International Journal of Clinical Pharmacy

, Volume 36, Issue 2, pp 261–263 | Cite as

Limb swelling in a pediatric sickle cell patient after revaccination with pneumococcal vaccine

  • Calvin C. Daniels
  • Chasity M. Shelton
  • Patricia J. Bass
  • Winfred C. Wang
  • Katie J. SudaEmail author
Case Report


Case (description) This report describes an incident of limb swelling after revaccination with the 23-valent pneumococcal polysaccharide vaccine (PPSV23). A 5-year old female with sickle cell disease experienced severe arm swelling with edema to the extent that it was difficult to put a shirt over the arm. The day prior, she received PPSV23 concomitantly with the meningococcal vaccine. She had received the PPSV23 vaccine 2.5 years prior to the event. The patient was managed with analgesics, antiemetics, and antibiotic prophylaxis and the arm swelling resolved 24 h later. A decreased length of time between revaccination and concurrent administration with the meningococcal vaccine could have contributed. Conclusion Although rare, limb swelling after revaccination could be a concern in special at-risk populations where repeated vaccination is necessary for pneumococcal protection.


Adverse drug reaction Limb swelling Pediatric Pneumococcal Sickle cell Vaccine 




Conflicts of interest



  1. 1.
    Updated Recommendations for Prevention of Invasive Pneumococcal Disease Among Adults Using the 23-Valent Pneumococcal Polysaccharide Vaccine (PPSV23). MMWR Recomm Rep. 2012;61:816–9.Google Scholar
  2. 2.
    Nuorti JP, Whitney CG. Prevention of pneumococcal disease among infants and children-use of 13-valent pneumococcal conjugate vaccine and 23-valent pneumococcal polysaccharide vaccine-recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2010;59:1–18.PubMedGoogle Scholar
  3. 3.
    Vernacchio L, Neufeld EJ, MacDonald K, et al. Combined schedule of 7-valent pneumococcal conjugate vaccine followed by 23-valent pneumococcal vaccine in children and young adults with sickle cell disease. J Pediatr. 1998;133:275–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Nelson K, Goldman JA, Perlino CA. Severe local reactions to pneumococcal vaccine. South Med J. 1980;73:264–5.PubMedCrossRefGoogle Scholar
  5. 5.
    Fine MJ, Smith MA, Carson CA, et al. Efficacy of pneumococcal vaccination in adults. A meta-analysis of randomized controlled trials. Arch Intern Med. 1994;154:2666–77.PubMedCrossRefGoogle Scholar
  6. 6.
    Jackson LA, Benson P, Sneller VP, et al. Safety of revaccination with pneumococcal polysaccharide vaccine. JAMA. 1999;281:243–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Jackson LA, Nelson JC, Whitney CG, et al. Assessment of the safety of a third dose of pneumococcal polysaccharide vaccine in the vaccine safety datalink population. Vaccine. 2006;24:151–6.PubMedCrossRefGoogle Scholar
  8. 8.
    Overturf GD, Rigau-Perez JG, Selzer J, et al. Pneumococcal polysaccharide immunization of children with sickle cell disease. I. Clinical reactions to immunization and relationship to preimmunization antibody. Am J Pediatr Hematol Oncol. 1982;4:19–23.PubMedGoogle Scholar
  9. 9.
    Rigau-Perez JG, Overturf GD, Chan LS, Weiss J, Powars D. Reactions to booster pneumococcal vaccination in patients with sickle cell disease. Pediatr Infect Dis. 1983;2:199–202.PubMedCrossRefGoogle Scholar
  10. 10.
    Kohl KS, Walop W, Gidudu J, et al. Swelling at or near injection site: case definition and guidelines for collection, analysis and presentation of immunization safety data. Vaccine. 2007;25:5858–74.PubMedCrossRefGoogle Scholar
  11. 11.
    Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.PubMedCrossRefGoogle Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Calvin C. Daniels
    • 1
  • Chasity M. Shelton
    • 1
  • Patricia J. Bass
    • 2
  • Winfred C. Wang
    • 3
  • Katie J. Suda
    • 1
    Email author
  1. 1.Department of Clinical PharmacyUniversity of Tennessee Health Science CenterMemphisUSA
  2. 2.Department of Pharmaceutical SciencesSt. Jude Children’s Research HospitalMemphisUSA
  3. 3.Department of HematologySt. Jude Children’s Research HospitalMemphisUSA

Personalised recommendations