Technical Q about Moderna Booster techniques

[Gaccha]

@Sheryl,

 

I am getting my second Moderna Booster tomorrow.

 

I requested a half-dose (as I had received at the same hospital in December) and was a bit surprised when they replied, "but why?". I thought it was standard for Moderna boosters.

 

Secondly, I want it aspirated if necessary for depth of injection. But this raises two sub-questions:

 

1. Where to inject for a half-dose? Is it IM? Or SC etc.? 

2. Should it only be aspirated if IM?

 

Thirdly, what on earth is the Thai word for this technical sense of 'aspirate'? Even the enormous Paiboon dictionary has nothing.

 

Thanks Sheryl and any others. 

 

 

[Boomer6969]

Falang tink to mut.

[Sheryl]

Moderna booster dose is a standard 0.25 ml.  As long as the place giving it knows it is booster, that is what they will administer. This is one reason why they ask your vaccine history.

 

When you said "half dose"  they likely did not know what you meant and perhaps thought you for some reason wanted just half the normal booster dose.  which of course makes no sense. The correct term is "booster dose".

 

It is only given IM.

 

You do not need to tell a nurse how to administer an injection and it is rather insulting to try. By the way aspiration is done not to ascertain depth of injection but as a precaution against the (rare) risk of sccidental injection into a blood vessel.  It is an automatic part of IM injection technique regardless of the drug. Even a first year student nurse not only knows to do this but does it reflexively.

 

Leave the injection technique to them.  You can if you want double check at the stage of injection that it is "booster dose".

[Gaccha]

1 hour ago, Sheryl said:

It is an automatic part of IM injection technique regardless of the drug. Even a first year student nurse not only knows to do this but does it reflexively.

You are in for a shock.

 

 

UK NHS best practice now is to NOT aspirate. This is the "Green Book", the protocol bible of the NHS.

 

Like you, I feel it should be obvious... and yet there we are... 

 

I am forced, as a consequence, to politely insult the nurse. 

 

I would, of course, never question the nurse's technique, but I leave it to the scientists as to which technique to use.

 

 

 

 

Edited July 28, 2022 by Gaccha

[Puccini]

6 hours ago, Gaccha said:

...UK NHS best practice now is to NOT aspirate. This is the "Green Book", the protocol bible of the NHS...

If you are getting your booster shot in the UK, you should have said so in your first post.

 

Do you honestly believe that people in Thailand's health care services take their cues from "the 'Green Book', the protocol bible of the NHS"?

[Gaccha]

8 hours ago, Puccini said:

Do you honestly believe that people in Thailand's health care services take their cues from "the 'Green Book', the protocol bible of the NHS"?

I was, of course, not pointing it out for that reason. Let me break it down for you. 

 

Sheryl made the (what turns out to be false) assertion that aspirating was so obvious that any 1st year nurse knows to do it for IM. 

 

Based on this (false) assertion she asserted that it would be insulting to even raise the issue with the nurse.

 

Had I thought that Thai nurses would rely on the Green Book, I would have mentioned it in my original topic opener, of course.

 

 

Edited July 29, 2022 by onthedarkside
flame comment removed

[yang123]

Less contentiously, what is the appropriate time gap between 2nd and 3rd booster shots (Moderna)?

Tks

[Gaccha]

To my amazement, as if this could not get more weird...

 

17 hours ago, Sheryl said:

Moderna booster dose is a standard 0.25 ml.  As long as the place giving it knows it is booster, that is what they will administer.

The nurse giving the injection and an assistant nurse said today, just prior to injecting: "you want a half-dose?"

 

I said "I want the Booster dose"

 

They said "At this hospital, the booster dose is the same as the normal doses".

 

Shocked response. Giggles from them.

 

"Uhhh... then I want a half-dose".

 

If anyone is wondering why I am insistent on a half-dose, it is because the academic literature shows the half-dose has the same efficacy as the full dose but without as many adverse responses. 

