Tag: statistics

Vaccination Tragedies are Rare

Vaccines work to prevent at least 2 to 3 million deaths each year worldwide.

Tragically, either because of errors or contamination, vaccines can sometimes actually cause people to get sick.

This can happen when health workers:

  • use a reconstituted vaccine after six hours – live vaccines can quickly become contaminated if they are kept and used for too long a time
  • mixup diluents – in addition to using the wrong diluent vaccination tragedies can occur when a dangerous medication is used instead of a vaccine’s standard diluent
  • improperly handle vaccines – breaking the cold chain
  • a vaccine is given to someone with a true medical contraindication

Fortunately, these situations are rare.

History of Vaccination Tragedies

With billions of doses of vaccines being given each year, it is likely not surprising that we see some problems. But when many of those vaccines are being given to kids, even one mishap, especially if it leads to life-threatening complications, is too many.

That’s why many safe guards have been put in place in the manufacturer and distribution of modern vaccines, so that we don’t see these types of vaccine tragedies:

  • the Cutter Incident, when, in 1955, at least 56 people developed polio and 5 children died after being vaccinated with inactivated polio vaccine that was poorly manufactured by Cutter Laboratories and still contained live polio virus
  • hepatitis-contaminated yellow fever vaccines – some lots of yellow fever vaccines used in the military in 1942 were unintentionally contaminated with the hepatitis B virus
  • the Lubeck Disaster – 75 children died and others got tuberculosis in 1929 Germany after there was a mixup between the BCG vaccine and the strain of Mycobacterium tuberculosis that causes tuberculosis. The BCG vaccine was supposed to be made with a weakened strain of Mycobacterium bovis bacteria instead.
  • the Bundaberg incident – 12 children died in Australia in 1928 after being given contaminated diphtheria vaccine from a multidose vial without preservative
  • tetanus contaminated smallpox vaccine in the 1890s and early 20th century

Although vaccines are much safer now, some rare incidents still occur.

Fifteen infants died and 75 children got sick in Syria in 2014 after they received a neuromuscular blocking agent, atracurium, instead of the measles vaccine they were supposed to get. How? The measles vaccine that was being used is mixed with a diluent, but instead of using the proper diluent, the health worker unintentionally used a bottle of atracurium instead.

In 2015, at least two kids died and 29 got sick in Chiapas, Mexico, among 52 children who were vaccinated. The children were reportedly given a BCG vaccine, the rotavirus vaccine, and/or a hepatitis B vaccine that day. However, the only vaccine that all of the sick children received in common was the hepatitis B vaccine. Since 130,000 doses from the same batch of vaccines had been given in the area, it was not thought to be a manufacturing problem or widespread issue. It was instead bacterial contamination of hepatitis B vaccine vials at that one clinic.

Fifteen children died in 2017 in a village in South Sudan after a poorly trained team that wasn’t adhering to WHO immunization safety standards used the same syringe to reconstitute measles vaccines over a four day period. They also didn’t keep the vaccine vials refrigerated.

“A single reconstitution syringe was used for multiple vaccine vials for the entire four days of the campaign instead of being discarded after single use. The reuse of the reconstitution syringe causes it to become contaminated which in turn contaminates the measles vaccine vials and infects the vaccinated children.”

Statement regarding findings of joint investigation of 15 deaths of children in Nachodokopele village, Kapoeta East County in South Sudan

As you can imagine, the conditions that led to these tragedies aren’t present when most kids get vaccinated.

Even in developing countries, most children get vaccinated by people adhering to WHO immunization safety standards. Why did they happened then? Both Syria and South Sudan have been rocked by war for years, leading to a breakdown in the ability to provide routine health care, even as basic as getting kids vaccinated. And Comunidad La Pimienta, Simojovel, Chiapas is a very poor part of southern Mexico.

These kinds of tragedies aren’t going to happen at your pediatrician’s office, as they don’t even have drugs like atracurium.

What Happened in Samoa?

Two toddlers died after being vaccinated at Safotu Hospital in Samoa.
Two toddlers died after being vaccinated at Safotu Hospital in Samoa.

In Samoa, four years after the deaths of the children in Syria, we are once again hearing about reports of deaths after kids were vaccinated with the MMR vaccine.

