The importance of injecting vaccines into muscle

BMJ 2000; 321 doi: http://dx.doi.org/10.1136/bmj.321.7271.1237 (Published 18 November 2000)
Cite this as: BMJ 2000;321:1237

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Different patients need different needle sizes

  1. Jane N Zuckerman (j.zuckerman@rfc.ucl.ac.uk), senior lecturer
  1. Academic Centre for Travel Medicine and Vaccines, Royal Free and University College Medical School, London NW3 2PF

    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.13 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 …

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