Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, California (C.Z., I.A.L., L.S.S., W.C., L.Q., D.S.R., S.S.K., C.M., S.J.J.).
Immunization Safety Office, Centers for Disease Control and Prevention, Atlanta, Georgia (J.D.).
Ann Intern Med. 2022 May;175(5):634-643. doi: 10.7326/M21-3023. Epub 2022 Mar 22.
Although shoulder conditions have been reported as an adverse event after intramuscular vaccination in the deltoid muscle, epidemiologic data on shoulder conditions after vaccination are limited.
To estimate the risk for shoulder conditions after vaccination and assess possible risk factors.
Retrospective cohort study.
Kaiser Permanente Southern California, a large integrated health care organization.
Kaiser Permanente Southern California members aged 3 years or older who had an intramuscular vaccination administered in the deltoid muscle between 1 April 2016 and 31 December 2017.
A natural language processing (NLP) algorithm was used to identify potential shoulder conditions among vaccinated persons with shoulder disorder diagnosis codes. All NLP-identified cases were manually chart confirmed on the basis of our case definition. The characteristics of vaccinated persons with and without shoulder conditions were compared.
Among 3 758 764 administered vaccinations, 371 cases of shoulder condition were identified, with an estimated incidence of 0.99 (95% CI, 0.89 to 1.09) per 10 000 vaccinations. The incidence was 1.22 (CI, 1.10 to 1.35) for the adult (aged ≥18 years) and 0.05 (CI, 0.02 to 0.14) for the pediatric (aged 3 to 17 years) vaccinated populations. In the adult vaccinated population, advanced age, female sex, an increased number of outpatient visits in the 6 months before vaccination, lower Charlson Comorbidity Index, and pneumococcal conjugate vaccine were associated with a higher risk for shoulder conditions. Among influenza vaccines, quadrivalent vaccines were associated with an increased risk for shoulder conditions. Simultaneous administration of vaccines was associated with a higher risk for shoulder conditions among elderly persons.
Generalizability to other health care settings, use of administrative data, and residual confounding.
These population-based data suggest a small absolute risk for shoulder conditions after vaccination. Given the high burden of shoulder conditions, clinicians should pay attention to any factors that may further increase risks.
Centers for Disease Control and Prevention.
虽然在三角肌肌内接种疫苗后出现肩部疾病已被报道为一种不良事件，但关于疫苗接种后肩部疾病的流行病学数据有限。
估计接种疫苗后肩部疾病的风险，并评估可能的危险因素。
回顾性队列研究。
凯撒永久南加州，一个大型综合医疗保健组织。
2016 年 4 月 1 日至 2017 年 12 月 31 日期间，在凯撒永久南加州接受三角肌肌内疫苗接种的年龄在 3 岁及以上的会员。
使用自然语言处理（NLP）算法在有肩部疾病诊断代码的接种者中识别潜在的肩部疾病。所有 NLP 识别的病例均根据我们的病例定义进行手动图表确认。比较接种者中有和没有肩部疾病的特征。
在 3758764 次接种中，发现 371 例肩部疾病，估计发病率为每 10000 次接种 0.99（95%CI，0.89 至 1.09）。成人（≥18 岁）接种人群的发病率为 1.22（CI，1.10 至 1.35），儿科（3 至 17 岁）接种人群的发病率为 0.05（CI，0.02 至 0.14）。在成人接种人群中，年龄较大、女性、接种前 6 个月内门诊就诊次数增加、Charlson 合并症指数较低和肺炎球菌结合疫苗与肩部疾病风险增加相关。在流感疫苗中，四价疫苗与肩部疾病风险增加相关。同时接种疫苗与老年人肩部疾病风险增加相关。
推广到其他医疗保健环境、使用行政数据和残留混杂因素。
这些基于人群的数据表明，接种疫苗后肩部疾病的绝对风险较小。鉴于肩部疾病的高负担，临床医生应注意任何可能进一步增加风险的因素。
疾病控制与预防中心。
