*The Pneumovax and IPV vaccines can be given either IM or Subcutaneously (SQ).
There are exceptions though. Kids with hemophilia can get IPV and the hepatitis A and B vaccines SQ, instead of IM.
Where to Give IM Injections?
After asking how many shots they are going to get, kids often ask where they are going to get them.
While newborns, infants, and younger toddlers get their IM injections in their anterolateral thigh muscle, older children typically get them in their anterolateral thigh muscle or in the deltoid muscle of their arm.
Be sure to use the correct needle size, length and gauge, and insert the needle with a quick thrust at a 90° angle to the skin (rapid injection technique). 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 IM Vaccines
It is important to know which vaccines need to be given intramuscularly (IM) and both how and where to give these shots.
Today, in the United States, children typically get:
36 doses of 10 vaccines (HepB, DTaP, Hib, Prevnar, IPV, Rota, MMR, Varivax, HepA, Flu) before starting kindergarten that protect them against 14 vaccine-preventable diseases
at least three or four more vaccines as a preteen and teen, including a Tdap booster and vaccines to protect against HPV and meningococcal disease, plus they continue to get a yearly flu vaccine
So by age 18, that equals about 57 dosages of 14 different vaccines to protect them against 16 different vaccine-preventable diseases.
While that sounds like a lot, keep in mind that 33% of those immunizations are just from your child’s yearly flu vaccine.
Of course, kids in the United States don’t get all available vaccines and aren’t protected against all possible vaccine preventable diseases. Some vaccines are just given if traveling to a high risk area or in other special situations.
Vaccine-preventable diseases (in the United States, children and teens are routinely protected against the diseases highlighted in bold) include:
adenovirus – a military vaccine
anthrax – vaccine only given if high risk
chicken pox – (Varivax, MMRV)
cholera – vaccine only given if high risk
dengue – vaccine not available in the United States
diphtheria – (DTaP/Tdap)
hepatitis A – (HepA)
hepatitis B – (HepB)
hepatitis E – vaccine not available in the United States
HPV – (Gardasil)
Haemophilus influenzae type b – (Hib)
measles – (MMR, MMRV)
meningococcal disease – (MCV4 and MenB and MenC)
pneumococcal disease – (Prevnar13 and PneumoVax23)
pertussis – (DTaP/Tdap)
polio – (bOPV and IPV)
Q-fever – vaccine not available in the United States
rabies – vaccine only given if high risk
rotavirus – (RV1, RV5)
rubella – (MMR, MMRV)
shingles – vaccine only given to seniors
smallpox – eradicated
tetanus – (DTaP/Tdap)
tick-borne encephalitis – vaccine not available in the United States
tuberculosis – (BCG) – vaccine only given if high risk
typhoid fever – vaccine only given if high risk
yellow fever – vaccine only given if high risk
Discontinued vaccines also once protected people against Rocky mountain spotted fever, plague, and typhus.
These vaccine-preventable diseases can be contrasted with infectious diseases for which no vaccines yet exist, like RSV, malaria, norovirus, and HIV, etc., although vaccines are in the pipeline for many of these diseases.
What To Know About Vaccine Preventable Diseases
Available vaccines are helping to eliminate or control a number of vaccine-preventable diseases, like polio, measles, and diphtheria, but a lot of work is left to be done.
But few likely now that we have had rabies vaccines since 1885, a flu vaccine since 1945, or that the last case of wild polio in the United States was in 1979.
“It is hard to fully appreciate how vaccines have revolutionized modern medicine. The long schedule of vaccines may seem like a hassle, and rumors about harmful effects unnerve parents. But, the fact is, vaccines have helped save millions and millions of lives. Just a few generations ago, people lived under the constant threat of deadly infectious diseases, like smallpox, polio, and hepatitis.
Let’s look at the greatest infectious scourges of the past 1,000 years and how vaccines have mitigated or even eradicated the danger.”
Public Health Understanding Vaccines
From historical safety concerns, like the Cutter Incident in 1955 or the withdrawal of the first rotavirus vaccine in 1999, to improvements in vaccine safety and the control, elimination, and eradication of vaccine-preventable diseases, understanding the history of vaccines can help you get educated and understand that vaccines work and that they are safe and necessary.
Early History of Vaccination
In the early history of vaccination we had the the smallpox vaccine and the beginning of the pre-vaccine era – the first vaccines.
Lady Mary Wortley Montagu brings variolation to England to prevent smallpox
George Washington mandated that every soldier in the Continental Army had to be inoculated against smallpox
Edward Jenner conducts experiments in 1796 that led to the creation of the first smallpox vaccine a few years later and replaces variolation as a preventative for smallpox
*Dr. Luigi Sacco becomes the Jenner of Italy
James Madison, one of the Founding Fathers, signed the Vaccine Act of 1813 – An Act to encourage Vaccination.
