When most folks think about getting a vaccine, they typically picture someone getting a shot.
It is important to remember that not all vaccines are shots though.
And even for those vaccines that are given as shots, not all of them are given intramuscularly (IM).
Some vaccines are also given orally, nasally, and subcutaneously.
Which Vaccines can be Given SQ?
Vaccines that are given by subcutaneous injection include:
- MMR
- ProQuad (MMR/V combination of MMR and chickenpox vaccines)
- Pneumovax* (Pneumococcal vaccine)
- IPV* (polio vaccine)
- Varivax (chickenpox vaccine)
- Zoster (shingles vaccine)
*The Pneumovax and IPV vaccines can be given either IM or Subcutaneously (SQ). And there are some other exceptions too. Kids with hemophilia can get the hepatitis A and B vaccines SQ, instead of IM.
Where to Give SQ Injections?
After asking how many shots they are going to get, kids often ask where they are going to get them?
While infants get their subcutaneous injections in the fatty tissue over their anterolateral thigh muscle, toddlers and older children get them in the fatty tissue over their anterolateral thigh muscle or triceps.
Be sure to use the correct needle size, length and gauge (typically 5/8″ and 23-25 gauge), and insert the needle with a quick thrust at a 45° angle to the skin (rapid injection technique), pinching up on the SQ tissue to avoid hitting the muscle, and instead injecting in the subcutaneous tissue between the skin and muscle.
Also keep in mind that it is not necessary to aspirate after injecting the needle and that multiple injections in the same extremity should be separated by at least one inch.
What to Know About SQ Vaccines
It is important to know which vaccines need to be given subcutaneously (SQ) and both how and where to give these shots.
More on SQ Vaccines
- AAP – Vaccine Administration
- ACIP – General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices
- How to Administer IM (Intramuscular) and SQ Injections
- Injectable Vaccines by Route
- Anatomic Sites for Immunization
- Administering Vaccines: Dose, Route, Site, and Needle Size
- Ask the Experts about Administering Vaccines
- CDC – Immunization: You Call the Shots-Module Eighteen- Vaccine Administration
- Don’t Be Guilty of These Preventable Errors in Vaccine Administration!
- Skills Checklist for Pediatric Immunization
- MASAC Recommendations on Administration of Vaccines to Individuals with Bleeding Disorders
- Injection vs Ingestion. Myths and Facts.
- Vaccines are a pain: What to do about it
When I was a child – late 1950s/early 1960s, my mother took me to the local health clinic when school was out each summer for a vaccine against a mosquito-borne disease. The ‘shot’ was given subcutaneously on the inside of my lower arm. It caused a small red bump similar to a mosquito bite for a couple of days, as best I recall. I asked that health dept what disease that protocol would have been for. They had no idea (in 2017 or 2018); no one remembered anything like that. Do you have any ideas? The SQ administration clearly stands out in my memory.
My question above refers to a practice in North Carolina where I lived as a child/teen.