1. health and fitness
2. disease
3. cold and flu

Administering Vaccines: Dose, Route, Site, and Needle Size
Vaccines
Dose
Route
Diphtheria, Tetanus,
Pertussis (DTaP, DT, Tdap, Td)
0.5 mL
IM
Haemophilus influenzae type b
(Hib)
0.5 mL
IM
Hepatitis A (HepA)
<18 yrs: 0.5 mL
>19 yrs: 1.0 mL
IM
Hepatitis B (HepB)
<19 yrs: 0.5 mL*
>20 yrs: 1.0 mL
IM
*Persons 11–15 yrs may be given Recombivax HB (Merck)
1.0 mL adult formulation on a 2-dose schedule.
®
Injection Site and Needle Size
Subcutaneous (SC) injection
Use a 23–25 gauge needle. Choose the injection site that is appropriate
to the person’s age and body mass.
Needle
Length
Infants (1–12 mos) e"
Injection Site
Children 12 mos or older, e"
adolescents, and adults
Fatty tissue over anterolateral thigh muscle or fatty tissue over triceps
Age
Fatty tissue over anterolat-
eral thigh muscle
Intramuscular (IM) injection
Human papillomavirus (HPV)
0.5 mL
IM
Influenza, live attenuated
(LAIV)
0.2 mL
Intranasal
spray
6–35 mos: 0.25 mL
>3 yrs: 0.5 mL
IM
Newborns (1st 28 days)
e"*
Anterolateral thigh muscle
Measles, mumps, rubella
(MMR)
0.5 mL
SC
1"
Infants (1–12 mos)
Anterolateral thigh muscle
Meningococcal – conjugate
(MCV)
0.5 mL
IM
Toddlers (1–2 yrs)
1–1¼"
e–1"*
Anterolateral thigh muscle
or deltoid muscle of arm
Meningococcal – polysaccharide
(MPSV)
0.5 mL
SC
e–1"*
Children & teens
1”–1¼"
(3–18 years)
Deltoid muscle of arm or
anterolateral thigh muscle
Pneumococcal conjugate (PCV)
0.5 mL
IM
Adults 19 yrs or older
Pneumococcal polysaccharide
(PPSV)
0.5 mL
IM or SC
Male or female
less than 130 lbs e–1"*
Deltoid muscle of arm
Polio, inactivated (IPV)
0.5 mL
IM or SC
Female 130–200 lbs
Male 130–260 lbs
1–1½"
Deltoid muscle of arm
Rotavirus (RV)
2.0 mL
Oral
Female 200+ lbs
Male 260+ lbs
1½"
Deltoid muscle of arm
Varicella (Var)
0.5 mL
SC
Zoster (Zos)
0.65 mL
SC
Influenza, trivalent
inactivated (TIV)
Age
Needle
Length
0.5 mL
IM
<12 yrs: 0.5 mL
SC
HepA+HepB (Twinrix®)
>18 yrs: 1.0 mL
IM
Intramuscular (IM) injection
90° angle
45° angle
skin
skin
MMR+Var (ProQuad®)
Injection Site
*A e" needle may be used only if the skin is stretched tight, subcutaneous tissue
is not bunched, and injection is made at a 90-degree angle.
Subcutaneous (SC) injection
Combination Vaccines
DTaP+HepB+IPV (Pediarix®)
DTaP+Hib+IPV (Pentacel®)
DTaP+Hib (Trihibit®)
DTaP+IPV (Kinrix®)
Hib+HepB (Comvax®)
Use a 22–25 gauge needle. Choose the injection site and needle length
appropriate to the person’s age and body mass.
subcutaneous tissue
muscle
subcutaneous tissue
muscle
Please note: Always refer to the package insert included with each biologic for complete vaccine administration information. CDC’s Advisory Committee
on Immunization Practices (ACIP) recommendations for the particular vaccine should be reviewed as well.
Technical content reviewed by the Centers for Disease Control and Prevention, February 2009.
www.immunize.org/catg.d/p3085.pdf • Item #P3085 (2/09)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Checklist for Safe Vaccine Storage and Handling
Here are the most important things you can do to safeguard your vaccine supply. Are you doing them all? Review this list to see
where you might make improvements in your vaccine management practices. Fill in each box with either YES or NO .
Establish Storage and Handling Policies
YES
NO
1. We have designated a primary vaccine coordinator and at least one back-up coordinator to be in charge of vaccine storage and handling at our facility.
YES
NO
2. Both the primary and back-up vaccine coordinator(s) have completely reviewed either CDC's online vaccine storage and handling guidance or equivalent training materials offered by our state health department's immunization program.
YES
NO
3. We have detailed, up-to-date, written policies for general vaccine management, including policies for routine activities and an emergency vaccine-retrieval-and-storage plan for power outages and other problems. Our
policies are based on CDC's vaccine storage and handling guidance and/or on instruction from our state or local
health department's immunization program.
YES
NO
4. We review these policies with all staff annually and with new staff, including temporary staff, when they are hired.
Log In New Vaccine Shipments
5. We maintain a vaccine inventory log that we use to document the following:
YES
NO
a. Vaccine name and number of doses received
YES
NO
b. Date we received the vaccine
YES
NO
c. Condition of vaccine when we received it
YES
NO
d. Vaccine manufacturer and lot number
YES
NO
e. Vaccine expiration date
Use Proper Storage Equipment
YES
NO
6. We store vaccines in refrigerator and freezer units designed specifically for storing biologics, including vaccines. Alternatively, we keep frozen and refrigerated vaccines in separate, free-standing freezer and refrigerator units. At a minimum, we use a household-style unit with a separate exterior door for the freezer and separate thermostats for the freezer and refrigerator. We do NOT use a dormitory-style unit (a small combination freezer-refrigerator unit with a freezer compartment inside the refrigerator).
YES
NO
7.We use only calibrated thermometers with a Certificate of Traceability and Calibration* that are recalibrated as recommended by the manufacturer.
YES
NO
8.We have planned back-up storage unit(s) in the event of a power failure or other unforeseen event. We perform regular maintenance to assure optimal functioning.
Ensure Optimal Operation of Storage Units
YES NO
9. We have a "Do Not Unplug" sign next to the electrical outlets for the refrigerator and freezer and a "Do Not Stop Power" warning label by the circuit breaker for the electrical outlets. Both include emergency contact information.
YES
NO
10. We keep the storage unit clean, dusting the coils and cleaning beneath it every 3–6 months.
Maintain Correct Temperatures
YES
NO
11.We always keep at least one accurate calibrated thermometer (+/-1ºC [+/-2ºF]) with the vaccines in the refrigerator;
ideally, we have a continuous-temperature logger and/or temperature-sensitive alarm system.
YES
NO
12.We maintain the refrigerator temperature at 35–46ºF (2–8ºC), and we aim for 40ºF (5ºC).
(Maintain Correct Temperatures continued on page 2)
*Certificate of Traceability and Calibration with calibration measurements traceable to a testing laboratory accredited by the International Organization of Standardization, to the standards of the National Institute of Standards and Technology, or to another internationally recognized standards
agency.
Technical content reviewed by the Centers for Disease Control and Prevention, July 2011.
www.immunize.org/catg.d/p3035.pdf • Item #P3035 (7/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org • www.immunize.org
Checklist for Safe Vaccine Storage and Handling (continued)
(page 2 of 2)
(Maintain Correct Temperatures continued from page 1)
YES
NO
13.We keep extra containers of water in the refrigerator (e.g., in the door, on the floor of the unit where the vegetable bins were located) to help maintain cool temperatures.
YES
NO
14.We always keep at least one accurate calibrated thermometer (+/-1ºC [+/-2ºF]) with vaccines in the freezer.
YES
NO
15.We maintain the average temperature in the freezer at +5ºF (-15ºC), preferably colder but no colder than -58ºF (-50ºC).
YES
NO
16.We keep ice packs or ice-filled containers in the freezer to help maintain cold temperatures.
Store Vaccines Correctly
YES
NO
17. We post signs on the doors of the refrigerator and freezer that indicate which vaccines should be stored in the refrigerator and which in the freezer.
YES
NO
18. We do NOT store any food or drink in any vaccine storage unit.
YES
NO
19. We store vaccines in the middle of the refrigerator or freezer (never in the doors), with room for air to circulate.
YES
NO
20. We have removed all vegetable and deli bins from the storage unit.
YES
NO
21. If we are using a combination refrigerator-freezer unit, we do not store vaccines in front of the cold air outlet that leads from the freezer to the refrigerator (often near the top shelf).
YES
NO
22. We check vaccine expiration dates and rotate our supply of each type of vaccine so that we use the vaccines that will expire soonest.
YES
NO
23. We store vaccines in their original packaging in clearly labeled uncovered containers with slotted sides that allow air to circulate.
Maintain Daily Temperature Logs
YES NO
24.On days when our practice is open, we document refrigerator and freezer temperatures on the daily log twice a
day — first thing in the morning and right before our facility closes.
YES NO
25. We consistently record temperatures on the log in either Fahrenheit or Celsius. We NEVER mix in any way how we record our temperatures. For example, if the log prompts us to insert an "x" by the temperature that's preprinted on the log, we do not attempt to write in the actual temperature.
YES NO
26.
The logs show whom to call if the temperature in the storage unit goes out of range.
YES NO
27.When we change the thermostat setting, we document it in the daily log sheet's note section.
YES NO
28.
If out-of-range temperatures occur in the unit, we document in the daily log sheet's note section who responded and when.
YES NO
29.Trained staff (other than staff designated to record the temperatures) review the logs weekly.
YES NO
30.We keep the temperature logs on file for at least 3 years.
Take Emergency Action As Needed
31. In the event that vaccines are exposed to improper storage conditions, we take the following steps:
a. We restore proper storage conditions as quickly as possible; if necessary, we move the vaccine to our planned YES
NO
back-up storage unit. We address the storage unit’s mechanical or electrical problems according to guidance from the manufacturer or repair service.
YES
NO
b.In responding to improper storage conditions, we do NOT make frequent or large changes in thermostat
settings. After changing the setting, we give the unit at least a day to stabilize its temperature.
YES
NO
c.We temporarily label exposed vaccines “Do not use” and keep them separate from any unexposed vaccines. We do not use exposed vaccines until our state health department’s immunization program or the vaccine manufacturer gives us approval.
YES
NO
d.We document exactly what happened, noting the temperature in the storage unit and the amount of time the
vaccines were out of proper storage conditions. We contact our state health department’s immunization
program or the vaccine manufacturer to determine how to handle the exposed vaccines.
YES
NO
e.We follow the health department or manufacturer’s instructions and keep a record detailing the event. Where
applicable, we mark the exposed vials with a revised expiration date provided by the manufacturer.
If we answer
YES
to all of the above, we give ourselves a pat on the back! If not, we assign someone to implement needed changes!
Immunization Action Coalition • www.immunize.org/catg.d/p3035.pdf • Item #P3035 (7/11)
Form
Decision to Not Vaccinate My Child
I am the parent/guardian of the child named at the bottom of this form. My healthcare provider has recommended that my
child be vaccinated against the diseases indicated below. I have been given a copy of the Vaccine Information Statement (VIS)
that explains the benefits and risks of receiving each of the vaccines recommended for my child. I have carefully reviewed and
considered all of the information given to me. However, I have decided not to have my child vaccinated at this time. I have read
and acknowledge the following:
• I understand that some vaccine-preventable diseases (e.g.,
measles, mumps, pertussis [whooping cough]) are infecting
unvaccinated U.S. children, resulting in many hospitalizations and even deaths.
• I understand that though vaccination has led to a dramatic
decline in the number of U.S. cases of the diseases listed
below, some of these diseases are quite common in other
countries and can be brought to the U.S. by international
travelers. My child, if unvaccinated, could easily get one of
these diseases while traveling or from a traveler.
• I understand that my unvaccinated child could spread disease
to another child who is too young to be vaccinated or whose
medical condition (e.g., leukemia, other forms of cancer,
immune system problems) prevents them from being vaccinated. This could result in long-term complications and
even death for the other child.
• I understand that if every parent exempted their child from
vaccination, these diseases would return to our community
in full force.
• I understand that my child may not be protected by “herd” or
“community” immunity (i.e., the degree of protection that is
Vaccine / Disease
VIS
given
(✓)
Vaccine recommended by
doctor or nurse
(Dr./Nurse initials)
I decline this
vaccine
(Initials of parent/
guardian)
the result of having most people in a population vaccinated
against a disease).
• I understand that some vaccine-preventable diseases such
as measles and pertussis are extremely infectious and have
been known to infect even the very few unvaccinated people
living in highly vaccinated populations.
• I understand that if my child is not vaccinated and consequently becomes infected, he or she could experience serious
consequences, such as amputation, pneumonia, hospitalization, brain damage, paralysis, meningitis, seizures, deafness,
and death. Many children left intentionally unvaccinated have
suffered severe health consequences from their parents’ decision not to vaccinate them.
• I understand that my child may be excluded from his or her
child care facility, school, sports events, or other organized
activities during disease outbreaks. This means that I could
miss many days of work to stay home with my child.
• I understand that the American Academy of Pediatrics, the
American Academy of Family Physicians, and the Centers
for Disease Control and Prevention all clearly support preventing diseases through vaccination.
VIS
given
Vaccine / Disease
(✓)
Diphtheria-tetanus-pertussis (DTaP)
Meningococcal (MCV)
Haemophilus influenzae type b (Hib)
Varicella (Var)
Hepatitis A (HepA)
Pneumococcal conjugate (PCV)
Hepatitis B (HepB)
Polio, inactivated (IPV)
Human papillomavirus (HPV)
Rotavirus (RV)
Influenza
Tetanus-diphtheria (Td)
Measles-mumps-rubella (MMR)
Tetanus-diphtheria-pertussis (Tdap)
Vaccine recommended by
doctor or nurse
(Dr./Nurse initials)
I decline this
vaccine
(Initials of parent/
guardian)
In signing this form, I acknowledge I am refusing to have my child vaccinated against one or more diseases listed above; I have
placed my initials in the column titled “I decline this vaccine” to indicate the vaccine(s) I am declining. I understand that at any
time in the future, I can change my mind and vaccinate my child.
