Adverse Reactions to Diphtheria, Tetanus, Pertussis-Polio Vaccination at 18 Months of Age: Effect of Injection Site and Needle Length

PEDIATRICS ◽  
1989 ◽  
Vol 83 (5) ◽  
pp. 679-682 ◽  
Author(s):  
Moshe M. Ipp ◽  
Ronald Gold ◽  
Morton Goldbach ◽  
David C. Maresky ◽  
Norman Saunders ◽  
...  
Keyword(s):  
Injection Site ◽  
Severe Pain ◽  
Adverse Reactions ◽  
Deltoid Muscle ◽  
Age Effect ◽  
Needle Length ◽  
Polio Vaccine ◽  
Systemic Reactions ◽  
Anterolateral Thigh ◽  
Polio Vaccination

Adverse reactions after diphtheria, pertussis, tetanus, polio vaccination at 18 months of age were investigated in three groups: 74 children injected in the deltoid muscle with a 16-mm (5/8-in) needle, 64 in the anterolateral thigh with a 16-mm needle, and 67 in the anterolateral thigh with a 25-mm (1-in) needle. No significant differences in systemic reactions were observed. Severe pain occurred in 30.5% of the groups injected in the thigh compared with only 8.1% of the group injected in the arm (P < .001). Children vaccinated in the thigh had decreased movement of the extremity significantly more often than those injected in the arm (49.9% v 25.6%, P < .005), and two thirds of the former limped for 24 to 48 hours. Redness and swelling were observed more often after injection in the arm than in the thigh (58.1% v 26.7%, P < .0005). The only effect of changing needle length in the groups injected in the thigh was the occurrence of more redness and swelling in children vaccinated with the 16-mm needle compared with the 25-mm needle. Overall, parents rated more reactions as moderate to severe among children injected in the thigh than among children injected in the arm (64.2% v 37.9%, P < .001). The deltoid muscle appears to be the preferred site for administration of diphtheria, pertussis, tetanus, polio vaccine at 18 months of age.

scholarly journals AB0542 REACTIONS TO PNEUMOCOCCAL 13-VALENT VACCINE IN PATIENTS WITH BEHCET SYNDROME

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1567.2-1568
Author(s):  
B. Yurttas ◽  
S. S. Taflan ◽  
N. Saltoglu ◽  
G. Hatemi
Keyword(s):  
Injection Site ◽  
Outpatient Clinic ◽  
Adverse Reactions ◽  
Skin Lesions ◽  
The Other ◽  
Tnf Inhibitor ◽  
Research Support ◽  
Systemic Reactions ◽  
Local Reactions ◽  
Inhibitor Treatment

