In 1910, as smallpox outbreaks continued and anti-vaccine folks made it harder to get folks vaccinated, he wrote:
“I would like to issue a Mount-Carmel-like challenge to any ten unvaccinated priests of Baal. I will go into the next severe epidemic with ten selected, vaccinated persons and ten selected unvaccinated persons – I should prefer to choose the latter – three members of Parliament, three anti-vaccination doctors (if they can be found), and four anti-vaccination propagandists.
And I will make this promise – neither to jeer nor jibe when they catch the disease, but to look after them as brothers, and for the four or five who are certain to die, I will try to arrange the funerals with all the pomp and ceremony of an anti-vaccination demonstration.”
Unfortunately, unlike the highly vocal minority of folks who are against vaccines, we rarely hear from vaccine advocates.
There are a lot of them out there though.
And we are finally starting to hear more about them!
“One woman took four of her kids for the M.M.R. that week.”
Amid a Measles Outbreak, an Ultra-Orthodox Nurse Fights Vaccination Fears in Her Community
Like the story of a nurse in Brooklyn who is educating vaccine-hesitant parents in the middle of a measles outbreak.
And how vaccine-hesitant parents in Oregon are attending vaccine workshops to learn about vaccines from medical professionals.
“The response has been overwhelmingly positive. In exit surveys, the vast majority of people who attend our workshops say they’ve decided to vaccinate their children as recommended by the American Academy of Pediatrics.”
How do you get anti-vaxxers to vaccinate their kids? Talk to them — for hours.
Although it would be great if mistakes never ever happened, the best we can do is to understand that mistakes do sometimes happen and take steps to avoid them.
How can we avoid mistakes and errors about vaccines?
Avoiding Vaccine Errors
It can help to:
understand the 7 Rights of vaccine administration, including that you give the Right vaccine to the Right patient at the Right time by the Right route at the Right injection site and then follow it with the Right documentation
use a 2d barcoding system with your EMR to help catch vaccine errors before administration
use a screening checklist to help avoid giving vaccines that are contraindicated
double check vaccines that look alike or have names that sound like, such as DTaP and Tdap
double check expiration dates
make sure you aren’t giving live vaccines within 28 days of each other, unless they are given at the same time
make sure you aren’t giving the wrong dosage amount for the patient’s age, as some vaccines have different formulations depending on the age of the patient, including flu shots, hepatitis A, and hepatitis B vaccines
be careful so that you don’t give a combination vaccine, such as Pediarix, Pentacel, Kinrix, Quadracel, or ProQuad, inappropriately
That we are have a 4-day grace period does help avoid the need to revaccinate some kids when vaccines are given a little too early.
“With the exception of rabies vaccine, ACIP allows a grace period of 4 days (i.e., vaccine doses administered up to 4 days before the recommended minimum interval or age can be counted as valid). However, if a dose was administered 5 or more days earlier than the recommended minimum interval between doses, it is not valid and must be repeated. The repeat dose should be spaced after the invalid dose by the recommended minimum interval.”
Ask the Experts About Scheduling Vaccines
In many cases, as long as vaccine doses were administered less than or equal to 4 days before the minimum interval or age, then they can still be counted and are considered valid.
Common Vaccine Errors
It’s easier than you think to prevent vaccine errors.
the rotavirus vaccine series must be completed by 8 months (32 weeks)
ProQuad, the MMR and chicken pox combination vaccine, is not licensed for kids who are older than 12 years, although if a teen or adult did get ProQuad, it could be considered an off-label dose and could still count.
Kinrix and Quadracel, the DTaP and polio combination vaccines are only licensed for the 5th dose of DTaP and 4th dose of polio in children who are 4 to 6 years old, so wouldn’t be appropriate for an 18-month-old, even if he needs both (DTaP and polio) vaccines. Earlier doses can sometimes count as off-label doses though.
the combination vaccines Pediarix and Pentacel are only licensed up through age six years, but don’t necessarily need to be repeated if given to older kids.
children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis A vaccine, while older teens, who are at least 19-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis A or even realize that there is a different version.
children and adolescent’s get a pediatric dose (0.5ml) of the hepatitis B vaccine, while older teens, who are at least 20-years-old, get an adult (1.0ml) dose. Since most kids get vaccinated when they are younger, many pediatricians may not have the adult version of the hepatitis B vaccine or even realize that there is a different version.
Most importantly, even when giving vaccines on schedule, be sure to triple check everything. This is especially important if multiple kids in the same room are getting immunizations.
Although none of these vaccine errors are very common (hundreds of millions of doses of vaccines are given in the United States each year), understanding which ones occur the most often can help to make sure that they don’t happen in your office.