Sepsis, parenteral vaccination and skin disinfection

Abstract

ASBSTRACTDisinfection should be required for all skin penetrative procedures including parenteral administration of vaccines. This review analyses medically attended infectious events following parenteral vaccination in terms of their microbiological aetiology and pathogenesis. Like ‘clean’ surgical site infections, the major pathogens responsible for these events were Staphylococcal species, implicating endogenous con-tamination as a significant source of infection. As 70% isopropyl alcohol swabbing has been shown to effectively disinfect the skin, it would be medico-legally difficult to defend a case of sepsis with the omission of skin disinfection unless the very low risk of this event was adequately explained to the patient and documented prior to vaccination. There was a significant cost-benefit for skin disinfection and cellulitis. Skin disinfection in the context of parenteral vaccination represents a new paradigm of medical practice; the use of a low cost intervention to prevent an event of very low prevalence but of significant cost.

Injection site vaccinology of a recombinant vaccinia-based vector reveals diverse innate immune signatures

“…The SCV-ZIKA/CHIK vaccine was tested for sterility and mycoplasma before inoculation. However, insights into unforeseen microbial contamination (adventitious agents) present in the vaccine preparation [ 172 ] or microbial infection(s) that might have been introduced during vaccination [ 173 ], can also be gleaned from injection-site vaccinology. The reads that were not mapped or assigned to the mouse ( S1C Fig ) or the vaccine genomes ( Fig 1A ) by the STAR aligner were thus analyzed by Kraken, a metagenomic sequence classification tool [ 174 , 175 ].…”

Herpes zoster vaccine (Zostavax®): Cellulitic injection site reaction or bacterial cellulitis?

“…If these cases were due to bacterial cellulitis, pathogenic bacteria could be introduced during vaccine administration from contaminated needles/syringes, infected vaccinator or from contaminated skin. 8 …”

Minimizing shoulder injury related to vaccine administration

“…There is no consensus on skin disinfection prior to vaccine administration among NITAGs. 11 In Australia, an ex-cathedra statement by Del Mar et al 12 based on tangential data not involving intramuscular injection of vaccines resulted in the recommended cessation of this practice. A similar recommendation was made in Canada as a consequence of an underpowered study 13 with multiple different vaccines, with different routes of administration, using injection site reaction (ISR) as a surrogate measure of infection.…”