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Kentucky Department for Public Health Alert

Posted December 20, 2018

Dear Healthcare Provider:

[Note: This is a statewide health alert that updates an earlier alert sent only to one region of Kentucky after learning that more regions of Kentucky may have experienced patients associated with this event.]

The Kentucky Department for Public Health (KDPH) is alerting you about a cluster of adverse vaccination reactions and requests information on any adult patients with adverse vaccination reactions occurring between September 1 and December 31, 2018. Reactions (abscesses, fibroid knots) are associated with a single healthcare provider in a rural county who was providing vaccination clinics at Kentucky businesses.  All available evidence points to an injection safety or practice issue and not a vaccine issue. The provider has ceased vaccinating, so there is no continuing risk to the public, but reactions can occur up to 8 weeks after vaccination so patients may develop reactions related to this practice until the end of 2018.

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 ask that you notify KDPH and we recommend a workup for nontuberculous mycobacteria (NTM) along with other bacterial and fungal pathogens. The following cultures and stains are recommended:

  • Anaerobic culture
  • Aerobic 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 Rachel Zinner or Rhonda Lucas at 502-564-4446. Laboratories should not discard specimens until KDPH has received reports and advised providers and laboratories about next steps.

Any adverse vaccination reaction should be reported on the Department of Health and Human Services’ Vaccine Adverse Event Reporting System (VAERS) at: For the current situation, all vaccine reactions, positive lab results, or diagnoses consistent with the information above, should also 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.

Thank you for your assistance in this matter!


Mel Bennett, MD, MPH
Manager, Infectious Disease Branch
Kentucky Department for Public Health

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