COVID-19 vaccination and the skin to deltoid muscle distance in adults with diabetes

Doppen, Marjan; Mirjalili, Ali; Harwood, Matire; Eathorne, Allie; Braithwaite, Irene; Bong, Jonathan; Kirton, Louis; Semprini, Ruth; Weatherall, Mark; Semprini, Alex; Kearns, Ciléin; Black, Melissa H.; Kung, Stacey; Walton, Michaela C.; Beasley, R. Palmer; Hills, Thomas

doi:10.1016/j.jvacx.2022.100248

Cited by 2 publications

(2 citation statements)

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“…Frontiers in Pharmacology frontiersin.org depending on BMI, sex, injection site and arm circumference (Doppen et al, 2023a;Doppen et al, 2023b). Currently the CDC Guidelines on immunization practices recommend using a 5/8" needle, 23-25 gauge for all patients (Centers for Disease Control and Prevention, 2023).…”

Section: Questions For Future Researchmentioning

confidence: 99%

Effects of biological therapies on patients with Type-2 high asthma and comorbid obesity

Garg,

Que,

Ingram

2024

Front. Pharmacol.

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Over 20 million adults and 6 million children in the United States (US) have asthma, a chronic respiratory disease characterized by airway inflammation, bronchoconstriction, and mucus hypersecretion. Obesity, another highly prevalent disease in the US, is a major risk factor for asthma and a significant cause of diminished asthma control, increased submucosal eosinophilia, and reduced quality of life. A large subgroup of these patients experiences severe symptoms and recurrent exacerbations despite maximal dosage of standard asthma therapies. In the past two decades, the development of biological therapies has revolutionized the field and advanced our understanding of type 2 inflammatory biomarkers. However, patients with obesity and comorbid asthma are not principally considered in clinical trials of biologics. Large landmark cluster analyses of patients with asthma have consistently identified specific asthma phenotypes that associate with obesity but may be differentiated by age of asthma onset and inflammatory cell profiles in sputum. These patterns suggest that biologic processes driving asthma pathology are heterogenous among patients with obesity. The biological mechanisms driving pathology in patients with asthma and comorbid obesity are not well understood and likely multifactorial. Future research needs to be done to elicit the cellular and metabolic functions in the relationship of obesity and asthma to yield the best treatment options for this multiplex condition. In this review, we explore the key features of type 2 inflammation in asthma and discuss the effectiveness, safety profile, and research gaps regarding the currently approved biological therapies in asthma patients with obesity.

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Section: Questions For Future Researchmentioning

confidence: 99%

Effects of biological therapies on patients with Type-2 high asthma and comorbid obesity

Garg,

Que,

Ingram

2024

Front. Pharmacol.

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“…4,8 However, progressively higher BMIs increase the likelihood of requiring a longer-than-standard needle length for deltoid intramuscular injection. [8][9][10] Worldwide, immunisation guidelines vary in their instructions on how to choose the correct needle length based on BMI and body weight, or contain non-specific terms such as "larger arms". [11][12][13] An accurate measurement of BMI for a vaccine recipient is not always readily available and the interpretation of arm size is subjective, resulting in an increased risk of inappropriate needle length choice and subcutaneous vaccine delivery.…”

mentioning

confidence: 99%

Skin-to-deltoid-muscle distance at three recommended sites for intramuscular vaccination in a population with obesity: an observational study

Beasley,

Kearns,

Doppen

et al. 2023

NZMJ

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aim: Worldwide, immunisation guidelines variably locate the deltoid injection site based on anatomical landmarks. This may influence the skin-to-deltoid-muscle distance and therefore the needle length required to achieve intramuscular injection. Obesity is associated with increased skin-to-deltoid-muscle distance, but it is unknown whether the injection site location chosen in individuals with obesity impacts the needle length required for intramuscular injection. The aim of the study was to estimate the differences in skin-to-deltoidmuscle distance between three different vaccine injection sites recommended by the national guidelines of the United States of America (USA), Australia and New Zealand, in obese adults. The study also explored i) the associations between skin-to-deltoid-muscle distance across the three recommended sites with sex, body mass index (BMI), and arm circumference, and ii) the proportion of participants with a skin-to-deltoid-muscle distance >20 millimetres (mm), in whom the standard 25mm needle length would not ensure deposition of vaccine within the deltoid muscle. method: Non-interventional cross-sectional study in a single site, non-clinical setting in Wellington, New Zealand. Forty participants (29 females), aged ≥18 years, with obesity (BMI>30 kilograms [km]/m 2 ). Measurements included distance from acromion to injection sites, BMI, arm circumference, and skin-to-deltoid-muscle distance measured by ultrasound at each recommended injection site. results: Mean (SD) skin-to-deltoid-muscle distances for USA, Australia and New Zealand sites were 13.96mm (4.54), 17.94mm (6.08) and 20.26mm (5.91) respectively, with a mean (95% confidence interval) for the distance between Australia minus New Zealand -2.7mm (-3.5 to -1.9), P<0.001; and USA minus New Zealand -7.6 mm (-8.5 to -6.7); P<0.001. Skin-to-deltoid-muscle distance was greater in females and was positively associated with BMI and arm circumference. The proportions with a skin-to-deltoid-muscle distance >20 mm were 45%, 40% and 15% for the New Zealand, Australia and USA sites respectively. However, the sample size was relatively small, limiting interpretation in specific sub-groups. conclusion: There were marked differences in the skin-to-deltoid-muscle distance between the three recommended injection sites studied. When choosing the required needle length to achieve intramuscular vaccination in obese vaccine recipients, consideration needs to be given to the injection site location, sex, BMI and/or arm circumference, as these factors all influence the skin-to-deltoidmuscle distance. A standard needle length of 25mm may be insufficient to ensure deposition of vaccine into the deltoid muscle in a substantive proportion of adults with obesity. Research is urgently required to determine anthropometric measurement cut-points that can be used to enable appropriate needle length selection to ensure intramuscular vaccination.

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COVID-19 vaccination and the skin to deltoid muscle distance in adults with diabetes

Cited by 2 publications

References 31 publications

Effects of biological therapies on patients with Type-2 high asthma and comorbid obesity

Effects of biological therapies on patients with Type-2 high asthma and comorbid obesity

Skin-to-deltoid-muscle distance at three recommended sites for intramuscular vaccination in a population with obesity: an observational study

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