imm assignment guidelines

IMM Graduate School Harvard Referencing System Guide

Description.

Click  here  to download. Updated July 2021.

Click here to read the General referencing Tutorial Letter.

Table of contents

• 1. HARVARD REFERENCING SYSTEM GUIDE
• 2. What is a Reference List?
• 3. In-text citation (referencing in the text)
• 4. Which referencing system has been approved by the IMM Graduate School:
• 5. Reasons to reference
• 6. When should sources be referenced?
• 7. What happens when sources are not referenced?
• 8. Deconstructing a book reference
• 9.1. Single author
• 9.2. 2 or 3 authors
• 9.3. Book: More than 3 authors
• 9.4. Book: author unknown
• 9.5. Book: editor
• 9.6. Book: 2 or more editors
• 9.7. Book: reprint in a different form
• 9.8. Book: organisation as author
• 9.10. Book chapters (when different authors have contributed towards a publication, i.e. by writing a specific chapter).
• 9.11. Dictionary or Encyclopedia
• 9.12. Book with chapter/page numbers used for direct quotes only (Note, page numbers and chapters are thus only required when a direct quote is used).
• 10. Deconstructing a journal citation
• 11.1. In general:
• 11.2. Journal article:
• 11.3. Journal article with two authors:
• 11.4. Journal article with three authors:
• 11.5. Journal article with more than three authors
• 11.6. Electronic journal article (no volume and issue numbers available)
• 11.7. Electronic journal article (Where the volume number and issue numbers of the journal are available)
• 12.1. In general
• 12.2. Newspaper: Print
• 12.3. Newspaper: Electronic database
• 12.4. Newspaper: Website
• 12.5. Newspaper: No author
• 13.1. Company report
• 13.2. Company profile
• 13.3. Datasets
• 14.1. Conference paper: Print
• 14.2. Conference paper: Electronic
• 14.3. Conference paper: Unpublished
• 15.1. In general
• 15.2. Website
• 15.3. Web page: no author
• 15.4. Web page: no date
• 15.6. Web based image / table / figure
• 15.7. Web document
• 15.8. Website
• 15.9. Computer software
• 16.2. Podcast
• 16.3. Television
• 16.4. YouTube
• 16.5. MOOCs video
• 16.6. Facebook, Twitter, etc.
• 16.7. Music track from an album
• 17.1. Lecture notes
• 17.2. Study Guide
• 18.1. Thesis: Unpublished
• 18.2. Thesis: Published
• 19.1. Telephone call, interview, etc.
• 19.2. E-mail
• 20.1. All or part of a table, figure, or data used in text: from a print journal
• 20.2. All or part of a table, figure, or data used in text: from a textbook
• 20.3. All or part of a table, figure, or data used in text: from the web
• 21.1. Cases
• 21.2. Delegated Legislation
• 21.3. Acts of Parliament
• 21.4. Bills
• 22.1. Patent
• 22.2. Standard: retrieved form a database
• 22.3. Standard: Published
• 23. Secondary sources examples
• 24. How to use quotations
• 25. Reference list:

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Referencing the IMM way

Click  here  to download the  Reference Guide . Updated January 2022. 

Click here  to read the General referencing Tutorial Letter.

CLICK HERE TO DOWNLOAD

Updated:  July 2021

• A full reference list is a list of all the information sources (references) that have been cited in the text.
• A reference list appears at the end of the assignment or report and before any addendums.
• The reference list contains all the necessary information to help the reader find the original work.
• The reference list items must be arranged alphabetically by the author surnames – but not in bullet or numbered format.
• Important: Every reference must link to an in-text citation in the body of the work.
• A reference list is NOT a Bibliography. The IMM Graduate School requires a reference list and not a bibliography.
• Items are listed only once in alphabetical order; the same source may not be used more than once.
• Provide full details of the sources used in the text.
• Use italics as indicated in the examples that follow.

• Use inverted commas “ ” as required (refer to the examples that follow).
• Use the correct URL address as indicated in the examples that follow.
• Leave an open space between the items on the reference list.

This is what an alphabetical reference list should look like . It should always appear at the END of your assignment/report/thesis:

Arya, C. (2003).  Design of structural elements . 2 nd ed. London: Spoon Press.

Bowlin, W.F., Simpson, H., Renner, C.J., and Rives, J.M. (2003). “A DEA study of gender equity in executive compensation”, Journal of the Operation Research Society . 54(7), pp. 751-7.

Chartered Institute of Library and Information Professionals (CILIP). (2008).  Information literacy: a definition . Available from: < http://www.cilip.org.uk/policyadvocay/informationliteracy/ definitiondefault.htm>. [Accessed 7 August 2008]

Department of Health. (2007).  Health inequalities: progress and next steps. Available from: < http://www.dh.gov.uk/> ;. [Accessed 23 January 2009]

Gerring, J. (2007).  Case study research: principles and practices. Available from: < http://www.myilibrary.com >. [Accessed 14 August 2008].

Lloyd, S. (2002). Capturing the consumer. Small firms: adding a spark: the 25 th ISBA national small firms’ policy conference. Robert Gordon University, Aberdeen, 15-17 November. Leeds: Institute for Small Business Affairs, pp.132-138.

Smith, D. (2008). House price markets, The Times, 26 June, p.25.

           What is in-text referencing?

• Each time a reference is made to someone else’s work in a document, the author’s name and the publication date of his/her work should be included within the text at the point where his/her ideas have been discussed. This is called citing the author’s work .
• Remember: When in-text citation is used and there is more than one author at a time, the author’s names should be listed in the order the authors appear on the title page of the book or article!

The IMM Graduate School follows the Harvard Referencing System in the listing of sources for academic texts, and NOT APA, Chicago, etc. Also note: The IMM Graduate School Harvard Referencing system is NOT similar to any other Harvard Referencing system, including the MS Word version.

As it is not possible to reproduce the complete set of Harvard Referencing System options in this document, only some basic examples are provided as a guideline.

All assignments and dissertations produced by the IMM Graduate School students must include in-text citations as well as a detailed list of references (the latter appears at the end of an assignment/report but before the Addendums). Each in-text citation needs to link up to a reference at the end of the document where the reference list contains the sources of the citations. These two types of references always go hand in hand. This means that for each in-text reference a corresponding entry should be included in the list of references at the end of the document. The reverse is also true: for each entry in the list of references, an in-text reference should be included in the text.

Do NOT use a Bibliography . A bibliography is a list of sources that have been used in preparation of the assignment or dissertation but that you have not necessarily cited in the text.

Giving credit to the original author by referencing sources is the only way to use other people’s work without plagiarising. Refer to the document called Plagiarism Avoidance Guide which you can find on the IMM Graduate School eLearn system.

