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Independents' Day

Long needles best for all infant vaccinations

By Danusia Osiowy

Use of long needles for infant vaccination can reduce local reactions without compromising immune response, a new primary care study concludes.

The researchers called for recommendations on immunisation to be overhauled, with 25mm needles used as standard for all two-, three- and four-month vaccines.

Their study, published online by the BMJ, found long needles were able to reduce adverse reactions by up to 54 per cent. There were fewer local reactions with diphtheria, tetanus, whole cell pertussis and haemophilus influenzae vaccines, the researchers found.

They calculated that for every six to eight children vaccinated, one fewer would suffer a local reaction with long needles, which can penetrate into an infant's thigh muscle.

Study leader Linda Diggle, principal research manager at the Oxford Vaccine Group, said: 'Most primary care staff are reluctant to use the long needle at two and three months because logic tells them it's kinder to inject a baby with a shorter needle – even though this means the vaccine is probably only reaching subcutaneous fat.

'Some vaccine manufacturers provide the narrow short needle within unidose packs so most GPs still use the shorter needle for the younger ages but the longer needle is best for reaching the muscle of the infant thigh which is where vaccines should go,' she said.

Needle length, rather than gauge, was the important factor for reducing local reactions, with no significant difference between 25mm needles of wide or narrow gauge.

Dr George Kassianos, RCGP immunisation spokesman, said: 'If the needle is too short, the tip may not enter the muscle. The consequences are there may be a local reaction and/or the vaccine may not take so well.'

Dr Kassianos, a GP in Bracknell, Berkshire, added: 'Inactivated vaccines should be given by deep intramuscular injection and live vaccines are best given subcutaneously, although the MMR vaccine has a licence for both in the UK.'

The research was based at 35 general practices and studied 612 healthy infants who were vaccinated at two, three and four months. Children were followed up until they reached five months of age.

Guidance on needle choice

• Use one of two needle types:

1. the blue 25mm needle

2. the long orange 25mm needle

• If the needle is welded to the syringe, use the vaccine product as it is

• If there is a needle in the vaccine pack, discard it if it is short orange but not if it is the long orange

• If no needle is supplied or the supplied needle is not 25mm long, use blue needle

• The orange 16mm may be appropriate for a very small (premature) infant

Source: RCGP

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