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Tavares LODM, Silva MA, Oliveira BRD, Amaral GG, Guimarães EADA, Couto RO, Oliveira VCD. Prevalence of errors causing events allegedly attributable to vaccination/immunization: systematic review and meta-analysis. Rev Gaucha Enferm 2024; 45:e20230097. [PMID: 38477748 DOI: 10.1590/1983-1447.2024.20230097.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/25/2023] [Indexed: 03/14/2024] Open
Abstract
OBJECTIVE To identify the prevalence of errors that caused events supposedly attributable to vaccination or immunization. METHOD Systematic literature review with meta-analysis carried out on the Medline, Cochrane Library, Cinahl, Web of Science, Lilacs, Scopus; Embase; Open Grey; Google Scholar; and Grey Lit databases; with studies that presented the prevalence of immunization errors that caused events or that provided data that allowed this indicator to be calculated. RESULTS We evaluated 11 articles published between 2010 and 2021, indicating a prevalence of 0.044 errors per 10,000 doses administered (n=762; CI95%: 0.026 - 0.075; I2 = 99%, p < 0.01). The prevalence was higher in children under 5 (0.334 / 10,000 doses; n=14). The predominant events were fever, local pain, edema and redness. CONCLUSION A low prevalence of errors causing events was identified. However, events supposedly attributable to vaccination or immunization can contribute to vaccine hesitancy and, consequently, have an impact on vaccination coverage.
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Affiliation(s)
| | - Marla Ariana Silva
- Universidade Federal de São João del-Rei (UFSJ). Programa de Pós-Graduação em Enfermagem. Divinópolis, Minas Gerais, Brasil
| | - Bianca Rabelo de Oliveira
- Universidade Federal de São João del-Rei (UFSJ). Departamento de Enfermagem. Divinópolis, Minas Gerais, Brasil
| | - Gabriela Gonçalves Amaral
- Universidade do Estado de Minas Gerais (UEMG). Departamento de Ciências da Reabilitação e Saúde. Divinópolis, Minas Gerais, Brasil
| | | | - Renê Oliveira Couto
- Universidade Federal de São João del-Rei (UFSJ). Programa de Pós-Graduação em Ciências Farmacêuticas. Divinópolis, Minas Gerais, Brasil
| | - Valéria Conceição de Oliveira
- Universidade Federal de São João del-Rei (UFSJ). Programa de Pós-Graduação em Enfermagem. Divinópolis, Minas Gerais, Brasil
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2
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Simões NCS, Tavares LODM, da Silva CMB, Rodrigues SB, Oliveira SH, Guimarães EADA, de Oliveira VC. Construction and validity of an educational video to prevent immunization errors. Rev Bras Enferm 2023; 76:e20230010. [PMID: 37820157 PMCID: PMC10561952 DOI: 10.1590/0034-7167-2023-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/03/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE to construct and validate an orientation video, based on a low-fidelity clinical simulation scenario, to prevent immunization errors. METHODS a methodological study with video construction, validated in two stages by different audiences. Content was selected based on a realistic simulation scenario of the vaccine administration process to a patient-actor. Items with concordance greater than 0.8 and 0.6 were considered valid, verified using the Content Validity Index (CVI) and the Content Validity Ratio (CVR), respectively. RESULTS judges' CVI had an average of 97.5%, and CVR, 0.9, and health professionals' CVI, 95.4%, and CVR, 0.8. Successes in administering vaccines were addressed, such as careful reading of labels, double-checking the vaccine, distractions/interruptions and error reporting. CONCLUSIONS the video was constructed and validated in terms of content, and can be used in training professionals working in vaccination.
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Gandhi AP, Venkatesh U, Murali N. Serious adverse event following immunization and thromboembolic events associated with COVID19 vaccination: An analysis of nationwide causality assessment from India. Indian Heart J 2023; 75:139-144. [PMID: 36863611 PMCID: PMC9970920 DOI: 10.1016/j.ihj.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/21/2023] [Accepted: 02/26/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Vaccines against the COVID-19 pandemic were introduced in late 2020. The present study has been conducted to study the serious Adverse Events Following Immunization (AEFIs) reported for COVID-19 vaccines from India. METHODS Secondary data analysis of the causality assessment reports for the 1112 serious AEFIs published by the Ministry of Health & Family Welfare, Government of India, was conducted. For the current analysis, all the reports published till 29.03.2022 were included. The primary outcome variables analyzed were the consistent causal association and the thromboembolic events. RESULTS The majority of the serious AEFIs assessed were either coincidental (578, 52%) or vaccine product related (218, 19.6%). All the serious AEFIs were reported among the Covishield (992, 89.2%) and COVAXIN (120, 10.8%) vaccines. Among these, 401 (36.1%) were deaths, and 711 (63.9%) were hospitalized and recovered. On adjusted analysis, females, the younger age group and non-fatal AEFIs showed a statistically significant consistent causal association with COVID-19 vaccination. Thromboembolic events were reported among 209 (18.8%) of the analyzed participants, with a significant association with higher age and case fatality rate. CONCLUSION Deaths reported under serious AEFIs were found to have a relatively lower consistent causal relationship with the COVID-19 vaccines than the recovered hospitalizations in India. No consistent causal association was found between the thromboembolic events and the type of COVID-19 vaccine administered in India.
