Tag: DTaP

Can Vaccinated Children Be Asymptomatic Carriers of Pertussis?

Why do anti-vaccine folks like to talk about baboons so much?

“Did you know that a study showed that baboons injected with whooping cough vaccine became infected with whooping cough anyway – and silently spread the disease to other baboons for 35 days?”

Anti-vaccine Meme

Is it because baboons are used in the study of vaccines?

That’s part of it, at least when they can find a study where they can cherry pick the results to suit their needs.

The Baboon Study

Like most anti-vaccine talking points, this one about baboons, has some truth to it.

An adult male baboon.
An adult male baboon. Photo by Elizabeth Miller

There was a baboon study with the pertussis vaccine and it found that previously vaccinated baboons could develop asymptomatic carriage of the pertussis bacteria after they were intentionally infected.

Here is where it is important to note that an infection is different than a disease.

The example that many people are familiar with is tuberculosis. It is common to have a TB infection without any signs or symptoms and to not feel sick. The only reason we know that they have TB is because they had a positive TB test.

Unfortunately, about 5 to 10% of these people with TB infections can eventually develop TB disease, with coughing, weight loss, night sweats, fever, and chest pain, etc.

It is kind of the same with the baboons in the study. Twenty-four hours after two previously vaccinated baboons were inoculated with pertussis bacteria in the back of their nose and trachea, an unvaccinated baboon was put in each of their cages.

The vaccinated baboons continued to have pertussis bacteria in their noses, which the researchers had put there, for up to 35 days. And they were able to eventually pass the pertussis bacteria to the unvaccinated baboons in their cages. Vaccinated baboons also became infected or colonized after they were put in a cage with an intentionally infected unvaccinated baboon.

“…animals did not cough and showed no reduction of activity, loss of appetite, or other outward signs of disease.”

Warfel et al on Acellular pertussis vaccines protect against disease but fail to prevent infection and transmission in a nonhuman primate model

The vaccinated baboons were infected, but they never did develop symptoms of pertussis.

What Does The Baboon Study Mean?

One thing that is for sure – the baboon study found that the pertussis vaccines work. Only unvaccinated baboons got sick with pertussis.

But does this study explain our current outbreaks of pertussis?

Are vaccinated people becoming colonized and then getting others sick?

I guess it is possible, but we are not baboons in a cage with other baboons. How would we spread a respiratory disease, even if we did become colonized with the bacteria, if we don’t have symptoms?

It may explain part of our outbreaks though.

If vaccinated people do commonly become colonized with pertussis bacteria, then they might very well test positive for pertussis even though they don’t have symptomatic pertussis disease. So when they develop a cold or bronchitis and are found to have a positive pertussis test, then couldn’t that test just indicate that they have a pertussis infection and not disease, even though something else is actually causing their symptoms?

That’s what we think happens with strep carriers, right?

That’s kind of what the baboon study found. All of the baboons tested positive, but only the unvaccinated baboons had symptomatic pertussis disease.

“Baboons vaccinated with wP vaccines exhibit a level of protection that is intermediate between convalescent animals and aP-vaccinated animals. They exhibit no outwards signs of disease and are initially colonized to the same high level as aP-vaccinated animals but clear the infection more rapidly.”

Pinto et al on Pertussis disease and transmission and host responses: insights from the baboon model of pertussis.

It is interesting to note that the baboon study also found that baboons who had received whole cell pertussis vaccines also became carriers. They just didn’t stay carriers for as long as the baboons who got the newer acellular pertussis vaccine. But since they were still carriers, if asymptomatic transmission is such a big problem, wouldn’t it have been a big problem back in the day when everyone got whole cell pertussis vaccines?

The Debate Over Asymptomatic Carriage

Most vaccines prevent the spread of disease.

Do the pertussis vaccines?

Most folks still think so.

“The baboon model pioneered by Warfel et al. is without question a game-changer, shedding light on the impact of vaccination on disease and infection. However, the view it affords is clearer with respect to immunity and pathology than with respect to transmission. We point out that the extrapolation of the possibility of transmission from vaccinated baboons in the laboratory to the probability of transmission from vaccinated humans in the population is unwarranted. More work is needed to elucidate the relative transmissibility of infections in vaccinated vs. unvaccinated hosts. The evidence adduced above suggests, however, that vaccination with aP must have a strong effect on transmission as well as disease.”