Child’s name:
Date of birth:
Parent/guardian signature:
Date:
Doctor/nurse signature:
Date:
www.immunize.org/catg.d/p4059.pdf • Item #P4059 (11/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Additional information for healthcare professionals about
IAC’s “Decision to Not Vaccinate My Child” form
Unfortunately, some parents will decide not to give their child some or all
vaccines. For healthcare providers who want to assure that these parents fully
understand the consequences of their decision, the Immunization Action
Coalition (IAC) has produced a new form titled “Decision to Not Vaccinate
My Child.” IAC’s form, which accompanies this page of additional information, facilitates and documents the discussion that a healthcare professional
can have with parents about the risks of not having their child immunized
before the child leaves the medical setting. Your use of IAC’s form demonstrates the importance you place on timely and complete vaccination, focuses
the parents’ attention on the unnecessary risk for which they are accepting
responsibility, and may encourage a vaccine-hesitant parent to accept your
recommendations. According to an American Academy of Pediatrics (AAP)
survey on immunization practices, almost all pediatricians reported that when
faced with parents who refuse vaccination they attempt to educate parents
regarding the importance of immunization and document the refusal in the
patient’s medical record.1
Recommendations from the child’s healthcare provider about a vaccine can
strongly influence parents’ final vaccination decision.2 Most parents trust
their children’s doctor for vaccine-safety information (76% endorsed “a lot
of trust”), according to researchers from the University of Michigan.3 Simi-
larly, analyses of the 2009 HealthStyles Survey found that the vast majority
of parents (81.7%) name their child’s doctor or nurse as the most important
source that helped them make decisions about vaccinating their child.4 Gust
and colleagues found that the advice of their children’s healthcare provider
was the main factor in changing the minds of parents who had been reluctant
to vaccinate their children or who had delayed their children’s vaccinations.5
Vaccine-hesitant parents who felt satisfied with their pediatricians’ discussion
of vaccination most often chose vaccination for their child.6
All parents and patients should be informed about the risks and benefits of
vaccination. This can be facilitated by providing the appropriate Vaccine
Information Statement (VIS) for each vaccine to the parent or legal representative, which is a requirement under federal law when vaccines are to be given.
When parents refuse one or more recommended immunizations, document
that you provided the VIS(s), and have the parent initial and sign the vaccine refusal form. Keep the form in the patient’s medical record. Revisit the
immunization discussion at each subsequent appointment. Some healthcare
providers may want to flag the charts of unimmunized or partially immunized
children to be reminded to revisit the immunization discussion. Flagging also
alerts the provider about missed immunizations when evaluating illness in
children, especially in young children with fever of unknown origin.
What do others say about documentation of parental refusal to vaccinate?
American Academy of Pediatrics (AAP): “Pediatricians need
to explain the risks of not vaccinating and should have (parents) sign an
informed refusal document at each visit during which vaccination is declined. A sample AAP Refusal to Vaccinate form is available at www.aap.
org/immunization.”7
Association of State and Territorial Health Officials (ASTHO):
“To address the risk of VPD, states should consider adopting more rigorous standards for non-medical vaccine exemptions that require parents
to demonstrate that they have made a conscious, concerted, and informed
decision in requesting these exemptions for their children. An example of
such a standard might include a requirement for parents to complete a form
that explicitly states the grounds for the exemption and requires them to
acknowledge awareness of the disease-specific risks associated with not
vaccinating their child(ren).”8
National Association of County & City Health Officials (NACCHO):
“School systems and childcare facilities (where appropriate) should use an
exemption application form that requires a parental signature acknowledging their understanding that their decision not to immunize places their child
and other children at risk for diseases and ensuing complications. The form
should also state that in the event of an exposure to a vaccine-preventable
illness, their child would be removed from school and all school-related activities for the appropriate two incubation periods beyond the date of onset
of the last case, which is standard public health practice.”9
Pediatric Infectious Diseases Society (PIDS): PIDS “opposes
any legislation or regulation that would allow children to be exempted from
mandatory immunizations based simply on their parents’, or, in the case of
adolescents, their own, secular personal beliefs.” PIDS further recognizes
that many states have or are considering adopting legislation or regulation
that would allow for personal belief exemptions and outlines specific provisions to minimize use of exemptions as the “path of least resistance.” One
of the provisions reads as follows: “Before a child is granted an exemption,
the parents or guardians must sign a statement that delineates the basis,
strength, and duration of their belief; their understanding of the risks that
refusal to immunize has on their child’s health and the health of others
(including the potential for serious illness or death); and their acknowledgement that they are making the decision not to vaccinate on behalf of their
child.”10
References
1. Diekema DS, and the Committee on Bioethics. Responding to parental refusals of
immunization of children. Pediatrics. 2005;115:1428-1431. http://aappolicy.aappublications.
org/cgi/content/full/pediatrics;115/5/1428
2. Brewer NT, Fazekas KI. Predictors of HPV vaccine acceptability: a theory-informed,
systematic review. Prev Med. 2007 Aug-Sep;45[2-3]:107-14. www.ncbi.nlm.nih.gov/
pubmed/17628649
3. Freed GL, Clark SJ, Butchart AT, Singer DC, Davis MM. Sources and perceived credibility
of vaccine-safety information for parents. Pediatrics. 2011 May;127 Suppl 1:S107-12. www.
ncbi.nlm.nih.gov/pubmed/21502236
4. Kennedy A, Basket M, Sheedy K. Vaccine attitudes, concerns, and information sources
reported by parents of young children: results from the 2009 HealthStyles survey.
Pediatrics. 2011; 127 Suppl 1:S92-9. www.ncbi.nlm.nih.gov/pubmed/21502253
5. Gust DA, Darling N, Kennedy A, Schwartz B. Parents with doubts about vaccines:
which vaccines and reasons why. Pediatrics. 2008;122:718-25. www.ncbi.nlm.nih.gov/
pubmed/18829793
6. Benin AL, Wisler-Scher DJ, Colson E, Shapiro ED, Holmboe ES. Qualitative analysis of
mothers’ decision-making about vaccines for infants: the importance of trust. Pediatrics.
2006;117[5]:1532-41. www.ncbi.nlm.nih.gov/pubmed/16651306
7. AAP. Communicating with Families, accessed on Oct. 17, 2011 on AAP website at www.
aap.org/immunization/pediatricians/pdf/ImproveVaccineLiabilityProtection.pdf.
8. ASTHO. Permissive State Exemption Laws Contribute to Increased Spread of Disease. 21
May 2011. Accessed on Oct. 17, 2011 on ASTHO website at www.astho.org/uploadedFiles/
Programs/Immunization/ASTHO%20Vaccine%20Refusal%20Brief.pdf
9. NACCHO. Eliminating Personal Belief Exemptions from Immunization Requirements for
Child Care and School Attendance. July 2011. Accessed on Oct. 17, 2011 on NACCHO website at
www.naccho.org/advocacy/positions/loader.cfm?csModule=security/getfile&PageID=204056
10.PIDS. A Statement Regarding Personal Belief Exemption from Immunization Mandates.
March 2011. Accessed on Oct. 17, 2011 on PIDS website at www.pids.org/images/stories/
pdf/pids-pbe-statement.pdf
www.immunize.org/catg.d/p4059.pdf • Item #P4059 (11/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Don’t Be Guilty of These Errors in Vaccine Storage and Handling
The following are frequently reported errors in vaccine storage and handling. Some of these errors are much more serious than others,
but none of them should occur. Be sure your clinic or practice is not making errors such as these.
Error #1: Designating only one person, rather than at least two,
to be responsible for storage and handling of vaccines
Since vaccines are both expensive and fragile, everyone in the office should
know the basics of vaccine handling, including what to do when a shipment
arrives and what to do in the event of an equipment failure or power outage.
It’s very important to train at least one back-up person in all aspects of proper
storage and handling of vaccines. The back-up and primary persons should be
equally familiar with all aspects of vaccine storage and handling, including knowing how to handle vaccines when they arrive, how to properly record refrigerator and freezer temperatures, and should be prepared to lead the response to
an equipment problem or power outage.
Error #2: Refrigerating vaccine in a manner that could jeopardize its quality
The temperature in the vegetable bins, on the floor, next to the walls, in the
door, and near the cold air outlet from the freezer may differ significantly from the
temperature in the body of the refrigerator: do not store your vaccines or place
thermometers in these locations. Always store vaccines in their original packaging in the body of the refrigerator away from these locations, and place your
thermometer with the vaccines. Place vaccine packages in such a way that air can
circulate around the compartment. Never overpack a refrigerator compartment.
Error #3: Storing food and drinks in the vaccine refrigerator
Frequent opening of the refrigerator door to retrieve food items can adversely
affect the internal temperature of the unit and damage vaccines.
Error #4: Inadvertently leaving the refrigerator or freezer door
open or having inadequate seals
Remind staff to close the unit doors tightly each time they open them. Also,
check the seals on the doors on a regular schedule, and if there is any indication
the door seal may be cracked or not sealing properly, have it replaced. Replacing a seal is much less costly than replacing a box of pneumococcal conjugate or
varicella vaccine.
Error #5: Storing vaccine in a dorm-style refrigerator
All vaccines should be stored in a refrigerator and/or freezer unit that is designed
specifically for the storage of biologics or, alternatively, in a separate free-standing unit. A dorm-style combination refrigerator-freezer unit with just one exterior door has been shown to be unacceptable no matter where the vaccine was
placed inside the unit. Small stand-alone refrigerator or freezer units are best for
short-term storage needs.
Error #6: Recording temperatures only once per day
Temperatures fluctuate throughout the day. Temperatures in the refrigertor and
freezer should be checked at the beginning and end of the day to determine if
the unit is getting too cold or too warm. Ideally, you should have continuous
thermometers that record temperatures all day and all night; those with alarms
can alert you when temperatures go out of range. A less expensive alternative
is to purchase maximum/minimum thermometers. Only thermometers with a
Current Certificate of Traceability and Calibration* should be used for vaccine
storage. It’s also a good idea to record the room temperature on your temperature log in case there is a problem with the storage unit. This information may
*A calibrated thermometer with a Certificate of Traceability and Calibration with calibration measurements traceable to a testing laboratory accredited by the International
Organization of Standardization, to the Standards of the National Institute of Standards and
Technology, or to another internationally recognized standards agency.
Technical content reviewed by the Centers for Disease Control and Prevention, April 2011.
be helpful to the vaccine manufacturer and/or state immunization program in
determining whether your vaccine is still usable.
Error #7: Recording temperatures for only the refrigerator or
freezer, rather than both
It is essential to monitor and record temperatures in all refrigerators and freezers used to store vaccine. At all times you should have calibrated thermometers
in the refrigerators as well as the freezers. Assure that your storage temperature monitoring is accurate by purchasing thermometers that have a Certificate
of Traceability and Calibration* and recalibrate them according to the manufacturer’s instructions. Your state immunization program may be able to provide
more information on calibrated thermometers.
Error #8: Documenting out-of-range temperatures on vaccine
temperature logs but not taking action
Documenting temperatures is not enough. Acting on the information is essential! So, what should you do? Notify your supervisor whenever you have
an out-of-range temperature. Sometimes the solution is as simple as shutting
a door left ajar or re-checking a freezer temperature that is slightly elevated as
it goes through a normal, brief defrost cycle. Check the condition of the unit
for problems. Are the seals on the door tight? Is there excessive lint or dust on
the coils? After you have made any adjustment, document the date, time, temperature, the nature of the problem, the action you took, and the results of
your action. Recheck the temperature every two hours. Call maintenance or a
repair person if the temperature is still out of range. If the solution is not quick
and easy, you will need to safeguard your vaccines by moving them to another
storage unit that is functioning at the proper temperature. Label the affected
vaccines “Do not use” and contact your state immunization program or vaccine manufacturer to find out if the affected vaccine is still usable. Be sure to
notify your state’s VFC Program Coordinator if VFC vaccine was involved.
Error #9: Discarding temperature logs at the end of every month
It’s important that you keep your temperature logs for at least three years. As
your refrigerator or freezer ages, you can track recurring problems. If out-ofrange temperatures have been documented, you can determine how long
and how often this has been happening and take appropriate action. It’s also a
great way to demonstrate why you need a new refrigerator or freezer.
Error #10: Discarding multi-dose vials 30 days after they are opened
Don’t discard your multi-dose vials of vaccines prematurely. Almost all multidose vaccine vials contain a preservative and can be used until the expiration
