Routes of vaccine administration
Aerosol, intranasal
It is believed that this route of vaccine administration improves immunity at the entrance gates of airborne infections (measles, influenza, rubella, etc.) by creating an immunological barrier on the mucous membranes.
At the same time, the immunity created in this way is not stable, and at the same time, general (so-called systemic) immunity may be insufficient to combat bacteria and viruses that have already penetrated the barrier of the mucous membranes into the body. A typical example of an intranasal vaccine is one of the domestic influenza vaccines.
Aerosol vaccination technique: a few drops of the vaccine are instilled into the nose or sprayed into the nasal passages using a special device.
The advantages of this route of vaccine administration are obvious: as for oral vaccination, aerosol administration does not require special education or training; such vaccination creates excellent immunity on the mucous membranes of the upper respiratory tract.
The disadvantages of oral administration of vaccines include significant spillage of the vaccine, loss of the vaccine (part of the drug enters the stomach), and insufficient general immunity.
Oral
A classic example of an oral vaccine is OPV, the live polio vaccine. Typically, live vaccines that protect against intestinal infections (poliomyelitis, typhoid fever) are administered in this way. However, oral vaccines are now being developed that will protect not only from intestinal infections - a vaccine against HIV infection on a bacterial carrier (Salmonella).
Oral vaccination technique: a few drops of the vaccine are dropped into the mouth. If the vaccine has an unpleasant taste, it is instilled either on a piece of sugar or a cookie.
The advantages of this method of administering the vaccine are obvious: such vaccination does not require special education or training, the method is simple, it is fast, and it saves on hiring qualified personnel.
Disadvantages of oral administration of vaccines include spillage of the vaccine, inaccuracy of the vaccine dosage (part of the drug is excreted in the feces without working), economic losses due to the need for repeated administration of the vaccine and its spillage.
Intradermal and cutaneous
A classic example of a vaccine intended for intradermal administration is BCG. Examples of intradermal vaccines include live tularemia vaccine and smallpox vaccine. As a rule, live bacterial vaccines are administered intradermally, the spread of microbes throughout the body is extremely undesirable. However, recently, intradermal administration of vaccines in a number of countries has begun to be used in order to save vaccine (such vaccination requires a smaller volume of vaccine) - for example, in some countries they are vaccinated against rabies. And WHO, meeting the wishes of health workers, has developed recommendations for the intradermal administration of rabies vaccines. For vaccines other than those mentioned, the intradermal route of administration is not yet recommended.
Technique: The traditional site for cutaneous vaccine administration is either the shoulder (above the deltoid muscle) or the forearm - midway between the wrist and the crook of the elbow. For intradermal administration, special syringes with special, thin needles should be used. The needle is inserted upward, almost parallel to the surface of the skin, pulling the skin upward. In this case, you need to make sure that the needle does not penetrate the skin. The correctness of the injection will be indicated by the formation of a specific “lemon peel” at the injection site - a whitish tint of the skin with characteristic indentations at the exit site of the ducts of the skin glands. If a “lemon peel” does not form during administration, it means that the vaccine is being administered incorrectly.
Advantages: Low antigenic load, relative painlessness.
Disadvantages: Quite a complex vaccination technique that requires special training. Possibility of incorrectly administering the vaccine, which can lead to post-vaccination complications.
Subcutaneous route of vaccine administration
A fairly traditional route for administering vaccines and other immunobiological drugs in the territory of the former USSR, well known to everyone with injections “under the shoulder blade” (this is how gangrenous and streptococcal toxoids are administered). In general, this route is suitable for live and inactivated vaccines, although it is preferable to use it for live ones (measles-mumps-rubella, yellow fever, etc.). Due to the fact that with subcutaneous administration, the immunogenicity and rate of development of the immune response are somewhat reduced, this route of administration is extremely undesirable for administering vaccines against rabies and viral hepatitis B.
The subcutaneous route of vaccine administration is desirable for patients with bleeding disorders; the risk of bleeding in such patients after subcutaneous injection is significantly lower than with intramuscular administration.
Technique: The vaccination site can be either the shoulder (the lateral surface of the middle between the shoulder and elbow joints) or the anterolateral surface of the middle third of the thigh. Using the index finger and thumb, the skin is taken into a fold and, at a slight angle, the needle is inserted under the skin. If the patient's subcutaneous layer is significantly expressed, the formation of a fold is not critical.
Advantages: Comparative simplicity of the technique, slightly less pain (which is not significant in children) compared to intramuscular injection. Unlike intradermal administration, a larger volume of vaccine or other immunobiological drug can be administered. Accuracy of the administered dose (compared to intradermal and oral routes of administration).
Disadvantages: “Deposition” of the vaccine and, as a result, a lower rate of development of immunity and its intensity when inactivated vaccines are administered. A greater number of local reactions - redness and hardness at the injection site.
Intramuscular route of vaccine administration
The most preferred route for administering vaccines. Good blood supply to the muscles guarantees both the maximum speed of immunity production and its maximum intensity, since a larger number of immune cells have the opportunity to “get acquainted” with vaccine antigens. The distance of the muscles from the skin ensures a smaller number of adverse reactions, which in the case of intramuscular administration are reduced only to some discomfort during active muscle movements within 1–2 days after vaccination.
