”

CDC Fainting Concerns

Although we usually hear about it after teens getting their vaccines, the “CDC has received reports of people fainting after nearly all vaccines.”

Fortunately, fainting after getting a vaccine does not cause any lasting effects, although getting hurt from a fall could, especially if the child hits their head.

To help prevent these types of injuries, “experts recommend having patients sit in a chair or lay down when they receive a vaccination.  In addition, patients should be observed for 15 minutes after vaccination.”

A common vaccine side effect, it isn’t clear though if it is the vaccine or the pain from the shot that leads to the fainting. Since teens commonly faint after other painful procedures, such as getting a blood draw or donating blood, it is almost certainly related to getting vaccinated and not the vaccine itself. It is certainly not a reason to skip or delay your teens vaccines.

More Information on Fainting After Vaccines:

 

VAPP

VAPP or vaccine-associated paralytic polio are cases of polio that are actually caused by the polio vaccine.

Very rarely, the attenuated (weakened) virus in the oral polio vaccine can revert to a form that can cause the person who was vaccinated or their close contact to actually develop polio.

It should not be confused with cVDPV or circulating vaccine-derived polio virus. With cVDPV, the original strain of attenuated vaccine virus reverts to a form that can not only cause polio, but can also spread from one person to another, causing outbreaks. Fortunately, these outbreaks are very rare.

Vaccine-Associated Paralytic Polio

How rarely? VAPP only occurs in about 1 in every 1.27 million children receiving their first dose of OPV.

Can’t we just stop using the live, oral polio vaccine?

Although a serious side effect of the vaccine, the vaccine’s benefit clearly outweighs the risk of VAPP while polio is endemic (lots of cases) in a region, after all, without the vaccine, hundreds of thousands of children would get polio and would be paralyzed.

Shedding of the OPV vaccine actually helps provide passive immunization to others in the community.

In polio-free countries, the risk of VAPP becomes greater than the risk of polio though, and they move to the inactivated polio vaccine. That helps prevent a situation in which the polio vaccines actually causes more cases of polio than wild type polio viruses.

Eventually, all countries will move to the IPV vaccine as we move closer to polio eradication. We came one step closer to that point in April 2016 when all countries that were still using the oral polio vaccine switched from trivalent OPV to bivalent OPV for their routine immunization programs. This should eliminate up to 38% of cases of VAPP!

What To Know About VAPP

VAPP or vaccine-associated paralytic polio is a rare side effect of the oral polio vaccine.

More Information About VAPP

Clinical Immunization Safety Assessment (CISA) Project

Many people think that VAERS is the only way that we can monitor the safety of vaccines in the Unites. They are clearly unaware of the Vaccine Safety Datalink (VSD) and of the Clinical Immunization Safety Assessment (CISA) Project.

CISA is a network of vaccine safety experts that can help pediatricians evaluate their patients who may have had vaccine injuries. CISA experts do research about vaccine safety too.

For more information:

  • CISA History
  • Requesting a CISA Evaluation
  • CISA Resources – includes an algorithm for the management of suspected allergic reactions to vaccines and an algorithm to assess causality after individual adverse events following immunizations.

Reporting to VAERS

Has your child had a bad reaction to a vaccine or what you think is a vaccine injury?

The CDC advises that “all significant adverse events that occur after vaccination of adults and children, even if you are not sure whether the vaccine caused the adverse event.”

What if your doctor won’t report the vaccine reaction?

While unfortunate, you can simply report the vaccine reaction yourself.

Health care providers are required to report:

  • Adverse events that are listed by the vaccine manufacturer as a contraindication to further doses of the vaccine.
  • Adverse events that are listed in the VAERS Table of Reportable Events Following Vaccination that occur within the specified time period after vaccination.

And keep in mind that VAERS isn’t the only way that the safety of vaccines is monitored, which should be reassuring to those who believe that vaccine reactions are under-reported. And remember that VAERS’ reports did help us quickly find the problems with the older rotavirus vaccines (increased risk of intussusception).

For more information: