Essential Programme on Immunization
The Essential Programme on Immunization aims to strengthen vaccine programmes, supply, and delivery, and ensure universal access to all relevant vaccines for all populations across the life course.

Safety and acceptability of multiple injections

Many countries have immunization schedules where children receive multiple vaccine injections at one visit. Globally, many middle and high-income countries have been safely using multiple injections for more than a decade, while achieving high coverage and acceptability. Vaccination schedules that involve multiple injections during the same visit are based on many years of pre-licensure and post-licensure safety and effectiveness data, including concomitant use studies.

When three intramuscular injections are scheduled simultaneously in infants under 12 months of age, it is correct and safe to give two injections in the same thigh. For example, both the IPV and the pneumococcal vaccines may be given in the same thigh, separated by 2.5cm.

The following resources may be helpful as countries consider the potential implications of adding new vaccines to immunization schedules that may result in multiple injections scheduled in the same visit.

Multiple Injections: Acceptability and Safety

Information on acceptability and safety of administering multiple injections in one visit, as well as strategies to reduce pain and distress at the time of vaccination.

Multiple Injections: Acceptability and Safety

Information on acceptability and safety of administering multiple injections in one visit, as well as strategies to reduce pain and distress at the time of vaccination.

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Administration of multiple injectable vaccines in a single visit and interventions to reduce pain at the time of vaccination.

    Meeting of the Strategic Advisory Group of Experts on Immunization,  April 2015: conclusions and recommendations
    Weekly Epidemiological Record, 90 (‎22)‎, 261 - 278.
    Reducing pain at the time of vaccination: WHO position paper – September 2015
    Weekly Epidemiological Record, 2015, vol. 90, 39 [‎full issue]‎