Matthieu Domenech de Cellès et al on Epidemiological evidence for herd immunity induced by acellular pertussis vaccines

Even the author of the baboon study has said that “We agree that these data should not be directly extrapolated to pertussis transmission in humans. Although baboons are >96% genetically similar to humans, there are likely differences in how the species respond to vaccination and infection. We also agree that aP-vaccinated infected people are likely less efficient at transmitting pertussis compared with unvaccinated infected people, although it is not clear to what extent.”

Others think that asymptomatic carriage of pertussis might behind a lot of our recent outbreaks. Or at least what helps them grow so large.

Still, it is important to remember that unvaccinated folks do play a role in these outbreaks too. In a pertussis outbreak at a Florida preschool, in which most kids were vaccinated, the outbreak was started by a vaccine-exempt toddler.

And we have seen this in many other areas and it has been confirmed by many studies. Whatever else is contributing to pertussis outbreaks, like waning immunity, they are also associated with vaccine refusal.

“Counties with higher exemption rates had higher rates of reported pertussis among exempted and vaccinated children when compared with the low-exemption counties.”

Imdad et al. on Religious exemptions for immunization and risk of pertussis in New York State, 2000-2011.

But what if the DTaP and Tdap vaccines do cause folks to be asymptomatic carriers?

Even if that is true, understand that these vaccines don’t actually infect you, making you a carrier. They just might not prevent you from becoming a carrier if you are exposed to someone else with pertussis. While that might be a good reason to develop a new and better pertussis vaccine, it certainly isn’t a reason to skip or delay your child’s vaccines now.

Remember that even with our current outbreaks, rates of pertussis were much higher in the pre-vaccine era.

What to Know About Vaccines and Asymptomatic Carriers of Pertussis

The role of asymptomatic carriers and pertussis is controversial, but it certainly isn’t a reason to skip or delay your child’s vaccines.

More on the Vaccines and Asymptomatic Carriers of Pertussis

Your Baby’s First Vaccines

Your baby’s first vaccines are very important.

While they don’t provide instant protection, they do start your baby on the path to eventually getting protected from 16 different vaccine-preventable diseases.

Your Baby’s First Vaccines

Rotavirus vaccines are associated with a very small risk of intussusception, but that is not a good reason to miss the benefits of this vaccine.
The rotavirus vaccine will be among your baby’s first vaccines. Photo by Vincent Iannelli, MD

After the birth dose of the hepatitis B vaccine, your baby’s first vaccines when you visit your pediatrician for their two month check up will include:

  • DTaP – diptheria – tetanus – pertussis
  • IPV – polio
  • Hepatitis B
  • Hib – haemophilus influenzae type b
  • Prevnar 13 – pneumococcal disease
  • Rotavirus

Sound like too many? Those vaccines work to protect your baby against eight vaccine-preventable diseases! Before these vaccines were routine, when infants got fewer immunizations, they got more disease.

And it doesn’t mean that your baby has to get six shots.

The rotavirus vaccine is oral – your baby drinks it.

And many of the other vaccines can be given as a combination vaccine, either Pediarix (combines DTaP-IPV-HepB) or Pentacel (combines DTaP-IPV-Hib), to reduce the number of individual shots your baby needs to get even more.

While that still means multiple injections, there are things you can do to minimize the pain during and after the vaccines, from breastfeeding and holding your baby to simply trying to get them distracted.

Your Baby’s Next Vaccines

After their first vaccines at two months, your baby will complete their primary series of vaccines with repeated dosages of the same vaccines at four and six months.

Why do we need to repeat the same vaccines?

Because that’s often what it takes to help us build up an immune response to a vaccine, especially at this age.

These first vaccines prime the immune system, which when followed by a later booster vaccine, provide good protection against each disease.

start your baby on the path to eventually getting protected from 16 different vaccine-preventable diseases.
Ari Brown, MD explains why you shouldn’t delay or skip your child’s vaccines.

And the requirement of multiple dosages of a vaccine is a small price to pay to be able to skip the symptoms and risk of more serious consequences that come from getting a natural infection and natural immunity.

Did your baby have a reaction to their first set of vaccines?

While some fever, pain, and fussiness is not unexpected, be sure to tell your health care provider if your baby had a reaction that you think was more severe, like a high fever or non-stop crying for several hours.