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Affiliation(s)
- Aravind P Gandhi
- Department of Community Medicine, ESIC Medical College & Hospital, Hyderabad, India.
| | - U Venkatesh
- Department of Community Medicine & Family Medicine, All India Institute of Medical Sciences, Gorakhpur, India.
| | - Naveen Murali
- Department of Pharmacology, PGIMER, Chandigarh, India
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4
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Lv L, Lin XQ, Chen Y, Chen HD, Zhang MX, Shao H, Tung TH, Zhu JS. Adverse reactions to inactivated COVID-19 vaccination in patients with chronic liver disease: The effect of anxiety. Hum Vaccin Immunother 2022; 18:2136435. [PMID: 36287551 PMCID: PMC9746530 DOI: 10.1080/21645515.2022.2136435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Studies have shown that patients with chronic liver disease are at a higher risk of contracting novel coronavirus pneumonia than healthy individuals, and many guidelines state that patients with chronic liver disease should be prioritized for COVID-19 vaccination, but there are a few studies on its safety in CLD patients. We aimed to evaluate the safety of the inactivated COVID-19 vaccine in patients with chronic liver disease, and the effect of anxiety on adverse reactions. A questionnaire survey for self-administered post-vaccination adverse reaction monitoring was conducted from June 17, 2021, to August 11, 2021, in patients with chronic liver disease attending a tertiary care hospital in Taizhou, China. We analyzed the data from of a total of 160 participants who scanned the QR code on social media to respond to the questionnaire. The overall incidence of adverse reactions after COVID-19 vaccination in patients with chronic liver disease was 44.4% (71/160), and the most common adverse reaction was local injection site reaction, accounting for 80.3% of adverse reactions (57/71). No serious adverse reactions were reported. Approximately 53.1% of the patients had anxiety about vaccination, and 51.8% of those who felt anxious reported adverse reactions. The safety of COVID-19 vaccination in patients with chronic liver disease is good, and there is a strong association between adverse reactions and vaccine anxiety. Pre-vaccination education for patients with vaccine anxiety and psychological counseling may reduce reports of adverse reactions and improve patients' confidence in the vaccine.
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Affiliation(s)
- Li Lv
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
| | - Xiao-Qing Lin
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Yan Chen
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - He-Dan Chen
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China
| | - Mei-Xian Zhang
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Hui Shao
- Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China,Tao-Hsin Tung Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, 150 Ximen Street, Linhai 317000, Zhejiang Province, China
| | - Tao-Hsin Tung
- Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China
| | - Jian-Sheng Zhu
- Department of Infectious Diseases, Taizhou Hospital, Zhejiang University, Linhai, Zhejiang, China,CONTACT Jian-Sheng Zhu Department of Infectious Diseases, Taizhou Hospital of Zhejiang Province, Zhejiang University, 150 Ximen Street, Linhai317000, Zhejiang Province, China
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Yamoah P, Mensah KB, Attakorah J, Padayachee N, Oosthuizen F, Bangalee V. Adverse events following immunization associated with coronavirus disease 2019 (COVID-19) vaccines: A descriptive analysis from VigiAccess. Hum Vaccin Immunother 2022; 18:2109365. [PMID: 35947052 PMCID: PMC9897635 DOI: 10.1080/21645515.2022.2109365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
This study assessed adverse events following immunizations (AEFIs) reported on COVID-19 vaccines in VigiAccess and determined the reporting trends across all continents of the world. The study was cross-sectional quantitative in design. VigiAccess was searched on 10 November 10 2021 for reported adverse events following the introduction of COVID-19 vaccines. After entering the search term, "COVID-19 vaccines" in VigiAccess, AEFIs associated with nine approved brands of COVID-19 vaccines had been documented in the database. Data were captured among age groups, sex, and continents of the world and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Overall, 2,457,386 AEFIs had been reported in VigiAccess at the time of the search. No causal associations could be established between the vaccines and the AEFIs. The public accessing VigiAccess data should therefore be made aware of this in order to not falsely attribute AEFIs to COVID-19 vaccines when assessing the database.
