Administering Vaccines: Dose, Route, Site, and Needle Size

Vaccine Dose Route Injection Site and Needle Size Pfizer-BioNTech Subcutaneous (Subcut) injection ≥12 yrs: 0.3 mL COVID-19 IM . Use a 23–25 gauge needle. Choose the injection site that is appropriate to Moderna; Janssen the person’s age and body mass. ≥18 yrs: 0.5 mL Needle Diphtheria, Tetanus, Pertussis age injection site 0.5 mL. . IM .. length (DTaP, DT, Tdap, Td) Fatty tissue over anterolateral Infants (1–12 mos) ⅝" Haemophilus influenzae type b (Hib) 0.5 mL IM thigh muscle ≤18 yrs: 0.5 mL Fatty tissue over anterolateral Hepatitis A (HepA) IM Children 12 mos or older, ⅝" thigh muscle or fatty tissue ≥19 yrs: 1.0 mL adolescents, and adults over triceps Engerix-B; Recombivax HB Hepatitis B (HepB) ≤19 yrs: 0.5 mL Intramuscular (IM) injection Persons 11–15 yrs may be given Recombivax HB (Merck) ≥20 yrs: 1.0 mL IM Use a 22–25 gauge needle. Choose the injection site and needle length that 1.0 mL adult formulation on a 2-dose schedule. Heplisav-B is appropriate to the person’s age and body mass. ≥18 yrs: 0.5 mL needle Human papillomavirus (HPV) 0.5 mL IM age length injection site 0.2 mL (0.1 mL in Intranasal 1 Influenza, live attenuated (LAIV) Newborns (1st 28 days) ⅝" Anterolateral thigh muscle each nostril) spray Infants (1–12 mos) 1" Anterolateral thigh muscle Afluria: 0.25 mL 1–1¼" Anterolateral thigh muscle2 Influenza, inactivated (IIV); for ages Fluzone: 0.25 or 0.5 mL Toddlers (1–2 years) IM 1 6–35 months ⅝–1" Deltoid muscle of arm FluLaval; Fluarix: 0.5 mL Children ⅝–1"1 Deltoid muscle of arm2 (3–10 years) 1–1¼" Anterolateral thigh muscle Influenza, inactivated (IIV), 3 yrs & old- 0.5 mL er; recombinant (RIV), 18 yrs & older; IM Adolescents and teens ⅝–1"1 Deltoid muscle of arm2 high-dose (HD-IIV) 65 yrs & older FluZone HD: 0.7 mL (11–18 years) 1–1½" Anterolateral thigh muscle Measles, Mumps, Rubella (MMR) 0.5 mL Subcut Adults 19 years or older Meningococcal serogroups A, C, W, Y † 0.5 mL IM Female or male <130 lbs ⅝–1" Deltoid muscle of arm (MenACWY) Female or male 130–152 lbs 1" Deltoid muscle of arm Meningococcal serogroup B (MenB) 0.5 mL IM Female 153–200 lbs 1–1½" Deltoid muscle of arm Pneumococcal conjugate (PCV) 0.5 mL IM Male 153–260 lbs IM or Female 200+ lbs Pneumococcal polysaccharide (PPSV) 0.5 mL 1½" Deltoid muscle of arm Subcut Male 260+ lbs IM or Polio, inactivated (IPV) 0.5 mL Subcut 1 A 5/8" needle may be used in newborns, preterm note: Always refer to the package insert Rotarix: 1.0 mL infants, and patients weighing less than 130 lbs included with each biologic for complete Rotavirus (RV) Oral Rotateq: 2.0 mL (<60 kg) for IM injection in the deltoid muscle vaccine administration information. CDC’s only if the skin stretched tight, the subcutaneous Advisory Committee on Immunization Varicella (VAR) 0.5 mL Subcut tissue is not bunched, and the injection is made Practices (ACIP) recommendations for the at a 90-degree angle to the skin. Zoster (Zos) Shingrix: 0.5* mL IM particular vaccine should be reviewed as 2 Preferred site Combination Vaccines well. Access the ACIP recommendations at www.immunize.org/acip. DTaP-HepB-IPV (Pediarix) DTaP-IPV/Hib (Pentacel) 0.5 mL IM DTaP-IPV (Kinrix; Quadracel) DTaP-IPV-Hib-HepB (Vaxelis) MMRV (ProQuad) ≤12 yrs: 0.5 mL Subcut HepA-HepB (Twinrix) ≥18 yrs: 1.0 mL IM * The Shingrix vial might contain more than 0.5 mL. Do not administer more than 0.5 mL. Intramuscular (IM) injection Subcutaneous (Subcut) injection

Intranasal (NAS) 90° angle 45° angle administration skin skin of Flumist (LAIV) subcutaneous tissue vaccine subcutaneous tissue muscle muscle

Immunization Action Coalition Saint Paul, Minnesota • 651-647-9009 • www.immunize.org • www.vaccineinformation.org www.immunize.org/catg.d/p3085.pdf • Item #P3085 (6/21)