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!
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.
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.
It is mostly because they think that anything bad that happens after someone is vaccinated, even if it is weeks or months later, must have been caused by the vaccine.
“Differentiation between coincidence and causality is of utmost importance in this respect. This is not always easy, especially when an event is rare and background rates are not available.”
Heininger on A risk-benefit analysis of vaccination
Of course, this discounts that fact that most people have a basic risk, often called the background rate, for developing most of these very same conditions, and they can just coincide with getting vaccinated.
Put more simply, the “reaction” would have happened whether or not they had been vaccinated.
“…when a number of well-controlled studies were conducted during the 1980s, the investigators found, nearly unanimously, that the number of SIDS deaths temporally associated with DTP vaccination was within the range expected to occur by chance. In other words, the SIDS deaths would have occurred even if no vaccinations had been given.”
WHO on Six Common Misconceptions About Immunization
That doesn’t mean that everything automatically gets blamed on coincidence though.
Is It a Vaccine Reaction?
When trying to determine if a child has had a vaccine reaction, experts typically go through a series of questions, looking at the evidence for and against :
How soon after the vaccine was given did the reaction occur? Was it minutes, hours, days, weeks, months, or years later?
Is there any evidence that something else could have caused the reaction?
Is there a known causal relation between the reaction and the vaccine?
Is there evidence that the vaccine does not have a causal association with the reaction?
Do any lab tests support the idea that it was a vaccine reaction?
Why is it important to consider these and other questions?
Because most of us are very good at jumping to conclusions, are quick to place blame, and like to know the reasons for why things happen.
We don’t like to think that things are just caused by coincidence.
Post hoc ergo propter hoc (after this, therefore, because of this).
We are especially good at linking events and often automatically assume that one thing caused another simply because it occurred afterwards.
It is incident to physicians, I am afraid, beyond all other men, to mistake subsequence for consequence.
Dr Samuel Johnson
But we also know that correlation does not imply causation. And because of the great benefits of vaccines, it is important to find strong evidence for a correlation before we blame vaccines for a reaction.
Too often though, the opposite happens. Despite strong evidence against a correlation, parents and some pediatricians still blame vaccines for many things, from SIDS and encephalitis to autism.
Background Rates vs Vaccine Reactions
Although anti-vaccine folks are always calling for vaccinated vs unvaccinated studies to further prove that vaccines are indeed safe, much of that work is already done by looking at the observed rate of possible reactions and comparing them to the background rate of reactions and conditions.
We often know how many people are expected to develop certain conditions, from seizures and type 1 diabetes mellitus to acute transverse myelitis and juvenile and rheumatoid arthritis.
“On the basis of the reviewed data, if a cohort of 10 million individuals was vaccinated in the UK, 21.5 cases of Guillain-Barré syndrome and 5.75 cases of sudden death would be expected to occur within 6 weeks of vaccination as coincident background cases. In female vaccinees in the USA, 86.3 cases of optic neuritis per 10 million population would be expected within 6 weeks of vaccination. 397 per 1 million vaccinated pregnant women would be predicted to have a spontaneous abortion within 1 day of vaccination.”
Black et al on Importance of background rates of disease in assessment of vaccine safety during mass immunisation with pandemic H1N1 influenza vaccines
Intussusception is a good example of this.
This might surprise some folks, but we diagnosed and treated kids with intussusception well before the first rotavirus vaccines were ever introduced. And then, it was only after the risk of intussusception after vaccination exceeded the background rate that experts were able to determine that there was an issue.
“Knowledge of the background incidence rates of possible adverse events is a crucial part of assessing possible vaccine safety concerns. It allows for a rapid observed vs expected analysis and helps to distinguish legitimate safety concerns from events that are temporally associated with but not necessarily caused by vaccination.”
Gadroen et al on Baseline incidence of intussusception in early childhood before rotavirus vaccine introduction, the Netherlands, January 2008 to December 2012
Fortunately, studies have never found an increased risk above the background rate for SIDS, non-febrile seizures, and other things that anti-vaccine folks often blame on vaccines. So when these things happen on the same day or one or two days after getting vaccinated, it almost certainly truly is a coincidence. It would have happened even if your child had not been vaccinated, just like we see these things happen in the days before a child was due to get their vaccines.
