Background Equine influenza, caused by the orthomyxovirus equine influenza A type 2 H3N8 subtype, is one of the most common infectious diseases of the respiratory tract of horses. Vaccine incident guidance: responding to errors in vaccine storage, handling and administration Ref: PHE publications gateway number: GW … When giving several injections at a single visit, administer each vaccine at a separate injection site. Subcutaneous injections are administered at a 45-degree angle, usually into the thigh for infants aged <12 months and in the upper-outer triceps area of persons aged ≥12 months. The deltoid muscle is preferred for children aged 3-10 years (21); the needle length for deltoid site injections can range from ⅝ to 1 inch on the basis of technique. Providers are sometimes concerned when they have the same contraindications or precautions as their patients from whom they withhold or defer vaccine. Different single-components of combination vaccines should never be mixed in the same syringe by an end-user unless specifically licensed for such use (4). For Medicaid-eligible beneficiaries age 19 years and older, purchased vaccine and administration costs may be billed to NC Medicaid, according to the guidelines stated in Tables 2 and 3 below. Deviation from the recommended route of administration might reduce vaccine efficacy (12-13) or increase the risk for local adverse reactions (14-16). Centers for Disease Control and Prevention. In certain circumstances in which a single vaccine type is being used (e.g., in preparation for a community influenza vaccination campaign), filling a small number (10 or fewer) of syringes may be considered (5). Additional resources can be found on CDC’s vaccine administration web page. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The needle gauge for intramuscular injection is 22-25 gauge. If a larger dose (volume) of influenza vaccine is inadvertently administered, count the dose as valid. 1 While this sounds very concise and achievable, it is a daunting task. The revised standards became effective in 2001 (2). Because the majority of vaccines have a similar appearance after being drawn into a syringe, prefilling might result in administration errors. In addition, we encourage providers to report all vaccine administration errors—even those not associated with an adverse event — to the Vaccine Adverse Event Reporting System (VAERS)external icon. For infants and younger children, if more than 2 vaccines are injected in a single limb, the thigh is the preferred site because of the greater muscle mass; the injections should be sufficiently separated (separate anatomic sites [i.e. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. (b) Note that prefilled syringes of High-Dose Fluzone have a volume of 0.7 cc and the recommended volume of administration is 0.7 ccs. For adults 19 years of age and older, the deltoid muscle in the upper arm is the preferred site, although the vastus lateralis muscle in the anterolateral thigh may be used if the deltoid site cannot be used. Injectable immunobiologics should be administered where local, neural, vascular, or tissue injury is unlikely. Do not remove dose-divider clip at the other end of the sprayer. Source: Adapted from Minnesota Department of Health. With the patient in an upright position, For live vaccines that require reconstitution, manufacturers typically recommend the vaccine be used as soon as possible after reconstitution and be discarded if not used within 30 minutes after reconstitution. Infants and children aged 6 months to <5 years are strongly recommended to receive annual influenza vaccine. If a smaller than recommended dose (volume) of any inactivated influenza product is inadvertently administered, additional vaccine should be given so that the patient receives a full dose. Use a 1- to 1½-inch needle for women who weigh 152–200 pounds (70–90 kg) and men who weigh 152–260 pounds (70–118 kg). However, for DTaP, Hib, and PCV13, there is no evidence related to immunogenicity of these 3 vaccines given subcutaneously. Hepatitis B administered by any route other than intramuscular, or in adults at any site other than the deltoid or anterolateral thigh, should not be counted as valid and should be repeated (7). The Advisory Committee on Immunization Practices’ General Best Practice Guidelines for Immunization state that aspiration is not required before administering a vaccine. Needles and syringes used for vaccine injections must be sterile and disposable. Information about flu vaccine delivery for the 2020/2021 season Update from the National Immunisation Advisory Committee. Evidence indicates that this cream does not interfere with the immune response to MMR (43). Knowledge of body mass can be useful for estimating the appropriate needle length (24). For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides comparatively larger muscle mass than the deltoid (Figure 2) (21). For toddlers, the anterolateral thigh muscle is preferred, and when this site is used, the needle should be at least 1 inch long. Rotavirus, adenovirus, cholera vaccine, and oral typhoid vaccines are the only vaccines administered orally in the United States. 