a vaccine for rabies is developed by Louis Pasteur in 1885
vaccines for cholera and typhoid were developed in 1896 and a plague vaccine in 1887
the first diphtheria vaccine is developed in about 1913 through the work of Emil Adolf Behring, William Hallock Park, and others
the first whole-cell pertussis vaccines is developed in 1914, although it will take several decades before they are more widely used
a tetanus vaccine is developed in 1927
12 children die when a multi-use bottle of diphtheria vaccine that didn’t contain a preservative became contaminated with bacteria in the Queensland Disaster in 1928
Max Theiler develops the first yellow fever vaccine in 1936
the AAP formally approves the use of a pertussis vaccine created by Pearl Kendrick and Grace Eldering in 1943
the first flu vaccine is licensed for use in the US in 1945
End of the Pre-Vaccine Era
In the mid-20th century, we started to get vaccines to control diseases that many of us have never seen, like polio, measles, and rubella.
the individual diphtheria, tetanus, and pertussis vaccines become combined in a single DTP vaccine in 1948
the last smallpox outbreak in the United States kills one person, Lillian Barber, in the Rio Grande Valley of South Texas in 1949
the Salk inactivated polio vaccine (IPV) is introduced in 1955
President Dwight D Eisenhower signed the Polio Vaccination Assistance Act in 1955, which gave $30 million in federal grants to states to cover the costs of planning and conducting polio vaccination programs, including purchasing polio vaccine
about 200 children develop polio in 1955 from contaminated polio vaccines in what becomes known as the Cutter Incident
the live, oral Sabin polio vaccine (OPV) replaces the Salk polio vaccine in 1962
President John F Kennedy signed the Vaccination Assistance Act in 1962 (Section 317 of the Public Health Service Act), which started as a three year program to help get kids vaccinated against polio, diphtheria, tetanus, and pertussis, but it has been continuously reauthorized ever since
the first live measles vaccine was licensed in 1963 but was replaced with a further attenuated measles virus that caused fewer side effects in 1968
President Lyndon B Johnson established a legacy of US leadership in global immunization by funding the CDC Smallpox Eradication program in 1965
the MMR vaccine becomes available in 1971, combined the vaccines for measles, mumps (licensed in 1967), and rubella (1969), and was routinely given when toddlers were about 15 months old
routine vaccination with smallpox vaccines end in the US in 1972
The Vaccination Era
The end of the 20th century brought more vaccines and protection against even more now vaccine preventable diseases.
Pneumovax, the first pneumococcal vaccine that protects kids and adults from certain types of Streptococcus pneumoniae bacteria is approved in 1971 and is given to high-risk kids
President Jimmy Carter’s National Childhood Immunization Initiative in 1977 reached its goal of immunizing 90% of children
the Thirty-Third World Health Assembly declares that smallpox is eradicated in 1979
Menomune, the first meningococcal vaccine is licensed in 1981 and is recommended for high-risk kids until it is later replaced by Menactra
a plasma-derived hepatitis B vaccine is licensed in 1981
a Haemophilus b capsular polysaccharide vaccine is licensed in 1985, but unfortunately does not provide good protection in kids younger than 18 to 24 months, who are most at risk for Haemophilus influenzae Type b disease
a recombinant hepatitis B vaccine (Recombivax HB) is approved in 1986 but is only recommended to be used in those at high risk for infection
another hepatitis B vaccine, Engerix-B, is approved in 1989
the first Haemophilus b conjugate vaccine (PRP-D) is approved in 1988 to provide protection against Haemophilus influenzae type b disease in all kids at least 18 months old, but in 1990, they are replaced with two improved Hib conjugate vaccines (PRP-HbOC and PRP-OMP) that can be given to infants as young as two months old
a booster dose of MMR is first recommended in 1989, but only for kids who live in counties that have at least 5 cases of measles. The routine 2 dose MMR schedule wasn’t put into use for all kids until 1994.
the Vaccine Adverse Events Reporting System (VAERS) is established in 1990
the hepatitis B and Hib vaccines are recommended for all infants in 1991
after year’s of neglect under President Reagan, President George HW Bush’s immunization action plan in 1991 once again raised immunization rates following three years of measles outbreaks
the DTaP vaccine, which is supposed to have fewer side effects than DTP is licensed, and by 1997 replaces DTP for all required doses, although DTP is never actually shown to have caused seizures or brain damage, as was once claimed in Vaccine Roulette
President Bill Clinton’s Childhood Immunization Initiative in 1993 includes signing the Vaccines for Children (VFC) Act, providing free vaccines to many children
the WHO declares that polio has been eliminated from the Western Hemisphere in 1994
a vaccine to protect kids against chicken pox (Varivax) is licensed in 1995
VAQTA, the first hepatitis A vaccine is approved by the FDA in 1996 for kids who are at least two years old, but is mainly given to kids at high risk to get hepatitis A
the Salk inactivated polio vaccine (IPV) is once again recommended for kids and replaces the oral polio vaccine (OPV) in 1996 because of a small risk of vaccine-associated paralytic poliomyelitis (VAPP), beginning with a sequential IPV-OPV vaccine schedule and then going to an all IPV schedule in 2000
RotaShield, the first rotavirus vaccine is licensed in 1998 but is soon withdrawn from the market in 1999 after it is associated with an increased risk of intussusception, a form of bowel obstruction
LYMErix, a Lyme disease vaccine, is licensed in 1998
Dr. Andrew Wakefield publishes a report in the journal Lancet and attempts to link the MMR vaccine to autism
thimerosal is removed from the vast majority of vaccines in the childhood immunization schedule in 1999 and 2000
endemic measles is declared eliminated in the United States in 2000
Prevnar, a newer pneumococcal vaccine is licensed in 2000 and is added to the immunization schedule the next year
LYMErix goes off the market because of insufficient sales in 2002
Flumist, a live, intranasal flu vaccine, is approved in 2004
endemic rubella is declared eliminated in the United States in 2004
a flu shot for all healthy children between 6 and 23 months became a formal recommendation for the 2004-05 flu season.
