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Importance of injecting vaccines into muscle

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7282.364 (Published 10 February 2001) Cite this as: BMJ 2001;322:364

Parenteral vaccines must be given subcutaneously in patients with congenital bleeding disorders

  1. J R C Seale (jim.seale{at}nww-tr.wales.nhs.uk), haemophilia centre director
  1. North West Wales NHS Trust, Ysbyty Gwynedd, Bangor LL57 2PW
  2. Academic Centre for Travel Medicine and Vaccines, Royal Free and University College Medical School, London NW3 2PF

    EDITOR—I am surprised that in her editorial on the importance of injecting vaccines into muscle Zuckerman omitted to mention that intramuscular injection is absolutely contraindicated in patients with congenital bleeding disorders.1 Her own institution contains one of the largest haemophilia centres in the United Kingdom, and its advice—as well as that of all other haemophilia centres as far as I am aware—is that in these patients all parenteral vaccines should be given subcutaneously. If this results in a lower rate of successful immunisation then it must be more than offset by the avoidance of the well documented risk of muscle haematoma.

    References

    1. 1.↵
      1. Zuckerman JN
      .The importance of injecting vaccines into muscle.BMJ2000;321: 1237–1238. (18 November.)
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    Author's reply

    1. Jane N Zuckerman (j.zuckerman{at}rfc.ucl.ac.uk), senior lecturer
    1. North West Wales NHS Trust, Ysbyty Gwynedd, Bangor LL57 2PW
    2. Academic Centre for Travel Medicine and Vaccines, Royal Free and University College Medical School, London NW3 2PF

      EDITOR—My editorial considered the site and administration of vaccines in terms of the general healthy population and not of special high risk groups. It is widely known that patients with coagulation disorders should be given parenteral vaccines by the deep subcutaneous route and not intramuscularly because of the risk of bleeding.1 The immunogenicity and safety of such vaccines given subcutaneously to those with congenital bleeding disorders as well as to other high risk groups are always assessed rigorously so as to ensure that the benefits of immunisation do clearly outweigh any known adverse events.2

      References

      1. 1.↵
        1. Salisbury DM,
        2. Begg NT
        , eds.Immunisation against infectious disease.London: HMSO,1996.
      2. 2.↵
        1. Zuckerman JN,
        2. Moore S,
        3. Smith J,
        4. Tyrrell H,
        5. Baxter A,
        6. Lee C
        .A study to assess the immunogenicity, reactogenicity and safety of hepatitis A vaccine administered subcutaneously to patients with congenital coagulation disorders.Haemophilia1996;2:235–239.
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