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Letter to the editor

Editor, - Irefer to the letter from Dr Justin Coleman and to Dr Paul Nisselle's comment ('Use of two needles' AustPrescr1998;21:60-1). There is one type of injection where it is important to use two needles and that is when giving certain vaccines. The outside of the needle may be contaminated by the toxoids and there is an increased risk of local reactions in the superficial tissues and along the track of the needle.

W.A.C. Young
General Practitioner
Mornington, Vic.


Dr Margaret Curran, Associate Medical Director, CSL Pharmaceuticals, comments:

Thank you for the opportunity to comment on Dr Young's letter about using two needles for injections.

The Australian Immunisation Handbook1 recommends that, 'for vaccines which are drawn up through a rubber bung, or are reconstituted, a new needle should be used for administration. If the vaccine has been drawn up from an open vial, the same needle may be used'.

For aluminium adsorbed vaccines, there is some suggestion in the literature2,3,4,5 that injection technique may contribute to the severity of local reactions, including abscess formation at the injection site, as a result of the antigen seeding the needle track.

The approved prescribing information for adult tetanus toxoid with diphtheria toxoid (ADT) and tetanus toxoid (Tet-Tox) states that local reactions can be minimised if care is taken to ensure that the intramuscular injection is given deeply and that none of the material (toxoid) is deposited superficially or along the track of the needle.

The approved prescribing information for both children's diphtheria toxoid with tetanus toxoid (CDT) and diphtheria, tetanus, pertussis vaccine(Triple Antigen) suggests the following precautions:

  • When withdrawing the antigen into the syringe, avoid any residue on the outer surface of the needle.
  • Administer by deep intramuscular injection.
  • Inject slowly so as to allow the injected material to disperse instead of coming up the needle track.


  1. National Health and Medical Research Council. The Australian immunisation handbook. 6th ed. Canberra: Australian Government Publishing Service, 1997:16.
  2. Sako W, Treuting WL, Witt DB, Nichamin SJ. Early immunization against pertussis with alum precipitated vaccine. JAMA1945;127: 379-84.
  3. Bernier RH, Frank JA, Nolan TF. Abscesses complicating DTP vaccination. Am J Dis Child 1981;135:826-8.
  4. Fawcett HA, Smith NP. Injection-site granulomadue to aluminium. Arch Dermatol 1984;120:1318-22.
  5. Wiesenthal AM, Lauer BA. Syringe preparation technique and minor adverse reactions to diphtheria-tetanus-pertussis immunization.Pediatr Infect Dis J 1987;6:1048-50.