Protocol for Administration of Vaccines

Vaccines that can be given subcutaneously

Additional Recommendations

Centers for Disease Control and Prevention (CDC) Guidelines

Document Overview

Design and created by Guideline Central in participation with the National Bleeding Disorders Foundation.

Administration of Vaccines to Individuals with Bleeding Disorders

National Bleeding Disorders Foundation

Publication Date: May 1, 2023

Page Last Updated: May 5, 2026

MASAC recommends that when giving immunizations, the following procedures may be considered

A fine-gauge needle (23 gauge or smaller caliber) be used.
Firm pressure should be applied to the site for at least 2 minutes without rubbing.
The patient and/or caregiver should be informed that there is risk of hematoma development at the injection site. Patients with hemophilia depending on their factor level, may consider use of therapy to prevent hematoma formation, in consultation with their hemophilia treatment center.
Anticipatory guidance should be given regarding when to call the physician or HTC regarding any adverse reactions such as hematoma, fever, warmth, redness.
For pain/fever relief, avoid aspirin and NSAIDS (such as ibuprofen, naproxen sodium) because of the potential risk of bleeding. Acetaminophen is a safe alternative, but should be used with caution, especially in individuals at risk for liver disease.
If the patient is receiving prophylaxis treatment for hemophilia, vaccination may be administered within 24 hours of Standard or Extended half-life FVIII or Standard half-life FIX concentrate and within 48 hours of administration of Extended half-life FIX concentrate, to decrease the risk of developing a hematoma.For patients with a basal FVIII or FIX level above 10%, no hemostatic precautions may be required.
Patients on Emicizumab prophylaxis may not require additional treatment prior to vaccinations.
Patients with Type 1 or 2 Willebrand disease (VWD), depending on their baseline von Willebrand factor (VWF) activity levels, may consider use of therapy to prevent hematoma formation, in consultation with their hemophilia treatment center. Patients with Type 3 VWD should consider a VWF-containing infusion prior to vaccination.
All rare bleeding disorder patients (including those with thrombocytopenia and/or platelet function disorders) should be vaccinated with the above general precautions.
Patients on Vitamin K antagonists should have prothrombin time testing performed within 72 hours prior to injection to determine international normalized ratio (INR); if results are stable and within the therapeutic range, they can be vaccinated intramuscularly. No data are available in patients on DOACs/NOACs.

Document Overview

Document Title: Administration of Vaccines to Individuals with Bleeding Disorders

Authoring Society: National Bleeding Disorders Foundation

Document Publication Date: May 1, 2023

Page Last Reviewed/Updated: May 5, 2026

Document Type: Guideline

Country of Publication: United States

Full Text Freely Available: Yes

Full Text Guideline: www.hemophilia.org/healthcare-professionals/guidelines-on-care/masac-documents/masac-document-278-masac-recommendations-on-administration-of-vaccines-to-individuals-with-bleeding-disorders

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives: There has been considerable discussion in the hemophilia community regarding the optimal protocol for the administration of vaccines to individuals with bleeding disorders. Speculation that vaccines may induce the development of inhibitors to factor concentrates are not substantiated¹. The MASAC Vaccine Working Group has reviewed the available literature, online and in print, and has developed the following recommendations.

Scope: Counseling, Management, Prevention

Keywords: bleeding disorders, vaccines

Target Patient Population: Individuals with bleeding disorders

Target Provider Population: Family practitioners, hematologists and other bleeding disorders specialists

Inclusion Criteria: Male, Female, Adolescent, Adult, Child, Older Adult

Health Care Settings: Ambulatory

Intended Users: Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

Number of Source Documents: 12

Includes peer/external review process?: Yes

Includes public comment process?: No

Methodologist involvement?: Yes

Patient involvement?: No

Includes multi-disciplinary group?: Yes

Includes systematic review?: Yes

Grades quality of strength of evidence?: No

Grades quality of strength of recommendation?: No

Includes benefits/harms analysis with recommendations?: No