title: Evaluation of Vaccines Injection Order on Pain Score of Intramuscular Injection of Diphtheria, Whole Cell Pertussis and Tetanus Vaccine.
abstract: OBJECTIVE
  To determine, whether or not intramuscular injection of diphtheria, pertussis and tetanus (DwPT) vaccine should be given first and subcutaneous injection of measles, mumps and rubella (MMR) thereafter or vice versa and can this cause less pain of DwPT vaccine injection.
  
  
  METHODS
  In a randomized parallel group clinical trial, seventy 18-mo-old healthy children who were referred for routine vaccination to Akbari Health Care Center, Yazd, Iran from September 2014 through March 2015 were randomly allocated to two groups to receive DwPT and then MMR vaccines or MMR first, and then DwPT. Primary outcomes included pain score during DwPT injection, pain score during MMR injection, overall pain score of vaccination and obtaining a pain score of less than three during DwPT injection. Pain scores were assessed based on Modified Behavioral Pain Scale. Secondary outcome was crying duration during DwPT injection.
  
  
  RESULTS
  Thirty seven girls and 33 boys were evaluated in two groups. Pain scores of DwPT and MMR injections, the frequency of pain score obtained to be less than three during DwPT injection and the crying duration were not different in both groups. But, overall pain score of vaccination was lower when subcutaneous injection of MMR vaccine was given before intramuscular injection of DwPT vaccine. (14.23 ± 1.35 vs. 15.61 ± 2.65; P = 0.04).
  
  
  CONCLUSIONS
  Overall pain score of vaccination in multiple vaccine injection at the same visit might be reduced if subcutaneous vaccine is injected before intramuscular one.
authors.affiliation: Department of Pediatrics, Growth Disorders of Children Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Razieh
authors.initials: R
authors.lastname: Fallah
authors.affiliation: Department of Pediatrics, Growth Disorders of Children Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Hossein
authors.initials: H
authors.lastname: Gholami
authors.affiliation: Department of Pediatrics, Growth Disorders of Children Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Farzad
authors.initials: F
authors.lastname: Ferdosian
authors.affiliation: Department of Pathology, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. binesh44@yahoo.com.
authors.forename: Fariba
authors.initials: F
authors.lastname: Binesh
mesh_terms: D002648:Child; D002675:Child, Preschool; D004165:Diphtheria; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007492:Iran; D008297:Male; D022542:Measles-Mumps-Rubella Vaccine / Q000008:administration & dosage / Q000009:adverse effects*; D010146:Pain / Q000209:etiology*; D013745:Tetanus Toxoid; D014611:Vaccination / Q000379:methods; D014917:Whooping Cough
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D022542:Measles-Mumps-Rubella Vaccine; D013745:Tetanus Toxoid
keywords: Child; DwPT; MMR; Order; Pain; Vaccination