Whenever words or ideas are borrowed the source needs to be acknowledged. The following situations almost always require referencing:

• Whenever quotes from a 3 rd party are used
• Whenever paraphrasing is used you still need to reference: - you may be using your own words but you are still using the ideas of another author to whom you need to give credit
• Whenever an idea that someone else has already expressed is used
• Whenever specific reference is made to the work of another author
• Whenever someone else’s work has been critical in the development of your own ideas. 

Students failing to reference or failing to do it properly become guilty of committing plagiarism. Refer to the document called Plagiarism Avoidance Guide Policy to familiarise yourself with the sanctions that are applicable when found guilty of plagiarism.

Here are examples of what the format of the in-text citation in the reference list should look like. Remember, in-text citation appears IN the document at the section / sentence where the specific book / author is being used, and the reference list appears at the end of your document before any appendices.

In general, the following guideline will apply for any book that needs to be referenced at the end of your document:

Example when reference to the author(s) appears at the end of the sentence:

Research has indicated the following….. (Author, year of publication). ( Note – author and year appear in brackets)

Example when author is part of the sentence:

Author (year) stated that the ….. ( Note: Only the year appears in brackets and the full-stop denoting the end of the sentence is inserted after the citation at the end of the sentence). 

Reference list:

Author, A. (year of publication in brackets) Title of Book in italics. Edition. Place of publication: publisher.

Specific examples pertaining to any books:

Wright (1997) explained the importance of proper referencing techniques... or at the end of the sentence, for example...  It is critical that all sources are always properly referenced (Wright, 1997). 

Wright, H. (1997) The principles of referencing . 2 nd ed. Timbuktu: Inside Publishing.

Rundle, Booysen and Dube (1990) states… or at the end of the sentence ...  Online messages can be interpreted in various manners (Rundle, Booysen & Dube, 1990).

Reference list: Rundle, D., Booysen, H. and Dube, P. (1990).  The interpretation of online messages. Timbuktu: Inside Publishing.

The first opportunity to cite a source with more than 3 authors requires you to mention all the authors and then, subsequent to that, you may use only the first name followed by et al.   

In-text: Bruwer, Wright, Prince and Victor (2010) states… or at the end of sentence... Study guides should be written in the correct format. (Bruwer, Wright, Prince and Victor, 2010). 

In-text subsequent to the first citation:  Bruwer et al. (2010) states … or at the end of the sentence … Study guides should be written in the correct format (Bruwer et al., 2020).

Reference list: Bruwer, A., Wright, P.R., Prince, M.C. & Victor, A. (2010).  The how-to guide to writing a study guide. Johannesburg: Academic Solutions Group.

In-text: Anonymous (2010) states… or at the end of the sentence, for example...  the end of the world is full of surprises (Anonymous, 2010).

Reference list: Anonymous. (2010).  A journey to the end of the world . Timbuktu: Imagination Express.

In-text: Griffiths (2013) explained various humorous situations in the boardroom… or at the end of the sentence ...   A boardroom situation may create various humorous situations (Griffiths, 2013). 

Note: The in-text citation does not carry the name of the editor, it must be the name of the author of that particular chapter, followed by the title of the chapter, followed by the name of the editor and the title of the book.

Reference list: Griffiths, C. (2013) “Humour in the boardroom” . In Bevan, M. ed. Laughing Matters, 2nd ed. Timbuktu: Inside Publishing.

Bevan and Hugo (2014) acknowledged the fact that marketing graduates have a bright future ahead of them... or at the end of the sentence...  Marketing graduates have a bright future ahead of them (Eds Bevan and Hugo, 2014). 

Bevan, M. and Hugo, J. (eds.) (2000) Towards the academic future . London: Academic Press Association.

McAlmon (1925) stated that in the three decades since New York City's Stonewall rebellion, gay literature has exploded as a distinctive form of cultural expression. ... or at the end of the sentence for example ...  In the three decades since New York City's Stonewall rebellion, gay literature has exploded as a distinctive form of cultural expression (McAlmon, 1925).

McAlmon, R. “Miss Knight”. (1925) The Columbia Anthology of Gay Literature: Readings from Western Antiquity to the Present Day. Ed. Byrne R.S. Fone. New York: Columbia UP, 1998, pp. 629-39. Print.

According to the Natal Rugby Association, (1980), Stefan Terblanche ….  or at the end of the sentence, for example...  Stefan Terblanche played for the Sharks …. (Natal Rugby Association, 1980). 

Natal Rugby Association. (1980) 80 th Anniversary Yearbook . Natal Rugby Association.

(Lipman, 1918). 

Author, A. (year of publication) Title of book. Edition. Available from: <url address>. [Accessed on date].

For example, the above mentioned in-text citation source will be handled as follows in the Reference list:

• Lipman, F.L. (1918) Creating capital: money-making as an aim in business . Available from: < http://www.gutenberg.org/files/29673/29673-h/29673-h.htm> ;. [Accessed on 25 February 2012]. 

(Bick, 2011). 

Bick, G. (2011) “Brand equity and brand valuation”, in Klopper, H.B., and North, E. (ed.) (2011) Brand Management. Cape Town: Pearson Education SA.

In-text: The Macquarie Dictionary (1997) defines...

Reference list: Note: No entry is needed in the reference list.

In-text: (Wright, 1997, Chapter 1, pp.100-101) or Wright (1997, Chapter 1, pp.100-101)

Reference list: Wright, H. (1997).  The principles of referencing. Timbuktu: Inside Publishing, Chapter 1, pp. 100-101.

Specific examples pertaining to any journals

In-text: (Author, year of publication)

Reference list: Author, A. (year of publication) “Title of article”, Title of Journal, volume, number, page numbers.

In-text:  Meindl (1987) suggested that advanced computing… or at the end of the sentence for example...   Advanced computing has ….. (Meindl, 1987). 

Reference list: Meindl, D. (1987) “Chips for advanced computing”, Scientific American , vol. 257, no. 4, pp. 54-62. 

In-text:   Oosthuizen and McDonald (2009) provided evidence on the growth of online marking…. or at the end of the sentence, for example...  Online marking is the way of the future (Oosthuizen and McDonald, 2009).

Reference list: Oosthuizen, D. and McDonald, G. (2009) “The online marking process: an overview”, The African Journal of Academics , vol. 10, no. 2, pp. 97-99.

In-text: …. Simpson, Thomas and Enslin (2014) explained that mobile technology…. or at the end of the sentence, for example...  Mobile technology has …. (Simpson, Thomas & Enslin, 2014).

Reference list: Simpson, J.A., Thomas, S.A. and Enslin, D.J. (2014) “The role of mobile technology in the media plan”, Journal of International Marketing , vol.17, no. 2, pp. 63-65.

