Comparison of antibody titres between intradermal and intramuscular rabies vaccination using inactivated vaccine in cattle in Bhutan.

In developing countries, the cost of vaccination limits the use of prophylactic rabies vaccination, especially in cattle. Intradermal vaccination delivers antigen directly to an area with higher number of antigen-presenting cells. Therefore, it could produce equivalent or higher antibody titres than conventional intramuscular vaccination even when a lower dose is given. This study aimed to compare the antibody response in cattle vaccinated intramuscularly with 1mL of inactivated rabies vaccine (Raksharab, Indian Immunologicals) against intradermally vaccinated cattle with 0.2mL of the same vaccine. The study was conducted in Haa province of Bhutan where rabies is not endemic. One hundred cattle from 27 farms were selected for the study. Virus neutralising antibody (VNA) response was measured using the fluorescent antibody virus neutralisation test on the day of vaccination (day 0) and 14, 30, 60 and 90 days later. Overall, 71% of intradermally vaccinated cattle and 89% of the intramuscularly vaccinated cattle produced an adequate response (≥0.5IU/mL). On days 14 and 30 post vaccination fewer cattle (P<0.02) in the intradermal group had adequate titres with 36% and 58%, respectively, having titres ≥0.5 IU/mL compared to the equivalent figures of 78% and 77% in the intramuscular group. The mean VNA titres were lower for the intradermal group than intramuscular group (p<0.001) with the mean difference being > 0.6 IU/mL. Although low dose intradermal vaccination did produce a detectable antibody response, it was inferior to intramuscular vaccination. Thus, although intradermal vaccination has the potential to reduce the cost of vaccination by reducing the dose required, this study showed that a single dose of 0.2 mL intradermally was inferior to an intramuscular dose of 1 mL. Further research evaluating dose and dose regimen is needed before intradermal vaccination using the Raksharab rabies vaccine can be recommended in cattle.

'Tough love': The experiences of midwives giving women sterile water injections for the relief of back pain in labour.

OBJECTIVE: To explore midwives' experiences of administering sterile water injections (SWI) to labouring women as analgesia for back pain in labour. DESIGN: A qualitative study, which generated data through semi-structured focus group interviews with midwives. Data were analysed thematically. SETTING: Two metropolitan maternity units in Queensland, Australia. PARTICIPANTS: Eleven midwives who had administered SWI for back pain in labour in a randomised controlled trial. FINDINGS: Three major themes were identified including: i. SWI, is it an intervention?; ii. Tough love, causing pain to relieve pain; iii. The analgesic effect of SWI and impact on midwifery practice. KEY CONCLUSIONS: Whilst acknowledging the potential benefits of SWI as an analgesic the midwives in this study described a dilemma between inflicting pain to relieve pain and the challenges encountered in their discussions with women when offering SWI. Midwives also faced conflict when women requested SWI in the face of institutional resistance to its use. IMPLICATIONS FOR PRACTICE: The procedural pain associated with SWI may discourage some midwives from offering women the procedure, providing women with accurate information regarding the intensity and the brevity of the injection pain and the expected degree of analgesic would assist in discussion about SWI with women.

High frequency ultrasound to assess skin thickness in healthy adults.

BACKGROUND: Intradermal immunization is gaining increased attention due to multiple factors: (1) intradermal (ID) vaccination has been shown to induce improved immunogenicity compared to intramuscular (IM) vaccination; (2) ID vaccination has been shown to have a dose-sparing potential over IM leading to a reduced vaccine cost and an increased availability of vaccines worldwide. However, the currently used Mantoux technique for ID injection is difficult to standardize and requires training. The aim of the study was (1) to assess the epidermal and dermal thickness at the proximal ventral and dorsal forearm (PVF & PDF) and deltoid in adults aged 18-65years (2) to determine the maximum penetration depth and needle characteristics for the development of a platform of medical devices suited for intradermal injection, VAX-ID™. MATERIALS AND METHODS: Mean thickness of the PVF, PDF and deltoid were measured using high-frequency ultrasound of healthy adults aged 18-65years. Correlation with gender, age and BMI was assessed using Mann-Whitney U Test, Spearman correlation and Wilcoxon Signed Ranks Test, respectively. RESULTS: Results showed an overall mean skin thickness of 1.19mm (0.65-1.55mm) at the PVF, 1.44mm (0.78-1.84mm) at the PDF, and 2.12mm (1,16-3.19mm) at the deltoid. Thickness of PVF & PDF and deltoid were significantly different for men vs women (pmean<0.001, <0.001, <0.001, and pmin<0.001, 0.012, <0.001, respectively). A significant association was found for age at the deltoid region (p<0.001). Skin thickness for PVF, PDF & deltoid was significantly associated to BMI (p<0.001). CONCLUSION: Significant differences in skin thickness were seen for the PVF, PDF and deltoid region for gender, and BMI. Age only influenced the skin thickness at deltoid region. A needle length of 1.0mm is best option for intradermal injection at the dorsal forearm (NCT02363465).

