Swelling, redness and pain at the site can be a common side effect from any injection. Most episodes post vaccines are expected, small, local reactions and are very short lived. In some cases, however, swelling at the injection site can be more extensive and potentially classified as a severe Injection Site Reaction (ISR).

Severe ISR can be defined as “joint to joint swelling” e.g. swelling extending from the shoulder joint to the elbow joint or “crossing joints” e.g. swelling that crosses at least one joint. Resolution of these symptoms usually occur within 5-7 days. Treatment can include oral pain relief and cold compress if required. Therapies such as antibiotics and antihistamines are generally not required if a child remains systemically well. Most cases do not experience a high grade fever.

Severe ISR can be seen in around 3-4% of children receiving the 4th dose of DTPa (whooping cough booster vaccine) which is scheduled to be given at 18-months of age. It is much lower for other vaccines on the National Immunisation Program.

Regarding recurrence of severe ISR, a 5th dose of DTPa is due to given at 4 years of age and it is estimated that up to 50% of children receiving this dose may have another severe ISR. Despite a previous report of severe ISR, it is still recommended for children to continue with the scheduled vaccines, to ensure protection from important vaccine preventable diseases. For more detailed discussion please contact SAEFVIC.


Author: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: July 2020

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

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