10 December 2014 Added new guidance about flu vaccination in pregnancy. For Nasal Flu Vaccine; Administer intranasally; sniffing is not required by the patient. If problems are noted, the vaccine should not be administered. The following children will require 2 doses of influenza vaccine, administered at least 4 weeks apart, for the 2020–2021 season: The following children will require 1 dose of influenza vaccine for the 2020–2021 season: *Doses do not need to have been received during the same or consecutive influenza seasons. These federal regulations require the use of engineering and work practice controls to eliminate or minimize employee exposure to bloodborne pathogensexternal icon. People using services, their families, carers and other members of the public, in particular those eligible for flu vaccination; Guideline development process. If different vaccines (such as flu and pneumococcal vaccines) will be available, set up a separate administration station for each vaccine type to prevent medication errors. More centres are opening all the time. For persons 3 years of age and older, the correct dosage is 0.5 mL for most inactivated influenza vaccine products. Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact (1). What are the current recommendations for persons with egg allergies? To decrease risk of local adverse events, inactivated vaccines containing an adjuvant should be injected into a muscle. Remember multiple immunizations given on the same day should be given a minimum of 1" apart. The amount of vaccine that should be administered is based on when the patient is available to be revaccinated. NICE worked with Public Health England to develop this guidance. Use a 1-inch needle for men and women who weigh 130–152 pounds (60–70 kg). Additional resources can be found on CDC’s vaccine administration web page. (a) If the gluteal muscle is chosen, injection should be administered lateral and superior to a line between the posterior superior iliac spine and the greater trochanter or in the ventrogluteal site, the center of a triangle bounded by the anterior superior iliac spine, the tubercle of the iliac crest, and the upper border of the greater trochanter. Administering vaccine by the wrong route is considered a vaccine administration error. Abbreviations: DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; HepA = hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HPV = human papillomavirus; IIV = inactivated influenza vaccine; IM = intramuscular; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; MenB = serogroup B meningococcal vaccine; MenCY = bivalent meningococcal conjugate vaccine component; MMR = measles, mumps, and rubella; MMRV = measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV13 = pneumococcal conjugate vaccine; PPSV23= pneumococcal polysaccharide vaccine; RV1 = live, attenuated monovalent rotavirus vaccine; RV5 = live, reassortment pentavalent rotavirus vaccine; RZV = recombinant adjuvanted zoster vaccine; Subcut = subcutaneous; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. The guideline provides guidance on Marketing Authorisation Applications for influenza vaccine s based on the types for which ample experience has been gained during seasonal vaccination campaigns as well as the 2009 H1N1 pandemic, namely inact ivated non -adjuvanted vaccine and inactivated vaccine Use of a topical refrigerant (vapocoolant) spray immediately before vaccination can reduce the short-term pain associated with injections and can be as effective as lidocaine-prilocaine cream (49). Influenza vaccines are not highly viscous, so a fine-gauge (22- to 25-gauge) needle can be used. Syringes that are prefilled by the manufacturer and activated (i.e., syringe cap removed or needle attached) but unused should be discarded at the end of the clinic day. Yes — if a formulation labeled for intramuscular injection is given by the subcutaneous or intradermal route, it should be repeated. Administration of a sweet-tasting solution in addition to breastfeeding before vaccine injections is … Children aged 6 months to <5 years who are receiving influenza vaccine for the first time are recommended to receive 2 doses of influenza vaccine. (b) If skin is stretched tightly and subcutaneous tissues are not bunched. However, this is considered a vaccine administration error. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures (46). Additional information on vaccine administration and safe injection practices can be found in the following resources: Epidemiology and Prevention of Vaccine-Preventable Diseases (the “Pink Book”), “Vaccine Administration” chapter (updated 11/2020), ACIP General Best Practice Guidelines for Immunization. Insert the needle at a 90-degree angle and stretch the skin flat between thumb and forefinger. For children 6–35 months of age, the correct dosage (volume) is: 0.25 mL or 0.5 mL for Fluzone Quadrivalent. Vaccines are medicines that protect you against specific diseases, such as measles, influenza (flu) or whooping cough. Live attenuated influenza vaccine is approved for healthy nonpregnant persons aged 2-49 years and is the only vaccine administered by the intranasal route. The anterolateral thigh also can be used. However, if 2 half-volume formulations of vaccine have already been administered on the same clinic day to a patient recommended for the full volume formulation, these 2 doses can count as one full