Vaccination against most childhood diseases is important for the overall health of the community. I've said that many times here and most recently, along with my Sciblings, bemoaned an increasing trend to refusing vaccination. The health related reasons for refusing to be vaccinated are largely based on false information, but that doesn't mean that when millions of people are being vaccinated something untoward doesn't happen. Usually what happens is innocuous and self-limiting. The person (often an adolescent) faints. We don't know how often that happens, but a recent effort by CDC has tried to get some handle on it. It is a relatively common vaccination associated adverse event but the operative word here is "relatively." The estimated rate is only a few cases in ten million vaccinations. Occasionally a serious injury will result from a fall after a faint. Here are two case examples from the CDC study:
Case 1. A girl aged 13 years fainted within 10 minutes of receiving HPV and MCV4 vaccinations. She fell backward and hit her head on the carpeted floor of the clinic. The girl was admitted to the pediatric intensive-care unit because of skull fractures and subarachnoid hemorrhage. When VAERS contacted her approximately 6 months after the injury, she had recovered completely.Case 2. A girl aged 16 years felt dizzy and had pallor within 5 minutes of receiving an HPV vaccination. While being escorted back to an examination room, she fainted, but the physician caught her as she fell. She was observed for 30 minutes in the clinic and recovered completely. (CDC, Morbidity and Mortality Weekly Reports [MMWR])
The medical word for fainting is syncope (sin'-coe-pee) and the mechanism for this kind of event is thought to be neural, via the tenth cranial nerve (the vagus nerve). Hence it is called vasovagal syncope. The vagus is the longest cranial nerve and winds its way from the brain down into the chest and innervates structures in and near the heart. It can be triggered by a variety of things but medical procedures are one of the most common. Fainting from some trigger event can be recurrent and often starts in adolescence. The actual faint is often preceded by lightheadedness, sweating and nausea. Usually the person is sitting up or standing and upon falling in a faint the recumbent position restores blood flow to the brain and they revive. There seems to be some variation in what happens when the vagus nerve is fired in the brainstem. For some people the main effect is to slow the heart rate, for others to dilate blood vessels which causes a drop in blood pressure and for others some mix of these two effects. The result is that not enough oxygen gets to the brain and loss of consciousness results.
Whatever the mechanism, vasovagal syncope can occur in the time immediately after getting a vaccination. In the last few years CDC and the medical community have introduced new vaccines and recommendations for adolescents, among them the quadrivalent human papillomavirus recombinant vaccine (HPV) (Gardasil®, Merck & Co., Inc., Whitehouse Station, New Jersey) in a 3-dose series, the quadrivalent meningococcal conjugate vaccine (MCV4) (Menactra®, Sanofi Pasteur, Inc., Swiftwater, Pennsylvania) in a single dose. These have been added to existing recommendations for tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine (Tdap) (Adacel®, Sanofi Pasteur; Boostrix®, GlaxoSmithKline Biologicals, Research Triangle Park, North Carolina) in a single dose. Using a passive and voluntary reporting system for vaccine adverse events (VAERS, the Vaccine Adverse Event Reporting System), FDA and CDC compiled information on vaccine syncope in the period 2005 - July 2007 and compared it to the period 2002- 2004 to see if there has been an increase since the new vaccines have come into use. The number of events were expressed as a rate of reported fainting in adolescents ages 5 to 18 years old per net number of doses distributed. Here are the raw results:
A total of 463 reports of postvaccination syncope during January 1, 2005--July 31, 2007, were identified among persons aged >5 years, compared with 203 reports during 2002--2004. The rate of reports for postvaccination syncope among persons aged >5 years were as follows: 0.30 reports per million doses distributed in 2002, 0.35 per million doses distributed in 2003, 0.28 per million doses distributed in 2004, 0.31 per million doses distributed in 2005, and 0.54 per million doses distributed in 2006. Compared with reports received during 2002--2004, those received during 2005--2007 were more likely to involve females (61.1% versus 77.5%) or persons aged 11--18 years (47.3% versus 62.0%). In 292 (63.1%) of the 463 reports during 2005--2007, syncope was associated with at least one of the following recently approved and recommended adolescent vaccines: MCV4, Tdap, and HPV. (CDC, MMWR)
Here's a bar graph from the CDC report so you can see a bit more clearly the temporal sequence:
This graph suggests that introduction of the HPV vaccine was associated with increased episodes of vasovagal syncope. Since adolescent girls are already at risk for vasovagal syncope, introduction of an additional vaccine specifically targeting this population would be expected to produce additional cases and it does. While it looks fairly dramatic in the graph, the additional risk is only about two episodes per ten million vaccinations. This isn't kids dropping like flies after being stuck with a needle. It is still quite rare as an event.
