Skip to Main Content
Centers for Disease Control and Prevention link     Centers for Disease Control and Prevention & Smallpox Centers for Disease Control and Prevention link CDC Smallpox Home
Smallpox Vaccination and Adverse Events Training Module - Reactions Links & Site Map Adverse Reactions link Normal Reactions link All Reactions link Site Map link
Side Navigation Menu & Copyright 2002 CDC/HHS Home Page link Smallpox link About the Vaccine link Contraindications link Vaccination Method link Preventing Contact Transmission link Vaccinia Immune Globulin link; Laboratory Testing link Continuing Education link Contact link

Vaccination Method

References link References Menu


Multiple Puncture Vaccination

In the past, vaccination was performed by the scratch or multiple insertion method. During the global eradication effort, the bifurcated needle came to be used universally along with a technique called multiple puncture vaccination. This is now the recommended method in the United States.

Each bifurcated needle is sterile and individually wrapped. The bifurcated needle is for single usage only and should be discarded in an appropriate biohazard container immediately after vaccinating each patient.

Caution: Needles should never be dipped into the vaccine vial more than once, in order to avoid contamination of the vial.

Preferred Site for Vaccination

Deltoid area on the upper arm

In the past, other sites have been chosen, such as the back or inner aspects of the extremities, or even the buttock.

These other sites were selected based on “cosmetic” concerns. It is strongly recommended that the deltoid site be used. Some experts cite the fact that there is differential skin sensitivity to vaccination and that most of the efficacy studies analyzed vaccinees who received deltoid vaccinations.

Step-by-Step Instructions

1. Skin Preparation: None

No skin preparation is required.
Under no circumstances should alcohol be applied to the skin prior to vaccination as it has been shown to inactivate the vaccine virus. 

2. Dip Needle

The needle is dipped into the vaccine vial and withdrawn. The needle is designed to hold a minute drop of vaccine of sufficient size and strength to ensure a take if properly administered. 

Consult the package insert for the number of bifurcated needle insertions to use in administering the vaccine for primary or revaccinations.

3. Perpendicular Insertions (15 for all vaccinees) should be made within a 5mm Diameter Area

The needle is held perpendicular to the site of insertion. The wrist of the vaccinator should be maintained in a firm position (*) by resting on the arm of the vaccinee.

The perpendicular insertions are given in rapid order in an area no larger than 5 mm in diameter.

Strokes should be vigorous enough to evoke a trace of blood at the site after 15-30 seconds.

The bifurcated needle is for single usage only and should be discarded in an appropriate biohazard container immediately after vaccinating each patient.

Caution: Needles should never be dipped into the vaccine vial more than once, in order to avoid contamination of the vial. 

4. Absorb Excess Vaccine

After vaccination, excess vaccine should be absorbed with sterile gauze. Discard the gauze in a safe manner (usually in a hazardous waste receptacle) in order not to contaminate the site or infect others who may come in contact with it. 

5. Cover Vaccination Site

It is important that the vaccination site be covered to prevent dissemination of virus. In addition, hands should always be washed immediately after touching the site or materials that contacted the site (dressings, clothing, etc.).

Recommended covering:
Clean or sterile gauze loosely secured by tape (†)
Healthcare workers should cover the site with gauze and then a semi-permeable dressing during patient care activities. (§)
•  Clothing that covers the site can provide added protection
   
Hypoallergenic tape should be used for people with tape allergies.
§ A semipermeable membrane occlusive dressing alone can result in a macerated vaccine site, prolonged irritation, and itching and may increase the risk of hand contamination from scratching or secondary bacterial infection. Dressings products that combine an absorbent base with an overlying semi-permeable layer can also be used.

6. Caution Vaccinee and/or Guardian

To avoid contact transmission of the virus, vaccinees and guardians must be cautioned:
•  No rubbing or scratching of
vaccination site
•  Discard gauze carefully
•  Wash hands thoroughly after
handling gauze

For further information on preventing dissemination of virus, please visit the Preventing Contact Transmission page.

Accidental Administration by Oral or Parenteral Route

Ingestion and intramuscular injection of a dose of vaccine are NOT recommended routes of administration. However, no harm has been recorded from such events. 

For further information please visit the Accidental Administration page.

 

Step 2
Step 2 - Dip Needle


Step 2 - Dip Needle
Step 3
Step 3 - Make 15 Perpendicular Insertions within a 5mm Diameter Area

Step 3 - Make 15 Perpendicular Insertions within a 5mm Diameter Area
Step 4
Step 4 - Absorb Excess Vaccine

Step 4 - Absorb Excess Vaccine
Step 5
Step 5 - Cover Vaccination Site

Step 5 - Cover Vaccination Site



Accidental Administration link Inadvertent Inoculation link Bacterial Infection link Congenital Vaccinia link Eczema Vaccinatum link Encephalitis link Erythema Multiforme link Generalized Vaccinia link Normal Primary link Normal Variants link Progressive Vaccinia link Vaccinia Keratitis link Revaccination link All Reactions links
Bifurcated needle