RT Journal
A1 Ipp M, Parkin PC, Lear N, Goldbach M, Taddio A
T1 ORder of vaccine injection and infant pain response
JF Archives of Pediatrics & Adolescent Medicine
JO Archives of Pediatrics & Adolescent Medicine
YR 2009
FD May 4
VO 163
IS 5
SP 469
OP 472
DO 10.1001/archpediatrics.2009.35
UL http://dx.doi.org/10.1001/archpediatrics.2009.35
AB Objective 
    To determine if acute pain response after administration of the diphtheria, polio, and tetanus toxoids and acellular pertussis and Haemophilus influenzae type b (DPTaP-Hib) vaccine and the pneumococcal conjugate vaccine (PCV) is affected by the order in which they are given.Design 
    Single-center, double-blind, randomized clinical trial.Setting 
    Outpatient pediatric clinic in Toronto, Ontario, Canada.Participants 
    Healthy infants 2 to 6 months of age undergoing routine immunization.Interventions 
    Infants received either their primary DPTaP-Hib vaccine or the PCV first, followed by the other vaccine.Main Outcome Measures 
    The primary outcome was infant pain during vaccine injection as assessed by a validated measure, the Modified Behavioral Pain Scale (MBPS), using videotaped recordings of the procedure. In addition, parents rated pain using a 10-cm visual analog scale (VAS). Crying (yes/no) was also measured.Results 
    The study was conducted between July 21, 2006, and June 21, 2007. A total of 120 infants participated: 60 received the DPTaP-Hib vaccine first and 60 received the PCV first. Infant characteristics did not differ between groups. Overall mean (SD) pain scores per infant after receiving both vaccine injections were significantly lower when DPTaP-Hib was administered first compared with when PCV was administered first (MBPS score, 7.6 [1.5] vs 8.2 [1.5], P = .037; parent VAS score, 4.2 [2.3] vs 5.6 [2.6], P = .003). When given first, the DPTaP-Hib vaccine caused significantly less pain (P < .001) than the PCV, as assessed by the MBPS, VAS, and crying.Conclusions 
    Pain was reduced when the DPTaP-Hib vaccine was administered before the PCV in infants undergoing routine vaccination. We recommend that the order of vaccine injections be the DPTaP-Hib vaccine followed by the PCV.Trial Registration 
    clinicaltrials.gov Identifier: NCT00390130