Can you expect a reaction to your baby’s second set of shots if they had a reaction to the first? Probably not. Side effects, even those that are serious, rarely happen again, even when the same vaccines are given.

Your Baby’s Vaccines

While you certainly shouldn’t skip or delay any of these vaccines, you should know that:

  • the routine age for starting these vaccines is at two months, but
  • if necessary, they can be given as early as when a baby is six weeks old.
  • the routine interval between dosages of the primary series of these vaccines is two months, but
  • if necessary (usually as part of a catch-up schedule), these vaccines can be usually be given as soon as four weeks apart, although the third dose in the series of DTaP, IPV, and Hepatitis B vaccines shouldn’t be given any sooner than at age six months.
  • infants who will be traveling out of the United States should get an early MMR vaccine – as early as six months of age

And if your baby is at least six months old during flu season, then they will also need two doses of the flu shot given one month apart. The minimum age to get a flu shot is six months, and kids get two doses during their first year of getting vaccinated against the flu to help the vaccine work better.

Learn more about if you are on the fence. Your baby needs to be vaccinated and protected.

What to Know About Your Baby’s First Vaccines

Your baby’s first vaccines are safe and necessary to start them on a path to eventually getting protected from 16 different vaccine-preventable diseases.

More on Your Baby’s First Vaccines

Updated February 7, 2018

Pertussis Outbreaks

Like measles and mumps, pertussis, or whooping cough, is another vaccine-preventable disease that has been increasing in recent years.

Pre-Vaccine Era Pertussis Outbreaks

Pertussis has been known since at least the Middle Ages, although the bacteria that causes pertussis, Bordetella pertussis, wasn’t discovered until 1906.

Like measles, pertussis was a top killer of young children in the pre-vaccine era.
Like measles, pertussis was a top killer of young children in the pre-vaccine era.

That discovery led to the later development of the first pertussis vaccines, but before then, pertussis was a big killer, with epidemic cycles every 2 to 5 years.

During one of these cycles in the United States, from 1926 to 1930, there were:

  • 909,705 cases, and
  • 36,013 deaths

Unfortunately, even natural infection doesn’t provide life-long immunity, so adults would get pertussis and give it to susceptible kids, who were most likely to die during these epidemics.

But even in non-epidemic years, a lot of folks got pertussis. The number of reported cases ranged from “just” 161,799 in 1928 to 202,210 in 1926. And during one of the biggest years, 1934, there were 265,269 cases!

Post-Vaccine Era Pertussis Outbreaks

That changed in the vaccine era.

The first pertussis vaccines were developed in the 1930s and became more widely used in the 1940s when it was combined into the whole-cell DTP vaccine.

This was replaced with the acellular DTaP vaccine in 1997, with the Tdap vaccine being added to the vaccine schedule in 2006.

These vaccines helped to greatly reduce how many people got pertussis and how many people died from pertussis:

  • 1940 – 183,866 cases
  • 1950 – 120,718 cases and 1, 118 deaths
  • 1960 – 14,809 cases and 118 deaths
  • 1970 – 4,249 cases and 12 deaths
  • 1980 – 1,730 cases and 11 deaths
  • 1990 – 4,570 cases and 12 deaths
  • 2000 – 7,867 cases and 12 deaths
  • 2010 – 27,550 cases and 26 deaths

They never eradicated pertussis though, and as you can see, recently, pertussis cases have started to rise again.

Is it a coincidence that whooping cough came back as more folks began to skip and delay vaccines for their kids?
Is it a coincidence that whooping cough came back as more folks began to skip and delay vaccines for their kids?

In 2012, there were 48,277 cases of pertussis in the United States, the most since 1950, when we had 68,687 cases. Unfortunately, with the rise in cases, we are also seeing the tragic consequences of this disease – 20 deaths in 2012, mostly infants under age 3 months.

Pertussis cases remained steady, but high, in 2013 and 2014, at around 30,000 cases in the United States.

In California, pertussis reached epidemic levels. The California Department of Public Health reported at least 11,114 cases in 2014 – the highest numbers of pertussis cases in the state in 70 years!

And as expected with the rise in cases, there were 3 pertussis related deaths in California that year – all infants who had contracted pertussis when they were less than 8 weeks old. Two of the infants became sick in 2013, but the third, a 5-week-old baby, got infected in 2014.

