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Order of vaccine injection and infant pain response

Moshe Ipp1, Patricia C Parkin, Naomi Lear

  • 1Department of Paediatrics, Paediatric Outcomes Research Team, Division of Paediatric Medicine, The Hospital for Sick Children Research Institute, University of Toronto, 555 University Ave, Toronto, ON M5G 1X8, Canada. mm.ipp@utoronto.ca

Archives of Pediatrics & Adolescent Medicine
|May 6, 2009
PubMed

Insights

Administering the diphtheria, polio, and tetanus toxoids and acellular pertussis and Haemophilus influenzae type b (DPTaP-Hib) vaccine before the pneumococcal conjugate vaccine (PCV) significantly reduced infant pain. This order is recommended for routine infant immunizations to minimize discomfort.

Area of Science:

  • Pediatric immunology
  • Pain management in infants
  • Vaccination protocols

Background:

  • Infant vaccination involves multiple injections, potentially causing acute pain.
  • The order of vaccine administration may influence pain perception and response.
  • Optimizing the vaccination sequence can improve the infant's experience.

Purpose of the Study:

  • To evaluate the impact of vaccine administration order on infant pain response.
  • To compare pain levels when DPTaP-Hib vaccine is given before PCV versus PCV given before DPTaP-Hib.
  • To provide evidence-based recommendations for vaccine sequencing in infants.

Main Methods:

  • A single-center, double-blind, randomized clinical trial was conducted.
  • Healthy infants aged 2 to 6 months received either DPTaP-Hib or PCV first.
  • Pain was assessed using the Modified Behavioral Pain Scale (MBPS) and a visual analog scale (VAS), with crying also recorded.

Main Results:

  • Infants receiving DPTaP-Hib first reported significantly lower pain scores (MBPS and VAS) compared to those receiving PCV first.
  • The DPTaP-Hib vaccine elicited less pain than the PCV when administered as the initial injection.
  • No significant differences in infant characteristics were observed between the groups.

Conclusions:

  • Administering the DPTaP-Hib vaccine before the PCV reduces acute pain in infants during routine immunization.
  • The study recommends the DPTaP-Hib vaccine be given prior to the PCV to minimize infant pain.
  • This finding supports optimizing vaccine administration order for improved patient comfort.
Abstract

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