Two children in Samoa, both one-year-olds, died within minutes  of being vaccinated on the same day in the same hospital on the island of Savai’i.

Not surprisingly, as health officials investigate the cause, use of the MMR vaccine had been suspended in Samoa.

So what happened?

“Until the investigations have been completed and reported on we cannot say what did happen.

However, given the batch of vaccine involved had been in use in that country since August last year, and given the same batch of vaccine has been used in South American countries and the Caribbean island nations without incident, it seems unlikely that there was anything wrong with the vaccine.

The reports from the parents of the children affected on Friday indicate the reactions occurred within minutes after vaccination. This would preclude a response to the vaccine viruses as this takes at least a week. While anaphylaxis occurs within minutes and can be fatal when not treated the odds of seeing this twice in a day at the same place, given a chance of 1 in a million doses, is literally astronomical.”

Dr. Helen Petousis Harrison on What happened in Samoa?

Since it happened so quickly, it sounds like it could have been a mix-up with the diluent, as happened in Syria. A five dose vial of MMR is used in Samoa, which means that unlike premixed vaccines, it does have to be mixed with a diluent.

What about contamination? It is known that vaccine vials can be contaminated with Staphylococcus bacteria if they are mishandled. Although Staphylococcus bacteria can directly cause infections, they can also release a toxin that can cause toxic shock syndrome (TSS).

Considering how quickly these children got died though (within minutes), it isn’t likely that the vaccines became contaminated with Staphylococcus toxins. There have been reports of TSS following vaccination in the past, usually with vaccines that don’t use preservatives, but symptoms typically develop over four to 24 hours.

“This particular vaccine batch lot arrived to Samoa in August 2017 and has been in use since then. The same vaccine batch lot used in Samoa is also in use in a number of South American and Caribbean countries (Belize, Ecuador, St. Vincent, Trinidad Tobago, Chile, Aruba, Dutch Antilles, St. Kitts & Nevis and Cuba) with no reports of adverse events from those countries.”

Government of Samoa – Ministry of Health Press Statement

Could this be related to what happened to two other children in Samoa who had died after getting their MMR vaccines?

Almost certainly not. Those children, siblings, died years earlier, one in 2015 and the other in 2017. Neither died immediately after being vaccinated and there are reports that they may have had some kind of an immunodeficiency syndrome that contributed to their deaths.

“A number of media outlets are already covering these tragic events, speculating on the cause of death before the investigation is completed, and the stories have been picked up by the anti-vaccination movement.”

Government of Samoa – Ministry of Health Press Statement

That some folks would use these rare tragedies to scare parents from vaccinating and protecting their kids is shameful. But that’s the modern anti-vaccine movement

What to Know About Vaccination Tragedies

Kids shouldn’t get sick or die after getting vaccinated. Fortunately, they rarely do, except in extreme circumstances that can make it more likely for errors to occur.

More on Vaccination Tragedies

Avoiding the Most Common Vaccine Errors

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 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.

Especially if there are more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child's name so that they don't get the wrong vaccines.
Especially if there is more than one child in the room getting vaccines, either the tray itself or the vaccines should be labeled with each child’s name so that they don’t get the wrong vaccines. Photo by Vincent Iannelli, MD

When are you most likely to make a vaccine error?

When you are doing something that isn’t routine, which most commonly happens when folks delay or skip some vaccines and are now playing catch-up.

In addition to the tips above, remember that:

  • the first dose of the rotavirus vaccines must be given by 15 weeks
  • 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.

Also remember that vaccine errors should be reported to the ISMP National Vaccine Errors Reporting Program (VERP) or VAERS, with the correct dose repeated if necessary.

What to Know About Common Vaccine Errors

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.

More on Common Vaccine Errors

America’s New Normal: Propaganda About the Unhealthiest Generation

My son started to have migraines when he was about 11 years old.

Must be stress, BPA, poor eating habits, all of the screen time, or vaccines, right?

