Vaccine safety

Barriers to Implementing a Pharmacist-Run Immunization Service, as Perceived by Pharmacists, in a Community Pharmacy Chain

Background:

Thousands of people die each year from vaccine-preventable diseases. Pharmacists can be a valuable resource in aiding the success of immunizations.

Objective:

To determine the barriers to implementing a program utilizing pharmacists as immunizers, as perceived by pharmacists, in a supermarket pharmacy chain.

Methods:

A 15 question survey regarding the perceived barriers to implementing a pharmacist-run immunization program was distributed to 60 pharmacists in a supermarket chain in northwestern Ohio. The responses were tabulated using a 5 point Likert scale. The data were analyzed utilizing the Statistical Package for Social Sciences.

Results:

Of the 60 pharmacists who received the survey, 43 completed the questionnaire (response rate 72.0%). A majority of the pharmacists surveyed believed that patient privacy was an issue in administering adult immunizations in a community pharmacy. The majority of pharmacists were concerned about the risk of adverse reactions to the vaccines and the need for a quick response to control these reactions. Twenty-five pharmacists believed that the prescription volume at their pharmacy limited them from having time to immunize. Twenty-one pharmacists cited cost as the main determining factor in a pharmacy immunization program.

Conclusions:

Many barriers to implementing a pharmacist-run immunization program exist. The future success of such an immunization program rests on overcoming the perceived barriers in a formal and timely manner.

Adverse events following immunization in children: retrospective analysis of spontaneous reports over a decade

PURPOSE

There is no doubt that paediatric immunization prevents serious diseases, but the administration of these vaccines to healthy children also involves risks of adverse drug reactions (ADRs), some of which are potentially serious. The current body of evidence on ADRs from immunization therapy at the population level is partly contradictory across countries, time periods and childhood immunization programmes. The objective of our study was to characterize reported adverse events (AEFIs) following immunization in Danish children.

METHODS

Adverse events (AEFIs) in 0- to 17-year-old children and adolescents reported to the Danish Medicines Agency (DKMA) between 1998 and 2007 were analysed. The unit of analysis was one AEFI. Data were categorized with respect to time, age, and gender of the children, suspected vaccines, category and seriousness of the AEFIs, and reporting rate.

RESULTS

During the study period, the DKMA received 1,365 reports covering 2,600 AEFIs, corresponding to 60% of all adverse events reported for children. One third of the AEFIs were classified as serious, and two deaths were reported. The annual number of serious AEFIs remained constant during the study period. Approximately 80% of AEFIs were reported in children aged 0-2 years. Of all reported AEs, 45% were in the category "general disorders and administration site conditions", followed by the categories "skin and subcutaneous tissue disorders" (20% of total AEFIs) and "nervous system disorders" (16% of total AEFIs). The largest share of serious events was from the category "nervous system disorders" (33% of serious AEFIs). The most frequently reported serious AEs were febrile convulsions, pyrexia, and injection-site reactions.

CONCLUSIONS

In Denmark, a large number of AEFIs following paediatric immunization have been reported, but the majority of cases were non-serious.

Putting endotoxin to work for us: monophosphoryl lipid A as a safe and effective vaccine adjuvant

The development of non-infectious subunit vaccines greatly increases the safety of prophylactic immunization, but also reinforces the need for a new generation of immunostimulatory adjuvants. Because adverse effects are a paramount concern in prophylactic immunization, few new adjuvants have received approval for use anywhere in the developed world. The vaccine adjuvant monophosphoryl lipid A is a detoxified form of the endotoxin lipopolysaccharide, and is among the first of a new generation of Toll-like receptor agonists likely to be used as vaccine adjuvants on a mass scale in human populations. Much remains to be learned about this compound's mechanism of action, but recent developments have made clear that it is unlikely to be simply a weak version of lipopolysaccharide. Instead, monophosphoryl lipid A's structure seems to have fortuitously retained several functions needed for stimulation of adaptive immune responses, while shedding those associated with pro-inflammatory side effects.

Efficacy of Modified Levamisole Adjuvant on Inactivated Virus Vaccine

To improve efficacy, especially for the cell-mediated response to inactivated viral vaccines, a modified levamisole (LMS) adjuvant formulation, designated LMS+, was evaluated for its efficacy in mice and chickens, using Newcastle Disease Virus (NDV) as a model pathogen. Compared with oil adjuvant, the killed NDV in LMS+ induced a significantly higher helper T cell type 1 response, as shown by higher levels of interleukin-2, interferon-gamma, T cell proliferation, and delayed-type hypersensitivity responses, without sacrificing the level of IgG production in mice. In addition, vaccine in LMS+ formulation increased the expression of MHC and costimulatory molecules as well as the number of CD11c+ dendritic cells, suggesting that the better response to the LMS+ formulation occurs partly via the maturation of dendritic cells and activation of MHC-antigen presentation and costimulation. Furthermore, this formulation provides 100% protection in chickens after challenge with a lethal dose of virulent NDV strain F48E9 at 1000 ELD50 (50% egg lethal dose). These results demonstrated that modified LMS+ adjuvant could be used to improve both humoral and cell-mediated responses for inactivated viral vaccines and its development as an effective inactivated viral vaccine is warranted.

