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We are concerned that the external validity of the findings by Reis et al,1 who evaluated measures to reduce the acute pain of multiple immunizations in infants, may be limited by their use of inappropriately short needles.
Nearly all inactivated vaccines recommended during infancy in the United States are licensed only for intramuscular injection. An exception, inactivated poliovirus vaccine, may be given intramuscularly or subcutaneously. To ensure intramuscular penetration when immunizing infants approximately 2 months old, the American Academy of Pediatrics, Elk Grove Village, Ill2 ; the American Academy of Family Physicians, Leawood, Kan; and the federal Advisory Committee on Immunization Practices, Atlanta, Ga,3 recommend a needle length of 2.22 to 2.54 cm (⅞-1 in). In contrast, Reis and colleagues immunized infants of this age with needles 1.59 cm (⅝ in) in length. The bore of the needles used in their study was 26 gauge, narrower than the recommended range of 22 to 25 gauge.2 - 3
A shorter needle increases the likelihood of inadvertent subcutaneous immunization, which may be less immunogenic4 and cause more local inflammation5 than intramuscular immunization. Infants aged approximately 4 months were less likely to have erythema (relative risk, 0.66) and swelling (relative risk, 0.39) at the injection site 6 hours after immunization with a 2.5-cm, 23-gauge needle in comparison with a 1.6-cm, 25-gauge needle.5
An additional practical consideration is that for needles of appropriate length, 26-gauge needles are scarcer than 23- or 25-gauge needles, especially for the safety-engineered syringes legally mandated by several states. We urge that the findings of Reis et al be verified using needles of the length and bore recommended for infant immunization.
Correspondence: Ms Hammer, Immunization Branch, State of California Health and Human Services Agency, 2151 Berkeley Way, Room 712, Berkeley, CA 94704 (shammer@dhs.ca.gov).
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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