Vaccines

Vaccines are second only to clean water in their benefit to public health (Public Health England (PHE), 2022). It is estimated that immunisation saves 2–3 million deaths each year from diseases such as diphtheria, tetanus, pertussis, influenza and measles (World Health Organisation (WHO), 2023). Guidelines for immunisation practice in the UK are decided by the Joint Committee on Vaccination and Immunisation. The JCVI publishes the ‘Green Book’, Immunisation Against Infectious Disease, which is regularly updated to reflect the latest evidence-based guidance and new technologies (PHE, 2020).

Training

Immunisers must have the appropriate training and have received supervised assessment of their competency to practise safely. They must also have had training in managing anaphylaxis and CPR. Regular training updates are necessary to maintain competence (Willcox, 2013).

There must be immediate access to adrenaline (epinephrine) to manage anaphylaxis if it occurs (PHE, 2020).

Vaccines are prescription-only medicines (POMs) and must be given by an appropriately trained health professional. There are three forms of authorisation for vaccine administration (PHE, 2020):

• an individual prescription
• a patient specific direction (PSD): an instruction from a prescriber to another health professional to administer or supply a product to a particular patient
• patient group direction (PGD): an instruction to administer or supply a product for a group of eligible patients

Cold chain

Vaccines are biological products which are sensitive to temperature and light. To maintain their effectiveness, they need to be kept at a

Safety

Contraindications: The immuniser must check that the patient has no contraindications to vaccination before proceeding, such as being unwell with a fever on the day, or having experienced an anaphylactic reaction to a previous dose of the vaccine or to one of its constituents.

Side effects: Patients should be advised about more common reactions such as soreness and redness at the site of injection, or a rise in temperature, and how long such effects may last. They should also be given advice on how to manage them.

Bleeding disorders: For patients with a bleeding disorder, vaccines that are normally given intramuscularly may be given subcutaneously to prevent bleeding (PHE, 2020).

Product: The immuniser should check that they have the right product for the individual patient and the correct authorisation for its use (prescription, PSD or PGD) before proceeding.

Consent: The patient or their parent/carer must give active informed consent

Route of administration

In general, inactivated vaccines are given via the intramuscular route, and live vaccines either by deep subcutaneous injection or intramuscularly (Driver, 2018). The BCG vaccine for tuberculosis (given only to high-risk populations in the UK) must be administered intradermally (PHE, 2020). The immuniser needs supervisory training to master the intradermal technique (Driver, 2018). As part of the UK child immunisation schedule, rotavirus vaccine is given orally and the live attenuated influenza vaccine by nasal spray (PHE, 2020).

Site of administration

In general, injectable vaccines are given in the deltoid muscle or in the anterolateral aspect of the thigh in small infants (Figures 1 and 2) (Table 1).

References

Driver C. Vaccine storage and administration. Nurse Prescribing. 2018; 16(5):218–22.

Medicines and Healthcare products Regulatory Agency (MHRA). The Black Triangle Scheme. 2014. https://www.gov.uk/drug-safety-update/the-black-triangle-scheme-or (accessed 20 May 2022)

Public Health England. Immunisation against infectious disease [the ‘Green Book’]. 2020. https://www.gov.uk/government/collections/immunisation-against-infectious-disease-the-green-book (accessed 16 January 2023)

Public Health England. Immunisation: Information for immunisation practitioners and other health professionals. 2022. https://www.gov.uk/government/collections/immunisation (accessed 16 January 2023)

Willcox A. Principles and practice of vaccination. Practice Nursing. 2011; 22(2):190–4.

World Health Organisation. Vaccines and immunization. 2023. https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1 (accessed 16 January 2023)