NCH Healthcare System, Naples, FL, United States.
Mayo Clinic Vaccine Research Group, Mayo Clinic, Rochester, MN, United States.
Vaccine. 2022 Aug 12;40(34):4964-4971. doi: 10.1016/j.vaccine.2022.06.002. Epub 2022 Jun 8.
The global fight against COVID-19 has required mass vaccination clinics as well as mass recruitment of personnel, including many who may not regularly administer intramuscular deltoid immunizations, potentially increasing the incidence of improper intramuscular injection. Shoulder injury related to vaccine administration (SIRVA) is a well-described, preventable injury resulting from improper injection into anatomic structures adjacent to the deltoid muscle leading to mechanical and chemical trauma augmented by an inflammatory immune response to the vaccine and/or adjuvants. SIRVA is best described in the setting of influenza vaccination, and little is known about it as it pertains to COVID-19 vaccination. This study aims to describe SIRVA in the current pandemic, increase clinician awareness, and offer considerations for prevention.
To identify clinical characteristics of patients with post-COVID-19-vaccination shoulder injuries, we performed a systematic review of the cases of vaccination-related shoulder injuries reported in the literature and conducted a review of the public Vaccine Adverse Event Reporting System (VAERS).
We identified 305 cases of SIRVA in the VAERS database and 28 cases of SIRVA in the setting of COVID-19 vaccination from the literature (n = 333). Patients had a mean age of 51.8 years and a median of 51.5 (range: 19-90) years. Of these, 76.3% were female and 23.7% male. Most patients sought medical evaluation with 54 of the 305 VAERS cases reporting utilizing emergency services. Of patients with imaging-confirmed SIRVA (n = 95), the most common diagnoses were adhesive capsulitis and bursitis, and the most common symptoms were pain (97.7%) and limited range of motion (68.1%). Most patients reported requiring treatment with the majority receiving physical therapy (56.3%), followed by cortisone injection (34.4%). Other modalities used were non-steroidal anti-inflammatory drugs, oral steroids, and surgery. Only 5 patients from this group reported recovery while 60 stated they had not yet recovered. Of those, 23.3% reported disability.
SIRVA should be regarded as an under-reported, significant cause of post-vaccination morbidity. In the setting of COVID-19 mass vaccination, clinicians must be aware of signs and symptoms of SIRVA as well as appropriate diagnostic modalities and treatment options. Additionally, standardization and proper education regarding injection technique and appropriate needle length is imperative to reducing harm.
全球抗击 COVID-19 疫情需要大规模疫苗接种诊所和大量人员招聘，其中包括许多可能不经常进行三角肌肌内注射的人员，这可能会增加肌肉注射不当的发生率。与疫苗接种相关的肩部损伤（SIRVA）是一种描述明确、可预防的损伤，由疫苗接种到三角肌相邻的解剖结构引起，导致机械和化学创伤，以及对疫苗和/或佐剂的炎症免疫反应。SIRVA 在流感疫苗接种中描述得最好，而关于 COVID-19 疫苗接种的 SIRVA 知之甚少。本研究旨在描述当前大流行期间的 SIRVA，提高临床医生的认识，并为预防措施提供考虑因素。
为了确定与 COVID-19 疫苗接种相关的肩部损伤患者的临床特征，我们对文献中报告的与疫苗接种相关的肩部损伤病例进行了系统回顾，并对公共疫苗不良事件报告系统（VAERS）进行了审查。
我们在 VAERS 数据库中确定了 305 例 SIRVA 病例，在文献中确定了 28 例 COVID-19 疫苗接种相关的 SIRVA 病例（n=333）。患者的平均年龄为 51.8 岁，中位数为 51.5（范围：19-90）岁。其中，76.3%为女性，23.7%为男性。大多数患者接受了医疗评估，305 例 VAERS 病例中有 54 例报告使用了急诊服务。在接受影像学证实的 SIRVA（n=95）的患者中，最常见的诊断是粘连性肩关节囊炎和滑囊炎，最常见的症状是疼痛（97.7%）和运动范围受限（68.1%）。大多数患者需要接受治疗，其中大多数接受物理治疗（56.3%），其次是皮质类固醇注射（34.4%）。其他使用的方法是非甾体抗炎药、口服类固醇和手术。只有 5 名患者从该组中报告康复，而 60 名患者表示尚未康复。其中，23.3%的患者报告残疾。
SIRVA 应被视为疫苗接种后发病率的一个报告不足但严重的原因。在 COVID-19 大规模疫苗接种的情况下，临床医生必须意识到 SIRVA 的体征和症状以及适当的诊断方法和治疗选择。此外，标准化和适当的注射技术和适当的针长教育对于减少伤害至关重要。
