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How many different ways are there for administering vaccines?

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You probably got your COVID vaccine on the muscles of the upper arm. So how many ways are the for administering vaccines?

There are different ways currently being used for administering vaccines around the world:

  • Injection into the adipose tissue – Certain pre-existing conditions may require an injection into the adipose tissue. 
  • Orally – The oral vaccination or the vaccination via the nasal mucosa are entirely without spades. 

Scientists are currently researching new needle-free application routes and vaccines that no longer require refrigeration. Find out the different ways in which vaccines are administered.


How many ways are there for administering vaccines?

To date, vaccines have been administered through the thigh, nose or arm – vaccinations give people immunity against the pathogens in different ways:

  • by injection into the muscle (intramuscular),
  • by injection under the skin (subcutaneous), less often also into the skin (intracutaneous),
  • as an oral vaccination or
  • via the nasal mucosa.

According to the manufacturers, some vaccines can be injected into the muscle as well as under the skin. This includes vaccinations against seasonal influenza (flu), against hepatitis, and TBE or tetanus . Being able to choose is especially important for patients with coagulation disorders: If a vessel is hit, an injection into the muscle could lead to bleeding that is difficult to stop. The fatty tissue under the skin is less well supplied with blood. This will reduce the risk of internal bleeding.

For some pathogens there are vaccine products to choose from that can be swallowed or injected, for example against typhoid. There are several vaccines available against influenza that are injected. But there is also a nasal vaccination spray for children and adolescents.

How do vaccinations work?

Killed or weakened pathogens are administered to the body. This enables the body’s own immune system to produce antibodies and is prepared for the next time it comes into contact with the pathogen.

administering vaccines

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Why do you inject vaccinations?

Doctors vaccinate muscles or adipose tissue to bypass the gastrointestinal tract. This is necessary because many vaccines contain protein and sugar. They would be digested and excreted on their gastrointestinal passage. They would not even arrive in the bloodstream, but depending on the disease, where they are needed for antibody formation. 

The vaccine against Cholera

The French chemist Louis Pasteur (1822-1895) dealt with the prevention of infectious diseases on the basis of the vaccination method developed by Jenner . In 1880 he succeeded for the first time in producing a vaccine against cholera in chickens.

Inoculate the muscle

The most common method is vaccination in the muscle. The muscles are traversed by fine vessels. The vaccine only gradually enters the bloodstream. The slow release gives the immune system enough time to “get used” to the vaccine and react accordingly. In other words, an injection into a muscle makes the vaccine more tolerable. If it were injected directly into the vessel, it could lead to intolerance. 

In the upper arm or thigh

As a rule, doctors choose the triangular deltoid muscle on the upper arm, the deltoid muscle, for vaccination. It lies on the surface, is only covered by a thin layer of fat and is easily accessible. Occasionally, the deltoid muscle is still too small in smaller children. They then get their vaccination in the outside of the thigh, in the vastus lateralis muscle. Here, too, there is little risk of injuring nerves or vessels from the injection.

Vaccines are no longer injected in the buttocks

In the past, children in particular were vaccinated in the buttocks. Today the doctors have abandoned it; Children and adults alike are injected into the upper arm. 

The reason: the large buttock muscle is covered by a more or less thick layer of fat. Depending on how thick it is and how long the needle, the injection could “miss”. It would end up in adipose tissue instead of in muscle. But there it works less well and there are more frequent complications. In addition, important nerve pathways run through the gluteal muscle, especially the sciatic nerve. If he were hit while vaccinated, it could become very painful and lead to nerve damage with neurological failures. In children, an injury to the nerve can also cause stunted growth and foot malformations. 

administering vaccines

Vaccination into the subcutaneous fatty tissue

Some people have an increased tendency to bleed, for example because they have hemophilia or because they have to take blood thinners. They should not be vaccinated into the muscles, but as an exception subcutaneously into the subcutaneous fatty tissue. With a few exceptions, there are vaccinations against all pathogens, in which – according to the manufacturer’s instructions – a vaccination into the subcutaneous fatty tissue is also possible. Doctors will advise vaccinees that there may be more reactions at the injection site. Some vaccines also work less well when given into the subcutaneous fat.

