The Editorial Executive Committee welcomes letters, which should be less than 250 words. Before a decision to publish is made, letters which refer to a published article may be sent to the author for a response. Any letter may be sent to an expert for comment. When letters are published, they are usually accompanied in the same issue by their responses or comments. The Committee screens out discourteous, inaccurate or libellous statements. The letters are sub-edited before publication. Authors are required to declare any conflicts of interest. The Committee's decision on publication is final.


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.

W.A.C. Young

General Practitioner, Mornington, Vic.

Margaret Curran

Associate Medical Director, CSL Pharmaceuticals,