What’s new, what’s changed on the vaccine front

It’s important to stay up-to-date on the latest news about vaccines, particularly when so many parents today are questioning the safety and necessity of vaccinations.

Mary Anne Jackson, MD, FAAP, FPIDS, FIDSA, division director of the Pediatric Infectious Diseases Section at Children’s Mercy Hospitals and Clinic, Kansas City, Missouri, and professor of Pediatrics at the University of Missouri-Kansas City School of Medicine, gave an overview of changes in vaccine recommendations, indications and uses for new vaccines, and a lesson on how vaccine recommendations are formulated at the session “Vaccine update: What’s new and what’s changed?” at the American Academy of Pediatrics (AAP) 2017 National Conference and Exhibition on Sunday, September 17.

“I hope practitioners will use the information they learn in my session to develop an education session with their staff that targets avoiding vaccine errors, identifying the potential for shoulder injuries related to vaccine administration (SIRVA) and how to address this, and to highlight some of the hot new topics,” Jackson says.

The main takeaway messages of the presentation, according to Jackson, are how to identify and respond to vaccine administration errors, how to stay abreast of changes in vaccine recommendations, and what are some of the new vaccine precautions and plans for special populations.

In terms of vaccine administration errors, Jackson says clinicians should be aware of the potential for errors and address them in the practice. A response plan is also necessary. Some of these errors may include a wrong dosage for a Tdap vaccine to an infant or DTaP to a teenager. Clinicians in this case should counsel parents, document the error, and respond medically. For infants given Tdap, the vaccine should be repeated because the dose of antigens for diphtheria and pertussis would be inadequate. For adolescents given DTaP, there may be a potential for an increase in local adverse events, but the vaccine would not need to be readministered.

If a wrong vaccine of diluent is given, there are other measures to take, Jackson says. For example, in the case of the meningococcal ACWY vaccine, the vaccine is provided in 2 different vials-one containing the liquid serogroups CWY and the other containing the lyophilized component with serogroup A. “Proper implementation is to combine the vials (liquid plus lyophilized) and then give the reconstituted vaccine,” Jackson says. “Errors related to provision of the liquid component alone have been confirmed; fewer have occurred when the lyophilized component vial is diluted incorrectly.”

Patients who end up receiving only the liquid vial are covered for serotypes that are prevalent in the United States, but if the patient is to travel to areas where serogroup A is endemic, then the vaccine would need to be repeated. For patients who receive only the lyophilized component, Jackson says they are at a high risk for meningococcal disease and the vaccine needs to be repeated.

For patients who are given a vaccine by the wrong route, site, or with the wrong needle size, the recommendations depend on the vaccine being administered. Jackson says the hepatitis B vaccine can only be given intramuscularly or in the deltoid or anterolateral thigh for adults. Rabies vaccines cannot be given in the gluteal site, and human papillomavirus vaccine (HPV) must be given intramuscularly. Clinicians and practice managers should have a plan in place to review vaccine inventories to avoid administering expired vaccines, she adds.

As for SIRVA injuries, these are more common in adults but more attention is being drawn to these types of injuries. To avoid injury or chronic pain caused by injury to the subacromial and subdeltoid bursa, tendons, or muscles, caregivers have to ensure that vaccines aren’t administered too high on the arm. Jackson recommends having patients seated during administration with their hand on their waist. The administrator should use the hand to locate the deltoid muscle, using the thumb and first finger to mark off the upper third of the deltoid. The administrator should also be seated, she adds.

Jackson says she also hopes that, in addition to reducing vaccine errors and injuries, the presentation will help clinicians optimize vaccine in practice. This includes using the 2-dose vaccine schedule for HPV; offering a birth dose of the hepatitis B vaccines; recognizing measles and influenza-associated parotitis; knowing how to explain the differences between meningococcal vaccines; being an advocate for vaccines such as Tdap and influenza during pregnancy; and special precautions for children born to mothers who received biologic modifiers during pregnancy.