date on the vial unless there is actual contamination or the vials are not stored
under appropriate temperatures. However, you must discard multi-dose vials
of reconstituted vaccine (e.g., meningococcal polysaccharide, yellow fever)
if they are not used within a defined period after reconstitution. Refer to the
vaccine package inserts for detailed information.
Error #11: Not having emergency plans for a power outage or
natural disaster
Every clinic should have a written Emergency Response Plan that identifies
a refrigerator and freezer in another location (ideally, a storage unit with a
back-up generator) in which to store vaccine in the event of a power outage
or natural disaster. Consider arranging in advance for a local hospital or similar facility to be your back-up location if you should need it. Be sure back-up
location staff understand vaccine storage and will allow you to supervise placement and verify storage temperatures so vaccine is not damaged.
www.immunize.org/catg.d/p3036.pdf • Item #P3036 (4/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Emergency Response Worksheet
What to do in case of a power failure or another event that results in vaccine storage
outside of the recommended temperature range
Follow these procedures:
1. Close the door tightly and/or plug in the refrigerator/freezer.
2. Ensure the vaccine is kept at appropriate temperatures. Make sure the refrigerator/freezer is working properly or move the vaccines to a unit that is.
Do not discard the affected vaccines. Mark the vaccines so that the
potentially compromised vaccines can be easily identified.
3. Notify the local or state health department or call the manufacturer (see
manufacturers’ phone numbers below).
4. Record action taken.
Record this information*:
1. Temperature of refrigerator: current______ max.______ min.______
2. Temperature of freezer:
current______ max.______ min.______
3. Air temperature of room where refrigerator is located:______
4. Estimated amount of time the unit’s temperature was outside normal range: refrigerator _______ freezer ________
5. Vaccines in the refrigerator/freezer during the event (use the table below)
*Using a recording thermometer is the most effective method of tracking the refrigerator and freezer temperatures over time. Visually checking thermometers twice a day is an effective method to identify inconsistent or fluctuating temperatures in a refrigerator and freezer.
Vaccines Stored in Refrigerator
Vaccine, manufacturer,
and lot #
Expiration
date
# of doses
# of affected
vials
Action taken
Vaccines Stored in Freezer
Vaccine, manufacturer,
and lot #
Expiration
date
# of doses
# of affected
vials
Action taken
Other Conditions
1. Prior to this event, was the vaccine exposed to temperatures outside the recommended range? Y N
2.Were water bottles in the refrigerator and ice packs in the freezer at the time of this event?
Y N
3.Other: ______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Manufacturers
Crucell Vaccines Inc. CSL Biotherapies, Inc.
GlaxoSmithKline MedImmune, Inc.
Merck & Co., Inc. Novartis Vaccines
Pfizer Inc.
sanofi pasteur
(800) 533-5899
(888) 435-8633
(888) 825-5249
(877) 633-4411
(800) 672-6372
(800) 244-7668
(800) 438-1985
(800) 822-2463
Other Resources
Local health department phone number_____________________________ State health department phone number______________________________
Adapted by the Immunization Action Coalition, courtesy of the Michigan Department of Community Health
Technical content reviewed by the Centers for Disease Control and Prevention, October 2010.
www.immunize.org/catg.d/p3051.pdf • Item #P3051 (10/10)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Guide to Contraindications and Precautions1 to Commonly Used Vaccines in Adults*
Vaccine
Contraindications
Precautions1
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• For Tdap only: Encephalopathy (e.g., coma, decreased level
of consciousness, prolonged seizures), not attributable to another
identifiable cause, within 7 days of administration of previous dose of
DTP, DTaP, or Tdap
• Moderate or severe acute illness with or without fever
• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of
tetanus toxoid-containing vaccine
• History of arthus-type hypersensitivity reactions following a previous dose of
tetanus toxoid-containing vaccine; defer vaccination until at least 10 years
have elapsed since the last tetanus toxoid-containing vaccine
• For Tdap only: Progressive or unstable neurologic disorder, uncontrolled
seizures, or progressive encephalopathy; defer vaccination with Tdap until a
treatment regimen has been established and the condition has stabilized
Human papillomavirus (HPV)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Moderate or severe acute illness with or without fever
• Pregnancy
Measles, mumps,
rubella (MMR)2
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Pregnancy
• Known severe immunodeficiency (e.g., from hematologic and solid
tumors; receiving chemotherapy; congenital immunodeficiency; longterm immunosuppressive therapy3; or patients with HIV infection who
are severely immunocompromised)
• Moderate or severe acute illness with or without fever
• Recent (within 11 months) receipt of antibody-containing blood product
(specific interval depends on product4)
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing5
Varicella (Var)2
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Known severe immunodeficiency (e.g., from hematologic and solid
tumors, receiving chemotherapy, congenital immunodeficiency or longterm immunosuppressive therapy3 or patients with HIV infection who
are severely immunocompromised)
• Pregnancy
• Moderate or severe acute illness with or without fever
• Recent (within 11 months) receipt of antibody-containing blood product
(specific interval depends on product4)
• Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination, if possible; delay resumption of these antiviral
drugs for 14 days after vaccination
Influenza, injectable
trivalent (TIV)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component, including egg protein
• Moderate or severe acute illness with or without fever
• History of GBS within 6 wks of previous influenza vaccine
Influenza, live attenuated (LAIV)2
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component, including egg protein
• Pregnancy
• Immunosuppression
• Certain chronic medical conditions6
• Moderate or severe acute illness with or without fever
• History of GBS within 6 wks of previous influenza vaccine
• Receipt of specific antivirals (i.e., amantadine, rimantadine, zanamivir, or
oseltamivir) 48 hours before vaccination; avoid use of these antiviral drugs
for 14 days after vaccination
Pneumococcal
polysaccharide (PPSV)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Moderate or severe acute illness with or without fever
Hepatitis A (HepA)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Moderate or severe acute illness with or without fever
• Pregnancy
Hepatitis B (HepB)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Moderate or severe acute illness with or without fever
Meningococcal,
conjugate (MCV4)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Moderate or severe acute illness with or without fever
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to
a vaccine component
• Substantial suppression of cellular immunity
• Pregnancy
• Moderate or severe acute illness with or without fever
• Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination, if possible; delay resumption of these antiviral
drugs for 14 days after vaccination
Tetanus, diphtheria,
pertussis (Tdap)
Tetanus, diphtheria
(Td)
Meningococcal, polysaccharide (MPSV4)
Zoster (Zos)
Footnotes
1.Events or conditions listed as precautions should be reviewed carefully. Benefits of and
risks for administering a specific vaccine to a person under these circumstances should
be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine
should not be administered. If the benefit of vaccination is believed to outweigh the risk, the
vaccine should be administered. 2. LAIV, MMR, and varicella vaccines can be administered on the same day. If not administered on the same day, these vaccines should be separated by at least 28 days.
3.Substantially immunosuppressive steroid dose is considered to be 2 weeks or more of daily
receipt of 20 mg (or 2 mg/kg body weight) of prednisone or equivalent.
4.Vaccine should be deferred for the appropriate interval if replacement immune globulin
products are being administered (see Table 5 in CDC. “General Recommendations on
Immunization: Recommendations of the Advisory Committee on Immunization Practices
[ACIP]” at www.cdc.gov/vaccines/pubs/acip-list.htm).
5. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing
vaccine can be administered on the same day as tuberculin skin testing. If testing cannot
be performed until after the day of MMR vaccination, the test should be postponed for at
least 4 weeks after the vaccination. If an urgent need exists to skin test, do so with the
understanding that reactivity might be reduced by the vaccine.
6.For details, see CDC. “Prevention and Control of Influenza: Recommendations of the Advisory
Committee on Immunization Practices (ACIP), 2010” at www.cdc.gov/vaccines/pubs/acip-list.htm.
*Adapted from “Table 6. Contraindications and Precautions to Commonly Used Vaccines,” found in: CDC. “General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices.” MMWR 2011; 60(No. RR-2), p.40–41.
Technical content reviewed by the Centers for Disease Control and Prevention, February 2011.
www.immunize.org/catg.d/p3072.pdf • Item #P3072 (2/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Guide to Contraindications and Precautions1 to Commonly Used Vaccines*
Vaccine
Contraindications
(Page 1 of 2)
Precautions1
Hepatitis B (HepB)
• Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
• Moderate or severe acute illness with or without fever
• Infant weighing less than 2000 grams (4 lbs, 6.4 oz)2
Rotavirus
(RV5 [RotaTeq],
RV1 [Rotarix])
• Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
• Severe combined immunodeficiency (SCID)
• Moderate or severe acute illness with or without fever
• Altered immunocompetence other than SCID
• History of intussusception
• Chronic gastrointestinal disease3
• Spina bifida or bladder exstrophy3
Diphtheria, tetanus,
pertussis (DTaP)
• Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
• Encephalopathy (e.g., coma, decreased level of consciousness, prolonged seizures) not attributable to another identifiable cause within 7 days of administration of previous dose of
DTP or DTaP (for DTaP); or of previous dose of DTP, DTaP, or
Tdap (for Tdap)
• Moderate or severe acute illness with or without fever
• Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid-containing vaccine
• History of arthus-type hypersensitivity reactions after a previous
dose of tetanus toxoid-containing vaccine; defer vaccination until at
least 10 years have elapsed since the last tetanus-toxoid containing
vaccine
• Progressive or unstable neurologic disorder (including infantile
spasms for DTaP), uncontrolled seizures, or progressive encephalopathy: defer vaccination with DTaP or Tdap until a treatment regimen has been established and the condition has stabilized
For DTaP only:
• Temperature of 105° F or higher (40.5° C or higher) within 48 hours after vaccination with a previous dose of DTP/DTaP
• Collapse or shock-like state (i.e., hypotonic hyporesponsive episode) within 48 hours after receiving a previous dose of DTP/DTaP
• Seizure within 3 days after receiving a previous dose of DTP/DTaP
• Persistent, inconsolable crying lasting 3 or more hours within 48 hours after receiving a previous dose of DTP/DTaP
Tetanus, diphtheria
(DT, Td)
• Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
• Moderate or severe acute illness with or without fever
• GBS within 6 weeks after a previous dose of tetanus toxoidcontaining vaccine
• History of arthus-type hypersensitivity reactions after a previous
dose of tetanus toxoid-containing vaccine; defer vaccination
until at least 10 years have elapsed since the last tetanus-toxoid
containing vaccine
Haemophilus influenzae type b (Hib)
• Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
• Age younger than 6 weeks
• Moderate or severe acute illness with or without fever
Inactivated poliovirus • Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
vaccine (IPV)
• Moderate or severe acute illness with or without fever
• Pregnancy
Tetanus, diphtheria,
pertussis (Tdap)
Pneumococcal
(PCV or PPSV)
• For PCV13, severe allergic reaction (e.g., anaphylaxis) after a
previous dose (of PCV7, PCV13, or any diphtheria toxoid-containing vaccine) or to a vaccine component (of PCV7, PCV13,
or any diphtheria toxoid-containing vaccine)
• For PPSV, severe allergic reaction (e.g., anaphylaxis) after a
previous dose or to a vaccine component
• Moderate or severe acute illness with or without fever
Measles, mumps,
rubella (MMR)4
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or to a vaccine component
• Pregnancy
• Known severe immunodeficiency (e.g., from hematologic and
solid tumors; receiving chemotherapy; congenital immunodeficiency; or long-term immunosuppressive therapy5; or patients
with HIV infection who are severely immunocompromised)6
• Moderate or severe acute illness with or without fever
• Recent (within 11 months) receipt of antibody-containing blood
product (specific interval depends on product)7
• History of thrombocytopenia or thrombocytopenic purpura
• Need for tuberculin skin testing8
Technical content reviewed by the Centers for Disease Control and Prevention, February 2011.
www.immunize.org/catg.d/p3072a.pdf • Item #P3072a (2/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Guide to Contraindications and Precautions1 to Commonly Used Vaccines* (continued) Vaccine
Contraindications
(Page 2 of 2)
Precautions1
Varicella (Var)4
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component
• Known severe immunodeficiency (e.g., from hematologic and solid
tumors, receiving chemotherapy, congenital immunodeficiency, or
long-term immunosuppressive therapy5 or patients with HIV infection
who are severely immunocompromised)6
• Pregnancy
• Moderate or severe acute illness with or without fever
• Recent (within 11 months) receipt of antibody-containing
blood product (specific interval depends on product)7
• Receipt of specific antivirals (i.e., acyclovir, famciclovir,
or valacyclovir) 24 hours before vaccination, if possible;
delay resumption of these antiviral drugs for 14 days after
vaccination.
Hepatitis A (HepA)
• Severe allergic reaction (e.g., anaphylaxis) after a previous
