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Monday, February 16, 2015
Polio
Definition
Polio is a contagious viral illness that in its most severe form causes paralysis, difficulty breathing and sometimes death.
The Centers for Disease Control and Prevention (CDC) advises taking precautions to protect against polio if you're traveling anywhere there's a risk of polio.
If you're a previously vaccinated adult who plans to travel to an area where polio is occurring, you should receive a booster dose of inactivated poliovirus vaccine (IPV). Immunity after a booster dose lasts a lifetime.
Symptoms
Although polio can cause paralysis and death, the vast majority of people who are infected with the poliovirus don't become sick and are never aware they've been infected with polio.
Nonparalytic polio
Some people who develop symptoms from the poliovirus contract nonparalytic polio — a type of polio that doesn't lead to paralysis (abortive polio). This usually causes the same mild, flu-like signs and symptoms typical of other viral illnesses.
Signs and symptoms, which generally last one to 10 days, include:
- Fever
- Sore throat
- Headache
- Vomiting
- Fatigue
- Back pain or stiffness
- Neck pain or stiffness
- Pain or stiffness in the arms or legs
- Muscle weakness or tenderness
- Meningitis
Paralytic polio
In rare cases, poliovirus infection leads to paralytic polio, the most serious form of the disease. Paralytic polio has several types, based on the part of your body that's affected — your spinal cord (spinal polio), your brainstem (bulbar polio) or both (bulbospinal polio).
Initial signs and symptoms of paralytic polio, such as fever and headache, often mimic those of nonparalytic polio. Within a week, however, signs and symptoms specific to paralytic polio appear, including:
- Loss of reflexes
- Severe muscle aches or weakness
- Loose and floppy limbs (flaccid paralysis), often worse on one side of the body
Post-polio syndrome
Post-polio syndrome is a cluster of disabling signs and symptoms that affect some people several years — an average of 35 years — after they had polio. Common signs and symptoms include:
- Progressive muscle or joint weakness and pain
- General fatigue and exhaustion after minimal activity
- Muscle atrophy
- Breathing or swallowing problems
- Sleep-related breathing disorders, such as sleep apnea
- Decreased tolerance of cold temperatures
- Cognitive problems, such as concentration and memory difficulties
- Depression or mood swings
When to see a doctor
Be sure to check with your doctor for polio vaccination recommendations before traveling to a part of the world where polio may still occur naturally, or where oral polio vaccine (OPV) is still used, such as Central and South America, Africa and Asia. In countries that use the OPV — vaccine made with live, but weakened (attenuated) polio virus — the risk of paralytic polio to travelers is extremely low, but not zero.
Additionally, call your doctor if:
- Your child hasn't completed the series of polio vaccinations
- Your child experiences an allergic reaction after receiving polio vaccine
- Your child has problems other than a mild redness or soreness at the vaccine injection site
- You have questions about adult vaccination or other concerns about polio immunization
- You had polio years ago and are now experiencing unexplained weakness and fatigue
Causes
The poliovirus resides only in humans and enters the environment in the feces of someone who's infected. Poliovirus spreads primarily through the fecal-oral route, especially in areas where sanitation is inadequate.
Poliovirus can be transmitted through contaminated water and food or through direct contact with someone infected with the virus. Polio is so contagious that anyone living with a recently infected person is likely to become infected, too. People carrying the poliovirus can spread the virus for weeks in their feces.
Risk factors
You're at greatest risk of polio if you haven't been immunized against the disease. In areas with poor sanitation and sporadic or nonexistent immunization programs, the most vulnerable members of the population — pregnant women, the very young and those with weakened immune systems — are especially susceptible to experience paralysis if they are infected with poliovirus.
These factors also increase your risk if you haven't been vaccinated:
- Travel to an area where polio is common or that has recently experienced an outbreak
- Living with or caring for someone who may be shedding poliovirus
- A compromised immune system, such as occurs with HIV infection
- Having had your tonsils removed (tonsillectomy)
- Extreme stress or strenuous physical activity after being exposed to poliovirus, both of which can depress your immune system
Complications
Paralytic polio can lead to temporary or permanent muscle paralysis, disability, and deformities of the hips, ankles and feet. Although many deformities can be corrected with surgery and physical therapy, these treatments may not be options in developing nations where polio is still common. As a result, children who survive polio may spend their lives with severe disabilities.
Preparing for your appointment
Call your doctor if you've recently returned from travel abroad and develop symptoms similar to those that occur with polio.
Here's some information to help you get ready and to know what to expect from your doctor.
