should lder in injury ry related to vaccine
play

Should lder In Injury ry Related to Vaccine Admin inistration (S (SIRVA) Georgie Lewis Clinical Manager SAEFVIC CVU Monash 25.11.2019 @ Murdoch Childrens Research Institute, 2017 SIRVA what you wil ill get out of f th this

0 downloads 3 Views 971 KB Size Report
  1. Should lder In Injury ry Related to Vaccine Admin inistration (S (SIRVA) Georgie Lewis Clinical Manager – SAEFVIC CVU Monash 25.11.2019 @ Murdoch Children’s Research Institute, 2017

  2. SIRVA – what you wil ill get out of f th this session  SIRVA – what is it?  Overview of cases reported to SAEFVIC  Impact/implications  How to avoid it  Future 2

  3. SIRVA – what is is it it?  Suspected inadvertent delivery of vaccine into the shoulder joint +/- surrounding structures  Associated diagnosis of bursitis on clinical assessment or medical imaging  Bursitis likely related to vaccine components – adjuvants/antigens causing an inflammatory response  Structural changes likely due to mechanical trauma from the needle  Shoulder injury likely due to poor injection technique/individuals anatomy 3

  4. Defi finition of f SIRVA – SAEFVIC coding  Rapid onset of shoulder pain - <48 hours  Pain on movement  Restriction of movement in the affected limb/joint  Abnormalities on medical imaging  Suspicion of incorrect vaccine administration technique 4

  5. Reported cases of f SI SIRVA by year Reported cases by year 35 30 25 Number of cases 20 15 10 5 0 2007 2009 2010 2012 2013 2014 2015 2016 2017 2018 2019 Year

  6. Clinically confirmed SIRVA on ult ltrasound Of the 67 reports of SIRVA made to SAEFVIC;  33 of 67 (50%) reported cases had a clinical diagnosis of Bursitis on ultrasound/radiological imaging  6 of the 33 cases were also diagnosed with impingement syndrome  3 of the 33 cases were also diagnosed with tendonitis  2 of the 33 cases were also diagnosed with supraspinatus tear 6

  7. Symptoms of f SIRVA +/- dia iagnosis of f bursitis on im imaging Cases reported some or all of the following symptoms;  Rapid onset of pain in shoulder of immunised arm  Pain with certain movements – abduction/adduction  Restricted movement of shoulder  Unable to carry out activities of daily living ie; hanging out washing , driving, dressing 7

  8. Ti Timing of f symptom onset aft fter vaccine administration Onset of symptoms Cases Sales Immediate 29 >immediate ≤24 hours 28 >24 hours ≤48 hours 6 >48 hours 2 Although 2 cases reported onset of symptoms >48 hours they still fit within clinical definition of SIRVA Unknown 2 1st Qtr 2nd Qtr 3rd Qtr 4th Qtr

  9. SI SIRVA cases by vaccine ty type SIRVA by vaccine type Vaccine type Cases Influenza 41 6% 4% 7% dTpa 17 Pneumovax 5 24% 59% Meningococcal B 4 Human Papilloma Virus 3 Meningococcal ACWY 1 *note some cases received more than 1 vaccine at the visit eg; Influenza +/- dTpa/Pneumovax Influenza dTpa Pneumovax Meningococcal B HPV

  10. SIRVA cases by provider Provider type Cases % 6% 7% GP 24 36% 36% 9% Hospital – 18 27% nurse/staff 15% health/doctor Council Nurse 10 15% 27% Practice nurse 6 9% Pharmacist 5 7% GP Hospital Council Nurse Practice Nurse Other/unknown 4 6% Pharmacist Other/Unknown Total 67 100%

  11. SI SIRVA versus overall AEFI reports by provider ty type Proportion of reports received by vaccine provider type 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% Unknown Community Clinic Council GP Hospital Interstate/Overseas Other Pharmacy Workplace Reports% SIRVA%

  12. Management of f SIRVA cases Specialist Treatment • GP • Over the counter anti- inflammatories - NSAIDS • Emergency department • Prescription pain relief – • Orthopaedic/sports physician Voltaren, Endone, Panadeine • Rheumatologist forte, • Physiotherapy/myotherapy • U/S guided cortisone injections • Hydrodilation of the shoulder

  13. Im Impact of f SIRVA  Difficulty performing ADL’s – dressing, cleaning, driving, hanging out washing , driving, dressing  Difficulty sleeping due to pain  Time off work/school  Unable to participate in sporting activities/championships  Compensation 13

  14. Im Implications of f SIR IRVA  Vaccine hesitancy  Immunogenicity of vaccine given - ?immunogenic if given into shoulder joint as opposed to deltoid muscle  Consumer confidence in health care providers  Cost of treatments  Emotional and mental impact on vaccinee and families 14

  15. Shoulder In Inju jury ry Rela lating to Vaccine Admin inistration (SIR IRVA) To avoid causing a shoulder injury related to vaccine administration:  Ensure you can visualise the deltoid from the shoulder to the elbow  Be familiar with the anatomical landmarks and surrounding structures  Follow recommended immunisation administration techniques  Aim for the middle of the deltoid  Do NOT inject too high or too low  For appropriate assessment, diagnosis and management report any suspected cases of SIRVA to SAEFVIC (Vic only) online at www.saefvic.org.au or by phone 1300 882 924 (Option 1). 15

  16. Sh Shoulder In Inju jury ry Rela lating to Vaccine Admin inistration (SI SIRVA) To locate the deltoid site for injection: • Expose the arm completely, from the top of the shoulder to the elbow; remove the shirt/clothing if needed. • Locate the shoulder tip (acromion) and the muscle insertion at the middle of the humerus (deltoid tuberosity). • Draw an imaginary inverted triangle below the shoulder tip, using the identified anatomical markers. • The deltoid site for injection is halfway between the acromion and the deltoid tuberosity, in the middle of the muscle (triangle). • More than 1 vaccine may be given into the deltoid muscle ensuring the deltoid mass is adequate and each vaccine is separated by 2.5cm.

  17. In Inje jection techniq ique Too high! Too low! 17

  18. Locatin ing correct anatomical la landmarks Injection technique: CORRECT! 18

  19. What have we done to prevent further cases? • Australian Immunisation Handbook - Avoiding shoulder injury related to vaccine administration • https://immunisationhandbook.health.gov.au/resource s/publications/avoiding-shoulder-injury-related-to- vaccine-administration

  20. Sh Should lder In Inju jury ry Rela latin ing to Vaccin ine Admin inis istratio ion (S (SIR IRVA) 20

  21. Administration of injected vaccines – correct technique • https://mvec.mcri.edu.au/immunisation-references/administration-of- injected-vaccines-correct-technique/ What have we Shoulder Injury Related to Vaccine Administration done to prevent • https://mvec.mcri.edu.au/immunisation-references/shoulder-injury- related-to-vaccine-administration/ further cases?

  22. SIR SIRVA where to fr from here? • SIRVA is described in literature however no clear definition has been formulated • Publication: SAEFVIC proposing 2 papers; • 1 - Descriptive – intro/methods/results/discussion with the aim for the end point to be case definition (SAEFVIC coding and look to formalise with Brighton Collaboration definition) • 2 – Long term follow up – individual cases, legal and clinical issues, vaccine safety surveillance 22

  23. Take home message Know your site and get it right!

Recommend Documents


analysis and reporting of injury related inpatient
Analysis and Reporting of

2017 CSTE Annual Conference Analysis and Reporting of Injury-Related Inpatient

economic injury disaster loans for coronavirus related
Economic Injury Disaster Loans For

Economic Injury Disaster Loans For Coronavirus Related Economic Disruptions

4 10 2017
4/10/2017 GOLF RELATED INJURY

4/10/2017 GOLF RELATED INJURY PREVALANCE: - 60% Of Golf Professionals -

vaccine preventable diseases vaccine preventable diseases
VACCINE PREVENTABLE DISEASES: VACCINE

VACCINE PREVENTABLE DISEASES: VACCINE PREVENTABLE DISEASES: VACCINE

may 3 2016
May 3, 2016 Narayan Nair, MD Acting

Overview of Proposed Changes to the Vaccine Injury Table May 3, 2016 Narayan

client alert
Client Alert Supreme Court Rules

Client Alert Supreme Court Rules Vaccine Firms Protected From Lawsuits

case law update 2017
Case Law Update 2017 Work related and

10/3/2017 Flug v. Wal Mart Associates, Inc., 2017 Wis. 72 (2017) Case Law

vaccine storage handling
Vaccine Storage & Handling Online

Vaccine Storage & Handling Online Ordering of Vaccine Objectives for

vaccine storage handling
Vaccine Storage & Handling Online

Vaccine Storage & Handling Online Ordering of Vaccine Objectives for

special processing unit spu
Special Processing Unit SPU Added to

Special Processing Unit SPU Added to the Guidelines for Practice Under the

relation to acl integrity a
RELATION TO ACL INTEGRITY: A CADAVER

QUADRICEPS- HAMSTRINGS RATIO & ITS RELATION TO ACL INTEGRITY: A CADAVER

albert c lo md ph d
Albert C. Lo, MD, Ph.D. Mandell Center

Consortium of Multiple Sclerosis Centers, Baltimore, June 3, 2016 Albert C.

efficient fficient econo onomy my
EFFICIENT FFICIENT ECONO ONOMY MY

LE LEVERA VERAGING GING A WATER TER EFFICIENT FFICIENT ECONO ONOMY MY

acl r in a professional chinese basketball player
ACL-R in a Professional Chinese

ACL-R in a Professional Chinese Basketball Player Brittany Lynch PT, DPT,

development and testing of an informal pa training
Development and Testing of an Informal

Development and Testing of an Informal PA Training Program (R-8) Jessica

effects of refractive surgery on binocular vision pre and
EFFECTS OF REFRACTIVE SURGERY ON

EFFECTS OF REFRACTIVE SURGERY ON BINOCULAR VISION : PRE- AND POST- LASIK

cartography of risks and vuln rability in union of comoros
CARTOGRAPHY OF RISKS AND VULNRABILITY

CARTOGRAPHY OF RISKS AND VULNRABILITY IN UNION OF COMOROS Djanfar MADJIDI

health fitness and performance health risk appraisal
Health, Fitness, and Performance;

1/12/18 W.I.T.S. Personal Trainer Certification Lecture One: Test Title

overview of multiple cartilage sparing
Overview of Multiple Cartilage Sparing

Overview of Multiple Cartilage Sparing Techniques and Rehab Principles For The

contour to support function
Contour to Support Function Presented

Custom Seating: Maximizing Contour to Support Function Presented By: Todd

and locomotion scores of cows milked in a
and locomotion scores of cows milked in

Effect of milking frequency on hoof health and locomotion scores of cows

the thrill of victory the agony of defeat lessons from 35
The Thrill of Victory, The Agony of

10/29/2012 The Thrill of Victory, The Agony of Defeat: Lessons from 35 Years