Reports of atypical shoulder pain and dysfunction following inactivated influenza vaccine, Vaccine Adverse Event Reporting System (VAERS), 2010–2017

Hibbs, Beth; Ng, Carmen S.; Museru, Oidda I.; Moro, Pedro L.; Marquez, Paige; Woo, Emily Jane; Cano, Maria; Shimabukuro, Tom T.

doi:10.1016/j.vaccine.2019.11.023

Cited by 42 publications

(110 citation statements)

References 27 publications

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“…The mechanism of injury was theorized to be related to the improper introduction of vaccine into the subdeltoid bursa, causing an inflammatory reaction leading to bursitis, tendonitis, and adhesive capsulitis (Macomb et al, 2020). Critically, the VICP does not limit the definition of SIRVA to those who have received the influenza vaccine, as several other vaccines have been reported to cause this condition (Atanasoff et al, 2010; Cross et al, 2016; HRSA, 2017; Hibbs et al, 2020). Given the likely inflammatory nature of this condition, we found that early administration of systemic or local glucocorticoids provided a benefit in most cases.…”

Section: Discussionmentioning

confidence: 99%

“…While early treatment is important, SIRVA is a preventable condition if vaccine is administered properly. The CDC (2017) and others have created guidelines on proper vaccination techniques that are meant to prevent cases of SIRVA (Hibbs et al, 2020). These guidelines focus on utilizing the proper length of needle based on patient gender and body weight, as well as proper insertion point in the center of the deltoid muscle which can be estimated by inserting the needle 2 to 3 finger lengths below the acromion (about 2 inches).…”

Section: Discussionmentioning

confidence: 99%

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Shoulder Injury Related to Vaccine Administration: Case Series of an Emerging Occupational Health Concern

Batra

Page

2020

Workplace Health Saf

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Background: Shoulder injury related to vaccine administration (SIRVA) is an increasingly recognized complication of improper vaccine administration. Due to the growing number of mandatory workplace vaccination programs, especially for annual influenza vaccine, it is essential that occupational health providers are aware of this condition to improve prevention and/or treatment of this condition when it arises. Therefore, we describe the clinical presentation and course of treatment of five cases of SIRVA that were seen in an employer-based Occupational Health Services Clinic (OHS) after mandatory influenza vaccine administration. Methods: A retrospective chart review was performed for five cases of SIRVA from 2017 to 2019. Findings: Five cases met clinical definition of SIRVA as defined by the National Vaccine Injury Compensation Program. All cases were of similar characteristics including gender, age range, and body mass index (BMI). All were treated using multiple modalities including medication, physical therapy, and modified work with eventual resolution of symptoms and full return to work. Conclusions/Application to Practice: Awareness of SIRVA is necessary in any occupational setting where vaccines are routinely administered. Avoidance of SIRVA by adhering to proper vaccination technique is crucial, as is awareness of how to recognize and manage the condition in affected employees to limit long-term impairment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Shoulder Injury Related to Vaccine Administration: Case Series of an Emerging Occupational Health Concern

Batra

Page

2020

Workplace Health Saf

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“…In the same decade, only 112 cases of SIRVA have been adjudicated by the Office of Special Masters of the US Court of Federal Claims, with half of those cases occurring in the past two years [14]. The true incidence and prevalence in the United States of SIRVA are unclear as research has primarily been reported as isolated case series [15]. SIRVA symptoms mimic multiple neuromusculoskeletal pathologies such as cervical radiculopathy, rotator cuff strain, and adhesive capsulitis, which can lead to underdiagnosis and misdiagnosis [14,15].…”

Section: Discussionmentioning

confidence: 99%

“…The true incidence and prevalence in the United States of SIRVA are unclear as research has primarily been reported as isolated case series [15]. SIRVA symptoms mimic multiple neuromusculoskeletal pathologies such as cervical radiculopathy, rotator cuff strain, and adhesive capsulitis, which can lead to underdiagnosis and misdiagnosis [14,15]. Thorough clinical history and elicitation of the inciting event is critical diagnosing SIRVA.…”

Section: Discussionmentioning

confidence: 99%

Use of Osteopathic Manipulation for Treatment of Chronic Shoulder Injury Related to Vaccine Administration

