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Vaccination has become a highly charged issue during the COVID-19 pandemic — but previously, millions of U.S. children and adults received immunizations against influenza, pneumococcal infection, pertussis, hepatitis A, tetanus, diphtheria, and other diseases, with vaccination-site infections (VSI) being rare. An outbreak of VSI during December 2018–February 2019 in Kentucky, Indiana, and Ohio involved 101 individuals who received at least one of these vaccines; 30 cases were due to infection with a nontuberculous Mycobacterium, M. porcinum. Vaccination was performed at 54 workplaces and had been contracted out to a single commercial company. No source of infection could be traced to a single vaccine or manufacturer; however, investigation of the vaccination provider revealed poor training, hygiene, storage, preparation, administration, and monitoring and reporting practices. Some vaccine samples had low antigen titers, suggesting inadequate storage.
Symptom onset occurred within a median 14 days after vaccination and included injection-site nodules, redness, and pain. Of the 77% of vaccine recipients seeking clinical care, 35% received incision and drainage.
Blau EF et al. Mycobacterium porcinum skin and soft tissue infections after vaccinations — Indiana, Kentucky, and Ohio, September 2018–February 2019. MMWR Morb Mortal Wkly Rep 2021 Oct 22; 70:1472. (https://doi.org/10.15585/mmwr.mm7042a3)
Comment
Since this outbreak, hundreds of millions of U.S. patients have been vaccinated against SARS-CoV-2. The capacity to immunize this many people in the shortest possible time has necessitated the creation of mass sites never before used for vaccination, virtually guaranteeing variation in training, storage, and other parameters of safe vaccination. To detect and manage such variation, all vaccination-site infections should be immediately reported to the Vaccine Adverse Event Reporting System (VAERS) and local health departments so that effective epidemiologic investigation can be rapidly executed.