For example, using background incidence rates in Danish children, one study found that if you vaccinated a million children with a new flu vaccine, you could expect that naturally, after seven days, you would see:
facial nerve palsy – one case
seizures – 36 cases
multiple sclerosis – one case
type 1 diabetes – three cases
juvenile and rheumatoid arthritis – three cases
After six weeks, those numbers of course go up. In addition to 4 kids developing MS, 20 develop diabetes, 19 develop arthritis, and 218 have seizures, and there would have been at least two deaths of unknown cause.
Would you blame the flu shot for these things?
What flu shot?
This was a “hypothetical vaccine cohort” that used 30 years of data from the Danish healthcare system to figure out background rates of each condition.
“In addition, the expected number of deaths in Japan following an estimated 15 million doses of H1N1 vaccine administered would be >8000 deaths during the 20 days following vaccination, based on the crude mortality rate.”
McCarthy et al on Mortality Rates and Cause-of-Death Patterns in a Vaccinated Population
Looking at background rates is especially helpful when folks report about vaccine deaths.
Using the Japan example that McCarthy studied, if they had looked at background rates, then all of a sudden, the 107 deaths they found after 15 million doses of H1N1 vaccine were given in 2009 would not have been so alarming. Background rates would have predicted a much, much higher number of deaths to naturally occur in that time period simply based on crude mortality rates.
Vaccines are safe and many of the things that folks think are vaccine reactions can be explained by looking at the background rates for these conditions and understanding that they would have happened anyway.
There are some true medical contraindications and precautions to getting vaccinated though. Still, it is important to remember that even more things are simply “conditions incorrectly perceived as contraindications to vaccination.”
Contraindications To Vaccinating Your Kids
There are actually some good reasons to delay or skip one or a few of your child’s vaccines, but only in some very specific situations.
These very specific situations are called contraindications and are what count as medical exemptions.
“A vaccine should not be administered when a contraindication is present; for example, MMR vaccine should not be administered to severely immunocompromised persons.”
CDC on Vaccine Contraindications and Precautions
Fortunately, there are not that many of these contraindications, they are usually specific to just one or a few vaccines, and they are usually, but not always, temporary.
That’s why it would be really unusual to get a true permanent medical exemption for all vaccines. Even if you had a severe allergy to a vaccine that contained yeast, latex, or gelatin, since vaccines contain different ingredients, you would very likely be able to safely get the others.
Remember, your doctor can’t, or at least shouldn’t, just make up contraindications and exemptions to help you avoid getting your kids vaccinated and help you keep them in school.
“I do not believe vaccines had anything to do with my child’s autism. I never noticed any change in his speech, behavior or development with vaccines. I believe the protection and benefits of vaccines far outweigh the risks!”
Michele Han, MD, FAAP
Autism, for example, has been shown to not be associated with vaccines, so it is not a contraindication to getting vaccinated. That’s why many parents vaccinate and protect their autistic kids!
Precautions To Vaccinating Your Kids
In addition to contraindications to getting vaccinated, there is an accompanying list of precautions.
“A precaution is a condition in a recipient that might increase the risk for a serious adverse reaction, might cause diagnostic confusion, or might compromise the ability of the vaccine to produce immunity (e.g., administering measles vaccine to a person with passive immunity to measles from a blood transfusion administered up to 7 months prior). A person might experience a more severe reaction to the vaccine than would have otherwise been expected; however, the risk for this happening is less than the risk expected with a contraindication. 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
Again, we are fortunate that most of the conditions that are listed as precautions are temporary.
In fact, the most common is having a “moderate or severe acute illness with or without fever.”
Don’t want to get your child vaccinated when he or she has a severe illness?
Your pediatrician usually doesn’t want to vaccinate your child in that situation either.
It is easy enough to wait a few days or a week to get vaccinated, when the illness has passed, keeping in mind that a “mild acute illness with or without fever” is neither a precaution nor a contraindication to getting vaccinated. So you can still get your child their recommended vaccines if they just have a cold, stomach bug, or ear infection, etc.
What to Know About Precautions and Contraindications to Vaccines
Although there are some true medical exemptions or contraindications and precautions to getting vaccinated, most are vaccine specific and many are temporary, so they shouldn’t keep you from getting your child at least mostly vaccinated and protected.
More on Precautions and Contraindications to Vaccines
That’s probably good, because although you should be familiar with different things, if you know what it is, then you likely know someone who has been affected by it.
What Is ADEM?
ADEM, an autoimmune disease, is an acronym for Acute Disseminated Encephalomyelitis.
“Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. ADEM often follows viral or bacterial infections, or less often, vaccination for measles, mumps, or rubella.”