The first opportunity to cite a source with more than 3 authors requires you to mention all the authors and then, subsequent to that, you may use only the first name followed by et al.  

In-text:  Shapiro, Bethu, Ndlovu and Wilcox (2000) provided an analysis of ….. or at the end of the sentence ... A new media planning format has been introduced…. (Shapiro, Bethu, Ndlovu and Wilcox , 2000). 

In-text subsequent to the first citation:  Shapiro et al. (2000) provided an analysis of ….. or at the end of the sentence ... A new media planning format has been introduced…. (Shapiro et al., 2000).

Reference list: Shapiro, D., Bethu, R., Ndlovu, B. and Wilcox, S.R. (2000) “A new media planning format”, Journal of Media planning , vol. 10, no. 5, pp. 454-65.

In-text:  Bouwer (2014) explained that social media is a great contributor…. ot at the end of the sentence, for example, ...  Social media has been a great contributor to ….. (Bouwer, 2014).

Reference list: Bouwer, C. (2014) “The role of social media in building brand equity”, Journal of Branding . Available from: < http://www.job.int.com/rosm-bbe/fulltext.121544162/PDF> ;. [Accessed on 23 May 2015].

Provide full location details if these are necessary to find the document OR just the main site details.

In-text: Bouwer, (2014, para 6.13) explained that social media is a great contributor…. or at the end of the sentence...  Social media has been a great contributor to ….. (Bouwer, 2014, para 6.13). 

Reference list: Bouwer, C. (2014) “The role of social media in building brand equity”, Journal of Branding , vol. 3, no. 70. Available from: < http://www.job.int.com/rosm-bbe/fulltext.121544162/PDF> ;. [Accessed on 23 May 2015].

Provide full location (web location) details if these are necessary to find the document OR just the main site details.

Specific examples pertaining any newspaper examples

In-text: Author (year of publication) states… or at the end of the sentence, for example...  (Author, year of publication).

Reference list: Author, A. (year of publication) “Title of the article”, Title of the newspaper , date, page number.

In-text: Roos (2015) urges all human beings…. or at the end of the sentence... for example...  Mother Earth needs all our love…. (Roos, 2015). 

Reference list: Roos, M. (2015) “Don’t turn your back on Mother Earth”, The Star , 8 June 2015, p. 10.

In-text: Or Meryment (2006) stated that Wineries are becoming …. or if at the end of a sentence... for example... Wineries are becoming more interested in focusing their marketing tactics on online marketing (Meryment, 2006). 

Reference list: Meryment, E. (2006) “Distaff winemakers raise a glass of their own to their own”, The Australian, 7 October, p. 5. Available from: Factiva. [Accessed on 2 February 2007].

In-text:  Hilts (1999) states… or, if at the end of a sentence... Hilts (1999). 

Reference list: Hilts, P.J. (1999) “In forecasting their emotions, most people flunk out”, The New York Times , 16 February, Available from < http://www.nytimes.com >. [Accessed on 19 February 2000].

In-text: It was stated in The Star (11 July 2010, p. 4) that...

Reference list: NO entry required

Specific examples pertaining any company information / company documents

In-text:  Vodacom (2010) stated the importance of growing its footprint into…. or, at the end of the sentence...  Vodacom extended its footprint... (Vodacom, 2010).

Reference list: Vodacom Annual Report 2010 . (2010) Available from: < http://www.vodacom.co.za >. [Accessed on 8 June 2015].

In-text:  M icroelectronics International (2002) identified ….. , or at the end of the sentence, for example, ...  Growth areas….. (Microelectronics International, 2002). 

Reference list: Microelectronics International. (2002) "Company Profile – IPL, Dorchester, UK" . Available from: Emerald Group Publishing Limited.

In-text: Statistics South Africa (2015) published ….  or, if at the end of the sentence, for example:  Population growth …. (Statistics South Africa, 2015). 

Statistics South Africa. (2015).  Mid-year population estimates, 2015, P0302. Available from: < http://www.statssa.gov.za/?page_id=1854&PPN=P0302&SCH=6334 >. [Accessed on 28 July 2015].

Specific examples pertaining any Conference papers

In-text: (Author, year of publication), for example: McIntee (2014) identified the growth …., or, if at the end of the sentence...  Marketing as an industry …. (McIntee, 2014). 

Reference list: Author, A. (year of publication). “Title of paper”, Title of Conference , location, date of conference, place of publication: publisher, page numbers. For example:

McIntee, H. (2014). “The growth of the marketing fraternity in Africa”, The African Marketing Confederation Conference , Zimbabwe, 15 September 2014, South Africa: African Marketing Confederation, pp. 11-15.

In-text: McIntee (2014) identified the growth …., or, at the end of the sentence...  The Marketing fraternity …. (McIntee, 2014). 

Reference list: McIntee, H. (2014). “The growth of the marketing fraternity in Africa”, The African Marketing Confederation Conference , pp.11-15. Available from: AMC Portal, AMC Digital Library. [Accessed 20 October 2014].

In-text: Simpson (2015) indicated that the retail sector…, or if at end of sentence...  The formal retail sector… (Simpson, 2015). 

Reference list: Simpson, M. (2015). “Is formalised retailing a positive sign?” paper presented at the African Marketing Confederation Conference , Zimbabwe.

Specific examples pertaining any Internet / Website examples

Reference list: Author, A. (year of publication / last updated).  Title of the Website. Available from: <online URL address>. [Accessed on date].

In-text: Johannesburg Stock Exchange (2015) provided a comprehensive …., or, if at end of the sentence...  The following are a list of companies …. (Johannesburg Stock Exchange, 2015). 

Reference list: Johannesburg Stock Exchange. (2015). “ Listed Companies” . Available from: < http://www.jse.co.za/current-companies/companies-and-financial-instruments> ;. [Accessed on 8 June 2015].

In-text:  M ayo Health (2014) provided a comprehensive list …., or, if used at the end of the sentence:  Early warning signs to look out for … (Mayo Health, 2014). 

Reference list: Mayo Health (2014). “ Surviving a heart attack: your early warning signs” . Available from: < http://www.mayohealth.com/i-cms?page=10221> ;. [Accessed on 8 May 2015].

In-text: Bevan (n.d.) stated that staff morale is much higher when….. Or, if used at the end of the sentence: Staff morale is much higher when …..(Bevan, n.d.).

Reference list: Bevan, M.R. (n.d.). “ The impact of a coffee machine on staff morale” . Available from: < http://www.coffeebeans.com >. [Accessed on 6 June 2015].

In-text: Sykes (2015) shared insights….. Or if used at the end of the sentence: The reasons why you are not a millionaire… (Sykes, 2015).

