Site and Route

The recommendations for the site and route for each vaccine are evidence-informed. Health professionals should adhere to instructions outlined in the vaccine monograph. Vaccine efficacy may decrease and the risk for local adverse events may increase if not administered correctly. See Table 3.4 for additional considerations for route of administration.


Table 3.4: Considerations for Route of Administration

Route Consideration



  • Inactivated vaccines are typically administered via IM injection because most contain adjuvants that can cause exaggerated local pain, swelling, and redness if not injected into the muscle.
  • In general, vaccines containing adjuvants are administered IM to reduce local adverse effects, such as skin irritation.
  • Insert needle at a 90 degree angle.



  • Pinch up a fold of skin to more easily access the fatty tissue above the muscle. Avoid injecting into the muscle tissue.
  • Always inject at a 45 degree angle.



  • This route is product-specific and should only be administered according to the product monograph.
  • Hold the skin taut. Place the needle almost flat against the patient’s skin with bevel up. Insert needle at a 5 to 15 degree angle.



  • Oral vaccines should be given prior to injectable vaccines. If an incomplete dose is given for any reason, a replacement dose should not be given. Oral vaccines may be given through a client’s NG or NJ tube.



  • The live-attenuated influenza vaccine is the only intranasal vaccine in Canada. It should be administered by a health professional (not a parent). If the client sneezes (or spits up) a repeat dose is not necessary. Intranasal vaccines should be deferred if the client has severe nasal congestion.



Points of Consideration

When immunizing young children, it is helpful for health professionals to remind parents or substitute decision makers (SDMs) about the upcoming vaccination and explain the site and route anticipated for the next visit. This will allow parents who want to prepare their children with analgesic patches to place them in the correct location (should be applied one hour before vaccine administration). It will also allow a parent to talk to the child about the vaccination before hand.

Attribution Statement

Content in this section was adapted, with editorial changes, from: Page 8: Canadian Immunization Guide: Part 1 – Key Immunization Information by the Government of Canada and is reproduced under non-commercial conditions.


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Vaccine Practice for Health Professionals: 1st Canadian Edition Copyright © by Oona St-Amant; Jennifer Lapum; Vinita Dubey; Karen Beckermann; Che-Sheu Huang; Carly Weeks; Kate Leslie; and Kim English is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License, except where otherwise noted.

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