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Large Vaccination Reactions and Robust Takes Bacterial Superinfection of Site

This document outlines the various vaccination reactions, including local skin responses and potential bacterial superinfections. Key indicators of robust reactions include a redness of over 3 inches, swelling, warmth, and pain, typically appearing 8-10 days post-vaccination. The risk of secondary bacterial infections can arise within 5 days or more than 30 days after vaccination. Effective clinical management involves vigilant observation, patient education, and supportive care, while specific adverse events related to the smallpox vaccine are also detailed.

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Large Vaccination Reactions and Robust Takes Bacterial Superinfection of Site

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  1. Large Vaccination Reactions and Robust TakesBacterial Superinfection of Site

  2. Robust TakesDefinition • Area of redness greater than 3 inches • Swelling • Warmth • Pain at Vaccination Site

  3. Robust TakesDifferentiation • Robust Take • Onset 8-10 days post-vaccination • Clinical improvement within 72 hours • Lack of clinical progression • Secondary Bacterial Infection • Onset within 5 days post-vaccination, OR • Greater than 30 days post-vaccination

  4. Robust TakesClinical Management • Vigilant observation • Patient Education • Supportive care • Rest of affected limb • Oral, non-steroidal anti-inflammatory medications • Oral anti-pruritic agents • Do NOT apply salves, creams or ointments to vaccination site

  5. Vaccinia Specific Adverse Events

  6. Vaccinia Adverse Events • Contact Transmission Cases • Eczema vaccinatum • Inadvertent inoculation • 5-19 days after suspected exposure • Rate of 2 to 6 per 100,000 first-time vaccinations

  7. Prevention of Contact Transmission • Proper hand-hygiene • Healthcare Setting • Cover with gauze • Cover gauze with semi-permeable dressing • Until scab separates • Non-Healthcare Setting • Cover with gauze • Wear sleeve over site

  8. Adverse Events Associated with Smallpox Vaccine • Inadvertent inoculation • Ocular vaccinia • Generalized vaccinia • Eczema vaccinatum • Progressive vaccinia • Post-vaccinial Encephalopathy • Encephalomyelitis • Fetal Vaccinia

  9. Contraindications to Smallpox Vaccine • Pregnant Women • Eczema or Atopic Dermatitis • Immunosuppression • Skin Conditions (burns, herpes, shingles, etc.) • Allergic to vaccine components

  10. Treatments for Adverse Events • VIG • Cidofovir • Ophthalmic antivirals

  11. Rates of Adverse Events1968

  12. Rates of Adverse EventsToday • May be higher today • More persons at risk from immune suppression • Cancer • Cancer therapy • Radiation • Organ Transplantation • HIV/AIDS • Eczema or Atopic Dermatitis

  13. Local Skin ReactionsIrritation from Adhesive Dressing

  14. Local Skin ReactionsIrritation from Adhesive Dressing

  15. Local Skin ReactionsSecondary Reaction to Adhesive Dressing

  16. Non-Specific RashesErythematous Patches

  17. Non-Specific RashesMaculopapular Rash

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