Vaccination Protocols for infants under the age of eighteen months

and subsequent protocols in the event of adversity

1. All practitioners who are designated to be regulated to give vaccinations to any

infant under the age of eighteen months, must have first been given training and
having satisfied the needs of the operation. They will then be placed on a database
which designates those who are able to vaccinate infants in that age range.
2. The training will include an understanding of the correct methods of vaccination for
any age of infant.
3. Each vaccine to be used in the vaccination of all infants under the age of eighteen
months must have been checked for its validity in respect to:
4. (i) A valid use-by date.
(ii) The container to be examined for any imperfections and if any are found it
should be returned to the manufacturer or supplier and the NHS (?) should be
notified.
(iii) It should be checked against any database of vaccination material that has
been subject to investigation or deemed to be faulty in any way.
(iv) A strict protocol should be followed for the administration of any vaccine and
this should include the following:

Most vaccines should be given via the intramuscular route into the deltoid (upper arm)
or the anterolateral aspect of the thigh. This optimises the immunogenicity of the
vaccine and minimises adverse reactions at the injection site. Scientific studies have
highlighted the importance of administering vaccines correctly. 1

In the case of vaccines in which the antigen is adsorbed to an aluminium salt adjuvant
such as diphtheria, tetanus, and pertussis vaccines, the intramuscular route is strongly
preferred because superficial administration leads to an increased incidence of local
reactions such as irritation, inflammation, granuloma formation, and necrosis.

The injection technique and needle size both determine how deep a substance is
injected. Injection technique involves stretching the skin flat before inserting the needle
or pinching a fold of skin before injection, which may necessitate the use of longer
needles. To make sure the needle reaches the muscle and that vaccine does not seep into
subcutaneous tissue the decision on the size of the needle and injection site should be
made individually for each person. It should also be based on the person's age, the
volume of material to be administered, and the size of the muscle.

Consideration should be given to needle gauge. A wider bore needle ensures that the
vaccine is dissipated over a wider area, thus reducing the risk of localised redness and
swelling. A standard size of needle will not guarantee successful intramuscular injection
in all people.

It is therefore relevant to consider that incorrect procedure may contribute to an

adverse reaction. This ought to give rise to a view that although individual factors may
not of themselves contribute entirely to an adverse response, a series of militating
1

factors might do so.

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1 The importance of injecting vaccines into muscle

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1118997/
 5. There should be strict adherence to what I will call The Berg Convention. 2 That is, if
any infant responds adversely to the first dose of a vaccination, he/she should not be
given another dose before the age of eighteen months and only then after strict
assessment by two consultants.
6. If an infant has responded adversely to a vaccination procedure, that incident must
be recorded in all documents which appertain to the infants health.
7. There should be a regular assessment made of that infant and if there is apparently
no further cause for concern, there should be another assessment at the age of
eighteen months.
8. If at any age after vaccination the infant/child shows any evidence of retarded
development and/or brain damage he/she should be assessed under the Vaccine
Damage Payments Act 1979 for an award.
9. If an award is made (at the current level of 120,000) this should not be seen as a
one-off/final payment.
10. A further assessment should be made at the age of three years and if there is
confirmation of continued abnormal development or brain damage, then a further
assessment for another award should be made under the Vaccine Damage
Payments Act 1979.
11. If the child is not assessed of being able to follow normal education at the age of five
years, then there should be a further assessment for another award under the
Vaccine Damage Payments Act 1979.
12. If there is any assessment made that the child cannot be educated to normal
standards and who will not be able to take up employment and who is unlikely to
have the capacity to have normal adult relationships that could lead to marriage
and parenthood, then a further assessment should be made for another award under
the Vaccine Damage Payments Act 1979.

Alan Challoner

23 April 2017

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2 Berg JM. (1958) Neurological complications of pertussis immunization. British Medical Journal 2:24-27