Ask the Experts: Shake, rattle, or roll: Preparing vaccines for administration

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APhA-compiled chart lists commonly administered vaccines and information regarding their preparation.

Some vaccines are suspensions, while some are solutions. Some need to be shaken vigorously, others need to be shaken gently, and some don't need any shaking, whether they are in a vial or a syringe. Attached is a chart listing commonly administered vaccines and information regarding their preparation. The FDA-approved labeling for the vaccines can be found here: www.fda.gov/BiologicsBloodVaccines/Vaccines/ApprovedProducts/ucm093833.htm.

Adult vaccines: Resource for immunization providers, compiled by APhA

Product name (click for FDA product page)

Trade name

Manufacturer

Preparation of vaccine prior to administration (source: FDA-approved package insert)

Hepatitis A Vaccine, Inactivated

Havrix

GlaxoSmithKline Biologicals

(1) Shake well before use. With thorough agitation, Havrix is a homogeneous, turbid, white suspension. Do not administer if it appears otherwise. (2) Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be 11 administered. (3) For the prefilled syringes, attach a sterile needle and administer intramuscularly. (4) For the vials, use a sterile needle and sterile syringe to withdraw the vaccine dose and administer intramuscularly. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated. Use a separate sterile needle and syringe for each individual.

Hepatitis A Vaccine, Inactivated

VAQTA

Merck & Co., Inc.

(1) Shake the single-dose vial or single-dose prefilled syringe well to obtain a slightly opaque, white suspension before withdrawal and use. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. (2) Discard if the suspension does not appear homogenous or if extraneous particulate matter remains or discoloration is observed. (3) For single-dose vials, withdraw and administer entire dose of VAQTA intramuscularly using a sterile needle and syringe.

Hepatitis A Inactivated and Hepatitis B (Recombinant) Vaccine

Twinrix

GlaxoSmithKline Biologicals

(1) Shake well before use. With thorough agitation, Twinrix is a slightly turbid white suspension. Do not administer if it appears otherwise. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered. (2) For the prefilled syringes, attach a sterile needle and administer intramuscularly. (3) For the vials, use a sterile needle and sterile syringe to withdraw the 1-mL dose and administer intramuscularly. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated. Use a separate sterile needle and syringe for each individual.

Hepatitis B Vaccine (Recombinant)

Recombivax HB

Merck & Co., Inc

Shake well before use. Thorough agitation at the time of administration is necessary to maintain suspension of the vaccine.

Hepatitis B Vaccine (Recombinant)

Engerix-B

GlaxoSmithKline Biologicals

(1) Shake well before use. With thorough agitation, Engerix-B is a homogeneous, turbid white suspension. Do not administer if it appears otherwise. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered. (2) For the prefilled syringes, attach a sterile needle and administer intramuscularly. (3) For the vials, use a sterile needle and sterile syringe to withdraw the vaccine dose and administer intramuscularly. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated. Use a separate sterile needle and syringe for each individual.

Human Papillomavirus Quadrivalent (Types 6, 11, 16, 18) Vaccine, Recombinant

Gardasil

Merck and Co., Inc.

Shake well before use. Thorough agitation immediately before administration is necessary to maintain suspension of the vaccine. Gardasil should not be diluted or mixed with other vaccines. After thorough agitation, Gardasil is a white, cloudy liquid. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration. Do not use the product if particulates are present or if it appears discolored.

Human Papillomavirus Bivalent (Types 16, 18) Vaccine, Recombinant

Cervarix

GlaxoSmithKline Biologicals

Shake syringe well before withdrawal and use. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered. With thorough agitation, Cervarix is a homogeneous, turbid, white suspension. Do not administer if it appears otherwise.

Influenza Virus Vaccine (Trivalent, Types A and B)

Afluria

CSL Limited

(1) Shake thoroughly and inspect visually before use. (2) When using a single-dose syringe, shake the syringe thoroughly and administer the dose immediately. (3) When using the multidose vial, shake the vial thoroughly before withdrawing each dose, and administer the dose immediately. Draw up the exact dose using a separate sterile needle and syringe for each individual patient. It is recommended that small syringes (0.5 or 1 mL) be used to minimize any product loss.

