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The Editor
British Medical Journal
BMA House
Tavistock Square
LONDON
WC1H 9JR
Dear Sir
Re: Zuckerman JN. The Importance of Injecting Vaccines into Muscle.
BMJ 2000;321:1237-8 (18 Nov)
I am surprised that Zuckerman omitted to mention that intramuscular
injection in patients with congenital bleeding disorders is absolutely
contra-indicated. Her own institution contains one of the largest
haemophilia centres in the UK and their advice, as well as that of all
other haemophilia centres, is that in patients with congenital bleeding
disorders all parenteral vaccines should be given sub-cutaneously.
Intramuscular injection in haemophiliacs frequently results in massive
muscle haematomas. These are still seen despite the efforts of haemophilia
centre doctors to advise both their colleagues and their patients. I fear
we may see more of them following your publication of this editorial.
Yours sincerely,
Dr J R C Seale
Haemophilia Centre Director
Ysbyty Gwynedd
Bangor
LL57 2PW
This is a timely and important editorial with useful information for
anyone concerned with administering vaccines. However, two further points
could have been made to avoid confusion among the readers:
1. Despite the overwhelming evidence that intramuscluar (i.m.) injection
of killed vaccines is preferable to the subcutaneous (s.c.) route, one
exception is worth mentioning: in the vaccinee with risk for haemorrhage
after i.m. injection (e.g. patients with bleeding disorders such as
heamophilia without recent factor replacement) a vaccine can be given more
safely subcutaneously.
2. Unfortunately it is not explicitly stated by the author that she is
referring to killed vaccines. For live-attenuated vaccines, such as
measles-mumps-rubella or yellow-fever, it is NOT disadvantegous - if not
advantegous - to use the s.c. route.
The importance of injecting vaccines into muscle
Our ref: JRCS/LFS/ Direct line: 01248 384370
Direct fax: 01248 384505
8th December 2000
The Editor
British Medical Journal
BMA House
Tavistock Square
LONDON
WC1H 9JR
Dear Sir
Re: Zuckerman JN. The Importance of Injecting Vaccines into Muscle.
BMJ 2000;321:1237-8 (18 Nov)
I am surprised that Zuckerman omitted to mention that intramuscular
injection in patients with congenital bleeding disorders is absolutely
contra-indicated. Her own institution contains one of the largest
haemophilia centres in the UK and their advice, as well as that of all
other haemophilia centres, is that in patients with congenital bleeding
disorders all parenteral vaccines should be given sub-cutaneously.
Intramuscular injection in haemophiliacs frequently results in massive
muscle haematomas. These are still seen despite the efforts of haemophilia
centre doctors to advise both their colleagues and their patients. I fear
we may see more of them following your publication of this editorial.
Yours sincerely,
Dr J R C Seale
Haemophilia Centre Director
Ysbyty Gwynedd
Bangor
LL57 2PW
Competing interests: No competing interests