Tracking vaccine lot lifecycles using reports to the vaccine adverse event reporting system (VAERS)

Safety assessment of recalled Haemophilus influenzae type b (Hib) conjugate vaccines--United States, 2007-2008

PURPOSE

On 13 December 2007, Merck & Co., Inc. voluntarily recalled 1.2 million doses of Haemophilus influenzae type b (Hib) vaccines that had been distributed since April 2007 for concerns regarding potential Bacillus cereus contamination. Enhanced postrecall surveillance was conducted to detect vaccine-associated B. cereus infections.

METHODS

We reviewed reports involving recalled Hib vaccines received by the Vaccine Adverse Event Reporting System (VAERS) during 1 April 2007-29 February 2008. For each reported death, autopsy review sought evidence of B. cereus infections. For each specified outcome, the proportional reporting ratios (PRRs) were calculated to compare the recalled Hib vaccines with the manufacturer's nonrecalled Hib vaccines in the VAERS databases. On 20 December 2007, we used the Epidemic Information Exchange (Epi-X) to solicit nongastrointestinal vaccine-associated B. cereus infections, and requested B. cereus isolates for genotyping to compare with the manufacturing facility isolate.

RESULTS

VAERS received 75 reports involving recalled Hib vaccines; none described a confirmed B. cereus infection. Comparative analyses did not reveal disproportionate reporting of specified outcomes for recalled Hib vaccines. The Epi-X posting triggered one report of vaccine-associated B. cereus bacteremia from a child who received a nonrecalled Hib vaccine manufactured by Merck; the genotypes of isolates from the patient and the manufacturing facility differed.

CONCLUSIONS

No evidence of vaccine-associated B. cereus infection had been found in recipients of recalled Hib vaccines. Conducting laboratory surveillance through Epi-X was feasible and may enhance public health response capacities for future vaccine safety emergencies.

A space-time cluster of adverse events associated with canine rabies vaccine

Electronic medical records of a large veterinary practice were used for surveillance of potential space–time clustering of adverse events associated with rabies vaccination in dogs. The study population was 257,564 dogs vaccinated in 169 hospitals in 13 US metropolitan areas during a 24-month period. Using a scan statistic for population rate data, significant space–time clusters were identified involving the Atlanta and Tampa/St. Petersburg areas during a 4-month period. Separate spatial–temporal analyses of these cities using coordinates for individual address coordinates identified one significant patient cluster (P = 0.002), associated with a 23.26 km-radius area in Atlanta (20 adverse events in 702 dogs; 2.85%) from November 2002 through February 2003. This percentage of adverse events was significantly increased after adjustment for host-related factors and the number of concurrent vaccinations.