Appendix 7: Vaccine presentation, preparation, disposal, and needle-stick recommendations

A7.1 Presentation of vaccines

Most of the vaccines in current use are supplied in prefilled syringes or vials. The exceptions to this are the rotavirus vaccine, which is supplied as a plastic dosing tube, and the BCG vaccine, which is supplied as a multi-dose vial.

A vial is a glass container with a rubber33 seal on the top, protected by a metal or plastic cap until it is ready for use. Vials contain either liquid or powder (freeze-dried or pellet/cake) preparations.

Vaccines should not be mixed in the same syringe, unless the manufacturer’s information sheet specifically states it is permitted (eg, the DTaP-IPV-HepB vaccine is mixed with the Hib pellet for the Infanrix-hexa vaccine).

A7.2 Preparation and administration of vaccinesTop

In order to minimise the risk of spread of infection and needle-stick injury, vaccinators should observe standard occupational health and safety guidelines.

Vaccines in vials require one needle to draw the vaccine into the syringe, and then a new needle to administer the vaccine. The passage of needles through rubber seals causes blunting, resulting in increased tissue trauma if that needle is used to administer the injection. Also, a new needle prevents tracking the vaccine through the skin and subcutaneous tissue, thereby reducing the risk of local reactions. Do not expel the air contained in the new needle – it is sterile and minute in quantity.

A7.2.1 Preparing vaccines supplied as a liquid preparation

A7.2.2 Preparing vaccines supplied as powder/pellet vaccines

Some vaccines are presented as a prefilled syringe and freeze-dried (lyophilised) combination vaccines where:

The method for reconstituting the vaccine varies depending upon whether vials or prefilled syringes are used, as follows.

Reconstituting vaccines where the diluent is in a vial

Reconstituting vaccines where the vaccine or diluent is in a prefilled syringe

A7.2.3 Preparing vaccines supplied as prefilled syringes

A7.2.4 Preparing the rotavirus vaccine

The rotavirus vaccine is administered orally. It is available as a single, prefilled dose in a plastic dosing tube with a twist-off cap. The dosing tube is contained in a pouch. The container and delivery system are latex-free.

puncture the dispensing tip by screwing the cap clockwise until it becomes tight
​– remove the cap by turning it counter clockwise.

A7.2.5 Preparing vaccines supplied as multi-dose vials34

A7.3 Disposal of needles, syringes and vaccine vialsTop

Note: for information about returning vaccines for destruction (such as in the event of a cold chain failure), see Appendix 6.

A7.3.1 Sharps containers

A7.3.2 Spillages

A7.3.3 Recommendations following a needle-stick injury

In the event of a needle-stick injury, follow the guidelines below.

For more information, see also section 8.5.3 for the management of blood and body fluid exposures (hepatitis B), the Starship Clinical Guidelines for Needle-stick Injuries35 or your local DHB guidelines (if available).
33Assume the rubber seal is latex unless stated ‘latex-free’.
34Sources: World Health Organization. 2014. WHO Policy Statement: Multi-dose vial policy (MDVP) – Handling of multi-dose vaccine vials after opening.; the Australian Technical Advisory Group on Immunisation (ATAGI) and the National Centre for Immunisation Research and Surveillance (NCIRS).