Information to gather in advance
- Pre-appointment restrictions. At the time you make your appointment, ask if there are any restrictions you need to follow in the time leading up to your visit. Your doctor may recommend taking steps to reduce the risk of spreading a potentially contagious illness to others.
- Symptom history. Write down any symptoms you've been experiencing and for how long.
- Recent exposure to possible sources of infection. Be sure to describe international trips in detail, including the countries you visited and the dates.
- Medical history. Make a list of your key medical information, including other conditions for which you're being treated and any medications, vitamins or supplements you're currently taking. Your doctor will also need to know your vaccination history.
- Questions to ask your doctor. Write down your questions in advance so that you can make the most of your time with your doctor.
For polio, some basic questions to ask your doctor include:
- Do I have polio?
- Are there any other possible causes for my symptoms?
- What kinds of tests do I need?
- What self-care steps can I take to aid my recovery?
- How long do you expect a full recovery will take?
- Am I contagious? If so, for how long?
- Do I need to follow any restrictions?
- When can I return to work or school?
- Am I at risk of any long-term complications from polio?
Don't hesitate to ask any additional questions that occur to you during your appointment.
What to expect from your doctor
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to talk about in-depth. Your doctor may ask:
- What are your symptoms?
- When did you first begin experiencing symptoms?
- Do your symptoms seem to be getting better or worse?
- Have you recently been around people with symptoms similar to yours?
- Have you recently traveled abroad? Where?
- Did you update your vaccinations before traveling?
- Are you being treated for any other medical conditions?
- Are you currently taking, or have you recently taken, any medications?
- Are you pregnant?
Tests and diagnosis
Doctors often recognize polio by symptoms, such as neck and back stiffness, abnormal reflexes, and difficulty swallowing and breathing. To confirm the diagnosis, a sample of throat secretions, stool or cerebrospinal fluid — a colorless fluid that surrounds your brain and spinal cord — is checked for the presence of poliovirus.
Treatments and drugs
Because no cure for polio exists, the focus is on increasing comfort, speeding recovery and preventing complications. Supportive treatments include:
- Bed rest
- Pain relievers
- Portable ventilators to assist breathing
- Moderate exercise (physical therapy) to prevent deformity and loss of muscle function
- A nutritious diet
Prevention
Although improved public sanitation and careful personal hygiene may help reduce the spread of polio, the most effective way to prevent the disease is with polio vaccine.
Polio vaccine
Currently, most children in the United States receive four doses of inactivated poliovirus vaccine (IPV) at the following ages:
- Two months
- Four months
- Between 6 and 18 months
- Between ages 4 and 6 when children are just entering school
IPV is 90 percent effective after two shots and 99 percent effective after three. It can't cause polio and is safe for people with weakened immune systems, although it's not certain just how protective the vaccine may be in cases of severe immune deficiency. Common side effects are pain and redness at the injection site.
Allergic reaction to the vaccine
IPV can cause an allergic reaction in some people. Because the vaccine contains trace amounts of the antibiotics streptomycin, polymyxin B and neomycin, it shouldn't be given to anyone who's had a reaction to these medications.
Signs and symptoms of an allergic reaction usually occur within minutes to a few hours after the shot and may include:
- Difficulty breathing
- Weakness
- Hoarseness or wheezing
- Rapid heart rate
- Hives
- Dizziness
- Unusual paleness
- Swelling of the throat
If you or your child experiences an allergic reaction after any shot, get medical help immediately.
Fewer shots for your child
Polio vaccine is normally given in conjunction with vaccinations against other diseases, including diphtheria, tetanus and acellular pertussis (DTaP), pneumococcal infections, and hepatitis B. But your child may not need to receive all these injections separately.
A combination vaccine called Pediarix is available that reduces the number of injections given during the first two years of life. Pediarix combines DTaP, hepatitis B and polio vaccine into a single vaccine. Side effects of Pediarix are similar to those of the individual vaccines administered separately, though fever is more likely to occur in children who receive Pediarix than in children who receive vaccines separately.
Adult vaccination
In the U.S., adults aren't routinely vaccinated against polio because most are already immune and the chances of contracting polio are minimal. However, certain adults at high risk of polio who have had a primary vaccination series with either IPV or the oral polio vaccine (OPV) should receive a single booster shot of IPV. A single booster dose of IPV lasts a lifetime. Adults at risk include those who are traveling to parts of the world where polio still occurs or those who care for people who may be excreting wild poliovirus.
If you're unvaccinated or your vaccination status is undocumented, get a series of primary polio vaccination shots — two doses of IPV at four– to eight–week intervals and a third dose six to 12 months after the second dose.