Reference list: Sykes, T. (2015). “4 Reasons you’re not a millionaire”. Timothy Sykes Blog . 30 May 2015. Available from: < http://www.timothysykes.com/2015/05/4-reasons-youre-not-millionaire> ;. [Accessed on 8 June 2015].

Note: Some blog authors may choose to blog anonymously (thus using an alias). Use this alias instead of surname and initials if that is all that is available.

In-text: (Immediate Marketing and Business Consulting, 2015)

Immediate Marketing and Business Consulting . (2015). Available from: < http://www.immediatemarketing.com/images/business_8.jpg> ;. [Accessed on 8 June 2015].

In-text: The Department of Trade & Industry (2014) published an article…. Or, if used at the end of a sentence: A study done to determine the correlation between … (Department of Trade & Industry, 2014).

Reference list: Department of Trade & Industry. (2014). “ Productivity and caffeine: Is there a connection?” South African Government. Available from: < http://www.coffeebeands.com >. [Accessed on 8 June 2015].

In-text: SARS (2015) issued a document …. Or, if used at the end of  sentence:  Follow the following procedure to report … (SARS, 2015).

Reference list: South African Revenue Services. (2015).  “How to report suspected non-compliance to SARS” . Available from: < http://www.sars.gov.za/TargTaxCrime/ReportCrime/Pages/default.aspx.> ;. [Accessed on 8 June 2015].

In-text: OpenOffice.org (2005) provides computer software … Or, if used at the end of a sentence:  A list of computer software is available… (OpenOffice.org, 2005).

Reference list: OpenOffice.org, computer software. (2005). Available from: < http://www.openoffice.org >. [Accessed on 12 January 2005].

Specific examples pertaining any Multimedia examples

In-text : (Marketing 101, 2015)

Reference list: Marketing 101. (2015) (DVD), Institute of Marketing Management Graduate School, South Africa.

In-text : (Duct Tape Marketing, 2015)

Reference list: How to differentiate your business. (June 2015). Duct Tape Marketing weekly podcast, (podcast) June 2015. Available from: < http://www.ducttapemarketing.com/blog/category/podcast> ;. [Accessed on 8 June 2015].

In-text: (Oliver, 2015)

Reference list: Oliver, J. (2015).  Last week tonight, The mittens of disapproval are on, (television broadcast show) 8 June 2015, Trinidad Television.

In-text: (Coca-Cola vs Pepsi - The new battle, 2007)

Reference list: Coca-Cola vs Pepsi – The new battle. (2013). (YouTube video file), added by sirelatan. Available from: < watch ;. [Accessed on 8 June 2015]

In-text: (Kaul, 2015)

Reference list: Kaul, G. (2015).  Introduction to Finance, video file in Introduction to Finance course, University of Michigan. Available from: < https://www.coursera.org/course/introfinance> ;. [Accessed on 7 June 2015]

In-text: (Buckingham, 2015)

Reference list: Buckingham, I. (2015).  Brand engagement group , (Facebook), 29 May 2015. Available from: < http://www.facebook.com >. [Accessed on 9 June 2015]

In-text: (Omi, 2015)

Reference list: Omi. (2015).  “Cheerleader” , on iTunes. Available from: < watch ;. [Accessed on 9 June 2015]

Specific examples pertaining any Lecture note examples

In-text: (Bruwer, 2014)

Reference list: Bruwer, A. (2014).  Brand equity , lecture notes distributed in Brand Management 101 at the IMM Graduate School, Johannesburg on 14 April 2014.

In-text: (IMM Graduate School, 2014)

Reference list: IMM Graduate School. (2014).  FM101B, Financial Management 101 Study Guide . South Africa: IMM Graduate School.

Specific examples pertaining any t hesi s examples

In-text: Potgieter (2010) presented evidence on the interrelationship …… or if used at the end of a sentence: Evidence are available to indicate the ….. (Potgieter, 2010).

Reference list: Potgieter, H. (2010).  The interrelationship between social context and the cultural landscape of the commercial film industry , Ph.D thesis, University of Timbuktu.

In-text: Terblanche (2014) covered the work of Quentin ….. or if used at the end of a sentence: The work of Quentin Tarrintino … (Terblanche, 2014).

Reference list: Terblanche, C. (2014).  Dismemberment and dispossession in the work of Quentin Tarantino and Nathalie Djurberg . South Africa: UNISA.

Specific examples pertaining any personal communication examples

If the information you are referencing was obtained by personal communication, i.e. telephone call, or a personal interview you need to document it in the text, however you are not required to add it to the reference list at the end. You may also add the abbreviation pers.comm to the reference.

When interviewed on 8 June 2015, Ms. McIntee confirmed….

(Mr. D. Thomas, 2013, pers. comm., 8 June)

In-text: Mr. L. Bekker confirmed this by email on 30 May 2014 or Bekker (2014) confirmed this… or It was confirmed that … (Bekker, 2014).

Reference list: Author, A. (date of message). “Subject of message”, email to recipient’s name, for example:

Bekker, L. (30 May 2014). email to Rehana Prinsloo.

Specific examples pertaining any tables and figures examples

Add in-text citation to the text of the illustration’s caption.

In-text: The data in column # are from “Evaluating the effectiveness of media dynamics” (Steyn, 2010, p.600)

Reference list: Steyn, P. (2010). “Evaluating the effectiveness of media dynamics”, Journal of Marketing , vol. 133, no. 8, pp. 600-602.

In-text: The data in column # are from Numeracy levels of first-year students (Potgieter, 2014, p.100).

Reference list: Potgieter, H. (2014).  Numeracy levels of first-year students. Timbuktu: Timbuktu Publishing Press.

In-text: The data in column # are from Export data to China, January 2014 (SAEX, 2014).

Reference list: South African Department of Export. (2014).  Export data to China, December 2014 (No.5439). Available from < http://www.exportsa.gov.za/exports/china_2014?url.document >. [Accessed on 1 February 2015].

Specific examples pertaining any cases and legislation examples

In-text: ( R v Willey (2013) 237 CLR 1).

Reference list: R v Willey (2013). 237 CLR 1.

In-text: ( Social Welfare Regulations 2001 (SA) reg.7).

Reference list: Social Welfare Regulations 2001 (SA) reg. 7

In-text: ( Communications Act 2001 (Cth) s 4)

Reference list: Communications Act 2001 (Cth).

In-text: (Protection of Information Bill (No. 1) 2010 (Sag)).

Reference list: Protection of Information Bill (No. 1) 2010 (Sag).

Specific examples pertaining any standards and patents examples

In-text: (Walker, 2000).

Reference list: Walker, N. (2005) Fastener for a briefcase system , US Patent 45555X1.

