The weight of obesity on the human immune response to vaccination

Painter, Scott D.; Ovsyannikova, Inna G.; Poland, Gregory A.

doi:10.1016/j.vaccine.2015.06.101

Cited by 167 publications

(141 citation statements)

References 85 publications

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“…Literature identifies medications such as risperidone, epinephrine, Depo-Provera, human chorionic gonadotropin (hCG), and Hepatitis A and B, rabies, and tetanus vaccines that if given into the subcutaneous tissue do not reach therapeutic effectiveness. [1][2][3] Instructions for IM injection technique vary in literature and in nursing texts, including guidelines for weight and gender, injection site, needle gauge and length, bunching or stretching the skin, aspiration, and z-track method. [4,5] As an example, educational texts offer inconsistencies in IM injection practices pertaining to z-track technique.…”

Section: Practice Variationmentioning

confidence: 99%

“…Current evidence guides practice to consider gender when administering an IM injection. [2,3,[11][12][13] Recent evidence recommends ventrogluteal site be the preferred site for IM injections. [14,15] Evidence shows the ventrogluteal site is far from major vascular and nerve structures and has a relatively low subcutaneous thickness in comparison with the traditionally used dorsogluteal site.…”

Section: Practice Variationmentioning

confidence: 99%

“…[20,21] Even with documented concern in the literature, populations such as asthma patients, women, and overweight and obese children and adults continue to be impacted by needles not reaching muscle. [3,12,17,[22][23][24][25] Subcutaneous fat distribution differs by gender, age, and ethnicity and determines the thickness of subcutaneous tissue at the IM injection site. For a male with a BMI of 25, a 1-inch needle may be sufficient for an IM injection at the deltoid, but a female with a BMI of 25 and above will most likely require a 1.5-inch-long needle to reach the deltoid muscle due to a thicker fat pad.…”

Section: Injection Depthmentioning

confidence: 99%

“…[3,21,27] Healthcare facilities should provide a variety of needles with different lengths and gauges, including 2+ inch safety needles. [25] In addition, requiring a clinical assessment of morbidly obese patients by a clinical nurse specialist, nurse practitioner or other specialized nurse before IM injections are given should be a standard within all healthcare facilities.…”

Section: Implications For Nursing Practicementioning

confidence: 99%

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Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

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Background and Objective: Intramuscular (IM) injections are administered to patients in all health care settings. Even though this procedure is invasive and the evidence supporting the process of administration is extensive, techniques and procedures vary throughout the literature and in practice. The purpose of this descriptive correlational study was to 1) investigate the literature on current evidence-based IM injection procedures pertaining to gender, patient weight, injection site, needle length, and technique, 2) compare surveyed healthcare personnel self-reported IM injection practices, and 3) query respondents on informational resources they access, continuing education they receive, and their years of healthcare experience and higher education. Methods: The Intramuscular Injection Questionnaire (IIQ) was sent via email to various professional healthcare facilities and their respective social media sites. Two hundred and six (206) healthcare personnel of various healthcare backgrounds and educational levels accessed the IIQ via a link to Qualtrics software. SPSS Version 24 was used for data analysis. Results: Most respondents were registered nurses with 4 -15+ years of experience. Seventy-eight percent of respondents considered their IM injection knowledge at above average or expert levels. Gender was not considered an important factor when selecting an injection needle among 75% of participants. Of all respondents, 61% use z-track technique, 59% use the ventrogluteal site and 34% always bunch or stretch the skin during injection. IM injection education was not provided in 75% of healthcare facilities. Conclusions: IM injection practices vary among respondents and in the literature; some reported practices are contrary to current evidence-based practice. While the evidence provides some sound recommendations, some procedures are not well-documented or supported including in nursing texts. Nurses and other healthcare personnel must critically analyze the site, depth, needle, volume, medication, vaccine, and whether to bunch or stretch, according to evidence-based practice. Healthcare facilities should provide IM injection education routinely to ensure safe practices. Future studies (Level 1 and 2) are needed to further demonstrate the best evidence leading to safe and effective IM injections.

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Section: Practice Variationmentioning

confidence: 99%

Section: Practice Variationmentioning

confidence: 99%

Section: Injection Depthmentioning

confidence: 99%

Section: Implications For Nursing Practicementioning

confidence: 99%

See 2 more Smart Citations

Evidence calls for practice change in intramuscular injection techniques

Strohfus

Paugh²,

Tindell³

et al. 2017

JNEP

View full text Add to dashboard Cite

show abstract

“…7,8 Additionally, more and more evidences have suggested that obese individuals had lower rate of antibody responses to vaccines, as compared with those non-obese subjects. 9,10 In the present commentary, we discussed the potential influences of obesity on the immunogenicity of hepatitis B vaccines.…”

Section: Introductionmentioning

confidence: 99%

Influences of obesity on the immunogenicity of Hepatitis B vaccine

Liu¹,

Guo

Dong

2017

Human Vaccines & Immunotherapeutics

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Objective: Hepatitis B vaccine is regarded as the most effective method for the prevention of hepatitis B virus (HBV) infection. However, several factors such as age, body mass index and immunocompetent state have been reported to be associated with reduced immunization responses. The present commentary was aimed to discuss the influences of obesity on the immunogenicity of hepatitis B vaccines. Data sources: Available peer-reviewed literatures, practice guidelines, and statistics published on hepatitis B vaccine in obesity between 1973 and 2015. Conclusions: Obesity was significantly associated with non-response to hepatitis B vaccine immunization. The risk of nonresponsiveness of hepatitis B vaccine among obese people increased with BMI. Moreover, the obesity might lead to an increased risk of HBV vaccine-escape mutations. The mechanism responsible for decreased immunization responses in obesity included leptininduced systemic and B cell intrinsic inflammation, impaired T cell responses and lymphocyte division and proliferation. Therefore, more studies should be performed to analyze the influences of obesity on the immunogenicity of hepatitis B vaccines to improve the immunoprotecive effect of hepatitis B vaccines in future.

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How Should We Approach Body Size Diversity in Clinical Trials?

2023

AMA Journal of Ethics

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Regulatory and ethical considerations mandate that minorities affected by health disparities be included in research. Despite concerns about clinical outcomes for patients with obesity, clinical trials have reported few data about participation of and outcomes for such patients. This article examines the lack of body size diversity in clinical research participants and reviews the evidence and ethical arguments for including larger-bodied patients. Drawing on examples of improved gender diversification of trial participants, this article suggests that similar benefits would be likely from inclusion of body diversity. Diversity in Clinical TrialsClinical trials have historically overrepresented White male participants and underrepresented children and older adults, women, gender and sexually diverse people, and people of color. 1 Given the higher burden of disease among disadvantaged minorities, 1,2,3 their lack of representative inclusion in trials threatens to exacerbate health disparities. 4 Continued disparities in cardiovascular health demonstrate this phenomenon, as women and people of color continue to be underrepresented in clinical trials and thus benefit less from research advances. 5,6

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The weight of obesity on the human immune response to vaccination

Cited by 167 publications

References 85 publications

Evidence calls for practice change in intramuscular injection techniques

Evidence calls for practice change in intramuscular injection techniques

Influences of obesity on the immunogenicity of Hepatitis B vaccine

How Should We Approach Body Size Diversity in Clinical Trials?

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