Bacillus Of Calmette And Guerin Vaccine, Live (Intradermal Route)
Diphtheria, tetanus, and acellular pertussis vaccine (also known as DTaP) is a combination immunizing agent given by injection to protect against infections caused by diphtheria, tetanus (lockjaw), and pertussis (whooping cough). This vaccine is given only to children 6 weeks through 6 years of age (before the child's 7th birthday).
Diphtheria is a serious illness that can cause breathing difficulties, heart problems, nerve damage, pneumonia, and possibly death. The risk of serious complications and death is greater in very young children and in the elderly.
Tetanus (also known as lockjaw) is a serious illness that causes convulsions (seizures) and severe muscle spasms that can be strong enough to cause bone fractures of the spine. Tetanus causes death in 30 to 40 percent of cases.
Pertussis (also known as whooping cough) is a serious disease that causes severe spells of coughing that can interfere with breathing. Pertussis also can cause pneumonia, long-lasting bronchitis, seizures, brain damage, and death.
Diphtheria, tetanus, and pertussis are serious diseases that can cause life-threatening illnesses. Although some serious side effects can occur after a dose of DTaP (usually from the pertussis vaccine part), this rarely happens. The chance of your child catching one of these diseases, and being permanently injured or dying as a result, is much greater than the chance of your child getting a serious side effect from the DTaP vaccine.
This vaccine is to be administered only by or under the supervision of your child's doctor or other health care professional.
This product is available in the following dosage forms:
- Suspension
Before Using
In deciding to use a vaccine, the risks of taking the vaccine must be weighed against the good it will do. This is a decision you and your doctor will make. For this vaccine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of diphtheria, tetanus, and acellular pertussis vaccine in children younger than 6 weeks of age and in children 7 years of age and older. Safety and efficacy have not been established.
Geriatric
Diphtheria, tetanus, and acellular pertussis vaccine is not recommended for use in adult populations.
No information is available on the relationship of age to the effects of Daptacel® in geriatric patients.
Pregnancy
| Pregnancy Category | Explanation | |
|---|---|---|
| All Trimesters | C | Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women. |
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Drug Interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this vaccine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Receiving this vaccine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Meningococcal Vaccine, Tetanus Toxoid Conjugate Quadrivalent
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this vaccine. Make sure you tell your doctor if you have any other medical problems, especially:
- Bleeding disorders (eg, hemophilia, thrombocytopenia)—Should not use in patients with this condition.
- Brain disease (eg, encephalopathy)—This includes a coma, a decreased level of consciousness, or seizures lasting a long time. Children who have these symptoms within 7 days of receiving a vaccine with pertussis should not get this vaccine.
- Guillain-Barré syndrome (nerve disease that causes paralysis), history of—If your child had this condition after getting a vaccine with tetanus toxoid in it, you should talk to your doctor about the potential benefits and possible risks of getting this vaccine.
- Immunodeficiency disorder or
- Weakened immune system—This vaccine may not work as well in children with this condition.
- Previous serious reaction to a vaccine—If your child had a serious reaction to this vaccine or another vaccine with pertussis in it, you should talk to your doctor about the potential benefits and possible risks of getting this vaccine. Some serious reactions include being less responsive than normal, crying continuously without stopping for 3 hours or more, having a seizure with or without a fever, or having a fever that was 105 degrees F or higher.
- Progressive neurologic disorder—This includes infantile spasms, progressive brain disease, or uncontrolled seizures. This vaccine should not be given until these conditions are treated and under control.
Proper Use
A nurse or other trained health professional will give your child this vaccine. The vaccine is given as a shot into one of your child's muscles.
This vaccine is usually given as a series of 4 or 5 shots. It is important that your child receive all of the shots in this series. Try to keep all scheduled appointments. If your child must miss a shot, make another appointment with the child's doctor as soon as possible.
Your child may receive other vaccines at the same time as this one, but in a different body area. You should receive information sheets about all of the vaccines your child receives. Make sure you understand all of the information that is given to you.
Your child may also receive a medicine to help prevent or treat some of the minor side effects of the vaccine, like fever and soreness.
Precautions
It is very important that the doctor check your child at regular visits to make sure this vaccine is working properly and to check for unwanted effects. It is very important that you return to your child's doctor for the next dose in the series.
Contact your doctor immediately if your child has sudden weakness in the arms and legs. This could be a sign of a serious condition called Guillain-Barré syndrome.
It is very important to tell the doctor if your child is allergic to rubber. The vial and syringes may contain dry natural latex rubber, which may cause an allergic reaction if your child has a latex allergy.
