How to Administer Multiple Intramuscular Vaccines
to Adults During One Visit The diagrams below illustrate options for administer-
ing one, two, or three vaccinations in a single arm,
It is not unusual for adults to need more than one vaccination at an office spaced at least 1" apart. Additional injections can also
be administered in the opposite arm.
visit. When that occurs, CDC recommends giving all needed vaccines at
the same visit to reduce missed opportunities. Use anatomical landmarks to determine the injection
site in the deltoid muscle (a large, rounded, triangular
These vaccines commonly administered to adults* shape). Find the acromion process, which is the
bony point at the end of the shoulder. Then, locate the
are administered via the intramuscular route: injection site which will be approximately 2" below
COVID-19 Influenza the bone and above the axillary fold/armpit.
Hepatitis A (HepA) Pneumococcal
Hepatitis B (HepB) Tdap and Td Single
Human papillomavirus (HPV) Zoster IM injection
Determine vaccines to be administered. in deltoid
▸ Review each patient’s vaccine history and determine needed vaccines
(see CDC’s recommended schedule of immunizations for adults at
•
www.cdc.gov/vaccines/schedules/downloads/adult/adult-combined- Acromion
schedule.pdf). process
Determine which vaccines to give in separate limbs.
▸ Administer vaccines more likely to cause a local reaction in separate
limbs, if possible. Vaccines that cause injection site pain in at least half Two
of recipients include COVID-19, zoster, HepA, HPV, pneumococcal IM injections
(PCV, PPSV), and tetanus-containing vaccines (Tdap, Td).† in deltoid
▸ If administration in separate limbs is not feasible or desired, administra-
tion in the same limb, separated by at least 1" (inch), is appropriate.
Space injections ••
at least 1" apart.
Select the injection site(s) for intramuscular injections.
▸ Determine which vaccine(s) will be administered in each limb (see
options in diagrams at right). You can administer 1, 2, or 3 injections per
deltoid, spaced at least 1" apart.
▸ Deltoid muscle: Locate the central and thickest portion of the deltoid Three
muscle – above the level of the armpit and approximately 2" below the IM injections
acromion process (see diagram at right). in deltoid
▸ Anterolateral thigh muscle: Locate the outer portion of the middle third
of the thigh (see diagram at right).
Space injections •••
at least 1" apart.
Prepare to administer IM injections.
▸ Choose the needle gauge and length needed for the patient’s age
and weight (see “Administering Vaccines to Adults: Dose, Route, Site,
and Needle Size” at www.immunize.org/catg.d/p3084.pdf).
▸ Draw up each vaccine using a separate, new needle and syringe. A single IM injection may also be administered in
▸ Label each vaccine syringe and clearly indicate on the label or tray the the anterolateral thigh muscle as shown below.
planned injection site (e.g., right arm [RA], left arm [LA], right thigh
[RT], left thigh [LT] ).
▸ Administer injection at a 90° angle (see “How to Administer Intramus-
cular and Subcutaneous Vaccine Injections to Adults” at www.immunize.
org/catg.d/p2020a.pdf). If more than one injection is given in
a single limb (arm or leg), separate the injections by a minimum of 1".
* Additional vaccines may be indicated for an adult due to missed childhood
vaccinations, medical conditions, exposure risk, travel plans, or occupational risk.
† According to clinical trial data provided in prescribing information.
for professionals www.immunize.org / for the public www.vaccineinformation.org
www.immunize.org/catg.d/p2030.pdf • Item #P2030 (12/21)