When it happens the main risk is in the fall, not the syncope itself. That's why doctors and nurses involved in routine well child care are being alerted to this and a further recommendation given that the patient be observed for 15 minutes after getting vaccinated.
Fainting from a vaccination happens. So do cervical cancer, measles pneumonia, chickenpox and mumps if you aren't vaccinated. I think the choice here is pretty obvious.
Medicine & Health
Comments
Interesting. I've lost consciousness after a vaccination (I was a teenager at the time- though I'm not sure exactly how old). I didn't realize it was quite that rare.
Do you have any data on when risk for this peaks, or other risk factors?
I'm not about to opt out of any vaccinations, but I've had a probably irrational prejudice against "pressure shots" ever since it happened (after all, I received dozens of conventional shots without ill effects, the first time I get the weird kind without a regular needle and boom, blackout... it's enough to make you dislike the method). Is it possible this is more likely with newer injection systems?
Posted by: Becca | May 7, 2008 12:11 PM
I'm a chronic fainter, though I don't believe it's ever happened during a vaccine. Usually it's during a blood draw or an I.V. The first time I fainted was when I was 5 years old. I believe I was getting an iron test or something. All I remember was screaming my head off and then the next minute I was on the floor with strange people staring at me.
After that I was a needle phobic all through adolescence, but I don't recall fainting again until I was an adult (which, ironically was right about the time I was actually getting over my needle phobia). I've fainted while getting an I.V. for an IVP procedure (I was actually lying down when it happened). I fainted while trying to give blood (that was the worst - I was sick for 4 hours afterward). Most recently I fainted while watching someone else get an I.V.
Now just the thought of a needle in my veins makes me queasy. Luckily I can recognize the signs pretty quick and have ample warning to get on the ground before I go out.
Posted by: Tasha | May 7, 2008 12:31 PM
I fainted after getting my vaccinations when I entered the Air Force. I was sitting down talking to the person next to me. About 10 minutes later, I starting getting tunnel vision and lost the ability to sit up. I slumped down on the floor and couldn't move. It was really weird. I never blacked out. The medical staff carried me to a room where they made me lay down until my blood pressure rose high enough to ensure that I wouldn't loose consciousness when I stood.
Two other people also had problems. I noticed that we were all small (female and about 100 lbs). I've always thought that perhaps the same dose was used regardless of body size and perhaps smaller people reacted to the larger dose per body weight. The vaccinations we received were for yellow fever, choleria, and typhoid fever. I had no problems with the subsequent vaccinations.
As a child and teenager, I had some severe allergic reactions and anaphylactic shock reactions (enough to put me in the hospital emergency room several times) to an unknown allergen. I've never known if this had anything to do with the fainting after getting vaccinated.
Posted by: Allie | May 7, 2008 12:55 PM
I've had this happen to me too: I was getting the big bunch 'o vaccines before college, hadn't eaten any breakfast, and was in the middle of the last shot when I passed out, forward off the exam table. The poor nurse had to catch me and finish giving me my meningitis shot. I also don't do well having my blood drawn, so I assumed that it was the action of getting a shot rather than the contents of the vaccine.
Posted by: JustaTech | May 7, 2008 1:04 PM
I share Tasha's severe phobia of venipuncture -- although I have no problem at all with injected vaccines, allergy shots, or dental anesthetics, I've had to be sedated for routine blood draws a few times. I sure wish I could faint instead. I do get dizzy and see green spots, but that's as far as it goes.
Incidentally, every time I need a blood draw, I ask that it be done while I'm lying down. That seems to help a lot, and the techs always thank me for the heads-up. In fact, they always encourage me to lie down for a few minutes afterwards to make sure I'm not wobbly If you've previously fainted or become dizzy after routine immunizations or blood tests, you might want to request that they be done while you're lying down. I've never been in a lab that didn't have at least one examining table that could be used for this purpose.
