Fall is just about here, which means the CDC campaign to get everyone’s yearly vaccine for influenza is ramping up. We’ll be seeing tons and tons of articles about it in all our media outlets in the next few months, which will be hard for some of us to take in. It’s time to decide if I’m getting a flu shot again. Are you going to get it?
Getting a shoulder injury related to vaccine administration (SIRVA) is a frustrating and conflicting experience for anyone who is pro-vaccine. It’s been very difficult to talk about it with friends and colleagues, because although I’m normally very open about my injuries (it’s a favorite subject among rock climbers), there is something unique about a vaccine-related injury in the public discourse. It’s a controversial and inflammatory (haha) issue and many people (like myself, before this happened) think that vaccines are very safe (with the possible exception of some rare and potentially devastating complications like Guillain-Barré syndrome), and certain claims to the contrary are pseudoscience.
But that was because I had no idea about the risks of shoulder injury from a mis-administered shot given by an incompetent person. Now that I am aware, in theory, I could prevent someone from screwing it up on me again. (I have thought about getting a bulls-eye tattoo on the meat of the deltoid muscle where the vaccine should go!) On the one hand, SIRVA is completely preventable; on the other hand, it is a painful and traumatic experience that takes us away for months or even years from the things we love to do. Here are a few things that we love to do that we have been prevented from doing or impaired at since the incidents (all of these are from responses to the SIRVA survey):
- Rock climbing (all right, that’s me)
- Weight lifting
- Picking up my dogs or boys
- Walking the dog, walking in general
- Ultimate Frisbee
- Yoga, planks, push-ups
- Playing with the kids
And not just the fun stuff, but also, survey respondents have had difficulty with many everyday things:
- Trouble driving with that arm
- Putting on deodorant, brushing hair, washing hair, styling hair
- Putting on/taking off clothes (especially bras)
- Trying to itch certain parts of the body
- Carrying groceries
- Cleaning the house
- Shoveling snow, snowblowing
- Sleeping on that side
There is no doubt about it, SIRVA is a disruptive, painful, life-upending experience that all of us wish we could have avoided.
The CDC is trying to make administrators of vaccines aware, but in my opinion, it’s too little of an effort. Also, their primary recommendations in that link for needle length (1-inch and greater) are not in line with what some authors of SIRVA papers have written. Pretty much all of us who got SIRVA got it from a 1-inch needle, which, frustratingly, the CDC still recommends. (Note that using a shorter needle alone may not be protective if it is still injected in the wrong location too high on the shoulder.) But from Barnes et al., 2012:
Based on Lippert’s study, corroborated by an ultrasonographic study of deltoids by Koster and Poland, a compelling argument could be made to change vaccination technique. Lippert suggests a weight-based vaccination technique: for instance, that a 1/2-inch needle be used for any female who weighs up to 70 kg [154 lbs] and any male who weighs up to 75 kg [165 lbs]. A 5/8-inch needle is recommended for any female who weighs between 70 and 115 kg [154 – 250 lbs] and any male who weighs between 75 and 140 kg [165 – 308 lbs]. A 7/8-inch or longer needle should be used for any female who weighs 115 kg [250 lbs] and any male who weighs 140 kg [308 lbs]. This recommendation could conceivably create a 0% overpenetration rate and a 10% underpenetration rate. … These methods could potentially prevent SIRVA as well as other problems associated with overpenetration of vaccination.
What do you think? There are strong arguments for getting the flu shot every year, some recent and intriguing arguments against getting it every year, and the usual debate about the effectiveness of each individual year. Are you going to get it?