Influenza Virus Vaccine (Trivalent, Types A and B)

FluLaval

ID Biomedical Corporation

(1) Shake the multidose vial vigorously each time before withdrawing a dose of vaccine. (2) Use a sterile needle and sterile syringe to withdraw the 0.5-mL dose from the multidose vial and administer intramuscularly. A sterile syringe with a needle bore no larger than 23 gauge is recommended for administration. It is recommended that small syringes (0.5 or 1 mL) be used to minimize any product loss. Use a separate sterile needle and syringe for each dose withdrawn from the multidose vial.

Influenza Vaccine, Live, Intranasal (Trivalent, Types A and B)

FluMist

MedImmune, LLC

No indication

Influenza Virus Vaccine (Trivalent, Types A and B)

Fluarix

GlaxoSmithKline Biologicals

Shake well before administration.

Influenza Virus Vaccine (Trivalent, Types A and B)

Fluvirin

Novartis Vaccines and Diagnostics, Inc.

Shake the syringe vigorously before administering the vaccine and shake the multidose vial preparation each time before withdrawing a dose of vaccine.

Influenza Virus Vaccine (Trivalent, Types A and B)

Agriflu

Novartis Vaccines and Diagnostics S.r.l.

Shake the contents of each syringe to aid inspection. Inspect Agriflu visually for the presence of particulate matter or discoloration prior to administration, whenever suspension and container permit. If either of these conditions exists, do not use the contents.

Influenza Virus Vaccine (Trivalent, Types A and B)

Fluzone, Fluzone High-Dose, and Fluzone Intradermal

Sanofi Pasteur, Inc.

(1) Fluzone: Before administering a dose of vaccine, shake the prefilled syringe or single-dose vial. Withdraw the vaccine using a sterile needle and syringe. (2) Fluzone High-Dose: Before administering a dose of vaccine, shake the prefilled syringe. (3) Fluzone Intradermal: Gently shake the microinjection system before administering the vaccine.

Influenza Virus Vaccine (Trivalent, Types A and B)

Flucelvax

Novartis Vaccines and Diagnostics, Inc.

Shake the syringe vigorously before administering. Flucelvax should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit.

Influenza Vaccine (Trivalent)

Flublok

Protein Sciences Corporation

Shake the single-dose vial gently before withdrawing the vaccine dose.

Influenza Vaccine, Live, Intranasal (Quadrivalent, Types A and Types B)
 

FluMist Quadrivalent

MedImmune, LLC

No indication

Influenza Virus Vaccine (Quadrivalent, Types A and Types B)

Fluarix Quadrivalent

GlaxoSmithKline Biologicals

Shake well before administration. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered.

Influenza Virus Vaccine (Quadrivalent, Types A and Types B)

Fluzone Quadrivalent

Sanofi Pasteur, Inc.

Before administering a dose of vaccine, shake the prefilled syringe or single-dose vial. Withdraw the vaccine using a sterile needle and syringe.

Influenza Virus Vaccine (Quadrivalent, Types A and Types B)

FluLaval Quadrivalent

ID Biomedical Corporation

(1) Shake the multidose vial vigorously each time before withdrawing a dose of vaccine. (2) Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the vaccine should not be administered. (3) Use a sterile needle and sterile syringe to withdraw the 0.5-mL dose from the multidose vial and administer intramuscularly. A sterile syringe with a needle bore no larger than 23 gauge is recommended for administration. It is recommended that small syringes (0.5 or 1 mL) be used to minimize any product loss. Use a separate sterile needle and syringe for each dose 26 withdrawn from the multidose vial.

Meningococcal (Groups A, C, Y, and W-135) Oligosaccharide Diphtheria CRM197 Conjugate Vaccine

Menveo

Novartis Vaccines and Diagnostics, Inc.

Menveo is supplied in two vials that must be combined prior to administration. Menveo must be prepared for administration by reconstituting the MenA lyophilized conjugate vaccine component with the MenCYW-135 liquid conjugate vaccine component. Using a graduated syringe, withdraw the entire contents of the vial of MenCYW-135 liquid conjugate component and inject into the MenA lyophilized conjugate component vial. Invert the vial and shake well until the vaccine is dissolved and then withdraw 0.5 mL of reconstituted product.

Meningococcal Groups C and Y and Haemophilus b Tetanus Toxoid Conjugate Vaccine

MenHibrix

GlaxoSmithKline Biologicals

MenHibrix is a solution for injection supplied as a single-dose vial of lyophilized vaccine to be reconstituted with the accompanying vial of saline diluent. Shake well in the reconstitution process. A single dose after reconstitution is 0.5 mL.