In-text: (Bureau of Standards SA 2012).

Reference list: Bureau of Standards, SA. (2012). Child seat regulations – general requirements, SA 4455.I-2008. Available from: South African Bureau of Standards. [Accessed on 1 December 2010].

Reference list: Bureau of Standards, SA. (2012).  Child seat regulations – general requirements, SA 4455.I-2008. 2008. SA: Bureau of Standards.

Specific examples pertaining any secondary sources examples

When you cite an author who refers to or quotes another author, this must be clearly indicated in the text (even though this practice should be kept to a minimum as the preferred option is for you to have read the original source itself).

Chambers (1983, p. 25) gives Whiteley’s (1979) definition of emotion as “a response to situations of one specific type ...”

In this example, the reference actually used was Chambers (1983), not Whiteley (1979).

A reference list entry must be made for Chambers, but can be made for both items if it is useful to your reader.

Reference: Chambers, P.K. (1983).  Your emotions revealed. New York: Lacrima and Ductule.

Reference: Whiteley, B.C. (1979). ‘Emotional response’, Brain Talk , vol. 2, no. 12, pp. 234-5. (optional at your discretion)

Use inverted commas to enclose the direct text. For short quotations (of less than 40 words), use a brief phrase to introduce the quotation. For example:

As Neville (2007, Chapter 1, pp.100-101) emphasises, “ … you should cite all sources and present full details of these in your list of references.” .

For longer quotations (of 40 words or more) a block quotation is required, without quotation marks, but clearly indented to indicate these words are not your own. For example:

Neville (2007, Chapter 1, pp.100-101) comments that: It can sometimes be difficult, if not impossible, to avoid using some of the author’s original words, particularly those that describe or label phenomena. However, you need to avoid copying out what the author said, word for word. Choose words that you feel give a true impression of the author’s original ideas or action and use these in your writing.

Therefore, treat the direct quote as follows: Slightly smaller font and indented from the left margin to distinguish it from the rest of the text. Also add the Chapter and page number .

Reference li st:

University of Wolverhampton. (2014).  Ref: LS067, Harvard Referencing . Produced by the Department of Learning & Information Services, University of Wolverhampton.

University of Wolverhampton. (2014) Ref: LS067, Harvard Referencing . Produced by the Department of Learning and Information Services, University of Wolverhampton.

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(b) When an item assigned for IMM is to be acquired by the requiring activity under DFARS 208.7003-1 (a)(3), the contracting officer must—

(i) Document the contract file with a statement of the specific advantage of local purchase for an acquisition exceeding the micro-purchase threshold in FAR Part 2; and

(ii) Ensure that a waiver is obtained from the IMM manager before initiating an acquisition exceeding the simplified acquisition threshold in FAR Part 2, if the IMM assignment is to the General Services Administration (GSA), the Defense Logistics Agency (DLA), or the Army Materiel Command (AMC). Submit requests for waiver—

(A) For GSA, to: Commissioner (F)

Federal Supply Service

Washington, DC 20406

(B) For DLA, to: DLA Land and Maritime

ATTN: DSCC-BDL

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ATTN: DSCP-ILSI (for General and Industrial) DSCP-OCS (for Medical, Clothing, and Textiles)

700 Robbins Avenue, Bldg. 4

Philadelphia, PA 19111-5096

(iii) In addition, forward a copy of each request to:

Defense Logistics Agency

Logistics Operations

ATTN: J-335

Fort Belvoir, VA 22060-6221

For AMC: HQ, Army Materiel Command

ATTN: AMCLG-SL

4400 Martin Road

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• Vaccine Recommendations

Vaccine Recommendations by AOR

For general policy guidance on every vaccine, please see the  Joint Regulation on Immunizations and Chemoprophylaxis for the Prevention of Infectious Diseases (AR 40-562, BUMEDINST 6230.15B, AFI 48-110_IP, CG COMDTINST M6230.4G) .

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Regional Vaccine Recommendations provided for informational reference purposes only. Always vaccinate according to package inserts and DoD/Service guidelines.

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Vaccine Administration

General Best Practice Guidelines for Immunization

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Infection Control and Sterile Technique

General precautions.

Persons administering vaccinations should follow appropriate precautions to minimize risk for disease exposure and spread. Hands should be cleansed with an alcohol-based waterless antiseptic hand rub or washed with soap and water before preparing vaccines for administration and between each patient contact ( 1 ). Occupational Safety and Health Administration (OSHA) regulations do not require gloves to be worn when administering vaccinations, unless persons administering vaccinations have open lesions on their hands or are likely to come into contact with a patient’s body fluids ( 2 ). If worn, gloves should be changed between patients.

Vaccine Administration: Preparation and Timely Disposal

Vaccines should be drawn up in a designated clean medication area that is not adjacent to areas where potentially contaminated items are placed. Multi-dose vials to be used for more than one patient should not be kept or accessed in the immediate patient treatment area. This is to prevent inadvertent contamination of the vial through direct or indirect contact with potentially contaminated surfaces or equipment that could then lead to infections in subsequent patients ( 3 ).  Smallpox vaccine is accessed by dipping a bifurcated needle directly into the vaccine vial. The vaccine adheres to the sides of the bifurcated needle, and is administered via skin puncture. The vial must be accessed in the immediate patient area to reduce environmental contamination by vaccine virus. To prevent contamination of the vial, make sure the patient area is clean and free of potentially contaminated equipment.

Different single-components of combination vaccines should never be mixed in the same syringe by an end-user unless specifically licensed for such use ( 4 ). Single-dose vials and manufacturer-filled syringes are designed for single-dose administration and should be discarded if vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer. Syringes that are prefilled by the manufacturer and activated (i.e., syringe cap removed or needle attached) but unused should be discarded at the end of the clinic day. For non-live vaccines, manufacturers typically recommend use within the same day that a vaccine is withdrawn or reconstituted. For live vaccines that require reconstitution, manufacturers typically recommend the vaccine be used as soon as possible after reconstitution and be discarded if not used within 30 minutes after reconstitution. For example, varicella vaccine should be discarded if not used within 30 minutes after reconstitution, whereas MMR vaccine, once reconstituted, must be kept in a dark place at 36°F to 46°F (2°C to 8°C) and should be discarded within 8 hours if not used. When in doubt about the appropriate handling of a vaccine, vaccination providers should contact that vaccine’s manufacturer.

ACIP discourages the routine practice of providers’ prefilling syringes for several reasons. Because the majority of vaccines have a similar appearance after being drawn into a syringe, prefilling might result in administration errors. Because unused prefilled syringes also typically must be discarded if not used within the same day that they are filled, vaccine wastage might occur. The FDA does not license administration syringes for vaccine storage.