Injection site: Injecting vaccines into the gluteal region is highly discouraged. Firstly, the syringe-dose needles of most imported vaccines are not long enough (15 mm) to reach the gluteal muscle, while, as is known, in both children and adults the skin-fat layer can have a significant thickness. If the vaccine is administered in the gluteal area, it is essentially administered subcutaneously. It should also be remembered that any injection into the gluteal region is accompanied by a certain risk of damage to the sciatic nerve in people with anatomical features of its passage through the muscles.
The preferred site for vaccine administration in children under 3 years of age is the anterolateral surface of the thigh in the middle third. This is explained by the fact that the muscle mass in this place is significant, despite the fact that the subcutaneous fat layer is less developed than in the gluteal region (especially in children who do not yet walk).
In children over two years of age and adults, the preferred site for vaccine administration is the deltoid muscle (muscle thickening at the top of the shoulder, above the head of the humerus), due to the small thickness of the skin and sufficient muscle mass to absorb 0.5–1.0 ml of vaccine drug. In younger children, this site of vaccine administration is not used due to insufficient development of muscle mass and greater pain.
Vaccination technique: Regardless of the chosen site of vaccine administration, the intramuscular injection should be made perpendicularly, that is, at an angle of 90 ° C to the skin surface. When introducing the vaccine into the deltoid muscle, the injection is made strictly from the side, the position of the syringe must be strictly horizontal.
T.N. The Z-track technique consists of moving the skin in one direction before injection and releasing it after the needle has been withdrawn. On the one hand, the passage of a needle through stretched skin is less painful, on the other hand, due to the displacement of the channel, the vaccine is, as it were, “sealed” in the muscle.
Advantages: good absorption of the vaccine and, as a result, high immunogenicity and speed of development of immunity. Fewer local adverse reactions. Accuracy of the administered dose (compared to intradermal and oral routes of administration).
Disadvantages: The subjective perception of intramuscular injections by young children is somewhat worse than with other methods of vaccination.
No. 1. Why are intra-articular injections better than intramuscular ones? Or do they give the same result?
Intra-articular injections are more effective than intramuscular injections because the medicine is delivered directly into the affected joint. A variety of medications are sent into the cavity, which relieve pain and inflammation, restore cartilage tissue, and become synovial fluid prostheses. The main thing is that they act in a targeted manner. Intramuscular injections are less effective, since the active substance is distributed throughout the body through the bloodstream and enters the joint in a much lower concentration.
Intra-articular injections hit the target exactly – they act on the affected joint
Useful tips for parents and doctors on vaccination techniques for children
- Do not deceive children - injections are not absolutely painless, it is worth taking into account at least the emotional experiences of children about injections. It’s better to say that the injection “hurts a little,” “like a mosquito bite.” In this case, the child will be mentally prepared for the injection and in most cases will not notice it at all, which he will be very happy about. You should not go into unnecessary details of the injection in young children and vice versa - in older children, some details will be appropriate to argue in favor of the painlessness of the injection (“just think, within one second the needle will pass through the skin”, “the vaccine is only two drops and a syringe tiny").
- Never use injections as a threat, for “punishment” (“uncle will come and give an injection”). You should not develop a negative attitude towards injections and vaccinations in children, much less frighten them with them. Injections are necessary to be healthy and not get sick - such motivation will be correct.
- During the injection, it is better to sit the child on your lap - on the one hand, the child feels safer, and on the other, his movements are easier to control.
- Try to keep the child relaxed. It is better to cuddle younger children, and simply distract older children (soap bubbles, blowing out cheeks or “the world’s largest” bubble gum bubbles, blowing out imaginary candles on an imaginary birthday cake). For younger children, a small piece of sugar placed in the cheek may be helpful.
- Children over 5 years old can be asked to choose the injection site, i.e. in the leg (“like little ones”) or in the shoulder (“like adults”). The child thus gains a certain degree of control over what is happening, and he is pleased that doctors are also interested in his opinion.
- If several vaccines need to be administered, the child is small and not in the mood, then it is better to administer the vaccines at once in order to reduce the duration of discomfort. For example, two doctors or two nurses can simultaneously give two injections in two different legs.
- If there are a lot of children, then the old trick “who is the bravest?” can be very useful. Children want to be known as the bravest, even if they don’t want to be vaccinated. More often than not, it turns out that the youngest children are the bravest, and in this case the “older” ones have no choice.
- A simple technique significantly reduces the pain of intramuscular injection: press (through sterile cotton wool moistened with a 70% ethyl alcohol solution) on the site of the planned injection for 10 seconds. By the way, applying ice, contrary to popular belief, only relieves pain for 1–2 seconds.
The process of preparing for injections
Before going to the doctor for “beauty injections” or to the plastic surgeon, the cosmetologist-esthetician will step by step prepare the skin for these complex manipulations. The first step is to collect anamnesis. Everything said by the client will be taken into account - lifestyle, past illnesses, and psychological status. Next, an effective skin care process is developed. A course of procedures will be recommended to the client. First of all, you need to stop taking the following medications:
- vitamin E,
- medications with analgesic, antipyretic and anti-inflammatory effects,
- fish oil,
- aspirin.
Fish oil and vitamin E increase the risk of bruising after injections. To avoid complications of infection due to injection damage, the herpes must be treated before administering medications.
Where does skin care begin before performing special injection procedures? There are certain regulations, the consistent implementation of which cannot be avoided.