dose or to a vaccine component
• Moderate or severe acute illness with or without fever
• Pregnancy
Influenza, injectable
trivalent (TIV)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component, including egg protein
• Moderate or severe acute illness with or without fever
• History of GBS within 6 weeks of previous influenza vaccine
Influenza, live attenuated (LAIV)4
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component, including egg protein
• Possible reactive airways disease in a child age 2 through 4 years
(e.g., history of recurrent wheezing or a recent wheezing episode)
• Pregnancy
• Immunosuppression
• Certain chronic medical conditions9
• Moderate or severe acute illness with or without fever
• History of GBS within 6 weeks of previous influenza vaccine
• Receipt of specific antivirals (i.e., amantadine, rimantadine,
zanamivir, or oseltamivir) 48 hours before vaccination.
Avoid use of these antiviral drugs for 14 days after vaccination.
Human papillomavirus (HPV)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component
• Moderate or severe acute illness with or without fever
• Pregnancy
Meningococcal,
conjugate (MCV4)
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component
• Moderate or severe acute illness with or without fever
• Severe allergic reaction (e.g., anaphylaxis) after a previous dose or
to a vaccine component
• Substantial suppression of cellular immunity
• Pregnancy
• Moderate or severe acute illness with or without fever
• Receipt of specific antivirals (i.e., acyclovir, famciclovir,
or valacyclovir) 24 hours before vaccination, if possible;
delay resumption of these antiviral drugs for 14 days after
vaccination.
Meningococcal, polysaccharide (MPSV4)
Zoster (Zos)
Footnotes
1. Events or conditions listed as precautions should be reviewed carefully. Benefits of and
risks for administering a specific vaccine to a person under these circumstances should
be considered. If the risk from the vaccine is believed to outweigh the benefit, the vaccine should not be administered. If the benefit of vaccination is believed to outweigh the
risk, the vaccine should be administered. Whether and when to administer DTaP to children with proven or suspected underlying neurologic disorders should be decided on a
case-by-case basis.
2. Hepatitis B vaccination should be deferred for preterm infants and infants weighing less than 2000 g if the mother is documented to be hepatitis B surface antigen
(HBsAg)-negative at the time of the infant’s birth. Vaccination can commence at
chronological age 1 month or at hospital discharge. For infants born to women who
are HBsAg-positive, hepatitis B immunoglobulin and hepatitis B vaccine should be
administered within 12 hours of birth, regardless of weight.
3. For details, see CDC. “Prevention of Rotavirus Gastroenteritis among Infants and
Children: Recommendations of the Advisory Committee on Immunization Practices.
(ACIP)” MMWR 2009;58(No. RR–2) at www.cdc.gov/vaccines/pubs/acip-list.htm.
4. LAIV, MMR, and varicella vaccines can be administered on the same day. If not administered on the same day, these vaccines should be separated by at least 28 days.
5. Substantially immunosuppressive steroid dose is considered to be 2 weeks or more of
daily receipt of 20 mg (or 2 mg/kg body weight) of prednisone or equivalent.
6. HIV-infected children may receive varicella and measles vaccine if CD4+ T-lymphocyte count is >15%. (Source: Adapted from American Academy of Pediatrics. Passive
Immunization. In: Pickering LK, ed. Red Book: 2009 Report of the Committee on Infectious Diseases. 28th ed. Elk Grove Village, IL: American Academy of Pediatrics: 2009.)
7. Vaccine should be deferred for the appropriate interval if replacement immune globulin
products are being administered (see Table 5 in CDC. “General Recommendations on
Immunization: Recommendations of the Advisory Committee on Immunization Practices (ACIP)” at www.cdc.gov/vaccines/pubs/acip-list.htm.)
8. Measles vaccination might suppress tuberculin reactivity temporarily. Measles-containing vaccine can be administered on the same day as tuberculin skin testing. If
testing cannot be performed until after the day of MMR vaccination, the test should be
postponed for at least 4 weeks after the vaccination. If an urgent need exists to skin
test, do so with the understanding that reactivity might be reduced by the vaccine.
9. For details, see CDC. “Prevention and Control of Influenza: Recommendations of the
Advisory Committee on Immunization Practices (ACIP), 2010” at www.cdc.gov/vaccines/pubs/acip-list.htm.
*Adapted from “Table 6. Contraindications and Precautions to Commonly Used Vaccines” found in: CDC. “General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization
Practices (ACIP).” MMWR 2011; 60(No. RR-2), p. 40–41.
How to Administer Intramuscular (IM) Vaccine Injections
Administer these vaccines by the intramuscular (IM) route: Diphtheria-tetanus (DT, Td) with pertussis (DTaP, Tdap); Haemophilus influenzae type b (Hib); hepatitis A (HepA); hepatitis B
(HepB); human papillomavirus (HPV); inactivated influenza (TIV); quadrivalent meningococcal conjugate (MCV4); and pneumococcal conjugate (PCV). Administer inactivated polio (IPV)
and pneumococcal polysaccharide (PPSV23) either IM or SC.
Patient age
Injection site
Needle size
Newborn (0–28 days)
Anterolateral thigh muscle
⅝"* (22–25 gauge)
Infant (1–12 months)
Anterolateral thigh muscle
1" (22–25 gauge)
Use a needle long enough to reach
deep into the muscle.
Anterolateral thigh muscle
1–1¼" (22–25 gauge)
Alternate site: Deltoid muscle of arm if
muscle mass is adequate
⅝–1"* (22–25 gauge)
Insert needle at a 90° angle to the skin
with a quick thrust.
Deltoid muscle (upper arm)
⅝–1"* (22–25 gauge)
Alternate site: Anterolateral thigh muscle
1–1¼" (22–25 gauge)
Deltoid muscle (upper arm)
1–1½"*† (22–25 gauge)
Alternate site: Anterolateral thigh muscle
1–1½" (22–25 gauge)
Toddler (1–2 years)
Children (3–18 years)
Adults 19 years and older
Needle insertion
90° angle
(Before administering an injection of
vaccine, it is not necessary to aspirate,
i.e., to pull back on the syringe plunger
after needle insertion.¶)
skin
subcutaneous tissue
Multiple injections given in the same
extremity should be separated by a
minimum of 1", if possible.
muscle
*A ⅝" needle may be used only if the skin is stretched tight, the subcutaneous tissue is not bunched, and injection is made at a 90° angle.
†A ⅝" needle is sufficient in adults weighing <130 lbs (<60 kg); a 1" needle is sufficient in adults weighing 130–152 lbs (60–70 kg);
a 1–1½" needle is recommended in women weighing 152–200 lbs (70–90 kg) and men weighing 152–260 lbs (70–118 kg); a 1½"
needle is recommended in women weighing >200 lbs (>90 kg) or men weighing >260 lbs (>118 kg).
IM site for infants and toddlers
¶
CDC. “ACIP General Recommendations on Immunization”
at www.immunize.org/acip
IM site for children
and adults
acromion
level of axilla
(armpit)
IM injection site
(shaded area)
elbow
IM injection site
(shaded area)
Insert needle at a 90° angle into the anterolateral thigh muscle.
Technical content reviewed by the Centers for Disease Control and Prevention, November 2010.
Insert needle at a 90° angle into thickest portion of deltoid muscle — above the level
of the axilla and below the acromion.
www.immunize.org/catg.d/p2020.pdf • Item #P2020 (11/10)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
How to Administer Subcutaneous (SC) Vaccine Injections
Administer these vaccines by the subcutaneous (SC) route: measles, mumps, and rubella (MMR), varicella (VAR), meningococcal polysaccharide (MPSV4), and zoster (shingles
[ZOS]). Administer inactivated polio (IPV) and pneumococcal polysaccharide (PPSV23) vaccines either SC or IM.
Injection site
Patient age
Birth to 12 mos.
12 mos. and older
Fatty tissue over the
anterolateral thigh muscle
Fatty tissue over anterolateral
thigh or fatty tissue over triceps
Needle size
⅝" needle,
23–25 gauge
⅝" needle,
23–25 gauge
Needle insertion
Pinch up on subcutaneous (SC) tissue to
prevent injection into muscle.
Insert needle at 45° angle to the skin.
(Before administering an injection of vaccine,
it is not necessary to aspirate, i.e., to pull back
on the syringe plunger after needle insertion.*)
45° angle
skin
Multiple injections given in the same
extremity should be separated by a
minimum of 1".
subcutaneous tissue
*CDC. “ACIP General Recommendations on Immunization” at
www.immunize.org/acip
SC site for infants
muscle
SC site for children (after the
1st birthday) and adults
acromion
SC injection site
(shaded area)
SC injection site
elbow
(shaded area)
Insert needle at a 45° angle into fatty tissue of the anterolateral thigh. Make sure you
pinch up on SC tissue to prevent injection into the muscle.
Technical content reviewed by the Centers for Disease Control and Prevention, November 2010.
Insert needle at a 45° angle into the fatty tissue over the triceps muscle. Make sure you pinch
up on the SC tissue to prevent injection into the muscle.
www.immunize.org/catg.d/p2020.pdf • Item #P2020 (11/10)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
How to administer intramuscular, intradermal, and intranasal influenza vaccines
Intramuscular injection
Intradermal administration
Intranasal administration
1. Use a needle long enough to reach deep into the
muscle. Infants age 6 through 11 mos: 1";
1 through 2 yrs: 1–13"; children and adults
3 yrs and older: 1–1½".
1. Gently shake the microinjection system before
administering the vaccine.
1. FluMist (LAIV) is for intranasal administration only.
Do not inject FluMist.
2. Hold the system by placing the
thumb and middle finger on
the finger pads; the index finger
should remain free.
2. Remove rubber tip protector. Do not remove dosedivider clip at the other end of the sprayer.
Live Attenuated Influenza Vaccine (LAIV)
Trivalent Inactivated Influenza Vaccine (TIV)
Trivalent Inactivated Influenza Vaccines (TIV)
2. With your left hand*, bunch up the muscle.
3. With your right hand*, insert the needle at a
90° angle to the skin with a quick thrust.
4. Push down on the plunger and inject the entire
contents of the syringe. There is no need to aspirate.
5. Remove the needle and simultaneously apply
pressure to the injection site with a dry cotton ball
or gauze. Hold in place for several seconds.
6. If there is any bleeding, cover the injection site with
a bandage.
7. Put the used syringe in a sharps container.
*Use the opposite hand if you are left-handed.
3. With the patient in an upright position
(i.e., head not tilted back), place the
tip just inside the nostril to
ensure LAIV is delivered
into the nose. The patient
should breathe normally.
3. Insert the needle perpendicular to the skin,
in the region of the deltoid, in a short, quick
movement.
4. Once the needle has been
inserted, maintain light pressure
on the surface of the skin and
inject using the index finger to
push on the plunger. Do not aspirate.
4. With a single motion, depress
plunger as rapidly as possible
until the dose-divider clip prevents
you from going further.
5. Remove the needle from the skin. With the
needle directed away from you and others,
push very firmly with the thumb on the
plunger to activate the needle shield.
You will hear a click when the
shield extends to cover the needle.
5. Pinch and remove the
dose-divider clip from
the plunger.
dose-divider clip
6. Place the tip just inside the other
nostril, and with a single motion, depress
plunger as rapidly as possible to deliver the
remaining vaccine.
6. Dispose of the applicator in a sharps container.
7. Dispose of the applicator in a sharps container.
90° angle
skin
subcutaneous tissue
muscle
www.immunize.org/catg.d/p2024.pdf • Item #P2024 (10/11)
Technical content reviewed by the Centers for Disease Control and Prevention, October 2011.
Immunization Action Coalition
•
1573 Selby Avenue
•
Saint Paul, MN 55104
•
(651) 647-9009
•
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•
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•
[email protected]
Medical Management of Vaccine Reactions in Children and Teens
All vaccines have the potential to cause an adverse reaction. To minimize adverse reactions, patients should be carefully
screened for precautions and contraindications before vaccine is administered. Even with careful screening, reactions can
occur. These reactions can vary from trivial and inconvenient (e.g., soreness, itching) to severe and life threatening (e.g.,
anaphylaxis). If reactions occur, staff should be prepared with procedures for their management. The table below describes procedures to follow if various reactions occur.
Reaction
Symptoms
Management
Localized
Soreness, redness, itching, or swelling at the
injection site
Apply a cold compress to the injection site. Consider
giving an analgesic (pain reliever) or antipruritic (antiitch) medication.
Slight bleeding
Apply an adhesive compress over the injection site.
Continuous bleeding
Place thick layer of gauze pads over site and maintain
direct and firm pressure; raise the bleeding injection
site (e.g., arm) above the level of the patient’s heart.
Fright before injection is given
Have patient sit or lie down for the vaccination.
Extreme paleness, sweating, coldness of the
hands and feet, nausea, light-headedness, dizziness, weakness, or visual disturbances
Have patient lie flat or sit with head between knees
for several minutes. Loosen any tight clothing and
maintain an open airway. Apply cool, damp cloths to
patient’s face and neck.
Fall, without loss of consciousness
Examine the patient to determine if injury is present
before attempting to move the patient. Place patient
flat on back with feet elevated.
Loss of consciousness
Check the patient to determine if injury is present before attempting to move the patient. Place patient flat
on back with feet elevated. Call 911 if patient does not
recover immediately.
Sudden or gradual onset of generalized itching,
erythema (redness), or urticaria (hives);
angioedema (swelling of the lips, face, or
throat); severe bronchospasm (wheezing);
shortness of breath; shock; abdominal
cramping; or cardiovascular collapse
See “Emergency Medical Protocol for Management
of Anaphylactic Reactions in Children and Teens” on
the next page for detailed steps to follow in treating
anaphylaxis.
Psychological
fright and
syncope
(fainting)
Anaphylaxis
(page 1 of 3)
Technical content reviewed by the Centers for Disease Control and Prevention, July 2011.
www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Medical Management of Vaccine Reactions in Children and Teens (continued)
(page 2 of 3)
Supplies you may need at a community immunization clinic

