Immune-mediated adverse reactions to vaccines

Abstract

Vaccination continues to be the single most important and successful public health intervention, due to its prevention of morbidity and mortality from prevalent infectious diseases. Severe immunologically mediated reactions are rare and less common with the vaccine than the true infection. However, these events can cause public fearfulness and loss of confidence in the safety of vaccination. In this paper, we perform a systematic literature search and narrative review of immune-mediated vaccine adverse events and their known and proposed mechanisms, and outline directions for future research. Improving our knowledge base of severe immunologically mediated vaccine reactions and their management drives better vaccine safety and efficacy outcomes.

Keywords: adverse drug reactions; allergy; drug allergy; hypersensitivity; immunology; vaccines.

Figure 1

Immediate hypersensitivity skin testing in an alpha‐gal allergic patient with anaphylaxis after vaccination demonstrates a skin test positive response to gelatine containing vaccines, which were subsequently demonstrated to also contain alpha‐gal allergen. Image modified from Stone et al.28, 29 DTaP = diphtheria, tetanus, and acellular pertussis; IPV = inactivated polio vaccine

Figure 2

Suggested pathway for evaluating and reporting cases of immediate hypersensitivity vaccine reactions in the literature26, 27, 28, 29

Figure 3

Disseminated papular rash after receipt of smallpox vaccine (ACAM2000), without detectable intralesional virus37

Figure 4

Mechanism category, adverse events, examples, predisposing factors, evaluation and strategies for management of immune‐mediated adverse events to vaccines. The blue column represents immediate‐type reactions, the pink columns represent delayed‐type reactions, and the green column represents failure to control live vaccine strain leading to a prolonged or disseminated vaccine strain infection19, 108