What are the steps to manage a reaction to the pneumococcal (pneumo) vaccine?

Management of Pneumococcal Vaccine Reactions

Most pneumococcal vaccine reactions are mild, self-limited local reactions requiring only reassurance and symptomatic management with analgesics or cold compresses, resolving within 48 hours without intervention. 1, 2

Initial Assessment and Triage

When a patient presents with a suspected pneumococcal vaccine reaction, immediately determine the severity and type:

Mild Local Reactions (Most Common)

• Pain, erythema, and swelling at injection site occur in approximately 28-50% of recipients 2, 3
• These reactions typically persist for less than 48 hours 1
• Management: Reassurance, over-the-counter analgesics, and cold compresses are sufficient 2
• More than 90% of local symptoms are mild to moderate and rarely interfere with arm use 3

Systemic Reactions (Less Common)

• Fever (22%), myalgias, and fatigue may occur but are generally no more frequent than baseline symptoms 2, 3
• A study of 1,006 vaccinated persons found similar or lower rates of systemic symptoms during the post-vaccination week compared to pre-vaccination baseline 3
• Management: Symptomatic treatment with antipyretics and rest

Severe Reactions Requiring Immediate Intervention

Anaphylaxis (Rare)

• Severe systemic adverse effects including anaphylactic reactions are rare but require immediate emergency management 1, 2
• Meta-analysis of nine randomized controlled trials found no reports of severe anaphylactic reactions among 7,531 patients 1
• Management protocol:
  • Administer intramuscular epinephrine immediately
  • Activate emergency medical services
  • Provide supportive care with IV fluids and airway management as needed
  • Consider skin testing and specific IgE determination for future vaccine decisions 4

Eosinophilic Pneumonia (Very Rare)

• Can present 2-7 days post-vaccination with fever, dyspnea, and bilateral infiltrates on imaging 5
• This is a life-threatening but treatable condition 5
• Management:
  • Obtain chest imaging if respiratory symptoms develop
  • Consider bronchoalveolar lavage if eosinophilic pneumonia suspected
  • Treat with systemic corticosteroids (typically 3-week course) 5
  • Drug lymphocyte stimulation testing can confirm vaccine causation 5

Severe Dermatologic Reactions (Rare)

• Extensive dermatitis with pruritus, urticaria, and petechiae may develop within 1 week post-vaccination 6
• Management:
  • Topical corticosteroids for localized reactions
  • Oral antihistamines (e.g., diphenhydramine)
  • Consider systemic corticosteroids for extensive involvement 6

Critical Contraindications for Future Vaccination

Revaccination is absolutely contraindicated in persons who experienced severe reactions (anaphylaxis or localized Arthus-type reactions) to the initial dose 1

This is a firm guideline from the Advisory Committee on Immunization Practices and must be documented clearly in the patient's record 1.

Reporting Requirements

All suspected adverse events must be reported to the Vaccine Adverse Event Reporting System (VAERS) at 1-800-822-7967 1, 2

This is a 24-hour toll-free number and reporting helps maintain vaccine safety surveillance 1.

Important Clinical Pearls

• Intradermal administration causes severe local reactions and is inappropriate—always use intramuscular route 1
• No neurologic disorders (including Guillain-Barré syndrome) have been associated with pneumococcal vaccination 1, 2
• Pneumococcal vaccination has not been causally associated with death among vaccine recipients 1, 2
• Arthus-type reactions are more severe when revaccination occurs within 2 years, but reactions after intervals ≥4 years are not increased compared to initial vaccination 1