Background:The European League Against Rheumatism (EULAR) recommends pneumococcal 13-valent (PCV13) and 23-valent vaccines in patients with rheumatic diseases (1). Adverse reactions to 23-valent pneumococcal vaccine were previously reported in patients with Behçet Syndrome (BS) (2). These were proposed to be associated with the pathergy phenomenon which may be observed in patients with BS.Objectives:To determine the frequency of adverse reactions to PCV13 in patients with BS who were candidates for TNF inhibitor treatment, together with ankylosing spondylitis (AS) and rheumatoid arthritis (RA) patients as controls.Methods:All of our patients who are candidates for TNF inhibitor therapy have been offered vaccination with PCV13 since 2016. We surveyed all patients with BS, AS and RA who were vaccinated with PCV13 in our infectious diseases outpatient clinic since 2016. Patients’ charts were reviewed and additionally patients were telephoned to identify any adverse local or systemic reactions. Local reactions were defined as redness, swelling, pain, and limitation of arm movement. Systemic reactions were defined as fever, headache, chills, rash, vomiting, joint pain, and muscle pain.Results:A total of 88 patients with BS, 143 patients with AS and 133 patients with RA had been vaccinated in our infectious diseases outpatient clinic. Among these, 55/88 (62%) patients with BS, 86/143 (60%) patients with AS and all 98/143 (68%) patients with RA could be contacted. Twenty-one of 55 (38%) patients with BS, 18/86 (20%) patients with AS and 27/98 (27%) patients with RA reported at least one local and/or systemic reaction after vaccination. Patients with BS reported more systemic reactions than the other two groups (48%, 12%, 23% respectively). On the other hand local reactions were less common among patients with BS (52%, 88%, 77% respectively). The local reactions were confined to erythema at injection site, pain and difficulty in moving among patients with AS and RA while 2 patients with BS had severe papulopustular skin lesions at injection site, in addition to erythema, pain and difficulty in moving. Both of these patients were pathergy positive at the time of the diagnosis.Conclusion:Severe papulopustular skin lesions at PCV13 injection site were observed only, but rarely, in patients with BS. Possibility of recall bias due to the retrospective nature of our study and the lack of other vaccines as controls are limitations of our study. Whether the skin lesions are caused by the skin pathergy reaction needs to be studied prospectively, as the pathergy status at diagnosis may be changed by the time these patients become candidates for TNF inhibitor treatment.References:[1]Furer V, Rondaan C, Heijstek MW, Agmon-Levin N, van Assen S, Bijl M, Breedveld FC, D’Amelio R, Dougados M, Kapetanovic MC, van Laar JM, de Thurah A, Landewé RB, Molto A, Müller-Ladner U, Schreiber K, Smolar L, Walker J, Warnatz K, Wulffraat NM, Elkayam O. 2019 update of EULAR recommendations for vaccination in adult patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis. 2020 Jan;79(1):39-52. doi: 10.1136/annrheumdis 2019-215882. Epub 2019 Aug 14. PubMed PMID: 31413005.[2]Saeidinejad M, Kardash S, Connell L. Behcet’s disease and severe inflammatory reaction to 23-valent pneumococcal polysaccharide vaccine: a case report and review of literature. Scott Med J. 2018 Sep 25:36933018801215. doi: 10.1177/0036933018801215. [Epub ahead of print] PubMed PMID: 30253703.Disclosure of Interests:Berna Yurttas: None declared, Sitki Safa Taflan: None declared, Nese Saltoglu: None declared, Gulen Hatemi Grant/research support from: BMS, Celgene Corporation, Silk Road Therapeutics – grant/research support, Consultant of: Bayer, Eli Lilly – consultant, Speakers bureau: AbbVie, Mustafa Nevzat, Novartis, UCB – speaker

scholarly journals Safety and Immunogenicity of Tetanus-Diphtheria-Acellular Pertussis Vaccine Administered to Children 10 or 11 Years of Age

2014 ◽  
Vol 21 (11) ◽  
pp. 1560-1564 ◽  
Author(s):  
Gary S. Marshall ◽  
Vitali Pool ◽  
David P. Greenberg ◽  
David R. Johnson ◽  
Xiaohua Sheng ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Adverse Events ◽  
Injection Site ◽  
Adverse Reactions ◽  
Geometric Mean ◽  
Serious Adverse Events ◽  
Intramuscular Dose ◽  
Injection Site Reactions ◽  
Systemic Reactions ◽  
Pertussis Antigens

ABSTRACTBoosting immunity to tetanus, diphtheria, and pertussis through the use of Tdap vaccines is routinely recommended at 11 to 12 years of age; some states, however, require Tdap for entry into middle school, which may begin at 10 years of age. This study was conducted to determine whether Tdap5 (Adacel), which is licensed for use in children beginning at 11 years of age, is as safe and immunogenic in 10-year-olds as it is in 11-year-olds. Children who had received 5 previous doses of any diphtheria-tetanus-acellular pertussis (DTaP) vaccine were enrolled in a phase IV clinical trial; 646 10-year-olds and 645 11-year-olds completed the study, which involved a single intramuscular dose of Tdap5 along with pre- and postvaccination serologies. Postvaccination geometric mean concentrations (GMCs) of antibody to pertussis antigens (pertussis toxoid, filamentous hemagglutinin, pertactin, and fimbria types 2 and 3) of 10-year-olds were noninferior to those of 11-year-olds, as were booster response rates for all pertussis antibodies, except for those to fimbrial antigens (94% and 97%, respectively). Seroprotection rates among 10-year-olds for tetanus and diphtheria were noninferior to those in 11-year-olds. Rates of injection site reactions, solicited systemic reactions, and unsolicited adverse events, adverse reactions, and serious adverse events were similar in the two groups. These data support the conclusion that Tdap5 is safe and immunogenic in 10-year-olds. (This study has been registered at ClinicalTrials.gov under registration no. NCT01311557.)

