Tag: vaccine 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 actually don’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.

And that the MMR vaccine is safe.

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

Vaccine 2D Barcoding and Barcode Scanners

Since at least 2004, most vaccine vials and syringes have had barcodes on them.

A lot of information is stored in that little 2D barcode on our vaccines.
A lot of information is stored in that little 2D barcode on our vaccines.

At first they were linear barcodes (like a UPC code), but since 2016, vaccine products began using 2D barcoding.

Vaccine 2D Barcoding

Although you may have never heard about it, vaccine barcoding has a lot of benefits, including:

  • improved patient safety by reducing vaccine errors, including flagging when the wrong vaccine or an expired vaccine is scanned
  • improved documentation
  • improved efficiency, as using a vaccine barcode scanner is faster than manually entering vaccine lot numbers

And vaccine barcoding makes it easier for clinics to manage their vaccine inventory.

Vaccine Barcode Scanners

Which vaccine barcode scanner should you get?

“Scanners, once configured for the specific EHR/PMS/IIS set-up, can decode the 2D barcode into a “string of numbers”. Once this string of numbers is available, the configuration from the scanner to the health record translates the informati​​​​on into the appropriate data needed to document GTIN, lot number, and expiration date.”

AAP on Getting the Scanner to Work

That’s probably going to depend on which EHR that you use, as you want to make sure that your scanner works with your EHR.

Scanning a vaccine into our EMR.
Scanning a vaccine into our EMR.

Once you know which model to get, you can also decide if you want one that is corded or that connects via WiFi or Bluetooth. While it might seem most convenient to go with a cordless device, that doesn’t necessarily mean that you can easily use the scanner on multiple computers. Each cordless device typically needs to be paired with a specific computer.

Are you using a vaccine barcode scanner yet?

More on Vaccine 2D Barcoding and Barcode Scanners

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

Update on the Samoa Vaccine Tragedy

Breaking News – MMR vaccination on Samoa will resume on April 15 (see below).

Many people remember that two young children died in Samoa in early July, shortly after getting an MMR vaccine.

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

Both incidents happened on the same day in the same hospital on the island of Savai’i.

“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?

And while many people have speculated on what had happened, we didn’t get much new information until the Attorney General Lemalu Herman Retzlaff issued a press statement:

It can be confirmed that one of the nurses involved with the vaccination injections of the two babies who passed away 6th July 2018, was charged by police on Saturday 4th August 2018. She is set to appear in Court 14th August 2018, where the charges will be confirmed publicly.

According to AG Lemalu, “the file was referred to this office for advice last week, after swift and hard-working investigations by the CID section of the Ministry of Police both in Apia and Savaii, which is to be commended.”

“And the decision to charge was thereafter supported by advice; and it is also confirmed by Police, that investigations are still active and on-going.”

Both nurses have now been charged and both have entered not guilty pleas to charges of manslaughter, negligence and conspiracy to defeat the course of justice.

A trial is set for January 21 June 2019.

Apparently though, an ongoing investigation into the deaths of the two toddlers that had been adjourned until September 12, 2018 as they were still waiting on the the post mortem reports from the pathologist in Australia, has been suspended even further.

“The inquiry into the deaths of two babies in Samoa has been suspended until further information is available from post mortem results”

Delays in Samoa deaths inquiry

So, we still don’t know what happened.

Were the vaccines contaminated somehow?

Was an error made?

Why were the nurses charged with manslaughter? Many think the main issue is that the nurses continued to use the MMR vaccine even after the first baby died.

“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

Whatever happened, it is important to remember that these kinds of tragedies are very rare and that vaccines are safe.

There certainly doesn’t seem to be a good reason to continue to halt all vaccinations in Samoa!

“This stop order is for the M.M.R. to be put on hold for the time being until the case and the investigation are completed,” said Tagaloa.

“But in relation to other vaccines, the ministry did not have any stop order on this. We advise that the other vaccination still continue, especially the vaccinations relating to newborns.”

He added the stop order in question was issued by the National Health Service (N.H.S.) and it involves all vaccinations from the day of the incident.

“But we have already advised them to continue with the other vaccines except for the M.M.R. vaccinations.”

Order to stop immunisation only for M.M.R.

Vaccinations in Samoa, except for MMR, did resume already thanks to a push by their Nurses Association.

What’s next?

MMR vaccinations are scheduled to restart on April 15.

We will have to wait until June for the trial though…

They have said that human error caused the tragedy. It wasn’t the MMR vaccine itself.

More on Samoa Vaccine Tragedy

Updated on April 10, 2019