Edited July 29, 2022 by Gaccha
Extra info added

[Dcheech]

2 hours ago, yang123 said:

Less contentiously, what is the appropriate time gap between 2nd and 3rd booster shots

A very contentious subject here. This from the health ministry.

 https://thethaiger.com/coronavirus/health-ministry-revises-criteria-for-administration-of-booster-vaccine-doses

[Hamus Yaigh]

45 minutes ago, Gaccha said:

If anyone is wondering why I am insistent on a half-dose, it is because the academic literature shows the half-dose has the same efficacy as the full dose but without as many adverse responses. 

I am guessing based on the original post you are not qualified in medical sciences. Therefore why question those that are? Just get jabbed like the rest of us.

[Gaccha]

39 minutes ago, Hamus Yaigh said:

Therefore why question those that are? Just get jabbed like the rest of us.

They asked me.

 

I deferred to Sheryl 's position on the Booster. This nurse then said their hospital did it differently. 

 

I am not questioning the experts. I'm deciding between two different positions of experts. Since, I know one group are correct, because I invested time to find out, I opted for that one. Your position is Russian Roulette. 

[Gaccha]

4 hours ago, yang123 said:

Less contentiously, what is the appropriate time gap between 2nd and 3rd booster shots (Moderna)?

Tks

Rather oddly, the Thai position speaks of an urgent "at most" disposition while the USA's CDC position is the safety-first "at least" disposition. See the link kindly provided by @Dcheech.

 

The CDC states:

 

"CDC recommends a 2nd booster of either Pfizer-BioNTech or Moderna COVID-19 vaccine at least 4 months after the 1st booster for:

• Adults ages 50 years and older
• People who are moderately or severely immunocompromised"

Note, the CDC makes no recommendations for a second booster for people outside those categories. 

 

The UK position is seasonal, but we can take their Autumnal position as 2nd boosters:

 

"Another Covid vaccine dose will be offered to:

• adults aged 50 and over
• people aged five to 49 with health conditions which mean they're at higher risk - including pregnant women
• care home staff
• frontline health and social care workers
• unpaid carers
• household contacts of people with weakened immune systems"

 

The implication of the British position is that at least 3 months will have passed. 

 

I have allowed 7 months between my first booster and second booster. 

 

I received my first AstraZeneca on the very first day of the public vaccination programme as a high priority candidate (at the time, very few Farang could get an appointment). So all my vaccinations are well spaced out. 

 

 

Edited July 29, 2022 by Gaccha

[Gaccha]

Ok. To clarify:

 

Aspirating is good. The Thai nurse aspirated. Sheryl thinks this. I think this. It simply means the nurse checks the needle did not enter a blood vessel in the muscle area.

 

Aspirating was regarded as such an obvious benefit that it was all but common sense. See Sheryl's comments. 

 

This position was altered by a WHO report from 2004. This was adopted by some countries. The UK's NHS no longer requires aspirating. See their bible on this. The report is a mere cost-benefit analysis. 

 

Most adverse heart responses to COVID vaccinations appear to be linked to a failure to aspirate. The victims described a metallic taste in the mouth shortly after injection as well as a cold sensation moving up their arms. This suggests the vaccine entered the bloodstream immediately.

 

These reactions are extremely rare but obviously if something can be avoided without a cost then avoid it. If you are paying for the vaccine yourself then the cost and time saving for the hospital of not aspirating should not be a consideration for the hospital. If you get it free, then the government may decide the time/cost saving is worth the increased risk.  

 

Thailand has seemingly not altered its position on aspirating, although this may be sheer inertia and may depend on the hospital's specific best practices. 

 

In terms of dosages: this is dependent on the hospital in Thailand. The peer reviewed literature tells us a half-dose of Moderna is as effective as a full dose but with reduced adverse reaction.

 

I wish everyone a safe year ahead in their vaccine experiences. Get them but make the decisions that the hospital allows you to make (dosage and type of injection). The hospital I attended, in contrast to the ferocious comments on this thread, was totally relaxed about altering these things for me. It was a non issue. Informed consent is the key to modern medicine.