Pharmacokinetics, safety, and tolerability of four 28-day cycle intramuscular injections for risperidone-ISM 75 mg in patients with schizophrenia: A phase-2 randomized study (PRISMA-2)

2016 ◽  
Vol 33 (S1) ◽  
pp. s240-s241 ◽  
Author(s):  
L. Anta ◽  
J. Llaudó ◽  
I. Ayani ◽  
B. Gorostidi ◽  
M. Monreal ◽  
...  
Keyword(s):  
Injection Site ◽  
Drug Administration ◽  
Randomized Study ◽  
Deltoid Muscle ◽  
Study Medication ◽  
Open Label ◽  
Active Moiety ◽  
Intramuscular Injections ◽  
Competing Interest ◽  
Long Acting

IntroductionRisperidone-ISM is a new long acting intramuscular formulation of risperidone, for monthly administration without oral supplementation.ObjectiveTo characterize the pharmacokinetic of risperidone over multiple intramuscular injections in patients with schizophrenia.MethodA multicenter, open label, two-arm, parallel design clinical trial was performed. Each patient received 4 intramuscular injections of 75 mg of risperidone-ISM in either, gluteal or deltoid muscle at 28-day intervals.ResultsA total of 70 patients were randomized, 67 received at least one dose of study medication. Preliminary data show that mean Cmax of the active moiety was achieved 24-48 hours (Tmax) after each administration and ranged over four consecutive doses from 39.6-53.2 ng/mL and 54.1-61 ng/mL, when given in gluteal or deltoid, respectively. All subjects achieved therapeutic levels (> 7.5 ng/mL for the active moiety) between 2-8 hours after drug administration. The mean concentrations were maintained above therapeutic levels throughout the 4-week dosing period. No significance changes across the study were observed, either on Positive and Negative Syndrome Scale or Extrapyramidal Symptoms Scale. Overall, 63 subjects (94%) experienced at least 1 Treatment Emergent Adverse Event (TEAE) during the study. One serious TEAE (dystonia) was related to study treatment. One death not related to study medication was informed. The most frequently reported TEAEs were hyperprolactinaemia (57.7%) and injection site pain (32.8%).ConclusionsRisperidone-ISM achieved therapeutic levels from the first hours after drug administration and provided a sustained release throughout the 4-weeks dosing period over multiple intramuscular injections independently of the injection site. Risperidone-ISM was found to be safe and well tolerated.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals POLIO VACCINATION

2018 ◽  
Vol 25 (01) ◽  
pp. 67-72
Author(s):  
Ahmad Ali ◽  
Liaqat Ali ◽  
Mussawar Shah ◽  
Naimatullah Khan ◽  
Muhammad Shafee ◽  
...  
Keyword(s):  
Viral Disease ◽  
Cultural Barriers ◽  
Religious Institutions ◽  
Test Statistics ◽  
Chi Square ◽  
Religious Background ◽  
Polio Vaccine ◽  
Polio Vaccination ◽  
Chi Square Test ◽  
Infantile Paralysis

Background: Polio is a viral disease causing infantile paralysis in the community.This study cultural and traditional barriers to Polio Vaccination. Pakistan in order to explore thecultural and traditional barriers in vaccination against polio. Setting: Tehsil Kwazakhela, Swat,KPK. Methods: A total of 200 respondents were selected from 364 household’s population. Aconceptual framework based on cultural barriers to polio vaccination (dependent variable) andimpediments to polio vaccination (dependent variable) was worked out and uni-variate analysisfor percentage and Chi square test statistics was carried out for association between variables.Results: At uni-variate level majority of the respondent’s i.e. 98% argued that misconceptionis a great issue in the area and 98.5% respondents treat the new born through traditional way.Furthermore, 79.5% masses were in favor of clergy’s fatwah and 95% were agreed that poliovaccine caused immodesty, 81.5% were facing hurdles due to religious background, and 68 %responded that polio vaccination affected from terrorism, 92% agreed that polio vaccination isagainst the prevalent culture. At bivariate level myth, clergies fatwah, polio vaccine is an Americanploy and common superstition spread by radicals were found significant with impediments topolio vaccination. Conclusion: A well patronized campaign over media through proper displayof victims from polio with explicit display of agonies from the victims is essential. Support fromclergies and other regional religious institutions will help in the success of campaign to fightagainst Polio.

