Post-vaccination abscesses requiring surgical drainage in a tertiary children’s hospital in Singapore

Abstract

Pyogenic abscess formation is a known but rare complication following childhood immunization. We present a retrospective review of seven infants in Singapore with methicillin-sensitive Staphylococcus aureus abscesses following a 5-in-1 vaccine (diphtheria toxoid-tetanus toxoid-acellular pertussis, inactivated Poliomyelitis and Haemophilus influenzae type b) administration in the thigh that required surgical drainage. The children were 4 to 7 months old at the time of diagnosis. All of them presented with thigh swelling and fever was manifested in six infants. Four patients had ultrasound examination prior to surgery. A breach of sterility during immunization at one center most likely accounted for a cluster of four cases. Health care personnel should have a high index of suspicion for post-vaccination abscess especially in a child that presents with limb swelling, with or without fever, and with a history of recent vaccination in the same limb. An ultrasound examination to diagnose intramuscular abscess is recommended for equivocal cases. Prevention strategies include strict adherence to sterility during immunization and timely reporting of post-vaccination abscesses to health care authorities.

Keywords

Vaccination - abscess - surgical drainage