Smart use of vaccines

Journal of Pediatrics
February 2018 Volume 193, p1-280

Editor’s Choice
Smart use of vaccines
Sarah S. Long
Published in issue: February 2018
The increasing complexities of the recommended immunization schedule and vaccine products available make it almost impossible for even the best informed and intentioned practitioners and staff to get it perfect. Mistakes are “costly,” leaving some children sub-optimally protected from vaccine-targeted diseases (and in some scenarios requiring extra doses), while other children may be over-immunized. In this volume of The Journal, Rodgers et al report a study of the frequency and cost of vaccinations administered outside minimum and maximum recommended ages despite using what currently is likely to be one of the “smartest” electronic systems that aims to prevent these errors. Data included examination and analysis of de-identified information throughout 2014 from 6 Centers for Disease Control and Prevention Sentinel Sites of Immunization Information Systems in 6 states, representing approximately 10% of the US population <19 years of age. The system possesses advanced functionality available at the point of clinical care.
In most regards, the findings are reassuring. Among roughly 3.4 million doses of vaccines with maximum age recommendations, only 0.3% of doses were given after the maximum age. Among roughly 7.5 million doses of vaccines with minimum age recommendations, only 0.1% of doses were administered before the minimum age. Monetary costs could accrue when an unnecessary dose was given after a maximum age (eg, Prevnar given after the fifth birthday) or an inadequate dose given required re-vaccination (eg, a 0.25 mL dose of Fluzone Quadrivalent given after the third birthday when a dose of 0.5 mL is recommended). The most costly errors of administration before a minimum recommended age are those requiring re-vaccination. This report identified approximately $291 000 in direct and indirect re-vaccination costs that would have been incurred in 1 year in this sample population if each error identified was corrected. An estimated annual cost on a national level would be 10-fold, ie, almost 3 million dollars.
Immunizations are a critical pillar of our children’s health, and a precious resource. Until an impossibly smart computer program can be brought to bear at the point of care to integrate each patient’s unique immunization record and need, and to preclude misuse, we will have to strive to be advocates for as well as best protectors of the precious resource.