1 The Pediatric Infectious Disease Journal Publish Ahead of Print DOI: 10.1097/INF.0000000000001620 Elevated Immune Response Among Children 4 Years Of Age With Pronounced Local Adverse Events After The Fifth Dtap Vaccination Saskia van der Lee, 1,2 BSc, Jeanet M. Kemmeren, 1 PhD, Lia G. H. de Rond, 1 BSc, Kemal Öztürk, 1 BSc, Anneke Westerhof, 1 BSc, Hester E. de Melker, 1 PhD, Elisabeth A.M. Sanders, 1,2 Guy A.M. Berbers, 1 PhD, Nicoline A.T. van der Maas, 1 MD, Hans C. Rümke, 3 PhD, and Anne- Marie Buisman, 1 PhD 1. Centre for Infectious Disease Control, National institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands 2. Department of Peadiatric Immunology and Infectious Diseases, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, The Netherlands 3. Netherlands Pharmacovigilance Centre Lareb, ‘s Hertogenbosch, The Netherlands Corresponding Author: Saskia van der Lee, P.O. box 1, 3720 BA Bilthoven, The Netherlands Telephone number: +31 302743407, Saskia.van.der.lee@rivm.nl Declaration of all sources of funding: Funded by the Dutch ministry of health Abbreviated Title: Vaccine Response in Children with Local Adverse Events Running Head: Immune Response After Local Adverse Events Author Disclosure: The authors have no conflicts of interest or funding to disclose ACCEPTED Copyright © 2017 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.