Immunization Reactions
Symptom Definition
- You believe your child is having a reaction to an immunization
- Reactions to DTP (Diphtheria, Tetanus, Pertussis), MMR (Measles, Mumps, Rubella), polio, Hemophilus influenzae type b, Hepatitis B, influenza, chickenpox (varicella) and pneumococcus vaccines are covered
- Most reactions at the injection site occur within 2 days and most general reactions or fever within 7 days
- Severe allergic reactions are very rare, but can occur with any vaccine
Call 911 Now (your child may need an ambulance) If
- Difficulty with breathing or swallowing
- Limp, weak or not moving
- Unresponsive or difficult to awaken
Call Your Doctor Now (night or day) If
- Your child looks or acts very sick
- Age less than 12 weeks with fever > 100.4°F (38°C) rectally (Exception: occurs within 48 hours after DTP shot)
- Fever > 104°F
- Crying continuously for > 3 hours
- Redness or red streak around the injection site bigger than 1 inch
- Redness around the injection site persists > 48 hours (2 days)
Call Your Doctor Within 24 Hours (between 9 and 4) If
- You think your child needs to be seen
- Fever present > 3 days
- Pain, tenderness, or swelling at the injection site persists > 3 days
- Measles vaccine rash (onset day 7 to 10) persists > 3 days
Call Your Doctor During Weekday Office Hours If
- You have other questions or concerns
Parent Care at Home If
- Normal immunization reaction and you don’t think your child needs to be seen
Home Care Advice for Immunization Reactions
- Local Reaction to the Injection (All vaccines except oral polio):
- Pain: For initial pain or tenderness at the injection site
- Apply ice to the area for 20 minutes once.
- Give acetaminophen or ibuprofen by mouth
- Fever: For fevers > 102°F (39°C), give acetaminophen (ok to use ibuprofen if > 6 months old)
- Call Your Doctor If
- Fever lasts > 3 days.
- Pain lasts > 3 days.
- Injection site starts to look infected.
- Your child becomes worse or develops any of the “Call Your Doctor” symptoms
- Pain: For initial pain or tenderness at the injection site
- For DTaP, DTP or DT Reactions: The following harmless reactions to DTP can occur: (Fever and other general reactions are less common with the newer DTaP)
- Pain, tenderness, swelling or redness at the injection site lasts for 24 to 48 hours (in 51% of children).
- Fever lasts for 24 to 48 hours (in 47% of children).
- Mild drowsiness (32%), fretfulness (53%) or poor appetite (21%) for 24 to 48 hours also occurs.
- Measles Vaccine Reactions:
- The measles vaccine can result in a fever (10% of children), and rash (5% of children) about 7 to 10 days following the injection. The fever is usually between 101 and 103°F (38.4° and 39.5°C) and lasts 2 or 3 days. The mild pink rash is mainly on the trunk and lasts 2 or 3 days. No treatment is necessary. Your child is not contagious.
- Call Your Doctor If
- Rash becomes very itchy.
- Rash changes to purple spots.
- Rash lasts > 3 days.
- Mumps or Rubella Vaccine:
- There are no reactions except for an occasional sore injection site.
- Polio Vaccine:
- There are no serious reactions to oral polio vaccine. Polio vaccine by injection occasionally causes some muscle soreness.
- Hib Vaccine (Hemophilus influenzae Type b Vaccine):
- No serious reactions reported.
- Sore injection site or mild fever only occurs in 1.5% of children
- Hepatitis B Virus Vaccine (HBV):
- No serious reactions reported.
- Sore injection site occurs in 30% of children and mild fever in 3% of children.
- Because fever from the vaccine is rare, any infant < 3 mo with a fever following the vaccine should be examined
- Influenza Virus Vaccine:
- Pain, tenderness or swelling at the injection site occurs within 6 to 8 hours in 10% of children.
- Fever 101 to 103°F (38.4° to 39.5°C) occurs in 18% of children. Fevers mainly occur in young children.
- Chickenpox Vaccine:
- Pain or swelling at the injection site for 1 to 2 days (in 19% of children)
- Fever lasting 1 to 3 days begins 5 to 28 days after the vaccine (in 14%) Give acetaminophen or ibuprofen for fever > 102°F (39°C). Never give aspirin for fever, pain or within 6 weeks of receiving the vaccine (Reason: risk of Reye’s syndrome – a rare but serious brain disease)
- Chickenpox-like vaccine rash (usually 2 lesions) at the injection site (in 3%)
- Chickenpox-like vaccine rash (usually 5 lesions) scattered over the body (in 4%)
- This mild rash begins 5 to 26 days after the vaccine and usually lasts a few days.
- Children with these vaccine rashes can go to day care or school. (Reason: for practical purposes, vaccine rashes are not contagious) EXCEPTION: avoid school if widespread, weepy lesions (Reason: probably actual chickenpox).
- Precaution: if vaccine rash contains fluid, cover it with clothing or Band-Aid.
- Pneumococcus Vaccine:
- Pain, tenderness, swelling OR redness at the injection site in 15-30%
- Mild fever < 102°F (39°C) in 15% for 1-2 days
- No serious reactions