Tag Archives: immunisation

December 2017 reading list

Retinoblastoma mnemonic this month.  Plus information on lower sugar content recipes for the reintroduction of cows milk into a child’s diet, labial adhesions, 6 in 1 vaccine and don’t miss infantile spasms as early treatment improves overall prognosis.  Do leave comments below.

November 2017 PDF

Children’s cancer information this month – prevalence and red flags, a link to the excellent immunisation resource – Oxford vaccine group – for all those questions about individual immunisations that you can’t always answer,  NICE’s recent UTI update and infant dyschezia.  Do leave comments below.

March 2016 uploaded

March 2016: a few odds and ends on asthma this month and assessing a child in an acute exacerbation, Childline survey, Meningococcus W and paediatric neck lumps.  Do leave comments below:

December 2014 – in time for Christmas

December 2014 : ‘flu vaccination for children, calprotectin, paintballing bruises, eczema and some useful links to atopy downloads.   Do leave comments:

May 2014 newsletter

Pityriasis rosea this month, plus domestic violence, constipation, domperidone, next instalment of headache and a link to a site for parents on immunisations.  Do leave comments below…

April 2014

More musings from Dr Waterfield this month – this time on paracetamol for immunisation discomfort.  Also the 7 important features of a headache y0u must ask about, a link to a very good paediatric emergency medicine site, NICE quality standards in depression, molluscum contagiosum and more musings from me, this time on paediatric phlebotomy.  Do leave comments below.

BCG lymphadenitis

BCG Lymphadenitis with thanks to Dr Mujahid Hassan

Lymphadenitis is the most common complication of BCG vaccination, and is of two types – suppurative and non-suppurative.

Normal course post-vaccination:
Intradermal injection -> local multiplication of vaccine -> transport to lymphatics via lymph glands -> haematogenous dissemination of BCG.
No clear definition of ‘BCG lymphadenitis,’ proposed definition is when it becomes palpable or concerning for parents.

Can appear as early as two weeks after vaccination, most within 6 months and almost all cases will be within 24 months.
Normally ipsilateral with one or two palpable lymph nodes, but can involve multiple nodes.  Normally axillary but can be with cervical/supraclavicular.

  • Isolated lymph node enlargement
  • BCG vaccination to ipsilateral side
  • Absence of tenderness or heat to lump
  • Absence of fever

Non-suppurative will resolve within a few weeks – this is a normal reaction and most of these are sub-clinical so go unnoticed.
Suppurative involves an enlarging lymph node with fluctuant appearances, oedema and erythema.  Happens in ’30-80%’ of cases of lymphadenitis.

Treatment of suppurative lymphadenitis:

Antibiotics: Previously erythromycin/rifampicin/isoniazid have been used but their clinical role is of dubious significance, so are not used routinely.
Reassurance and followup are what is needed.

Fine Needle Aspiration: Suppurative lymphadenitis can result in spontaneous perforation and sinus formation, which can result in several unpleasant months of dressing and wound care.  FNA is thus recommended to prevent this and reduce time for healing.

Surgical excision:  Risks of general anaesthesia – other than in extreme cases of failed FNA/multiloculated lymph nodes – far outweigh the potential benefits.































Management pathway and images courtesy of:
WM Chan, YW Kwan, CW Leung.  Management of Bacillus Calmette-Guérin Lymphadenitis, Hong Kong Journal of Paediatrics (New Series). Vol 16. No. 2, 2011, available via http://www.hkjpaed.org/details.asp?id=782&show=1234

J Goraya and V Virdi,  Bacille Calmette-Guérin lymphadenitis, Postgrad Med J. 2002 June; 78(920): 327–329,
available via http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1742390/pdf/v078p00327.pdf


October 2013 newsletter

Lots of writing on this month’s PDF digest, much of it thanks to our registrars.  Rotavirus oral vaccination, wheezing in the under 2s, bradycardia, conduct disorder, Kawasaki disease and force feeding.  Do leave comments below.

July 2013 PDF

Neglect and emotional abuse is the safeguarding topic this month.  ED advice on the management of minor head injuries, a report from BPSU in hypocalcaemic fits secondary to vitamin D deficiency, the new UK immunisation poster and a bit on crying babies.  Hope you find it all helpful.  Comments welcome below

Whooping cough outbreak 2012

More background to pertussis with thanks to Dr Rupa Vora

  • whooping cough is caused by Bordetella pertussis, a gram negative pleomorphic bacillus. It is spread by aerosol transmission and the bacteria cause damage by attaching to the respiratory cilia
  • it occurs in clusters every 2-5 years during the summer months. We currently have an outbreak with the HPA provisionally reporting 665 cases in the first quarter of 2012 (cf. 1040 cases in 2011, 421 in 2010)
  • cases have dropped dramatically since pertussis vaccinations have been introduced. Acellular pertussis vaccination is given at 2 and 3 months, followed by a pre-school booster.  However, protection wanes quickly and has virtually disappeared by 12 years old
  • incubation period is 3-12 days and children are most infectious in the first 2-3 weeks. They are most likely to present in the second phase of illness at 3-4 weeks
  • can present with coryza (1st stage which lasts a couple of weeks), paroxysms of cough, difficulty feeding and pneumonia. Younger infants (<6months) may not present with the characteristic ‘whoop’. Older children and adults often present with a persistent cough
  • complications include chronic cough (“100 day cough”), hypoglycaemia, seizures, encephalopathy and intracranial haemorrhage
  • any infant is vulnerable and up to 50% may need hospitalisation.  Especially vulnerable are ex-prems and those with underlying cardiology, respiratory or neurological problems.  
  • In England and Wales, whooping cough is statutorily notifiable.  The diagnosis is usually made on clinical grounds without the requirement for laboratory confirmation
  • The UK Health Protection Agency advises a 7 day course of erythromycin or clarithromycin (or azithromycin for 3-5 days if under 4 weeks) to reduce spread.  A pernasal swab to confirm or refute B. pertussis as the causative organism can be carried out.  If the cough has been present for more than two weeks and the child is in the community, serum serology can be sent to Colindale.  See table below:


Appropriate laboratory tests for a sporadic case of pertussis reported to HPA on clinical suspicion (with thanks to Dr Maria O’Callaghan): 

Age Clinical symptoms
≤ 2 weeks cough > 2 weeks cough
≤ 1 yr



PNS for culture (local laboratory)


PNS for culture (local laboratory)

Serum for serology (RSIL)

≤ 1 yr


PNS for culture (local laboratory) Serum for serology (RSIL)
> 1 yr to 6 yr
6 to 15 yr Serum for serology (RSIL)
> 15 yr

 NPA – nasopharyngeal aspirate; PNS – pernasal swab;

RSIL – Respiratory and Systemic Infections Laboratory, Colindale

Useful websites:

HPA: www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/WhoopingCough/

NHS Choices: www.nhs.uk/Conditions/Whooping-cough/Pages/Introduction.aspx