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DTP vaccine reactions: effect of prior reactions on rate of subsequent reactions
Insights
Children previously experiencing reactions to diphtheria-tetanus-pertussis (DTP) immunization are significantly more likely to have similar or more severe reactions upon subsequent DTP immunizations. This study confirms increased rates of local and systemic reactions in infants with a history of prior DTP vaccine reactions.
Area of Science:
- Pediatrics
- Immunology
- Vaccinology
Background:
- Diphtheria-tetanus-pertussis (DTP) immunization is a standard pediatric vaccination.
- A common concern is whether prior reactions to DTP increase the likelihood or severity of future reactions.
Purpose of the Study:
- To evaluate the association between previous DTP immunization reactions and subsequent reactions in infants.
- To quantify the rates of specific local and systemic reactions following DTP immunization based on prior reaction history.
Main Methods:
- A cohort of 1,241 infants under one year of age receiving primary DTP immunization was studied.
- Rates of local (redness, swelling, pain) and systemic (drowsiness, fretfulness, vomiting, anorexia, fever, crying) reactions within 48 hours of DTP immunization were recorded.
- Reactions were compared between infants with and without a history of prior reactions.
Main Results:
- Both local and systemic reactions were significantly more frequent in infants with a history of prior DTP reactions.
- Specific reactions like redness, swelling, pain, drowsiness, fretfulness, vomiting, anorexia, and fever showed statistically significant increases (p < 0.05) in infants with prior reactions.
- Infants with fever (≥38°C) after the first DTP dose were more likely to have higher fever (≥39°C) after the second dose (12.4% vs. 4.2%, p=0.0017).
Conclusions:
- The presumption that prior DTP reactions predict subsequent reactions is strongly supported by the data.
- Healthcare providers should be aware of the increased likelihood of reactions in infants with a history of DTP immunization reactions.
- This information is crucial for parental counseling and monitoring post-vaccination.
Abstract:
It is generally presumed that children who have had reactions to diphtheria-tetanus-pertussis (DTP) immunization will be more likely to have similar reactions or more severe reactions upon subsequent immunization. To evaluate this contention, we studied the rates of selected reactions occurring within 48 hours of primary DTP immunization in 1,241 infants less than one year of age. Both local and systemic reactions were significantly more frequent following subsequent DTP immunization if present following a prior immunization. The rates of local reactions following subsequent DTP immunization as a function of previous reactions were as follows (no prior reactions/prior reaction): local redness greater than or equal to 2.5 cm, 12.5%/25.5% (p less than 0.0001); local swelling greater than or equal to 2.5 cm, 16.8%/29.0% (p less than 0.0001); local pain, 37.4%/56.4%; (p less than 0.0001). The rates of systemic reactions as a function of previous reactions were as follows (no prior reactions/prior reaction): drowsiness, 24.9%/42.8% (p less than 0.0001); fretfulness, 47.5%/64.7% (p less than 0.0001); vomiting, 4.8%/11.2% (p = 0.0084); anorexia 16.0%/26.3% (p = 0.0001); fever greater than or equal to 38 degrees C, 37.6%/58.5% (p less than) 0.0001); persistent crying, 2.6%/4.5% (p = 0.3557). In addition, infants who experienced a fever greater than or equal to 38 degrees C on the first of two immunizations were more likely to have a temperature greater than or equal to 39 degrees C following the second immunization, 4.2% vs. 12.4% (p = 0.0017). These data strongly support the presumption that children who have had previous reactions following DTP immunization are more likely to have similar reactions upon subsequent immunization.