Outbreak of pyogenic abscesses after diphtheria and tetanus toxoids and pertussis vaccination

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Abstract
Nine children who received diphtheria and tetanus toxoids and pertussis vaccine from the same vial at a clinic in Colorado developed pyogenic abscesses at the site of injection. Eight abscesses required surgical drainage and five children were hospitalized. Group A Streptococcus (GAS) was cultured from eight wounds and Staphylococcus aureus was also isolated from four. Epidemiologic investigation revealed that within the hour of the first child's vaccination, three children had been diagnosed in the clinic with GAS pharyngitis. GAS recovered from repeat throat swabs from two of these children and the eight case-isolates were all serotype M-12, T-12 and had identical immunoblot patterns on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. Laboratory simulation studies demonstrated that GAS can survive for at least 4 days on the external surface of a vaccine vial rubber stopper and contaminate needles inserted through the stopper. Swabbing the stopper with 70% isopropyl alcohol resulted in effective disinfection. To prevent potential contamination meticulous attention to sterile technique is important when withdrawing vaccine from multidose vaccine vials.

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