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A more comprehensive review of the literature was conducted for certain specific AEFIs, including sterile abscesses, macrophagic myofasciitis, reactions to aluminium adjuvants, Guillain\u2013Barr\u00e9 syndrome, acute disseminated encephalomyelitis (ADEM) and anaphylaxis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Acellular (aP) vaccines are generally associated with mild reactions such as local pain, redness, and transient fever. Moderate reactions, including prolonged crying, hypotonic\u2010hyporesponsive episodes, extensive limb swelling, and aluminium\u2010induced granuloma, occur infrequently and are self\u2010limiting. Severe outcomes such as seizures or encephalopathy have been extensively investigated, with large studies showing no consistent increase above background incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Licensed acellular pertussis vaccine combinations demonstrate acceptable safety profiles, with serious adverse events being rare. Continuous pharmacovigilance and balanced, evidence\u2010based communication remain essential to sustain trust in pertussis immunisation programmes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/apa.70676","type":"journal-article","created":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T15:53:33Z","timestamp":1783871613000},"page":"2370-2379","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Update on Selected Adverse Events of Concern Following Immunization With Acellular Pertussis Vaccines, a Narrative Review"],"prefix":"10.1111","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6845-6723","authenticated-orcid":false,"given":"Lennart","family":"Nilsson","sequence":"first","affiliation":[{"name":"Department of Biomedical and Clinical Sciences Link\u00f6ping University  Link\u00f6ping Sweden"},{"name":"Former Allergy Center, now Guest professor at Link\u00f6ping University  Link\u00f6ping Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jann","family":"Storsaeter","sequence":"additional","affiliation":[{"name":"Former Vaccine Department of the Public Health Agency  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,12]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0264\u2010410x(03)00302\u20105"},{"key":"e_1_2_13_3_1","volume-title":"Plotkin's Vaccines","year":"2024"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0264\u2010410x(02)00770\u20103"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858"},{"key":"e_1_2_13_6_1","article-title":"Combined DTP\u2010HBV\u2010HIB vaccine versus separately administered DTP\u2010HBV and HIB vaccines for primary prevention of diphtheria, tetanus, pertussis, hepatitis B and \n                     Haemophilus influenzae\n                   B (HIB)","volume":"4","author":"Bar\u2010ON ES","year":"2012","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"e_1_2_13_7_1","first-page":"433","article-title":"Pertussis Vaccines: WHO Position Paper September 2015","volume":"90","author":"World Health Organization","year":"2015","journal-title":"Weekly Epidemiological Record"},{"key":"e_1_2_13_8_1","unstructured":"WHO \u201cInformation sheet observed rate of vaccine reactions. 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