Management of Syncope Following Immunization

Abstract

Mary S. Hayney lowing immunization.1 From 1990 to 1995, a total of 697 reports of syncope were made (Table 2). Of particular note is the timing of the episodes. This timing may guide immunizers to ask their patients to remain seated and under observation for 15 minutes following immunization. Although nearly one fourth of the VAERS reports included a mention of rhythmic movements with loss of consciousness, none of the reports noted that a new seizure diagnosis was made. The authors speculated that since the tonic or clonic jerking movements were more likely to be reported for syncopal episodes within 15 minutes of immunization, these are more likely to be vasovagal responses rather than seizures. Most episodes of syncope are harmless, and the real issue is the fall associated with the loss of consciousness and postural tone. Six individuals in the Braun et al. study sustained serious head injuries during the syncopal episode.1 The affected individuals were older (aged 12 to 28 years) than the group overall, and they were therefore heavier than a young child—giving credence to the saying, “The bigger they are the harder they fall.” Also, of particular importance to immunizers is that five of the six fainters were adolescent boys and men. Because fainting is perceived as less acceptable for men in our society, they may be less likely to admit to presyncopal signs (see below). They may even Syncope occurs in a situation the patient perceives as distressing. Although no data are available, one could reasonably assume that known fainters are unlikely to seek immunization services in a pharmacy. The key issue though is that fainting can be unpredictable. Syncope with immunization has not been systematically studied, but it occurs, and individuals with a fear of needles sometimes selfdefer immunization.1,2