Tag: errors

The Tragedy in Samoa Was Not Caused by the MMR Vaccine

Remember the two young children who died in Samoa in early July 2018, shortly after getting an MMR vaccine?

In addition to the tragic deaths of those two children, it led to the suspension of all vaccinations in the country.

The Tragedy in Samoa Was Not Caused by the MMR Vaccine

Fortunately, that suspension was eventually reversed, but they did continue to hold MMR vaccinations.

How long did they suspend MMR vaccinations?

They didn’t restart until April 15.

And while the trial for the two nurses involved in the tragedy is delayed until June, the Director General of Health, Leausa Take Naseri, has said that their deaths were a mistake caused by human error.

“On 4 June 2019, both nurses pleaded guilty to negligence causing manslaughter. On 2 August, both nurses were sentenced to five years in prison. During the sentencing hearing, it was confirmed that one of the nurses mixed the MMR vaccine powder with expired muscle relaxant anaesthetic instead of water for injection supplied in a vial with the vaccine.”

Infant deaths in Samoa a tragic outcome from error preparing MMR vaccine

With measles outbreaks in many nearby countries, health experts and parents are eager to get vaccinations restarted and to get kids caught up.

Local officials say that Taylor Winterstein, the face of the VAXXED tour in Australia, is taking advantage of what happened at the Safotu District Hospital

Hopefully, they get vaccinated before anti-vaccine folks head to Samoa to try and scare folks away from getting vaccinated.

More on The Vaccine Tragedy in Samoa

How Long Is a Vaccine Month?

Are you ever concerned that your kids will get their vaccines too early or too late?

Vaccine intervals are typically based on weeks and "months."
Vaccine intervals are typically based on weeks and “months.” But how long is a month?

For example, if your child needs a booster dose of a vaccine in a month, just how long is that?

Does it depend on which month you are in?

For intervals of 3 months or less, you should use 28 days (4 weeks) as a “month.”

Ask the Experts on Scheduling Vaccines

In general, while we often use calendar months, because it is more convenient, you can use a minimum interval of 28 days or 4 weeks as a full month, as long as we are only counting up to three months.

So a second flu shot after a dose on January 1st could be done as early as January 29th. That’s technically one month (28 days, 4 weeks) later. And no, you wouldn’t have to repeat the second dose if you got it on February 1st, as we are typically worried about the minimum intervals or spacing and not about getting the dose a little late.

For intervals of 4 months or longer, you should consider a month a “calendar month”: the interval from one calendar date to the next a month later.

Ask the Experts on Scheduling Vaccines

And just count calendar months if you are counting more than 3 months. So if you got a vaccine on January 1 and needed another 4 months later, you would return on May 1.

Why switch to using “calendar months” for longer intervals? With longer 28 day intervals, scheduling mistakes will likely be made.

More on Spacing and Scheduling Vaccine Doses

Is There a Grace Period for Getting Vaccines?

You know about the standard immunization schedule.

Looking at the latest immunization schedule from the CDC and AAP, it should be clear that kids don't get 69 vaccines.
What happens if you get a vaccine a few days too early?

You may even know about the minimum ages or minimum intervals between vaccines, but what happens if your child gets a vaccine just a few days early?

Is There a Grace Period for Getting Vaccines?

Fortunately, in most cases, getting a vaccine just a little early isn’t going to mean that the vaccine dose has to be repeated.

“Doses administered too close together or at too young an age can lead to a suboptimal immune response. However, administering a dose a few days earlier than the minimum interval or age is unlikely to have a substantially negative effect on the immune response to that dose. Known as the “grace period”, vaccine doses administered ≤4 days before the minimum interval or age are considered valid; however, local or state mandates might supersede this 4-day guideline.”

General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP)

That’s because the Advisory Committee on Immunization Practices (ACIP) allows a 4-day grace period for most vaccines. So if your child got their vaccines 3 or 4 days before their 1st birthday, instead of on or after turning 12 months old, they would still count!

