Vaccines serve a critical public health function by protecting people from serious and potentially deadly diseases like tetanus, measles and influenza. Millions of people in the United States receive vaccinations each year. For instance, the Centers for Disease Control estimate that 43% of the United States population received the seasonal influenza vaccination for the 2010 flu season. That is more than 140 million people!
Generally vaccines are safe and effective but each year, a very small number of people develop vaccine-related complications that range from acute allergic reactions to systemic immune injuries like Guillain-Barre Syndrome to a more recently recognized mechanical injury to the shoulder known as SIRVA.
SIRVA stands for Shoulder Injury Related to Vaccine Administration and in this article, we outline what we know about SIRVA, what can be done to prevent it and what a person should do if they are diagnosed with it.
Transient mild shoulder discomfort at the injection site is a normal reaction to receiving an intramuscular vaccine injection. However, beginning in the early 2000s, case reports started to appear of a more severe shoulder injury that developed within days of an intramuscular vaccine injection. It was characterized by rapid onset of severe, prolonged shoulder pain and loss of range of motion and function that has come to be known as SIRVA.
A 2010 article by Atanasoff and colleagues reviewed 13 claims of vaccine related shoulder injuries characterized by limited and painful range of motion of the shoulder following vaccine administration. A 2012 Institute of Medicine study concluded that the evidence convincingly supported a causal relationship between vaccine injection and deltoid bursitis.
In February 2017, SIRVA was added to the Vaccine Injury Table of the National Vaccine Injury Compensation Program. This is significant because the Program now recognizes SIRVA as a vaccine injury entitled to compensation.
SIRVA is a mechanical injury to the shoulder into which an intramuscular vaccine injection is administered. It is believed to be a local immune mediated inflammatory response that attacks the ligaments, tendons and bursa of the shoulder. SIRVA results in damage to the shoulder capsule that is often diagnosed as subacromial bursitis, bicipital tendonitis, rotator cuff syndrome or adhesive capsulitis. Up to 30% of people who develop SIRVA end up having surgery and more than 60% report persistent residual symptoms.
SIRVA is believed to be caused by injections placed too high on the shoulder, resulting in the inadvertent direct injection of the vaccine into the deltoid bursa or joint space, where it damages the soft tissues in those areas. Thus, SIRVA can be prevented by proper vaccination technique and positioning. In terms of position, the top one-third of the deltoid muscle should be avoided. It is also important to use a needle where the vaccine can be introduced directly into the muscle.
Given that many millions of Americans receive vaccines every year, the number of people who develop SIRVA is very small. When getting a vaccine injection, it is important to get it from a trained professional who will properly position the injection on the shoulder and introduce the vaccine into the muscle.
Even after a proper vaccination, localized pain at the injection site is normal, but that pain should go away. If the pain gets worse over the next few days and begins to affect your ability to move your shoulder, you should seek medical attention immediately.