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Published on: June 11, 2012
Strict interpretation of vaccination guidelines with computerized algorithms and improper timing of administered
A J Butte1, J S Shaw, H Bernstein
1Division of Endocrinology, Children's Hospital, Boston, MA 02115, USA. atul-butte@harvard.edu
Insights
Many children receive incorrectly timed vaccinations, with over 35% having at least one invalid dose. Simplifying national guidelines and clinician awareness of common vaccine errors are crucial.
Area of Science:
- Pediatrics
- Immunology
- Public Health
Background:
- Changing immunization recommendations can lead to errors in vaccine administration.
- Inappropriately timed vaccinations pose a risk to child health and public health efforts.
Purpose of the Study:
- To assess the frequency and types of incorrectly administered vaccine doses in young children.
- To identify common errors in vaccination timing and the characteristics of these events.
Main Methods:
- Prospective analysis of immunization histories for children under 5 years old.
- Utilized the Massachusetts Immunization Information System to analyze vaccine timing against strict guidelines.
- Manual review identified reasons for invalid vaccine doses and the providers involved.
Main Results:
- 4.1% of all administered vaccine doses were invalid, affecting 35.5% of patients.
- Common errors included early hepatitis B vaccine and unnecessary poliovirus vaccine doses.
- Pediatric residents and fellows administered a significantly higher proportion of invalid doses.
Conclusions:
- A significant number of children receive vaccinations that do not adhere to established guidelines.
- Clinicians need greater awareness of frequent vaccination timing errors.
- Simplification of national immunization guidelines may reduce administration errors.
Background:
Frequently changing immunization recommendations may lead to incorrectly administered doses.
Objective:
To determine the incidence and characteristics of inappropriately timed vaccinations.
Methods:
Prospectively collected immunization histories of patients <5 years old from well-child care encounters with pediatric residents in a large urban clinic during a 3-month study period. New patients or those with no immunization history in the medical record were excluded. Paper records were verified before each visit and served as the immunization history. Immunization records were entered into and analyzed by the Massachusetts Immunization Information System with strict interpretation of minimum spacing and age guidelines to identify invalid vaccine doses. Reasons for invalidity were determined by manual review. Invalid doses were cross-referenced with clinic schedule to determine who delivered doses.
Results:
Inclusion criteria were met by 690 encounters. Charts were available for review before the encounter for 580, containing 6983 total immunizations. Of these 289 (4.1%) administered doses were invalid; 206 of 580 (35.5%) patients had at least one invalid dose. Common invalid doses given were unnecessary poliovirus vaccine around 18 months (n = 66) and second hepatitis B vaccine given too soon after the first (n = 53). All types of providers gave invalid doses; pediatric residents and fellows delivered significantly more (P < 0.01).
Conclusions:
By strict interpretation of immunization guidelines, many patients were immunized incorrectly. Clinicians should be aware of common errors in vaccine dosing and national guidelines should be simplified.
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