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Affiliation(s)
- Peter Yamoah
- School of Pharmacy, University of Health and Allied Sciences, Ho, Ghana,College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,CONTACT Peter Yamoah School of Pharmacy, University of Health and Allied Sciences, HoPMB 31, Ghana
| | - Kofi Boamah Mensah
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa,Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph Attakorah
- Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Neelaveni Padayachee
- Department of Pharmacy and Pharmacology, University of Witwatersrand, Johannesburg, South Africa
| | - Frasia Oosthuizen
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Varsha Bangalee
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Donnini DA, Silva CMB, Gusmão JD, Matozinhos FP, Silva RB, Amaral GG, Guimarães EADA, de Oliveira VC. Incidence of immunization errors in the state of Minas Gerais, Brazil: a cross-sectional study, 2015-2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2022; 31:e2022055. [PMID: 36351058 PMCID: PMC9887969 DOI: 10.1590/s2237-96222022000300008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 08/10/2022] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE To evaluate the incidence of immunization errors in the public health service of the state of Minas Gerais, Brazil. METHODS This was a cross-sectional study, based on errors reported on the National Immunization Program Information System between 2015 and 2019. A descriptive analysis and calculation of the incidence for the state's health macro-regions were performed. RESULTS A total of 3,829 notifications were analyzed. Children younger than 1 year old were the most affected (39.1%) and the intramuscular route accounted for 29.4% of the errors. The most frequently reported error was administration of vaccines outside minimum and maximum recommended ages (37.7%). There was a higher incidence of errors in Vale do Aço (26.5/100,000) and Triângulo do Norte (22.6/100,000) macro-regions. CONCLUSION Immunization errors showed a heterogeneous incidence among the macro-regions of the state of Minas Gerais, between 2015-2019, and the administration of vaccines outside minimum and maximum recommended ages was the most frequently reported error.
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Affiliation(s)
- Deborah Amaral Donnini
- Universidade Federal de São João del-Rei, Programa de Pós-Graduação
em Enfermagem, Divinópolis, MG, Brazil
| | | | - Josianne Dias Gusmão
- Secretaria de Estado da Saúde de Minas Gerais, Superintendência de
Vigilância Epidemiológica, Belo Horizonte, MG, Brazil
| | - Fernanda Penido Matozinhos
- Universidade Federal de Minas Gerais, Programa de Pós-Graduação em
Enfermagem, Belo Horizonte, MG, Brazil
| | - Roberta Barros Silva
- Secretaria de Estado da Saúde de Minas Gerais, Superintendência de
Vigilância Epidemiológica, Belo Horizonte, MG, Brazil
| | - Gabriela Gonçalves Amaral
- Universidade de São Paulo, Programa de Pós-Graduação em Enfermagem
em Saúde Pública, Ribierão Preto, SP, Brazil
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7
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Longley AT, Date K, Luby SP, Bhatnagar P, Bentsi-Enchill AD, Goyal V, Shimpi R, Katkar A, Yewale V, Jayaprasad N, Horng L, Kunwar A, Harvey P, Haldar P, Dutta S, Gidudu JF. Evaluation of Vaccine Safety After the First Public Sector Introduction of Typhoid Conjugate Vaccine-Navi Mumbai, India, 2018. Clin Infect Dis 2021; 73:e927-e933. [PMID: 33502453 PMCID: PMC8366822 DOI: 10.1093/cid/ciab059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 01/22/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In December 2017, the World Health Organization (WHO) prequalified the first typhoid conjugate vaccine (TCV; Typbar-TCV). While no safety concerns were identified in pre- and postlicensure studies, WHO's Global Advisory Committee on Vaccine Safety recommended robust safety evaluation with large-scale TCV introductions. During July-August 2018, the Navi Mumbai Municipal Corporation (NMMC) launched the world's first public sector TCV introduction. Per administrative reports, 113 420 children 9 months-14 years old received TCV. METHODS We evaluated adverse events following immunization (AEFIs) using passive and active surveillance via (1) reports from the passive NMMC AEFI surveillance system, (2) telephone interviews with 5% of caregivers of vaccine recipients 48 hours and 7 days postvaccination, and (3) chart abstraction for adverse events of special interest (AESIs) among patients admitted to 5 hospitals using the Brighton Collaboration criteria followed by ascertainment of vaccination status. RESULTS We identified 222/113 420 (0.2%) vaccine recipients with AEFIs through the NMMC AEFI surveillance system: 211 (0.19%) experienced minor AEFIs, 2 (0.002%) severe, and 9 serious (0.008%). At 48 hours postvaccination, 1852/5605 (33%) caregivers reported ≥1 AEFI, including injection site pain (n = 1452, 26%), swelling (n = 419, 7.5%), and fever (n = 416, 7.4%). Of the 4728 interviews completed at 7 days postvaccination, the most reported AEFIs included fever (n = 200, 4%), pain (n = 52, 1%), and headache (n = 42, 1%). Among 525 hospitalized children diagnosed with an AESI, 60 were vaccinated; no AESIs were causally associated with TCV. CONCLUSIONS No unexpected safety signals were identified with TCV introduction. This provides further reassurance for the large-scale use of Typbar-TCV among children 9 months-14 years old.