[Techniques to enhance the accuracy and efficiency of injections of the face in aesthetic medicine]. / Techniques visant à améliorer la précision et l'efficacité des injections de la face en médecine esthétique.

The common principle of injections in esthetic medicine is to treat and to prevent the signs of aging with minimal doses and with more precision and efficiency. This relies on functional, histological, ultrasound or electromyographic analysis of the soft tissues and of the mechanisms of facial skin aging (fine lines, wrinkles, hollows). These injections may be done with hyaluronic acid (HA) and botulinum toxin. The aim of this technical note was to present four delivery techniques allowing for more precision and low doses of product. The techniques of "vacuum", "interpores" and "blanching" will be addressed for HA injection and the concept of "Face Recurve" for botulinum toxin injection.

WHO guideline on the use of safety-engineered syringes for intramuscular, intradermal and subcutaneous injections in health care settings / Lignes directrices de l'OMS sur l'utilisation de seringues sécurisées pour les injections intramusculaires, intradermiques et sous-cutanées dans les structures de soins

Injections are one of the most common health care procedures. Every year at least 16 billion injections are administered worldwide. The vast majority around 90% are given in curative care. Immunization injections account for around 5% of all injections, with the remaining covering other indications, including transfusion of blood and blood products, intravenous administration of drugs and fluids and the administration of injectable contraceptives. This guideline provides global, evidence-based recommendations on the use of safety-engineered injection devices to prevent the re-use of syringes and/or prevent needle-stick injuries in health care workers (HCWs). The ultimate aim is to make injection practices safer for patients and HCWs, and to prevent the injection-related transmission of deadly viruses, particularly HIV, hepatitis C and hepatitis B. The procedures covered are intramuscular (IM), intradermal (ID) and subcutaneous (SC) injections, including the syringes needed for the reconstitution of medication or vaccines when required.

Les injections font partie des procédures de soins les plus courantes. Chaque année, au moins 16 milliards d'injections sont administrées dans le monde, dont la grande majorité (environ 90 %) à des fins thérapeutiques. La vaccination représente environ 5 % des injections et les 5 % restants concernent la transfusion de sang et de produits sanguins, l'administration de médicaments et de liquides par voie intraveineuse et l'administration de contraceptifs injectables. Ces lignes directrices présentent des recommandations générales s'appuyant sur des preuves relatives à l'utilisation de matériel d'injection sécurisé afin d'empêcher la réutilisation des seringues et/ou de prévenir les accidents dus à des piqûres d'aiguille chez les agents de santé. L'objectif ultime est de réduire le plus possible les risques associés aux pratiques d'injection, tant pour les patients que pour les agents de santé, et d'éviter la transmission de virus mortels, en particulier le VIH, l'hépatite C et l'hépatite B. Ces lignes directrices couvrent les procédures suivantes : injections intramusculaires (IM), intradermiques (ID) et sous-cutanées (SC), y compris les seringues utilisées pour la reconstitution de médicaments ou de vaccins.

Mesotherapy: a bibliographical review.