“Americans spend the least on food, the most on health care, have the most highly vaccinated kids, and have the sickest kids of any industrialized country. More kids than not are now chronically ill, developmentally delayed, and eating or injecting prescription medications from cradle to grave – which is going to be a quicker trip for them than it was for their parents, according to data on life expectancy in the US. We are inured to childhood autism, epilepsy, allergy, asthma, diabetes, obesity, Crohn’s disease and cancer. We are dying younger. We are going backwards.”

Judy Converse on America’s New Normal: Chronically Ill Kids

That likely seems like a young age to get migraines and would fit well with the narrative that kids today are part of the unhealthiest generation ever.

Except that I started to get migraines at about the same age, and so did my mother. Like many of the other conditions that seem to be ballooning today, migraines have a genetic component.

The Unhealthiest Generation?

The CDC has long kept statistics on everything from asthma and cancer rates to diabetes and life expectancy rates and helps folks see how healthy kids really are today.
The CDC has long kept statistics on everything from asthma and cancer rates to diabetes and life expectancy rates and helps folks see how healthy kids really are today.

Who says that today’s kids are part of the unhealthiest generation ever?

Mostly anti-vaccine folks who blame vaccines for making kids unhealthy and alternative medical providers who think their holistic remedies will fix all of the problems they see in our unhealthy kids who they claim are full of “toxins.”

Toxins? If you are going to believe that our kids are all sick, then you have to buy into the narrative that toxins are everywhere, especially in vaccines, and they are making kids sick.

Of course, none of that is true.

Vaccines are safe and work to prevent us from getting sick and there are 2 to 3 million fewer deaths in the world each year because people are vaccinated and protected.

“From developing groundbreaking treatments for deadly chronic diseases to saving babies who are born premature, pediatric researchers have increased the ability of children to live full and fulfilling lives that only a few decades before would have been tragically cut short.”

Sandra G. Hassink, MD on the 7 Great Achievements in Pediatric Research

And today’s kids, all 73.6 million of them in the United States, aren’t the unhealthiest. They are actually a very healthy generation, being born with the lowest child and infant mortality rates ever, low rates of hospitalizations, and one of the highest life expectancies in history.

Our Healthy Kids

How do we know today’s kids are healthy?

One easy way is to compare them to kids in the past…

If you have only been listening to the alarmists who talk about the unhealthiest generation all of the time, you likely wouldn’t know that:

  • while 2.6% of kids were thought to be in fair or poor health in 1991, that is down to just 1.8% today (2015)
  • fewer kids today (4.5%) report having had an asthma attack in the previous year than they did in 1997 (5.4%), and that fewer kids have asthma today (8.5%) than in 2003 (8.7%)
  • since 1997, fewer children, whether or not they have insurance, are visiting the emergency room
  • fewer children are requiring overnight hospital stays, down from 5.5% to just 2.1% today (2015)
  • rates of hay fever or respiratory allergy are down since 1997, from 17.5% of kids to 15.6% of kids today (2015)
  • rates of epilepsy have been stable in children for at least 40 years
  • fewer kids have multiple ear infections since 1997, when 7.1% of kids had 3 or more ear infections, to just 5% of kids today (2015)
  • fewer kids are being prescribed antibiotics
  • childhood cancer rates have been rising, but only slightly, and mortality rates have been declining
  • suicide rates are rising, but only from historic lows – they used to be about the same or higher in the early 1990s

Of course, some conditions are on the rise, including ADHD, type 1 diabetes, food allergies, eczema,  obesity, and most autoimmune diseases.

“A few conditions have decreased because of prevention (eg, lead encephalopathy), a few represent relatively new conditions (eg, human immunodeficiency virus type 1 infection), and some have increased after dramatic improvements in survival for individually low-prevalence childhood conditions that previously had high fatality rates (eg, leukemia, cystic fibrosis, congenital heart diseases). Most growth, however, reflects dramatic increases in incidence of a few high-prevalence conditions.”

James M. Perrin, MD on The Increase of Childhood Chronic Conditions in the United States

And autism rates have been up, but we mostly know why.

“…the numbers of people born with autism aren’t necessarily increasing dramatically. It’s just that we’re getting better and better at counting them.”

Emily Willingham

Although we don’t know why most other conditions are trending up (it isn’t vaccines), we will hopefully continue to develop new theories and reverse those trends.

It should be reassuring that many of the trends do show that our kids are indeed healthy.

