Q:

9/20/2012
I recently had a toddler come in with complaints of hives, elevated temp, pruritus and joint pain 6 days after receiving the following vaccinations: HIB, Pediarix, Pneumococcal Vaccine, and Poliomyelitis. There are some parents and experts who believe there is a correlation between vaccinations and serum sickness, but I could not find definitive material to support this. Your help in this matter would be greatly appreciated.

A:

Thank you for your inquiry.

Serum sickness reactions are probably very rarely due to vaccines, but they have been reported. I have copied below abstracts and references of several of these reports. Unfortunately, there is no definitive way of which I am aware to determine whether or not your toddler had these complaints due to the vaccines or whether there was an unrelated cause (e.g., virile infection).

Thank you again for your inquiry and we hope this response is helpful to you.

Immunologic studies in subjects with a serum sickness-like illness after immunization with human diploid cell rabies vaccine
Journal of Allergy and Clinical Immunology
Volume 79, Issue 4, April 1987, Pages 605-610
Ten patients developing a serum sickness-like hypersensitivity reaction to human diploid cell rabies vaccine were studied and compared with control subjects matched for previous vaccination history and level of rabies virus-specific IgG response to immunization. The clinical reaction consisted of delayed onset, generalized urticaria, and angioedema, with some arthralgias. Skin biopsy specimens demonstrated a leukocytoclastic vasculitis. Individuals reacting to the vaccine possessed IgE antibodies to human diploid cell rabies vaccine, to mock vaccine lacking viral antigen, and to fetal calf serum (FCS), a vaccine trace contaminant. Increased levels of IgG antibodies to FCS, mock vaccine, and â-propiolactone-modified FCS, and human serum albumin were also found. Such humoral responses to vaccine components other than rabies virus might be responsible for the hypersensitivity reactions developing after rabies vaccination.

Arthritis & Rheumatism
Volume 14, Issue 1, pages 19-26, January/February 197
Abstract
After a field trial of rubella virus vaccine (HPV-77 DK 12 strain), 329 children (2.8%) developed joint symptoms. Forty had complete rheumatologic evaluation and constitute the basis of this report. Twenty children (50%) had predominantly knee complaints; 13 (33%) had symptoms suggesting the carpal tunnel syndrome; and 7 (17%) had polyarthritis. The mean duration of arthritis was 18.4 days, and the mean interval between vaccination and onset of arthritis was 30.6 days.

Clin Infect Dis. 2009 Jul 1;49(1):e18-22.
Serum sickness-like reaction associated with inactivated influenza vaccination among
Thai health care personnel: risk factors and outcomes.
Apisarnthanarak A, Uyeki TM, Miller ER, Mundy LM.
Source
Thammasat University Hospital, Pratumthani, Thailand.
Abstract
Fourteen (3%) of 495 Thai health care personnel were identified as having a serum sickness-like reaction in 2008 after receipt of inactivated influenza vaccine manufactured in Thailand. These health care personnel experienced fever, myalgia, centrifugal arthralgias, and injection site erythema. A history of allergic reactions to food or drugs (adjusted odds ratio, 5.9; 95% confidence interval, 1.54-25.4) was independently associated with a serum sickness-like reaction.

Int J STD AIDS. 2006 Mar;17(3):210-1.
Severe serum sickness following pneumococcal vaccination in an AIDS patient.
Hengge UR, Scharf RE, Kroon FP, Pfeffer K.

J Med Assoc Thai. 2002 Aug;85 Suppl 2:S607-12.
Serum sickness and hepatitis B vaccine including review of the literature.
Arkachaisri T.
Source
Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Abstract
HB vaccine is one of the most widely administered vaccines in the world. Its efficacy approaches 95 per cent. The majority of adverse reactions are generally mild, although there have been individual case reports of serious reactions since the vaccine has become commercially available. Here, a patient with a serum sickness-like reaction after her second HB immunization is reported. Review of the literature for reports of serious adverse reactions to the vaccine was also carried out.

JAMA. 1972 Jun 19;220(12):1619.
Serum sickness and tetanus immunization.
Daschbach RJ.

Pediatrics. 1987 Aug;80(2):270-4.
Adverse reactions reported following receipt of Haemophilus influenzae type b vaccine: an analysis after 1 year of marketing.
Milstien JB, Gross TP, Kuritsky JN.
Abstract
An analysis of adverse reactions occurring after receipt of Haemophilus influenzae type b vaccine and reported to the Food and Drug Administration during the first year of marketing of the product was performed. During the period April 1985 to May 1986, adverse reaction reports on 152 patients, excluding those of vaccine failure and concurrent infection, were received. Several adverse reactions not previously recognized, including convulsions, allergic reactions such as anaphylactoid-like and serum sickness-like reactions, and vomiting were received. The vast majority of adverse reactions were benign. Because there are many biases that result in the reporting of or failure to report an adverse reaction, it is not possible to derive a rate of reactions from these data. Furthermore, causality cannot be inferred from any single report. The data, however, indicate that, in light of widespread use of the vaccine, its use appears to be safe.

Sincerely,
Phil Lieberman, M.D.



AAAAI - American Academy of Allergy Asthma & Immunology