Influenza virus vaccine

INFLUENZA VIRUS VACCINE LOCAL AND SYSTEMIC REACTIONS I N C H I L D R E N

H. B. G~ANT, M.D. DURHAM, N . C.

M U N I Z A T I O N of adults with inactive influenza virus has been reported by I MHirst, Rickard, and FriedewaldP A mild febrile response and inflammation at the site of injection were noted. However, much more severe reactions have been r e p o r t e d b y word of mouth b y numerous other people, p a r t i c u l a r l y from members of the A r m e d Forces. W i t h the lack of a n y information about dosage or reaction of children to the vaccine, ]6 children between the ages of 1 and 8 years were given influenza virus vaccine, types A and B, in variable amounts.t The first four patients were given 0.25 e.c. of the vaccine subcutaneously and the t e m p e r a t u r e was r e c o r d e d e v e r y 4 hours, for 36 hours or until normal (Table I). As one p a t i e n t had a mild local and systemic reaction and another a slight febrile response, six children were given 0.5 c.e. of the vaccine subcutaneously and observed as was the previous group (Table I I ) . In this group a mild local reaction was noted in every subject and a slight febrile reaction was noted in about one-half of the children. None of the patients a p p e a r e d extremely ill nor did the local reactions seem much greater than in the previous group. Even t h o u g h the severity and f r e q u e n c y of reactions seemed somewhat greater t h a n in the group given 0.25 c.c., it was decided to increase the dose to the normal adult dose of 1 c.c. for six patients in a similar age group as was used previously (Table I I I ) . The f r e q u e n c y of the reactions was no greater t h a n either previous group but the severity was m a r k e d l y increased. All patients had an increase in the local reaction and two of the patients were acutely ill, one having a generalized convulsion at the height of the fever (40.7 ~ C.). Both patients were normal within 48 hours. The two older patients who were given 1 c.c. had no systemic reaction and the local reaction was about the same as in the younger patients. The observations made in this series of patients showed that the febrile reaction in children is much more f r e q u e n t t h a n is mentioned in adults. Whe~ 1 c.c. was given, the reaction was much too severe to recommend the general use of this a m o u n t of vaccine for children. The reaction to 0.5 c.c. of the vaccine is about the same as is noted in adults when ] c.c. of the vaccine is given. The reaction to 0.5 c.c. of the vaccine is quite mild and we think this dose is optimal and all t h a t will be t o l e r a t e d for active immunization against types A and B influenza virus. To increase the necessary i m m u n i t y this dose can be repeated, perhaps, in two weeks. F r o m the D e p a r t m e n t of Pediatrics, Duke U n i v e r s i t y School of Medicine a nd Duke Hospital. *Hirst, G. K., R i c k a r d , E. 1~., and F r i e d e w a l d , W. ~ . : J. Expe r. ~Vled. 80: 265, 1944. ~Lederle. This vaccine w a s s u p p l i e d t h r o u g h the c o u r t e s y of the Lederle Company, New York, N. Y. 485

486

THE JOURNAL OF PEDIATRICS TABLE I AGE

REACTION

JE@T

(MO.)

D.~.

26

Pain

P.W.

21

P a i n ; ] em, erythema

M.T.

14

Pain

E.A.

]3

Pain

I~MEDIATE

I

12 HOURS I :[ em, n o d u l e ; norreal t e m p e r a t u r e 1.5 cm. e r y t h e m a ; S.c. nodule ; T. 38.1 ~ C. ] cm. n o d u l e ; norreal temperature 1 cm. n o d u l e ; norreal t e m p e r a t u r e

24 HOURS I 0.5 em. n o d u l e ; normal temperature 1 era. n o d u l e ; normal temperature 0.5 cm. n o d u l e ; normal temperature 0.5 era. n o d u l e ; T. 38.1 ~ C.

36 HOURS N o r m a l temperature 0.5 cm. n o d u l e ; n o r m a l ternperature N o r m a l ternperature N o r m a l ternperature

r.r ABLE I I REACTIONS

SUBJECT

(M0.)

D.G.

14

IMMEDIATE Pain

]3. ~I.

32

Pain

D.B.

44

Pain

D.K.

33

Pain

D.M.

36

Pain

D.S.

24

Pain

AGE

. I

12 IIOURS T. 38 ~ C.; I cm. s.c. nodule

I 24 HOURS I era. s.c. nodul e

1.5 era. s.c. n o d u l e ; normal temperature T. 38.6 ~ C.; 0.5 cm. s.c. n o d u l e T. 38.1 ~ C.; 1 cm. s.c. nodule

1 era. s.c. nodul e ; normal temperature ~ormal temperature 0.5 s.c. n o d u l e ; normal temperature 0.5 era. s.c. n o d u l e ; T, 38.6 ~ C. 0.5 cm. n o d u l e ; normal temperature

T. 38.4 ~ C.; 1 era. s.c. n o d u l e 1 em. n o d u l e ; norreal temperature

I 36 HOURS T. 38.5 ~ C. 0 . 5 cm. n o d u l e ( n o r m a l 60 hr.) N o r m a l ternperature N o r m a l temperature N o r m a l ternperature N o r m a l ternperature N o r m a l temper~ture

TABLE I I I SUB-

REACTIONS

JECTS J.Q.

AGE 19 too.

I~MEDIATE Pain

] 12 HOURS ].5 cm. s.c. n o d u l e ; normal temperature 2.5 cm. s.c. n o d u l e ; normal temperature 2 era. s.c. n o d u l e ; T. 39,6 ~ C.

V.P.

30 too.

Pain

C.F.

24 too.

Pain

R.B.

36mo.

Pain

2 era. s.c. n o d u l e ; 4 cm. e r y t h e m a ; T. 40.7 ~ C.

M.L.

8 yr.

Pain

P.B.

6yr.

Pain

1.5 em. s.c. n o d u l e ; normal temperature 2 em. s.c. n o d u l e ; normal temperature

I 24 HOURS 0.5 s.c. nodule ; normal temperature 1 cm. s.c. nodul e ; normal temperature 1 cm. n o d u I e ; 1 cm. e r y t h e m a ; T. 37.8 ~ C. 1,5 era. n o d u l e ; T. 38 ~ C.

I era. s.c. n o d u l e ; normal temperature 1 cm. s.c. n o d u l e ; n o r m a l t e mpe ra ture

[ 36 HOURS N o r m a l ternperature N o r m a l ternperature N o r m s ] t e mperature 0.5 em. n o d u l e ( n o r m a l 48 h o u r s ) ; normal temperature N o r m a l ternperature 0.5 em. s.c. n o d u l e (norre a l 48 h r . ) ; n o r m a l temperature