S Letter

Shoulder injury related to vaccine administration

Shoulder Injury Related to Vaccine Administration (SIRVA) is a rare complication of suspected incorrect vaccine administration into the shoulder and not into the correct site of the deltoid muscle. Damage to local structures within the shoulder joint can occur, including to ligaments and tendons, as well as a local inflammatory response to the vaccine components. This results in shoulder pain and limited range of movement of the affected limb. Symptoms are usually immediate and can last for days, months or as long as years. Following investigation, many affected individuals are diagnosed with bursitis, impingement syndrome or ligament tears.

Implications of SIRVA

SIRVA can be an extremely painful condition. The pain and limited range of movement can impact a patient’s ability to perform work duties, sporting activities and basic activities of daily living. When symptoms persist for months, individuals can experience impacts on their mental and emotional wellbeing. There are other implications of SIRVA to consider including the immunogenicity of the vaccine, cost of time off work, investigations and treatments, vaccine hesitancy and consumer confidence in healthcare providers.

Injection technique

Incorrect site- injection given too high                                           Correct site- in the deltoid muscle

Please refer to MVEC: Administration of injected vaccines- correct technique for further information on correct injection technique.

Suspected cases of SIRVA

Any adverse event following immunisation (AEFI) should be reported to SAEFVIC. Reports can be made online via www.saefvic.org.au or by telephone on 1300 882 924 (option 1) during business hours.

Resources

• MVEC: Administration of injected vaccines- correct technique
• MVEC Education portal eLearning package: Shoulder Injury Related to Vaccine Administration (SIRVA)
• Australian immunisation handbook: Avoiding shoulder injury related to vaccine administration
• SIRVA (Shoulder injury related to vaccine administration); A case series- "Are you on target?"
• Cross GB, Moghaddas J, ButteryJ, Ayoub S, Korman TM. Don't aim too high: Avoiding shoulder injury related to vaccine administration. Aust Fam Physician 2016;45(5):303-306

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Special Risk Chapter in the Australian Immunisation Handbook

What is it?

Individuals that are at higher risk of vaccine preventable diseases (VPD) are classified as ‘special risk’ groups in the Australian Immunisation Handbook.

This includes populations at special risk (e.g. Aboriginal and Torres Straight Islanders) and those with additional vaccine requirements (e.g. maternal vaccination; preterm infants). It also has detailed sections on those at special risk because of immune suppression (disease and/or therapy) e.g. Asplenia, cancer/chemotherapy.

The chapter is updated online using the latest available scientific evidence

The Handbook is endorsed by:

• The Australian Technical Advisory Group on Immunisation [ATAGI] and
• The National Health and Medical Research Council [NHMRC]

Resources

• Australian Immunisation Handbook: Vaccination for Special Risk Groups
• MVEC: Australian Technical Advisory Group on Immunisation

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Solid organ transplant recipient

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SAEFVIC

Surveillance of Adverse Events Following Vaccination In the Community (SAEFVIC) is the central reporting service in Victoria for any significant adverse events following immunisations (AEFI). It is a public health partnership initiative of the Victorian Immunisation Program funded by the Department of Health, Victoria.

What is an adverse event?

An Adverse Event Following Immunisation (AEFI) can be any unexpected or serious outcome that happens following administration of a vaccine. It may be related to the vaccine itself, handling of the vaccine or its administration. An AEFI can be coincidentally associated with the timing of immunisation without necessarily being caused by the vaccine or immunisation process.

Who can report an AEFI?

An AEFI can be reported by the patient, patient’s guardian or immunisation provider.

NB: SAEFVIC is not an emergency contact. Hours of operation are Monday – Friday, 9am – 4 pm.

Please see your GP, local Emergency Department, or call 000 if immediate assistance is required

What AEFI should be reported?

Any event felt to be significant following immunisation should be reported. You do not need to report common/minor/expected reactions, however any vaccine reaction which has affected a family’s confidence in future immunisation can and should be reported.

What happens following an AEFI report to SAEFVIC?

• Where consent has been obtained, advice will be provided to the patient and immunisation provider and/or reporter as appropriate.
• Expert clinical consultation is offered (GP/specialist referral required) at the Royal Children’s Hospital, Parkville (RCH – Children) or Monash Health, Clayton (MH- Children and Adults). We also have satellite clinics offering paediatric and adult services.
• Allergy services are currently available at RCH (paediatrics)  or Monash health (adults)
• Telehealth video consultation is available for regional patients
  • We can offer individualised assessment on the adverse event and outline options regarding future vaccinations if required.
  • Following serious AEFI, the next immunisation doses can often be given under supervision at the specialised clinics, or as a monitored hospital inpatient.
• Feedback will be provided to immunisation providers/reporters.

Please note: In response to the COVID-19 pandemic, local telehealth is now available and we have changed our service delivery to telehealth video consultations for our initial Immunisation clinical consultation rather than the traditional face to face discussion. If a supervised setting is required for further vaccination, a plan will be established during this discussion.

Why report to SAEFVIC?

• Individualised clinical assistance for patients and families affected by an AEFI.
• SAEFVIC will confidentially collect, analyse and report data about significant AEFI as part of monitoring vaccine safety in Victoria.
• Any trends are notified and investigated quickly, with close liaison with Victorian and National Health Authorities.

How can I report?

• For online reporting of AEFI please head to SAEFVIC
• Immunisation Hotline: 1300 882 924 (option 1)
• Email: saefvic@mcri.edu.au

Resources

• DHHS: Adverse events following immunisation reporting

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Science of immunisation

What is it?

‘The Science of Immunisation’ was first published in 2012 and aims to address confusion created by inconsistent information found in public sources such as searching ‘Google’. It details the current situation in immunisation science, including where there is agreement in the scientific community and where the answers aren’t clear.

This document summarises and clarifies the current understanding of immunisation around six key questions:

1. What is immunisation?
2. What is a vaccine?
3. Who benefits from vaccines?
4. Are vaccines safe?
5. How are vaccines shown to be safe?
6. What does the future hold for vaccination?

Is it a reputable source of information and is the information current?

Yes. It was published in November 2012 by the Australian Academy of Science.

Answers to the questions were reviewed by a committee of experts including:

• Professor Gus Nossal who is an internationally renowned scientist and has been a significant figure in Australia's medical and scientific community. He was Director of the Walter and Eliza Hall Institute (1965-1996), Professor of Medical Biology at the University of Melbourne and President of the Australian Academy of Science.
• Professor Fiona Stanley who is the Founding Director and Patron of the Telethon Institute for Child Health Research and Distinguished Research Professor, School of Paediatrics & Child Health at the University of Western Australia.  She was named Australian of the Year in 2003 and in 2006.

The publication has been endorsed by

• The Royal Australasian College of Physicians
• The Australian Medical Association

Resources

• The Science of Immunisation

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