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Affiliation(s)
- Ashley T Longley
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kashmira Date
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California,USA
| | - Pankaj Bhatnagar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Adwoa D Bentsi-Enchill
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Vineet Goyal
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Rahul Shimpi
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Arun Katkar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Vijay Yewale
- Dr Yewale Multi Specialty Hospital for Children, Navi Mumbai, India
| | - Niniya Jayaprasad
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Lily Horng
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California,USA
| | - Abhishek Kunwar
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Pauline Harvey
- World Health Organization–Country Office for India, National Public Health Surveillance Project, New Delhi, India
| | - Pradeep Haldar
- Ministry of Health and Family Welfare, Government of India, New Delhi, India
| | - Shanta Dutta
- National Institute of Cholera and Enteric Diseases, Indian Council of Medical Research, Kolkata, India
| | - Jane F Gidudu
- Global Immunization Division, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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8
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Oliveira PMND, Lignani LK, Conceição DAD, Farias PMCDM, Takey PRG, Maia MDLDS, Camacho LAB. Surveillance of adverse events following immunization in the late 2010s: an overview of the importance, tools, and challenges. CAD SAUDE PUBLICA 2020; 36Suppl 2:e00182019. [PMID: 32965327 DOI: 10.1590/0102-311x00182019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 02/14/2020] [Indexed: 11/22/2022] Open
Abstract
Immunization is one of the most effective measures to protect individuals and the population against vaccine-preventable diseases. Vaccines are safe and effective products, but like any other drug they can cause adverse events, which tend to become more visible as the diseases are controlled, eliminated, or eradicated. This study analyzed activities in the surveillance of adverse events following immunization (AEFI) based on data from the scientific literature, websites of immunization programs and health andregulatory agencies, and the authors' expertise in the areas of immunizations and pharmacovigilance. With the increase in the number of vaccines in the basic immunization schedule and expansion of the population's access, it has become essential to establish an efficient surveillance system for AEFI in Brazil. However, underreporting of cases in Brazil and in other countries hinders the detection of AEFI, especially rare events. Constantly updated information on vaccines' risks and benefits allows immunization programs to provide rapid and clear responses to rumors of AEFI. This ensures the system's reliability, especially in the face of the growing antivaccine movement and the increasing influence of social media in public opinion.
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Affiliation(s)
| | - Letícia Kegele Lignani
- Instituto de Tecnologia em Imunobiológicos, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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9
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Barboza TC, Guimarães RA, Gimenes FRE, Silva AEBDC. Retrospective study of immunization errors reported in an online Information System. Rev Lat Am Enfermagem 2020; 28:e3303. [PMID: 32578753 PMCID: PMC7304978 DOI: 10.1590/1518-8345.3343.3303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 03/20/2020] [Indexed: 11/30/2022] Open
Abstract
Objective: to analyze the immunization errors reported in an online Information
System. Method: retrospective study conducted with data from the Adverse Event Following
Immunization Surveillance Information System. Immunization errors were
analyzed with respect to demographic characteristics and the vaccination
process. Frequencies and error incidence rates have been calculated.
Binomial and chi-square tests were used to verify differences in the
proportions of the variables. Results: 501 errors were analyzed, the majority involving routine doses (92.6%),
without Adverse Event Following Immunization (90.6%) and in children under
five years old (55.7%). The most frequent types of errors were inadequacy in
the indication of the immunobiological (26.9%), inadequate interval between
doses (18.2%) and error in the administration technique (14.2%). The overall
error incidence rate was 4.05/100,000 doses applied; the highest incidences
of routine vaccines were for human rabies vaccine, human papillomavirus and
triple viral; the incidence rate of errors with Adverse Events Following
Immunization was 0.45/100,000 doses applied. Conclusion: it was found that immunization errors are a reality to be faced by the health
systems, but they are amenable to prevention through interventions such as
the adoption of protocols, checklists and permanent education in health.