First-line treatment: Aqueous
epinephrine 1:1000 dilution, in
ampules, vials of solution, or prefilled
syringes, including epinephrine autoinjectors (e.g., EpiPen). If EpiPens
are to be stocked, both EpiPen Jr.
(0.15 mg) and adult EpiPens (0.30 mg)
should be available.

Secondary treatment option:
Diphenhydramine (Benadryl)
injectable (50 mg/mL solution) or
oral (12.5 mg/5 mL liquid, 25 or 50 mg
capsules/tablets)

Syringes: 1 and 3 cc, 22–25g, 1",
1½", and 2" needles for epinephrine
and diphenhydramine (Benadryl)

Alcohol wipes

Tourniquet

Pediatric & adult airways (small,
medium, and large)

Pediatric & adult size pocket masks
with one-way valve

Oxygen (if available)

Stethoscope

Sphygmomanometer (blood pressure
measuring device) child, adult
and extra-large cuffs)

Tongue depressors

Flashlight with extra batteries (for
examination of mouth and throat)

Wrist watch with ability to count
seconds

Cell phone or access to an onsite
phone
Emergency medical protocol for management of anaphylactic reactions in children and teens
1. If itching and swelling are confined to the injection site where the vaccination was given, observe patient closely for the development of generalized symptoms.
2. If symptoms are generalized, activate the emergency medical system (EMS; e.g., call 911) and notify the on-call physician. This should be done by a second person, while the primary nurse assesses the airway, breathing, circulation, and level of consciousness of the patient.
3. Drug Dosing Information:
a. First-line treatment: Administer aqueous epinephrine 1:1000 dilution (i.e., 1 mg/mL) intramuscularly; the standard dose is 0.01 mg/kg body weight, up to 0.3 mg maximum single dose in children and 0.5 mg maximum in adolescents (see chart on next page).
b. Secondary treatment option: For hives or itching, you may also administer diphenhydramine either orally or by intramuscular injection; the standard dose is 1–2 mg/kg body weight, up to 30 mg maximum dose in children
and 50 mg maximum dose in adolescents (see chart on next page).
4.
Monitor the patient closely until EMS arrives. Perform cardiopulmonary resuscitation (CPR), if necessary, and maintain airway. Keep patient in supine position (flat on back) unless he or she is having breathing difficulty. If breathing is difficult, patient’s head may be elevated, provided blood pressure is adequate to prevent loss of consciousness. If blood pressure is low, elevate legs. Monitor blood pressure and pulse every 5 minutes.
5. If EMS has not arrived and symptoms are still present, repeat dose of epinephrine every 5–15 minutes for up to 3 doses, depending on patient’s response.
6 Record all vital signs, medications administered to the patient, including the time, dosage, response, and the name of the medical personnel who administered the medication, and other relevant clinical information.
7. Notify the patient’s primary care physician.
(page 2 of 3)
www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Medical Management of Vaccine Reactions in Children and Teens (continued)
(page 3 of 3)
For your convenience, approximate dosages based on weight and age are provided in the charts below. Please
confirm that you are administering the correct dose for your patient.
First-Line Treatment: Epinephrine (the recommended dose for epinephrine is 0.01 mg/kg body weight)
Age Group
Infants
and
Children
Teens
Range of weight
(lb)
Range of weight
(kg)*
Epinephrine Dose
1 mg/mL injectable
(1:1000 dilution)
intramuscular
Minimum dose: 0.05 mL
EpiPen (Dey, L.P.)
Epinephrine
auto-injector 0.15 mg
or 0.3 mg
1–6 months
9–19 lb
4–8.5 kg
0.05 mL (or mg)
off label
7–36 months
20–32 lb
9–14.5 kg
0.1 mL (or mg)
off label
37–59 months
33–39 lb
15–17.5 kg
0.15 mL (or mg)
0.15 mg
5–7 years
40–56 lb
18–25.5 kg
0.2–0.25 mL (or mg)
0.15 mg
8–10 years
57–76 lb
26–34.5 kg
0.25–0.3 mL† (or mg)
0.15 mg or 0.3 mg
11–12 years
77–99 lb
35–45 kg
0.35–0.4 mL (or mg)
0.3 mg
13 years & older
100+ lb
46+ kg
0.5 mL (or mg) 0.3 mg
‡
Note: If body weight is known, then dosing by weight is preferred. If weight is not known or not readily available, dosing by age is appropriate.
*Rounded weight at the 50th percentile for each age range
†
Maximum dose for children
‡
Maximum dose for teens
Secondary Treatment Option: Diphenyhydramine (the recommended dose
for diphenhydramine [Benadryl] is 1–2 mg/kg body weight)
Age Group
Infants
and
Children
Teens
Range of weight
(lb)
Range of weight
(kg)*
Diphenhydramine Dose
12.5 mg/5 mL liquid
25 mg or 50 mg tablets
50 mg/mL injectable (IV or IM)
7–36 months
20–32 lb
9–14.5 kg
10 mg–20 mg
37–59 months
33–39 lb
15–17.5 kg
15 mg–30 mg†
5–7 years
40–56 lb
18–25.5 kg
20 mg–30 mg†
8–12 years
57–99 lb
26–45 kg
30 mg†
13 years & older
100+ lb
46+ kg
50 mg‡
Note: If body weight is known, then dosing by weight is preferred. If weight is not known or not readily available, dosing by age is appropriate.
*Rounded weight at the 50th percentile for each age range
†
Maximum dose for children
‡
Maximum dose for teens
Sources
Boyce JA, Assa’ad A, Burks AW, et al. Guidelines for the Diagnosis and Management of Food Allergy in the United States: Report of the NIAID-Sponsored Expert
Panel. Allergy Clin Immunol 2010; 126(6):S1–S57.
Simons FE, Camargo CA. Anaphylaxis: Rapid recognition and treatment. In: UpToDate, Bochnew BS (Ed). UpToDate: Waltham, MA, 2010.
These standing orders for the medical management of vaccine reactions in child and teenage patients shall remain in effect for
patients of the
until rescinded or until
name of clinic
Medical Director’s signature
date
.
Effective date
www.immunize.org/catg.d/p3082a.pdf • Item #P3082a (7/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Quick Chart of Vaccine-Preventable Disease Terms in Multiple Languages
(Page 1 of 2)
Eastern European Languages
English
Bosnian
Croatian
DTP
Detepe
Detepe
Diphtheria
difterija
difterije
Haemophilus
influenzae type b
Hemofili na
influenca tipa B
Haemophilus
influenzae tipa b
Hepatitis A
utica A,
Hepatitis A
utica A,
hepatitisa A
Human
papillomavirus
utica B,
Hepatitis B
Ljudski
papiloma virus
utica B,
hepatitisa B
papilomavirusi
čovjeka
wirusowemu
zapaleniu wątroby
typu A
wirusowemu zapaleniu wątroby typu B
wirus brodawczaka
ludzkiego
Influenza
gripa
gripe
grypa
MMR
MMR
Measles
rubeola
Hepatitis B
Meningococcal
conjugate
Polish
Romanian
Russian
Serbian
Slovak
Ukrainian
Di-Te-Per
АКДС
Detepe
DiTePe
przeciwko błonicy
difteriei
дифтерия
дифтерије
záškrt
дифтерії
Haemophilus
influenzae typu b
Haemophilus
influenzae tip b
boala
гемофільной
инфекции типа B
Хаемопхилус
инфлуензае тип
Б болести
Haemophilus
influenzae typ b
ochorenia
гемофільної інфекції
типу B захворювань
hepatita A
гепатит А
хепатитиса A
hepatitída A
гепатиту S
hepatita B
гепатит B
хепатитиса Б
hepatitída B
гепатиту В
papilomavirus
uman
вирус папилломы
человека
људски
папилома вирус
ľudský
papillomavírus
вірус папіломи
людини
gripa
грипп
грип
chrípka
грипу
ΜMR
ospice
odra
pojarul
коpЬ
Μале бοгиње
morbilli, osýpky
meningokoknog
konjugirati
meningokokom
sprzężenia
conjugate
meningococice
менингококковая
сопряженных
менингококне
коњуговано
meningokokove
j konjugovanou
менінгококова
сполучених
Mumps
zauške
zauŠnjaci
swinka
oreionul, oreion
свинка, ларотит
Эаушκе
parotitis
кір
Pertussis
veliki kašalj
kašalj hripavac
krztuścowi
tusei convulsive
коклюша
великог кашља
čierny kašeľ
кашлюку
Poliomyelitis
dje ja paraliza
dječje paralize
polio
poliomielita
пoлиомиелит
дечје парализе
detská obrna
поліомієліту
Pneumococcal
conjugate
upala plu a
pneumokoka
konjugirano
skoniugowanej
szczepionki
pneumokokowej
pneumococic
conjugat
пневмококковоя
конъюгированной
Пнеумоцоццал
коњунговане
konjugovaná
pneumokoková
пневмококковой
конъюгированной
Rotavirus
Rotavirus
rotavirusa
rotavirusy
rotavirus
ротавірусной
рота-вируса
Ροтавирус
ротавірусної
rubeola
r
rubeola, rubeolei,
pojar German
краснуха
Ρубеοла
rubeola
šindra
półpasiec
Herpes zoster
(zona zoster)
опоясывающий
лишай
херпес зостер
(појасни херпес)
pásového oparu
(pásový opar)
Rubella
male boginje
Shingles
(Herpes zoster)
ycka
Smallpox
veliki boginje
veliki boginje
ospa
variola, variolei
оспа
veliki boginje
kiahne
Tetanus
tetanus
tetanusa
tężcowi
tetanosului
столбняк
тетануса
tetanus
Tuberculosis
tuberkuloza
tuberkuloza
gruzlica
tuberculozei
туберкулеѕ
Tuberkuloza
tuberkulóza
Varicella
(chickenpox)
ospice
varicella (vodene
kozice)
ospy wietrznej (ospa
wietrzna)
şi varicelă
(varicelă)
ветряная оспа
(вітрянка)
Варицелла
(цхицкен
богиње)
ovčím kiahňam
(ovčie kiahne)
оперізуючий герпес
(оперізуючий
лишай)
правця
вітряної віспи
(вітрянка)

Immunization Action Coalition

1573 Selby Avenue

St. Paul, MN 55104

(651) 647-9009

www.immunize.org

[email protected]
Quick Chart of Vaccine-Preventable Disease Terms in Multiple Languages
(Page 2 of 2)
Western European Languages
English
Dutch
French
German
Italian
DTP
DKTP
DT Coq, DTC
Diphtheria
difterie
diphtérie
Haemophilus
influenzae type b
Haemophilus
influenzae b
Haemophilus
influenzae de
type b
Haemophilus
influenzae type b
Hepatitis A
hepatitis A
hepatite A
Hepatitis B
hepatitis B
Human
papillomavirus
humaan
papillovirus
Influenza (“flu”)
MMR
Norwegian
Portuguese
Spanish
Swedish
Tríplice
diphtherie
difterite
trippel
difteri
difteria
Difteria
difteri
Haemophilus
influenzae b
Haemophilus
influenzae tipe b
doenca
Haemophilus
influenzae tipo b
Hemófilo tipo b,
Haemophilus
influenzae tipo b
Haemophilus
influenzae typ b
hepatitis A
epatite A
hepatitt A
hepatite A
hepatitis A
hepatit A
hepatite B
hepatitis B
epatite B
hepatitt B
hepatite B
hepatitis B
hepatit B
papillovirus
humaines
humanen
papillovirus
il papillovirus
umano
humant
papillomavirus
virus do papiloma
humano
Virus del papiloma
humano
mänskliga
papillovirus
influenza (griep)
grippe
influenza (grippe)
l’nfluenzae
influensa
influenza (gripe)
influenza (gripe)
influensa
BMR
ROR
MMR
MPR
SPR
SRP
MPR
Measles
mazelen
rougeole
masern
morbillo
meslinger
sarampo
Meningococcal
conjugate
meningokokken
conjugaat
conjugué contre
le méningocoque
meningokokken
konjugatimpfstoff
coniugato meningococcico
meningokokksykdom konjugert
meningocóccica
conjugada
sarampión,
sarampión comun
meningococo
conjugada
Mumps
bof
oreillons
ziegenpeter
parotite
kusma
caçhumba
paperas, parotiditis
påssjuka
Pertussis
kinkhoest
coqueluche
keuchhusten
pertosse
kikhoste
coqueluche
coqueluche
kikhosta
Poliomyelitis
poliomyelitis
poliomyélite
kinderlähmung
poliomielite
poliomyelitt
Pneumococcal
conjugate
pneumokokken
conjugaat
antipneumococcique conjugué
pneumokokken
konjugat
pneumococcico
coniugato
pneumokokk
komjugatvaksine
poliomielite,
paralisia Infantil
pneumocócica
conjugada
polio,
poliomielitis
antineumocócica
conjugada
Rotavirus
rotavirus
rotavirus
rotavirus
rotavirus
rotavirus
rotavírus
rotavirus
rotavirus
Rubella
rode hond
- rubéole
- rubéola
röteln
rosolia
røde hunder
rubéola
(sarampo alamão)
rubéola,
sarampión aleman
röda hund
Shingles
(Herpes zoster)
gordelroos
(herpes zoster)
zona
(l’herpès zoster)
gürtelrose
(herpes zoster)
fuoco di
Sant’Antonion
(l’herpes zoster)
helvetesild
(herpes zoster)
zona
(herpes zoster)
zona de matojos
(herpes)
bältros
(herpes zoste)
Smallpox
pokken
variole
pocken
vaioloso
kopper
varíola
viruela
smittkopper
Tetanus
tetanus
tétanos
wundstarrkrampf
tetano
stivkrampe
tétano,
tetânica
tétanos, tetánica,
tétano
stelkramp
Tuberculosis
tering
tuberculose
tuberkulose
tubercolosi
tuberkulose
tuberculose
tuberculínica
tuberkulos
Varicella
(chickenpox)
varicella
(waterpokken)
varicelle
varizellen
(windpocken)
varicella
vannkopper
(vannkopper)
varicella
(catapora)
varicela
vattkopper
(Whooping cough)
(tosse asinina)
(tos ferina)
mässling
meningokockinfektion konjugatet
poliomyelitis
konjugerat
pneumokock

