Vaccines with Diluents: How to Use Them

a. If the reconstituted vaccine is not used within this time period, it must be discarded.

The Pfizer-BioNTech COVID-19 formulation for children age 6 mos through 4 yrs is a liquid concentrate that requires dilution.

c. For purposes of this guidance, Immunize.org defines “immediately” as within 30 minutes or less.

d. Rotarix and Menveo vaccines are available as either a liquid formulation that does not require dilution or as a

lyophilized vaccine that requires reconstitution. Both formulations of the Rotarix vaccine are administered by mouth;

they should not be administered as an injection.

e. Vaxchora dilution: 30 minutes if sucrose or unflavored stevia added; 4 hours if sucrose or unflavored stevia have

not been added.

Always refer to package inserts for detailed instrucons on reconstung specic vaccines. In general, follow the steps below.

1 For single-dose vaccine products (excepons: Rotarix,

Vaxchora), select a syringe and needle of proper length

to be used for both reconstuon and administraon

of the vaccine. For Rotarix and Vaxchora, see the

package insert.

2 Before reconstung, check labels on both the

lyophilized vaccine vial and the diluent to verify that

• they are the correct two products to mix together,

• the diluent is the correct volume, and

• neither the vaccine nor the diluent has expired.

3 Reconstute (i.e., mix) vaccine before use

by:

• removing the protecve caps and wiping each

stopper with an alcohol swab,

• inserng needle of syringe into diluent vial and

withdrawing contents, and

• injecng diluent into lyophilized vaccine vial and

rotang or inverng to thoroughly dissolve the

lyophilized powder.

4 Check the appearance of the reconstuted vaccine.

• Reconstuted vaccine may be used if the color and

appearance match the descripon on the package

insert.

• If there is discoloraon, parculate maer, obvious

lack of resuspension, or the vaccine cannot be

thoroughly mixed, mark the vial as “DO NOT

USE,” return it to proper storage condions, and

contact your state or local health department

immunizaon program or the vaccine manufacturer.

5 If reconstuted vaccine is not used immediately

or comes in a muldose vial, be sure to

• clearly mark the vial with the date and me the

vaccine was reconstuted,

• maintain the product at 2°–8°C (36°–46°F); do not

freeze, and

• use only within the me indicated on chart above.

Vaccine

product name

Manufacturer

Lyophilized

(powder)

vaccine

Liquid diluent

(may contain vaccine)

Time allowed between

mixing and use

Diluent

storage

environment

Abrysvo Pzer RSV Sterile water 4 hrs

Refrigerator

or room temp

ActHIB (Hib) Sano Hib Sodium chloride 0.4% 24 hrs Refrigerator

Arexvy

GSK

RSV

ASO1E adjuvant suspension 4 hrs Refrigerator

COVID-19, Pzer-BioNTech,

6 mos through 4 yrs formulaon

Pzer-BioNTech

see footnote

Sodium chloride 0.9% 12 hrs

Refrigerator

or room temp

Dengvaxia (DEN4CYD) Sano Dengue Sodium chloride 0.4% 30 min Refrigerator

Hiberix (Hib) GSK Hib Sodium chloride 0.9%

Immediately

Refrigerator

or room temp

Imovax (RAB

HDCV

) Sano Rabies Sterile water

Immediately

Refrigerator

Ixchiq Valneva

Chikungunya

Sterile water

Immediately

Refrigerator

M-M-R II (MMR) Merck MMR Sterile water 8 hrs

Refrigerator

or room temp

Menveo

(MenACWY)

GSK MenA MenCWY component 8 hrs Refrigerator

Penbraya (MenABCWY)

Pzer MenACWY MenB component 4 hrs Refrigerator

Pentacel (DTaP-IPV/Hib) Sano Hib DTaP-IPV component

Immediately

Refrigerator

Priorix (MMR)

GSK MMR Sterile water 8 hrs

Refrigerator

or room temp

ProQuad (MMRV) Merck MMRV Sterile water 30 min

Refrigerator

or room temp

RabAvert (RAB

PCECV

) GSK Rabies Sterile water

Immediately

Refrigerator

Rotarix

(RV1)

GSK RV1

Sterile water, calcium

carbonate, and xanthan

24 hrs

Refrigerator

or room temp

Shingrix (RZV) GSK RZV

AS01B

adjuvant suspension

6 hrs Refrigerator

Varivax (VAR) Merck VAR Sterile water 30 min

Refrigerator

or room temp

Vaxchora (CVD 103-HgR) Bavarian Nordic Cholera Buer soluon plus boled water

see footnote

Refrigerator

YF-VAX (YF) Sano YF Sodium chloride 0.9% 60 min

Refrigerator

or room temp

Vaccines with Diluents: How to Use Them

Be sure to reconstute (mix) the following vaccines correctly

before administering them! Reconstuon means that the

lyophilized (freeze-dried) vaccine powder in one vial must be

mixed with the diluent (liquid) in another.

• Only use the diluent provided by the manufacturer for that

vaccine as indicated on the chart.

• ALWAYS check the expiraon date on the diluent and

vaccine. NEVER use expired diluent or vaccine.

• Never freeze diluents.

FOR PROFESSIONALS www.immunize.org / FOR THE PUBLIC www.vaccineinformaon.org

www.immunize.org/catg.d/p3040.pdf

Item #P3040 (8/22/2024)

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Vaccine abbreviaons in column 3:

Hib =Haemophilus inuenzae type b

MenA = Meningococcal serogroup A

MenACWY = Meningococcal serogroups A, C, W, Y

MMR = Measles, mumps, & rubella

MMRV = MMR + varicella

RSV = Respiratory syncyal virus

RV1 = Rotavirus vaccine, monovalent

RZV = Zoster vaccine, recombinant

YF = Yellow fever