Use of electronic immunization registry in the surveillance of adverse events following immunization

Barriers to healthcare workers reporting adverse events following immunization in Zhejiang province, China

Objectives

A cross-sectional survey was conducted among healthcare workers (HCWs) to assess their knowledge, attitude, and reporting behavior in adverse event following immunization (AEFI) surveillance as well as to identify barriers.

Methods

A simple random sample of 170 vaccination clinics was selected and one HCW was informed to participate in this survey in each selected vaccination clinic. The survey was developed using a secure online platform and consisted of a structured online questionnaire. The distributions of the respondents’ characteristics were presented. Training status, knowledge, attitude, and reporting behavior were compared between sub-groups of HCWs. Barriers and suggestions on AEFI reporting were also summarized.

Results

Of the 170 surveyed HCWs, 61.76% received the training on AEFI surveillance while 15.88% had no AEFI training at all. The higher level of knowledge and the more positive attitude and reporting behavior on AEFI surveillance were observed among HCWs with the longer working duration on AEFI surveillance, or among HCWs who received the training. The most critical barrier to reporting an AEFI was ‘not being sure if the AEFI is related to the vaccine’ (122, 71.76%). Other barriers were: ‘I do not want to raise unnecessary public alarm about a vaccine’ (105, 61.76%); ‘reporting form or other method being too complicated’ (65, 38.23%).

Conclusion

The study findings highlighted the need to prioritize training on AEFI surveillance for HCWs. It is recommended that the development of the targeted interventions to strengthen AEFI surveillance system be required based on the barriers found in this study.

Analysis of adverse events following immunization in Zhejiang, China, 2019: a retrospective cross-sectional study based on the passive surveillance system

Objectives: This study summarizes passive surveillance data for adverse events following immunization (AEFI) in Zhejiang province.Methods: The AEFI reports and number of doses on all vaccines used were extracted from the national AEFI surveillance system and the immunization information system of Zhejiang province (ZJIIS). Reporting rates of AEFI were calculated by age, city, severity of AEFI, categories of AEFI, vaccine types, and reaction categories.Results: A total of 13,079 AEFI records were reported and 23,091,401 vaccine doses were administered, with a reporting rate of 56.64/100,000 doses for AEFI. The highest reporting rate of AEFI was observed among the infants <1 year of age (108.61/100,000 doses) and the lowest rate was observed among recipients aged ≥60 years. Most of the AEFI reports were vaccine product-related reactions (48.81/100,000 doses), and the lowest was vaccination errors (0.02/100,000 doses). The most frequently reported individual vaccine was DTP and Hib combined vaccine, with a reporting rate of 426.62/100,000 doses. The most frequently reported AEFI was fever/redness/induration (48.82/100,000 doses).Conclusion: Our findings illustrated the high level of vaccine safety since the majority of those reported were not serious, or coincidentally associated with vaccination. Furthermore, the national AEFI surveillance system should be continuously used as a surveillance tool for monitoring of AEFI.

[Post-vaccination adverse events in the elderly in the State of São Paulo, Brazil, 2015 to 2017]

Vaccination is one of the public health measures that has most contributed to decreasing the incidence of vaccine-preventable diseases. However, vaccines can lead to post-vaccination adverse events. This study thus aimed to analyze the prevalence of post-vaccination adverse events in elderly persons, determine the reported post-vaccination adverse events, identify the vaccines that cause post-vaccination adverse events, and verify the post-vaccination adverse events and vaccines that lead to hospitalizations in the State of São Paulo, Brazil, from 2015 to 2017. This was a descriptive cross-sectional study with a quantitative approach based on notifications of post-vaccination adverse events recorded in the Information System of the National Immunization Program. The results showed that of the 15,196,080 elderly persons that were immunized, there were 207 reports of post-vaccination adverse events, of which 187 (89%) were non-serious adverse events and 15 (8%) due to immunization errors (IE). The majority of the patients were female (86%), white (49%), and from 60 to 69 years of age (70%). Clinical manifestations featured local reactions at the injection site (84%). There were 131 cases (64%) that evolved to cure without sequelae. Two individuals (2%) were hospitalized due to serious adverse events. The first had received adult diphtheria/tetanus (dT), pneumococcal (Pn23), and influenza vaccines, and the second had received Pn23. The post-vaccination adverse events notifications showed incomplete information. In conclusion, notification of post-vaccination adverse events is essential. Health professionals need to be committed to adequate completion of the notification forms, with health surveillance supervision aimed at quality of care for elderly persons with post-vaccination adverse events.

Updates on Vaccine Safety and Post-Licensure Surveillance for Adverse Events Following Immunization in South Korea, 2005-2017

PURPOSE

Vaccine hesitancy is among the top ten threats to global health, and access to precise data on adverse events following immunization (AEFIs) is imperative to alleviate public concerns surrounding vaccines. This study aimed to present the overall trends of AEFIs reported in South Korea.

MATERIALS AND METHODS

We evaluated the trends of AEFIs using the Korea Institute of Drug Safety & Risk Management-Korea Adverse Event Reporting System database between January 2005 and December 2017. AEFIs were classified into five categories to evaluate associations between vaccines and AEFIs through a case-non-case study: neurologic reactions, general systemic reactions, local reactions, allergic reactions, and others.

RESULTS

Among 54378 reported adverse events (AEs) associated with all vaccines approved in South Korea, more than half (56.7%) occurred following influenza vaccination, followed by the pneumococcal (11.6%) and Bacillus Calmette-Guérin (BCG) vaccines (5.0%). After immunization with most vaccines, general systemic reactions were most common, followed by local and neurologic reactions. Adjusted reporting odds ratios were calculated for all neurologic, general, local, and allergic reactions: of all vaccines, rotavirus [neurologic 2.43, 95% confidence interval (CI), 2.25-2.62], BCG (general; 2.20, 95% CI, 1.91-2.53), BCG (local; 3.15, 95% CI, 2.69-3.68), and Japanese encephalitis (allergic 2.38, 95% CI, 1.98-2.87) vaccines showed the highest values.

CONCLUSION

The majority of reported AEFIs were non-serious and mostly general systemic reactions. Sufficient knowledge on the AEFIs would secure public confidence on the safety of vaccines, thereby reducing public health burden from vaccine-preventable diseases.

Introduction of new vaccines for immunization in pregnancy - Programmatic, regulatory, safety and ethical considerations

Immunizing pregnant women is a promising strategy to reduce infectious disease-related morbidity and mortality in pregnant women and their infants. Important pre-requisites for the successful introduction of new vaccines for immunization in pregnancy include political commitment and adequate financial resources: trained, committed and sufficient numbers of healthcare workers to deliver the vaccines; close integration of immunization programs with antenatal care and Maternal and Child Health services; adequate access to antenatal care by pregnant women in the country (especially in low and middle-income countries (LMIC)); and a high proportion of births occurring in health facilities (to ensure maternal and neonatal follow-up can be done). The framework needed to advance a vaccine program from product licensure to successful country-level implementation includes establishing and organizing evidence for anticipated vaccine program impact, developing supportive policies, and translating policies into local action. International and national coordination efforts, proactive planning from conception to implementation of the programs (including country-level policy making, planning, and implementation, regulatory guidance, pharmacovigilance) and country-specific and cultural factors must be taken into account during the vaccines introduction.