[Sheryl]

9 hours ago, Gaccha said:

Ok. To clarify:

 

Aspirating is good. The Thai nurse aspirated. Sheryl thinks this. I think this. It simply means the nurse checks the needle did not enter a blood vessel in the muscle area.

 

Aspirating was regarded as such an obvious benefit that it was all but common sense. See Sheryl's comments. 

 

This position was altered by a WHO report from 2004. This was adopted by some countries. The UK's NHS no longer requires aspirating. See their bible on this. The report is a mere cost-benefit  analysis.

Do you have a link to this? It is very hard to imagine how aspirating  would gave any  cost implication. Also hard to imagine that IM injection technique by nurses would be of concern to  WHO.   Might they have been talking  solely about vaccinations and in scenarios where there aren't enough health professionals to administer   vaccinations requiring use of nonprofessionals to  do do?

 

There are a number of drugs which cause serious adverse effects -- even death -- if inadvertently injected into a blood vessel.  I cannot believe it is UK policy to never aspirate with any injection. Would cause unnecessary and completely preventable harm with no upside. The aspiration stage literally takes 1-2 seconds only.  

[Gaccha]

2 hours ago, Sheryl said:

Do you have a link to this? It is very hard to imagine how aspirating  would gave any  cost implication. Also hard to imagine that IM injection technique by nurses would be of concern to  WHO.   Might they have been talking  solely about vaccinations and in scenarios where there aren't enough health professionals to administer   vaccinations requiring use of nonprofessionals to  do do?

 

There are a number of drugs which cause serious adverse effects -- even death -- if inadvertently injected into a blood vessel.  I cannot believe it is UK policy to never aspirate with any injection. Would cause unnecessary and completely preventable harm with no upside. The aspiration stage literally takes 1-2 seconds only.  

The WHO report is one of two reports/papers referenced in the Green Book as seen above in this thread. You can see the reference right there. They have the detailed citation later on.

 

Your intuition is, I believe, exactly right. The reason for the cost/time implication should not have been generalised from specific diseases/specific places/specific vaccinations to all diseases/all countries/all diseases by the NHS, and yet somehow it was. I feel amazed by it. I'll predict a reversal within 2 or 3 years of feedback from the mass vaccinations from COVID. My guess is the reasoning for the initial decision was 'forgotten' as committee members changed. 

 

I've spoken to 2 British GP friends, and both said for all the COVID vaccinations there was no requirement to aspirate. I forgot to ask if they did any injections themselves. I suppose not.

 

I'm paying so I don't care if the nurse 'wastes' 2 seconds of their time doing it.

 

The other people on this thread don't understand that besides the science, cost issues and time issues will also come into play. And if you go private you get to override them. 

 

Anyway, technical issue that I'll leave behind now.... until my 5th jab in 4 or 5 months.... The hospital turned out to be totally relaxed about my requests, suggesting I wasn't the first. 

[Sheryl]

2 hours ago, Gaccha said:

The WHO report is one of two reports/papers referenced in the Green Book as seen above in this thread. You can see the reference right there. They have the detailed citation later on.

 

Your intuition is, I believe, exactly right. The reason for the cost/time implication should not have been generalised from specific diseases/specific places/specific vaccinations to all diseases/all countries/all diseases by the NHS, and yet somehow it was. 

 

What makes you think it has been? This "Green Book" applies only to vaccinations.

 

Inconceivable that British RNs no longer aspirate on any injection, even those that may be fatal if inadvertently injected into a blood vessel.

 

Further you excerpt -- which pertains solely to vaccinations -- says aspiration is "not necessary". Not that it should not be be done or is forbidden. I suspect this is to provide flexibility so that, if necessary, non professional injectors can be utilized.  Nothing in the wording would  prevent a British RN from aspirating and they would surely  do so  as an automatic reflex.