What to apply on a Respiratory Syncytial Virus (RSV) injection site reaction?

Management of RSV Injection Site Reactions

For RSV injection site reactions, apply a cold compress or ice pack to the affected area for 15-20 minutes at a time to reduce swelling and discomfort. 1

Understanding RSV Injection Site Reactions

RSV injection site reactions are common and typically manifest as:

• Local swelling at or near the injection site
• Redness
• Pain or discomfort
• Possible induration (hardening of the tissue)

These reactions are generally mild to moderate in severity and self-limiting, typically resolving within a few days without specific treatment 1.

Management Algorithm

First-line interventions:

1. Cold compresses/ice packs:

   • Apply for 15-20 minutes at a time
   • Use several times daily as needed
   • Wrap ice in a cloth to prevent direct skin contact

2. Over-the-counter pain relievers (if needed):

   • Acetaminophen or NSAIDs can help manage discomfort
   • Follow recommended dosing guidelines

For moderate reactions:

• Continue cold compresses
• Rest the affected area
• Monitor for improvement within 24-48 hours

When to seek medical attention:

• If the reaction extends beyond the size of your palm (8-10 cm)
• If symptoms worsen after 48 hours
• If you develop fever, significant pain, or other systemic symptoms

Evidence and Clinical Context

The 2024 clinical practice guidelines from the American Academy of Otolaryngology-Head and Neck Surgery indicate that local reactions to vaccine injections, including RSV vaccines, generally do not require dose adjustments or specific medical interventions 1. These guidelines note that local reactions are not predictive of systemic reactions and can be managed with supportive care.

The Portuguese Society of Pulmonology and other medical societies note that injection site pain is among the most common adverse events reported with RSV vaccines, but these reactions are typically self-limiting and mild to moderate in severity 1.

Important Considerations

• Large local reactions (>8-10 cm) may warrant medical evaluation but are not necessarily a contraindication to future doses 1
• Local reactions do not predict future systemic reactions 1
• Clinicians administering RSV vaccines should be able to recognize the difference between normal local reactions and more serious adverse events 1

Special Populations

For pregnant women receiving RSV vaccination (RSVpreF/Abrysvo) to protect their infants, the same management approach applies for injection site reactions 1.

For elderly patients who may have thinner skin or be more susceptible to bruising, extra care should be taken when applying cold compresses to avoid tissue damage.