In certain circumstances in which a single vaccine type is being used (e.g., in preparation for a community influenza vaccination campaign), filling a small number (10 or fewer) of syringes may be considered (5). The doses should be administered as soon as possible after filling, by the same person who filled the syringes. Unused syringes that are prefilled by the manufacturer and activated (i.e., syringe cap removed or needle attached) should be discarded at the end of the clinic day. Vaccine from two or more vials should never be combined to make one or more doses. This can lead to violation of expiration dates and product contamination ( 6,7 ).

Health Care Provider Exposure to Vaccine Components

Providers are sometimes concerned when they have the same contraindications or precautions as their patients from whom they withhold or defer vaccine. For administration of routinely recommended vaccines, there is no evidence of risk of exposure of vaccine components to the health care provider, so conditions in the provider labeled as contraindications and precautions to a vaccine components are not a reason to withdraw from this function of administering the vaccine to someone else. Historic concerns about exposure to vaccine components are limited to non-parenteral vaccines in which some degree of environmental exposure is unavoidable ( 5, 8 ), or situations in which self-inoculation is likely due to the nature of the vaccine microbe [e.g. reduced attenuation of smallpox vaccine virus ( 9 )]. Persons administering ACAM 2000 smallpox vaccine to laboratory and health care personnel at risk for occupational exposure to orthopoxviruses can decrease the risk for inadvertent infection through recommended infection prevention measures. However, because of a theoretical risk for infection, vaccination with ACAM2000 can be offered to health care personnel administering this vaccine, provided individual persons have no specified contraindications to vaccination ( 10 ).

Safe Use of Needles and Syringes

Needles and syringes used for vaccine injections must be sterile and disposable. A separate needle and syringe should be used for each injection. Changing needles between drawing vaccine from a vial and injecting it into a recipient is not necessary unless the needle has been damaged or contaminated ( 11 ).

Bloodborne diseases (e.g., hepatitis B, hepatitis C, human immunodeficiency virus [HIV]) are occupational hazards for clinicians and other health-care providers. The Needlestick Safety and Prevention Act ( 2 ) was enacted in 2000 to reduce the incidence of needlestick injury and the consequent risk for bloodborne diseases acquired from patients. The act directed OSHA to strengthen its existing bloodborne pathogen standards. The revised standards became effective in 2001 ( 2 ). These federal regulations require the use of engineering and work practice controls to eliminate or minimize employee exposure to bloodborne pathogens . Engineering controls means controls (e.g., sharps disposal containers, self-sheathing needles, safer medical devices, such as sharps with engineered sharps injury protections and needleless systems) that isolate or  remove the bloodborne pathogens hazard from the workplace). Needle-shielding or needle-free devices that might satisfy the occupational safety regulations for administering injectable vaccines are available in the United States ( 12-13 ). The regulations also require maintenance of records documenting injuries caused by needles and other medical sharp objects and that nonmanagerial employees be involved in the evaluation and selection of safety-engineered devices before they are procured. Additional information about implementation and enforcement of these regulations is available from OSHA.

To prevent inadvertent needlestick injury or reuse, safety mechanisms should be deployed after use and needles and syringes should be discarded immediately in labeled, puncture-proof containers located in the same room where the vaccine is administered ( 5 ). Used needles should never be recapped.

Route of Administration

Injectable route.

Routes of administration are recommended by the manufacturer for each immunobiologic ( Table 6-1 ). With the exceptions of bacille Calmette-Guérin (BCG) vaccine and smallpox vaccine [ACAM2000] (both administered by the percutaneous route), injectable vaccines are administered by the intramuscular or subcutaneous route. The smallpox/monkeypox vaccine (Jynneos) is primarily administered by the subcutaneous route but in some circumstances is administered by the intradermal route. Deviation from the recommended route of administration might reduce vaccine efficacy ( 14-15 ) or increase the risk for local adverse reactions ( 16-18 ).

The method of administration of injectable vaccines is determined, in part, by the inclusion of adjuvants in some vaccines. An adjuvant is a vaccine component distinct from the antigen that enhances the immune response to the antigen, but might also increase risk of adverse reactions. To decrease risk of local adverse events, non-live vaccines containing an adjuvant should be injected into a muscle. Administering a vaccine containing an adjuvant either subcutaneously or intradermally can cause local irritation, induration, skin discoloration, inflammation, and granuloma formation.

Intramuscular Injections

Needle length.

Injectable immunobiologics should be administered where local, neural, vascular, or tissue injury is unlikely. Use of longer needles has been associated with less redness or swelling than occurs with shorter needles because of injection into deeper muscle mass ( 16 ). Appropriate needle length depends on age and body mass. Injection technique is the most important parameter to ensure efficient intramuscular vaccine delivery.

For all intramuscular injections, the needle should be long enough to reach the muscle mass and prevent vaccine from seeping into subcutaneous tissue, but not so long as to involve underlying nerves, blood vessels, or bone ( 15,19-22 ). Vaccinators should be familiar with the anatomy of the area into which they are injecting vaccine. Intramuscular injections are administered at a 90-degree angle to the skin, preferably into the anterolateral aspect of the thigh or the deltoid muscle of the upper arm, depending on the age of the patient ( Table 6-2 ).

The needle gauge for intramuscular injection is 22-25 gauge. A decision on needle length and site of injection must be made for each person on the basis of the size of the muscle, the thickness of adipose tissue at the injection site, the volume of the material to be administered, injection technique, and the depth below the muscle surface into which the material is to be injected ( Figure 1 ). Some experts allow intramuscular injection with a ⅝-inch needle but ONLY if the skin is stretched flat ( 21 ). If the subcutaneous and muscle tissue are bunched to minimize the chance of striking bone ( 19 ), a 1-inch needle or larger is required to ensure intramuscular administration. Aspiration before injection of vaccines or toxoids (i.e., pulling back on the syringe plunger after needle insertion but before injection) is not necessary because no large blood vessels are present at the recommended injection sites, and a process that includes aspiration might be more painful for infants ( 22 ).

Infants (Aged <12 Months)

For the majority of infants, the anterolateral aspect of the thigh is the recommended site for injection because it provides comparatively larger muscle mass than the deltoid ( Figure 2 ) ( 23 ). In certain circumstances (e.g., physical obstruction to other sites and no reasonable indication to defer doses), the gluteal muscle can be used. If the gluteal muscle must be used, care should be taken to define the anatomic landmarks. (a) For the majority of infants, a 1-inch needle is sufficient to penetrate the thigh muscle.

Toddlers (Aged 12 Months-2 Years)

For toddlers, the anterolateral thigh muscle is preferred, and when this site is used, the needle should be at least 1 inch long. The deltoid muscle can be used if the muscle mass is adequate. If 2 vaccines are to be administered in a single limb, they should be spaced an inch apart ( 4 , 24 ).

