Medical management of vaccine reactions in children and teens

Medical Management of Vaccine Reactions in Children and Teens
All vaccines have the potential to cause an adverse reaction. To minimize adverse reactions, patients should be carefully screened for precautions and contraindications before vaccine is administered. Even with careful screening, reactions can occur. These reactions can vary from trivial and inconvenient (e.g., soreness, itching) to severe and life threatening (e.g., anaphylaxis). If reactions occur, staff should be prepared with procedures for their management. The table below de-scribes procedures to follow if various reactions occur. Reaction
Symptoms
Management
Localized
Soreness, redness, itching, or swelling at the Apply a cold compress to the injection site. Consider giving an analgesic (pain reliever) or antipruritic (anti-itch) medication.
Apply an adhesive compress over the injection site.
Place thick layer of gauze pads over site and maintain direct and firm pressure; raise the bleeding injection site (e.g., arm) above the level of the patient’s heart.
Psychological
Have patient sit or lie down for the vaccination.
fright and
syncope
Extreme paleness, sweating, coldness of the Have patient lie flat or sit with head between knees (fainting)
hands and feet, nausea, light-headedness, diz- for several minutes. Loosen any tight clothing and maintain an open airway. Apply cool, damp cloths to patient’s face and neck.
Examine the patient to determine if injury is present before attempting to move the patient. Place patient flat on back with feet elevated.
Check the patient to determine if injury is present be-fore attempting to move the patient. Place patient flat on back with feet elevated. Call 911 if patient does not recover immediately.
Anaphylaxis
Sudden or gradual onset of generalized itching, See “Emergency Medical Protocol for Management erythema (redness), or urticaria (hives); of Anaphylactic Reactions in Children and Teens” on angioedema (swelling of the lips, face, or the next page for detailed steps to follow in treating throat); severe bronchospasm (wheezing); shortness of breath; shock; abdominal cramping; or cardiovascular collapse Technical content reviewed by the Centers for Disease Control and Prevention, July 2011.
www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11) Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org Medical Management of Vaccine Reactions in Children and Teens (continued)
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Supplies you may need at a community immunization clinic
First-line treatment: Aqueous
1½", and 2" needles for epinephrine ampules, vials of solution, or prefilled Secondary treatment option:
oral (12.5 mg/5 mL liquid, 25 or 50 mg  Stethoscope Emergency medical protocol for management of anaphylactic reactions in children and teens
1. If itching and swelling are confined to the injection site where the vaccination was given, observe patient closely for the
development of generalized symptoms.
2. If symptoms are generalized, activate the emergency medical system (EMS; e.g., call 911) and notify the on-call physician. This should be done by a second person, while the primary nurse assesses the airway, breathing, circulation, and level of consciousness of the patient.
a. First-line treatment: Administer aqueous epinephrine 1:1000 dilution (i.e., 1 mg/mL) intramuscularly; the standard dose
is 0.01 mg/kg body weight, up to 0.3 mg maximum single dose in children and 0.5 mg maximum in adolescents (see chart
on next page).
b. Secondary treatment option: For hives or itching, you may also administer diphenhydramine either orally or
by intramuscular injection; the standard dose is 1–2 mg/kg body weight, up to 30 mg maximum dose in children
and 50 mg maximum dose in adolescents (see chart on next page).
4. Monitor the patient closely until EMS arrives. Perform cardiopulmonary resuscitation (CPR), if necessary, and maintain airway. Keep patient in supine position (flat on back) unless he or she is having breathing difficulty. If breathing is difficult, patient’s head may be elevated, provided blood pressure is adequate to prevent loss of consciousness. If blood pressure is low, elevate legs. Monitor blood pressure and pulse every 5 minutes.
5. If EMS has not arrived and symptoms are still present, repeat dose of epinephrine every 5–15 minutes for up to 3 doses, 6 Record all vital signs, medications administered to the patient, including the time, dosage, response, and the name of the medical personnel who administered the medication, and other relevant clinical information.
7. Notify the patient’s primary care physician.
www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11) Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org Medical Management of Vaccine Reactions in Children and Teens (continued)
(page 3 of 3)
For your convenience, approximate dosages based on weight and age are provided in the charts below. Please
confirm that you are administering the correct dose for your patient.
First-Line Treatment: Epinephrine (the recommended dose for epinephrine is 0.01 mg/kg body weight)
Age Group
Range of weight
Range of weight
Epinephrine Dose
and
Children
0.25–0.3 mL† (or mg)
Note: If body weight is known, then dosing by weight is preferred. If weight is not known or not readily available, dosing by age is appropriate.
*Rounded weight at the 50th percentile for each age range
†Maximum dose for children
‡Maximum dose for teens
Secondary Treatment Option: Diphenyhydramine (the recommended dose
for diphenhydramine [Benadryl] is 1–2 mg/kg body weight)
Age Group
Range of weight
Range of weight
Diphenhydramine Dose
25 mg or 50 mg tablets50 mg/mL injectable (IV or IM) 15 mg–30 mg†
Children
20 mg–30 mg†
If body weight is known, then dosing by weight is preferred. If weight is not known or not readily available, dosing by age is appropriate.
*Rounded weight at the 50th percentile for each age range
†Maximum dose for children
‡Maximum dose for teens
Sources
Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert
Panel. Allergy Clin Immunol 2010; 126(6):S1–S57.
Simons FE, Camargo CA. Anaphylaxis: Rapid recognition and treatment. In: UpToDate, Bochnew BS (Ed). UpToDate: Waltham, MA, 2010.
These standing orders for the medical management of vaccine reactions in child and teenage patients shall remain in effect for patients of the until rescinded or until .
www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11) www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11) Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org

Source: http://www.immunize.org/catg.d/p3082a.pdf