This vaccine will not treat an active infection. If your child has an infection due to diphtheria, tetanus, or pertussis, your child will need medicines to treat these infections.
Syncope (fainting) may occur after receiving this vaccine. Your doctor may want your child to be observed after receiving the injection to prevent and manage fainting.
Be sure to tell your child's doctor about any side effects that occur after your child receives the vaccine. This may include seizures, fever, crying that will not stop, or severe redness or swelling where the shot was given.
This vaccine may cause apnea (breathing stops for short periods) in some premature infants. Discuss this with your child's doctor if you are concerned.
Make sure your doctor knows if you are using medicines that weaken your immune system such as cancer medicines, radiation treatment, or steroids.
Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
Less common
- Collapse or shock-like state
- crying for 3 hours or more
- fever over 102.2 °F
- redness or swelling of 4 inches or more at the injection site
- seizures (convulsions)
- severe pain at the injection site
Incidence not known
- Agitation
- back pain
- black, tarry stools
- bleeding gums
- bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- blood in the urine or stools
- bloody nose
- bluish color of the fingernails, lips, skin, palms, or nail beds
- blurred vision
- confusion
- cough
- diarrhea
- difficulty with swallowing
- dizziness
- drowsiness
- fast heartbeat
- hallucinations
- headache
- hoarseness
- irritability
- irritation
- joint pain, stiffness, or swelling
- loss of bladder control
- loss of consciousness
- loss of strength or energy
- muscle pain or weakness
- nausea and vomiting
- pain or cramping in the abdomen or stomach
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- rash with flat lesions or small raised lesions on the skin
- screaming
- shortness of breath
- sleepiness or unusual drowsiness
- sneezing
- sore throat
- stiff neck
- swollen, painful, or tender lymph glands in the neck, armpit, or groin
- tightness in the chest
- total body jerking
- unusual bleeding or bruising
- unusual tiredness or weakness (sudden and severe)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Fever of 99.5 °F or more
- fussiness
- loss of appetite
- mild pain, redness, swelling, or tenderness at the injection site
- restlessness
- weight loss
Incidence not known
- Crying
- ear pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Diphtheria, Tetanus, And Acellular Pertussis Vaccine (Intramuscular Route)
Diphtheria, tetanus, and acellular pertussis vaccine (also known as DTaP) is a combination immunizing agent given by injection to protect against infections caused by diphtheria, tetanus (lockjaw), and pertussis (whooping cough). This vaccine is given only to children 6 weeks through 6 years of age (before the child's 7th birthday).
Diphtheria is a serious illness that can cause breathing difficulties, heart problems, nerve damage, pneumonia, and possibly death. The risk of serious complications and death is greater in very young children and in the elderly.
Tetanus (also known as lockjaw) is a serious illness that causes convulsions (seizures) and severe muscle spasms that can be strong enough to cause bone fractures of the spine. Tetanus causes death in 30 to 40 percent of cases.
Pertussis (also known as whooping cough) is a serious disease that causes severe spells of coughing that can interfere with breathing. Pertussis also can cause pneumonia, long-lasting bronchitis, seizures, brain damage, and death.
Diphtheria, tetanus, and pertussis are serious diseases that can cause life-threatening illnesses. Although some serious side effects can occur after a dose of DTaP (usually from the pertussis vaccine part), this rarely happens. The chance of your child catching one of these diseases, and being permanently injured or dying as a result, is much greater than the chance of your child getting a serious side effect from the DTaP vaccine.
This vaccine is to be administered only by or under the supervision of your child's doctor or other health care professional.
This product is available in the following dosage forms:
- Suspension
Before Using
In deciding to use a vaccine, the risks of taking the vaccine must be weighed against the good it will do. This is a decision you and your doctor will make. For this vaccine, the following should be considered:
Allergies
Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.
Pediatric
Appropriate studies have not been performed on the relationship of age to the effects of diphtheria, tetanus, and acellular pertussis vaccine in children younger than 6 weeks of age and in children 7 years of age and older. Safety and efficacy have not been established.
Geriatric
Diphtheria, tetanus, and acellular pertussis vaccine is not recommended for use in adult populations.
No information is available on the relationship of age to the effects of Daptacel® in geriatric patients.
Pregnancy
| Pregnancy Category | Explanation | |
|---|---|---|
| All Trimesters | C | Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women. |
Breastfeeding
There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.
Drug Interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this vaccine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Receiving this vaccine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Meningococcal Vaccine, Tetanus Toxoid Conjugate Quadrivalent
Other Interactions
Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.
