infectious diseases
Overview of Immunization
Vaccine Administration
Vaccines should be given exactly as recommended on the package insert. Noncompliance or other factors may result in changes in vaccine schedule for individual patients; for most vaccines, the interval between a series of doses may be lengthened without losing efficacy. If a vaccine series (eg, for hepatitis B or human papillomavirus) is interrupted, clinicians should give the next recommended dose the next time the patient presents, provided that the recommended interval between doses has passed. They should not restart the series (ie, with dose 1). Injection vaccines are usually given intramuscularly into the midlateral thigh (in infants and toddlers) or into the deltoid muscle (in school-aged children and adults). Some vaccines are given subcutaneously. For details on vaccine administration, see theGeneral Best Practice Guidelines for Vaccine Administrationfrom the Advisory Committee for Immunization Practices (ACIP),Administering Vaccines to Adultsfrom the Immunization Action Coalition, andCDC: Administer the Vaccine(s). For patients with upper extremity lymphedema (eg, breast cancer patients), best practice is to use the other arm or an alternate location. Shoulder injury related to vaccine administration (SIRVA) may be caused by the unintentional injection of a vaccine into tissues and structures under the deltoid muscle of the shoulder ( Vaccine administration reference ). Clinicians should have a process in place to ensure that patient vaccination status is reviewed at each visit so that vaccines are given as per recommendations. Patients (or caregivers) should be encouraged to keep a history (written or electronic) of their vaccinations and share this information with new health care professionals and institutions to make sure that vaccinations are up to date. For all routinely administered vaccinations, if a vaccine series is interrupted, clinicians should give the next recommended dose the next time the patient presents, provided that the recommended interval between doses has passed; they should not restart the series (ie, with dose 1). With rare exceptions, Use of Multiple, Simultaneous Vaccines is safe, effective, and convenient; it is particularly recommended when children may be unavailable for future vaccination or when adults require multiple vaccines before international travel. An exception is simultaneous administration of pneumococcal conjugate vaccine and the meningococcal conjugate vaccine MenACWY-D (Menactra) to children with functional or anatomic asplenia; these vaccinations should not be given during the same visit but should be separated by ≥ 4 weeks. Simultaneous administration may involve combination vaccines (see table Vaccines Available in the US ) or use of If live-virus vaccines (eg, varicella and measles-mumps-rubella [MMR]) are not given at the same time, they should be given ≥ 4 weeks apart. 1.Barnes MG, Ledford C, Hogan K: A "needling" problem: Shoulder injury related to vaccine administration.J Am Board Fam Med25(6):919–922, 2012. doi: 10.3122/jabfm.2012.06.110334 