Prior vaccine problem worries reader

Dear Dr. Roach: Two years ago, I received the high-dose flu vaccinee. It resulted in a severe case of SIRVA bursitis in my shoulder. I suffered for three months. Since then I have been afraid to get another vaccine. However, when I broke my elbow, the emergency doctor gave me a tetanus shot, which did not cause any discomfort. Now that a COVID-19 vaccine might become available shortly, how I can avoid the experience that I had with the flu shot?

A.L.

Answer: Shoulder Injury Related to Vaccine Administration happens when the vaccine is injected too deep in the shoulder. Instead of going into the muscle, the vaccine goes into the shoulder bursa, causing a strong immune reaction.

SIRVA can be avoided with proper administration technique.

Some professionals always place the needle to the hub, but in smaller people, that may be too deep. Using a smaller needle or just placing the tip into the middle of the muscle will prevent SIRVA. Tell the doctor that you have had this problem before and that they need to take extra care with the injection.

There are several candidate vaccines for SARS-CoV-2, and some are intramuscular while others are subcutaneous, which do not cause SIRVA.

Dear Dr. Roach: My 94-year-old father was diagnosed with bullous pemphigoid. He lives in a senior living facility. Can you give me information on this condition?

K.O.

Answer: Bullous pemphigoid is an autoimmune disorder whose primary manifestation is blistering of the skin. It is most common in people over 60.

Itching is very common and can be severe.

Treatment is with steroids, either in creams or ointments, or taken orally. Treatment topically with very potent steroids was shown to be 99% effective within three weeks.

Unfortunately, 30-45% of people will have a relapse within a year. Recurrences may be treated the same way.

You can read more at www.pemphigus.org.