Swelling, redness and pain at the site can be a common side effect from any injection. Most episodes post vaccines are expected small local reactions and are very short lived. In some cases, however, swelling at the injection site can be more extensive and potentially classified as a severe Injection Site Reaction (ISR).

Severe ISR can be defined as “joint to joint swelling” e.g. swelling extending from the shoulder joint to the elbow joint or “crossing joints” e.g. swelling that crosses at least one joint. Resolution of these symptoms usually occur within 5-7 days. Treatment can include oral pain relief and cold compress if required. Therapies such as antibiotics and antihistamines are generally not required if a child remains systemically well. Most cases do not experience a high grade fever.

Severe ISR can be seen in around 3-4% of children receiving the 4th dose of DTPa (whooping cough booster vaccine) which is scheduled to be given at 18-months of age. It is much lower for other vaccines on the National Immunisation Program.

Regarding recurrence of severe ISR, a 5th dose of DTPa is due to given at 4 years of age and it is estimated that up to 50% of children receiving this dose may have another severe ISR. Despite a previous report of severe ISR, it is still recommended for children to continue with the scheduled vaccines, to ensure protection from important vaccine preventable diseases. For more detailed discussion please contact SAEFVIC (Victorian Vaccine safety service- details below).

All severe ISRs should be reported to SAEFVIC.

Photographs of the reaction are also recommended utilising the MVEC Photographing a severe local reaction guide as this can help with appropriate diagnosis.

Resources

Injection site reactions following booster doses of DTPa vaccines – an education article

Reviewed by: Nigel Crawford (Paediatrician, The Royal Children’s Hospital, Melbourne), Georgie Lewis (SAEFVIC Clinical manager), Rachael McGuire (MVEC Nurse Educator)
Date: April 2016
Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.
You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.


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Welcome to MVEC

The Melbourne Vaccine Education Centre (MVEC) is a new web-based initiative, providing up-to-date immunisation information for healthcare professionals, parents and the public.

It is a collaboration between The Royal Children’s Hospital (RCH) and its Melbourne Children’s campus partners (Murdoch Children's Research Institute and The University of Melbourne) and Monash Health.

MVEC aims to address common queries around vaccines and to promote the benefits of immunisation for both children and adults.