Other Medical Problems
The presence of other medical problems may affect the use of this vaccine. Make sure you tell your doctor if you have any other medical problems, especially:
- Bleeding disorders (eg, hemophilia, thrombocytopenia)—Should not use in patients with this condition.
- Brain disease (eg, encephalopathy)—This includes a coma, a decreased level of consciousness, or seizures lasting a long time. Children who have these symptoms within 7 days of receiving a vaccine with pertussis should not get this vaccine.
- Guillain-Barré syndrome (nerve disease that causes paralysis), history of—If your child had this condition after getting a vaccine with tetanus toxoid in it, you should talk to your doctor about the potential benefits and possible risks of getting this vaccine.
- Immunodeficiency disorder or
- Weakened immune system—This vaccine may not work as well in children with this condition.
- Previous serious reaction to a vaccine—If your child had a serious reaction to this vaccine or another vaccine with pertussis in it, you should talk to your doctor about the potential benefits and possible risks of getting this vaccine. Some serious reactions include being less responsive than normal, crying continuously without stopping for 3 hours or more, having a seizure with or without a fever, or having a fever that was 105 degrees F or higher.
- Progressive neurologic disorder—This includes infantile spasms, progressive brain disease, or uncontrolled seizures. This vaccine should not be given until these conditions are treated and under control.
Proper Use
A nurse or other trained health professional will give your child this vaccine. The vaccine is given as a shot into one of your child's muscles.
This vaccine is usually given as a series of 4 or 5 shots. It is important that your child receive all of the shots in this series. Try to keep all scheduled appointments. If your child must miss a shot, make another appointment with the child's doctor as soon as possible.
Your child may receive other vaccines at the same time as this one, but in a different body area. You should receive information sheets about all of the vaccines your child receives. Make sure you understand all of the information that is given to you.
Your child may also receive a medicine to help prevent or treat some of the minor side effects of the vaccine, like fever and soreness.
Precautions
It is very important that the doctor check your child at regular visits to make sure this vaccine is working properly and to check for unwanted effects. It is very important that you return to your child's doctor for the next dose in the series.
Contact your doctor immediately if your child has sudden weakness in the arms and legs. This could be a sign of a serious condition called Guillain-Barré syndrome.
It is very important to tell the doctor if your child is allergic to rubber. The vial and syringes may contain dry natural latex rubber, which may cause an allergic reaction if your child has a latex allergy.
This vaccine will not treat an active infection. If your child has an infection due to diphtheria, tetanus, or pertussis, your child will need medicines to treat these infections.
Syncope (fainting) may occur after receiving this vaccine. Your doctor may want your child to be observed after receiving the injection to prevent and manage fainting.
Be sure to tell your child's doctor about any side effects that occur after your child receives the vaccine. This may include seizures, fever, crying that will not stop, or severe redness or swelling where the shot was given.
This vaccine may cause apnea (breathing stops for short periods) in some premature infants. Discuss this with your child's doctor if you are concerned.
Make sure your doctor knows if you are using medicines that weaken your immune system such as cancer medicines, radiation treatment, or steroids.
Side Effects
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
Less common
- Collapse or shock-like state
- crying for 3 hours or more
- fever over 102.2 °F
- redness or swelling of 4 inches or more at the injection site
- seizures (convulsions)
- severe pain at the injection site
Incidence not known
- Agitation
- back pain
- black, tarry stools
- bleeding gums
- bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
- blood in the urine or stools
- bloody nose
- bluish color of the fingernails, lips, skin, palms, or nail beds
- blurred vision
- confusion
- cough
- diarrhea
- difficulty with swallowing
- dizziness
- drowsiness
- fast heartbeat
- hallucinations
- headache
- hoarseness
- irritability
- irritation
- joint pain, stiffness, or swelling
- loss of bladder control
- loss of consciousness
- loss of strength or energy
- muscle pain or weakness
- nausea and vomiting
- pain or cramping in the abdomen or stomach
- pinpoint red spots on the skin
- puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
- rash with flat lesions or small raised lesions on the skin
- screaming
- shortness of breath
- sleepiness or unusual drowsiness
- sneezing
- sore throat
- stiff neck
- swollen, painful, or tender lymph glands in the neck, armpit, or groin
- tightness in the chest
- total body jerking
- unusual bleeding or bruising
- unusual tiredness or weakness (sudden and severe)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
- Fever of 99.5 °F or more
- fussiness
- loss of appetite
- mild pain, redness, swelling, or tenderness at the injection site
- restlessness
- weight loss
Incidence not known
- Crying
- ear pain
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
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