Acute Disseminated Encephalomyelitis Information Page
Children and young adults with ADEM can have:
encephalopathy with confusion and irritability
hemiplegia – paralysis on one side of the body
ataxia – loss of full control of bodily movements leading to an unsteady walk
optic neuritis with vision impairment and vision loss
myelitis – inflammation in the spinal cord
hemiparesthesia – numbness on one side of the body and other sensory changes
seizures – especially in younger children
These symptoms typically follow a few days of fever, headache, nausea, vomiting, and feeling tired.
And to make the diagnosis, children with these symptoms of ADEM will have “focal or multifocal lesions predominantly involving white matter” on an MRI of their brain.
Fortunately, although ADEM can be life-threatening, there are treatments (steroids) for these kids and usually the outcome is good, with a complete or near complete recovery.
“ADEM is usually triggered by a preceding viral infection or immunization.”
Infection and Autoimmunity, Chapter 60
A lot of textbooks still list vaccines as a rare trigger too…
It is important to understand that ADEM most commonly occurs after a nondescript (not easily described), natural, viral or bacterial infection.
Interestingly, one of the first cases of ADEM was reported in 1790 – in a 23-year-old women who had just gotten over measles. Like many other serious complications of measles, ADEM is reported to occur after 1 in every 1,000 cases of measles.
What other infections can cause ADEM?
Most of them.
From HHV-6 (causes Roseola) and the coxsackievirus (hand, foot, and mouth disease) to HIV and Dengue, they are all associated with ADEM. Many bacterial infections too, like Strep, Mycoplasma, and Salmonella.
“Older formulations of rabies vaccine did cause Acute Disseminated Encephalomyelitis (ADEM), but newer formulations of rabies vaccine have not been shown to cause ADEM, and rabies vaccine is not routinely recommended to the general population in the United States. Other vaccines that are currently routinely recommended to the general population in the U.S. have not been shown to cause ADEM.”
Institute for Vaccine Safety on Do Vaccines Cause Acute Disseminated Encephalomyelitis (ADEM)?
So what about vaccines?
Why do some folks still say that ADEM can follow getting vaccinated, especially after the 2012 IOM report on Adverse Effects of Vaccines: Evidence and Causality, found all of the evidence linking ADEM to vaccines “weak,” and in most cases, that the epidemiological evidence was “insufficient or absent to assess an association between” the vaccines and ADEM?
“Post vaccine aetiology was described for 5% of all ADEM cases and several vaccines have been described to be related to this condition. The incidence of ADEM onset ranges from 1/106 to 1/105 and may change between different vaccine formulations. Epidemiological data about this adverse event are still missing; this may be due to the rarity of post vaccine ADEM.”
Pellegrino et al on Acute Disseminated Encephalomyelitis Onset: Evaluation Based on Vaccine Adverse Events Reporting Systems
At most, ADEM is a very rare, 1 in a million type (1/106) vaccine reaction that is mainly published about in case reports and by reviewing VAERS.
Interestingly, no trigger is reported in up to 30% of cases (they don’t recall having a recent infection or getting a vaccine) and an infectious agent (a virus or bacteria) is usually not isolated from these children once they develop symptoms of ADEM.
“Epidemiologic evidence from this study suggests an infectious cause for ADEM. The agent is most likely a difficult-to-diagnose winter/spring respiratory virus.”
Murty et al on Acute Disseminated Encephalomyelitis in Children
Being so rare, it is hard to prove that ADEM absolutely isn’t caused by vaccines, but it does seem clear that many vaccine-preventable diseases might, from measles, mumps, rubella, chicken pox, flu, to hepatitis A.
Want to try and avoid ADEM? Get vaccinated.
What To Know About ADEM and Vaccines
Although vaccines have rarely been thought to cause Acute Disseminated Encephalomyelitis historically, it is very important to keep in mind that the overwhelming majority of cases of ADEM are caused by natural infections, many of which are vaccine preventable.
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:
redness or swelling at the injection site
soreness or tenderness at the injection site
chills and sore joints
swelling of glands in the cheeks or neck
How commonly do they occur?
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.”
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.
Anti-vaccine folks claim that an awful lot of things are encephalitis, from crying excessively after getting a vaccine to autism.
Although the Vaccine Information Statement for the DTaP vaccine (it was more common after the older DTP vaccine) does state that children may uncommonly have “non-stop crying, for 3 hours or more” it is not because they have brain inflammation, and the reaction “although unnerving, is otherwise benign.” It is not even a contraindication to getting another dose of DTaP or a later dose of Tdap.
