Tag: reporting vaccine side effects

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

Rash After the MMR – Is This Normal?

It is not uncommon to get a rash after your child gets their MMR vaccine.

In fact, about 1 in 20 people get a rash after their first dose of MMR.

It typically shows up about 6 to 14 days after the dose.

Fortunately, it doesn’t mean that your child has full-blown measles as some people suspect.

Rash After the MMR

So why do some kids get a rash after their MMR?

It depends on which rash they have.

While there is one classic MMR rash that we think about, there are actually a few other rashes that can occur even more rarely, including:

  • hives – an allergic reaction to the vaccine or one of it’s components
  • petechia and/or purpura – caused by temporary thrombocytopenia (low platelet count) in about one out of every 30,000 to 40,000 doses of vaccine given

And then there is the rash that up to 5% or people get about 7 to 10 days after their dose of MMR – a mild vaccine reaction that goes away on its own without treatment.

Most importantly, the presence of this measles-like rash does not mean that your child has actually gotten measles from the vaccine.

How do we know?

For one thing, the MMR vaccine is made with an attenuated or weakened form of the measles virus, so it can’t actually cause full-blown measles, unless maybe a child has a severe immune system problem.

Also, there is no viremia after vaccination.

“There are no reports of isolation of vaccine virus from blood in normal humans.”

Plotkin’s Vaccines

It is also important to note that “person-to-person transmission of vaccine virus has never been documented.”

And kids who get a rash after their MMR vaccine are not considered to be contagious. At most, you would expect them to shed the weakened vaccine virus, but they don’t.

What’s causing this measles-like rash then?

Like the fever, it is thought to be a delayed immune response to the live, attenuated virus in the vaccine.

When the Rash Really is Measles

Are there any situations in which a child gets a rash after their MMR vaccine and it could really be measles?

Sure.

An infant hospitalized during a measles outbreak in the Philippines in which 110 people died.
An infant with wild type measles hospitalized during a measles outbreak in the Philippines in which 110 people died. Photo by Jim Goodson, M.P.H.

Your child could have been exposed to wild type measles right around the time they got vaccinated, and then went on to develop regular measles.

While getting a measles vaccine within 72 hours of exposure (post-exposure prophylaxis) can reduce your chance of getting measles, it isn’t a perfect strategy.

Or your child could have been vaccinated and been one of the few people for whom the vaccine failed to work. So their rash, again, would be from a wild type strain of measles that they were exposed to and not from the shot.

Can you tell the difference if someone has measles from the vaccine or from a wild type strain?

Sure.

“During outbreaks, measles vaccine is administered to help control the outbreak, and in these situations, vaccine reactions may be mistakenly classified as measles cases.”

CDC on Genetic Analysis of Measles Viruses

You just have to test the measles strain to see if it is the wild type virus or a vaccine strain.

Does It Matter If It Is the MMR Vaccine or Measles?

About now, you are probably wondering why it matters knowing if a child’s rash is caused by measles or the MMR vaccine, right?

For one thing, if a parent thinks a vaccine gave their child measles, then they might not want to get vaccinated again. They will especially think twice about getting another MMR.

Also, if a child really does have full-blown, wild type measles and you simply blame their MMR vaccine, then you might miss someone else in the community that exposed the child to measles. And that’s why some outbreaks are hard to stop.

Lastly, if you simply blame the vaccine, you might miss something else that is causing the child to be sick.

Need an example?

During the 2010 measles outbreaks in Canada, a 15-month-old develop a rash, fever, and other symptoms 12 days after getting their MMR vaccine. Did the have measles, a vaccine reaction, or something else?

Turns out that he had scarlet fever.

The child tested positive for Streptococcus pyogenes (group A streptococcus), the bacteria that causes strep throat and scarlet fever. He also tested positive for vaccine strain measles. He did not have the wild strain of measles, and in fact, did not have measles at all.

Again, he had scarlet fever and it was just a coincidence that he had recently received an MMR vaccine.

But isn’t there another case report from Canada that does prove that you can get full-blown measles from the MMR vaccine? While there is such a case report, it is hardly proof of anything.

