What should we do if we give an injection by the wrong route (subcutaneous [subcut], instead of intramuscular [IM])?

Your practice should put procedures in place to ensure that you always give vaccines by the recommended route because data regarding safety and efficacy of alternate routes are limited.

CDC and/or ACIP guidance about vaccination by the wrong route vary depending upon the vaccine and route:

• It is not necessary to repeat doses of vaccines that are recommended to be given subcut if they are inadvertently administered IM.
• If hepatitis B, rabies, HPV, or inactivated influenza vaccine is administered subcut, the dose should not be counted as valid and should be repeated and administered IM.
• CDC’s guidance on what to do following inadvertent subcut administration of RSV vaccine depends upon the recipient: if given to an older adult by the subcutaneous route, the RSV dose should not count and should be repeated IM; if the recipient is pregnant, the RSV dose should count and should not be repeated.
• ACIP states that if PCV, Hib, or DTaP is administered subcut, a provider has the discretion to repeat the dose(s) IM because there is no evidence related to immunogenicity of these vaccine administered subcut. There is no minimum interval between the invalid dose and the repeat dose.
• If HepA, MenACWY, IPV, PPSV23, COVID-19, or RZV (Shingrix) vaccines are administered subcutaneously, the doses can count and do not need to be repeated.
• ACIP and CDC have no recommendation for Tdap, Td, MenB, Typhim VI (injectable typhoid), or Japanese Encephalitis-VC.