An investigation of three injections techniques in reducing local injection pain with a human papillomavirus vaccine: A randomized trial

BackgroundPrevious research suggests vaccine injection technique can influence local reactogenicity.ObjectiveTo 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.DesignRandomised 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.SettingClinic rooms at the University of Auckland.ParticipantsFemales aged 14–45 years and males aged 14–26 years recruited to the study.Main outcome measuresPrimary outcome measures were perceived pain on injection and the local injection site reactions pain, erythema, swelling and induration.ResultsThe 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.ConclusionsMost 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.

► We trial 3 injection techniques to administer HPV vaccine to young adults.
► We also examine demographic characteristics and association with local reactions.
► The techniques had no effect on outcomes and reactions were very mild.
► We recommend these techniques for administration of HPV vaccine in young adults.