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Vaccination-Abscess Provider Alert


December 13, 2018

The Kentucky Department for Public Health (KDPH) has become aware of a recent increase of adverse reactions in adult vaccinations in your area. While we continue to investigate the situation, all available evidence points to an injection safety or practice issue and not a vaccine issue.  All patient reactions are limited to services from one provider in a rural county who has ceased vaccinating, so there is no continuing risk to anyone in the public.  However, based on the incubation period, patients may continue to present to healthcare providers with adverse reactions to previously-administered vaccinations. Thus, we want to alert you about the possibility of seeing patients presenting with vaccination reactions that might be related to this situation.

Primarily, we have been informed of abscesses at the site of injection and inflammatory or fibrous nodules following the administration of hepA, TDaP, pneumococcal, or seasonal influenza vaccinations.  If you encounter this in your practice, we recommend a workup for nontuberculous mycobacteria (NTM) along with other bacterial and fungal pathogens. The following cultures and stains are recommended:

•             Aerobic culture

•             Anaerobic culture

•             Fungal culture

•             AFB smear and culture

Clinicians have reported removing “nodules” or “knots” from the arms of some patients at the vaccination sites.  Any biologic material should be sent for the same cultures listed above and also sent to pathology for analysis.

Specimens can be submitted through your regular laboratory network or directly to the Kentucky State Division of Laboratory Services (DLS) for those with access to the Outreach system. For more information, visit the Kentucky DLS website:, or call Leigh Ann Bates at 502-564-4446. Laboratories should not discard specimens until KDPH has received reports and advised providers and laboratories about next steps.

Vaccine reactions, positive lab results or diagnoses consistent with the information above, should be reported to the Kentucky Department for Public Health via phone or secure fax.

Phone number: 1-888-9-REPORT

Secure fax: 502-696-3803

With flu season and the ongoing hepatitis A outbreak, we urge you to continue to vaccinate at-risk populations. 


Mel Bennett, MD, MPH

Manager, Infectious Disease Branch

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