How to Administer Intramuscular and Subcutaneous

Vaccine Injections to Adults

Intramuscular (IM) Injections
Administer by IM route only Diagram 1
• COVID-19 acromion process
• Haemophilus influenzae type b (Hib) • (bony prominence above deltoid)
• Hepatitis A (HepA) level of armpit
• Hepatitis B (HepB)
IM injection site
• Human papillomavirus (HPV)
(shaded area = deltoid muscle)
• Inactivated influenza vaccine (IIV)
• Meningococcal serogroups A, C, W, Y (MenACWY) Diagram 2
• Meningococcal serogroup B (MenB) elbow
• Pneumococcal conjugate (PCV)
• Respiratory Syncytial Virus (RSV)
• Tetanus, diphtheria (Td), or with pertussis (Tdap)
• Zoster (RZV)

Administer by IM or Subcutaneous (Subcut) route

• Inactivated polio vaccine (IPV)
• Measles, mumps, and rubella (MMR) – MMR II (Merck) Diagram 3
• Pneumococcal polysacchariade (PPSV23)
90° angle
• Varicella (VAR)

Injection site skin

Deltoid: Give in the central and thickest portion of the deltoid muscle — subcutaneous tissue
above the level of the armpit and approximately 2–3 fingerbreadths (~2")
below the acromion process (see diagram 1). To avoid causing an injury, muscle
do not inject too high (near the acromion process) or too low.
Anterolateral thigh: As an alternative, the anterolateral thigh muscle
Note: For deltoid injections, use a 1" needle in adults weighing 130–152 lbs
may be used; locate the outer portion of the middle third of the thigh
(60–70 kg); based on the biological sex of the patient, use a 1–1½" needle
(see diagram 2).
in women weighing 153–200 lbs (70–90 kg) and men weighing 153–260
Needle size lbs (70–118 kg); a 1½" needle in women weighing more than 200 lbs (91
kg) or men weighing more than 260 lbs (more than 118 kg). For injections
22–25 gauge, 1–1½" needle (see note at right)
in the anterolateral thigh, use a 1½" needle for adults of any weight.
Needle insertion (see diagram 3) Alternate needle lengths may be used if the skin is stretched tightly
• Use a needle long enough to reach deep into the muscle. and subcutaneous tissues are not bunched, as follows: 1) a ⅝" needle in
• Insert the needle at a 90° angle to the skin with a quick thrust. adults weighing less than 130 lbs (<60 kg) for IM injection in the deltoid
• Separate two injections given in the same deltoid muscle (or muscle only, or 2) a 1" needle for administration in the thigh muscle for
anterolateral thigh muscle, if using) by a minimum of 1". adults of any weight.

Subcutaneous (Subcut) Injections Administer by Subcut route only

• MMR – Priorix (GSK)
acromion process Administer by Subcut or IM route
(bony prominence • MMR – MMR II (Merck)
above deltoid) • Pneumococcal polysaccharide (PPSV23)
• Inactivated polio vaccine (IPV)
• Varicella (VAR; chickenpox)
Subcut injection site Administer by Subcut or intradermal (ID) route
(shaded area) • Mpox (Jynneos)*
Note: Subcut is indicated on the package insert. ID administration to adults
(18+ years) is permitted under FDA emergency use authorization (see www.fda.gov/
media/160774/download)
elbow
Injection site
Give in fatty tissue over the triceps. See the diagram.
45° angle Needle size
23–25 gauge, 5/8" needle
skin
Needle insertion
subcutaneous tissue • Pinch up on the tissue to prevent injection into the muscle.
Insert the needle at a 45° angle to the skin.
muscle • Separate two injections given in the same
area of fatty tissue by a minimum of 1".

www.immunize.org/catg.d/p2020a.pdf
FOR PROFESSIONALS www.immunize.org / FOR THE PUBLIC www.vaccineinformation.org Item #P2020a (10/23/2023)
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