Tag: needle size

Propaganda Busting Confirms Anti-vaccine Sites Photoshop Images

Spend a few minutes going through our list of anti-vaccine PRATTs, and you will quickly realize that they just push misinformation and propaganda.

Propaganda Busting Confirms Anti-vaccine Sites Photoshop Images

How easy is it to refute their claims?

Consider this “article” about measles outbreaks

It shows an infant with chicken pox.

While that could be a simple mistake, it is actually a Photoshopped stock image of an infant with chicken pox that adds a big scary needle and syringe, that I guess is supposed to represent a vaccine.

Where's the syringe and needle?
Where’s the syringe and needle?

The thing is, neither the chicken pox nor MMR vaccine look like that and neither would be given with such a long needle!

In fact, that needle is about twice the size as any needle that would be used on an infant or toddler, which is why they had to Photoshop a separate photo of a big syringe and needle onto the infant with chicken pox.

It's just a stock image of a big syringe and needle...
It’s just a stock image of a big syringe and needle…

Now that you know that the photo is make-believe, you shouldn’t be surprised that their “article” is too.

This erroneous thinking has led the public, media and government alike to attribute the origin of measles outbreaks, such as the one reported at Disney in 2015 (and which lead to the passing of SB277 that year, stripping vaccine exemptions for all but medical reasons in California), to the non-vaccinated, even though 18% of the measles cases occurred in those who had been vaccinated against it — hardly the vaccine’s two-dose claimed “97% effectiveness.”

Government Research Confirms Measles Outbreaks Are Transmitted By The Vaccinated

By itself, the number of cases in an outbreak doesn’t exactly tell you a vaccine’s effectiveness. You also have to know something about how many people were vaccinated and unvaccinated and the attack rate, etc.

“Among the 110 California patients, 49 (45%) were unvaccinated; five (5%) had 1 dose of measles-containing vaccine, seven (6%) had 2 doses, one (1%) had 3 doses, 47 (43%) had unknown or undocumented vaccination status, and one (1%) had immunoglobulin G seropositivity documented, which indicates prior vaccination or measles infection at an undetermined time.”

Measles Outbreak — California, December 2014–February 2015

Anyway, in the Disneyland outbreak, if you do the math correctly, you can see that only 8 of 110 were fully vaccinated, or about 7%.

What does that tell you about vaccine effectiveness?

Not much!

Again, we don’t know how many vaccinated vs unvaccinated folks were exposed and didn’t get measles.

We can guess though…

Most folks are vaccinated, even in California. So the fact that only 7% of the people that got measles in the outbreak were fully vaccinated actually says quite a lot about how effective the MMR vaccine really is.

What about the idea that vaccinated people are starting outbreaks and spreading measles?

While the vast majority of measles outbreaks are in fact traced to someone who is unvaccinated, there was one outbreak in 2011 that was “started” by someone who was vaccinated.

“She had documentation of receipt of MMR vaccination at 3 years and 4 years of age. There was no travel during the incubation period and no known sick contacts. However, the index patient worked at a theater frequented by tourists.”

Outbreak of Measles Among Persons With Prior Evidence of Immunity, New York City, 2011

Since even the MMR vaccine isn’t 100% effective, is it really so surprising that occasionally, someone who received two doses of the vaccine could get measles and pass it to others, especially considering that around 220 people got measles in the United States that year?

“During 2011, a provisional total of 222 measles cases were reported from 31 states… Most patients were unvaccinated (65%) or had unknown vaccination status (21%). Of the 222, a total of 196 were U.S. residents. Of those U.S. residents who had measles, 166 were unvaccinated or had unknown vaccination status, 141 (85%) were eligible for MMR vaccination, 18 (11%) were too young for vaccination, six (4%) were born before 1957 and presumed immune, and one (1%) had previous laboratory evidence of presumptive immunity to measles.”

Measles — United States, 2011

Is the MMR vaccine a failure because there were some still some outbreaks in the 1980s, before we started to give kids a second dose? The attack rate in many of these school outbreaks, in which many kids had one dose of MMR, was still only about 2 to 3%.

It is safe to blame a failure to vaccinate and intentionally unvaccinated kids for most of the recent measles outbreaks.

Is the MMR vaccine a failure because we still have outbreaks among intentionally unvaccinated kids and every once in a while, in someone who is fully vaccinated who gets caught up in an outbreak?

Of course not!

It is easy to do a little research, consider what disease rates looked like in the pre-vaccine era, and know that vaccines work and that they are necessary.

More on Propaganda Busting Confirms Anti-vaccine Sites Photoshop Images

Which Vaccines can be Given SQ?

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.

Older children get SQ injections in the the upper-outer triceps area.
Older children get SQ injections in the the upper-outer triceps area.

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


Vaccines and Hemophilia

Kids with hemophilia bleed.

The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends "that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age."
The Medical and Scientific Advisory Council of the National Hemophilia Foundation recommends “that patients with bleeding disorders continue to follow the American Academy of Pediatrics’ and CDC’s vaccine recommendation route and schedule for their age.”

They bleed into their joints, into their skin (hematoma), and from their mouth and gums. They can bleed after surgery and even after getting their vaccinations.

Vaccines and Hemophilia

Having hemophilia is certainly not a contraindication to getting vaccinated though.

“Your child should get regular immunizations with necessary precautions to prevent bleeding from the injection sites.”

Hemophilia FAQs

There are some precautions that are recommended before giving vaccines to a child with hemophilia, including:

  • using a 23-gauge or smaller caliber fine-gauge needle – consider a 25- or 27-gauge needle
  • when possible, giving the vaccine SQ instead of IM – for example, although the IPV (polio), hepatitis A, and hepatitis B vaccines are usually given IM, studies have shown that they can be given SQ to kids with hemophilia
  • applying firm pressure, without rubbing, after the vaccine is given for at least two minutes and up to 5 to 10 minutes
  • giving acetaminophen for pain relief, if necessary, instead of ibuprofen
  • warning about the risk of a hematoma developing at the injection site

Most importantly, if the child with hemophilia is already getting routine prophylaxis to prevent bleeding, schedule their vaccines around the same time to decrease the risk of bleeding.

Your child’s hematologist will likely give you specific instructions to provide to your pediatrician regarding immunization precautions.

What to Know About Vaccines and Hemophilia

Kids with hemophilia should get all of their vaccines on schedule, but precautions should be taken to decrease the chance of bleeding after getting an immunization.

More About Vaccines and Hemophilia