General instructions:

  • Vaccination at birth means as early as possible within 24 to 72 hours after birth or at least not later than one week after birth
  • Whenever multiple vaccinations are to be given simultaneously, they should be given within 24 hours if simultaneous administration is not feasible due to some reasons
  • The recommended age in weeks/months/years mean completed weeks/months/years
  • Any dose not administered at the recommended age should be administered at a subsequent visit, when indicated and feasible.
  • The use of a combination vaccine generally is preferred over separate injections of its equivalent component vaccines
  • When two or more live parenteral/intranasal vaccines are not administered on the same day, they should be given at least 28 days (4 weeks) apart; this rule does not apply to live oral vaccines
  • Any interval can be kept between live and inactivated vaccines.
  • If given <4 weeks apart, the vaccine given 2nd should be repeated
  • The minimum interval between 2 doses of same inactivated vaccines is usually 4 weeks (exception rabies). However, any interval can be kept between doses of different inactivated vaccines.
  • Vaccine doses administered up to 4 days before the minimum interval or age can be counted as valid (exception rabies). If the vaccine is administered > 5 days before minimum period it is counted as invalid dose.
  • Any number of antigens can be given on the same day
  • Changing needles between drawing vaccine into the syringe and injecting it into the child is not necessary.
  • Once the protective cap on a single-dose vial has been removed, the vaccine should be discarded at the end of the immunization session because it may not be possible to determine if the rubber seal has been punctured
  • Different vaccines should not be mixed in the same syringe unless specifically licensed and labeled for such use.
  • Patients should be observed for an allergic reaction for 15 to 20 minutes after receiving immunization(s).
  • When necessary, 2 vaccines can be given in the same limb at a single visit.
  • The anterolateral aspect of the thigh is the preferred site for 2 simultaneous IM injections because of its greater muscle mass.
  • The distance separating the 2 injections is arbitrary but should be at least 1 inch so that local reactions are unlikely to overlap
  • Although most experts recommend "aspiration" by gently pulling back on the syringe before the injection is given, there are no data to document the necessity for this procedure. If blood appears after negative pressure, the needle should be withdrawn and another site should be selected using a new needle.
  • A previous immunization with a dose that was less than the standard dose or one administered by a nonstandard route should not be counted, and the person should be re-immunized as appropriate for age.