“It is possible that the case’s symptoms were not measles-vaccine-related but an inter-current illness confounding the presentation.”

Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013

The problem with the case?

For one thing, the child already had high levels of IgG antibodies at the time he had the rash, which developed 37 days after he got his vaccine.

“The two-fold rise between acute and convalescent measles-specific IgG suggests the vaccine-mediated immune response had been underway prior to the onset of symptoms.”

Murti et al on Case of vaccine-associated measles five weeks post-immunisation, British Columbia, Canada, October 2013

This was neither a typical reaction nor a typical case. And it very well might not have been measles. If it was, it was a very rare exception to the rule that rashes after the MMR vaccine aren’t full-blown measles.

What to Know About Rashes After the MMR Vaccine

The rash that your child can get after their MMR vaccine is not a sign that they have developed full-blown measles, instead, it is a mild vaccine reaction that will quickly go away without any treatment.

More on Rashes After the MMR Vaccine

 

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

Vaccines and the Risk of Intussusception

Many people first heard the term intussusception after it became associated with Rotashield, the first rotavirus vaccine, back in 1999.

What is Intussusception?

Intussusception is a type of intestinal blockage that occurs when one part of a child’s intestine in pulled into or slides into another.

This leads to younger children, typically between the ages of 3 months and 3 years, developing colicky abdominal pain (severe pain that comes and goes) and loose stools that are filled with blood and mucous.

Fortunately, if caught early, it can be both diagnosed and treated with an air contrast enema.

Do Rotavirus Vaccines Cause Intussusception?

Intussusception in children is not a new condition. In fact, Samuel Mitchel reported treating children with intussusception as early as 1838!

So what causes intussusception?

Surprisingly, in most cases, we just don’t know why kids get intussusception.

We do know that it occurs in about 1 in 100,000 US infants, with about 2,000 cases being diagnosed and treated each year.

“There is also a small risk of intussusception from rotavirus vaccination, usually within a week after the first or second dose. This additional risk is estimated to range from about 1 in 20,000 to 1 in 100,000 US infants who get rotavirus vaccine.”

CDC on Questions & Answers about Intussusception and Rotavirus Vaccine

And we know that getting a rotavirus vaccine adds a small extra risk for intussusception.

The association was found by looking at reports to VAERS and studies by the FDA’s Post-licensure Rapid Immunization Safety Monitoring System (PRISM).

And it is not just the original Rotashield vaccine, which was withdrawn, but the rotavirus vaccines that we now use that have also been linked to intussusception. The difference is that the risk is much less with the newer rotavirus vaccines.

“Given the magnitude of declines in rotavirus disease compared with this small increase in intussusception, the benefits of rotavirus vaccination outweigh the increase risk of intussusception.”

Tate et al on Intussusception Rates Before and After the Introduction of Rotavirus Vaccine

This small risk must also be viewed against the many benefits of the rotavirus vaccines.

“Rotavirus is the leading cause of severe gastroenteritis among young children worldwide, and was estimated to account for approximately one-third of the estimated 578,000 deaths from childhood gastroenteritis and more than 2 million hospitalizations and 25 million outpatient clinic visits among children <5 years of age each year in the pre-vaccine era.”

Parashar et al on Value of post-licensure data on benefits and risks of vaccination to inform vaccine policy: The example of rotavirus 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.
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. Photo by Vincent Iannelli, MD

It is also still not clear if the rotavirus vaccines actually “trigger” intussusception or if they simply cause it to occur earlier in infants that would have gotten it anyway. That’s because while the latest studies have found excess cases shortly after the first dose of vaccine, studies looking at intussusception trends “have not consistently demonstrated an overall increase in rates post-vaccination.” So there were the same number of total cases, even with the few extra cases right after the kids were vaccinated.

Also, it is thought that wild type rotavirus infections can also trigger intussusception, so the rotavirus vaccines might prevent those cases.

Most importantly though, remember that even if the rotavirus vaccines cause an extra 35 to 100 hospitalizations a year because of intussusception, they are preventing up to 70,000 hospitalizations from severe rotavirus diarrheal disease that occurred in the pre-vaccine era. The vaccines are also preventing about 20-60 deaths from rotavirus disease, while intussusception is rarely life-threatening.

