BMJ 2001;322:364 ( 10 February )

Letters

Importance of injecting vaccines into muscle

    Parenteral vaccines must be given subcutaneously in patients with congenital bleeding disorders
    Author's reply

Parenteral vaccines must be given subcutaneously in patients with congenital bleeding disorders

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

EDITOR---I am surprised that in her editorial on the importance of injecting vaccines into muscle Zuckerman omitted to mention that intramuscular injection is absolutely contraindicated in patients with congenital bleeding disorders.1 Her own institution contains one of the largest haemophilia centres in the United Kingdom, and its advice---as well as that of all other haemophilia centres as far as I am aware---is that in these patients all parenteral vaccines should be given subcutaneously. If this results in a lower rate of successful immunisation then it must be more than offset by the avoidance of the well documented risk of muscle haematoma.

J R C Seale, haemophilia centre director. 
North West Wales NHS Trust, Ysbyty Gwynedd, Bangor LL57 2PW jim.seale@nww-tr.wales.nhs.uk


1. Zuckerman JN. The importance of injecting vaccines into muscle. BMJ 2000; 321: 1237-1238[Free Full Text]. (18 November.)

Author's reply

EDITOR---My editorial considered the site and administration of vaccines in terms of the general healthy population and not of special high risk groups. It is widely known that patients with coagulation disorders should be given parenteral vaccines by the deep subcutaneous route and . . . [Full text of this article]
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Relevant Article

The importance of injecting vaccines into muscle
Jane N Zuckerman
BMJ 2000 321: 1237-1238. [Extract] [Full Text] [PDF]

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