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

Vaccine Dose Route Injection Site and Needle Size Diphtheria, Tetanus, Pertussis 0.5 mL IM Subcutaneous (SC) injection (DTaP, DT, Tdap, Td) Use a 23–25 gauge needle. Choose the injection site that is Haemophilus influenzae type b (Hib) 0.5 mL IM appropriate to the person’s age and body mass. <18 yrs; 0.5 mL Needle Hepatitis A (HepA) IM Age Injection Site >19 yrs; 1.0 mL Length 5 Fatty tissue over anterolat- <19yrs: 0.5 mL Infants (1–12 mos) 8" Hepatitis B (HepB) eral thigh muscle >20 yrs: 1.0 mL *Persons 11–15 yrs may be given Recombivax HB IM Fatty tissue over anterolat- (Merck) 1.0 mL adult formulation on a 2-dose schedule. Children 12 mos or older, 5 8" eral thigh muscle or fatty adolescents, and adults Human papillomavirus (HPV) 0.5 mL IM tissue over triceps Intrana- Influenza, live attenuated (LAIV) 0.2 mL Intramuscular (IM) injection sal spray Use a 22–25 gauge needle. Choose the injection site and needle 6-35 mos: 0.25 mL length appropriate to the person’s age and body mass. Influenza, trivalent inactivated(TIV) IM >3 yrs: 0.5 mL Age Needle Injection Site Length TIV: Fluzone intradermal (18–64 yrs) 0.1 mL ID st 5 Measles, Mumps, Rubella (MMR) 0.5 mL SC Newborns (1 28 days) 8"* Anterolateral thigh muscle Meningococcal – conjugate (MCV) 0.5 mL IM Infants (1–12 mos) 1" Anterolateral thigh muscle Meningococcal – polysaccharide (MPSV) 0.5 mL SC Toddlers (1–2 yrs) 1–1¼" Anterolateral thigh muscle

Pneumococcal conjugate (PCV) 0.5 mL IM 5 8 –1"* or deltoid muscle of arm Pneumococcal polysaccharide (PPSV) 0.5 mL IM or SC

Children & teens 5 8 –1"* Deltoid muscle of arm or Polio, inactivated (IPV) 0.5 mL IM or SC (3–18 years) 1"–1¼" anterolateral thigh muscle Rotarix: 1.0 mL Rotavirus (RV) Oral Adults 19 yrs or older Rotateq: 2.0 mL Varicella (Var) 0.5 mL SC Male or female 5 –1"* Deltoid muscle of arm less than 130 lbs 8 Zoster (Zos) 0.65 mL SC

Combination Vaccines Female 130–200 lbs 1–1½" Deltoid muscle of arm DTaP-HepB-IPV (Pediarix) Male 130–260 lbs DTaP-IPV/Hib (Pentacel) 0.5 mL IM Female 200+ lbs DTaP-IPV (Kinrix) 1½" Deltoid muscle of arm Male 260+ lbs Hib-HepB (Comvax) MMRV (ProQuad) <12 yrs: 0.5 mL SC *A 5/8" needle may be used for patients weighing less than 130 lbs (<60 kg) for IM injection in the deltoid muscle only if the skin is stretched tight, the subcutaneous HepA-HepB (Twinrix) >18 yrs: 1.0 mL IM tissue is not bunched, and the injection is made at a 90-degree angle.

Intramuscular (IM) injection Subcutaneous (SC) injection Intradermal (ID) administration Intranasal (IN) administration of Fluzone ID vaccine of FluMist (LAIV) vaccine

90° angle 90° angle 45° angle Administer in area of skin skin deltoid

subcutaneous tissue subcutaneous tissue muscle muscle

Please note: Always refer to the package insert included with each biologic for complete vaccine administration information. CDC’s Advisory Committee on Immunization Practices (ACIP) recommendations for the particular vaccine should be reviewed as well (see www.immunize.org/acip).

Technical content reviewed by the Centers for Disease Control and Prevention www.immunize.org/catg.d/p3085.pdf • Item #P3085 (7/12)

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