In this new medical climate, vaccinations are more important than ever. As many of our medical billing clients are rural medical offices, and are likely overburdened with covid-19 and seasonal flu patients, we wanted to offer our help in better treating these patients. For that reason, we think it is an appropriate time to discuss vaccine processes, and in this article, we will be focusing on vaccine placement.


National Institutes of Health (NIH) recommendations are that vaccine placements should be intramuscularly administered, typically in the thigh (deltoid or anterolateral area). This NIH recommendation is due to this placement optimizing of patient immune response. As a bonus, a deltoid or anterolateral injection may reduce detrimental reactions at the injection site. 


Fatty Tissue Vaccine Injection

NIH recommends muscular placement because fatty tissue injection may reduce (or even eliminate) vaccine viability. The antigen may fail to move throughout the body if the injection is made into fatty tissue. For instance, in fatty tissue injections, Influenza vaccines, Hepatitis B, Rabies vaccines, etc., form antibody rates in blood serum that result in reduced effectiveness and rapid decay.


While it was once common to inject into the buttocks, the abundance of fatty tissue there means the vaccine may fail. The NIH says it is vital that you choose a location with an abundance of antigen-presenting or phagocytic cells. Reducing circulation, via lack of musculature, slows, diminishes and potentially arrests the movement of the antigen. For this reason, macrophage processing, along with the overall effect of presentation to B and T cells involved in the immune response, slows considerably. In addition, antigen denaturing by enzymes results when vaccine serum is left in fat for days.


Muscular Vaccine Injection

The abundant blood supply in musculature results in decreased reactions, unlike injections into the adipose tissue, which conversely has poor drainage. Injection into muscles do not generally form local reactions, including necrosis, granuloma, inflammation, or even irritation. This strong blood supply also ensures greater vaccine efficacy, as the serum is moved throughout the body more quickly and efficiently, resulting in a vastly elevated response time to make antibodies.


Finally, don’t forget to take special care when choosing needle size. This will vary due to patient age and placement site. If a skin pinch is necessary, the needle will need to be longer to reach the subcutaneous tissue than what would be necessary if a skin pinch is not utilized.


While fatty tissue was once common for vaccine placement, the NIH has determined that intramuscular vaccination sites are far more effective, resulting in faster creation and disbursement of antibodies and reducing local reactions to vaccines due to fast transference. As you combat this flu season and Covid-19 pandemic, review the NIH guidelines for vaccine placement to ensure you are vaccinating per the most recent advice.