Compulsory and recommended vaccination in Italy: evaluation of coverage and non-compliance between 1998-2002 in Northern Italy

BACKGROUND

Since vaccinations are an effective prevention tool for maintaining the health of society, the monitoring of immunization coverage allows us to identify areas where disease outbreaks are likely to occur, and possibly assist us in predicting future outbreaks. The aim of this study is the investigation of the coverage achieved for compulsory (diphtheria, tetanus, polio, hepatitis B,) and recommended (pertussis, Haemophilus influenzae, measles-mumps-rubella) vaccinations between 1998 and 2002 in the municipality of Bologna and the identification of the subjects not complying with compulsory and recommended vaccinations.

METHODS

The statistics regarding vaccinal coverage were elaborated from the data supplied by the Bologna vaccinal registration system (1998-2000) and the IPV4 program (2001-2002). To calculate the coverage for compulsory vaccinations and cases of non-compliance reference was made to the protocol drawn up by the Emilia Romagna Regional Administration. The reasons for non-compliance were divided into various categories

RESULTS

In Bologna the levels of immunization for the four compulsory vaccinations are satisfactory: over 95% children completed the vaccinal cycle, receiving the booster for anti-polio foreseen in their 3rd year and for anti-diphtheria, tetanus, pertussis at 6 years. The frequency of subjects with total non-compliance (i.e. those who have not begun any compulsory vaccinations by the age of one year) is generally higher in Bologna than in the region, with a slight increase in 2002 (2.52% and 1.06% in the city and the region respectively). The frequency of the anti-measles vaccination is higher than that of mumps and rubella, which means that the single vaccine, as opposed to the combined MMR (measles-mumps-rubella) was still being used in the period in question. The most common reason for non compliance is objection of parents and is probably due to reduction of certain diseases or anxiety about the possible risks.

CONCLUSION

In Bologna the frequency of children aged 12 and 24 months who have achieved compulsory vaccination varied, in 2002, between 95% and 98%. As regards recommended vaccinations the percentage of coverage against Haemophilus influenzae is 93.3%, while the levels for measles, mumps and pertussis range from 84% to approx. 92%. Although these percentages are higher if compared to those obtained by other Italian regions, every effort should be made to strengthen the aspects that lead to a successful vaccinal strategy.

Incidence of and risk factors for adverse events associated with distemper and rabies vaccine administration in ferrets

OBJECTIVE

To determine incidence of and risk factors for adverse events associated with distemper and rabies vaccine administration in ferrets.

DESIGN

Retrospective cohort study.

ANIMALS

3,587 ferrets that received a rabies or distemper vaccine between January 1, 2002, and December 31, 2003.

PROCEDURES

Electronic medical records were searched for possible vaccine-associated adverse events. Adverse events were classified by attending veterinarians as nonspecific vaccine reactions, allergic reactions, or anaphylaxis. Patient information that was collected included age, weight, sex, cumulative number of distemper and rabies vaccinations received, clinical signs, and treatment. The association between potential risk factors and occurrence of an adverse event was estimated with logistic regression.

RESULTS

30 adverse events were recorded. The adverse event incidence rates for administration of rabies vaccine alone, distemper vaccine alone, and rabies and distemper vaccines together were 0.51%, 1.00%, and 0.85%, respectively. These rates were not significantly different. All adverse events occurred immediately following vaccine administration and most commonly consisted of vomiting and diarrhea (52%) or vomiting alone (31%). Age, sex, and body weight were not significantly associated with occurrence of adverse events, but adverse event incidence rate increased as the cumulative number of distemper or rabies vaccinations received increased. In multivariate logistic regression analysis, only the cumulative number of distemper vaccinations received was significantly associated with the occurrence of an adverse event.

CONCLUSIONS AND CLINICAL RELEVANCE

Results suggest that in ferrets, the risk of vaccine-associated adverse events was primarily associated with an increase in the number of distemper vaccinations.

Update on side effects from common vaccines

Vaccines have had a tremendous impact on public health by reducing morbidity and mortality from a variety of virulent pathogens. However, unintended side effects continue to pose a potential risk that may outweigh the vaccine's protective attributes. In this review, we discuss recent articles and controversies pertaining to vaccine-associated adverse events. Included in the discussion are influenza, hepatitis B, measles-mumps-rubella, diphtheria-tetanus-pertussis, polio, Haemophilus influenzae type b, and rotavirus vaccines. The importance and contribution of vaccine constituents (such as thimerosal) to side effects is also reviewed.