***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: Background The present r and omized non-blind trial was conducted to clarify the effect of analgesics on febrile responses of booster diphtheria-tetanus-whole cell pertussis ( DTP ) vaccine in 15–20 months old infants . Methods A total of 270 healthy infants were r and omized to receive acetaminophen ( 10 mg/kg ) along with DTP vaccine ( group 1 ) , 2 hours after vaccination ( group 2 ) , and after the appearance of febrile reactions or irritability following vaccination ( group 3 , control ) . In addition to study medication , if the axillary temperature was higher than 38 ° C or if the infant seemed to be irritable , the parents were told to give acetaminophen ( 10 mg/kg ) and record on a diary card . Vaccinees were monitored for local and systemic reactions . Results The incidences of local swelling , pain and erythema were not significantly different among the 3 groups . No difference was observed in the incidence of systemic reactions including febrile responses , irritability , anorexia , and vomiting among the 3 groups during the 7 days after vaccination . Of the infants , 45.1 % , 46.7 % and 51.9 % manifested fever ( axillary temperature ≥38 ° C ) within 24 hours after the vaccination in groups 1 , 2 and 3 , respectively ( P>0.05 ) . The second dose of acetaminophen was less in the control group than in the prophylactic groups ( P=0.009 ) . Conclusions Administration of acetaminophen along with DTP vaccine or 2 hours after vaccination does not affect the occurrence of febrile responses following booster vaccination . Unnecessary use of analgesics should be prevented OBJECTIVE : To determine the effects of acetaminophen and axillary temperature responses on  infant sleep duration  after immunization . METHODS : We conducted a prospect i ve , r and omized controlled trial to compare the sleep of 70 infants monitored by using ankle actigraphy for 24 hours before and after their first immunization series at ∼2 months of age . Mothers of infants in the control group received st and ard care instructions from their infants ' health care provider , and mothers of infants in the intervention group were provided with predosed acetaminophen and instructed to administer a dose 30 minutes before the scheduled immunization and every 4 hours thereafter , for a total of 5 doses . Infant age and birth weight and immunization factors , such as acetaminophen use and timing of administration , were evaluated for changes in infant sleep times after immunization . RESULTS : Sleep duration in the first 24 hours after immunization was increased , particularly for infants who received their immunizations after 1:30 pm and for those who experienced elevated temperatures in response to the vaccines . Infants who  received acetaminophen  at or after immunization had smaller increases in sleep duration than did infants who did not . However , acetaminophen use was not a significant predictor of sleep duration when other factors were controlled . CONCLUSIONS : If further research confirms the relationship between time of day of vaccine administration , increased sleep duration after immunization , and antibody responses , then our findings suggest that afternoon immunizations should be recommended to facilitate increased sleep in the 24 hours after immunization , regardless of acetaminophen administration Background In two clinical trials , low- grade fever was observed more frequently after coadministration than after separate administration of two recommended routine pediatric vaccines . Since fever is an important issue with vaccine tolerability , we performed this open-label study on the efficacy and safety of prophylactic use of paracetamol ( acetaminophen , Benuron ® ) in children administered routine 7-valent pneumococcal conjugate vaccine ( PCV-7 ) coadministered with hexavalent vaccine ( diphtheria-tetanus-acellular pertussis-hepatitis B , poliovirus , Haemophilus influenzae type b vaccine [ DTPa-HBV-IPV/Hib ] ) in Germany . Methods Healthy infants ( N = 301 ) who received a 3-dose infant series of PCV-7 and DTPa-HBV-IPV/Hib plus a toddler dose were r and omly assigned 1:1 to prophylactic paracetamol ( 125 mg or 250 mg suppositories , based on body weight ) at vaccination , and at 6–8 hour intervals thereafter , or a control group that received no paracetamol . Rectal temperature and local and other systemic reactions were measured for 4 days post vaccination ; adverse events were collected throughout the study . Results In the intent-to-treat population , paracetamol reduced the incidence of fever ≥38 ° C , but this reduction was only significant for the infant series , with computed efficacy of 43.0 % ( 95 % confidence interval [ CI ] : 17.4 , 61.2 ) , and not significant after the toddler dose ( efficacy 15.9 % ; 95 % CI : −19.9 , 41.3 ) ; results were similar in the per protocol ( PP ) population . Fever > 39 ° C was rare during the infant series , such that there were too few cases for assessment . After the toddler dose , paracetamol  effectively reduced fever > 39 ° C , reaching statistical significance in the PP population only ( efficacy 79 % ; 95 % CI : 3.9 , 97.7 ) . Paracetamol  also reduced reactogenicity , but there were few significant differences between groups after any dose . No vaccine-related serious adverse events were reported . Conclusions Paracetamol  effectively prevented fever and other reactions , mainly during the infant series . However , as events were generally mild and of no concern in either group our data support current recommendations to administer paracetamol to treat symptoms only and not for routine prophylaxis . Trial registration The effect of acetaminophen on reducing the frequency and severity of adverse reactions  following  diphtheria-pertussis-tetanus toxoids-polio vaccine  was studied in a r and omized clinical trial involving 519 vaccinations in 383 infants 2 to 6 months of age and 70 infants 18 months of age . Significantly fewer local and systemic reactions were reported in acetaminophen-treated infants at 2 to 6 months of age . Acetaminophen also reduced the incidence of fever greater than 38.0 degrees C from 44 % to 27 % . Only 0.9 % of acetaminophen-treated infants had overall behavioral changes rated as severe by parents compared to 13 % of the placebo group . Infants vaccinated at 18 months of age had higher rates of systemic and local reactions than younger infants . Acetaminophen did not result in significant reductions in reaction rates after the booster at 18 months . We conclude that acetaminophen administered at the time of primary vaccination with diphtheria-pertussis-tetanus toxoids-polio can significantly reduce the frequency and severity of common adverse reactions ABSTRACT . The effectiveness of acetaminophen in preventing post‐vaccination fever was studied in a double‐blind r and omized manner . Healthy five‐month‐old infants vaccinated with diphtheria‐tetanus‐pertussis ( DTP ) or DTP‐inactivated polio vaccine were r and omly allocated to receive either placebo ( n=130 ) or 75 mg of acetaminophen ( n=133 ) four hours after the vaccination . Rectal temperatures of the infants were measured in the post‐vaccination evening and next morning by the parents . The mean values of rectal temperatures were equal in both groups , i.e. 37.6 ° C , both in the evening and in the morning . No significant difference was found in the occurrence of other minor adverse reactions . Antibody titres to diphtheria and tetanus toxoids and pertussis bacteria of the placebo ( n=25 ) and acetaminophen ( n=34 ) groups did not differ significantly from each other . It is concluded that acetaminophen in a single dose schedule is ineffective in decreasing post‐vaccination fever and other symptoms BACKGROUND Although fever is part of the normal inflammatory process after immunisation , prophylactic antipyretic drugs are sometimes recommended to allay concerns of high fever and febrile convulsion . We assessed the effect of prophylactic administration of paracetamol at vaccination on  infant febrile reaction rates and vaccine responses . METHODS In two consecutive ( primary and booster ) r and omised , controlled , open-label vaccination studies , 459 healthy infants were enrolled from ten centres in the Czech Republic . Infants were r and omly assigned with a computer-generated r and omisation list to receive three prophylactic paracetamol doses every 6 - 8 h in the first 24 h ( n=226 ) or no prophylactic paracetamol ( n=233 ) after each vaccination with a ten-valent pneumococcal non-typeable Haemophilus influenzae protein D-conjugate vaccine ( PHiD-CV ) co-administered with the hexavalent diphtheria-tetanus-3-component acellular pertussis-hepatitis B-inactivated poliovirus types 1 , 2 , and 3-H influenzae type b ( DTPa-HBV-IPV/Hib ) and oral human rotavirus vaccines . The primary objective in both studies was the reduction in febrile reactions of 38.0 degrees C or greater in the total vaccinated cohort . The second objective was assessment of immunogenicity in the according-to- protocol cohort . These studies are registered