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Once manufactured in large amounts, actual vaccine delivery and administration are of prime importance for it to be successful in preventing the ailment. Vaccine administration has been traditionally via injections but several new methods of vaccine delivery are also being explored these days. These new methods are hoped to improve compliance of the general population, ease administration and help in larger coverage.
Before administration the vaccine needs adequate preparation and handling.
Syringe selection is vital with a new sterile needle and syringe used for each injection. An injectable vaccine may be delivered in either a 1-mL or 3-mL syringe as long as the prescribed dosage is delivered.
Needle Selection – the needle should be suitable for the site of injection and route of vaccine administration. Needle size also depends on the size of the individual, volume and viscosity of the vaccine, and injection technique. Typically, vaccines are not highly viscous so a fine gauge needle (22-25 gauge) can be used.
Before administration, the vaccine vial and diluent needs to be inspected thoroughly. This is done to spot damage or contamination prior to use. The expiration date printed on the vial or box should be checked.
Vaccines can be used through the last day of the month indicated by the expiration date unless otherwise stated on the package labelling. Expired vaccine or diluent should never be used.
Several vaccines are prepared in a lyophilized (freeze-dried) form. The liquid diluent (usually sterile saline or distilled water) is provided in a separate ampoule for reconstitution. Each diluent is specific to the corresponding vaccine in volume, sterility, pH, and chemical balance. If the wrong diluent is used, the vaccine dose is not valid and will need to be repeated using the correct diluent.
The vaccines should be reconstituted just before administration. After reconstitution the vial needs to be agitated or shaken to mix the vaccine thoroughly and obtain a uniform suspension prior to withdrawing each dose.
The recommended route and site for each vaccine are based on clinical trials, experience and theoretical considerations. This information is included in the manufacturer’s product information for each vaccine.
The routes of administration for most vaccines include:
There are only two routinely recommended IM sites for administration of vaccines, the vastus lateralis muscle (anterolateral thigh) and the deltoid muscle (upper arm).
In infants the thigh is the recommended site for injection because it provides a large muscle mass. The muscles of the buttock are not used for administration of vaccines in infants and children. This is because this technique may injure the sciatic nerve. In adults the deltoid muscle of the upper arm is chosen.
|LVL||Left Vastus Lateralis||Infants (& toddlers lacking adequate deltoid mass)||IM||
Diptheria, Tetanus, Pertussis (DTaP, DT, Tdap,Td), Haemophilus influezae B (Hib), Hepatitis A (HepA), Hepatitis B (HepB), Influena, trivalent inactivated (TIV), Meningoccal conjugated (MCV4), Pneumococcal Conjuage (PCV7), Pneumococcal Polysaccharide (PPV), Polio, inactivated (IPV) - Need Size 22-25g, 1-2"
|RVL||Right Vastus Lateralis|
|LD||Left Deltoid||Toddlers, children and adults||IM|
|LALT||Left Antero Lateral fat or Thigh||Infants and young children||SQ||Measles, Mumps, Rubella (MMR), Meningococcal polysaccharide (MPSV4), Pneumococcal polysaccharide (PPV), Polio, inactivated (IPV), Varicella (Var) - Need Size 23-25g, 5/8"|
|RALT||Right Antero Lateral fat or Thigh|
|LPUA||Left Posterolateral Fat of Upper Arm||Children and adults||SQ|
|RPUA||Right Posterolateral Fat of Upper Arm|
|LFA||Left Fore Arm||Intradermal||Tuberculin ppd skin test|
|RFA||Right Fore Arm
Latest vaccine delivery methods include use of oral vaccines. Polio vaccine was the first oral vaccine to be developed. The results were very positive in that the ease of the vaccines increased dramatically. With an oral vaccine there are myriad of advantages including ease of administration, no risk of blood contamination, more stability, less likely to freeze, less need for keeping and maintaining the cold chain and decrease costs.
Needle-Free Injections are jet injectors that have been developed to decrease the risks of needle stick injuries to healthcare personnel and to prevent improper reuse of syringes and needles.
Another method is the microneedle approach, which is still in stages of development. Here pointed projections are made into arrays that can allow vaccine delivery through skin. Vaccine delivery by nasal sprays is also being tried.
Newer techniques include use of liposomes for vaccine delivery and use of plasmids. Plasmids may be used in cancer vaccines.
Some situations mandate special precautions. These include: