Cochrane · systematic review · CD010720
Needle size for vaccination procedures in children and adolescents
Beirne, PV, Hennessy, S, Cadogan, SL, et al. · Cochrane Database of Systematic Reviews · 2018 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
33
current version
GRADE rated
23
No studies
10
Included studies
NR
No studies 10 · 30.3%Ungraded 0 · 0%Very low 6 · 18.2%Low 2 · 6.1%Moderate 14 · 42.4%High 1 · 3%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlyComparison between needles with different lengths but with the same gauge
Population: infants aged approximately 2 to 6 months undergoing vaccination in the anterolateral thigh with a DTwP‐Hib vaccine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib) (not measured) | no estimate extracted | NR | No studies |
2a. Adequate immune response (seroprotection) against diphtheria (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 312 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2b. Adequate immune response (seroprotection) against tetanus (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 390 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2c. Adequate immune response (seroprotection) against pertussis (not measured) | no estimate extracted | NR | No studies |
2d. Adequate immune response (seroprotection) against Haemophilus influenzae type b disease (surrogate outcome) | RR 1.1 [1.01, 1.2] | 1 study · 400 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pain (not measured) | no estimate extracted | NR | No studies |
4a. Procedural crying (during and immediately after the vaccination procedure) (not measured) | no estimate extracted | NR | No studies |
4b. Persistent inconsolable crying4 | RR 2.49 [0.49, 12.7] | 1 study · 447 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe local reaction8 | RR 0.05 [0, 0.89] | 1 study · 447 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Non‐severe local reaction10 | RR 0.64 [0.52, 0.79] | 1 study · 447 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Fever14 | RR 1.44 [1.01, 2.06] | 1 study · 447 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Comparison between needles with different gauges but with the same length
Population: infants aged approximately 2 to 6 months undergoing vaccination in the anterolateral thigh with a DTwP combination vaccine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib) (not measured) | no estimate extracted | NR | No studies |
2a. Adequate immune response (seroprotection) against diphtheria (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 311 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2b. Adequate immune response (seroprotection) against tetanus (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 402 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2c. Adequate immune response (seroprotection) against pertussis (not measured) | no estimate extracted | NR | No studies |
2d. Adequate immune response (seroprotection) against Haemophilus influenzae type b disease (surrogate outcome) | RR 1.03 [0.96, 1.11] | 1 study · 414 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pain: 0 to 10 on MBPS 0 = no pain; 10 = worst possible pain4 | no estimate extracted | 1 study · 320 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
4a. Procedural crying (during and immediately after the vaccination procedure) | no estimate extracted | 1 study · 320 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
4b. Persistent inconsolable crying8 | RR 1.31 [0.36, 4.8] | 1 study · 459 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe local reaction11 | no estimate extracted | 2 studies · 559 participants | High |
Non‐severe local reaction13 | RR 0.92 [0.73, 1.17] | 1 study · 459 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Fever | no estimate extracted | 2 studies · 561 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Comparison between needles with different lengths and different gauges
Population: infants aged approximately 2 to 6 months undergoing vaccination in the anterolateral thigh with a DTwP‐Hib vaccine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib) (not measured) | no estimate extracted | NR | No studies |
2a. Adequate immune response (seroprotection) against diphtheria (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 309 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2b. Adequate immune response (seroprotection) against tetanus (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 394 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2c. Adequate immune response (seroprotection) against pertussis (not measured) | no estimate extracted | NR | No studies |
2d. Adequate immune response (seroprotection) against Haemophilus influenzae type b disease (surrogate outcome) | RR 1.06 [0.97, 1.16] | 1 study · 402 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pain (not measured) | no estimate extracted | NR | No studies |
4a. Procedural crying (during and immediately after the vaccination procedure) (not measured) | no estimate extracted | NR | No studies |
4b. Persistent inconsolable crying4 | RR 1.9 [0.35, 10.26] | 1 study · 458 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe local reaction8 | RR 0.11 [0.01, 0.83] | 1 study · 458 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Non‐severe local reaction11 | RR 0.69 [0.57, 0.84] | 1 study · 458 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Fever15 | RR 1.14 [0.78, 1.66] | 1 study · 458 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Comparison 1: Comparison between needles with different lengths but with the same gauge