No one in a medical office or lab wants a patient to fall down and get hurt, and the nurse will probably thank you for being up-front about any possible problems.
Posted by: Julie Stahlhut | May 7, 2008 1:07 PM
I used to get quarterly injections of a birth control prescription. Never had an issue (it was a different location from your average vaccination, though).
But there was one nurse who would never let me just stand for this. She always made me use the exam table. She said that every so often someone just fainted from injections, and she was kinda tiny and couldn't have caught me, probably. So she was trying to be careful. Made sense to me if that was her experience.
Posted by: Eileen | May 7, 2008 1:21 PM
This has happened to be since I was about 12 years old with both vaccines or anything in excess of one dose of dental anaesthetic, although I never outright fainted. A doctor tried to convince me I was afraid of needles and should get hypnosis. Thing is, I didn't even flinch when I had an IV put in, nor did I faint when I got a sharp object stuck in my finger and had to wait for an hour to get it removed. I'm not small for a female - about 5'8.5".
Posted by: CC | May 7, 2008 2:08 PM
This answers questions about the incidence of syncope due to vaccination, but what about the root cause.
Anti-vaccine folks would like us to believe that it is due to the biology or chemistry of the vaccine. Is this really the case or is it more a psychological issue.
Julie mentions her phobia of venipuncture.
I've felt dizzy upon occaisions after opening my circulatory system, usually through some idiot behavior with a tomato knife or such..,
When they say "it's all in your head," sometimes I think it really is.
Posted by: neil | May 7, 2008 3:04 PM
There's a distinction between neurological (as per the above post) and psychological to be made here. I can say that whenever this has happened to me, I wasn't expecting it. For instance, I got vaccinated and became dizzy. Then I had an NSAID injected, presumably using a different type of needle and everything was fine. The next time I went to get vaccinated, I assumed I'd be ok since nothing happened with the last injection, didn't even warn the doctor, and suddenly found myself saying "Err, I'm seeing white spots..." after the fact. I get my teeth drilled with no anesthetic because my dentist know about my little injection issue...
Posted by: CC | May 7, 2008 3:33 PM
I've never had any problems with injections, IV's, or getting blood drawn. Just the one time with the vaccinations. Every other time with vaccinations is just fine.In fact, I've just finished getting Hep A& B vaccinations for travel and didn't have any problems, other that feeling slightly feverish overnight.
Posted by: Allie | May 7, 2008 3:46 PM
Oh, something else I just remember.When I was eleven years old, I had a cut in my armpit that cut the vein open. I thought is was really cool to see the doctor stich it up. Never bothered me a bit. So for me, I don't think the vaccination fainting incident was completely psychological. My blood pressure was very low, even though I did not pass out completely.
A couple of months ago, I watched a show about hard to diagnose conditions. There was a man whose heart would stop every time he drank cold water. It was the vagus nerve. Very bizarre.
Posted by: Allie | May 7, 2008 3:52 PM
Never had a problem with vaccination reactions, but my dad faints when watching the doctor working on his kids. Does that count? :)
Posted by: Left_Wing_Fox | May 7, 2008 3:58 PM
I've never had an episode of syncope from having a needle, but I do tend to get what they call "needle shock" or "stick shock" both from injections and blood draws. (Oddly, it doesn't seem to happen as severely with injections to my gums.) I've resolved to go to the next injection or blood draw carrying a Coke, a sandwich, and a couple of cookies, just so that I don't find myself freezing and shivering 20-30 minutes after they're done with me -- I can crank my blood sugar back up after the initial nausea passes.
Revere -- I always get a bit of a chuckle from the medical use of the word "syncope." I first learnt the term as it relates to linguistics, which is a deletion in sound in the middle of a word, which turns the pronunciation of "forecastle" into "folk-sle" and "brougham" into "brum." (Syncope is linguistically congruent with apocope, which is loss of sound at the end of a word, such as the English "silent E.") :)
Posted by: Interrobang | May 7, 2008 5:02 PM
It could be just nerves. I worked with a woman who regularly fainted every time she got a needle, no matter what it was for (injection or blood sample). And with a man who fainted at the sight of people giving blood. Or it could be the bodily invasion. I've never fainted, but once when I got a gum-"freezing" needle at the dentist's I went pale so fast that they were concerned. I don't know what that was about: going to the dentist is a breeze to me.