Veera¹,

Chin²,

Kleyn³

et al. 2020

Cureus

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Shoulder injury related to vaccine administration (SIRVA) is an increasingly reported phenomenon that causes inflammation of surrounding structures, along with pain and decreased range of motion of the affected shoulder. Current literature emphasizes proper injection techniques and locations to decrease incidence; however, there is limited information available on successful treatments. The aim of this report is to describe a case of SIRVA and review treatment options, specifically the role of osteopathic manipulative medicine (OMM) in the resolution of symptoms refractory to standard care. Here we present a case of chronic SIRVA in a 58-year-old female due to a poorly administered influenza vaccination with emphasis on a stepwise osteopathic therapy approach as a lasting treatment to decrease the effects of the inflammatory process and improve daily function of the shoulder. OMM, with the option of anesthesia, can be performed in outpatient family medicine practices as a noninvasive and safe adjunct treatment. Specifically, the Spencer technique has been shown to improve shoulder-related pathologies that include adhesions, capsulitis, and inflammation and was used in this case under anesthesia. The patient reported good improvement in her symptoms and increased range of motion. SIRVA is an underdiagnosed phenomenon that involves inflammation of surrounding structures after a vaccine administration. In chronic cases, such as in this patient, OMM may be enhanced with the use of anesthesia to optimize the treatment's effect on scar tissue and fibrosis.

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“…To be eligible to file a VICP claim, symptoms must last more than 6 months after vaccination. [21] Based on the VICP SIRVA case definition and other publications, [1,8,12,22,23] we created a SIRVA case definition suitable for a population-based study using EHR data. A valid SIRVA case needed to meet five criteria: 1) Damage to the shoulder region occurred and was confirmed by signs and symptoms (i.e., pain, limited range of motion, weakness, stiffness) and clinical diagnosis.…”

Section: Sirva Case Definitionmentioning

confidence: 99%

Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) Using Natural Language Processing

Zheng

Duffy

et al. 2021

Preprint

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Background: Shoulder injury related to vaccine administration (SIRVA) accounts for more than half of all claims received by the National Vaccine Injury Compensation Program. However, there is a lack of population-based studies due to the challenge of identifying SIRVA cases in large health care databases. Objective: To develop a natural language processing (NLP) method to identify SIRVA cases from clinical notes. Methods: We conducted the study among members of a large integrated health care organization who were vaccinated between 04/1/2016 and 12/31/2017 and had subsequent diagnosis codes indicative of shoulder injury. Based on a training dataset with a chart review reference standard of 164 individuals, we developed an NLP algorithm to extract shoulder disorder information, including prior vaccination, anatomic location, temporality and causality. The algorithm identified three groups of positive SIRVA cases (definite, probable and possible) based on the strength of evidence. We compared NLP results to a chart review reference standard of 100 vaccinated individuals. We then applied the final automated NLP algorithm to a broader cohort of vaccinated individuals with a shoulder injury diagnosis code and performed manual chart confirmation on a random sample of NLP-identified definite cases and all NLP-identified probable and possible cases. Results: In the validation sample, the NLP algorithm had 100% accuracy for identifying 4 SIRVA cases and 96 individuals without SIRVA. In the broader cohort of 53,585 individuals, the NLP algorithm identified 291 definite, 124 probable, and 52 possible SIRVA cases. The chart-confirmation rates for these groups were 95.3%, 67.7% and 18.9%, respectively. Conclusions: The algorithm performed with high sensitivity and reasonable specificity in identifying positive SIRVA cases. The NLP algorithm can potentially be used in future population-based studies to identify this rare adverse event, avoiding labor-intensive chart review validation.

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Reports of atypical shoulder pain and dysfunction following inactivated influenza vaccine, Vaccine Adverse Event Reporting System (VAERS), 2010–2017

Cited by 42 publications

References 27 publications

Shoulder Injury Related to Vaccine Administration: Case Series of an Emerging Occupational Health Concern

Shoulder Injury Related to Vaccine Administration: Case Series of an Emerging Occupational Health Concern

Use of Osteopathic Manipulation for Treatment of Chronic Shoulder Injury Related to Vaccine Administration

Identifying Cases of Shoulder Injury Related to Vaccine Administration (SIRVA) Using Natural Language Processing

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