Immunization Action Coalition

1573 Selby Avenue

St. Paul, MN 55104

(651) 647-9009

www.immunize.org

[email protected]
Sample Vaccine Policy Statement
Ready for you to adapt for your practice
Use the vaccine policy statement below as is, or modify it to reflect
your practice’s own strong statement of support for the vital role vaccination plays in safeguarding the health of children. Your practice’s
clearly expressed commitment to immunization can be powerfully persuasive with parents who are hesitant to have their child vaccinated because of scientifically invalid information they have encountered on the
Internet or through the news media. The policy statement below was
developed by clinicians at All Star Pediatrics in Lionville, Penn., where it is
posted in every exam room and given to parents at the prenatal “meet and
greet” and newborn visit. The results have been that parents new to All Star
Pediatrics know exactly where their doctors stand on immunization, and the
families of established patients feel supported in the choice they’ve made to
immunize their children. The following statement was originally published
as a letter to the editor in AAP News, May 2008, by Bradley J. Dyer, MD,
FAAP, and his colleagues at All Star Pediatrics.
[Your practice name here] Vaccine Policy Statement
We firmly believe in the effectiveness of vaccines to prevent serious illn
ness and to save lives.
We firmly believe in the safety of our vaccines.
n
We firmly believe that all children and young adults should receive all
n
of the recommended vaccines according to the schedule published by the
Centers for Disease Control and Prevention and the American Academy of
Pediatrics.
We firmly believe, based on all available literature, evidence, and curn
rent studies, that vaccines do not cause autism or other developmental disabilities. We firmly believe that thimerosal, a preservative that has been in
vaccines for decades and remains in some vaccines, does not cause autism
or other developmental disabilities.
We firmly believe that vaccinating children and young adults may
n
be the single most important health-promoting intervention we perform as health care providers, and that you can perform as parents/
caregivers. The recommended vaccines and their schedule given
are the results of years and years of scientific study and data gathering on millions of children by thousands of our brightest scientists and
physicians.
These things being said, we recognize that there has always been and will
likely always be controversy surrounding vaccination. Indeed, Benjamin
Franklin, persuaded by his brother, was opposed to smallpox vaccine until
scientific data convinced him otherwise. Tragically, he had delayed inoculating his favorite son Franky, who contracted smallpox and died at the age
of 4, leaving Ben with a lifetime of guilt and remorse. Quoting Mr. Franklin’s autobiography:
“In 1736, I lost one of my sons, a fine boy of four years old, by the
smallpox . . . I long regretted bitterly, and still regret that I had not
given it to him by inoculation. This I mention for the sake of parents
who omit that operation, on the supposition that they should never
forgive themselves if a child died under it, my example showing that
the regret may be the same either way, and that, therefore, the safer
should be chosen.”
The vaccine campaign is truly a victim of its own success. It is precisely
because vaccines are so effective at preventing illness that we are even discussing whether or not they should be given. Because of vaccines, many of
you have never seen a child with polio, tetanus, whooping cough, bacterial
meningitis, or even chickenpox, or known a friend or family member whose
child died of one of these diseases. Such success can make us complacent or
even lazy about vaccinating. But such an attitude, if it becomes widespread,
can only lead to tragic results.
nate their children. As a result of underimmunization, there were large outbreaks of measles, with several deaths from complications of the disease.
In 2010 there were more than 3000 cases of whooping cough in California,
with nine deaths in children less than six months of age. Again, many of
those who contracted the illness (and then passed it on to the infants, who
were too young to have been fully vaccinated) had made a conscious decision not to vaccinate.
Furthermore, by not vaccinating your child you are taking selfish advantage
of thousands of others who do vaccinate their children, which decreases the
likelihood that your child will contract one of these diseases. We feel such
an attitude to be self-centered and unacceptable.
We are making you aware of these facts not to scare you or coerce you, but
to emphasize the importance of vaccinating your child. We recognize that
the choice may be a very emotional one for some parents. We will do everything we can to convince you that vaccinating according to the schedule
is the right thing to do. However, should you have doubts, please discuss
these with your health care provider in advance of your visit. In some
cases, we may alter the schedule to accommodate parental concerns or reservations. Please be advised, however, that delaying or “breaking up the
vaccines” to give one or two at a time over two or more visits goes against
expert recommendations, and can put your child at risk for serious illness (or even death) and goes against our medical advice as providers at
[Your practice name here]. Such additional visits will require additional
co-pays on your part. Furthermore, please realize that you will be required
to sign a “Refusal to Vaccinate” acknowledgement in the event of lengthy
delays.
All patients in the practice are required to receive a minimum of DTaP, Hib,
polio, and pneumococcal vaccines by three months of age, all AAP-recommended immunizations by two years of age, and meningococcal vaccine
and booster doses of Tdap and varicella vaccines by age 12 years.
Finally, if you should absolutely refuse to vaccinate your child despite all
our efforts, we will ask you to find another health care provider who shares
your views. We do not keep a list of such providers, nor would we recommend any such physician. Please recognize that by not vaccinating you are
putting your child at unnecessary risk for life-threatening illness and disability, and even death.
As medical professionals, we feel very strongly that vaccinating children on
schedule with currently available vaccines is absolutely the right thing to do
for all children and young adults. Thank you for your time in reading this
policy, and please feel free to discuss any questions or concerns you may
have about vaccines with any one of us.
After publication of an unfounded accusation (later retracted) that MMR
vaccine caused autism in 1998, many people in Europe chose not to vacci-
www.immunize.org/catg.d/p2067.pdf • Item #P2067 (1/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
✓
IMM-694B (9/01)
Skills Checklist for Immunization
The DVD “Immunization Techniques: Best Practices with Infants, Children, and Adults” ensures that staff administer vaccines correctly. Order online at www.immunize.org/shop/dvd-immunization-techniques.asp
The Skills
Skills Checklist
Checklistisisaaself-assessment
self-assessmenttool
toolforforhealth
healthcare
carestaff
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mance again. When all competency areas meet expectations, file the Skills Checklist in their
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complete
the Skills Checklist.
Supervisor Review
Self-Assessment
Competency
Clinical Skills,Techniques, and Procedures
A. Patient/Parent
Education
1. Welcomes patient/family, establishes rapport, and answers any questions.
Need to
Improve
Meets or
Exceeds
Need to
Improve
Meets or
Exceeds
Plan of Action*
2. Explains what vaccines will be given and which type(s) of injection will be done.
3. Accommodates language or literacy barriers and special needs of patient/parents to
help make them feel comfortable and informed about the procedure.
4. Verifies patient/parents received the Vaccine Information Statements for indicated
vaccines and had time to read them and ask questions.
5. Screens for contraindications. (MA: score NA–not applicable–if this is MD function.)
6. Reviews comfort measures and after care instructions with patient/parents,
inviting questions.
B. Medical
Protocols
1. Identifies the location of the medical protocols (i.e. immunization protocol,
emergency protocol, reference material).
2. Identifies the location of the epinephrine, its administration technique, and clinical
situations where its use would be indicated.
3. Maintains up-to-date CPR certification.
4. Understands the need to report any needlestick injury and to maintain a sharps
injury log.
C. Vaccine
Handling
1. Checks vial expiration date. Double-checks vial label and contents prior to
drawing up.
2. Maintains aseptic technique throughout.
1/ 2and
1"-1IM
" forSC.
IM (DTaP, Td, Hib, HepA, HepB, Pneumo
3. Selects the correct needle size. for
Conj., Flu); 5/ 8" for SC (MMR, Var); IPV and Pneumo Poly depends on route to be used.
4. Shakes vaccine vial and/or reconstitutes and mixes using the diluent supplied.
Inverts vial and draws up correct dose of vaccine. Rechecks vial label.
5. Labels each filled syringe or uses labeled tray to keep them identified.
6. Demonstrates knowledge of proper vaccine handling, e.g. protects MMR from light,
logs refrigerator temperature.
Adapted from California Department of Public Health • Immunization Branch
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org • www.immunize.org
www.immunize.org/catg.d/p7010.pdf • Item #P7010 (8/11) page 1 of 2
Supervisor Review
Self-Assessment
Competency
D. Administering
Immunizations
Clinical Skills,Techniques, and Procedures
Need to
Improve
Meets or
Exceeds
Need to
Improve
Meets or
Exceeds
Plan of Action*
1. Rechecks the physician’s order or instructions against prepared syringes.
2. Washes hands and if office policy puts on disposable gloves.
3. Demonstrates knowledge of the appropriate route for each vaccine. (IM for DTaP, Td,
Hib, HepA, HepB, Pneumo Conj, Flu; SC for MMR, Var; Either SC or IM for IPV and Pneumo Poly).
4. Positions patient and/or restrains the child with parent’s help; locates anatomic
landmarks specific for IM or SC
5. Preps the site with an alcohol wipe using a circular motion from the center to a
2" to 3" circle. Allows alcohol to dry.
6. Controls the limb with the non-dominant hand; holds the needle an inch from the
skin and inserts it quickly at the appropriate angle (45º for SC or 90º for IM).
7. Injects vaccine using steady pressure; withdraws needle at angle of insertion.
8. Applies gentle pressure to injection site for several seconds with a dry cotton ball.
9. Properly disposes of needle and syringe in sharps container. Properly disposes of
live vaccine vial.
10.Encourages comfort measures before, during and after the procedure.
E. Records
Procedures
1. Fully documents each immunization in patient’s chart: date, lot number,
manufacturer, site, VIS date, name/initials.
2. If applicable, demonstrates ability to use IZ registry or computer to call up patient
record, assess what is due today, and update computer immunization history.
3. Asks for and updates patient’s record of immunizations and reminds them to bring
it to each visit.
Plan of Action:
Circle desired next steps and write in the agreed deadline and date for the follow-up performance review. a. Watch video on immunization techniques.
b. Review office protocols. c. Review manuals, textbooks, wall charts or other guides. d. Review package inserts. e. Review vaccine handling guidelines or video. f. Observe
other staff with patients. g. Practice injections. h. Read Vaccine Information Statements. i. Be mentored by someone who has these skills. j. Role play with other staff interactions with parents and patients, including age-appropriate comfort measures. k. Attend a skills training or other courses or training. l. Attend health care customer satisfaction or
cultural competency training. m. Renew CPR certification. Other:_______________________________________
Employee Signature
Date
Plan of Action Deadline
Supervisor Signature
Date
Date of Next Performance Review
California Department of Health Services • Immunization Branch • 2151 Berkeley Way • Berkeley, CA 94704
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.vaccineinformation.org • www.immunize.org
IMM-694B (9/01)
www.immunize.org/catg.d/p7010.pdf • Item #P7010 (8/11) page 2 of 2
Suggestions to Improve Your
Immunization Services
T
Following are several ideas that healthcare professionals and practices can use to improve their
efficiency in administering vaccines and increase their immunization rates. Read each idea and check the response
that applies to your work setting. Yes = We already practice this.
No = We don’t like this idea, or it couldn’t work in our practice setting.
Partly = We do some of this (or do it sometimes); we will consider it.
Yes
1. In all exam rooms, we post the current,
official U.S. immunization schedule for
children and/or adults or variations thereof
(for example, the official schedule of a medical
society or of a state health department).
2. We use the official “catch-up” schedule for
children for advice on how to bring children
up to date on their vaccinations when they
have fallen behind.
3. We are familiar with special vaccination
recommendations for high-risk patients
(e.g., special groups who need hepatitis A,
hepatitis B, pneumococcal, influenza
vaccines).
4. When scheduling appointments, we remind
patients/parents to bring along their (or their
child’s) personal immunization record. We
also confirm the address and phone number
in case we need to contact them.
No
Partly
Yes
10. We provide vaccination services during some
evening and/or weekend hours.
11. Patients can walk in during office hours for
a “nurse only” visit and get vaccinated.
12. We use all patient encounters (including
acute-care and follow-up visits) to assess
and provide vaccinations.
13. Whenever a patient comes in, the staff
routinely asks to see his/her immunization
record to determine if the patient received
vaccinations at another healthcare site.
14. If a patient tells us “I’m up to date with my
vaccinations,” or “my child’s vaccinations
are up to date,” we are not convinced. We
must have written documentation.
15. We ask patients/parents to complete a
simple screening questionnaire for contraindications to determine if the vaccinations
they need can be given safely on the day
of their visit. To save time, we have them
complete it prior to seeing the clinician (e.g.,
in the waiting room or exam room).
6. Our staff are trained to administer multiple
vaccinations to patients who are due for
multiple vaccinations.
16. Before the clinician sees the patient, a
staff member completes an immunization
assessment and gives Vaccine Information
Statements (VISs) to the patient/parent to
read. If they need a VIS in another language,
we give it, if it is available.
8. We maintain a comprehensive immunization record in a visible location in each
patient’s chart (e.g., the front of the chart).
Technical content reviewed by the Centers for Disease Control and Prevention, June 2008.
Partly
9. Prior to patient visits, we review the
immunization record for each patient and
flag charts of those who are due or overdue.
5. We’ve trained our nursing and office staff
(e.g., receptionist, scheduler) to know
how to determine valid and invalid contraindications to vaccinations, as well as the
minimum intervals permissible between
vaccinations. This training ensures that our
clinic staff miss no opportunity to vaccinate.
7. Our nurses can give vaccinations under
standing orders (i.e., they can independently
screen patients and administer vaccines
under pre-existing signed physician’s orders).
No
17. We can call on translators when we need
to communicate with patients who speak
little or no English.
(continued on next page)
www.immunize.org/catg.d/p2045.pdf • Item #P2045 (6/08)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Continued from previous page
Yes
18. If children in our waiting room are the
siblings or children of the patient, we pull
their charts and review their immunization
status and vaccinate them if needed before
they leave the office.
19. If no immunization record exists for a
patient at the time of the visit and we are
unable to obtain records by phone, we
give the vaccinations that we THINK are
indicated, based on the history provided
by the patient/parent. We have the patient/
parent sign a release of records to obtain
immunization records from previous
providers. If no records of previous
vaccinations can be located, the patient is
treated as if unimmunized.
20. With each patient visit, we document on
the patient’s chart that their immunization
status has been reviewed (e.g., a notation
such as “immunization status reviewed” is
pre-printed on the progress note or other
chart form).
21. We give patients/parents a simple schedule
of recommended vaccinations.
22. We give patients/parents an information
sheet about how to treat pain and fever
following vaccinations.
23. We always update the patient’s personal
immunization record card each time we
administer vaccinations. If the patient
doesn’t have a card, we give them one that
contains their vaccination history.
24. We provide resources (e.g., information,
pamphlets, websites, hotline numbers) to
patients/parents who have questions or
concerns about vaccine safety or who want
more vaccine information. We provide
translated materials, if available.
No
Yes
Partly
No
Partly
26. When giving vaccinations, we inform the
patient/parent when the next appointment
for vaccinations is due. We schedule the
visit before they leave the office if our
appointment system allows it; otherwise
we put the information in a manual tickler
system or electronic recall system.
27. If children miss “well-child” visits and can’t
be rescheduled quickly, we reschedule
them in one to two weeks for a “shots only”
visit.
28. We contact all patients who are due for
vaccinations with a reminder (e.g., by
phone or mail) and those who are past due
with a recall (e.g., using computerized
tracking or a simple tickler system).
29. If we have written confirmation that a patient
received vaccines at another site or at a
public health, school-based, worksite-based,
or community-based immunization site, we
update the patient’s medical chart with that
information, recording the vaccination
date(s) and healthcare site(s) where the
vaccination was received.
30. We routinely assess immunization levels of
our patient population, including those with
high-risk indicators. (Contact your state or
local health department’s immunization
staff for assistance in performing such an
assessment.) We share this information with
all our staff and use it to develop strategies to
improve immunization rates.
31. We a r e e n r ol l e d i n t he Va cci ne s
for Children (VFC) program so that we can
provide free vaccine to uninsured children
(0–18 years) and others who are eligible
under the state’s program.
25. If we see a patient in our office and don’t
administer a vaccination when it’s due, we
document the reason why in the patient’s
chart.
Now that you know where you stand on your office practices, you can take steps that will likely improve your
immunization rates. Talk to your local or state health department for assistance or visit the website of the
Immunization Action Coalition at www.immunize.org/izpractices for resources to help you change your
“partly” statements into “yes” statements.
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Frozen
Supplies You May Need at a Community Immunization Clinic
Vaccine options*

Diphtheria, tetanus, and pertussis (DTaP)

DTaP-HepB-IPV (Pediarix)

DTaP-Hib (Trihibit)

DTaP-Hib-IPV (Pentacel)

DTaP-IPV (Kinrix)

Haemophilus influenzae type b (Hib)

Hepatitis A

Hepatitis B

Hep B-Hib (Comvax)

Hep A-Hep B (Twinrix)

Human papillomavirus (HPV)

Influenza, trivalent injectable (TIV) (in season)

Measles, mumps, rubella (MMR)

Meningococcal

Pneumococcal conjugate (PCV)

Pneumococcal polysaccharide (PPSV)

Polio, inactivated (IPV)

Rotavirus (RV)

Tetanus-diphtheria, adult (Td)

Tetanus, diphtheria, and pertussis (Tdap)

Influenza, live attenuated intranasal (LAIV) (in season)

Measles, mumps, rubella, varicella (MMRV)

Varicella

Zoster (shingles)
Note: do not place diluent in container with dry ice.
For instructions on how to pack and transport vaccines, go to
www.immunize.org/catg.d/p3049.pdf
Immunization Clinic Documentation

Immunization clinic standing orders and protocols†

Vaccination administration records† (i.e., medical records)

Billing forms
 Screening Questionnaire for Childhood Immunization†

Screening Questionnaire for Adult Immunization†

Summary of Recommendations for Childhood and Adolescent Immunization†
 Summary of Recommendations for Adult Immunization†
 Immunization record cards for patients‡

Release of information forms

Notification of Vaccination Letter† (to send to primary clinic)

Vaccine Adverse Events Reporting (VAERS) forms

List of clinics, phone #s, and other referral sources

Supplies You May Need at a Community Immunization Clinic† (i.e., this form)

Schedules including dates and times of future clinics
Miscellaneous Office Supplies

Calendar

Stapler/staples

Pens, black and red

Rubber bands

Files

Tape

Scissors

Paper clips

Pad of paper
Technical content reviewed by the Centers for Disease Control and Prevention, May 2010.
Vaccine Information Statements (VISs)*

DTaP/DT/DTP

Polio

Hepatitis A

PCV

Hepatitis B

PPSV

HPV (Cervarix or Gardasil) 
Rotavirus

Hib

Td/Tdap

Influenza (TIV)

Varicella

Influenza (LAIV)

Zoster (shingles)

MMR

Multi-vaccine

Meningococcal
Emergency Supplies*

Standing orders for medical emergencies†

Aqueous epinephrine USP (1:1000), in ampules, vials
of solution, or prefilled syringes (including Epi-Pens)

Diphenhydramine (e.g., Benadryl) injectable (50 mg/mL solution) and oral (12.5 mg/5 mL suspension) and 25 mg or 50 mg capsules or tablets

1 and 3 cc syringes with 1", 1½", and 2" needles for epinephrine or diphenhydramine

Alcohol wipes

Tourniquet

Pediatric and adult airways (small, medium, and large)

Pediatric & adult size pocket masks with one-way valve

Oxygen (if available)

Stethoscope

Sphygmomanometer (child, adult & extra-large cuffs) 
Tongue depressors

Flashlight & extra batteries (for examination of mouth & throat)