1. Why not generally into adipose tissue?

The advantage of why people with a tendency to clot in the subcutaneous fatty tissue should be vaccinated is at the same time the disadvantage for healthy people: the fatty tissue is poorly supplied with blood. As a result, the immune system may not have sufficient ability to produce antibodies against the vaccine.

In addition, local vaccination reactions can occur more frequently: injections into adipose tissue can occur

  • painful inflammation and hardening at the puncture site,
  • to tumors (granulomas) as well
  • lead to abscesses, nodules, and cysts.

The vaccine against Cholera

The French chemist Louis Pasteur (1822-1895) dealt with the prevention of infectious diseases on the basis of the vaccination method developed by Jenner . In 1880 he succeeded for the first time in producing a vaccine against cholera in chickens.

2. Oral vaccination

There are other ways to vaccinate, for example against rotavirus. The infection causes diarrhea, especially in younger children, and can be life-threatening because the children lose a lot of fluids. Since 2013, the Standing Vaccination Commission (STIKO) has recommended vaccinating children aged six months and over against rotavirus. The children swallow the vaccine. In the intestine, the weakened virus causes the immune system to produce protective antibodies. It is precisely there that local immunity is desirable, since this is where the disease takes place.

Other vaccines that are swallowed:

  • cholera
  • Polio (not used in Germany since 1998)
  • typhus
  • Tuberculosis (no longer recommended in Germany since 1998)

Some infants spit out all or part of the vaccination so that the vaccination has to be repeated. Oral vaccines lose their effectiveness if the vaccines have a gastrointestinal infection or are taking certain antibiotics at the same time.

The vaccine against anthrax

Louis Pasteur’s student Emile Roux (1853-1933) was able to demonstrate the active principle of this immune defense through blood tests. A year later, an effective vaccine against anthrax was developed.

3. Vaccine by nasal spray

There is also a vaccine against seasonal influenza that is administered through the nose (quadruple vaccine against four strains of the virus). It is approved for children between the ages of two and 17. With the help of a sprayer, the children are given a stroke of vaccine in both nostrils. Immunity develops directly in the nasal mucosa. This is desirable because this is where the pathogen enters. 

However, STIKO does not see any significant advantage in the nasal spray compared to conventional flu vaccines that are injected into the muscle. Therefore, spray vaccination is usually reserved for children who are afraid of injections or have problems with clotting.

A spray could also replace the syringe in the vaccination against measles in the future – if the inhaled vaccine works at least as well. That is not the case yet. In the future, spray vaccination against measles could be of particular interest in countries with poor hygienic conditions and where it is difficult to maintain hygiene standards when spraying.

When did the age of modern vaccination begins?

In 1796 – The first “modern” vaccination is attributed to the English doctor Edward Jenner. He discovered a vaccine that could protect against what was then referred to as cowpox. But he had no idea of ​​the smallpox virus. It was not until 1930, 134 years after Jenner, that viruses could be presented for the first time.

administering vaccines

Needle-free vaccines – vaccinating without spades

Scientists all over the world are researching needle-free vaccines: Using creams, tablets or suppositories, they want to avoid the spades that prevent part of the population from getting vaccinated. This would also eliminate any vaccination reactions that might occur at the injection site, such as pain, swelling and redness or infections. People with a panic fear of syringes (syringe phobics) would no longer have to do without the life-saving injections. 

Vaccine patch

Research is relatively far on vaccine patches with a vaccine against seasonal influenza (flu). The patch releases the vaccine into the skin with the help of the finest micro needles within a few minutes. The advantage: the plaster is painless. And you don’t need medical staff to bring it up. The specialty: the micro needles dissolve in the skin after a short time. The sticky plaster that is left behind can easily be disposed of in the trash. The first developments come from the Emory Vaccine Center in Atlanta, USA. Australian scientists are also currently developing a vaccination patch.

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