beginning in the 2004-05 flu season, a flu shot is recommended for women who will be pregnant during flu season, in any trimester, which is different than previous recommendations for a flu vaccine if a women was going to be beyond the first trimester of pregnancy during flu season. Unfortunately, even though they are in a high-risk category, only about only 13% of pregnant women received a flu vaccine in 2003.
Havrix, another hepatitis A vaccine, is approved in 2005 and the age indication for both hepatitis A vaccines is lowered to 12 months.
Menactra, a vaccine to protect against certain types of meningococcal disease is licensed in 2005 and is added to the immunization schedule in 2006, being recommended for all at 11 to 12 years of age or when they enter high school
the Tdap vaccine (Boostrix or Adacel) is recommended for teens and adults to protect them from pertussis in 2006 and replaces the previous Td vaccine that only worked against tetanus and diphtheria
RotaTeq, another rotavirus vaccine, is licensed in 2006, and is added to the immunization schedule in 2007
the hepatitis A vaccine is added to the routine childhood immunization schedule in 2006
a 2nd booster dose of the chicken pox vaccine is added to the immunization schedule in 2007 to help prevent breakthrough infections
The Post Vaccination Era
Why call it the post-vaccination era?
It has been some time since a vaccine for a new disease has been added to the routine vaccination schedule, but we are also starting to see more and more outbreaks of old diseases, especially pertussis, mumps, and measles.
another rotavirus vaccine, RotaRix, is approved in 2008
another HPV vaccine, Cervarix, is approved in 2009
another meningococcal vaccine, Menveo, is approved in 2010
a newer version of Prevnar, which can provide coverage against 13 strains of the pneumococcal bacteria, is approved and replaces the older version (Prevnar 7) in 2010
Fluzone Intradermal and Fluzone High-Dose are two new flu vaccine options that became available in 2011
a combination vaccine that protects against both Haemophilus influenzae type b and Neisseria meningitidis serogroups C and Y was approved by the FDA in 2013. MenHibrix is recommended for infants at high risk for meningococcal disease.
Quadrivalent flu vaccines, which protect against four strains of flu, become available for the 2013-14 flu season
Trumenba, the first vaccine to protect against serogroup B Meningococcal disease is approved by the FDA (October 2014). Previously, Bexsero, a MenB vaccine that is approved in some other countries, was given to some college students during outbreaks under the FDA’s expanded access program for investigational products. Both are now recommended by the ACIP for those at increased risk for meningococcal serogroup B infections.
Gardasil 9 is approved by the FDA (December 2014) to provide protection against five additional types of HPV.
Cervarix is discontinued in the US in 2016 because of poor sales
Vaxchora is approved to in 2016 for adults traveling to cholera-affected areas
MenHibrix is discontinued in the US in 2016 because of low demand
Menomune is discontinued in the US in 2017 as it was long ago replaced by the new meningococcal vaccines Menactra and Menveo
Smallpox was officially declared to have been eradicated in 1980.
Not eliminated. Not eradicated in the United States. It was eradicated.
When was the last case of smallpox?
The last wild case occurred in 1977, in Somalia. Another case occurred in 1978, but that followed a lab accident in Birmingham, England.
We still have stocks of the smallpox virus in at least two secure laboratories and with the risk that smallpox can be used as a biological weapon, we still have a smallpox vaccine.
It isn’t for just anyone though.
The live, attenuated smallpox vaccine made vaccinia virus, ACAM2000, is given as a single dose to those who are at high risk for getting smallpox.
The latest version of the smallpox vaccine was licensed in 2007 and replaced Dryvax, the previous vaccine.
The routine civilian production and distribution of a smallpox vaccine ended in 1983. We had already stopped routinely vaccinating people long before that though. Routine smallpox vaccination, which was typically given when children were about 12 months old, ended in 1972 in the United States.
Adenovirus is a very common if not well known viral infection.
It can cause cold like symptoms, a sore throat, pink eye, diarrhea, and fever, etc.
An adenovirus vaccine is available, but is only given to enlisted soldiers during basic training. A live vaccine that protects against adenovirus types 4 and 7, the vaccine helps to prevent adenovirus outbreaks among military personnel.
Although people usually think in terms of live vs inactivated vaccines, there are actually many other types of vaccines, including those made up of subunits of a virus or bacterial antigen, toxoid vaccines, conjugate vaccines, DNA vaccines, and recombinant vector vaccines.
Unlike those other vaccine types, live vaccines included a weakened version of a virus or bacteria.