Wrist watch with ability to count seconds

Cell phone or access to an onsite phone
Vaccine Supplies*

1 or 2 needle disposal containers

1 box of 3 cc syringes

22–25g needles

e"; 
1"; 
1½"; 
2"

1 box of medical gloves

Alcohol wipes

Spot bandaids 
Rectangular bandaids

1" gauze pads or cotton balls

Thermometers along with probe covers

Certified calibrated thermometer for vaccine cooler

Paper towels

Bleach solution in spray bottle
* Always check the expiration dates of all vaccines, medications, and medical supplies before using! In addition, be sure to check that you have the most current versions of the VISs. To learn more about VISs, visit www.immunize.org/vis.
†These materials are available at www.immunize.org/printmaterials.
‡These materials may be purchased at www.immunize.org/shop.
www.immunize.org/catg.d/p3046.pdf • Item #P3046 (5/10)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Cº Temperature Log for Freezer — Celsius
Month/Year:___________________ Days 1–15
Take Action!
Completing this temperature log: Check the temperature in the freezer compartment of your vaccine storage unit at least twice each working day. Place an
“X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s
completed form for 3 years, unless state or local jurisdictions require a longer
time period.
If temperature is too warm (above -15oC):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
If the recorded temperature is warmer than -15ºC: this represents an unacceptable temperature range. You must take action!
Staff Initials
Day of Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Room Temp.
Exact Time
ampmampmampm ampmampm ampmampmampmampmampmampmampmampmampm ampm
*Write any unacceptable
temps (above -15oC)
on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above -15ºC are too warm!
-15ºC
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Danger! Temperatures above 5oF are too warm!
Write any unacceptable temperature on the lines above* and call your VFC Rep immediately!
-16ºC
-17ºC
-18ºC
-19ºC
-20ºC
-21ºC
-22ºC
-23ºC to -40ºC
and colder†
†
Some frozen vaccines must not be stored colder than -50oC. Check the Prescribing Information on the vaccine
manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
Adapted with appreciation from California Department of Public Health
www.immunize.org/catg.d/p3038C.pdf • Item #P3038C (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Cº Temperature Log for Freezer — Celsius
Month/Year:___________________ Days 16–31
Completing this temperature log: Check the temperature in the freezer compartment of your vaccine storage unit at least twice each working day. Place an
“X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s
completed form for 3 years, unless state or local jurisdictions require a longer
time period.
If the recorded temperature is warmer than -15ºC: this represents an unacceptable temperature range. You must take action!
Take Action!
If temperature is too warm (above -15oC):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
Staff Initials
16
Day of Month
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Room Temp.
Exact Time
ampmampm ampmampm ampm ampmampmampm ampmampmampmampmampm ampmampm am pm
*Write any unacceptable
temps (above -15oC)
on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above -15ºC are too warm!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
-15ºC
-16ºC
-17ºC
-18ºC
-19ºC
-20ºC
-21ºC
-22ºC
-23ºC to -40ºC
and colder†
†
Some frozen vaccines must not be stored colder than -50oC. Check the Prescribing Information on the vaccine
manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
Adapted with appreciation from California Department of Public Health
www.immunize.org/catg.d/p3038C.pdf • Item #P3038C (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Fº Temperature Log for Freezer — Fahrenheit
Completing this temperature log: Check the temperature in the freezer compartment of your vaccine storage unit at least twice each working day. Place an
“X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s
completed form for 3 years, unless state or local jurisdictions require a longer
time period.
Month/Year:___________________ Days 1–15
Take Action!
If temperature is too warm (above 5oF):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
If the recorded temperature is warmer than 5º: this represents an unacceptable temperature range. You must take action!
Staff Initials
Day of Month
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Room Temp.
Exact Time
ampmampmampm ampmampm ampmampmampmampmampmampmampmampmampm ampm
*Write any unacceptable
temps (above 5oF)
on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above 5ºF are too warm!
5ºF
4ºF
3ºF
2ºF
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Danger! Temperatures above 5oF are too warm!
Write any unacceptable temperature on the lines above* and call your VFC Rep immediately!
1ºF
0ºF
-1ºF
-2ºF
-3ºF
-4ºF
-5ºF to -30ºF
and colder†
†
Some frozen vaccines must not be stored colder than -58oF. Check the Prescribing Information on the vaccine
manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
Adapted with appreciation from California Department of Public Health
www.immunize.org/catg.d/p3038F.pdf • Item #P3038F (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Fº Temperature Log for Freezer — Fahrenheit
Completing this temperature log: Check the temperature in the freezer compartment of your vaccine storage unit at least twice each working day. Place an
“X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s
completed form for 3 years, unless state or local jurisdictions require a longer
time period.
If the recorded temperature is warmer than 5º: this represents an unacceptable temperature range. You must take action!
Month/Year:___________________ Days 16–31
Take Action!
If temperature is too warm (above 5oF):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
Staff Initials
16
Day of Month
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Room Temp.
Exact Time
ampmampm ampmampm ampm ampmampmampm ampmampmampmampmampm ampmampm am pm
*Write any unacceptable
temps (above 5oF)
on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above 5ºF are too warm!
5ºF
4ºF
3ºF
2ºF
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Danger! Temperatures above 5oF are too warm!
Write any unacceptable temperature on the lines above* and call your VFC Rep immediately!
1ºF
0ºF
-1ºF
-2ºF
-3ºF
-4ºF
-5ºF to -30ºF
and colder†
†
Some frozen vaccines must not be stored colder than -58oF. Check the Prescribing Information on the vaccine
manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
Adapted with appreciation from California Department of Public Health
www.immunize.org/catg.d/p3038F.pdf • Item #P3038F (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Cº Temperature Log for Refrigerator — Celsius Take Action!
Completing this temperature log: Check the temperature in the refrigerator compartment of your vaccine storage unit at least twice each working day.
Place an “X” in the box that corresponds with the temperature, the time of the
temperature reading, and your initials. Once the month has ended, save each
month’s completed form for 3 years, unless state or local jurisdictions require a
longer time period.
Month/Year:___________________ Days 1–15
If temperature is too warm (above 8oC) or too cold (below 2oC):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
If the recorded temperature is warmer than 8ºC or colder than 2ºC: this
represents an unacceptable temperature range. You must take action!
Staff Initials
1
Day of Month
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Room Temp.
Exact Time
ampmampmampm ampmampm ampmampmampmampmampmampmampmampmampm ampm
*Write any unacceptable
temps (above 8oC or below
2oC) on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above 8ºC are too warm!
8ºC
7ºC
6ºC
5ºC
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Danger! Temperatures above 5oF are too warm!
Write any unacceptable temperature on the lines above* and call your VFC Rep immediately!
4ºC
3ºC
2ºC Danger! Temperatures below 2ºC are too cold!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
www.immunize.org/catg.d/p3037C.pdf • Item #P3037C (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Cº Temperature Log for Refrigerator — Celsius Take Action!
Completing this temperature log: Check the temperature in the freezer compartment of your vaccine storage unit at least twice each working day. Place an
“X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s
completed form for 3 years, unless state or local jurisdictions require a longer
time period.
If the recorded temperature is warmer than 8ºC or colder than 2ºC: this
represents an unacceptable temperature range. You must take action!
Month/Year:___________________ Days 16–31
If temperature is too warm (above 8oC) or too cold (below 2oC):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
Staff Initials
16
Day of Month
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Room Temp.
Exact Time
ampmampm ampmampm ampm ampmampmampm ampmampmampmampmampm ampmampm am pm
*Write any unacceptable
temps (above 8oC or below
2oC) on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above 8ºC are too warm!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
8ºC
7ºC
6ºC
5ºC
4ºC
3ºC
2ºC Danger! Temperatures below 2ºC are too cold!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
www.immunize.org/catg.d/p3037C.pdf • Item #P3037C (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Fº Temperature Log for Refrigerator — Fahrenheit
Take Action!
Completing this temperature log: Check the temperature in the refrigerator compartment of your vaccine storage unit at least twice each working day.
Place an “X” in the box that corresponds with the temperature, the time of the
temperature reading, and your initials. Once the month has ended, save each
month’s completed form for 3 years, unless state or local jurisdictions require a
longer time period.
Month/Year:___________________ Days 1–15
If temperature is too warm (above 46oF) or too cold (below 35oF):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
If the recorded temperature is warmer than 46ºF or colder than 35ºF: this
represents an unacceptable temperature range. You must take action!
Staff Initials
1
Day of Month
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Room Temp.
Exact Time
ampmampmampm ampmampm ampmampmampmampmampmampmampmampmampm ampm
*Write any unacceptable
temps (above 46oF or below
35oF) on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above 46ºF are too warm!
46ºF
45ºF
44ºF
43ºF
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Danger! Temperatures above 5oF are too warm!
Write any unacceptable temperature on the lines above* and call your VFC Rep immediately!
42ºF
41ºF
40ºF
39ºF
38ºF
37ºF
36ºF
35ºF
Danger! Temperatures below 35ºF are too cold!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
www.immunize.org/catg.d/p3037F.pdf • Item #P3037F (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Fº Temperature Log for Refrigerator — Fahrenheit
Take Action!
Completing this temperature log: Check the temperature in the freezer compartment of your vaccine storage unit at least twice each working day. Place an
“X” in the box that corresponds with the temperature, the time of the temperature reading, and your initials. Once the month has ended, save each month’s
completed form for 3 years, unless state or local jurisdictions require a longer
time period.
If the recorded temperature is warmer than 46ºF or colder than 35ºF: this
represents an unacceptable temperature range. You must take action!
Month/Year:___________________ Days 16–31
If temperature is too warm (above 46oF) or too cold (below 35oF):
1. Store the vaccine under proper conditions as quickly as possible.
2. Temporarily mark exposed vaccine “do not use” until you have verified whether or not the vaccine may be used.
3. Call the immunization program at your state or local health department and/or the vaccine manufacturer to determine whether the potency of the vaccine(s) has been affected: (_______) ______________________.
4. Document the action taken on the reverse side of this log.
Staff Initials
Day of Month
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Room Temp.
Exact Time
ampmampm ampmampm ampm ampmampmampm ampmampmampmampmampm ampmampm am pm
*Write any unacceptable
temps (above 46oF or below
35oF) on these lines.
Then take action!
Acceptable Temperatures
Danger! Temperatures above 46ºF are too warm!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
46ºF
45ºF
44ºF
43ºF
42ºF
41ºF
40ºF
39ºF
38ºF
37ºF
36ºF
35ºF
Danger! Temperatures below 35ºF are too cold!
Write any unacceptable temperature on the lines above* and call your state or local health department immediately!
Adapted with appreciation from California Department of Public Health
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
See back for “Vaccine Storage Troubleshooting Record”
www.immunize.org/catg.d/p3037F.pdf • Item #P3037F (8/11)
Vaccine Storage Troubleshooting Record
Date
Time
Storage Room
Unit
Temp
Temp
Problem
Action Taken
Results
Staff
Initials
Temperature Log for Refrigerator and Freezer — Celsius
Completing this temperature log: Check the temperatures in both the freezer and the
refrigerator compartments of your vaccine storage units at least twice each working day.
Place an “X” in the box that corresponds with the temperature and record the ambient
(room) temperature, the time of the temperature readings, and your initials. Once the
month has ended, save each month’s completed form for 3 years, unless state or local
jurisdictions require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
Too cold*
Aim for 5°
Too warm*
Freezer temp
Refrigerator temperature
Too warm*
Day of Month
Staff Initials
Room Temp.
Exact Time
oC Temp
>11o
10o
9o
8o
7o
6o
5o
4o
3o
2o
1o
0o
<-1o
>-12o
-13o
-14o
-15o
-16o
<-17o†
1
2
3
4
5
6
7
Month/Year:___________ Days 1–15
temperature range. Follow these steps:
1.Store the vaccine under proper conditions as quickly as possible.
2.Temporarily mark exposed vaccine “do not use” until you have verified whether or
not the vaccine may be used.
3.Call the immunization program at your state or local health department and/
or the vaccine manufacturer to determine whether the vaccine is still usable:
(_____) _________________.
4.Document the action taken on the reverse side of this log.
8
9
10
11
12
13
14
15
ampm ampm ampmampm ampm ampm ampm ampmampmampm ampmampm ampm am pm ampm
Take immediate corrective action if temperature is in shaded section*
Take immediate corrective action if temperature is in shaded section*
Take immediate corrective action if temperature is in shaded section*
†
Some frozen vaccines must not be stored colder than -50oC. Check the Prescribing Information on the vaccine manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Adapted by the Immunization Action Coalition courtesy of the Michigan Department
of Community Health and the California Department of Health Services.
www.immunize.org/catg.d/p3039c.pdf • Item #P3039C (8/11)
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
Vaccine Storage Troubleshooting Record
Use this page to record the details of the vaccine storage incident, including the date and time of the last known temperature within the appropriate vaccine storage range.
Storage Room
Date
Time
Incident Unit
Temp
Temp
Action Taken
Results
Initials
Temperature Log for Refrigerator and Freezer — Celsius
Completing this temperature log: Check the temperatures in both the freezer and the
refrigerator compartments of your vaccine storage units at least twice each working day.
Place an “X” in the box that corresponds with the temperature and record the ambient
(room) temperature, the time of the temperature readings, and your initials. Once the
month has ended, save each month’s completed form for 3 years, unless state or local
jurisdictions require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
Month/Year:___________ Days 16–31
temperature range. Follow these steps:
1.Store the vaccine under proper conditions as quickly as possible.
2.Temporarily mark exposed vaccine “do not use” until you have verified whether or