If you are on the fence about vaccines, worry about intussusception is not a good reason to skip or delay your child’s vaccines.

What to Know About Vaccines and Intussusception

Because of a small risk of intussusception, parents should be aware of the symptoms and signs of intussusception and that they may appear six to eight days after an infant’s first dose of rotavirus vaccine.

More on Vaccines and Intussusception

Global Vaccine Side Effect Reporting Systems

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

Did you or your pediatrician report it?

Reporting Side Effects to VAERS

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.”

But VAERS isn’t for everyone.

VAERS is for anyone who gives or receives a licensed vaccine in the United States.

Global Vaccine Side Effect Reporting Systems

What to folks do outside the United States?

In Canada, Adverse Events following Immunization (AEFI) forms are submitted to the Canadian Adverse Events Following Immunization Surveillance System.
In Canada, Adverse Events following Immunization (AEFI) forms are submitted to the Canadian Adverse Events Following Immunization Surveillance System.

Not surprisingly, most countries have a reporting system for possible adverse events to vaccines that is similar to VAERS, including, but not limited to:

You can also report possible side effects directly to vaccine manufacturers.

And like our Vaccine Safety Datalink, in addition to having a passive reporting system, like VAERS, many countries have an active vaccine safety surveillance system to make sure that their vaccines are safe:

  • Australia – AusVaxSafety monitors 156 surveillance sites
  • Canada – IMPACT or Canada’s Immunization Monitoring Program ACTive that actively monitors “12 Canadian centres, which represent about 90% of all tertiary care pediatric beds in Canada” for “adverse events following immunization, vaccine failures and selected infectious diseases that are, or will be, vaccine preventable.”
  • UK – the Clinical Practice Research Datalink (CPRD)

A lot of this work is also done as part of the World Health Organization’s Global Vaccine Safety Initiative (GVSI). In fact, many (about 110) WHO member countries report to the VigiBase system that is actively monitored by the WHO’s Uppsala Monitoring Centre.

What to Know About Global Vaccine Side Effect Reporting Systems

Passive and active vaccine side effect reporting systems in countries around the world help to make sure that our vaccines are safe.

More on Global Vaccine Side Effect Reporting Systems

 

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Vaccine Injuries

Vaccines are often described as one of the greatest public health achievements of the 20th century.

“The evidence for the safety and effectiveness of vaccines routinely given to children and adults in the Unites States is overwhelmingly favorable.”

Miller et al on Deaths following vaccination: What does the evidence show?

There is no doubt of for most people that vaccines work and have prevented millions of deaths from vaccine-preventable diseases.

Since vaccines are also safe, that great benefit also leaves no doubt for most people that getting vaccinated and fully protected far outweigh the very small risk of a vaccine injury.

Vaccine Injuries vs Vaccine Side Effects

Vaccines can certainly have side effects and reactions.

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.

Other vaccine side effects can include persistent crying, nodules at the injection site, limb swelling, and febrile seizures, etc.

These are well known vaccine side effects that are minor and temporary though. They are not the much more rare type of serious vaccine side effects that might be classified as a vaccine injury.

Types of Vaccine Injuries

In addition to the more common mild side effects, vaccines can very rarely cause these types of vaccine injuries (most are table injuries):

  • life threatening allergic reactions
  • brachial neuritis (shoulder pain and then weakness) following a tetanus containing vaccine
  • encephalopathy/encephalitis following a measles, mumps, or rubella, or pertussis containing vaccine
  • chronic arthritis following a rubella containing vaccine
  • thrombocytopenic purpura (TTP) following a measles containing vaccine
  • vaccine-strain measles viral infection in an immunodeficient recipient following a measles containing vaccine
  • intussusception – following a rotavirus vaccine

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.

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.

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.

It is also important to keep in mind that vaccines do not cause many of the things that are portrayed in vaccine injury videos and stories that scare parents.

What to Know About Vaccine Injuries

While vaccines can rarely cause some serious reactions or vaccine injuries, most of things portrayed in vaccine injury videos are not actually caused by vaccines.

More on Vaccine Injuries

Updated January 31, 2018