Does anyone know why tetanus boosters hurt more than a regular shot? They usually aren’t so bad at first, but after an hour or so the injection point is usually really tender and this lasts (on me at least) for a couple of days.
Is this the tetanus vaccine, the type of needle used, or just wimpy ol’ me?
I always thought that it was because, unlike some injections, it is shot into the muscle. I may, of course, be wrong.
“Regular” or “normal” nonwithstanding, both tetanus vaccine and tetanus “serum” inject proteins, not isotonic saline, into your tissues. Saline is absorbed fast. Protein is always foreign, causes inflammation. It hurts.
Peace - don’t most injections contain proteins of some sort? Why wouldn’t ALL vaccines, then, cause such discomfort? Don’t they all contain viruses? And aren’t viruses essentially protein? And who just gets saltwater injections? Thank you for your help.
CC, Jay didn’t say yet what’s meant by “normal” injections.
Viruses are mostly DNA or RNA in a protein “envelop”. Most “injections” contain drugs dissolved in something. Then as much saline (0.9% NaCl in water) is added as possible to make the solution isotonic with tissues. The simpler (chemically) the drug and the closer the tonicity is to 0.9% NaCl, the less inflammation there is. I guess, Jay meant tetanus immune globulin, which is protein.
How much an injection of vaccine hurts probably depends the volume of the injection and on your body’s reaction to whatever is in it. Tetanus vaccine contains tetanus toxoid which is a preparation antigenically similar to the toxin produced by a Clostridium tetani infection. ( By “antigenically similar” I means that the antibodies your body produces against the toxoid will neutralize any real toxin produced by the C. tetani bacteria if you get infected. It is the toxin that causes the muscle spasms called lockjaw.) Some other vaccines seem to cause less discomfort. For example most people don’t complain much about hepatitis B vaccine which is a purified fragment of hepatitis B virus. A vaccine notorious for its side effects is injectable typhoid vaccine which is, IIRC, made of ground up, dead typhoid bacteria. You can expect that it will make your arm sore for a day or two and many people have a fever and other symptoms for 24 hours or so.
It’s safe to say that anything injected into your muscle is likely to hurt more than anything injected into your fat.
When vaccines are injected into upper arms, they are usually intended to go into muscle (there are exceptions) and they usually do go into muscle and this has to make the muscle sore, at least for a while. Injections into the buttocks, on the other hand, usually go into fat. Unfortunately, some vaccines (e.g., hepatitis B) won’t work (as well) if you inject them into fat, they have to be injected into muscle.
Yeah, some of your statesments are yeah, and some nah, e.g., whatever is injected in your butt, goes into the muscle. It’s just easier to inject there without hitting anyting important, like big vessels or nerves.
An inflammation at the site of injection depends on many factors.
The direct comparison of effects is moot, as all vaccines, as you noticed, are different. Normally, formalin treated Clostridium tet. preparation does not get into the human muscle. Neither does Hepatatis virus, but this route is closer to the natural infection through microtrauma. So, the reactions are different. The reaction to the TB bacillus is probably similar (my guess), whether introduced with the air to the lung or as a vaccine to the skin. And so on, and on, and on…
Peace,
do you care to elaborate on the statement that…
“formalin treated clostridium tet. preparation does not get into the human muscle. Neither does the Hepatitus virus, but this rote is closer to the natural infection through microtrauma.”
Now, there is no “normal” route of infection for any virus or bacteria. There are routes that are more infectious than others, but Hep C can infect you if it finds any way through the skin, be it sexual contact, a needle stick, or through a break in the skin via splashed blood.
Also, from what I understood you are saying that the tetnus bacteria does not often get into human muscle. If that was the case why do patients often recieve tetnus boosters when they, for example, step on a nail? The nail would most deffinately place the bacteria into the muscle of the patient.
From what I remember (I’m reaching back a little for this) the tetnus booster is a relatively large injection. That would be part of the reasion for discomfort if my memory serves me well. Also, it depends on the body’s response to the injection, and depends on how the injection is made.
Q: Now, there is no “normal” route of infection for any virus or bacteria
Yes, there is. You may not like it, but still. Cold viruses “normally” infect through the nose. Hepatitie virus infects as you said (needle stick is not exactly “normal”, but the mechanism is not different).
Rusty nails did not exist untill recently. Stepping on such may or may not deliver Clos. tet. into the muscle.
In civilized countries each child is given tetanus “toxoid” shortly after birth. The body produces antibodies against it, so it is “ready” when the real Clos. tet. comes. This immunity does not last forever and that’s why a “booster” is given in cases of trauma. The booster contains the antibodies already made and ready to act, there is no virus. So, again: it’s a large amount of protein which is normally does not occur in muscle, it’s “out of place” there. So, the body reacts.
wait one “second”. Isn’t the discomfort of a shot mainly caused by the immune system’s response to foreign bodies? quotes such as these make it seem as if the pain is caused by infection.
am I way off base here?
jb
Normal route of infection of a cold
sure, it can enter through the nose.