not the vaccine may be used.
3.Call the immunization program at your state or local health department and/
or the vaccine manufacturer to determine whether the vaccine is still usable:
(_____) _________________.
4.Document the action taken on the reverse side of this log.
Too cold*
Aim for 5°
Too warm*
Freezer temp
Refrigerator temperature
Too warm*
Day of Month161718 1920 21222324 25262728293031
Staff Initials
Room Temp.
Exact Time
oC Temp
ampmampmampmampmampm ampmampmampmampmampmampmampmampmampm ampmampm
>11o
10o
Take immediate corrective action if temperature is in shaded section*
9o
8o
7o
6o
5o
4o
3o
2o
1o
0o
Take immediate corrective action if temperature is in shaded section*
<-1o
>-12o
-13o
-14o
-15o
-16o
<-17o†
Take immediate corrective action if temperature is in shaded section*
†
Some frozen vaccines must not be stored colder than -50oC. Check the Prescribing Information on the vaccine manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Adapted by the Immunization Action Coalition courtesy of the Michigan Department
of Community Health and the California Department of Health Services.
www.immunize.org/catg.d/p3039c.pdf • Item #P3039C (8/11)
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
Vaccine Storage Troubleshooting Record
Use this page to record the details of the vaccine storage incident, including the date and time of the last known temperature within the appropriate vaccine storage range.
Storage Room
Date
Time
Incident Unit
Temp
Temp
Action Taken
Results
Initials
Temperature Log for Refrigerator and Freezer — Fahrenheit
Completing this temperature log: Check the temperatures in both the freezer and the
refrigerator compartments of your vaccine storage units at least twice each working day.
Place an “X” in the box that corresponds with the temperature and record the ambient
(room) temperature, the time of the temperature readings, and your initials. Once the
month has ended, save each month’s completed form for 3 years, unless state or local
jurisdictions require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
1
2
3
4
5
6
7
temperature range. Follow these steps:
1.Store the vaccine under proper conditions as quickly as possible.
2.Temporarily mark exposed vaccine “do not use” until you have verified whether or
not the vaccine may be used.
3.Call the immunization program at your state or local health department and/
or the vaccine manufacturer to determine whether the vaccine is still usable:
(_____) _________________.
4.Document the action taken on the reverse side of this log.
8
9
10
11
12
13
14
15
ampm ampm ampmampm ampm ampm ampm ampmampmampm ampmampm ampm am pm ampm
Take immediate corrective action if temperature is in shaded section*
Too warm*
Freezer temp
Too cold*
Refrigerator temperature
Too warm*
Day of Month
Staff Initials
Room Temp.
Exact Time
oF Temp
>49o
48o
47o
46o
45o
44o
43o
42o
41o
Aim for 40° 40o
39o
38o
37o
36o
35o
34o
33o
<32o
Month/Year:___________ Days 1–15
>8o
7o
6o
5o
4o
<3o†
Take immediate corrective action if temperature is in shaded section*
Take immediate corrective action if temperature is in shaded section*
†
Some frozen vaccines must not be stored colder than -58oF. Check the Prescribing Information on the vaccine manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Adapted by the Immunization Action Coalition courtesy of the Michigan Department
of Community Health and the California Department of Health Services.
www.immunize.org/catg.d/p3039f.pdf • Item #P3039F (8/11)
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
Vaccine Storage Troubleshooting Record
Use this page to record the details of the vaccine storage incident, including the date and time of the last known temperature within the appropriate vaccine storage range.
Storage Room
Date
Time
Incident Unit
Temp
Temp
Action Taken
Results
Initials
Temperature Log for Refrigerator and Freezer — Fahrenheit
Completing this temperature log: Check the temperatures in both the freezer and the
refrigerator compartments of your vaccine storage units at least twice each working day.
Place an “X” in the box that corresponds with the temperature and record the ambient
(room) temperature, the time of the temperature readings, and your initials. Once the
month has ended, save each month’s completed form for 3 years, unless state or local
jurisdictions require a longer time period.
If the recorded temperature is in the shaded zone: This represents an unacceptable
Month/Year:___________ Days 16–31
temperature range. Follow these steps:
1.Store the vaccine under proper conditions as quickly as possible.
2.Temporarily mark exposed vaccine “do not use” until you have verified whether or
not the vaccine may be used.
3.Call the immunization program at your state or local health department and/
or the vaccine manufacturer to determine whether the vaccine is still usable:
(_____) _________________.
4.Document the action taken on the reverse side of this log.
Too warm*
Freezer temp
Too cold*
Refrigerator temperature
Too warm*
Day of Month161718 1920 21222324 25262728293031
Staff Initials
Room Temp.
Exact Time
oF Temp
ampmampmampmampmampm ampmampmampmampmampmampmampmampmampm ampmampm
>49o
48o
Take immediate corrective action if temperature is in shaded section*
47o
46o
45o
44o
43o
42o
41o
Aim for 40° 40o
39o
38o
37o
36o
35o
34o
33o
Take immediate corrective action if temperature is in shaded section*
<32o
>8o
7o
6o
5o
4o
<3o†
Take immediate corrective action if temperature is in shaded section*
†
Some frozen vaccines must not be stored colder than -58oF. Check the Prescribing Information on the vaccine manufacturer’s website for specific storage temperature instructions.
Technical content reviewed by the Centers for Disease Control and Prevention, August 2011.
Adapted by the Immunization Action Coalition courtesy of the Michigan Department
of Community Health and the California Department of Health Services.
www.immunize.org/catg.d/p3039f.pdf • Item #P3039F (8/11)
Distributed by the Immunization Action Coalition • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org • [email protected]
Vaccine Storage Troubleshooting Record
Use this page to record the details of the vaccine storage incident, including the date and time of the last known temperature within the appropriate vaccine storage range.
Storage Room
Date
Time
Incident Unit
Temp
Temp
Action Taken
Results
Initials
Transporting Refrigerated Vaccine
Guidelines for vaccine transport and short-term storage
•
•
The procedure below for packing vaccine will keep all vaccines (except varicella vaccine) within recommended temperatures for 12 hours during transport and/or storage at room temperatures (inside a car, building, etc.). It will also maintain recommended temperatures if the cooler is exposed to outside temperatures as low as -4ºF for one of those 12 hours.
If the vaccine will be stored in refrigerators after transport, be sure those refrigerators have maintained temperatures between 35ºF and 46ºF for at least 3 to 5 days.
Assemble packing supplies
1. Cooler. Use hard plastic Igloo-type coolers.
Attach a “Vaccines: Do Not Freeze” label to the cooler.
2. “Conditioned” cold packs. Condition frozen gel packs by leaving
them at room temperature for 1 to 2 hours until the edges have defrosted and packs look like they’ve been “sweating.” Cold packs that are not
conditioned can freeze vaccine. Do not use dry ice.
3. Thermometer. Prepare the thermometer by placing it in the refrigerator at least 2 hours before you pack the vaccine.
4. Packing material. Use two 2-inch layers of bubble wrap.
Not using enough bubble wrap can cause the vaccine to freeze.
Pack vaccine
1. Cold packs
Spread conditioned cold packs
to cover only half of the bottom of the cooler.
4. Bubble wrap
Completely cover the vaccine with
another 2-inch layer of bubble
wrap.
2. Bubble wrap
& Thermometer
Completely cover the cold
packs with a 2-inch layer of
bubble wrap.
Then, place the thermometer/
probe on top of the bubble
wrap directly above a cold pack.
3. Vaccine
Stack layers of vaccine boxes on
the bubble wrap. Do not let the
boxes of vaccine touch the cold
packs.
5. Cold packs
Spread “conditioned” cold packs to
cover only half of the bubble wrap.
Make sure that the cold packs do
not touch the boxes of vaccine.
6. Form & display
Fill the cooler to the top with
bubble wrap. Place the thermometer’s digital display and the Return
or Transfer of Vaccines Report form
on top. It’s ok if temperatures go
above 46ºF while packing.
As soon as you reach the destination site, check the vaccine temperature. If the vaccine is:
• Between 35ºF and 46ºF, put it in the refrigerator.
• Below 35ºF or above 46ºF, contact your VFC Rep or the VFC program immediately at 1-877-243-8832. For H1N1 vaccine,
call 1-888-867-6319. Then label the vaccine “Do Not Use” and put it in the refrigerator.
www.eziz.org
California Department of Public Health, Immunization Branch
IMM-983 (2/10)
Vaccine Handling Tips
Outdated or improperly stored vaccines won’t protect patients!
Refrigerator
Freezer
DTaP, Tdap, Td, DT
Hib
Hepatitis A
Hepatitis B
MMR*
MMRV
Varicella
Zoster
Human papillomavirus
Influenza (TIV/LAIV)
Polio (IPV)
MMR*
Meningococcal
(MCV4 & MPSV4)
Pneumococcal
Maintain refrigerator temperature
between 35° and 46°F
(2° and 8°C)
(PPSV & PCV13)
Rotavirus
Maintain freezer temperature
between -58°and 5°F
(-50° and -15°C)
Manage vaccine inventories.
Inventory your vaccine supplies at least monthly and before
placing an order. Expired vaccine must never be used and
is money wasted!
Always use the vaccine with the soonest
expiration date first.
Move vaccine with the soonest expiration date to the front
of the storage unit and mark it to be used first. Keep vaccine
vials in their original boxes.
Store vaccine appropriately.†
Place vaccines in refrigerator or freezer immediately upon
receiving shipment. Keep vaccine vials in their original packaging. Place vaccine in clearly labeled wire baskets or other
open containers with a 2–3" separation between baskets and
from wall of unit. Separate vaccines that have been supplied
from your state’s Vaccines for Children program from vaccines that are privately purchased. Do not store vaccines in
the door or on the floor of the unit.
Stabilize temperatures.
Store ice packs in the freezer and large jugs of water in the
refrigerator along with the vaccines. This will help maintain a
stable, cold temperature in case of a power failure or if the refrigerator or freezer doors are opened frequently or left open.
Frequent opening of either the refrigerator or freezer door
can lead to temperature variations inside, which could affect
vaccine efficacy. For this reason you should not store food
or beverages in the refrigerator or freezer.
Safeguard the electrical supply to the refrigerator.
Make sure the refrigerator and freezer are plugged into outlets
in a protected area where they cannot be disconnected accidentally. Label the refrigerator, freezer, electrical outlets,
fuses, and circuit breakers on the power circuit with information that clearly identifies the perishable nature of vaccines
and the immediate steps to be taken in case of interruption
of power. If your building has auxiliary power, use the outlet
supplied by that system.
*MMR may be stored in either the freezer or the refrigerator.
†
Refer to package insert for specific instructions on the storage of each vaccine. If you have questions about the condition of the vaccine upon arrival,
you should immediately place the vaccine in recommended storage, mark it “do not use,” and then call your state health department or the vaccine
manufacturer(s) to determine whether the potency of the vaccine(s) has been affected. For other questions, call the immunization program at your state
or local health department.
Record your health department’s phone number here:
Technical content reviewed by the Centers for Disease Control and Prevention, December 2011.
www.immunize.org/catg.d/p3048.pdf • Item #P3048 (12/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org
Vaccines with Diluents: How to Use Them
The following vaccines must be reconstituted correctly before they are administered. Reconstitution means that
the lyophilized (freeze-dried) vaccine powder or wafer in one vial must be reconstituted (mixed) with the diluent
(liquid) in another. Only use the diluent provided by the manufacturer for that vaccine as indicated on the chart.
ALWAYS check the expiration date on the diluent and vaccine. NEVER use expired diluent or vaccine.
Lyophilized
vaccine
(powder)
Liquid diluent (may
contain vaccine)
Time allowed between
reconstitution and use*
Vaccine
product name
Manufacturer
Diluent storage
environment
ActHIB (Hib)
sanofi pasteur
ActHIB
0.4% sodium chloride
24 hrs
Hiberix (Hib)
GlaxoSmithKline
Hib
0.9% sodium chloride
24 hrs
Imovax (RABHDCV)
sanofi pasteur
Imovax
Sterile water
Immediately
M-M-R II (MMR)
Merck
MMR
Sterile water
8 hrs
Menomune
(MPSV4)
sanofi pasteur
MPSV4
Distilled water
30 min (single-dose vial)
35 days (multi-dose vial)
Refrigerator
Menveo (MCV4)
Novartis
MenA
MenCWY
8 hrs
Refrigerator
Pentacel
(DTaP-IPV/Hib)
sanofi pasteur
ActHIB
DTaP-IPV
Immediately†
Refrigerator
ProQuad (MMRV)
Merck
MMRV
Sterile water
30 min
Refrigerator or
room temp
RabAvert (RABPCECV)
Novartis
RabAvert
Sterile water
Immediately
Refrigerator
Rotarix (RV1)‡
GlaxoSmithKline
RV1
Sterile water, calcium
carbonate, and xanthan*
24 hrs
Room temp
Varivax (VAR)
Merck
VAR
Sterile water
30 min
YF-VAX (YF)
sanofi pasteur
YF-VAX
0.9% sodium chloride
60 min
Zostavax (ZOS)
Merck
ZOS
Sterile water
30 min
Refrigerator or
room temp
Refrigerator or
room temp
Refrigerator or
room temp
Refrigerator
Refrigerator or
room temp
Refrigerator
Refrigerator or
room temp
Always refer to package inserts for detailed instructions on reconstituting specific vaccines. In general, follow these steps:
1. For single-dose vaccine products (exceptions are Menomune in the multidose vial and Rotarix‡), select a syringe and a needle of proper length to be
used for both reconstitution and administration of the vaccine. Following reconstitution, Menomune in a multi-dose vial will require a new needle and
syringe for each dose of vaccine to be administered. For Rotarix, see the package insert.‡
2. Before reconstituting, check labels on both the lyophilized vaccine vial and
the diluent to verify the following:
• that they are the correct two products to mix together
• that the diluent is the correct volume (especially for Menomune in the multi-dose vial)
• that neither vaccine nor diluent has expired
3. Reconstitute (i.e., mix) vaccine just prior to use‡ by
• removing the protective caps and wiping each stopper with an alcohol swab
• inserting needle of syringe into diluent vial and withdrawing entire contents
• injecting diluent into lyophilized vaccine vial and rotating or agitating to thoroughly dissolve the lyophilized powder
4. Check the appearance of the reconstituted vaccine.
• Reconstituted vaccine may be used if the color and appearance match the description on the package insert.
• If there is discoloration, extraneous particulate matter, obvious lack of resuspension, or cannot be thoroughly mixed, mark the vial as “DO NOT USE,” return it to proper storage conditions, and contact your state or local health department immunization program or the vaccine manufacturer.
5. If reconstituted vaccine is not used immediately or comes in a multi-dose
vial (i.e., multi-dose Menomune),
• clearly mark the vial with the date and time the vaccine was reconstituted
• maintain the product at 35°–46°F (2°–8°C); do not freeze
• protect reconstituted vaccines from light
• use only within the time indicated on chart above
* If the reconstituted vaccine is not used within this time period, it must be discarded.
†
Within 30 minutes or less.
‡
Rotarix vaccine is administered by mouth using the applicator that contains the diluent. It is not administered as an injection.
Technical content reviewed by the Centers for Disease Control and Prevention, June 2011.
www.immunize.org/catg.d/p3040.pdf • Item #P3040 (6/11)
Immunization Action Coalition • 1573 Selby Ave. • St. Paul, MN 55104 • (651) 647-9009 • www.immunize.org • www.vaccineinformation.org