How to Administer Intramuscular and Subcutaneous Vaccine Injections

Administration by the Intramuscular (IM) Route

Administer these vaccines patient age injection site needle size
via IM route Newborn (0–28 days) Anterolateral thigh muscle ⅝"* (22–25 gauge)
• Diphtheria-tetanus-pertussis (DTaP,
Infant (1–12 mos) Anterolateral thigh muscle 1" (22–25 gauge)
Tdap)
• Diphtheria-tetanus (DT, Td)
Anterolateral thigh muscle 1–1¼" (22–25 gauge)
• Haemophilus influenzae type b (Hib) Toddler (1–2 years) Alternate site: Deltoid muscle of arm if
⅝*–1" (22–25 gauge)
• Hepatitis A (HepA) muscle mass is adequate
• Hepatitis B (HepB) Deltoid muscle (upper arm) ⅝*–1" (22–25 gauge)
• Human papillomavirus (HPV) Children (3–10 years) Alternate site: Anterolateral thigh
• Inactivated influenza (IIV)
1–1¼" (22–25 gauge)
muscle
• Meningococcal serogroups A,C,W, Y Deltoid muscle (upper arm) ⅝†–1" (22–25 gauge)
(MenACWY) Children and adults
• Meningococcal serogroup B (MenB) (11 years and older) Alternate site: Anterolateral thigh 1–1½" (22–25 gauge)
muscle
• Pneumococcal conjugate (PCV13)
• Zoster, recombinant (RZV) * A ⅝" needle usually is adequate for neonates (first thumb and forefinger and the needle is inserted at a
28 days of life), preterm infants, and children ages 90º angle to the skin; a 1" needle is sufficient in
Administer inactivated polio (IPV) 1 through 18 years if the skin is stretched flat between patients weighing 130–152 lbs (60–70 kg); a 1–1½"
and pneumococcal polysaccharide the thumb and forefinger and the needle is inserted needle is recommended in women weighing 153–200
(PPSV23) vaccines either IM or at a 90° angle to the skin. lbs (70–90 kg) and men weighing 153–260 lbs (70–118
† A ⅝" needle may be used in patients weighing less kg); a 1½" needle is recommended in women
subcutaneously (Subcut).
than 130 lbs (<60 kg) for IM injection in the deltoid weighing more than 200 lbs (91 kg) or men weighing
muscle only if the skin is stretched flat between the more than 260 lbs (118 kg).

Intramuscular (IM) injection Intramuscular (IM) injection

90° angle site for infants and toddlers site for children and adults
skin acromion
process
subcutaneous tissue (bony prominence
above deltoid)
muscle
•
Needle insertion level of armpit
Use a needle long enough to reach IM injection
site
deep into the muscle. (shaded area)
Insert needle at a 90° angle to the
skin with a quick thrust. IM injection site
(shaded area) elbow
(Before administering an injection of
vaccine, it is not necessary to aspi-
rate, i.e., to pull back on the syringe
plunger after needle insertion.¶)
Multiple injections given in the Insert needle at a 90° angle into the Give in the central and thickest portion of the
same extremity should be separated anterolateral thigh muscle. deltoid muscle – above the level of the armpit
by a minimum of 1", if possible. and approximately 2–3 fingerbreadths (~2")
below the acromion process. See the diagram.
¶
CDC. “General Best Practices Guidelines for To avoid causing an injury, do not inject too
Immunization: Best Practices Guidance of
high (near the acromion process) or too low.
the ACIP” at https://www.cdc.gov/vaccines/
hcp/acip-recs/general-recs/downloads/
general-recs.pdf

continued on the next page ▶

Technical content reviewed by the Centers for Disease Control and Prevention

Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org

www.immunize.org/catg.d/p2020.pdf • Item #P2020 (1/18)
How to Administer Intramuscular and Subcutaneous Vaccine Injections (continued) page 2 of 2

Administration by the Subcutaneous (Subcut) Route

Administer these vaccines
via Subcut route
• Measles, mumps, and rubella patient age injection site needle size
(MMR)
• Varicella (VAR) Fatty tissue overlying the anterolateral
Birth to 12 months ⅝" (23–25 gauge)
• Zoster, live (ZVL) thigh muscle
Administer inactivated polio (IPV) Fatty tissue overlying the anterolateral
12 months and older ⅝" (23–25 gauge)
and pneumococcal polysaccharide thigh muscle or fatty tissue over triceps
(PPSV23) vaccines either IM or
Subcut.

Subcutaneous (Subcut) Subcutaneous (Subcut)

45° angle
injection site for infants injection site for children (after
skin the 1st birthday) and adults
subcutaneous tissue
acromion
muscle process
(bony prominence
above deltoid)

Needle insertion Subcut injection site

(shaded area)
Pinch up on subcutaneous tissue
to prevent injection into muscle.
Insert needle at 45° angle to the elbow
skin.
(Before administering an injection
of vaccine, it is not necessary to
aspirate, i.e., to pull back on the
syringe plunger after needle
insertion.*) Insert needle at a 45° angle into the fatty
Subcut injection site tissue overlying the triceps muscle. Make
Multiple injections given in the (shaded area)
sure you pinch up on the subcutaneous
same extremity should be separated
tissue to prevent injection into the muscle.
by a minimum of 1". Insert needle at a 45° angle into fatty tissue
of the anterolateral thigh. Make sure you
* CDC.“General Best Practices Guidelines for
Immunization: Best Practices Guidance of pinch up on subcutaneous tissue to prevent
the ACIP” at https://www.cdc.gov/vaccines/ injection into the muscle.
hcp/acip-recs/general-recs/downloads/

Immunization Action Coalition • Saint Paul, Minnesota • 651- 647- 9009 • www.immunize.org • www.vaccineinformation.org
www.immunize.org/catg.d/p2020.pdf • Item #P2020 (1/18)