Accuracy in images

I am concerned about the scary picture on the cover of the Sept. 9 issue of CMAJ, which highlights articles about the human papillomavirus (HPV) vaccine. Although the articles did a good job of accurately conveying the low risks associated with use of the vaccine,1^–3 the blue gloves in the picture gave the reader a sense that the vaccine was some type of biohazard. Gloving is not a routine precaution when giving intramuscular or subcutaneous injections or immunizations.

Upon further inspection of the photograph, I noted several other inaccuracies. The HPV vaccine is an intramuscular vaccine requiring a 1-inch needle, not the 5/8-inch needle pictured. The patient has a smallpox vaccination scar on her arm and thus she would be at least in her mid-thirties (in Canada we stopped vaccinating the general population against smallpox in 1972), whereas the current maximum age for vaccination against HPV is 26 years. Finally, the HPV vaccine currently available in Canada is supplied with a spring-loaded safety syringe that covers the needle with a plastic sleeve after injection, which protects the health care provider from a needle-stick injury.

It is important for us to be as accurate with our pictures in a peer- reviewed scientific journal as with our words. Stock photographs will not do, especially on the front cover.