Vaccine errors climb 7% over 14-year period

Vaccination errors made up 7 percent of all reports to the Vaccine Adverse Event Reporting System (VAERS) from 2000-2013, according to new data from the Centers for Disease Control and Prevention (CDC).

Beth F. Hibbs, RN, MPH, with the CDC’s Immunization Safety Office in the Division of Healthcare Quality Promotion, presented the VAERS data during a CDC conference call last week.

Also, How to combat the top 10 vaccine errors

Susan Hariri, PhD, with the CDC’s Epidemiology and Statistics Branch in the Division of STD Prevention, also updated listeners on recommendations for the quadrivalent human papillomavirus (HPV) vaccine.

There were 20,585 vaccination error reports in the VAERS, out of 311,185 total VAERS reports. Of the total error reports, 5,204 resulted in an adverse health event and most were not serious. 

Causes of vaccine errors

Most vaccine errors were caused by inappropriate scheduling, followed by storage/ dispensing, wrong vaccine, general error, incorrect dose, and administration error.

With the HPV vaccine, wrong timing was the most common error report. “With the rotavirus vaccine, wrong timing was another common error. The first and last dose were given late,” Hibbs said. “Both the rotavirus and HPV vaccines have conflicting schedules. Vaccines with conflicting schedules may require more care.”

Another common error was improper storage of vaccines. “The most common errors involved seasonal live attenuated influenza (LAIV) vaccines,” Hibbs said. Vaccines kept outside of proper storage temperatures was another common problem.

The CDC’s “Vaccine Storage & Handling Toolkit” may be helpful to prevent some storage problems, she added.

Meanwhile, the CDC’s Advisory Committee on Immunization Practices (ACIP)’s most recent guidelines state that the HPV vaccine is recommended at age 11 or 12 years and through age 26 for females and age 21 for males not previously vaccinated.

Vaccination of females is recommended with the following formulations: 2vHPV, 4vHPV, or 9vHPV. The formulation of 4vHPV or 9vHPV is recommended for males.

“[The formulations] 2vHPV, 4vHPV, and 9vHPV all protect against HPV 16 and 18, types that cause about 66 percent of cervical cancers and the majority of other HPV-attributable cancers in the U.S. [The formulation] 9vHPV targets five additional cancer-causing types, which account for about 15 percent of cervical cancers,” Hariri said.

While the ACIP has not changed its recommendations for the HPV vaccine during pregnancy (it should still not be used), a new vaccine in the pregnancy registry has been established for 9vPHPV. Registries for 4vHPV and 2vHPV have been closed with concurrence from FDA.