Injection Sites for Pneumococcal and Influenza Vaccines
Both influenza and pneumococcal vaccines should be administered intramuscularly (IM) in the deltoid muscle for older children and adults, while infants and young children should receive injections in the anterolateral aspect of the thigh. 12
Influenza Vaccine Administration
Site Selection by Age
- Infants and young children: Anterolateral aspect of the thigh (preferred site)
- Older children and adults: Deltoid muscle (recommended site)
Route and Technique
- IM-administered influenza vaccines must be given by needle and syringe only (with rare exceptions for specific jet injector devices in limited age ranges)
- The standard dose is 0.5 mL administered intramuscularly
- One exception: FluMist (live attenuated vaccine) is administered intranasally, not by injection 1
Key Considerations
- Needle length should be appropriate for the patient's age and body mass to ensure proper IM delivery
- Refer to General Best Practice Guidelines for Immunization for specific needle length recommendations based on patient characteristics 1
Pneumococcal Vaccine Administration
Site and Route
- PCV13 (pneumococcal conjugate vaccine): Administered intramuscularly as a 0.5-mL dose
- Available in latex-free, single-dose, prefilled syringes
- Same anatomical sites as influenza vaccine: deltoid for adults and older children, anterolateral thigh for infants and young children 2
Important Administration Notes
- PCV13 can be administered concurrently with other routine vaccinations, including influenza vaccine
- Must use separate syringes and separate injection sites when giving multiple vaccines simultaneously
- The safety and efficacy of concurrent administration of PCV13 and PPSV23 (23-valent polysaccharide vaccine) has not been studied and is not recommended 2
Clinical Pitfalls to Avoid
- Never administer vaccines subcutaneously when IM route is specified - this may reduce immunogenicity
- Do not use the same injection site for multiple vaccines - separate sites by at least 1 inch when possible
- Avoid the gluteal region - this is not a recommended site for these vaccines due to variable fat thickness and potential for reduced immune response
- For infants, ensure proper technique in the anterolateral thigh to avoid sciatic nerve injury