L MacDonald1, M Naus1,2. 1. Immunization Programs and Vaccine Preventable Diseases Service, British Columbia Centre for Disease Control, Vancouver, BC. 2. School of Population and Public Health, University of British Columbia, Vancouver, BC.
Abstract
BACKGROUND: In British Columbia, vaccine safety is monitored through a passive surveillance system with voluntary reporting of adverse events following immunization (AEFIs) from immunizers to five regional health authorities and onward to the British Columbia Centre for Disease Control (BCCDC). OBJECTIVE: To review and summarize all documented AEFI cluster or signal investigations carried out by BCCDC between November 2007 and July 2014. METHOD: Documented cluster or signal investigations were reviewed to summarize year, alerting mechanism, event type and vaccine, investigative analysis approach, results, and public health actions. The findings and public health actions of two cluster investigations are described in detail. RESULTS: There were two fatality investigations and thirteen cluster investigations. The two fatalities were found to be due to sudden infant death syndrome and were not vaccine-related. Clusters were predominantly identified through notification from regional medical health officers or public health nurses, and the majority were local injection site reactions (54%), or allergic events (39%). Most investigations did not identify a specific association to a vaccine or a lot of vaccine, and no public health actions were taken. Two recent investigations-reports of hypotonic-hyporesponsive episodes with or without severe vomiting and diarrhea following receipt of a single lot of DPT-IPV/Hib/hepatitis B vaccine, and reports of severe pain past nearest joint following administration of a single lot of influenza vaccine-were thought to be vaccine-related. The former investigation did not find an association to vaccine, while the severe local reactions post-influenza immunization were determined to be a result of improper injection technique. Public health actions included communication to federal/provincial/territorial vaccine safety partners and additional injection technique training. CONCLUSION: This investigative aspect of public health immunization programs is often not in the public eye but is an important component of behind the scenes activities that serve to protect public safety.
BACKGROUND: In British Columbia, vaccine safety is monitored through a passive surveillance system with voluntary reporting of adverse events following immunization (AEFIs) from immunizers to five regional health authorities and onward to the British Columbia Centre for Disease Control (BCCDC). OBJECTIVE: To review and summarize all documented AEFI cluster or signal investigations carried out by BCCDC between November 2007 and July 2014. METHOD: Documented cluster or signal investigations were reviewed to summarize year, alerting mechanism, event type and vaccine, investigative analysis approach, results, and public health actions. The findings and public health actions of two cluster investigations are described in detail. RESULTS: There were two fatality investigations and thirteen cluster investigations. The two fatalities were found to be due to sudden infant death syndrome and were not vaccine-related. Clusters were predominantly identified through notification from regional medical health officers or public health nurses, and the majority were local injection site reactions (54%), or allergic events (39%). Most investigations did not identify a specific association to a vaccine or a lot of vaccine, and no public health actions were taken. Two recent investigations-reports of hypotonic-hyporesponsive episodes with or without severe vomiting and diarrhea following receipt of a single lot of DPT-IPV/Hib/hepatitis B vaccine, and reports of severe pain past nearest joint following administration of a single lot of influenza vaccine-were thought to be vaccine-related. The former investigation did not find an association to vaccine, while the severe local reactions post-influenza immunization were determined to be a result of improper injection technique. Public health actions included communication to federal/provincial/territorial vaccine safety partners and additional injection technique training. CONCLUSION: This investigative aspect of public health immunization programs is often not in the public eye but is an important component of behind the scenes activities that serve to protect public safety.
Authors: Preciosa M Coloma; Martijn J Schuemie; Gianluca Trifirò; Rosa Gini; Ron Herings; Julia Hippisley-Cox; Giampiero Mazzaglia; Carlo Giaquinto; Giovanni Corrao; Lars Pedersen; Johan van der Lei; Miriam Sturkenboom Journal: Pharmacoepidemiol Drug Saf Date: 2010-11-08 Impact factor: 2.890
Authors: Jens U Rüggeberg; Michael S Gold; José-Maria Bayas; Michael D Blum; Jan Bonhoeffer; Sheila Friedlander; Glacus de Souza Brito; Ulrich Heininger; Babatunde Imoukhuede; Ali Khamesipour; Michel Erlewyn-Lajeunesse; Susana Martin; Mika Mäkelä; Patricia Nell; Vitali Pool; Nick Simpson Journal: Vaccine Date: 2007-03-12 Impact factor: 3.641
Authors: F E Andre; R Booy; H L Bock; J Clemens; S K Datta; T J John; B W Lee; S Lolekha; H Peltola; T A Ruff; M Santosham; H J Schmitt Journal: Bull World Health Organ Date: 2008-02 Impact factor: 9.408