Another baby, only 25 days old died in early 2015, but will be counted as the 2nd death of 2014 since that is when the illness started. About 383 patients, mostly infants who are less than 4 months old, were hospitalized in California that year, including 80 who required intensive care. And according to the California Department of Public Health, about 82% of the cases in infants were born to mothers who did not receive a dose of Tdap during their third trimester of pregnancy.

What’s happened since then?

Pertussis cases are continuing to fall each year! In fact, with about 16,000 cases in the United States, 2017 may have ended with the lowest number of pertussis cases since 2008.

Still, with just 1,830 pertussis cases in California in 2016, there were two deaths – both infants who were younger than 3 months of age when they got sick. And there was at least one death in 2017, with similar rates of disease, although reports are still preliminary.

Why So Many Pertussis Outbreaks?

Ever since a 2010 California pertussis outbreak, in which there were 9,154 cases of pertussis, the most in 63 years, and 10 infants died, many people, especially parents, began wondering why we were seeing more pertussis these days.

Is it because the pertussis vaccines simply don’t work, as the anti-vaccine movement would have you think?

Or is it because there are higher rates of unvaccinated kids these days and parents using alternative immunization schedules, instead of the standard immunization schedule from the CDC?

James Cherry, MD is an expert on pertussis and pertussis vaccines.
James Cherry, MD is an expert on pertussis and pertussis vaccines.

A commentary, Why Do Pertussis Vaccines Fail?, by James Cherry, MD, gave us some answers.

While the title of the article might have you think that all of the blame lies with the pertussis vaccines, that certainly isn’t the case. While there can be vaccine failures with the pertussis vaccines, just like any other vaccine, that doesn’t mean that the vaccine doesn’t work for most children.

One of the problems is that the DTaP vaccine likely isn’t as effective as the older DTP vaccine. So instead of efficacy of 84 to 85%, as was once believed, it is likely closer to just 71 to 78%.

Other issues, including waning immunity, the possibility of an incorrect balance of antigens in the vaccine that could create a blocking effect, and genetic changes in the B. pertussis bacteria, could also possibly lead to increased vaccine failure rates.

So it isn’t that the pertussis vaccines don’t work.

That should be easy to see when you look at the pertussis rates in California, when the highest rates by far were in infants less than 6 months of age (434 per 100,000 people). In contrast, children who were 6 months to 6 years old had a rate of only 62 per 100,000.

And the results of a study that were presented at the 49th annual meeting of the Infectious Diseases Society of America in Boston show just how important the pertussis vaccine is, as:

  • vaccine effectiveness was 98.1 percent among children who received their 5th dose within the past year
  • long term effectiveness – children who were five or more years past their last DTaP dose – was about 71 percent
  • children who had never received any doses of DTaP (unvaccinated children) faced odds of having whooping cough at least eight times higher than children who received all five doses

It is also important to note that the high rates seen in 2010 in California are still well below the rates that were seen in the pre-vaccination era, when the attack rate of pertussis in the United States was as high as 157 per 100,000 people, with about 200,000 cases a year.

What’s the answer?

“The present “resurgence of pertussis” is mainly due to greater awareness and the use of PCR for diagnosis. There are also many other factors which have contributed to the “resurgence.” New vaccines are clearly needed; with our present vaccines (DTaP and adolescent and adult formulated tetanus and diphtheria toxoids and acellular pertussis vaccine (Tdap)), if used correctly, severe pertussis and deaths in infants can be prevented.”

James D. Cherry, MD on The History of Pertussis (Whooping Cough); 1906 – 2015: Facts, Myths, and Misconceptions

It certainly isn’t for more kids to follow non-standard, parent-selected, delayed protection vaccine schedules or to simply skip vaccines all together. Since natural immunity isn’t going to keep newborns and infants from getting pertussis, the ages which are most at risk for life-threatening infections, they can catch pertussis from people around them, including those working on their natural immunity. Natural infections don’t even provide life-long protection against pertussis, as some people believe. That natural immunity wanes fairly quickly too.

Not Vaccinated? No Kisses!
Not Vaccinated? No Kisses!

The future of pertussis control is more likely going to be in maximizing our current vaccination program, including getting more teens and adults to get the Tdap vaccine, especially when women are pregnant.

