BACKGROUND:
Before the start of a school-based, universal immunization program, Public Health Nurses sought direction about the concurrent administration of two vaccines to grade 6 students

OBJECTIVE:
To: (a) compare rates of reactions from meningococcal C conjugate vaccine (Neis Vac-C) and hepatitis B vaccine (Recombivax HB), and (b) compare reactions when both injections were given simultaneously in one arm versus one in each arm.

METHOD:
Schools were randomized to receive both vaccines in one arm (Group 1), or one vaccine in each arm (Group II). Structured telephone interviews were conducted following immunization. Respondents were asked about local and systemic reactions, interference with school or other activities, need for medical attention, and lost parental work time.

RESULT:
There were 202 participants in Group I and 188 in Group II. Group II reported more local redness >46 mm (6.5% vs 0.5%, p<0.001), moderate to severe tenderness (28% vs 18%, p<0.05), and drowsiness (14% vs 7%, p<0.05). The association between moderate or severe tenderness and study group was not significant when adjusting for vaccine product. There were no differences between groups in terms of interference with school attendance or other activities, need for medical attention, or lost parental work time. There was more redness (6.4% vs 1.6%, p<0.05) and tenderness (53.7% vs 32.4%, p<0.001) experienced with Neis Vac-C than with Recombivax HB, respectively.

CONCLUSION:
Vaccinating in one arm did not cause more local reaction than in separate arms and remains an option. If vaccinating in two arms, Neis Vac-C should be given in the non-dominant arm.

LEARNING OBJECTIVES:
Participants will obtain information pertaining to the local reactions observed when Neis Vac-C and RecombivaxHB vaccines are given in one arm versus one vaccine in each arm. This information informs nursing practice with regard to site selection for concurrent administration of these two vaccines