Abstract Ref Number = APCP1231
SHOULDER INJURY RELATED TO VACCINE ADMINISTRATION, A CASE REPORT OF ARM PARALYSIS FOLLOWING MEASLES RUBELLA VACCINATION
Wigit Kristianto,Dominicus Husada,Agoes Boediono
Djatiroto General Hospital Lumajang Indonesia Department of Child Health, Faculty of Medicine, Airlangga University, Surabaya, Indonesia Nganjuk General Hospital, Nganjuk, East Java, Indonesia
Background : Parental distrust to healthcare providers is a significant factor related to vaccine hesitancy. Preventing adverse events of vaccine administration is a keystone to maintain public confidence to healthcare providers. This case report discuss about arm paralysis after vaccine administration, and its potential implication for vaccine hesitancy.
Case Presentation Summary : We report an 8 years old girl who hospitalized with shoulder pain and gradual left arm paralysis, two days following measles rubella (MR) immunization in Nganjuk District, East Java. Left arm muscle strength on elbow extension, wrist extension, and thumb extension were 2/5, 3/5, and 0/5 respectively. There are no abnormalities on sensory function and laboratory studies. She was clinically diagnosed as having left radial nerve lesion which is suspected as neurapraxia. Ultrasound diathermy (UDS) was perform on her left arm. In the 5th day, there is improvement on her elbow extension strength (3/5). Then, She became an outpatient at the physiotherapy clinic to continue the therapy.
Learning Points/Discussion : The patient developed symptoms and signs consistent with shoulder injury related to vaccine administration (SIRVA). The anterior branch of the axillary nerve, C6 radiculopathy, and complete radial nerve palsy are nerve-related SIRVA previously reported in literature. These cases were always related to improper technique of injection. Proper injection technique for administration of intramuscular vaccinations can reduce the risk of shoulder injury and prevent parental distrust on immunization. Thus, the preparation of the immunization program should also prepare human resource skills in addition to vaccines and other equipment.
Keywords: Shoulder Injury Arm Paralysis Measles Rubella Vaccine