Comprehensive assessment of serious adverse events following immunization by health care providers

Adverse Event Following Immunization (AEFI) in Children: An Analysis of Reporting in VigiAccess

INTRODUCTION

It is an indubitable fact that vaccination has been instrumental in the eradication and prevention of the deadliest diseases worldwide. Continuous vaccine safety surveillance is helpful to counter the negative perception and thus allay the fear of Adverse Events Following Immunization (AEFI) in the general public. VigiAccess, the WHO global database of reported side effects of medicinal products, can be accessed by the public at large. The objective of this study is to assess the characteristics of AEFIs of the commonly used vaccines in children in VigiAccess.

MATERIALS AND METHODS

VigiAccess was thoroughly explored for the categories, number, and types of AEFIs of commonly used vaccines among children that are reported in five continents between 2011 and 2021.

RESULTS

After a comprehensive analysis in VigiAccess, 27 kinds of AEFIs were discovered. For the nine vaccines, a total of 1,412,339 AEFIs were found. The most prevalent AEFIs were general disorder and administration site condition (436,199 or 30%). The majority of AEFIs are found in America, with Europe, Oceania, Asia, and Africa following closely behind. Girls of age from 27 days to 23 months had the highest number of AEFIs. The highest number of AEFIs was recorded in the year 2018.

CONCLUSION

America has the maximum, whilst Africa has the least AEFI. Few AEFIs were caused by the measles vaccination, while the majority were related to the general disorder and administration site condition. Data synchronization in VigiAccess needs to be enhanced to improve its dependability.

Knowledge of adverse events following immunization, its prevalence and actions of mothers of children aged 0–23 months in a tertiary health institution in Jos, North Central Nigeria

Background:

Adverse Event Following Immunization (AEFI) is any unfavorable event occurring following vaccination related to the vaccine administration and or its handling. AEFI can lead to death or a life-threatening condition requiring hospitalization with or without permanent sequel. Hence, this study was conducted to determine the knowledge of AEFI among mothers of children aged 0–23 months, its prevalence and actions of mothers of following AEFIs.

Methodology:

This was a cross-sectional study conducted among 400 mothers of children aged 0–23 months between November 2017 and April 2018 using quantitative method of data collection. IBM SPSS version 20 was used for data analysis where chi square was used as a test of association a P-value of ≤ 0.05 considered statistically significant.

Results:

The mean age of the respondents in the study was 29.0 ±5.3 years with 222 (55.5%) demonstrating good knowledge of AEFI. The prevalence of AEFI was found to be 46.5% with fever as the most experienced AEFI accounting for 90.3% of all cases experienced followed by pain and swelling mentioned by 141 (75.8%) and 26 (14.0%) respectively. Only 26 (14.5) of the mothers were adjudged to have taken appropriate action following the experience of AEFI in their children. Appropriateness of actions taken by the mothers following the occurrence of AEFI was influenced by the mother’s employment status (COR= 3.84; 95% CI=1.366–10.575; P=0.007).

Conclusion:

This study has demonstrated a sub-optimal level of knowledge of AEFI among the mothers of children aged 0–23 months with a relatively high self-reported prevalence and poor level of appropriateness of actions taken following AEFI.

Knowledge, practice and approaches of health professionals to adverse events following immunization and their reporting in Albania