Intradermotherapy is a medical procedure introduced by Pistor in 1958 that consists in the application of intradermal injections of diluted pharmacological substances that are given directly into the region to be treated. There are reports of the use of intradermotherapy to treat painful diseases, skin diseases and unaesthetic conditions. Medical clinics have been recently offering the treatment of intradermotherapy, using the more popular name for this practice - mesotherapy. There is only scant scientific information about this subject published in periodicals indexed on MedLine. Only a few states rigorously pursue this method. Most indexed publications about this subject deal with the complications of this technique. Unaesthetic dermatoses have been a common complaint in dermatologic clinics, and it has become necessary to have scientific evidence to give to patients. Therefore, well-researched scientific studies about this technique are necessary to offer data to medical professionals that will clearly explain to patients both the benefits and the risks of these procedures. A bibliographical review was conducted and we verified the need for new studies with adequate methods to confirm the benefits of intradermotherapy as used in dermatologic treatment.

Mesoterapia: uma revisão bibliográfica / Mesotherapy: a bibliographical review

A intradermoterapia é um procedimento médico introduzido por Pistor, em 1958, e consiste na aplicação, diretamente na região a ser tratada, de injeções intradérmicas de substâncias farmacológicas muito diluídas. Esse método é capaz de estimular o tecido que recebe os medicamentos tanto pela ação da punctura quanto pela ação dos fármacos, e apregoa-se que sua vantagem é evitar o uso de medicação sistêmica. Há relatos da utilização da intradermoterapia para tratamento de doenças dolorosas, dermatoses e condições consideradas inestéticas. Atualmente, clínicas médicas oferecem esse tratamento, utilizando, porém, o nome mais popular para essa prática, mesoterapia. Há escassa informação científica sobre o tema publicada em periódicos indexados no MedLine e poucos estudos com metodologia mais rigorosa sobre a eficácia e o mecanismo de ação da via intradérmica. A maioria das publicações indexadas sobre esse tema versa sobre as complicações dessa técnica. As dermatoses inestéticas têm se tornado queixas frequentes nos consultórios dermatológicos, sendo necessário um embasamento científico para lidar com tais pacientes, os quais, muitas vezes, estão em busca das novidades mostradas através da mídia. Assim, há necessidade de estudos cientificamente bem conduzidos sobre essa técnica. Estes estudos deverão oferecer aos médicos elementos para esclarecer os pacientes sobre quais benefícios esperar e quais os riscos de tal abordagem. Desse modo, realizou-se uma revisão bibliográfica sobre o assunto e constatou-se a necessidade de novos estudos com metodologia adequada para a confirmação dos benefícios da intradermoterapia como ferramenta útil no tratamento dermatológico.

Intradermotherapy is a medical procedure introduced by Pistor in 1958 that consists in the application of intradermal injections of diluted pharmacological substances that are given directly into the region to be treated. There are reports of the use of intradermotherapy to treat painful diseases, skin diseases and unaesthetic conditions. Medical clinics have been recently offering the treatment of intradermotherapy, using the more popular name for this practice - mesotherapy. There is only scant scientific information about this subject published in periodicals indexed on MedLine. Only a few states rigorously pursue this method. Most indexed publications about this subject deal with the complications of this technique. Unaesthetic dermatoses have been a common complaint in dermatologic clinics, and it has become necessary to have scientific evidence to give to patients. Therefore, well-researched scientific studies about this technique are necessary to offer data to medical professionals that will clearly explain to patients both the benefits and the risks of these procedures. A bibliographical review was conducted and we verified the need for new studies with adequate methods to confirm the benefits of intradermotherapy as used in dermatologic treatment.

Best practice in vaccine administration.

Good practice is essential for nurses working in the field of vaccine administration to ensure that patients receive the best care possible. This article discusses the results of a survey of 500 practice nurses to assess knowledge of best practice in vaccine administration. As a result, a task force of expert nurses and doctors was convened to develop guidance on best practice in this area.

Contamination of intradermal skin test syringes.

Syringes used in intradermal skin testing have commonly been used for multiple patients. Recently the safety of this practice was questioned, raising the possibility that these syringes may transmit disease from one patient to another. Since this practice is so widespread and because of a scarcity of articles linking the spread of disease with this practice, we repeated these studies and performed other experiments to test this hypothesis. With the use of Escherichia coli, Staphylococcus aureus, and tritiated thymidine, we found contamination of syringe contents that indicated a clear potential for common syringes to spread disease. These studies and studies reported elsewhere suggest that common syringes should not be used in skin testing.