That’s the best strategy, at least until new pertussis vaccines are developed. It provides a lot of benefits. According to the CDC, like with the flu vaccine, when you get a pertussis vaccine, in addition to protecting yourself and those people around you, “people who do catch whooping cough after being vaccinated are much less likely to be hospitalized or die from the disease.”

Unfortunately, not everyone has gotten the message. And because of waning immunity, children who aren’t vaccinated against pertussis can’t “hide in the herd” and rely on the rest of us who do vaccinate our children to provide them with protection. Instead, since they are at a higher risk, they get pertussis and get even more people sick.

This slogan, during a whooping cough epidemic, reminded parents to get their kids vaccinated now.
This slogan, during a whooping cough epidemic, reminded parents to get their kids vaccinated now.

In one study, Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children, researchers found that “vaccine refusers had a 23-fold increased risk for pertussis when compared with vaccine acceptors, and 11% of pertussis cases in the entire study population were attributed to vaccine refusal.” The highly contagious nature of pertussis then means every primary case is probably going to infect as many as 17 other people. That’s why it makes sense that higher rates of children using vaccine exemptions could be at least one of the factors in these outbreaks.

In fact, several studies, including, Geographic Clustering of Nonmedical Exemptions to School Immunization Requirements and Associations With Geographic Clustering of Pertussis, found that “geographic pockets of vaccine refusal are associated with the risk of pertussis outbreaks in the whole community.”

Get educated. Vaccines are safe and as you can see with the rise in outbreaks, vaccines are necessary.

What to Know About Pertussis Outbreaks

Many factors are responsible for the rise in pertussis outbreaks in recent years, but it is clear that being unvaccinated and unprotected put you at greatest risk for getting pertussis and passing it on to others.

More on Pertussis Outbreaks

What Causes Non-Stop Crying After DTaP Vaccines?

Most children cry after getting a shot.

Fortunately, they can usually be comforted quickly.

Historically, there has been one situation where kids might cry for longer periods of times.

Non-Stop Crying After DTaP Vaccines

The DTP vaccine was known to cause non-stop crying, for 3 hours or more in up to about 1 child out of 1,000.

“Persistent crying following DTaP (as well as other vaccines) has been observed far less frequently than it was following the use of DTP. When it occurred after DTP, it was considered to be an absolute contraindication to further doses of pertussis-containing vaccine. When it occurs following DTaP, it is considered a “precaution” (or warning). If you believe the benefit of the pertussis vaccine exceeds the risk of more crying (which, although unnerving, is otherwise benign), you can administer DTaP.”

Immunization Action Coalition on Ask the Experts about DTP

Although uncommon, it is certainly scary to have a child cry for 3 hours or more after a vaccine.

I guess that’s one good reason we don’t use the DTP vaccine anymore. On the other hand, although the newer DTaP has fewer side effects, it doesn’t work as well as the older DTP vaccine at protecting kids against pertussis.

What Causes Non-Stop Crying After DTaP Vaccines?

Some people have very wrong ideas about what caused this non-stop crying after the DTP vaccine, which is reflected in the nick-names they gave it, such as the “DTP scream,” “cry-encephalitis,” or the “encephalitic cry.”

If your child has had non-stop crying after their DTP vaccine, or DTaP vaccine for that matter, you can be reassured that they didn’t have encephalitis!

The forums of Mothering.com are notorious for pushing anti-vax misinformation, including the idea of an "encephalitic cry."
The forums of Mothering.com are notorious for pushing anti-vax misinformation, including the idea of an “encephalitic cry” after DTP vaccines.

Again, although it is scary to have your child crying non-stop for 3 hours or more, this crying is benign and has no long term effects.

So what is causing it?

It is thought to be a painful local reaction.

Remember that the next time you see a vaccine scare video about the “DTaP scream” or talk about encephalitis

What to Know About DTaP Crying

Crying non-stop for 3 hours or more after a vaccine can be scary. Fortunately, DTaP crying is not caused by encephalitis or any other terrible thing you might read about. It is a painful local reaction.

More on DTaP Crying

What Are Hypotonic-Hyporesponsive Episodes?

Just about any side effect after a vaccine can be scary for parents.

What if your child suddenly became limp, wasn’t responsive, and was pale?

That would be scary for any parent.

What Are Hypotonic-Hyporesponsive Episodes?

But that’s just what can happen when a child has a hypotonic–hyporesponsive episode (HHE).

