Cellulitis post pneumococcal vaccine

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    Has anyone here had a patient develop cellulitis around the injection site post pneumococcal vaccine? I'm talking for both the polysaccharide (Pneumovax 23) as well as the conjugate (Prevnar 13 or Synflorix) Literature for the Pneumovax 23 states that there's a very slight chance of developing a "cellulitis-like reaction" after the vaccine.

    I work in a family practice and we have had 3 patients develop a severe "cellulitis like" reaction within 24 hours of receiving the pneumococcal vaccines. One was early November after receiving the Prevnar and the other two were within the last 2 weeks, both received Pneumovax. The arm that was vaccinated was very red, hot to the touch, swollen and painful from the shoulder to the elbow. The doctor started the patients on antibiotic and the cellulitis resolved within about 48 hours. All the lot numbers were different and they were given by different nurses. The only thing that they had in common was that they received the flu shot at the same time.

    Has anyone experienced this before? The literature states that this reaction is very rare for the pneumovax (2 in 100,000) and there's no mention with the Prevnar.

    Any comments?
  2. 17 Comments so far...

  3. 4
    How was the cellulitis documented other than by inspection/palpation? A good whopping immune response can look just like that, and also subside in 48-72 hours. Did they check WBC, or just dole out the antibiotics? I'd be surprised if a cellulitis that extensive (shoulder to elbow) due to an infection resolved that promptly, but I'm willing to be convinced.
  4. 0
    Quote from GrnTea
    I'd be surprised if a cellulitis that extensive (shoulder to elbow) due to an infection resolved that promptly, but I'm willing to be convinced.
    That's exactly my thinking....it did resolve very quickly...almost too quickly. That's why I was asking if anyone had ever seen that before. The reaction was way worse than any of the really bad vaccine reactions I have ever seen. It did, in fact, look exactly like cellulitis. (Even had me second guessing myself wondering if I did anything wrong. But I wasn't the only nurse involved in these vaccines.) The doc didn't do any blood work. She decided to err on the side of caution and treat the cellulitis with antibiotics.

    We've reported the reactions to Public Health and they advised us to toss all of our Pneumovax, which we did. We will see if it happens again I guess.

    Thanks!

    Laura
  5. 1
    You should also contact the manufacturer of the vaccines, and provide the lot numbers and expiration dates, as well as the reactions that the patients had. I realize you discarded the vaccines, already, but perhaps the lot #'s and expiration dates are documented in the affected patient charts?
    NRSKarenRN likes this.
  6. 1
    That's part of our Adverse Event reporting here. We contact public health who in turn contacts the manufacturer. We're getting a new shipment of pneumovax this week. We'll see how it goes.

    Thanks
    Laura
    NRSKarenRN likes this.
  7. 1
    Ohhhh...this just burns me!!!

    We got back a response from Public Health for the reactions we encountered here. Even though the manufacturer has documented information on post vaccine cellulitis, Public Health stated that the cellulitis was caused by "contamination of the multi-dose vial of vaccine due to improper administration. This is due to either improper cleaning of the vial stopper, not changing the needle prior to vaccination and/or not cleaning the skin properly." First of all, it's a unidose vial. Second we ALWAYS change the needle and third we ALWAYS clean the skin with alcohol prior to injecting.

    Once again, whose fault is it? The nurses!

    It's so easy to blame us when things go wrong. Grrr......

    At least the doctor involved knows it wasn't our fault.
    Esme12 likes this.
  8. 1
    Quote from Laura in Canada
    Ohhhh...this just burns me!!!

    We got back a response from Public Health for the reactions we encountered here. Even though the manufacturer has documented information on post vaccine cellulitis, Public Health stated that the cellulitis was caused by "contamination of the multi-dose vial of vaccine due to improper administration. This is due to either improper cleaning of the vial stopper, not changing the needle prior to vaccination and/or not cleaning the skin properly." First of all, it's a unidose vial. Second we ALWAYS change the needle and third we ALWAYS clean the skin with alcohol prior to injecting.

    Once again, whose fault is it? The nurses!

    It's so easy to blame us when things go wrong. Grrr......

    At least the doctor involved knows it wasn't our fault.


    I would go back to them and point those out, in writing, and include a statement from the MD (I hate that it's beneficial to include that last part, but hey, reality bites). They collect statistics and if that's the level of accuracy they have, they'll be wrong.
    NRSKarenRN likes this.
  9. 0
    This has happened with me twice (2 different patients). Once in November and once in February.
    Funny thing is, both patients received the Influenza and Pneumococcal vaccine but in different deltoids. The Pneumo vaccine caused intense pain along with swelling from shoulder to elbow.

    Starting to dread when my patients say they want the Pneumo vaccine!
  10. 1
    Quote from LeggyNurse
    This has happened with me twice (2 different patients). Once in November and once in February.
    Funny thing is, both patients received the Influenza and Pneumococcal vaccine but in different deltoids. The Pneumo vaccine caused intense pain along with swelling from shoulder to elbow.

    Starting to dread when my patients say they want the Pneumo vaccine!

    oh my! What a scary coincidence! Your reactions were in November and February and mine were in November and January. And like you, they all received flu shots at the same time. I wonder if it has anything to do with the particular strains in the flu shot or the actual brand? What brand did you use? We used the Agriflu for all our patients.


    Laura
    GrnTea likes this.
  11. 0
    Hi! My name is Sarah and I just personally went thru this a month ago. Have you found out more information about this? I was hospitalized for 5 days after receiving both the flu and pneumonia vaccines. The symptoms you described are the same that I experienced. The doctor was unsure exactly what my final diagnosis was and was mainly thinking cellulitus but also possible sepsis. He also thought that it was possible they didn't not sterilize my arm prior to administering the vaccine but I could not remember for sure either. I found out the day I was discharged that two more people came into the same ER with the exact same symptoms as I had after receiving both vaccines as I was contacted by public health and I found out that we did not receive the vaccines at the same location but yes in the same city. I would like to know if you have learned more information about this?


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