SIRVA: A Risk With Every Vaccine
Published January 25, 2017 | Opinion
Shoulder injury related to vaccine administration (SIRVA) occurs when a vaccine, any vaccine, is injected improperly, causing physical and functional damage to the affected arm and shoulder. The injury occurs when a vaccine is mistakenly injected into the shoulder joint or bursa, a fluid filled sac that keeps the shoulder lubricated and moving smoothly.
Arm injections are aimed at the deltoid muscle, but in the case of SIRVA, are placed too high or too deep into the upper arm, setting up an inflammatory reaction that affects the local tendons, ligaments, nerves and/or bursa. The result is a cluster of symptoms that can include prolonged shoulder pain, limited range of motion, and weakness. The injury, which health professionals have tended to dismiss, is now recognized by the Vaccine Injury Compensation Program (VICP) and the number of claims have risen steadily.
SIRVA is underreported in the medical literature and many, if not most, health care providers have never heard of it. I am a physician who in the past, both received and administered vaccines, and I first learned of SIRVA when I read about it on a wellness blog. At that point, I had seen a number of doctors for shoulder and arm pain so incapacitating that it not only interfered with my daily routine, it also prevented me from falling and staying asleep. I am a strongly left-hand dominant, not the least bit ambidextrous, so this problem affected most aspects of my daily living.
The blog told a story of a woman who had suffered a SIRVA injury, and I felt like I was reading my own story. A light went off and suddenly everything made sense. I realized I’d had a vaccine injury I’d never heard of, and apparently, neither had any of my doctors.
This is my history: In 2009, while in the driver’s seat of my car, stopped at a red light, I reached my right arm straight back to grab something, without turning my body. I heard a distinct ripping sound, which turned out to be my rotator cuff rupturing. Six years later, in 2015, the morning after I was given a pneumonia vaccine in my left arm, I had an uncanny experience: I awoke with the same pain I had with my previous rotator injury. I had pain at rest and pain with attempted movement of the arm. The problem was, in the case of my right arm, I knew exactly when and why it had happened.
No matter how hard I wracked my brain, I couldn’t think of anything that had occurred that could be remotely responsible for my symptoms that morning. I immediately phoned my doctor and scheduled her first available appointment. My primary doctor and my orthopedist, who concluded I had a left rotator injury, never asked about my vaccination history, which I never thought to share.
The first published report of SIRVA in 2007 described the injury resulting from influenza and pneumonia vaccinations. Since then, we learned the most common cause of SIRVA is the seasonal flu shot, representing about 70% of cases, likely because it’s the most commonly administered vaccine. The second most common cause of SIRVA is the tetanus shot. Vaccines are designed to provoke an immune response, which in the case of SIRVA, provoke it in the wrong place.
These are the symptoms of SIRVA:
- Sudden onset of acute shoulder pain shortly after vaccination. Symptoms develop in 75% of people within 24 hours of vaccination, in 93% within 48 hours. The pain is typically dull and achy at rest, made worse by trying to use the arm for simple tasks such as lifting a cup of coffee, hanging a coat in the closet, brushing hair, and driving.
- Shoulder pain becomes persistent and chronic, often severe.
- Limited range of motion of the shoulder joint, which reduces function of arm and shoulder.
- Arm weakness.
- Arm and shoulder stiffness.
- Less common:tendonitis
- rotator cuff tears
- frozen shoulder (adhesive capsulitis)
- impingement syndrome
- brachial nerve damage, brachial neuritis
- bone erosion
To qualify as a SIRVA injury, there must be no history of shoulder problems prior to vaccination and the causative vaccine has to be subject to a federal excise tax and recommended by the CDC for adults as well as children. Adult-only vaccines such as shingles and Pneumovax-23 not covered by the vaccine compensation program, which leaves a malpractice action an option for compensation.
In 2015, the Advisory Commission of Childhood Vaccines decided against recommending changing the law to allow adult-only vaccines to be heard in vaccine court. That same year, the government proposed adding SIRVA to the federally operated “Vaccine Injury Table,” a list of recognized vaccine complications that qualify for compensation through the vaccine court. As of 2016, the federally approved schedule for adult vaccination includes 61 doses of 12 vaccines, which are meant to follow the 69 doses of 16 vaccines recommended in childhood through the age of 18. Since 2011, over 100 SIRVA victims have been paid about $20 million dollars, with at least one, a nurse, over one million. More cases pending and more are likely as awareness rises.
- The CDC current injection guidelines have been criticized for being one-size-fits-all, listing a one inch long needle as appropriate for use in most patients, except newborns and those weighing over 200 pounds. To avoid over-penetration of the deltoid muscle, researchers suggest a weight-based vaccination technique using needle lengths as short as one half inch for women weighing under 150 pounds. Combining the weight-based vaccination method with purposeful avoidance of the upper third of the arm for injection could potentially eliminate all or nearly all SIRVA injuries.
- Avoiding vaccination is the only foolproof method of preventing SIRVA. For those who choose to be vaccinated, these steps can reduce the chance of injury:
- Make sure the health care provider giving the injection is aware of SIRVA it by choosing a needle whose length is appropriate for your weight, and properly injecting the vaccine in the lower two thirds of the deltoid muscle.
- Remove your shirt or wear one that you can easily pull up over your shoulder. Do not wear a shirt that you pull down, because that exposes your upper shoulder.
- Take only one vaccine per visit.
I also learned that approval for this vaccine was based on studies of male novice gold miners in South Africa, male and female nursing home residents in France, individuals who have sickle cell disease, absence of the spleen and other chronic conditions, and immunocompetent individuals 65 years or older. I don’t fit any of those categories, but I do qualify for inclusion in the “Post-Marketing Experience” reported as “decreased limb mobility.”
Note: This article was reprinted with permission. It was originally published at GreenMedInfo.com. The author is a physician interested in how the synergies of evidence-based and modern peer-reviewed knowledge can offer a holistic approach to wellness.