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Affiliation(s)
- Tânia Cristina Barboza
- Secretaria de Estado de Saúde de Goiás, Superintendência de Vigilância em Saúde, Goiânia, GO, Brazil
| | | | - Fernanda Raphael Escobar Gimenes
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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Abstract
Pharmacovigilance of vaccines is of paramount importance to promote the safe use of vaccines among their recipients. India launched the Adverse Events Following Immunization (AEFI) surveillance program in 1986 for monitoring suspected adverse events following immunization and since then, the AEFI surveillance guideline has been updated periodically, with the latest being in 2015. The successful AEFI surveillance program in India required the concerted effort of all stakeholders such as National AEFI Secretariat, National Technical Collaborating Centre, Central Drug Standard Control Organization, marketing authorization holder, and health-care professionals.
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Affiliation(s)
- Bikash Ranjan Meher
- Department of Pharmacology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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11
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Bellavite P. Causality assessment of adverse events following immunization: the problem of multifactorial pathology. F1000Res 2020; 9:170. [PMID: 32269767 PMCID: PMC7111503 DOI: 10.12688/f1000research.22600.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2020] [Indexed: 07/22/2023] Open
Abstract
The analysis of Adverse Events Following Immunization (AEFI) is important in a balanced epidemiological evaluation of vaccines and in the issues related to national vaccine injury compensation programs. If manufacturing defects or vaccine storage and delivering errors are excluded, the majority of adverse reactions to vaccines occur as excessive or biased inflammatory and immune responses. These unwanted phenomena, occasionally severe, are associated with many different endogenous and exogenous factors, which often interact in complex ways. The confirmation or denial of the causal link between an AEFI and vaccination is determined pursuant to WHO guidelines, which propose a four-step analysis and algorithmic diagramming. The evaluation process from the onset considers all possible "other causes" that can explain the AEFI and thus exclude the role of the vaccine. Subsequently, even if there was biological plausibility and temporal compatibility for a causal association between the vaccine and the AEFI, the guidelines ask to look for any possible evidence that the vaccine could not have caused that event. Such an algorithmic method presents some concerns that are discussed here, in the light of the multifactorial nature of the inflammatory and immune pathologies induced by vaccines, including emerging knowledge of genetic susceptibility to adverse effects. It is proposed that the causality assessment could exclude a consistent association of the adverse event with the vaccine only when the presumed "other cause" is independent of an interaction with the vaccine. Furthermore, the scientific literature should be viewed not as an exclusion criterion but as a comprehensive analysis of all the evidence for or against the role of the vaccine in causing an adverse reaction. These issues are discussed in relation to the laws that, in some countries, regulate the mandatory vaccinations and the compensation for those who have suffered serious adverse effects.
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Affiliation(s)
- Paolo Bellavite
- Department of Medicine, Section of General Pathology, University of Verona Medical School, Verona, 37134, Italy
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12
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Abstract
The analysis of Adverse Events Following Immunization (AEFI) is important in a balanced epidemiological evaluation of vaccines and in the issues related to vaccine injury compensation programs. The majority of adverse reactions to vaccines occur as excessive or biased inflammatory and immune responses. These unwanted phenomena, occasionally severe, are associated with many different endogenous and exogenous factors, which often interact in complex ways. The confirmation or denial of the causal link between an AEFI and vaccination is determined pursuant to WHO guidelines, which propose a four-step analysis and algorithmic diagramming. The evaluation process from the onset considers all possible "other causes" that might explain the AEFI and thus exclude the role of the vaccine. Subsequently, even if there was biological plausibility and temporal compatibility for a causal association between the vaccine and the AEFI, the guidelines ask to look for any possible evidence that the vaccine could not have caused that event. Such an algorithmic method presents several concerns that are discussed here, in the light of the multifactorial nature of the inflammatory and immune pathologies induced by vaccines, including emerging knowledge of genetic susceptibility to adverse effects. It is proposed that the causality assessment could exclude a consistent association of the adverse event with the vaccine only when the presumed "other cause" is independent of an interaction with the vaccine. Furthermore, the scientific literature should be viewed not as an exclusion criterion but as a comprehensive analysis of all the evidence for or against the role of the vaccine in causing an adverse reaction. Given these inadequacies in the evaluation of multifactorial diseases, the WHO guidelines need to be reevaluated and revised. These issues are discussed in relation to the laws that, in some countries, regulate the mandatory vaccinations and the compensation for those who have suffered serious adverse effects.
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Affiliation(s)
- Paolo Bellavite
- Department of Medicine, Section of General Pathology, University of Verona Medical School, Verona, 37134, Italy
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