It is important to keep in mind that:

  • day 1 is the day before the day that marks the minimum age or minimum interval for a vaccine.
  • the grace period doesn’t apply to the rabies vaccine
  • if a vaccine is given 5 or more days too early, beyond the grace period, then the interval to the next dose starts from the day that invalid dose was given. For example, if the second dose of Hib is given two weeks after the first dose (instead of the minimum 4 weeks), then you don’t repeat this invalid dose in two weeks (four weeks from the first dose), but instead wait an additional four weeks from the invalid second dose
  • you can’t usually add the grace period to an accelerated schedule
  • live vaccines must be given at least 28 days apart if they are not given at the same time and the grace period can not be used to shorten this interval

Most importantly, in place since 2002, the grace period protects kids from having to repeat vaccines because of minor vaccine scheduling errors.

More on the Vaccine Grace Period

What Are the Recommended and Minimum Ages and Intervals Between Doses of Vaccines?

Most parents likely don’t think about the minimum age or minimum intervals between vaccines, as they just get their kids vaccinated according to the routine immunization schedule.

Things don’t always go according to schedule though…

Recommended and Minimum Ages for Vaccines

After their birth dose of the hepatitis B vaccine, your baby’s next vaccines are usually at two months.

Can you get them earlier?

When necessary, many vaccines can be given earlier and faster than the standard schedule.
When necessary, many vaccines can be given earlier and faster than the standard schedule.

Yes. The minimum age for the first dose of rotavirus, DTaP, IPV, Hib, Prevnar, is 6 weeks.

Some other vaccines can be given earlier than their recommended age too, including:

  • the first MMR vaccine, which can be given as early as age 6 months in certain high risk situations, like traveling out of the country or in an outbreak situation, although this dose will have to be repeated once the child is 12 months old
  • the 4th dose of DTaP, which can be given as early as age 12 to 15 months, as long as at least 4 to 6 months have passed since the third dose
  • the 2nd dose of Varivax, which may be given as early as 1 to 3 months after the first dose
  • the Tdap vaccine, which can be given as early as age 7 years, instead of the more typical 11 to 12 years
  • the HPV vaccine, which can be given as early as age 9 years, instead of the more typical 11 to 12 years

Why would you get a vaccine early?

What if you are going to be traveling just before you infant is going to be 2 months old? Or your 9 year old stepped on a rusty nail, and it had been just over 5 years since his last tetanus (DTaP) shot?

Recommended and Minimum Intervals for Vaccines

In addition to earlier ages, you can sometimes get vaccines more quickly, on an accelerated schedule.

For example:

  • the minimum interval between the 1st and 2nd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 2nd and 3rd dose of rotavirus, DTaP, IPV, Hib, Prevnar is 4 weeks, instead of the standard 2 months
  • the minimum interval between the 1st and 2nd dose of HPV is either 4 weeks (3 dose schedule) or 5 months (2 dose schedule)
  • the minimum interval between the 2nd and 3rd dose of HPV is 12 weeks
  • the minimum interval between the 1st and 3rd dose of HPV is 5 months, instead of the standard 6 months

Why give these vaccines more quickly than usual?

The usual reason is that a child is a little behind and is working to get caught up.

Absolute Minimum Ages for Vaccines

It is important to remember that in some cases, there are some hard and fast rules about minimum ages. That means that if you get these vaccines any earlier, they won’t count and you will likely have to repeat them, including getting :

  • the 3rd dose of hepatitis B before 6 months (24 weeks) or sooner than 8 weeks after 2nd dose and  16 weeks after 1st dose
  • the first dose of MMR, Varivax or hepatitis A before 12 months
  • the 4th dose of Hib before 12 months
  • the 4th dose of Prevnar before 12 months
  • the 4th dose of DTaP before 12 months
  • the 5th dose of DTaP before 4 years
  • the 4th dose of IPV before 4 years

Sticking to the routine schedule helps to avoid vaccine errors, like giving a vaccine too early. In some situations, the 4 day grace period helps if a vaccine is given a little early.

More on Recommended and Minimum Ages and Intervals Between Doses of Vaccines