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Postvaccination syncope presents problem for adolescents
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Because syncope is a common postvaccination adverse event for adolescents and young adults, physicians who administer vaccinations should consider preventive measures and be familiar with the Advisory Committee on Immunization Practices’ recommendations, data presented here suggest.
CDC researchers conducted a telephone survey of people who reported episodes of postvaccination syncope to the Vaccine Adverse Event Reporting System between Jan. 1, 2009, and Aug. 31, 2009, to examine the nature of this particular adverse event.
Angela Calugar, MD, MPH, of the CDC, presented the preliminary findings from the survey.
The researchers’ specific objectives concerned recognizing signs and symptoms before, during and after the episode; the circumstances under which the syncope occurred and preventive measures employed by the physician, according to Calugar.
A convenience sample of 114 cases were included in the study, Calugar reported, with 92 involving female patients who had a mean age of 17.3 years and a median age of 15 years. One hundred ten survey participants were health care providers, one was a parent, one was a patient and two were categorized as “other.”
Forty-two patients experienced syncope within five minutes after immunization, while 12 episodes occurred 15 minutes or longer after immunization, according to the researchers. Data also indicated that children aged 12 to 18 years had the highest incidence of postvaccination syncope.
Seventy-nine syncope episodes were witnessed, according to Calugar. Associated symptoms included pale face, anxiety, nausea, sweating, vomiting, severe injection site pain and tonic-clonic movements.
Twelve patients experienced falls that did not result in injury. Thirty-one patients, however, fell and sustained various injuries, such as head lacerations, broken noses or abrasions. The researchers identified three cases as serious and required hospitalization, including follow-up by neurologists, Calugar said.
Forty-four physicians requested that patients who just received vaccinations wait before leaving, according to the survey responses. Of those who did not have a waiting policy, nine health care providers modified their policies to require vaccinees to observe a postvaccination waiting period after the episode of syncope occurred.
“Postvaccination syncope remains a concern, especially because of secondary injuries. There are existing ACIP and AAP recommendations for a 15-minute waiting and observation period following vaccination. Often, health care providers consider additional prevention measures based on their own observations or on medical literature,” Calugar said during the presentation.
“We may want to work more on increasing awareness among health care workers about these recommendations; it is important to recognize the signs and symptoms. This information and awareness might avert serious outcomes. Refined evidence-based prevention recommendations are needed,” she said.
Calugar A. Post vaccination syncope: Follow up survey of reports to vaccine adverse event reporting system (VAERS). #22848. Presented at: 44th National Immunization Conference; April 19-22, 2010; Atlanta.