4.2.2  Subcutaneous immunization with measles vaccine

Where vitamin A deficiency is common among children, as in Ethiopia, vitamin A drops are given at the same time as measles vaccine, as described in Study Session 3.

Subcutaneous (SC) injections are given into the fatty tissue below the skin and above the muscle. Measles vaccine is the only routine EPI vaccine which is administered subcutaneously. The vaccine comes in powder form and must be reconstituted before use with the approved diluent (as described in Section 4.1.4), and used within six hours of reconstitution.

For the immunization, select a sterile 1 ml auto-disable (AD) syringe or a sterile syringe attached to a 23 gauge needle, and draw 0.5 ml of the reconstituted measles vaccine into the syringe. Expel any air bubbles as described above for BCG immunization (Section 4.2.1). Swab the skin of the child’s outer upper arm with antiseptic solution and let it air dry. Hold the child’s arm from below, and pinch the skin with your fingers and thumb (as shown in Figure 4.15), to push up a fold of skin on top of the arm. Push the needle a little way under the pinched-up skin. The needle should go in at a sloping angle (Figure 4.16), not straight down. Inject 0.5 ml of the vaccine into the fatty subcutaneous layer below the skin, but above the muscle.

The child shown in Figure 4.15 should be held securely by a caregiver to prevent sudden movements

Figure 4.15  Subcutaneous injection of measles vaccine. (Source: WHO, 1998, Immunization in Practice, Module 8, During a session: giving immunizations, Figure 8-N)
Figure 4.16  Needle position for subcutaneous injection of measles and yellow fever vaccines. (Source: WHO, 2001, as Figure 4.13, but Figure 2-B)

4.2.1  Intradermal immunization with BCG vaccine

4.2.3  Subcutaneous immunization with yellow fever vaccine