Posted by: Monado, FCD | May 7, 2008 5:51 PM
The article and all the personal stories really surprised me. I had no idea that passing out after vaccinations was as common as the facts presented. I've heard of and seen plenty of patients pass out in a medical setting, but typically it has little to do with the actual medicine. I wonder if this study might be more effective if further studies were conducted on those who had passed out to see whether this was a typical reaction in medical settings (i.e. procedures, blood donations, IV's) or not, that way it would be easier to tell whether the loss of consciousness was due to the actual vaccine or just a result of a type of phobia or a related complication.
Posted by: Maggie Nielsen | May 7, 2008 6:14 PM
Yeah, for me it was always a problem with venipuncture (I'd never heard that term before... thanks for the new terminology). Aside from my childhood needle-phobia, these days you can inject me with just about anything, and it's no big deal. But if you stick the needle in my vein (as opposed to the upper arm for an injection) and my body just freaks. It's a purely physical reaction. Mentally I think it's kind of cool to watch, but physically I get queasy and light-headed and then boom, I'm out.
Just because it's a physical response doesn't mean it's not psychosomatic. It's just not due to a conscious fear of needles. That said, one of the times I fainted it seemed to have something to do with actually being able to feel the needle in my arm. It was really bizarre.
Of course, by now it could just be a classic Pavlovian association. It's happened to me so many times that now my body just reacts instinctually.
Posted by: Tasha | May 7, 2008 6:27 PM
And then there's the issue with one 11-16 year old girl legitimately fainting which causes an hysterical chain reaction down the line.
Some of these may not be independent incidents.
http://www.who.int/bulletin/archives/79(8)764.pdf
Posted by: NM | May 7, 2008 6:48 PM
I've fainted four times - having a blood sample taken, after an injection, and, more bizarrely, after bashing my funny bone and while cleaning my teeth (I think my gums started bleeding a little, but even so...). These are all things that I have done without problems at other times.
I generally found that the aftermath was worse than the faint. The injection one the school nurse left me lying with my hand on the hot water tank, and fussed for ages when I came round. The blood sample time, the doctor lifted me onto the bed - fine for me, but he hurt his back.
I have also nearly fainted while giving blood - and soon learned not to mention it on subsequent visits. They make a big fuss and make you lie down for ages - fine for some people, but I knew I wasn't going to faint this time. I get plenty of warning these days and recover very quickly - I find the waiting worse than the actual faint.
Posted by: Jefrir | May 7, 2008 7:15 PM
I'm a chronic fainter. I pass out when I'm in pain or am sick. However, the first time I passed out at age 8 it was because I was overheated--my grandmother had given me a sweater for my birthday and I insisted on wearing it all day at school. In middle and high school I passed out several times when I felt sick (don't really remember the details, just the passing out part). Once when I was about 10 I passed out during breakfast. I fell off my chair onto the hardwood floor and got a huge bruise on the side of my face. I passed out once at the top of the Washington Monument because I was feeling a bit sick (I was 16 and absolutely mortified). A few years ago I was taking a stained glass class, cut myself while snipping some glass, looked at the cut and passed out (I decided that hobby wasn't a wise choice after that). I passed out once getting a shot. Usually shots or getting blood drawn don't bother me, not sure what triggered the fainting the one time it happened. But the problem was indeed with the "falling over" part. My head narrowly missed the corner of a table. Now, I insist that I get all shots/blood drawn lying down and nurses usually make me stay still for about 10 minutes to make sure I won't fall flat on my face as I leave. My aunt faints just as much as I do so I've always wondered if there's some hereditary component to my weird fainting spells. The last time I passed out was last month. I'm sure I sound like a total wimp, but the funny thing is I participate in a bunch of outdoor sports and have never had any kind of problem with my normal activities.
The risk of fainting is a stupid reason to not vaccinate children. Just ask the nurse to allow them lie down on the table and then rest for about 10 minutes afterwards. That's what I do. The idea that the risk of fainting one time in a doctor's office outweighs the risk of getting cancer, tetanus, etc. later on in life is simply absurd.
