Effect of warming adult diphtheria-tetanus vaccine on discomfort after injection: a randomised controlled trial.
OBJECTIVE
To determine whether warming or rubbing adult diphtheria tetanus (ADT) vaccine immediately before administration affects its temperature and reduces the incidence of pain.


METHODS
Double-blind, randomised controlled trial and in-vitro temperature study.


METHODS
Emergency department (ED) of a regional hospital between April and December 2001.


METHODS
Convenience sample of 150 patients aged 16 years or over who presented to the ED requiring ADT booster vaccination.


METHODS
Patients were randomised to receive vaccine that was "cold" (no deliberate warming), "rubbed" between the palms for 1 minute, or "warmed" in a 37 degrees C incubator; vaccine was administered as recommended in Australian guidelines.


METHODS
Incidence of pain and pain score on McGill Present Pain Intensity Questionnaire at 5 minutes, 24 hours and 48 hours after injection; and temperature of vaccine after preparation for simulated administration.


RESULTS
The "cold" vaccine had significantly lower temperature (mean, 19.1 degrees C; 95% CI, 17.5-20.7 degrees C) than the "warmed" vaccine (mean, 28.9 degrees C; 95% CI, 28.4-29.4 degrees C) and "rubbed" vaccine (mean, 26.9 degrees C; 95% CI, 24.5-29.3 degrees C). There was no significant difference in incidence of pain between the groups who received vaccine prepared in different ways at any follow-up (5 min: P = 0.62; 24 h: P = 0.58; 48 h: P = 0.61) or overall (P = 0.99). Among those who completed follow-up, incidence of pain at any time was 77/138 (56%); there was no difference in their time-averaged pain scores (P = 0.63) or peak pain scores (P = 0.60).


CONCLUSIONS
Warming or rubbing ADT vaccine does not reduce the incidence of pain after administration. Regardless of how ADT vaccine is prepared, its temperature approaches ambient by the time it is injected.
Department of Emergency Medicine, Wangaratta District Base Hospital, Green Street, Wangaratta, VIC 3677. mjmaiden@ozemail.com.au
Matthew J
MJ
Maiden
Gregory N
GN
Benton
Russell A
RA
Bourne
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D022422:Diphtheria-Tetanus Vaccine / Q000008:administration & dosage* / Q000009:adverse effects; D004311:Double-Blind Method; D005260:Female; D006358:Hot Temperature; D006801:Humans; D007117:Immunization, Secondary; D015994:Incidence; D007267:Injections / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control; D010147:Pain Measurement; D016896:Treatment Outcome
D022422:Diphtheria-Tetanus Vaccine