Inadvertent subcutaneous injection of COVID-19 vaccine.
Inadvertent subcutaneous injection of COVID-19 vaccine.
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DOI：
10.1136/postgradmedj-2021-139870
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发表时间：
2021-06
影响因子：
5.1
通讯作者：
Ng JY
中科院分区：
文献类型：
--
作者：
Ng JY
COVID-19是历史上最严重的公共卫生突发事件。在这一扩大规模期间，全球对疫苗的需求大大超过了现有供应。因此，有必要培训更多的疫苗接种人员，以便在短时间内最大限度地接种疫苗。与大多数其他疫苗一样，COVID-19疫苗应肌肉注射。肌肉具有良好的血管分布，因此允许注射的药物快速到达体循环，绕过首过代谢。1三角肌的肌内注射应沿着从肩峰中部垂直向下的线沿着进行。2生产商建议疫苗不应通过血管内、皮下或皮内注射。3.将疫苗注射到皮下脂肪层，血管分布不良，导致抗原动员和加工缓慢，导致疫苗失败。4抗原沉积在脂肪中后可能需要更长的时间才能到达循环，延迟呈递给免疫反应所必需的T和B细胞。此外，如果抗原在皮下长时间保留，则存在抗原可能被酶变性的风险。皮下注射可导致局部蜂窝织炎、肉芽肿形成和脓肿。如果正确肌肉注射，COVID-19疫苗已被证明具有高疗效。皮下注射可能会无意中发生（图1），影响疫苗接种的有效性，并可能导致局部不良事件。加强肌肉注射培训并定期进行能力评估至关重要，以最大限度地提高疗效并保持公众信心。
COVID-19 has been the single greatest public health emergency in the history. The global demand for vaccine vastly outstrip available supply during this scale-up period. There is therefore a need to train up more vaccinators to maximise vaccine uptake in short time period. Like most other vaccines, the COVID-19 vaccine should be given intramuscularly. Muscles have good vascularity, and therefore allowing injected drug to reach systemic circulation quickly, bypassing the first-pass metabolism. 1 Intramuscular injection of the deltoid muscle should be given along a line drawn vertically downwards from the mid acromion. 2 The manufacturers advise that the vaccine should not be injected intravascularly, subcutaneously or intradermally. 3 Injecting a vaccine into the layer of subcutaneous fat with poor vascularity resulting in slow mobilisation and processing of antigen leading to vaccine failure. 4 The antigen may take longer to reach the circulation after being deposited in fat, delaying presentation to T and B cells that are essential for immune response. In addition, there is a risk that the antigens may be denatured by enzymes if they remain subcutaneously for prolonged period. Subcutaneous injections can lead to localised cellulitis, granuloma formation and abscess.The COVID-19 vaccine has shown to have high efficacy if given correctly intramuscularly. Subcutaneous injection can happen inadvertently (figure 1), affecting efficacy of vaccination and potentiate local adverse events. It is vital importance to reinforce intramuscular injection training with competency assessment at intervals in order to maximise efficacy and maintain public confidence.
影响因子：
4.8
作者：
Cook IF
通讯作者：
Cook IF
影响因子：
4.8
作者：
Cook IF
通讯作者：
Cook IF