title: An investigation of three injections techniques in reducing local injection pain with a human papillomavirus vaccine: a randomized trial.
abstract: BACKGROUND
  Previous research suggests vaccine injection technique can influence local reactogenicity.
  
  
  OBJECTIVE
  To identify characteristics of vaccination technique and individual vaccinees associated with frequency and severity of pain on injection and local reactogenicity following immunisation with quadrivalent human papillomavirus vaccine.
  
  
  METHODS
  Randomised cross-over trial of three injection techniques. Data were collected on health history, perceived stress and social support using a 10 item perceived stress scale and a single item social support question. Pain on injection was measured using a visual analogue scale and reactogenicity data was collected using participant-held diaries.
  
  
  METHODS
  Clinic rooms at the University of Auckland.
  
  
  METHODS
  Females aged 14-45 years and males aged 14-26 years recruited to the study.
  
  
  METHODS
  Primary outcome measures were perceived pain on injection and the local injection site reactions pain, erythema, swelling and induration.
  
  
  RESULTS
  The three injection techniques did not affect injection site reactogenicity. Females tended to experience more reactogenicity. Perceived stress, social support and atopy were not associated with reactogenicity outcomes and exercise showed little effect. No variables, including injection technique, were associated with wide variation in perceived pain in injection. Case by case observational data suggest some variations in anatomical site may be important.
  
  
  CONCLUSIONS
  Most injection site reactions in this study were mild. The three injection techniques used in this study were equivalent in their reactogenicity and pain profiles and could be recommended for use in this population.
authors.affiliation: Immunisation Advisory Centre, Department of General Practice and Primary Health Care, Level 3, School of Population Health, University of Auckland, Tamaki Campus, Glen Innes, Private Bag 92019, Auckland 1072, New Zealand. h.petousis-harris@auckland.ac.nz
authors.forename: Helen
authors.initials: H
authors.lastname: Petousis-Harris
authors.forename: Tracey
authors.initials: T
authors.lastname: Poole
authors.forename: Joanna
authors.initials: J
authors.lastname: Stewart
authors.forename: Nikki
authors.initials: N
authors.lastname: Turner
authors.forename: Felicity
authors.initials: F
authors.lastname: Goodyear-Smith
authors.forename: Gregor
authors.initials: G
authors.lastname: Coster
authors.forename: Diana
authors.initials: D
authors.lastname: Lennon
mesh_terms: D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D064420:Drug-Related Side Effects and Adverse Reactions / Q000453:epidemiology; D005260:Female; D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D006801:Humans; D007267:Injections / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000139:chemically induced* / Q000175:diagnosis*; D053918:Papillomavirus Vaccines / Q000008:administration & dosage* / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D000068857:Human Papillomavirus Recombinant Vaccine Quadrivalent, Types 6, 11, 16, 18; D053918:Papillomavirus Vaccines