What causes this non-stop crying? It is thought to be a painful local reaction. Fortunately, it does not happen as often with the newer DTaP vaccines.
And autism is not encephalitis.
“That measles infections can cause neurologic side effects on rare occasions is known, but the complication rate for vaccinations is low. After infectious measles encephalitis, risk of an autistic regression has occurred in 1/1000 to 1/10,000 cases. If the trend toward delaying vaccination continues because parents remain misinformed about the MMR, the number of children with neurologic complications of measles or rubella will increase. ”
Chez et al on Immunizations, Immunology, and Autism
Can encephalitis lead a child to have symptoms of autism?
In addition to natural measles infections, there have been reports of children developing autism after HSV encephalitis, varicella encephalitis, congenital rubella syndrome, and congenital syphilis.
But the great majority of kids with autism do not first have encephalitis. They do not have ongoing brain inflammation.
Saying that encephalitis can cause autism is not the same thing as saying that autism is encephalitis.
Do Vaccines Cause Encephalitis?
And even though encephalitis has long been a table injury for a few vaccines, the 2012 IOM report, “Adverse Effects of Vaccines: Evidence and Causality,” found inadequate evidence to be able to conclude that encephalitis was caused by vaccines.
“Follow-up investigations in that cohort and others, however, found no evidence of a real increased incidence of encephalitis following DTwP. In addition, the most recent IOM report concludes that the evidence is inadequate to accept or reject a causal relationship between diphtheria toxoid-, tetanus toxoid-, or acellular pertussis-containing vaccine and encephalitis or encephalopathy.”
Vaccinophobia and Vaccine Controversies of the 21st Century
That’s not surprising, because follow-up of children studied in the 1980s, from which the original claims about DTP and encephalitis were made, found no evidence of an increased risk of encephalitis.
What about the MMR vaccine?
Again, the IOM report found inadequate evidence, but the problem has always been that “acute encephalitis post-MMR is so rare that it has been impossible to distinguish from the background encephalitis rate of 1 in one million in immune competent hosts.”
Doesn’t the discovery of anti-N-methyl-D-aspartate (anti-NMDA) receptor encephalitis prove that vaccines cause autism?
“Anti-NMDA receptor encephalitis is a disease occurring when antibodies produced by the body’s own immune system attack NMDA receptors in the brain.”
The Anti-NMDA Receptor Encephalitis Foundation
Often associated with tumors, isolated case reports do correlate anti-NMDAR encephalitis with vaccines. There are so few cases of anti-NMDAR encephalitis though, it is hard to know what they mean, as are the reports of autism developing after anti-NMDAR encephalitis.
What to Know About Vaccines and Encephalitis
Vaccines still don’t cause autism and the latest safety studies report that vaccines probably don’t cause encephalitis, although a few are still listed as a table injury.
Fever, pain at the injection site, and redness and swelling where the shot was given are all common, mild problems that can be associated with almost any vaccine.
Some vaccines might also commonly cause fussiness, tiredness or poor appetite, and vomiting within 1 to 3 days of getting the vaccine. Others can cause a rash, headache, or muscle and joint pain for a few days.
Even syncope or fainting can commonly occur within 15 minutes getting a vaccine, especially in teenagers.
Still, while vaccines are associated with some serious adverse events, the research is clear that vaccines are not associated with autism, SIDS, shaken baby syndrome, type 1 diabetes, multiple sclerosis, and inflammatory bowel disease, etc.
And simply being in a VAERS report doesn’t necessarily mean that the vaccine was the cause of the ‘injury.’ Surprisingly, neither does being listed on the vaccine injury table or getting compensated by the Vaccine Court. Many of these cases are settled and “cannot be characterized as a decision by HHS or by the Court that the vaccine caused an injury.”
For example, even though encephalopathy or encephalitis after DTaP is still listed as a table injury, a Canadian study of encephalopathy related to pertussis vaccine found only 7 cases of encephalopathy beginning within 7 days of receiving a pertussis containing vaccine out of over 6.5 million doses of vaccines given between 1993 and 2002. And all 7 cases had a more likely cause than the vaccine! The final diagnosis for these children’s encephalopathy included herpes simplex encephalitis, influenza A encephalopathy (3 patients), parainfluenza encephalopathy, a probable gastrointestinal infection, and adrenal insufficiency in a child with previous episodes of hypoglycemia.