Posted by: Jennifer | May 7, 2008 7:37 PM
I too don't take to needles well -- though I survived yesterday's blood draw for my annual physical without incident (hurrah). In addition to some needle triggered cases, I've also been forcefully transported by ambulance to the emergency room twice for syncope incidences that didn't involve actual needles or injury. Once when my wife's doctor was discussing amniocentesis in his office, no pictures or anything beyond my own vivid imagination; another time when getting "General Employee Radiation Training" when they surprised me with a photo of a rad burn. Both times I was too out-of-it to force them to let me just recover on my own (sometimes the floor is much more comfortable than a chair in the emergency room).
Though I think the worst case was once when I was in the hospital due to chest pain (in the end probably just gas or somesuch -- again I should have been more forceful in saying "no" and not allowing them to pressuring me to be "safe" and stay overnight for observation). They woke me several times to take blood for tests and since I was lying down it wasn't too big a deal. Until the 4am case when the nurse wasn't, well, very good at it. I'm told that I had zero blood pressure at one point for about a minute. Conscious essentially the whole time except possible a possibly a few seconds -- so, Julie S, fainting doesn't really "get it over with". At least for me it's several (5-10) minutes of dizziness, shortness of breath, sweating, tunnel/red vision, paralysis (probably due to the low blood pressure) preceding the syncope blackout and then 15-30 minutes of the same plus tingling nerve ending coming out of it.
But, getting back directly to the meat of this entry. It's seems a poorly designed study. Shouldn't there be something to compare with. How many incidences of fainting are there not associated with vaccines? It would seem that blood draws could make a reasonable control to compare against. Also, I haven't read the article itself, but from the summary I don't see anything but an absolute number per unit time. Lots of things could drive that up: kids getting more shot on average, better reporting procedures, more doctors reporting, ...
Posted by: Don't Panic | May 7, 2008 8:51 PM
Fainting seems not to be an issue so long as those issuing the vaccine are aware of it, and apparently not everyone is.
In determining if you should subject your child to HPV vaccine, you have to ask does the benefit outweigh the risk.
We all know FDA's approach to safety. If the manufacturers says it's safe, it's safe. Merck tested the vaccine on 11,000 women before it was approved, and apparently missed the fainting issue. There is risk, and there have been some reported deaths under "investigation".
I would be surprised if there have been 10 million individuals receiving HPV vaccinations in this age group, so the incidence is likely much higher than 2 cases per 10 million vaccinations if the numbers have increased from under 10 per month to over 50 per month.
What are the benfits. The HPV vaccines target 4 HPV viruses that cause 70% of cervical cancer. So being vaccinated offers a reduced risk to cervical cancer, but does not eliminate the risk.
What is the risk of cervical cancer anyways. It occurs at an incidence of 7 per 100,000, and has been declining at a 3.7% rate since 1996. So theoretically, the HPV vaccine may reduce cervical cancer by 5 per 100,000. Or using todays figures where there are 11,000 new cases each year, and 3,600 fatalities, we can expect a reduction of 7,700 cases per year, 2,500 fewer deaths per year.
Putting the numbers into perspective, we lose 5,000 pedestrians per year due to being hit by a car. Women die from cancer of all types at a rate of 270,000 per year.
And HPV is simply a STD, and is preventable with proper precautions. Once infected, it persists only in a small number of cases, and then takes on average 28 years to cause cervical cancer.
I don't have any daughters, but if I did, they would not be getting this vaccine. So long as the vaccine is voluntary, I have no issue with it. My concern is with those who seek to make it mandatory. HPV, unlike measles, chickenpox and mumps is not infectious is a school setting, so I have to be suspicous of the motives.
Posted by: pft | May 7, 2008 9:05 PM
Well, pft, making you wear your seatbelt doesn't save anyone else's life, either, but a lot of places see the saving of lives and the reduction in health costs to make it worthwhile passing a law. Most of the people I've known who die of cancer take a year or so in and out of hospital to do it. Some kinds, like cancer of the solid organs (liver, pancreas) are faster.
Cervical cancer is going down partly because women go for examinations and Pap smears every year. Ideally it should be every six months, to get it while it's small. If you can't count on your child always being organized enough or, in the U.S., having the money, maybe it _is_ a good investment. Cancer is a horrible way to die.