“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

These types of episodes were once thought to happen once for every 1,750 DTP vaccines given.

HHE is much more rare since we switched to a new pertussis vaccine.
HHE is much rarer since we switched to a new pertussis vaccine.

Fortunately, although they certainly do sound scary, the episodes stop on their own and  don’t cause any permanent harm.

Hypotonic-hyporesponsive episodes were even 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 it is rare for kids to have a second episode, so they can continue to get vaccinated. HHE is not a good reason to skip or delay all of your child’s vaccines. While not a contraindication to getting vaccinated, having an episode of HHE “within 48 hours after receiving a previous dose of DTP/DTaP,” is listed as a precaution to getting another dose of DTaP or Tdap though.

“In general, vaccinations should be deferred when a precaution is present. However, a vaccination might be indicated in the presence of a precaution if the benefit of protection from the vaccine outweighs the risk for an adverse reaction.”

CDC on Vaccine Contraindications and Precautions

Also, HHE has become even more rare since we switched to using DTaP, instead of the older DTP vaccine. So being worried about HHE is definitely not a good reason to skip or delay any vaccines.

What to Know About Hypotonic-Hyporesponsive Episodes

Hypotonic-hyporesponsive episodes were more common after the older DTP vaccines, but still didn’t cause any long term problems and aren’t a good reason to skip or delay your child’s vaccines.

More About Hypotonic-Hyporesponsive Episodes

Vaccine Reactions – Is This Normal?

Vaccines are very safe.

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

“Considering that the vaccines in the infant schedule are administered to millions of children each year, the list of known adverse events, even rare ones, is impressively short.”

O’Leary et al on Adverse Events Following Immunization: Will It Happen Again?

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 Vaccine Reactions

Although most kids don’t have any reactions at all, some do have mild reactions.

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

  • fussiness
  • headache
  • fever
  • body aches
  • redness or swelling at the injection site
  • soreness or tenderness at the injection site
  • tiredness
  • poor appetite
  • chills and sore joints
  • rash
  • diarrhea
  • vomiting
  • swelling of glands in the cheeks or neck

How commonly do they occur?

In this 2011 report, the IOM concluded that few health problems are caused by or clearly associated with vaccines.
In this 2011 report, the IOM concluded that “few health problems are caused by or clearly associated with vaccines.”

These side effects depend on the vaccine that was received and can range from 1 in 3 kids for some fussiness all the way down to 1 in 75 kids for kids who have swelling of their glands.

And they usually 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.

Keep in mind that some reactions are more delayed though. This is especially true for the MMR vaccine, in which mild reactions, like a fever, rash, or swelling of glands might not occur until 6 to 14 days after a child got his vaccine.

What can you do if your child has a mild vaccine reaction?

Consult your health care provider, but keep in mind that treatment is often symptomatic, typically with a cold pack or cool cloth/compress for local reactions and pain reliever.

Fainting also commonly occurs after vaccines, especially in teens, but it is thought to be due to the vaccination process itself and not the vaccines. Still, it is something to be aware of.

What About More Moderate Reactions?

More moderate reactions after vaccines are fortunately more uncommon.

“There is low public tolerance of vaccine adverse reactions. Vaccines are therefore only licensed when the frequency of severe reactions is very rare and when only minor, self-limiting reactions are reported.”

WHO on Adverse events following immunization

Some of these moderate reactions might include:

  • febrile seizures
  • high fever
  • persistent crying for 3 or more hours
  • swelling of the entire arm or leg where the shot was given (especially after the 4th or 5th dose of DTaP)
  • a temporary low platelet count (immune thrombocytopenic purpura or ITP)

Like the more common, mild reactions, these less common moderate reactions are also temporary and don’t usually have any lasting risks or consequences.

Then there are the more severe reactions, which thankfully are even more rare. These are the 1 in a million dose type reactions, such as life-threatening allergic reactions.

Of course, you should seek medical attention if you think that your child is having a more moderate or severe reaction to a vaccine.

And lastly, there are the so-called vaccine induced diseases, which are simply made up.

All of these reactions, as well as the risks of getting a natural infection, are listed in each vaccine’s VIS. The Vaccine Information Statements also includes information on how to report all possible vaccine side effects to VAERS.

What to Know About Common Vaccine Reactions

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

More About Common Vaccine Reactions

 

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