Rapid Responses to:

EDITORIALS: Jane N Zuckerman The importance of injecting vaccines into muscle BMJ 2000; 321: 1237-1238 [Full text]

Rapid Responses: Submit a response to this article

Rapid Responses published:

Exceptions to the rule

Ulrich Heininger   (30 November 2000)

The importance of injecting vaccines into muscle

Jim Seale   (23 December 2000)

Exceptions to the rule 30 November 2000
Ulrich Heininger, University Children's Hospital, CH-4005 Basel Paeditric Infectious Diseases and Vaccinology Send response to journal: Re: Exceptions to the rule	Editor, This is a timely and important editorial with useful information for anyone concerned with administering vaccines. However, two further points could have been made to avoid confusion among the readers: 1. Despite the overwhelming evidence that intramuscluar (i.m.) injection of killed vaccines is preferable to the subcutaneous (s.c.) route, one exception is worth mentioning: in the vaccinee with risk for haemorrhage after i.m. injection (e.g. patients with bleeding disorders such as heamophilia without recent factor replacement) a vaccine can be given more safely subcutaneously. 2. Unfortunately it is not explicitly stated by the author that she is referring to killed vaccines. For live-attenuated vaccines, such as measles-mumps-rubella or yellow-fever, it is NOT disadvantegous - if not advantegous - to use the s.c. route. Sincerely, Ulrich Heininger
The importance of injecting vaccines into muscle 23 December 2000
Jim Seale, Haemophilia Centre Director Ysbyty Gwynedd Send response to journal: Re: The importance of injecting vaccines into muscle	Our ref: JRCS/LFS/ Direct line: 01248 384370 Direct fax: 01248 384505 8th December 2000 The Editor British Medical Journal BMA House Tavistock Square LONDON WC1H 9JR Dear Sir Re: Zuckerman JN. The Importance of Injecting Vaccines into Muscle. BMJ 2000;321:1237-8 (18 Nov) I am surprised that Zuckerman omitted to mention that intramuscular injection in patients with congenital bleeding disorders is absolutely contra-indicated. Her own institution contains one of the largest haemophilia centres in the UK and their advice, as well as that of all other haemophilia centres, is that in patients with congenital bleeding disorders all parenteral vaccines should be given sub-cutaneously. Intramuscular injection in haemophiliacs frequently results in massive muscle haematomas. These are still seen despite the efforts of haemophilia centre doctors to advise both their colleagues and their patients. I fear we may see more of them following your publication of this editorial. Yours sincerely, Dr J R C Seale Haemophilia Centre Director Ysbyty Gwynedd Bangor LL57 2PW