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Immunizations - childhood vaccination programme - Management
How should I administer vaccines in children requiring additional immunization?

  • Obtain written or verbal consent from a person with parental responsibility, at the time of vaccination.
    • Adults over 18 years of age are presumed to be competent to consent to treatment provided they can comprehend and retain the information they are given, they believe it, and they can consider the facts and make an informed decision.
    • Young people 16 and 17 years of age are also presumed to be competent using the same criteria as older adults.
    • Younger people can also give consent if they fully understand what is involved, but ideally someone with parental responsibility should also be involved.
    • Consent may be given in writing, orally, or implied by cooperation.
  • Check that the vaccine is correct and has not expired. Wash the site with soap and water only if it is visibly dirty.
  • Routes of administration:
    • Vaccines for hepatitis B, influenza and PPV are usually administered intramuscularly using a 23-gauge (blue) or 25-gauge (orange) needle, unless the child has a bleeding disorder (in which case use the subcutaneous route to reduce the risk of bleeding).
      • For children less than 1 year of age, use the anterolateral aspect of the thigh.
      • For children over 1 year of age, use the deltoid muscle.
    • The varicella vaccine is given by deep subcutaneous injection.
    • BCG is usually given by intradermal injection at designated centres.
  • Record the site of administration. If an additional vaccine is required on the same day, use separate limbs if possible, or inject at sites at least 2.5 cm apart.
  • After administration, ensure any bleeding has stopped and check the child has no symptoms of anaphylaxis before they leave.
    • Anaphylaxis is extremely rare, and usually becomes apparent within 10 minutes. By the time the site has been checked for bleeding and documentation has been completed, most reactions will have become apparent.
    • It is prudent to have a final assessment of the person before letting them leave the premises.

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