Posted by: Monado, FCD | May 7, 2008 9:55 PM
I second the motion that the study should do everything possible to separate vaccination from fainting. In British Columbia one year the local government announced that they were spraying for some tree pest on certain dates. Dozens of people called in saying that their children were sick, were coughing, had been irritated by the spraying, and so on. And the nice government people had to tell them that spraying had been postponed and had not happened yet. The imagination is a wonderful thing.
Posted by: Monado, FCD | May 7, 2008 10:08 PM
If most of the fainting occurs with young women, are they screened for potential eating disorders/hypoglycemic reactions?
I used to faint in church on a regular basis as a kid fasting for Holy Communion on First Fridays ('benefit' of a catholic school education). As soon as I made sure I ate breakfast on those days, no more fainting (but seeing my kids get stitches or fractures reduced did get me queasy).
Otherwise, love starting iv's giving shots etc to other people the past 36 years!
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Posted by: Kasap | May 8, 2008 2:50 AM
I used to work an immunization clinic in the Air Force- my syncope anecdotes (out of >20K vaccinations on the job; all syringes, thank you, none of that pneumatic business) are actually the opposite of other commenters.
Most of my fainters were athletic young guys; I'd say almost all under 25 or so. I'd also suggest that psychology played a big role, especially during big group immunizations (like flu season). They'd be teasing each other in line, and the more nervous a guy was, the worse they picked on him. Some of them would be pretty worked up by the time they got to me.
There's a real selection bias at work there, of course, since most military clinics see a large number of athletic young men as patients. Still, USAF has a fair number of women, and very few ladies ever dropped out on me. I've seen scores of guys drop. My record was 4 fainters in a day, during one of the big flu rushes. All dudes.
We had three simples rules to deal with the fainting problem. First, I moved 'em close to a wall, so they couldn't tip straight over. Second, I never let go with my off hand until I could feel them standing firm. Third, *nobody* left my sight for at least 20 minutes (which also helps catch any potential anaphylaxis; I had a few of those, too).
Interestingly, we never tracked simple fainting in the absence of other s&s as an adverse vaccine reaction. Also interstingly, although I did pediatric shots for all ages (we still saw dependent families in those days), I never, ever had a simple faint in a kid under 15. Ever.
Posted by: DBC | May 8, 2008 3:20 AM
I just about fainted last week after waking up from hernia surgery. The nurses asked me to take a little walk about 30 minutes after I awoke (from strong twilight anesthesia, not general). After about 20 steps I started to get tunnel vision, sounds seemed to come from very far away, and I felt like I would fall. I was able to sit and recover, but the nurses said the fainting spell was more common in younger men (I'm 33), although they weren't sure why. My bp was fine before I stood, and I had already had some food and drink. One doctor in the recovery room mentioned something about "fight or flight" response to medical procedures. In any case, I'm fairly sure I have some weird fainting reaction in medical settings. I've never had it after getting a shot, but I did get it once (in dozens of times) after getting blood drawn, and once after I had blood drained from a thrombosed vein. Generally, I'm not that squeamish. I'm a biologist who has done plenty of gory dissections, and I'm usually not that alarmed when I hurt myself enough to bleed a bit. I feel like the fainting is some subconscious psychological thing, but I'm not sure what triggers it.
Posted by: Comstock | May 8, 2008 11:10 AM
Many years ago I had a lactose-intolerance test. I had to drink the sugar solution, and then get blood draws over the period of an hour or two, as I recall.
The phlebotomist said she hated being alone in the office, some people get so queasy about blood and needles. Once, she had a tall teenaged boy in her office and after she drew blood, he fainted and/or had some sort of seizure. She had her hands full trying to manage someone so large, while he was trashing about in the small room.
It seemed like it would have been a good idea to have one more person on staff.
Posted by: wenchacha | May 8, 2008 11:20 AM
I've experienced vasovagal reflex without syncope after endometrial biopsies - lightheadedness, nausea, sweating. It was exactly the same sensation that used to accompany each bout of bad menstrual cramps when I was younger.
Posted by: zy | May 8, 2008 11:31 AM
I'm a 24 yr old male, and have only fainted once. I was getting an allergy test, and all of a sudden the lights went out. I woke up, and it turns out it was an advanced allergic reaction to one of the allergens in the test.
