BMJ 2000;321:1237-1238 ( 18 November )

Editorials

The importance of injecting vaccines into muscle

Different patients need different needle sizes

The first 150 words of the full text of this article appear below.

Most vaccines should be given via the intramuscular route into the deltoid or the anterolateral aspect of the thigh. This optimises the immunogenicity of the vaccine and minimises adverse reactions at the injection site. Recent studies have highlighted the importance of administering vaccines correctly.1-3 Clinical practice needs to reflect considerations about the right length and gauge of needles used to ensure that those vaccinated get the immunological benefit of the vaccines without local side effects.

Injecting a vaccine into the layer of subcutaneous fat, where poor vascularity may result in slow mobilisation and processing of antigen, is a cause of vaccine failure1---for example in hepatitis B,2 rabies, and influenza vaccines.3 Compared with intramuscular administration, subcutaneous injection of hepatitis B vaccine leads to significantly lower seroconversion rates and more rapid decay of antibody response.1

Traditionally the buttocks were thought to be an appropriate site for vaccination, but the layers of . . . [Full text of this article]
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Effect of needle size on immunogenicity and reactogenicity of vaccines in infants: randomised controlled trial
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This article has been cited by other articles:

  • Lippert, W. C., Wall, E. J. (2008). Optimal Intramuscular Needle-Penetration Depth. Pediatrics 122: e556-e563 [Abstract] [Full text]  
  • Schechter, N. L., Zempsky, W. T., Cohen, L. L., McGrath, P. J., McMurtry, C. M., Bright, N. S. (2007). Pain Reduction During Pediatric Immunizations: Evidence-Based Review and Recommendations. Pediatrics 119: e1184-e1198 [Abstract] [Full text]  
  • Diggle, L., Deeks, J. J, Pollard, A. J (2006). Effect of needle size on immunogenicity and reactogenicity of vaccines in infants: randomised controlled trial. BMJ 333: 571- [Abstract] [Full text]  
  • Hammer, S. J., Backer, H., Schechter, R. (2004). Immunization Injections. Arch Pediatr Adolesc Med 158: 708-708 [Full text]  
  • Seale, J R C, Zuckerman, J. N (2001). Importance of injecting vaccines into muscle. BMJ 322: 364-364 [Full text]  

Rapid Responses:

Read all Rapid Responses

Exceptions to the rule
Ulrich Heininger
bmj.com, 30 Nov 2000 [Full text]
The importance of injecting vaccines into muscle
Jim Seale
bmj.com, 23 Dec 2000 [Full text]
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