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Syringe preparation technique and minor adverse reactions to diphtheria-tetanus-pertussis immunization
1Colorado Permanente Medical Group, Denver.
Abstract:
Minor local reactions and subcutaneous abscesses following diphtheria, tetanus and pertussis immunization have been attributed to vaccine left in the subcutaneous needle path from vaccine coating the needle. Various syringe preparation techniques have therefore been advocated to prevent reactions. To evaluate these recommendations we compared rates of minor reactions in 200 children randomly assigned to one of three groups that differed only in the handling of the filled syringe: in Group 1 the needle was changed before injection; in Group 2 the needle was wiped with sterile gauze before injection; in Group 3 the same needle was used to draw up and to inject the dose and was not wiped. Overall 27% of children had febrile (greater than 38 degrees C) reactions, 62% became fussy and 79% had a local reaction. Rates of reactions were nearly identical in the three groups, except that children in group 2 receiving their second dose or more of diphtheria-tetanus toxoid-pertussis vaccine were more likely to become febrile at greater than 38 degrees C (32%) or fussy (78%) (P less than 0.05 and P less than 0.02, respectively). We conclude that changing needles does not reduce the rate of minor local and systemic reactions. Wiping needles may increase the rate of reactions.
Insights
Changing needles before administering diphtheria, tetanus, and pertussis (DTP) vaccine does not reduce minor reactions. Wiping the needle before injection may even increase fever and fussiness in children receiving subsequent DTP doses.
Area of Science:
- Pediatrics
- Immunology
- Vaccine Administration
Background:
- Minor local reactions and subcutaneous abscesses can occur after diphtheria, tetanus, and pertussis (DTP) immunization.
- These reactions are often attributed to vaccine residue in the needle path.
- Various syringe preparation techniques are recommended to minimize these adverse events.
Purpose of the Study:
- To evaluate the effectiveness of different syringe handling techniques in preventing minor reactions following DTP immunization.
- To compare the rates of febrile, fussy, and local reactions across three distinct syringe preparation groups.
Main Methods:
- 200 children were randomly assigned to one of three groups based on syringe handling post-vaccine draw-up.
- Group 1: Needle changed before injection.
- Group 2: Needle wiped with sterile gauze before injection.
- Group 3: Same needle used for drawing and injection, not wiped.
Main Results:
- Overall reaction rates were similar across groups: 27% febrile, 62% fussy, 79% local.
- Children in Group 2 (wiped needle) receiving their second or subsequent DTP dose showed increased febrile (32%) and fussy (78%) reactions (P < 0.05 and P < 0.02).
Conclusions:
- Changing needles before DTP injection does not decrease the incidence of minor local or systemic reactions.
- Wiping the needle prior to injection may potentially increase the rate of adverse reactions, particularly in children receiving multiple DTP doses.