I got sympathy for all you nurses, though. I'm sure a 6'8" 275lber is a little hard to move around on the ground.
Posted by: Faux | May 8, 2008 12:30 PM
I recently got a Twinrex (combined Hep A and B) booster shot and I nearly fainted about 10 minutes after I had the vaccination. Luckily, I was still in the health center. My mother has problems with her vagus nerve when it comes to needles, but I never had, and I used to routinely donate blood. I'd had this same vaccination only 3 months previous, too, along with 3 other travel vaccines, and nothing happened other than a little muscle stiffness.
Can anyone tell me if this was also a vagus nerve reaction, or if it had something to do with the fact that the vaccine was a booster and I already had antibodies from the first round in my system?
Posted by: Melanie | May 8, 2008 4:36 PM
When I look at these data, I wonder about changes in the age-specific rates of syncope in girls, rather than just the number over time. There aren't a lot of other vaccines given to 13-15 year olds besides HPV. Maybe syncope incidetns are increasing because females in this age group, who may be more susceptible, are getting vaccinated more recently compared to pre-2007.
We had our first serious syncope-relate vaccination incident recently in our clinic, a skull fracture in a 17 year old, who was getting meningococcal vaccine for college. This is the first serious injury I've seen in 25 years of local public health work. She recovered fully.
Posted by: bc | May 8, 2008 11:28 PM
I've never fainted from an injection, but once I had to have arterial blood drawn for a test and I was warned I might faint and should stay seated for 10 minutes after the draw.
They were right... I was fine at first (aside from the OW-- they hit my bracial nerve before they found the artery)-- but after 2-3 minutes, I informed them I was on the verge of blacking out; it had happened before in band and I knew the cotton wool/bottom of well sound effects on the voices and getting gray spots from the periphery of my vision and crowding in meant that. So my seat was adjusted to recline and I felt better after and could leave on schedule.
I'm sure that a spare, reclining seat would take care of the risk.
Posted by: Samantha Vimes | May 9, 2008 3:38 AM
I fainted several times during childhood getting vaccinations, but I also fainted: after my dad yanked out a loose tooth; having blood drawn; getting stitches without local anesthetic; having a piece of glass removed from my cornea.
In my 30's my knee was badly gashed playing rugby (teammate stepped on me and pivoted his studs on my knee) and I was fine even seeing down to the bone; then the ER doctor started roughly stitching me up...
On the other hand, when I have been hospitalized I became accustomed to repeated blood draws. I now know how to prepare for blood draws, but even in my 50's I still get queasy seeing things like compound fractures, and I suspect I could pass out again under the right circumstances.
Posted by: ray | May 9, 2008 7:31 AM
Hell's teeth, get over yourselves. So you pass out when frightened by blood or needles... What's new? I don't like steel plunged into my flesh either.By any route.JEEEZZ you sookies. Lie down first ,harden-up, or just get used to it. I expect retired RNs like moi are a bit hardened this way. Cheers.
Posted by: mara | May 12, 2008 1:15 AM
When I was a kid, and went in for dental procedures, I'd typically close my eyes and try to distract myself. I'd seen the dentist apply novocaine to my gums with a Q-tip and I had always thought that this was all there was to it.
One day I opened my eyes briefly, and saw... ....a needle!
I thought, "Oh, so *that's* how they get enough novocaine in there!"
But since those novocaine needles had never hurt before (thanks to the novocaine on the gums), I had no fear of them.
Nitrous oxide also helps because you're half asleep / disassociated, and physical sensations are on a random delay or entirely attenuated.
In recent years the only needle that's given me major grief was one for an arterial blood draw from the wrist during a hospital stay (when I was getting stuck with plenty of other needles every day, the vast majority of which were only slightly bothersome). But that arterial: Oww - oww - oww! dammit, oww! After that I got afraid merely seeing the phlebotomist go by.
Seems to me that the dental routine would go a long way to getting people over their troubles with needles. Topical novocaine, nitrous oxide for five minutes or so, and then let the person sit in a chair while the gas wears off, during which time they can be observed for anaphylaxis and other adverse reactions. So: why not? Or at least, why not for people who have a serious needle-phobia or high sensitivity to pain?
Posted by: g336 | May 15, 2008 5:19 AM