TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Moderator
  2. Vaccines and delivery technologies
  3. Wednesday, 20 August 2008
POST 01308E: APPLICABILITY OF CDC’S INTRAMUSCULAR INJECTION RECOMMENDATIONS IN DEVELOPING COUNTRIES 20 AUGUST 2008 ******************************************* For most childhood vaccines, intramuscular injection is the preferred route of administration. The vastus lateralis muscle of the thigh is the preferred site for infants up to 12 to 18 months of age, and the deltoid muscle of the shoulder is preferred for children older than 18 months of age. When properly delivered to the intramuscular level, vaccines increase immunogenicity and produce a better immune response than when they are delivered at the subcutaneous or intradermal level. Needle overpenetration of the intramuscular level into the bone or periosteum can cause pain and/or damage to the bone or periosteum, and it can cause the needle to detach from the syringe. REVIEW OF CDC GUIDELINES BY William C. Lippert and Eric J. Wall Use of the Centers for Disease Control and Prevention's recommended 1–1 1/4 inch needles for intramuscular vaccination in the thigh of children 1 year of age would result in 11% (11 of 100) and 39% (34 of 88) overpenetration, respectively, with a minimal risk for underpenetration at 2% (2 of 100). Patients with vaccinations in the shoulder with the Centers for Disease Control and Prevention–recommended 5/8–1 inches needles would experience 11% (16 of 150), 55% (83 of 150), and 61% (92 of 150) overpenetration, respectively. RECOMMENDATIONS • For vaccination in the shoulder, the new recommendations are a 1/2 inch needle (for any girl weighing 70 kg or less and any boy weighing 75 kg or less) • To ensure proper intramuscular injections in the thigh muscle, the study authors therefore recommend a 7/8 inch or longer needle for all children up to age 6 years. Full article available at: Optimal Intramuscular Needle-Penetration Depth http://pediatrics.aappublications.org/cgi/content/abstract/peds.2008-0374v1?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=1&andorexacttitle=and&andorexacttitleabs=and&fulltext=Needle-Length+&andorexactfulltext=phrase&searchid=1&FIRSTINDEX=0&sortspec=relevance&resourcetype=HWCIT&eaf http://www.medscape.com/viewarticle/579120?src=mpnews&spon=34&uac=67363AY THE ISSUES FOR DISCUSSION: [list=1] Are the results generalisable to children in developing countries with higher malnutrition rates and less subcutaneous fat? Will the needles in such settings be required to be shorter due to less subcutaneous fat? Can data from nutritional surveys give an answer or do we need more studies? [/ol] [list=1] The current length of Kojak Selinge used in immunisation programme in India is 1.2/1.0 inches. How can the current recommendation be adapted in the current supplied syringes- for instance- insert 1¾ of the needle? [/ol] Dr RK Sood ([email=drrksood@GMAIL.COM]drrksood@GMAIL.COM[/email]) India Post generated using Mail2Forum (http://www.mail2forum.com)


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