Needle size for vaccination procedures in children and adolescents

Thumbnail Image
6798.pdf(1.5 MB)
Published version
Beirne, Paul V.
Hennessy, Sarah
Cadogan, Sharon L.
Shiely, Frances
Fitzgerald, Tony
MacLeod, Fiona
Journal Title
Journal ISSN
Volume Title
John Wiley & Sons, Ltd.
Research Projects
Organizational Units
Journal Issue
Background: This is an update of a Cochrane Review first published in 2015. The conclusions have not changed. Hypodermic needles of different sizes (gauges and lengths) can be used for vaccination procedures. The gauge (G) refers to the outside diameter of the needle tubing. The higher the gauge number, the smaller the diameter of the needle (e.g. a 23 G needle is 0.6 mm in diameter, whereas a 25 G needle is 0.5 mm in diameter). Many vaccines are recommended for injection into muscle (intramuscularly), although some are delivered subcutaneously (under the skin) and intradermally (into skin). Choosing an appropriate length and gauge of a needle may be important to ensure that a vaccine is delivered to the appropriate site and produces the maximum immune response while causing the least possible harm. Guidelines conflict regarding the sizes of needles that should be used for vaccinating children and adolescents. Objectives: To assess the effects of using needles of different sizes for administering vaccines to children and adolescents on vaccine immunogenicity (the ability of the vaccine to elicit an immune response), procedural pain, and other reactogenicity events (adverse events following vaccine administration). Search methods: We updated our searches of CENTRAL, MEDLINE, Embase, and CINAHL to October 2017. We also searched proceedings of vaccine conferences and two trials registers. Selection criteria: Randomised controlled trials evaluating the effects of using hypodermic needles of any gauge or length to administer any type of vaccine to people aged from birth to 24 years. Data collection and analysis: Three review authors independently extracted trial data and assessed the risk of bias. We contacted trial authors for additional information. We rated the quality of evidence using the GRADE system. Main results: We included five trials involving 1350 participants in the original review. The updated review identified no new trials. The evidence from two small trials (one trial including infants and one including adolescents) was insufficient to allow any definitive statements to be made about the effects of the needles evaluated in the trials on vaccine immunogenicity and reactogenicity. The remaining three trials (1135 participants) contributed data to comparisons between 25 G 25 mm, 23 G 25 mm, and 25 G 16 mm needles. These trials included infants predominantly aged from two to six months undergoing intramuscular vaccination in the anterolateral thigh using the World Health Organization (WHO) injection technique (skin stretched flat, needle inserted at a 90° angle and up to the needle hub in healthy infants). The vaccines administered were combination vaccines containing diphtheria, tetanus, and whole‐cell pertussis antigens (DTwP). In some trials, the vaccines also contained Haemophilus influenzae type b (DTwP‐Hib) and hepatitis B (DTwP‐Hib‐Hep B) antigen components. Primary outcomes: Incidence of vaccine‐preventable diseases: No trials reported this outcome. Procedural pain and crying: Using a wider gauge 23 G 25 mm needle may slightly reduce procedural pain (low‐quality evidence) and probably leads to a slight reduction in the duration of crying time immediately after vaccination (moderate‐quality evidence) compared with a narrower gauge 25 G 25 mm needle (one trial, 320 participants). The effects are probably not large enough to be clinically relevant…Authors' conclusions: Using 25 mm needles (either 23 G or 25 G) for intramuscular vaccination procedures in the anterolateral thigh of infants using the WHO injection technique probably reduces the occurrence of local reactions while achieving a comparable immune response to 25 G 16 mm needles. These findings are applicable to healthy infants aged two to six months receiving combination DTwP vaccines with a reactogenic whole‐cell pertussis antigen component. These vaccines are predominantly used in low‐ and middle‐income countries. The applicability of the findings to vaccines with acellular pertussis components and other vaccines with different reactogenicity profiles is uncertain.
Needles, adverse effects , Adolescent , Child , Child, preschool , Crying , Equipment design , Humans , Immunization, instrumentation , Immunization, methods , Infant , Injections, intramuscular , Injections, instrumentation , Injections, methods , Pain, prevention and control , Randomized controlled trials as topic , Vaccines, administration and dosage , Vaccines, immunology , Young Adult
Beirne, P. V., Hennessy, S., Cadogan, S. L., Shiely, F., Fitzgerald, T. and MacLeod, F. (2018) 'Needle size for vaccination procedures in children and adolescents', Cochrane Database of Systematic Reviews, Issue 8, Art. No.: CD010720 (123 pp). doi:10.1002/14651858.CD010720.pub3
© 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. All rights reserved. This review is published as a Cochrane Review in the Cochrane Database of Systematic Reviews 2018 Issue 8. Cochrane Reviews are regularly updated as new evidence emerges and in response to comments and criticisms, and the Cochrane Database of Systematic Reviews should be consulted for the most recent version of the Review