1.4 Administration of vaccines
Please note: due to continuous updates being made to the Immunisation Handbook, the page number on the electronic version will not always match the hard copy version.
The choice of injection sites depends primarily upon the age of the individual being vaccinated. The 2 anatomical sites recommended as routine injection sites are the anterolateral thigh (Figure 1.4.6) and the deltoid muscle (Figure 1.4.9). All practitioners should ensure that they are familiar with the landmarks used to identify any anatomical sites used for vaccination. Photographs and diagrams are provided in this section but are not a substitute for training. Further detail on identifying the recommended injection sites is provided in Section 1.4.8.
Infants <12 months of age
The vastus lateralis muscle in the anterolateral thigh is the recommended site for IM vaccination in infants <12 months of age (see Figures 1.4.5 and 1.4.6, Section 1.4.8).
The ventrogluteal area (see Figures 1.4.7 and 1.4.8, Section 1.4.8) is an alternative site for IM vaccination of infants. It is important that vaccine providers who choose to use this site are familiar with the landmarks used to identify it. The reactogenicity and immunogenicity of vaccines given in this site are comparable to those of vaccines given in the anterolateral thigh.20-22
The deltoid muscle is not recommended for IM vaccination of infants <12 months of age.
Children ≥12 months of age
The deltoid muscle is the recommended site for IM vaccination in children ≥12 months of age (see Figure 1.4.9, Section 1.4.8).
The ventrogluteal area is an alternative site for IM vaccination of children ≥12 months of age. However, vaccine providers should be familiar with the landmarks used to identify this site.
The vastus lateralis in the anterolateral thigh may also be used in children ≥12 months of age, but if this site is used, the less locally reactogenic vaccines, eg. MMR, should be given in the thigh.
Adolescents and adults
The deltoid muscle is the recommended site for IM vaccination in adolescents and adults (see Figure 1.4.9, Section 1.4.8).
The anterolateral thigh can also be used in older children and adults.
The ventrogluteal area is an alternative injection site. However, vaccine providers should be familiar with the landmarks used to identify this site.
PRECAUTION:
Vaccine injections should not be given in the dorsogluteal site or upper outer quadrant of the buttock because of the possibility of a suboptimal immune response.23,24 Immunoglobulin can be administered intramuscularly into the upper outer quadrant of the buttock, but care must be taken to ensure that the other quadrants are not used.References
20. Cook IF, Murtagh J. Comparative immunogenicity of hepatitis B vaccine administered into the ventrogluteal area and anterolateral thigh in infants. Journal of Paediatrics & Child Health 2002;38:393-6.
21. Cook IF, Murtagh J. Comparative reactogenicity and parental acceptability of pertussis vaccines administered into the ventrogluteal area and anterolateral thigh in children aged 2, 4, 6 and 18 months. Vaccine 2003;21:3330-4.
22. Cook IF, Murtagh J. Ventrogluteal area—a suitable site for intramuscular vaccination of infants and toddlers. Vaccine 2006;24:2403-8.
23. de Lalla F, Rinaldi E, Santoro D, Pravettoni G. Immune response to hepatitis B vaccine given at different injection sites and by different routes: a controlled randomized study. European Journal of Epidemiology 1988;4:256-8.
24. Shaw FE, Jr., Guess HA, Roets JM, et al. Effect of anatomic injection site, age and smoking on the immune response to hepatitis B vaccination. Vaccine 1989;7:425-30.