Vaccine
Technique
For Administering the Vaccine
[For further
information refer to CDC’s “Vaccine – Guidelines
and Recommendations” at http://www.bt.cdc.gov/agent/smallpox/vaccination/guidelines.asp]
Vaccination
is normally performed using a bifurcated needle. A sterile needle
is inserted into an ampoule of reconstituted vaccine and, on withdrawal,
a droplet of vaccine sufficient for vaccination is held by capillarity
between the 2 tines. The needle is held at right angles to the
skin; the wrist of the vaccinator rests against the arm. Fifteen
perpendicular strokes of the needle are rapidly made in an area
of about 5 mm in diameter. The strokes should be sufficiently vigorous
so that a trace of blood appears at the vaccination site after
15 to 30 seconds. After vaccination, excess vaccine should be wiped
from the site with gauze that should be discarded in a hazardous
waste receptacle. The site should be covered with a loose, non-occlusive
bandage to deter the individual from touching the site and perhaps
transferring virus to other parts of the body. (9:8)

A successful
vaccination for those with partial immunity may manifest a gradient
of responses. These range from what appears to be a primary take
(as described herein) to an accelerated reaction in which there
may be little more than a papule surrounded by erythema that reaches
a peak between 3 and 7 days. A response that reaches a peak in
erythema within 48 hours represents a hypersensitivity reaction
and does not signify that growth of the vaccinia virus has occurred.
Persons exhibiting such a reaction should be revaccinated. (9:8-9)

Only the diluent
supplied with the vaccine should be used for reconstitution. Vaccine
reconstituted with any other diluent should be discarded. Reconstituted,
vaccine should be kept at refrigerator temperature, 2-8¾C. (22:V6:42) Once
reconstituted, the vaccine may be used for 30 days if kept at the
recommended storage temperature.

Vaccination
Steps from CDCs “Smallpox: Disease, Prevention and Intervention” (22:V1:25-33) are
listed below.
- First, remove
the bifurcated needle from its package. The needle is sterile,
so be careful not to touch the bifurcated, pointed end.
- Dip the bifurcated
point of needle into the vaccine solution – so that the
needle is perpendicular to the floor. The needle will pick up
a drop of the vaccine in the space between the two prongs. Inspect
the needle tip after dipping to assure that vaccine is present
between the prongs. DO NOT shake the needle after it has been
dipped into the vaccine vial. If no vaccine is between the prongs
of the needle, and the needle has not touched the skin of the
vaccinee (i.e., it is still sterile), it may be dipped again.
- Do NOT re-dip
the needle into the vaccine solution once it has touched the
person’s skin. A single dip into the vaccine will prevent
contamination of the vaccine vial.
- Pull the
skin on the arm taut, rest you wrist on the arm, and prick the
skin the recommended number of times. This should be done rapidly,
perpendicular to the skin, within an area 5 millimeters in diameter.
The intention is to break the skin and introduce the vaccine
into the skin. The wrist of the vaccinator should be resting
on the arm while pricking the skin.
- Prior to
administration of smallpox vaccine, please refer to the package
insert for number of bifurcated needle punctures to administer. (22:V6:50)
- Administering
the strokes rapidly, within about 3 seconds, also helps induce
enough pressure by the needle to produce this small amount of
bleeding and assure that the vaccine was administered appropriately.
This method allows the live vaccinia virus to penetrate the superficial
layers of the skin so that viral multiplication can occur and
produce immunity.
- A trace of
blood should be present after 10-20 seconds.
- Bifucated
needles should never be re-used. Dispose of used needles immediately
into sharps container.
Cover
the vaccination site to prevent dissemination of the virus. The
site should be covered by a gauze pad then tape applied over
the gauze. For hospital personnel, the gauze should in turn be
covered by a semi-permeable occlusive dressings. Semi-permeable
dressing alone should not be used because it causes skin maceration
and may increase the risk of secondary bacterial cellulitis.
Vaccinees
should be instructed that thorough hand washing with soap and water
or disinfecting agents should be performed after any direct contact
with the site or contact with materials that have come into contact
with the site. Care must be taken to prevent contact of the site
or contact with contaminated materials from the site by any other
person. Keeping the site covered provides barrier protection against
inadvertent inoculation or transmission. (22:V6:56)
|