Mycobacterium porcinum Skin and Soft Tissue Infections After Vaccinations - Indiana, Kentucky, and Ohio, September 2018-February 2019

Abstract

During December 2018-February 2019, a multistate investigation identified 101 patients with vaccination-associated adverse events among an estimated 940 persons in Kentucky, Indiana, and Ohio who had received influenza; hepatitis A; pneumococcal; or tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines at the workplace during September 11-November 28, 2018. These vaccines had been administered by staff members of a third-party health care company contracted by 24 businesses. Company A provided multiple vaccine types during workplace vaccination events across 54 locations in these adjoining states. Injection-site wound isolates from patients yielded Mycobacterium porcinum, a nontuberculous mycobacteria (NTM) species in the Mycobacterium fortuitum group; subtyping using pulsed-field gel electrophoresis of all 28 available isolates identified two closely related clusters. Site visits to company A and interviews with staff members identified inadequate hand hygiene, improper vaccine storage and handling, lack of appropriate medical record documentation, and lack of reporting to the Vaccine Adverse Event Reporting System (VAERS). Vaccination-associated adverse events can be prevented by training health care workers responsible for handling or administering vaccines in safe vaccine handling, administration, and storage practices, timely reporting of any suspected vaccination-associated adverse events to VAERS, and notifying public health authorities of any adverse event clusters.

FIGURE 1

Dates of vaccination, symptom onset, and specimen collection in 90 patients* with vaccination-associated adverse events^† after vaccination^§ by company A — Indiana, Kentucky, and Ohio, September 2018–February 2019 Abbreviation: Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. * Of the 101 interviewed patients, 90 reported both vaccination date and symptom onset date. Of these 90 patients, 21 had cultures that yielded Mycobacterium porcinum with specimen collection dates reported. ^† A case was defined as a vaccination-associated adverse event characterized by severe redness or swelling, nodule, pustule, abscess, or drainage at the injection site in a vaccine recipient within150 days after vaccination by company A, after September 1, 2018. ^§ Vaccines administered by company A included influenza, hepatitis A, pneumococcal, and Tdap vaccines.

FIGURE 2

Pulsed-field gel electrophoresis dendrogram* of 28 Mycobacterium porcinum specimens isolated from patients vaccinated^† by company A — Kentucky and Ohio, September 2018–February 2019 Abbreviations: PFGE = pulsed-field gel electrophoresis; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine. * PFGE patterns of the 28 Mycobacterium porcinum clinical isolates, 27 from Kentucky and one from Ohio, showed two closely related clusters with one band difference; isolates within each cluster are indistinguishable. M. porcinum is a nontuberculous mycobacteria species in the Mycobacterium fortuitum group. ^† Vaccines administered by company A included influenza, hepatitis A, pneumococcal, and Tdap vaccines.