In Albania, the reporting of an adverse events following immunization (AEFI) is done not only by immunization providers but also from clinicians providing clinical treatment of AEFI in health posts, health centers and private or public hospitals. The AEFI reporting system in Albania has started in 2001 with the establishment of National Regulatory Authority of Vaccines in the Institute of Public Health. The most important problems of passive surveillance systems include underreporting, deficiency and inaccuracy of information. A structured questionnaire containing 68 questions constructed from immunization experts constituted the study tool. The questionnaire addressed health professionals working at child consultant's facilities and primary health centers in the district of Tirana. There were a total of 102 health professional interviewed. The majority of the respondents working at health centers in the district of Tirana in general, had poor knowledge levels on AEFI surveillance. The lowest score were received in knowledge about the role of different stakeholders involved in AEFI surveillance. The number of years practicing the profession did not influence in the total score of "practice and attitude toward reporting and managing an AEFI". Although the majority of health care professionals have encountered an AEFI during their practice (72/102, 70,5%), only half of them have never reported an AEFI (37/102, 36,2%). Barriers to reporting included lack of interest, unclear definition of AEFI and lack of awareness of what to report. Nevertheless, the main reason for not reporting was because a respondent thought he or she had not observed an AEFI in the last years (44,1%). Majority of the respondents did not have any training about AEFI (68,6%, 70/102). From this study it is concluded that it is necessary to develop training and educational programs in order to increase awareness of all health professionals involved in child health toward reporting of adverse events following immunization. It is necessary to build feedback systems to give information on AEFI. This study shows the influence of knowledge, perceptions and practices of health care workers in the surveillance of adverse events following immunization. Thus, information generated from this study might be valuable for the public health regulators to generate new guidelines about AEFI surveillance and update existing information.

Immunizing Patients With Adverse Events After Immunization and Potential Contraindications to Immunization: A Report From the Special Immunization Clinics Network

BACKGROUND

For patients who have experienced adverse events following immunization (AEFI) or who have specific medical conditions, there is limited evidence regarding the best approach to immunization. The Special Immunization Clinics (SICs) Network was established to standardize patient management and assess outcomes after reimmunization. The study objective was to describe the first 2 years of the network's implementation.

METHODS

Twelve SICs were established across Canada by infectious diseases specialists and allergists. Inclusion criteria were as follows: local reaction ≥ 10 cm, allergic symptoms < 24 hours postimmunization, neurologic symptoms and other AEFI or medical conditions of concern. Eligible patients underwent a standardized evaluation, causality assessment was performed, immunization recommendations were made by expert physicians and patients were followed up to capture AEFI. After individual consent, data were transferred to a central database for analysis.

RESULTS

From June 2013 to May 2015, 151 patients were enrolled. Most were referred for prior AEFI (132/151, 87%): 42 (32%) for allergic-like reactions, 31 (23%) for injection-site reactions, 20 (15%) for neurologic symptoms and 39 (30%) for other systemic symptoms. Nineteen patients (13%) were seen for underlying conditions that complicated immunization. Reimmunization was recommended for 109 patients, 60 of whom (55%) were immunized and followed up. Eleven patients (18%) experienced recurrence of their AEFI; none were serious (eg, resulting in hospitalization, permanent disability or death).

CONCLUSIONS

The most frequent reasons for referral to a SIC were allergic-like events and injection site reactions. Reimmunization was safe in most patients. Larger studies are needed to determine outcomes for specific types of AEFI.

Canadian paediatricians' approaches to managing patients with adverse events following immunization: The role of the Special Immunization Clinic network

BACKGROUND

When moderate or severe adverse events occur after vaccination, physicians and patients may have concerns about future immunizations. Similar concerns arise in patients with underlying conditions whose risk for adverse events may differ from the general population. The Special Immunization Clinic (SIC) network was established in 2013 at 13 sites in Canada to provide expertise in the clinical evaluation and vaccination of these patients.

OBJECTIVES

To assess referral patterns for patients with vaccine adverse events or potential vaccine contraindications among paediatricians and to assess the anticipated utilization of an SIC.

METHODS

A 12-item questionnaire was distributed to paediatricians and subspecialists participating in the Canadian Paediatric Surveillance Program through monthly e-mail and mail contacts.

RESULTS

The response rate was 24% (586 of 2490). Fifty-three percent of respondents practiced general paediatrics exclusively and 52% reported that they administer vaccines. In the previous 12 months, 26% of respondents had encountered children with challenging adverse events or potential vaccine contraindications in their practice and 29% had received referrals for such patients, including 27% of subspecialists. Overall, 69% of respondents indicated that they would be likely or very likely to refer patients to an SIC, and 34% indicated that they would have referred at least one patient to an SIC in the previous 12 months.

CONCLUSIONS

Patients who experience challenging adverse events following immunization or potential vaccine contraindications are encountered by paediatricians and subspecialists in all practice settings. The SIC network will be able to respond to a clinical need and support paediatricians in managing these patients.