What to Know About Our Healthy Kids

From gun violence and climate change to the threat of emerging infections, out children do face many threats and are certainly under a lot of stress. There is no evidence that this is the unhealthiest generation though. If anything, they are on track to be one of the healthiest.

More on Our Healthy Kids

Vaccines Statistics and Numbers

To help you get better educated about vaccines, it can help to learn some vaccine statistics and some other numbers behind vaccines.

Vaccine Statistics

For all of the talk of some folks delaying or skipping vaccines, do you know how many vaccines are given each day?

According to the CDC, from 2006 to 2016, at least 3,153,876,236 doses of vaccines were distributed in the United States. These are the vaccines that are covered by the National Vaccine Injury Compensation Program, such as DTaP, MMR, Hepatitis A and B, HPV, and flu, etc.

That’s over 286 million doses each year!

The WHO reports that 85% of infants around the world receive vaccines against DTP, polio, measles, and hepatitis B.
The WHO reports that 85% of infants around the world receive vaccines against DTP, polio, measles, and hepatitis B.

How about worldwide?

That’s harder to know, but consider that the World Health Organization reports that 85% of infants worldwide, or almost 100 million infants, get at least:

  • 3 doses of DTP
  • 3 doses of hepatitis B
  • at least one doses of measles
  • 3 doses of polio

Plus, an increasing number are getting vaccines to protect them against Hib, pneumococcal disease, rotavirus, HPV, meningitis A, mumps, rubella, tetanus, and yellow fever.

“UNICEF supplies vaccines reaching 45 per cent of the world’s children under five years old as part of its commitment to improving child survival.”

How many vaccine doses are we talking about?

A lot. UNICEF alone buys 2.8 billion doses of vaccines each year! Those vaccines are then distributed to children in over 100 countries.

Vaccine-Preventable Disease Statistics

As impressive as the number of vaccines that are given each year are the numbers about what happens when we give vaccines:

  • there are 2 to 3 million fewer deaths in the world each year because people are vaccinated and protected
  • in the Unites States, every $1 spent on vaccines provides $3 in direct benefits and up to $10 in benefits if you include societal costs
  • in developing countries, every $1 spent on vaccines provides $16 in direct benefits, but that goes up to $44 when you take “into account the broader economic impact of illness”
  • for children born in the United States during “1994–2013, routine childhood immunization was estimated to prevent 322 million illnesses (averaging 4.1 illnesses per child) and 21 million hospitalizations (0.27 per child) over the course of their lifetimes and avert 732,000 premature deaths from vaccine-preventable illnesses,” and it also “will potentially avert $402 billion in direct costs and $1.5 trillion in societal costs because of illnesses prevented”
  • only two countries continue to have wild polio – Afghanistan and Pakistan – and together, they only had 21 cases in 2017

Still, only one vaccine-preventable disease, smallpox, has been eradicated.

And worldwide, more than 3 million people still die from vaccine-preventable diseases every year, many of them young children.

Other Vaccine Numbers

There are some other numbers about vaccines and vaccine-preventable diseases folks should know:

  • the number of pediatricians who got a $3 million vaccine bonus – zero
  • the number of vaccines that contain antifreeze as an ingredient – zero
  • the number of vaccines that contain peanut oil as an ingredient – zero
  • the number of studies that link vaccines to autism – zero
  • the number of diseases that homeopathic vaccines can prevent – zero
  • the number of anti-vaccine sites that mention any benefits of vaccines – zero
  • the number of VAERS reports that are thought to be unrelated to a vaccine – 53%
  • the number of VAERS reports that are thought to be definitely caused by a vaccine – 3%
  • the number of definite VAERS reports that were serious – 1 (anaphylaxis)
  • the number of myths about vaccines that can scare you away from vaccinating and protecting your kids – 100s

Vaccines work. Vaccines are safe. Vaccines are necessary.

Get vaccinated and protected.

What’s the biggest number you should be thinking about? Way too many people are still getting and dying from vaccine-preventable diseases.

What to Know About Vaccine Statistics

Although more work needs to be done to protect more people, vaccine statistics clearly show that vaccines work and that they are safe and necessary.

More on Vaccines Statistics