Recurrent Abscess Formation Following DTP Immunizations: Association with Hypersensitivity to Tetanus Toxoid

PEDIATRICS ◽  
1985 ◽  
Vol 75 (5) ◽  
pp. 899-900
Author(s):  
JOSEPH A. CHURCH ◽  
WARREN RICHARDS
Keyword(s):  
Injection Site ◽  
Tetanus Toxoid ◽  
Adverse Reactions ◽  
Antibody Responses ◽  
Abscess Formation ◽  
Intramuscular Injections ◽  
Pertussis Antigen ◽  
Dtp Vaccine ◽  
Local Reactions

Adverse local reactions to vaccines containing diphtheria and tetanus toxoids and pertussis antigen (DTP) are common, but generally benign. Most often, these reactions are manifested by erythema, induration, and tenderness occurring at the injection site 12 to 24 hours following immunization.1-3 Less frequently, abscess formation may complicate intramuscular injections and these may be staphylococcal, clostridial, or sterile in etiology.4 Tetanus toxoid has been associated with a reaction incidence of 3% to 13%,5,6 and adverse reactions appear to be related to the number of prior immunizations and the height of preexisting antibody responses.3,6 However, recurrent abscess formation associated with hypersensitivity to one or more of the components of the DTP vaccine has not been reported previously.

Nature and Rates of Adverse Reactions Associated with DTP and DT Immunizations in Infants and Children

PEDIATRICS ◽  
1981 ◽  
Vol 68 (5) ◽  
pp. 650-660 ◽  
Author(s):  
Christopher L. Cody ◽  
Larry J. Baraff ◽  
James D. Cherry ◽  
S. Michael Marcy ◽  
Charles R. Manclark
Keyword(s):  
Adverse Reactions ◽  
Reaction Rates ◽  
Infants And Children ◽  
Systemic Reactions ◽  
Dtp Vaccine ◽  
In Infants And Children

In 784 DT and 15,752 DTP immunizations given to children 0 to 6 years of age who were prospectively studied for reactions occurring within 48 hours following immunization, minor reactions were significantly more frequent following DTP vaccine. The ratio of reaction rates associated with DTP and DT immunizations (DTP/DT) for selected local and systemic reactions was as follows: local redness, 37.4%/7.6%; local swelling, 40.7%/7.6%; pain, 50.9%/9.9%; fever, 31.5%/14.9%; drowsiness, 31.5%/14.9%; fretfulness, 53.4%/22.6%; vomiting, 6.2%/2.6%; anorexia, 20.9%/7.0% and persistent crying, 3.1%/0.7%. Following DTP immunization nine children developed convulsions and nine developed hypotonic hyporesponsive episodes. No sequelae were detected following these reactions.

Trivalent Oral Polio Vaccine (Continued)

PEDIATRICS ◽  
1971 ◽  
Vol 48 (3) ◽  
pp. 494-494
Author(s):  
Milton R. Aisenson ◽  
Shanti Ghosh
Keyword(s):  
Oral Polio Vaccine ◽  
Polio Vaccine ◽  
Polio Vaccination

I hesitate to offer the suggestion that Doctor Ghosh's disappointing results with oral polio vaccine1 may have been the result of an impotent product. Its efficacy is affected by heat, by alternate thawing and refreezing, and possibly by antiseptics and other chemicals. Before dismissing oral polio vaccination, these factors should be studied.

