Management of Adverse Reactions After Monkey Bite Vaccination

Normal Expected Reactions

The Centers for Disease Control and Prevention recommends that primary vaccination can produce swelling and tenderness of regional lymph nodes, beginning 3-10 days after vaccination and persisting for 2-4 weeks after the skin lesion has healed 1
Erythematous or urticarial rashes may occur approximately 10 days after primary vaccination, with the vaccinee usually afebrile, and the rash resolving spontaneously within 2-4 days, as reported by the Centers for Disease Control and Prevention 3
Fever is common after vaccination, with up to 70% of recipients experiencing temperatures >100°F for 4-14 days after primary vaccination, according to the Centers for Disease Control and Prevention 2

Local swelling, redness, and pain at the injection site are expected normal reactions, and the Centers for Disease Control and Prevention recommends applying cool compresses to reduce swelling and discomfort 1
The Centers for Disease Control and Prevention suggests using over-the-counter antihistamines for itching, and taking acetaminophen or NSAIDs for pain and fever as needed 4, 6
The Centers for Disease Control and Prevention recommends keeping the vaccination site clean and dry, and monitoring the site for 2-4 days, as most reactions resolve spontaneously within this timeframe 1, 3

Generalized vaccinia is a rare but serious reaction, characterized by a vesicular rash of varying extent, and the Centers for Disease Control and Prevention recommends immediate medical attention if signs of anaphylaxis develop 2, 5
Eczema vaccinatum is a localized or systemic dissemination of vaccinia virus among persons with eczema or history of eczema, and the Centers for Disease Control and Prevention recommends close monitoring of individuals with a history of atopic dermatitis 4
Progressive vaccinia is a severe, potentially fatal illness characterized by progressive necrosis at the vaccination site, and the Centers for Disease Control and Prevention recommends immediate medical attention if signs of progressive vaccinia occur 4

Persons with a history of atopic dermatitis (eczema) are at higher risk for developing eczema vaccinatum, and the Centers for Disease Control and Prevention recommends close monitoring of these individuals 4
Immunocompromised individuals are at higher risk for progressive vaccinia, and the Centers for Disease Control and Prevention recommends that they should not receive live vaccinia vaccines 4
Pregnant women should avoid vaccinia vaccination due to risk of fetal vaccinia, as recommended by the Centers for Disease Control and Prevention 4

Vaccinia can be transmitted from the vaccination site to other persons by close contact, and the Centers for Disease Control and Prevention recommends washing hands with warm soapy water or hand rubs containing >60% alcohol after touching the vaccination site 4
The Centers for Disease Control and Prevention suggests keeping the vaccination site covered with a bandage until the scab separates from the skin, and disposing of used bandages in sealed plastic bags 4