4.2.4  Intramuscular immunization with all other EPI vaccines

All the other EPI vaccines in routine use in Ethiopia are injected intramuscularly. Intramuscular (IM) injections are administered into the muscle layer below the skin and subcutaneous tissue, using a 1 ml syringe with a 26 gauge needle pointing straight down into the muscle (Figure 4.17).

Figure 4.17  Needle position for intramuscular injections. (Source: WHO, 2001, as Figure 4.13, but Figure 2-C)

Pentavalent and pneumococcal vaccines

Pentavalent vaccine and the new pneumococcal vaccine (PCV10) are injected intramuscularly into the opposite thighs. Swab the thigh area with antiseptic solution and let it air dry, then inject 0.5 ml of vaccine as shown in Figure 4.18. Make sure the child is held securely.

Note that pentavalent vaccine and PCV10 must be given as two separate injections into opposite thighs (pentavalent on the left and PCV10 on the right).

Figure 4.18  Holding a child for immunization by intramuscular injection into the outer upper thigh. (Photo: Dr Kalid Asrat)

Tetanus toxoid (TT) vaccine

Tetanus toxoid is commonly given separately on its own to pregnant women and non-pregnant women of childbearing age. Before giving TT vaccine, you should shake the vial so that any particles of vaccine that have settled to the bottom of the vial are mixed completely with the liquid. If the tetanus toxoid is not well mixed, the correct dose may not be given.

Inject 0.5 ml of TT vaccine intramuscularly (IM) using a sterile 1 ml syringe and a sterile 22 gauge needle into the muscle of the upper left or right arm, depending on the woman’s preference (Figure 4.19). At least two doses, and ideally five doses, should be given for maximum protection of women and their newborns from tetanus.

Figure 4.19  Intramuscular injection of tetanus toxoid into a woman of childbearing age. (Source: WHO, 2004, Immunization in Practice, Module 6, Holding an Immunization Session, p.22)

You learned about the effectiveness of different numbers of TT vaccine doses in Study Session 2, Table 2.7.

The shake test

Pentavalent, PCV10 and TT vaccines are all damaged by freezing. After freezing, the vaccine tends to form flakes that quickly settle at the bottom of the vial after shaking. If you suspect the vaccine has been accidentally frozen, you should check for damage by conducting a shake test before you use it. (You will learn how to do the shake test in Study Session 6.)

4.2.3  Subcutaneous immunization with yellow fever vaccine

4.3  Oral administration of vaccines