Vaccine Administration

This information is about preventing or responding to smallpox. For the latest information about the current mpox outbreak, including information on symptoms, prevention, and vaccines, please visit CDC’s Mpox site.

Unlike a typical vaccine, the ACAM2000® is given using the multiple puncture technique, using the bifurcated needle.

Step-by-Step Instructions

  1. Review patient history for contraindications (nonemergency screening questions, emergency screening questions).
  2. Choose the site for vaccination – the deltoid area on the upper arm is recommended.
  3. No skin preparation is required. DO NOT apply alcohol to the skin prior to vaccination. Alcohol will inactivate the vaccinia virus.
  4. Dip the bifurcated needle into the vaccine vial and withdraw it. The needle is designed to hold a tiny drop of vaccine of sufficient size and strength to ensure a successful vaccination (if administered correctly). DO NOT REINSERT THE NEEDLE INTO THE VACCINE VIAL once it has touched the patient’s skin or you may contaminate the vial.
  5. Administer the vaccine
    • Hold the needle perpendicular to the site of insertion. Keep your wrist stable by resting it on the patient’s arm or on another firm support.
    • Hold the skin taught. Prick the skin rapidly with the needle 15 times (or the number of times specified in the vaccine package insert). Keep the needle pricks within an area approximately 5 mm in diameter. A trace of blood should appear at the vaccination site within 10 to 20 seconds.
    • Immediately after vaccinating the patient, discard the bifurcated needle in an appropriate sharps biohazard container.
  6. Use sterile gauze to wipe up excess vaccine on the patient’s vaccination site. Discard the used gauze in a biohazard container in order not to contaminate the site or infect others who may come in contact with it.
  7. Cover vaccination site with gauze and secure it loosely with first aid adhesive tape.
    • Vaccinees who expect to be in close personal contact with others (such as parents of infants and young children) should also wear a long-sleeved shirt or other clothing that covers the vaccination site and gauze.
    • Healthcare workers or individuals who provide direct patient care (e.g., caregivers/caretakers) may wear semipermeable dressings to provide additional protection against spreading vaccinia while at work. Non-healthcare worker vaccinees should wear semipermeable dressings only when they are bathing. The prolonged use of a semipermeable dressing could cause maceration of the vaccination site along with irritation and itching. This may increase touching, scratching, and contamination of the hands, and possibly delay healing of the vaccination site lesion.
  8. Educate vaccinee about how to care for the vaccination site to prevent spreading the virus to other parts of their body or to other people.
  9. Evaluate the reaction – Evaluate the patient’s vaccination site 6 to 8 days following vaccination for a successful “take.”