dose. The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. The regulations also require maintenance of records documenting injuries caused by needles and other medical sharp objects and that nonmanagerial employees be involved in the evaluation and selection of safety-engineered devices before they are procured. Administering a vaccine containing an adjuvant either subcutaneously or intradermally can cause local irritation, induration, skin discoloration, inflammation, and granuloma formation. ACIP discourages the routine practice of providers’ prefilling syringes for several reasons. However, because of a theoretical risk for infection, vaccination with ACAM2000 can be offered to health care personnel administering this vaccine, provided individual persons have no specified contraindications to vaccination (8). The location of all injection sites with the corresponding vaccine injected should be documented in each patient’s medical record. For adults a measurement of body mass/weight is allowable prior to vaccination, understanding that resources to measure body mass/weight are not available in all clinical settings. Health-care practices should consider using a vaccination site map so that all persons administering vaccines routinely use a particular anatomic site for each particular vaccine. Vaccine Administration. CDC recommends only preparing and drawing up vaccines just prior to administration. Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. To determine who is eligible for NCIP influenza and other vaccines, visit DPH’s Immunization Branch web page . With a new, sterile dose chamber and nozzle for each patient and correct use, these devices do not have the same safety concerns as multiple-use nozzle jet injectors. Topical lidocaine-prilocaine emulsion should not be used on infants aged <12 months who are receiving treatment with methemoglobin-inducing agents (e.g., acetaminophen, amyl nitrate, nitroprusside, dapsone) because of the possible development of methemoglobinemia (48). If a vaccine and an immune globulin preparation are administered simultaneously (e.g., Td/Tdap and tetanus immune globulin [TIG], hepatitis B and hepatitis B immunoglobulin [HBIG]), separate limbs should be used for each injection (27-28). Can they receive influenza vaccine? However, if two live, attenuated vaccines (injectable and intranasal) are not given during the same clinical visit, they should be separated by at least 4 weeks (28 days) to minimize the potential risk for interference. The following information provides general guidance for those who administer vaccines and should be used in conjunction with professional standards of medication administration and vaccine manufacturers' guidelines. In adults (but not in infants) (50), the immunogenicity of hepatitis B is substantially lower when the gluteal rather than the deltoid site is used for administration (6). There are 2 brands of rotavirus vaccine, and they have different types of applicators. This prevents inactivation of live vaccines and reduces the likelihood of irritation at the injection site. Administering volumes smaller than recommended (e.g., inappropriately divided doses) might result in inadequate protection. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. If 2 vaccines are to be administered in a single limb, they should be spaced an inch apart (4, 22). Discard any remaining vaccine in predrawn syringes at the end of the workday. If the patient cannot be revaccinated until the next day or later, a full dose of inactivated influenza vaccine should be administered as soon as the patient can return. A staff member inadvertently administered the wrong dosage (amount) of influenza vaccine. Hepatitis A vaccine and meningococcal conjugate vaccine do not need to be repeated if administered by the subcutaneous route (53-54). The capsules should not be opened or mixed with any other substance. Influenza (Flu) vaccine. The Needlestick Safety and Prevention Act (2) was enacted in 2000 to reduce the incidence of needlestick injury and the consequent risk for bloodborne diseases acquired from patients. If the skin is visibly clean, there is no need to wipe it with an antiseptic (such as an alcohol wipe). There is no evidence the cream interferes with other vaccines (44-47). Flu vaccine information statements (CDC) Guidelines and supplemental information: influenza vaccine information statements (CDC) Seasonal influenza vaccine dosage and administration (CDC) Pretreatment (30-60 minutes before injection) with a 5% topical lidocaine-prilocaine emulsion might decrease the pain of vaccination by causing superficial anesthesia (41-42). What is the correct dosage (volume) of vaccine? Used needles should never be recapped. For administration of routinely recommended vaccines, there is no evidence of risk of exposure of vaccine components to the health care provider, so conditions in the provider labeled as contraindications and precautions to a vaccine components are not a reason to withdraw from this function of administering the vaccine to someone else. A new generation of jet injectors with disposable cartridges and syringes has been developed since the 1990s. ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine. Oral typhoid capsules should be administered as directed by the manufacturer. If the subcutaneous and muscle tissue are bunched to minimize the chance of striking bone (17), a 1-inch needle or larger is required to ensure intramuscular administration. Jet injectors are needle-free devices that pressurize liquid medication, forcing it through a nozzle orifice into a narrow stream capable of penetrating skin to deliver a drug or vaccine into intradermal, subcutaneous, or intramuscular tissues (30-31). Fluzone High-Dose Quadrivalent is for use in persons 65 years of age and older, and the correct dosage is 0.7 mL. The amount of inactivated (injectable) vaccine that should be administered intramuscularly is based on the patient’s age and the vaccine product you are using. Excessive units of either code(s) will be denied – i.e. For women who weigh >200 lbs (>90 kg) or men who weigh >260 lbs (>118 kg), a 1.5-inch needle is recommended (table 6-2) (18). You Because unused prefilled syringes also typically must be discarded if not used within the same day that they are filled, vaccine wastage might occur. Healthcare personnel should take steps to determine how the error occurred and put strategies in place to prevent it from happening in the future. If a partial dose of an inactivated influenza vaccine product is administered and revaccination can occur on the same clinic day, the patient should receive a remaining volume to total the correct dosage. Get the most up to date list of billing codes, payment allowances and effective dates for the 2020–2021 flu season. Variation from the recommended route and site can result in inadequate protection. Other persons at increased risk for influenza complications can administer LAIV. (a) Persons aged 11-15 years may be administered Recombivax HB (Merck), 1.0 mL (adult formulation) on a 2-dose schedule. 4,9 If you use alcohol or other disinfecting agents to clean skin that is visibly dirty, the skin must be allowed to dry before injecting the vaccine. Influenza Surveillance Report (FluView), Past Flu Seasons Flu Forecasting Accuracy Results, Tools to Prepare Your Practice for Flu Season, Information for Clinicians on Influenza Virus Testing, Multiplex Assays Authorized for Simultaneous Detection of Influenza Viruses and SARS-CoV-2, Information on Collection of Respiratory Specimens for Influenza Virus Testing, Information for Clinicians on Rapid Diagnostic Testing for Influenza, Information on Rapid Molecular Assays, RT-PCR, and other Molecular Assays for Diagnosis of Influenza Virus Infection, Algorithm: Interpreting Influenza Testing Results When Influenza is Circulating, Algorithm: Interpreting Influenza Testing Results When Influenza is NOT Circulating, Guide: Influenza Diagnostic Testing in Closed Setting Outbreaks, Guidance: Standard-Based Electronic Laboratory Reporting, Guidance: Antiviral and Obstetric Health Care, Guidance: Outbreak Management in Long-Term Care Facilities, Guidance: Use of Mask to Control Influenza Transmission, Guidance: Prevention & Control in Peri- and Postpartum Settings, Health Professional References & Resources, Responding to Problems with Purchasing Needles for Flu Vaccination, U.S. Department of Health & Human Services. When in doubt about the appropriate handling of a vaccine, vaccination providers should contact that vaccine’s manufacturer. Administration of vaccine via aerosol avoids local soreness from injection. This document summarizes key points in running a successful clinic, and pro… CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. The Immunisation Guidelines for Ireland are only available online. Single-dose vials and manufacturer-filled syringes are designed for single-dose administration and should be discarded if vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer. Use a ⅝- to 1-inch needle for men and women who weigh less than 130 pounds (60 kg). Annual influenza vaccination is recommended for persons 6 months of age and older. Additional information on vaccine storage and handling can be found in CDC’s Vaccine Storage and Handling Toolkit. Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. (a) For the majority of infants, a 1-inch needle is sufficient to penetrate the thigh muscle. Inactivated influenza vaccine is immunogenic when administered in a lower-than-standard dose by the intradermal route to healthy adult volunteers. Needle-shielding or needle-free devices that might satisfy the occupational safety regulations for administering injectable vaccines are available in the United States (10-11). Some experts allow intramuscular injection with a ⅝-inch needle but ONLY if the skin is stretched flat (19). Do not inject FluMist. In certain circumstances (e.g., physical obstruction to other sites and no reasonable indication to defer doses), the gluteal muscle can be used. If an inactivated influenza formulation approved for adults is inadvertently administered to a child, this should be counted as a single valid dose for the child. Children up to 24 months of age, who are not breastfed during immunization, may be given a sweet-tasting solution such as sucrose or glucose solution 1 to 2 minutes before vaccine injection. Influenza, also known as the flu, is a contagious disease that is caused by influenza viruses. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
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