PEDIATRICS Vol. 75 No. 2 February 1985, pp. 299-303
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Outbreaks of Group A Streptococcal Abscesses Following Diphtheria-Tetanus Toxoid-Pertussis Vaccination

Harrison C. Stetler MD1, Paul L. Garbe DVM, MPH1, Diane M. Dwyer MD1, Richard R. Facklam PhD1, Walter A. Orenstein MD1, Gary R. West 1, K. Joyce Dudley 1, and Alan B. Bloch MD, MPH1

1 From the Center for Prevention Services, Centers for Disease Control, Department of Health and Human Services, Atlanta

Two outbreaks of group A streptococcal abscesses following receipt of diphtheria-tetanus toxoid-pertussis (DTP) vaccine from different manufacturers were reported to the Centers for Disease Control (CDC) in 1982. The clustering of the immunization times of cases, the isolation of the same serotype of Streptococcus from all cases in each outbreak, and the absence of reported abscesses associated with receipt of the same lots of vaccine in other regions of the country, suggest that each outbreak was probably caused by contamination of a single 15-dose vial of vaccine. The preservative thimerosal was present within acceptable limits in unopened vials from the same lot of DTP vaccine in each outbreak. Challenge studies indicate that a strain of Streptococcus from one of the patients can survive up to 15 days in DTP vaccine at 4°C. Contamination of vials during manufacturing would have required survival of streptococci for a minimum of 8 months. Preservatives in multidose vaccine vials do not prevent short-term bacterial contamination. Options to prevent further clusters of streptococcal abscesses are discussed. The only feasible and cost-effective preventive measure now available is careful attention to sterile technique when administering vaccine from multidose vials.

Key Words: streptococcal abscesses • abscesses • diphtheria-tetanus toxoid-pertussis (DTP) vaccine • vaccine reactions

Submitted on December 23, 1983
Accepted on April 3, 1984




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