It can also enter through the mouth. Ever drink after someone and get sick?
how about using a towel after someone and getting sick.
Saying that the “normal” route of getting sick is through the nasal or oral openings to the body is not quite a true statement. The nasal and oral passages may be the most common, simply because they are constantly open to the outside environment. However, if the cold virus was to enter through a break in the skin, then the patient would have a good chance of getting sick.
I dont specifically recall if the “booster” contains the antibodies, or if it contains the again deactivated bacteria or virus. I’d have to pull up the specific injection to find that out (I’m searching for it)
Yes. The discomfort is caused by the “bulge”: 10cc or so in the middle of muscle. Anything will cause it. But normal saline will be quickly absorbed, while the globuline sits there and causes inflammation. It is absorbed eventually.
To dot the ii, the pain is not caused by “infection”. Tetanus infection causes muscle spasm.
Kinoons, viruses in general are very specific. Only a few will cause disease by several routes. Some cold viruses may cause “stomach cold”, but I do not know whether they enter the body by ingestion. They do, however, by nasal mucosa, whether they enter via the nose or mouth.
Per The Merck Manual of Diagnosis and Therapy
Tetanus toxoid is combined with diphtheria toxoid in tetanus and diphtheria toxoids adsorbed(Td). Although tetanus is rare, it has a high mortality rate. Since 1/3 of cases result from only minor injuries, universal vaccination remains necessary. Adults who missed the primary series of three tetanus injections in childhood should receive an initial dose, followed by a 2nd dose 1 mo later, and a 3rd dose 6 mo later. Thereafter, a booster of q 10 yr maintains lifelong immunity (all doses 0.5 mL IM). Alternatively, some authorities recommend a single booster at age 50 because of excellent long-term protection from the primary immunization.
A toxoid is a modified bacterial toxin that has been rendered nontoxic but retains the ability to stimulate the formation of antibodies.
however, the same manual states that an immunoglobulin is available for tetanus. This is made of specific human antibodies. The manual does not seem to state if this is the commonly used booster (I wouldnt think so. The antibodies will die at some point, and this injection would not “retrain” the body to produce antibodies. The first listed injection would). This form of injection would be useful in the acute case of tetanus that the patients own immune response is not being completely successful.
As I read further on…
The initial series of three primary doses of DTwP or DTaP is followed by a booster at age 15 to 20 mo and another at 4 to 6 yr. Subsequent routine tetanus boosters (indicated for all children and adults) every 10 yr should maintain protection; use of adult-type tetanus and diphtheria toxoids,adsorbed (Td), is preferred for these boosters, and studies are underway to assess the use of DTaP in adolescents and adults. Because adverse reactions to toxoid may occur, more frequent Td boosters are unwarranted. At any interval after initial immunization, immunity can be reestablished by a single booster dose; however, after an interval of > 10 yr from the last injection of tetanus toxoid, the rate of antibody rise to the booster response may be somewhat slower.
okay, so the booster in a non acute case is again the toxoids. Let me see if I can find the acute case
heres the best I could find…
Hyperimmune globulin is prepared from the plasma of persons with high titers of antibody against a specific organism or antigen. It is derived from artificially hyperimmunized donors or from persons convalescing from natural infections. Available hyperimmune globulins include those for hepatitis B, rabies, tetanus, and varicella-zoster. Administration is painful, and anaphylaxis may occur.
Againt the above does not provide prolonged protection. This injection is used in the acute sense.
Tetanus injections are usually done on little kids.
Doctors hate little kids.
Q.E.D.
peace: “Yeah, some of your statesments are yeah, and some nah, e.g., whatever is injected in your butt, goes into the muscle. It’s just easier to inject there without hitting anyting important, like big vessels or nerves.”
Your misconception is shared by a lot of people, probably including many medically trained people. In fact, the 1.5" 22 gauge needle traditionally used for “intramuscular” injections into the buttocks of adults doesn’t reach the buttocks in most American adults. Investigators in the early 1980s showed this. IIRC, a review of X-rays found a lot of calcifications (which can be caused by injections) in the fat overlying the gluteal muscles of a lot of adults and a review of CAT scans showed that the thickness of the fat overlying the gluteus maximus of American adults was usually greater than 1.5". I can’t get my hands on the article (which I think was “Injections into fat instead of muscle” N Engl J Med. 1982 Dec 16;307(25):1580-1) but IIRC the authors found that something like 70-90% of women had more than 1.5" of fat and something like 60-80% of men had that much fat. This is a good thing. Back when people used to get “gamma globulin” injections (typically 5 cc) in the buttock as prophylaxis against hepaptis A, most had only moderate pain because the 5 cc went into the fat where there is a fair amount of room for it. I pity the slim men with less than 1.5" of fat protecting their gluteal muscle because when they got such an injection from an earnest health care provider, they got 5cc crammed into solid muscle. It hurts just thinking about it.