with Clinical Trials.gov , numbers NCT00370318 and NCT00496015 . FINDINGS Fever greater than 39.5 degrees C was uncommon in both groups ( after primary : one of 226 participants [ < 1 % ] in prophylactic paracetamol group vs three of 233 [ 1 % ] in no prophylactic paracetamol group ; after booster : three of 178 [ 2 % ] vs two of 172 [ 1 % ] ) . The percentage of children with temperature of 38 degrees C or greater after at least one dose was significantly lower in the prophylactic paracetamol group ( 94/226 [ 42 % ] after primary vaccination and 64/178 [ 36 % ] after booster vaccination ) than in the no prophylactic paracetamol group ( 154/233 [ 66 % ] after primary vaccination and 100/172 [ 58 % ] after booster vaccination ) . Antibody geometric mean concentrations ( GMCs ) were significantly lower in the prophylactic paracetamol group than in the no prophylactic paracetamol group after primary vaccination for all ten pneumococcal vaccine serotypes , protein D , antipolyribosyl-ribitol phosphate , antidiphtheria , antitetanus , and antipertactin . After boosting , lower antibody GMCs persisted in the prophylactic paracetamol group for antitetanus , protein D , and all pneumococcal serotypes apart from 19F . INTERPRETATION Although febrile reactions significantly decreased , prophylactic administration of antipyretic drugs at the time of vaccination should not be routinely recommended since antibody responses to several vaccine antigens were reduced . FUNDING GlaxoSmithKline Biologicals ( Belgium ) To determine the effect of prophylactic acetaminophen on reactions after diphtheria and tetanus toxoids and pertussis vaccination , 282 children received either acetaminophen or placebo in a double-blind , r and omized fashion before and 3 , 7 , 12 , and 18 hours after vaccination .  Fever and local and systemic reactions were monitored . Switching to known acetaminophen was permitted if the patient 's temperature was 38.9 degrees C or higher or for moderate pain . Overall , the reaction score of acetaminophen recipients was significantly less than that of placebo recipients . The rates of occurrence of fever and fussiness and the degree of pain at the injection site were significantly reduced by acetaminophen administration . Children who received acetaminophen were less likely to be switched to " open " acetaminophen  than placebo recipients . It is concluded that prophylactic acetaminophen as given in this study had a moderating effect on fever , pain , and fussiness after diphtheria and tetanus toxoids and pertussis immunization OBJECTIVE The perceived reactogenicity of pertussis-containing vaccines is of considerable public health importance . The purpose of this study was to establish prospect ively the incidence of systemic and local clinical signs associated with the first three doses of the diphtheria-tetanus-pertussis vaccine ( DTP ) currently used in Australia . In addition , in order to determine whether variability in reporting of such phenomena might be associated with variation in DTP batches , infant behaviour was studied with three batches for the first of the three DTP vaccinations . METHODOLOGY Double blind , r and omized controlled trial . There were 591 eligible infants who were recruited sequentially from centres for vaccination in three large Melbourne municipalities , of whom 531 ( mean age 10 weeks , 45 % female ) were r and omized and immunized . Of 181 subjects who received DTP from batch 1 , 151 were studied at the time of their second DTP dose , and 98 at the 
    Output:
    
Prophylactic antipyretic administration significantly reduced the febrile reactions ( ≥ 38.0 ° C ) after primary and booster vaccinations .
Though there were statistically significant differences in the antibody responses between the two groups , the prophylactic PCM group had what would be considered protective levels of antibodies to all of the antigens given after the primary and booster vaccinations .
No significant difference in the nasopharyngeal carriage rates ( short-term and long-term ) of H. influenzae or S. pneumoniae serotypes was found between the prophylactic and no prophylactic PCM group .
There was a significant reduction in the local and systemic symptoms after primary , but not booster vaccinations .
Though prophylactic antipyretic administration leads to relief of the local and systemic symptoms after primary vaccinations , there is a reduction in antibody responses to some vaccine antigens without any effect on the nasopharyngeal carriage rates of S. pneumoniae & H. influenza serotypes .