Children (Aged 3-10 Years)

The deltoid muscle is preferred for children aged 3-10 years ( 25 ); the needle length for deltoid site injections can range from ⅝ to 1 inch on the basis of technique. The anterolateral thigh can also be used ( 25 ). In this case the needle length should be 1 inch to 1.25 inches. Knowledge of body mass can be useful for estimating the appropriate needle length ( 26 ).

Young Adolescents (Aged 11-18 years)

The deltoid muscle is preferred for adolescents 11-18 years of age. The anterolateral thigh can also be used. For injection into the anterolateral thigh, most adolescents will require a 1-1.5-inch needle to ensure intramuscular administration ( 27 ).

Adults (Aged ≥19 Years)

For adults, the deltoid muscle is recommended for routine intramuscular vaccinations ( 23 ) ( Figure 3 ). The anterolateral thigh also can be used. When injecting into the deltoid muscle, for adults a measurement of body mass/weight is allowable prior to vaccination, understanding that resources to measure body mass/weight are not available in all clinical settings. For men and women who weigh <130 lbs (<60 kg), a ⅝-inch needle is sufficient to ensure intramuscular injection in the deltoid muscle if the injection is made at a 90-degree angle and the tissue is not bunched. For men and women who weigh 130-152 lbs (60-70 kg), a 1-inch needle is sufficient. For women who weigh 152-200 lbs (70-90 kg) and men who weigh 152-260 lbs (70-118 kg), a 1- to 1.5-inch needle is recommended. For women who weigh >200 lbs (>90 kg) or men who weigh >260 lbs (>118 kg), a 1.5-inch needle is recommended ( table 6-2 ) ( 20 ) . For injection into the anterolateral thigh muscle, a 1.5-inch needle should be used, although a 1-inch needle may be used if the skin is stretched tightly and subcutaneous tissues are not bunched.

Subcutaneous Injections

Subcutaneous injections are administered at a 45-degree angle, usually into the thigh for infants aged <12 months and in the upper-outer triceps area of persons aged ≥12 months. Subcutaneous injections may be administered into the upper-outer triceps area of an infant if necessary. A ⅝-inch, 23- to 25-gauge needle should be inserted into the subcutaneous tissue ( Figures 4  and 5 ) ( 4 ).

Rotavirus, adenovirus, cholera vaccine, and oral typhoid vaccines are the only vaccines administered orally in the United States. Oral typhoid capsules should be administered as directed by the manufacturer. The capsules should not be opened or mixed with any other substance. Rotavirus vaccines are licensed for infants. There are 2 brands of rotavirus vaccine, and they have different types of applicators. Providers should consult package inserts for details.

Intranasal Route

Live attenuated influenza vaccine is approved for healthy nonpregnant persons aged 2-49 years and is the only vaccine administered by the intranasal route. The administration device is a nasal sprayer with a dose-divider clip that allows introduction of one 0.1-mL spray into each naris. The tip should be inserted slightly into the naris before administration. Even if the person coughs or sneezes immediately after administration or the dose is expelled any other way, the vaccine dose need not be repeated ( 5 ).

Severely immunosuppressed persons (i.e., those who require care in a protected environment, e.g., bone marrow transplant recipients, individuals with severe combined immunodeficiency diseases) should not administer LAIV. It would be uncommon for persons with these conditions to be in a role administering vaccines. Other persons at increased risk for influenza complications can administer LAIV. These include persons with underlying medical conditions placing them at higher risk or who are likely to be at risk, including pregnant women, persons with asthma, and persons aged ≥50 years ( 2 ).

Multiple Injections

If multiple vaccines are administered at a single visit, administer each preparation at a different anatomic site ( 28 ). The location of all injection sites with the corresponding vaccine injected should be documented in each patient’s medical record. Health-care practices should consider using a vaccination site map so that all persons administering vaccines routinely use a particular anatomic site for each particular vaccine.

For infants and younger children, if more than 2 vaccines are injected in a single limb, the thigh is the preferred site because of the greater muscle mass; the injections should be sufficiently separated (separate anatomic sites [i.e. ≥1 inch] if possible) so that any local reactions can be differentiated ( 13 , 29 ). For older children and adults, the deltoid muscle can be used for more than one intramuscular injection.

If a vaccine and an immune globulin preparation are administered simultaneously (e.g., Td/Tdap and tetanus immune globulin [TIG], hepatitis B and hepatitis B immunoglobulin [HBIG]), separate limbs should be used for each injection ( 29-30 ).

Jet Injections

Jet injectors are needle-free devices that pressurize liquid medication, forcing it through a nozzle orifice into a narrow stream capable of penetrating skin to deliver a drug or vaccine into intradermal, subcutaneous, or intramuscular tissues ( 32-33 ). Immune responses generated by jet injectors against both attenuated and non-live viral and bacterial antigens are usually equivalent to, and occasionally greater than, immune responses induced by needle injection. However, local reactions or injuries (e.g., skin laceration, transient neuropathy, hematoma) are sometimes more frequent on delivery of vaccine by jet injectors compared with needle injection, depending on the inherent irritability of the vaccine and operator technique ( 33 ).

Multiple use jet injectors using the same nozzle for consecutive injections without intervening sterilization were used in mass vaccination campaigns from the 1950s through the 1990s ( 33 ); however, these were found to be unsafe because of the possibility of bloodborne pathogen transmission ( 34-37 ) and should not be used. A new generation of jet injectors with disposable cartridges and syringes has been developed since the 1990s. With a new, sterile dose chamber and nozzle for each patient and correct use, these devices do not have the same safety concerns as multiple-use nozzle jet injectors. Several of the newer devices have been approved by FDA for use with specific vaccines ( 33 ). Jet injectors prevent needlestick injuries to health-care providers ( 2 ) and can overcome improper, unsterile reuse and other drawbacks of needles and syringes in developing countries ( 9 , 38-39 ).

