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.
Are Anti-Vaccine Folks Smarter Than the Rest of Us?
Not surprisingly, anti-vaccine folks think they are smarter.
“In the end we are left with a powerful sense of knowledge – false knowledge. Confirmation bias leads to a high level of confidence, we feel we are right in our gut. And when confronted with someone saying we are wrong, or promoting an alternate view, some people become hostile.
The Dunning-Kruger effect is not just a curiosity of psychology, it touches on a critical aspect of the default mode of human thought, and a major flaw in our thinking. It also applies to everyone – we are all at various places on that curve with respect to different areas of knowledge. You may be an expert in some things, and competent in others, but will also be toward the bottom of the curve in some areas of knowledge.”
Steven Novella on Lessons from Dunning-Kruger
While it is easy to blame it on the Dunning-Kruger effect, a study that appeared in the July 2004 issue of Pediatrics, Children who have received no vaccines: who are they and where do they live?, is often used by anti-vaccine folks to reinforce the idea that they are smarter.
“Undervaccinated children tended to be black, to have a younger mother who was not married and did not have a college degree, to live in a household near the poverty level, and to live in a central city. Unvaccinated children tended to be white, to have a mother who was married and had a college degree, to live in a household with an annual income exceeding 75,000 dollars, and to have parents who expressed concerns regarding the safety of vaccines and indicated that medical doctors have little influence over vaccination decisions for their children”
Children who have received no vaccines: who are they and where do they live?
But the part of the study that is often quoted is comparing unvaccinated vs undervaccinated.
In the same study, the education level of unvaccinated vs vaccinated is virtually the same.
And the differences for the unvaccinated vs undervaccinated kids was about their living near the poverty level. If these families grew up with less money, they likely had less opportunities to go to school, and unfortunately, had less opportunities to keep their kids up-to-date on their vaccines.
One study, Maternal characteristics and hospital policies as risk factors for nonreceipt of hepatitis B vaccine in the newborn nursery, did seem to associate a higher education level with refusing the newborn hepatitis B vaccine, but an even bigger factor was being born in a facility that actually had a policy that offered the vaccine.
“Likewise, vaccine refusal now appears to be less a function of socioeconomic status than it once was. Previously, maternal education was strongly associated with vaccine refusal, but now mothers without a high school diploma are even more likely than college graduates to have unvaccinated children . Also, unvaccinated children are no longer found primarily in the highest income households (perhaps a function of income data being top-coded at $50,000), but now are equally likely to live in households with more moderate (or even below poverty) incomes.”
Laura Blakeslee on Trends and Characteristics of Unvaccinated Children in the United States : The National Immunization Survey, 2002 − 2010
Other studies have either showed a higher level of college graduates for those who vaccinated their kids or no difference.
What about all of the experts in the anti-vaccine movement? Remember that the heroes and so called experts of the the anti-vaccine movement mostly includes celebrities, some doctors and scientists who are practicing way out of their field of expertise when they talk about vaccines, and others whose work is not supported by the great majority of experts in their field.
That’s not necessarily the end of the story though.
Yet another study (a small survey), Parental Delay or Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model, found that as compared to parents who vaccinated their kids, those who delayed or refused vaccines:
were less likely to think that vaccines were necessary
were less likely to think that their kids would get a disease if they weren’t vaccinated
were less likely to believe that vaccines are safe
And surprisingly, considering that the above things are basically anti-vaccine talking points that are easily disproven, they were actually more likely to have gone to college and to be a college graduate. It is not a surprise that they were less likely to have a good relationship with their doctor and were less likely to believe that their doctor had their child’s best interest at heart.
So maybe some anti-vaccine parents are indeed well-educated about some things, but that just gets us back to the Dunning-Kruger effect, as they certainly aren’t making smart decisions about vaccines.