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Outbreak of pyogenic abscesses after diphtheria and tetanus toxoids and pertussis vaccination
P A Simon1, R T Chen, J A Elliott
1Division of Field Epidemiology, Centers for Disease Control and Prevention, Atlanta, GA.
Insights
Group A Streptococcus (GAS) contamination of a diphtheria, tetanus, and pertussis vaccine vial led to pyogenic abscesses in nine children. Strict sterile techniques, including stopper disinfection, are crucial to prevent such vaccine-related infections.
Area of Science:
- Infectious Diseases
- Pediatrics
- Vaccinology
Background:
- Pyogenic abscesses developed in nine children following vaccination with diphtheria and tetanus toxoids and pertussis vaccine from a single vial.
- Eight abscesses necessitated surgical drainage, and five children required hospitalization, indicating a significant adverse event.
- Group A Streptococcus (GAS) and Staphylococcus aureus were identified as causative agents in the wound infections.
Purpose of the Study:
- To investigate the cause of pyogenic abscesses in children after receiving a combined diphtheria, tetanus, and pertussis vaccine.
- To identify the specific pathogen responsible for the infections and determine the source of contamination.
- To recommend preventive measures against vaccine vial contamination.
Main Methods:
- Epidemiological investigation of the affected children and the vaccination clinic.
- Microbiological cultures from wound sites and throat swabs of potentially infected individuals.
- Laboratory studies simulating vaccine vial contamination with GAS and evaluating disinfection methods.
Main Results:
- Group A Streptococcus (GAS) was isolated from eight of the nine abscesses and identified as the primary pathogen.
- Epidemiological links suggested GAS pharyngitis in clinic patients preceded vaccinations.
- Laboratory studies confirmed GAS survival on vaccine vial stoppers and needle contamination, with effective disinfection achieved using 70% isopropyl alcohol.
Conclusions:
- Contamination of the multidose vaccine vial with GAS, likely introduced through the rubber stopper, caused the pyogenic abscesses.
- Meticulous attention to sterile technique during vaccine withdrawal is essential to prevent contamination.
- Disinfection of vaccine vial stoppers prior to needle insertion is a critical preventive measure.
Abstract:
Nine children who received diphtheria and tetanus toxoids and pertussis vaccine from the same vial at a clinic in Colorado developed pyogenic abscesses at the site of injection. Eight abscesses required surgical drainage and five children were hospitalized. Group A Streptococcus (GAS) was cultured from eight wounds and Staphylococcus aureus was also isolated from four. Epidemiologic investigation revealed that within the hour of the first child's vaccination, three children had been diagnosed in the clinic with GAS pharyngitis. GAS recovered from repeat throat swabs from two of these children and the eight case-isolates were all serotype M-12, T-12 and had identical immunoblot patterns on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Laboratory simulation studies demonstrated that GAS can survive for at least 4 days on the external surface of a vaccine vial rubber stopper and contaminate needles inserted through the stopper. Swabbing the stopper with 70% isopropyl alcohol resulted in effective disinfection. To prevent potential contamination meticulous attention to sterile technique is important when withdrawing vaccine from multidose vaccine vials.