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Methods for Alleviating Discomfort and Pain Associated with Vaccination

Comfort measures, such as distraction (e.g., playing music or pretending to blow away the pain), cooling of the injection site(s), topical analgesia, ingestion of sweet liquids, breastfeeding, swaddling, and slow, lateral swaying can help infants or children cope with the discomfort associated with vaccination ( 40-42 ). Pretreatment (30-60 minutes before injection) with a 5% topical lidocaine-prilocaine emulsion might decrease the pain of vaccination by causing superficial anesthesia ( 43-44 ). Evidence indicates that this cream does not interfere with the immune response to MMR ( 45 ). There is no evidence the cream interferes with other vaccines ( 46-49 ). Topical lidocaine-prilocaine emulsion should not be used on infants aged <12 months who are receiving treatment with methemoglobin-inducing agents (e.g., acetaminophen, amyl nitrate, nitroprusside, dapsone) because of the possible development of methemoglobinemia ( 50 ). Use of a topical refrigerant (vapocoolant) spray immediately before vaccination can reduce the short-term pain associated with injections and can be as effective as lidocaine-prilocaine cream ( 51 ) . Evidence does not support use of antipyretics before or at the time of vaccination; however, they can be used for the treatment of fever and local discomfort that might occur following vaccination. Studies of children with previous febrile seizures have not demonstrated antipyretics to be effective in the prevention of febrile seizures ( 48 ).

Clinical Implications of Nonstandard Vaccination Practices

Best practice guidance for route, site, and dosage of immunobiologics is derived from data from clinical trials, practical experience, normal intervals of health care visits, and theoretical considerations. ACIP discourages variations from the recommended route, site, volume, or number of doses of any vaccine.

Variation from the recommended route and site can result in inadequate protection. In adults (but not in infants) ( 52 ), the immunogenicity of hepatitis B is substantially lower when the gluteal rather than the deltoid site is used for administration ( 8 ). Hepatitis B administered intradermally might result in a lower seroconversion rate and final titer of hepatitis B surface antibody than when administered by the deltoid intramuscular route ( 53-54 ). Hepatitis B administered by any route other than intramuscular, or in adults at any site other than the deltoid or anterolateral thigh, should not be counted as valid and should be repeated ( 9 ). Similarly, doses of rabies vaccine administered in the gluteal site should not be counted as valid doses and should be repeated ( 54 ). Hepatitis A vaccine and meningococcal conjugate vaccine do not need to be repeated if administered by the subcutaneous route ( 55-56 ). However, for DTaP, Hib, and PCV13, there is no evidence related to immunogenicity of these 3 vaccines given subcutaneously. Providers should address circumstances in which dose(s) of these vaccines have been administered subcutaneously on a case-by-case basis. Inactivated influenza vaccine is immunogenic when administered in a lower-than-standard dose by the intradermal route to healthy adult volunteers. Intradermal injection produced antibody responses similar to intramuscular injection in vaccinees aged 18-60 years ( 57 ). However, the immunogenicity for persons aged ≥65 years is inadequate, and varying the recommended route and dose either with the intradermal product licensed through 64 years of age or with other influenza vaccines is not recommended ( 24 ).

Live, attenuated injectable vaccines (e.g., MMR, varicella, yellow fever) and certain non-live vaccines (e.g., meningococcal polysaccharide) are recommended by the manufacturers to be administered by subcutaneous injection. PPSV23and IPV are recommended by the manufacturer to be administered by the subcutaneous or intramuscular route. Response to vaccines recommended by the subcutaneous route is unlikely to be affected if the vaccines are administered by the intramuscular rather than subcutaneous route. Repeating doses of vaccine administered by the intramuscular route when recommended to be by the subcutaneous route is not necessary ( 10 ).

Administering volumes smaller than recommended (e.g., inappropriately divided doses) might result in inadequate protection. Using reduced doses administered at multiple vaccination visits that equal a full dose or using smaller divided doses is not recommended ( 4 ). Any vaccination using less than the standard dose should not be counted, and the person should be revaccinated according to age unless serologic testing indicates that an adequate response has developed. However, if 2 half-volume formulations of vaccine have already been administered on the same clinic day to a patient recommended for the full volume formulation, these 2 doses can count as one full dose. If less than a full recommended dose of a vaccine is administered because of syringe, applicator, or needle leakage, the dose should be repeated ( 5 ). Using larger-than-recommended dosages can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents.

(a) If the gluteal muscle is chosen, injection should be administered lateral and superior to a line between the posterior superior iliac spine and the greater trochanter or in the ventrogluteal site, the center of a triangle bounded by the anterior superior iliac spine, the tubercle of the iliac crest, and the upper border of the greater trochanter.

TABLE 6-1. Dose and route of administration for selected vaccines

Abbreviations: DEN4CYD = dengue vaccine; DT = diphtheria and tetanus toxoids; DTaP = diphtheria and tetanus toxoids and acellular pertussis; HepA = hepatitis A; HepB = hepatitis B; Hib = Haemophilus influenzae type b; HPV = human papillomavirus; IIV = inactivated influenza vaccine; IM = intramuscular; IPV = inactivated poliovirus; LAIV = live, attenuated influenza vaccine; MenACWY = quadrivalent meningococcal conjugate vaccine; MenB = serogroup B meningococcal vaccine; MenCY = bivalent meningococcal conjugate vaccine component; MMR = measles, mumps, and rubella; MMRV = measles, mumps, rubella, and varicella; MPSV4 = quadrivalent meningococcal polysaccharide vaccine; PCV13 = pneumococcal conjugate vaccine; PPSV23= pneumococcal polysaccharide vaccine; RV1 = live, attenuated monovalent rotavirus vaccine; RV5 = live, reassortment pentavalent rotavirus vaccine; RZV = recombinant adjuvanted zoster vaccine; Subcut = subcutaneous; Td = tetanus and diphtheria toxoids; Tdap = tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis.

Source: Adapted from Immunization Action Coalition .

(a) Persons aged 11-15 years may be administered Recombivax HB (Merck), 1.0 mL (adult formulation) on a 2-dose schedule. (b) Note that prefilled syringes of High-Dose Fluzone have a volume of 0.7 cc and the recommended volume of administration is 0.7 ccs. (c) Do not withdraw more than 0.5 mL from the reconstituted product, even if some product is left in the vial.

TABLE 6-2. Needle length and injection site of IM injections for children aged ≤18 years (by age) and adults aged ≥19 years (by sex and weight)

Abbreviation: IM = intramuscular.

Source: ( 17 ).

(a) First 28 days of life.

(b) If skin is stretched tightly and subcutaneous tissues are not bunched.

(c) Preferred site.

(d) Some experts recommend a 5/8-inch needle for men and women who weigh <60 kg, if used, skin must be stretched tightly (do not bunch subcutaneous tissue)

(e) Some experts recommend a 1-inch needle if the skin is stretched tightly and subcutaneous tissues are not bunched.

Figure 1. Intramuscular needle insertion

Source: Adapted from California Immunization Branch.

Figure 2. Intramuscular/subcutaneous site of administration: anterolateral thigh

Source: Adapted from Minnesota Department of Health.

Figure 3. Intramuscular site of administration: deltoid

Source: Adapted from Minnesota Department of Health and Immunize.org.

Figure 4. Subcutaneous site of administration: triceps

Figure 5. Subcutaneous needle insertion

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