Affiliations: Department of Pediatric Medicine, Infectious Disease
Service, KK Women's and Children's Hospital, Singapore | Department of Orthopedic Surgery, Changi General
Hospital, Singapore | Infection Control Unit, KK Women's and Children's
Hospital, Singapore | Pharmacovigilance and Compliance Division, Health
Products Regulation Group, Health Sciences Authority, Singapore | Department of Orthopedic Surgery, KK Women's and
Children's Hospital, Singapore
Note: [] Correspondence: Dr. Natalie Woon Hui Tan, Department of
Pediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road,
229899, Singapore. Tel.: +65 63941139; Fax: +65 63941973; E-mail:
[email protected]
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.
