Vaccination Method

Multiple Puncture Vaccination

In the past, vaccination was performed by the scratch or multiple insertion method. During the global eradication effort, the bifurcated needle came to be universally used and a technique called multiple puncture vaccination. This method is now recommended for use in the United States.

Each bifurcated needle is sterile and individually wrapped. The bifurcated needle is for single usage only and should be discarded in an appropriate biohazard container immediately after vaccinating each patient.

Caution: Needles should never be dipped into the vaccine vial more than once, in order to avoid contamination of the vial.


Step-by-Step Instructions

1. Skin Preparation: None
No skin preparation is required.
Under no circumstances should alcohol be applied to the skin prior to vaccination as it has been shown to inactivate the virus.

2. Dip Needle
The needle is dipped into the vaccine vial and withdrawn. The needle is designed to hold a minute drop of vaccine of sufficient size and strength to ensure a take if properly administered.

3. Make 15 Perpendicular Insertions within a 5mm Diameter Area
The needle is held perpendicular to the site of insertion. The wrist of the vaccinator should be maintained in a firm position (1) by resting on the arm of the vaccinee or other firm support.

Fifteen perpendicular insertions are made in rapid order in an area approximately 5 mm in diameter.

Strokes should be vigorous enough to evoke a trace of blood at the site after
15-30 seconds.

Caution: Needles should never be dipped into the vaccine more than once, in order to avoid contamination of the vial.

4. Absorb Excess Vaccine
After vaccination, excess vaccine should be absorbed with sterile gauze. Discard the gauze in a safe manner (usually in a hazardous waste receptacle) in order not to contaminate the site or infect others who may come in contact with it.

5. Cover Vaccination Site
It is important that the vaccination site be
covered to prevent dissemination of virus.
Recommended covering:

Other coverings that have been used:

6. Caution Vaccinee and/or Guardian
To avoid contact transmission of the virus, vaccinees and guardians must be cautioned:

For further information on preventing disseminatoin of virus, visit the Preventing Contact Transmission page.


Accidental Administration by Oral or Parenteral Route

Ingestion and intramuscular injection of a dose of vaccine are NOT recommended routes of administration. However, no harm has been recordedfrom such events.

Preferred Site for Vaccination

Deltoid area on the upper arm

In the past, other sites have been chosen, such as the back or inner aspects of the extremities, or even the buttock.

These other sites were selected based on “cosmetic” concerns. It is strongly recommended that the deltoid site be used. Some experts cite the fact that there is differential skin sensitivity to vaccination and that most of the efficacy studies analyzed vaccinees who received deltoid vaccinations.

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Step 2

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Step 5

Notes:

(1)

When vaccinating infants or children, it may be necessary to appropriately restrain the child to avoid accidents during administration.

(2)

Some also advise pinning a piece of sterile gauze to clothing over the vaccination site.

(3)

In recent trials, a semipermeable membrane occlusive dressing resulted in a macerated lesion in a number of vaccinees and may increase therisk of secondary bacterial infection.

For further information please visit the Accidental Administration page.