Population: infants aged approximately 2‐6 months undergoing vaccination in the anterolateral thigh with a DTwP‐Hib vaccine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib) (not measured) | no estimate extracted | NR | No studies |
2a. Adequate immune response (seroprotection) against diphtheria (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 312 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2b. Adequate immune response (seroprotection) against tetanus (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 390 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2c. Adequate immune response (seroprotection) against pertussis (not measured) | no estimate extracted | NR | No studies |
2d. Adequate immune response (seroprotection) against Haemophilus influenzae type b disease (surrogate outcome) | RR 1.1 [1.01, 1.2] | 1 study · 400 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pain (not measured) | no estimate extracted | NR | No studies |
4a. Procedural crying (during and immediately after the vaccination procedure) (not measured) | no estimate extracted | NR | No studies |
4b. Persistent inconsolable crying4 | RR 2.49 [0.49, 12.7] | 1 study · 447 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe local reaction8 | RR 0.05 [0, 0.89] | 1 study · 447 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Non‐severe local reaction10 | RR 0.64 [0.52, 0.79] | 1 study · 447 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Fever14 | RR 1.44 [1.01, 2.06] | 1 study · 447 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Comparison 2: Comparison between needles with different gauges but with the same length
Population: infants aged approximately 2‐6 months undergoing vaccination in the anterolateral thigh with a DTwP combination vaccine
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib) (not measured) | no estimate extracted | NR | No studies |
2a. Adequate immune response (seroprotection) against diphtheria (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 311 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2b. Adequate immune response (seroprotection) against tetanus (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 402 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2c. Adequate immune response (seroprotection) against pertussis (not measured) | no estimate extracted | NR | No studies |
2d. Adequate immune response (seroprotection) against Haemophilus influenzae type b disease (surrogate outcome) | RR 1.03 [0.96, 1.11] | 1 study · 414 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pain: 0 to 10 on MBPS 0 = no pain; 10 = worst possible pain4 | no estimate extracted | 1 study · 320 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
4a. Procedural crying (during and immediately after the vaccination procedure) | no estimate extracted | 1 study · 320 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
4b. Persistent inconsolable crying8 | RR 1.31 [0.36, 4.8] | 1 study · 459 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe local reaction11 | no estimate extracted | 2 studies · 559 participants | High |
Non‐severe local reaction13 | RR 0.92 [0.73, 1.17] | 1 study · 459 participants | Low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Fever | no estimate extracted | 2 studies · 561 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Comparison 3: Comparison between needles with different lengths and different gauges
Population: infants aged approximately 2‐6 months undergoing vaccination in the anterolateral thigh with a DTwP‐Hib vaccine.
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Incidence of diphtheria, tetanus, pertussis, Haemophilus influenzae type b (Hib) (not measured) | no estimate extracted | NR | No studies |
2a. Adequate immune response (seroprotection) against diphtheria (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 309 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2b. Adequate immune response (seroprotection) against tetanus (surrogate outcome) | RR 1 [0.99, 1.01] | 1 study · 394 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
2c. Adequate immune response (seroprotection) against pertussis (not measured) | no estimate extracted | NR | No studies |
2d. Adequate immune response (seroprotection) against Haemophilus influenzae type b disease (surrogate outcome) | RR 1.06 [0.97, 1.16] | 1 study · 402 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Pain (not measured) | no estimate extracted | NR | No studies |
4a. Procedural crying (during and immediately after the vaccination procedure) (not measured) | no estimate extracted | NR | No studies |
4b. Persistent inconsolable crying4 | RR 1.9 [0.35, 10.26] | 1 study · 458 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Severe local reaction8 | RR 0.11 [0.01, 0.83] | 1 study · 458 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Non‐severe local reaction11 | RR 0.69 [0.57, 0.84] | 1 study · 458 participants | Moderate Downgraded: risk of bias, imprecision, inconsistency, indirectness |
Fever15 | RR 1.14 [0.78, 1.66] | 1 study · 458 participants | Very low Downgraded: risk of bias, imprecision, inconsistency, indirectness |