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Smallpox Vaccine Administration Video

This training was developed for use with Dryvax vaccine. Another brand of vaccine, ACAM2000, has been licensed that, while nearly identical in administration and technique, does have some minor differences; most notably the change to 15 insertions for both primary and secondary vaccinees. Healthcare providers are advised to familiarize themselves with the information in the package insert before beginning vaccination clinics

As part of our bioterrorism preparedness activities, public health and hospital-based healthcare providers should again become familiar with smallpox vaccine and the technique for its administration. This video describes smallpox vaccine and common reactions following vaccination; how to screen potential vaccinees for contraindications to vaccination; how to administer smallpox vaccine; and how to care for the vaccination site.


Watch the entire video - Windows Media format (4 min 44 sec)


In this segment of the program we will discuss the administration of smallpox vaccine and demonstrate the recommended method of administration.

We recommend that you wear gloves when administering smallpox vaccine. Because of the risk of inadvertent exposure to vaccine virus, persons administering the vaccine should be vaccinated. Healthcare providers or vaccinators who themselves have a contraindication to vaccination should not handle or administer the vaccine.

You should consult the package insert or protocol that comes with the vaccine for instructions on vaccine reconstitution.

Once you have prepared the vaccine, you're ready to administer it. To administer the smallpox vaccine, a special bifurcated needle is used. No other vaccine uses this type of needle, and smallpox vaccine must never be administered by any other method. You should review the package insert or protocol that is provided with the vaccine for any additional instructions regarding vaccine administration.

When the bifurcated needle is dipped into the vaccine vial and withdrawn, the tiny amount of vaccine required for a single dose is captured between the two prongs of the needle.

A stopper for the vial and sterilized, individually packaged needles will be provided within the vaccine packaging.

In general, alcohol, soap and water, or other chemical agents are not needed for preparation of the skin for vaccination unless the area is grossly contaminated. If needed, soap and water are the preferred cleaning agents. If any cleaning agent is used, the skin must be thoroughly dry in order to prevent inactivation of the vaccine.

Remove the bifurcated needle from its packaging. The needle is sterile, so be careful not to touch the bifurcated, pointed end.

Dip the bifurcated point of needle into the vaccine solution—so that the needle is perpendicular to the floor. The needle will pick up a drop of the vaccine in the space between the two prongs.

Remember—do not redip the needle into the vaccine solution once it has touched the patient’s skin. This will prevent contamination of the vaccine vial.

Prior to the administration of smallpox vaccine, please refer to the package insert for the appropriate number of needle punctures to administer. The following is a demonstration of 15 punctures, which would be used for revaccination.

Pull the skin on the arm taut, rest your wrist on the arm, and prick the skin 15 times as shown here. This should be done rapidly, perpendicular to the skin, within an area 5 millimeters in diameter. The intention is to break the skin and introduce the vaccine into the skin. The wrist of the vaccinator should be resting on the arm while pricking the skin. Enough pressure should be used to visibly push down the skin and produce a trace of blood at the vaccination site that appears 10 to 20 seconds after vaccination.

Administering the strokes rapidly, within about 3 seconds, also helps induce enough pressure by the needle to produce this small amount of bleeding and assure that the vaccine was administered appropriately. This method allows the live vaccinia virus to penetrate the superficial layers of the skin so that viral multiplication can occur and produce immunity.

Once the vaccine is administered, you should dispose of the needle into an appropriate sharps disposal container. Cover the vaccination site with a piece of gauze or other appropriate dressing.

Here is the vaccination procedure again.

Instructions are included with each vaccine shipment that outline the vaccination procedure you’ve just seen. The instructions also contain other important information about smallpox vaccine.