We’ve rolled into November. It’s colder, damper and darker. It’s also the start of flu season. Experts would recommend getting a flu shot. Much less obviously – the cold and damp thing – they’d suggest wearing a short-sleeved shirt when doing so.
The counter-intuitive part of that has to do with giving the person doing the injection a better shot at finding the right spot for the needle. A misplaced injection can make the experience more painful and, on rare occasions, more injurious, says Kelly Grindrod is an associate professor at the University of Waterloo’s School of Pharmacy and School of Public Health.
The best way to prevent any adverse effects from the vaccination can be fairly simply: avoid wearing long sleeves.
“If you’re getting a flu shot and the needle is injected too high in the arm, and it goes into the shoulder, it causes shoulder injury,” said Grindrod. “One thing that causes problems is when you wear a long-sleeve shirt that you have to pull down over your shoulder.
“When you pull the neck down over your shoulder, it doesn’t give enough space. Sometimes that’s what can make it that the needle goes into the shoulder instead of the arm. People should wear T-shirts or sleeveless shirts for their flu shot.”
Getting the injection on target helps avoid what is known as shoulder injury related to vaccination administration, or SIRVA for short. It occurs when the vaccine is injected into the musculoskeletal structures of the shoulder –ligaments or tendons, for example – instead of the arm muscle.
The first case of SIRVA was reported in 2006. While some soreness or bruising is typical after receiving the vaccine, the difference is that the pain does not get better – it keeps getting worse.
“Some things to watch out for is shoulder pain, there might have a decreased range of motion,” said Grindrod. “And it starts within two days of getting the pain; you start to notice those symptoms. People will get a sore arm after getting the vaccine, that’s normal. The key difference is that it doesn’t get better.”
Symptoms will start to show within 48 hours of getting the vaccine. SIRVA is typically treated with anti-inflammatory medication, pain relievers, and in some cases physical therapy exercises.
Grindrod emphasized that these cases are relatively rare and that it should not deter someone from getting the flu shot.
“This is not common; it’s quite rare. We don’t expect it to happen. But in the very rare case that it does, it’s just helpful to recognize it so that they can see their physicians earlier and get treatment,” she said.
“There an increasing number of case reports in literature, but the number is probably going up because more people are aware of it.”
It also decreases the effectiveness of the vaccine, since it is supposed to be absorbed into the muscle.
We are currently in the midst of flu season, running from late fall to early spring. The flu causes approximately 3,500 deaths and almost 12,200 hospitalizations in Canada each year. The vaccination is the best defence against the flu, experts say.
Flu shots are available free of charge at the doctor’s office or from your local pharmacist.
“Pharmacists offer the public a convenient and accessible option for receiving a number of vaccinations, including against influenza,” said Sherilyn Houle, a pharmacist and assistant professor at the UW School of Pharmacy, in a release.
“This convenience may be especially advantageous for working adults who can be immunized without having to book an appointment, and across longer operating hours than many other immunization providers.”
Other ways to prevent getting and spreading flu include cleaning and disinfecting surfaces and shared items, washing your hands frequently, and staying home when sick.