Yeah,
Now it may me true that most injections given in the butt are given subq – they are intended to go into the muscle, seeing as how an IM neddle is a 1.5" - 2.0" 22 gauge needle. a SQ injection uses a 25ga 5/8" needle.
also, a larger amount of fluid can be given intramuscularly than in the SQ region, unless my entire paramedic class was taught wrong.
I dont remember the book answers, I’ll have to get back to you on that. In general we were taught to not give more than 1cc SubQ or 3cc’s IM.
Here’s an aside (which will probably engender its own thread none the less)…
It’s enlightening to a layman such as myself(not bragging here)to see the degree of disagreement and overlapping understandings and misunderstandings among members of the medical community. I know that that’s what the journals are all about, but I don’t read those with enough frequency to detect the slowly unfolding issues which are debated. This little thread presents what, on the surface, was an interesting question, mutating into a discussion on just exactly is in an innoculation, what causes pain, how much does what, etc. It reminds me that knowledge is alive - it’s transitory, it’s somewhat relative, it grows, it’s in the eye of the holder. Hey, now I’m out on a limb. Perhaps one of these experts can perform an emergency epistomology on me. xo C.
The volume you can inject reasonably comfortably depends not only on the tissue but the site. When you give a subq injection, it is usually in the muscle overlying the deltoid where there is not a lot of room. One cc shouldn’t be much of a problem but more could be. When you give an injection into muscle, more than one cc or so hurts a lot no matter where it is injected because it mechanically disrupts the muscle tissue. (There are some research articles on this.) However, when you inject in a large mass of fat, such as that of most American adults’ buttocks, there is plenty of room to accommodate a large volume.
A “simple” question caused a lot of interset. So, I thought I’ll try to explain once again. (The Merck’s quote is mostly correct, but confusing).
A baby is born somewhat protected my the antibodies it received from the mother. So, a series of vacinations is done. The purpose: to introduce attenuated pathogens (harmful microorganisms) in the way sufficient to induce the production of antibodies but insufficient to cause the full blown disease. Sometimes, an abortive (minor) desease occur. So, in the case of tetanus a “toxoid” is given together with diphteria and pertusis (whooping couph). It induces the “natural” production of antibodies. They last several years. After that, a repeat injection, a “booster” is needed. If an open trauma occured, an injection of “immune globulin” is done. Immune globulin contains already made antibodies, as natural production is slow and at this point a “toxoid” injection is too late and may, in fact, be harmful.
About injections and needles. There are several medications which MUST be administered a certain way (e.g.,CaCl2: only in the bloodstream, it will cause solid tissue necrosis). Most meds are better absorbed (resorbed) when injected into muscle or fat. Injection in the bloodstream is done sometimes to speed the action. A med injected into muscle, will “leak” into fat, even if injected correctly. The Yeah’s info is interesting. Personally, I always use 2.5cm needles and/or do IM injections into the external femur (thigh), instead of butt. Even a 10cc water based IM injectin is not painful. The are more small blood vessels (capillaries) in the muscle, than in fat. But fat-soluble meds might be better resorbed from fat. Anyway, inflammation with subsequent calcification is possible, is not usually dangerous.
If you “stepped on a rusty nail”, the chances of frequently lethal tetanus are sufficient to justify suffering from bearable pain for a few days.
A few clarifications re the last post:
“So, a series of vacinations is done. The purpose: to introduce attenuated pathogens (harmful microorganisms) in the way sufficient to induce the production of antibodies but insufficient to cause the full blown disease.”
A few vaccines are like this, such as the Sabin (but not Salk) polio vaccine which uses “live virus.” But most vacines do not contain anything “live.”
“So, in the case of tetanus a ‘toxoid’ is given together with diphteria and pertusis (whooping couph).”
The reason that diptheria and pertussus vaccine is given with tetanus vaccine to small children is for convenience. Just as the measles, mumps, and rubella are often given together.
“If an open trauma occured, an injection of ‘immune globulin’ is done.”
Tetanus immune globlulin is only given to people not fully immunized against tetanus, regardless of what kind of trauma they experienced.
“Personally, I always use 2.5cm needles and/or do IM injections into the external femur (thigh), instead of butt.”
A 2.5 cm (1 inch) needle won’t make it into an adult’s femur. Not just because it’s too short but also because the femur is a bone.