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Administering vaccines to adults: Dose, route, site, needle size, and preparation

Vaccine	Dose	Route	Site	Needle size	Vaccine preparation
Tetanus, Diphtheria (Td) with Pertussis (Tdap)	0.5 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*	Shake vial vigorously to obtain a uniform suspension prior to withdrawing each dose. Whenever solution and container permit, inspect vaccine visually for particulate matter and/or discoloration prior to administration. If problems are noted (eg, vaccine cannot be resuspended), the vaccine should not be administered.
Hepatitis A (HepA)	≤18 yrs.:0.5 mL ≥19 yrs.:1.0 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
Hepatitis B (HepB)	≤19 yrs.:0.5 mL ≥20 yrs.:1.0 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
HepA+HepB (Twinrix)	≥18 yrs.:1.0 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
Human papillomavirus (HPV)	0.5 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
Influenza, trivalent inactivated (TIV)	0.5 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
Pneumococcal polysaccharide (PPSV)	0.5 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
Pneumococcal polysaccharide (PPSV)	0.5 mL	SC	Fatty tissue over triceps	23 to 25 g, ⅝"
Meningococcal, conjugated (MCV)	0.5 mL	IM	Deltoid muscle	22 to 25 g, 1 to 1½"*
Meningococcal, polysaccharide (MPSV)	0.5 mL	SC	Fatty tissue over triceps	23 to 25 g, ⅝"	Reconstitute just before using. Use only the diluent supplied with the vaccine. Inject the volume of the diluent shown on the diluent label into the vial of lyophilized vaccine and gently agitate to mix thoroughly. Withdraw the entire contents and administer immediately after reconstitution. Discard single dose MPSV, varicella, and zoster vaccines if not used within 30 minutes after reconstitution. NOTE: Unused reconstituted MMR vaccine and multidose MPSV vaccine may be stored at 35°46°F (2°8°C) for a limited time. The reconstituted MPSV vaccine must be used within 35 days; the reconstituted MMR vaccine must be used within 8 hours. Do not freeze either reconstituted vaccine.
Measles, mumps, rubella (MMR)	0.5 mL	SC	Fatty tissue over triceps	23 to 25 g, ⅝"
Zoster (Zos)	0.65 mL	SC	Fatty tissue over triceps	23 to 25 g, ⅝"
Varicella (Var)	0.5 mL	SC	Fatty tissue over triceps	23 to 25 g, ⅝"
Influenza, live, attenuated (LAIV)	0.2 mL (0.1 mL into each nostril)	Intranasal spray	Intranasal	NA	Consult package insert

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

IM: intramuscular; SC: subcutaneous; NA: not applicable.

* When giving intramuscular injections, a ⅝" needle is sufficient in adults weighing <130 lbs (<60 kg); a 1" needle is sufficient in adults weighing 130 to 152 lbs (60 to 70 kg); a 1 to 1½" needle is recommended in women weighing 152 to 200 lbs (70 to 90 kg) and men weighing 152 to 260 lbs (70 to 118 kg); a 1½" needle is recommended in women weighing >200 lbs (>90 kg) or men weighing >260 lbs (>118 kg). A ⅝" (16 mm) needle may be used only if the skin is stretched tight, the subcutaneous tissue is not bunched, and injection is made at a 90-degree angle.

Acquired from: http://www.immunize.org/catg.d/p3084.pdf on January 12, 2012. We thank the Immunization Action Coalition.

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