Meningococcal (Groups A, C, Y and W-135) Polysaccharide Diphtheria Toxoid Conjugate Vaccine

Menactra

Sanofi Pasteur, Inc.

Menactra vaccine is a clear to slightly turbid solution. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If any of these conditions exist, the vaccine should not be administered (no indication of shaking). Withdraw the 0.5 mL dose of vaccine from the single-dose vial using a sterile needle and syringe.

Meningococcal Polysaccharide Vaccine, Groups A, C, Y and W-135 Combined

Menomune-A/C/Y/W-135

Sanofi Pasteur, Inc.

After removing the "flip-off" caps, cleanse the vaccine and diluent vial stoppers with a suitable germicide. Do not remove the vial stoppers or metal seals holding them in place. Using a suitable sterile needle and syringe and aseptic technique, withdraw the supplied diluent (0.6 mL for single-dose presentation and 6.0 mL for multidose presentation) and inject into the vial containing the lyophilized vaccine . Swirl the vial until the vaccine is thoroughly dissolved. When reconstituted, the vaccine should be a clear, colorless liquid.

Pneumococcal Vaccine, Polyvalent

Pneumovax 23

Merck & Co., Inc.

No indication

Pneumococcal 7-valent Conjugate Vaccine (Diphtheria CRM197 Protein)

Prevnar

Wyeth Pharmaceuticals Inc.

(1) Since this product is a suspension containing an adjuvant, shake vigorously immediately prior to use to obtain a uniform suspension in the vaccine container. The vaccine should not be used if it cannot be resuspended. (2) After shaking, the vaccine is a homogeneous, white suspension.

Pneumococcal 13-valent Conjugate Vaccine (Diphtheria CRM197 Protein)

Prevnar 13

Wyeth Pharmaceuticals, Inc.

Since this product is a suspension containing an adjuvant, shake vigorously immediately prior to use to obtain a homogenous, white suspension in the vaccine container. Do not use the vaccine, if it cannot be resuspended. Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration This product should not be used if particulate matter or discoloration is found.

Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed

Adacel

Sanofi Pasteur, Inc.

(1) Just before use, shake the vial or syringe well until a uniform, white, cloudy suspension results. (2) Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exist, the vaccine should not be administered. (3) When withdrawing a dose from a stoppered vial, do not remove either the stopper or the metal seal holding it in place. Use a separate sterile needle and syringe for each injection. Using a sterile needle and syringe, withdraw the 0.5-mL dose of vaccine from the single-dose vial and administer the vaccine to the individual. Changing needles between withdrawing the vaccine from the vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated. (4) Adacel vaccine should not be combined through reconstitution or mixed with any other vaccine.

Tetanus Toxoid, Reduced Diphtheria Toxoid and Acellular Pertussis Vaccine, Adsorbed

Boostrix

GlaxoSmithKline Biologicals

(1) Shake vigorously to obtain a homogeneous, turbid, white suspension before administration. Do not use if resuspension does not occur with vigorous shaking. (2) Parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. If either of these conditions exists, the 11 vaccine should not be administered. (3) For the prefilled syringes, attach a sterile needle and administer intramuscularly. (4) For the vials, use a sterile needle and sterile syringe to withdraw the 0.5-mL dose and administer intramuscularly. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated. Use a separate sterile needle and syringe for each individual. (5) Do not administer this product intravenously, intradermally, or subcutaneously.

Zoster Vaccine, Live, (Oka/Merck)

Zostavax

Merck & Co., Inc.

(1) Use only sterile syringes free of preservatives, antiseptics, and detergents for each injection and/or reconstitution of Zostavax. Preservatives, antiseptics, and detergents may inactivate the vaccine virus. (2) Zostavax is stored frozen and should be reconstituted immediately upon removal from the freezer. (3) When reconstituted, Zostavax is a semihazy to translucent, off-white to pale yellow liquid. (4) Reconstitution: (a) Use only the diluent supplied. (b) Withdraw the entire contents of the diluent into a syringe. (c) To avoid excessive foaming, slowly inject all of the diluent in the syringe into the vial of lyophilized vaccine and gently agitate to mix thoroughly. (d) Withdraw the entire contents of reconstituted vaccine into a syringe and inject the total volume subcutaneously. (e) ADMINISTER IMMEDIATELY AFTER RECONSTITUTION to minimize loss of potency. Discard reconstituted vaccine if not used within 30 minutes. Do not freeze reconstituted vaccine.

 

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