Technical procedure in the administration of immunobiological the deltoid muscle and the anterolateral thigh

2010 ◽  
Vol 4 (2) ◽  
pp. 802
Author(s):  
Adriana Olimpia Barbosa Felipe ◽  
Félix Ocáriz Bazzano ◽  
Maria Betânia Tinti Andrade ◽  
Fábio Souza Terra
Keyword(s):  
Vastus Lateralis ◽  
Deltoid Muscle ◽  
Major Effect ◽  
Descriptive Research ◽  
Technical Procedure ◽  
Anterolateral Thigh ◽  
Ethics In Research ◽  
Local Reactions ◽  
Nursing Health ◽  
Nursing Professionals

 Objective: to evaluate the technical procedure in the administration of immunobiological the deltoid muscle and anterolateral thigh in children. Method: this is an observational descriptive research, from quantitative approach, conducted with 12 nursing professionals who had the responsibility of administration immunobiological in four health facilities in Alfenas-MG. 117 applications DPT deltoid and vastus lateralis were evaluated. To data collect it was used an instrument with questions structured and semi-structured. The study was approved by the Ethics in Research Unifenas (protocol number 115/06). Results: it was found that some professionals underwent the procedure without hand hygiene, the deltoid and vastus lateralis were defined incorrectly, used non-standard needle in deltoid and positioning of the member for the immunobiological administration. Regarding the exchange of hand during the procedure, there was a major effect of exchange applications with hand or application with one hand. Conclusion: the reality shows that professionals are the most diverse knowledge gaps that involve performing the procedure safely directly favoring the occurrence of local reactions. Descriptors: immunization; intramusculares injections; muscles; nursing; health personnel; education continuing; public health.RESUMOObjetivo: Avaliar o procedimento técnico na administração de imunobiológicos na musculatura do deltóideo e vasto lateral da coxa em crianças. Método: trata-se de pesquisa observacional, quantitativa e descritiva, realizada com 12 profissionais da enfermagem que tinham como responsabilidade administração de imunobiológicos em quatro unidades de saúde no município de Alfenas-MG. Foram avaliadas 117 aplicações de DPT na região deltóideo e vasto lateral. Para a coleta utilizou-se um instrumento com questões estruturadas e semi-estruturadas. O estudo foi aprovado pelo Comitê de Ética em Pesquisa da Unifenas (número de protocolo 115/06). Resultados: verificou-se que alguns profissionais realizaram o procedimento sem a higienização das mãos, a região deltóideo e vasto lateral foram delimitadas incorretamente, usaram agulha não padronizada no deltóideo e posicionamento inadequado do membro para administração do imunobiológico. Com relação a troca de mão durante o procedimento, houve uma incidência relevante de aplicações com troca de mão ou aplicação com mão única. Conclusão: a realidade evidencia que os profissionais apresentam as mais diversas lacunas de conhecimento que envolve a execução do procedimento de maneira segura favorecendo diretamente a ocorrência das reações locais. Descritores: imunização; injeções intramusculares; músculos; enfermagem; pessoal de saúde; educação continuada; saúde pública.RESUMENObjetivo: evaluar el procedimiento técnico en la administración de inmunobiológicos el músculo deltoides y cara anterolateral del muslo en niños. Método: se trata de la investigación observacional, cuantitativo y descriptivo, realizado con 12 profesionales de enfermería que tiene la responsabilidad de la administración de inmunobiológicos en cuatro centros de salud en Alfenas-MG. Se evaluaron 117 solicitudes DPT deltoides y vasto lateral. Para recoger utiliza un instrumento con preguntas estructuradas y semi-estructurados. El estudio fue aprobado por la Ética en la Investigación UNIFENAS (número del protocolo 115/06). Resultados: se encontró que algunos profesionales se sometieron al procedimiento, sin higiene de las manos, el deltoides y vasto lateral se definieron incorrectamente utilizados no aguja estándar en el deltoides y el posicionamiento de los miembros de la administración inmunobiológicos. En cuanto al intercambio de la mano durante el procedimiento, no hubo un efecto importante de las solicitudes de intercambio con la mano o la aplicación con una mano. Conclusión: la realidad muestra que los profesionales son las lagunas en los conocimientos más diversos que implica realizar el procedimiento de forma segura directamente a favorecer la aparición de reacciones locales. Descriptores: inmunización; inyecciones intramusculares; músculos; enfermería; personal de salud; educación continua; salud pública. 

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