Vaccine "Take" Evaluation

About

A “take” or “major cutaneous reaction” indicates successful vaccination. A normal take will show a pustular lesion or an area of definite induration or congestion surrounding a central lesion, which can be a scab or an ulcer. Anything else is considered a “non-take.”

Overview

A "take" or "major cutaneous reaction" indicates successful vaccination. A normal take will show a pustular lesion or an area of definite induration or congestion surrounding a central lesion, which can be a scab or an ulcer. Anything else is considered a "non-take."

Non-takes can be caused by improper vaccination technique, use of vaccine that has lost its potency, or residual vaccinial immunity among previously vaccinated persons. Do not presume a person with a non-take to be immune to smallpox. Revaccinate anyone with a non-take reaction using a different vaccine lot.

Evaluate the vaccine site for both first-time vaccinees and revaccinees on the 6th, 7th, or 8th day following vaccination. Vaccine site evaluations on other days may not be reliable.

Examples of “takes”

The three images below clearly demonstrate a central lesion.

An upper arm with a rash and central lesion after smallpox vaccination
Arm of vaccinated patient showing a central lesion, indicating a successful “take.”
SOURCE:

Ramzy Azar, LTJG, MSC, United States Navy: National Naval Medical Center, Bethesda, MD

An upper arm with a lesion from smallpox vaccination
Arm of patient with central lesion at smallpox vaccination site. Ruler showing diameter of lesion is approximately 1 centimeter. Central lesion shows a successful “take.”
SOURCE:

Ramzy Azar, LTJG, MSC, United States Navy: National Naval Medical Center, Bethesda, MD

A close up of a grayish pustule from smallpox vaccination on dark skin
Grayish pustule, with difficult to detect surrounding erythema in dark skin.
SOURCE:

IH, digital enhancement ©Logical Images, Inc.

See Also: Examples of Major or “Take” Reactions to Smallpox Vaccination

Examples of “Non-Takes”

An upper arm with an erythema around the vaccination site
Arm of patient who was unsuccessfully vaccinated for smallpox. Vaccination site has an area of erythema but no central lesion. Source: Ramzy Azar, LTJG, MSC, United States Navy: National Naval Medical Center, Bethesda, MD.
SOURCE:

Ramzy Azar, LTJG, MSC, United States Navy: National Naval Medical Center, Bethesda, MD

An upper arm that has no erythema or central lesion after vaccination
Arm of patient with a non-take at the vaccination site. The vaccination site has neither erythema nor a central lesion. Source: Stephen Heyse, MD, National Institutes of Health.
SOURCE:

Stephen Heyse, MD, National Institutes of Health

See Also: Comparison of Reactions for First-Time Vaccinees and Revaccinees

Resources

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Content Source:
National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)