Educational interventions for the prevention and management of adverse events following immunisation: a systematic review

Vasconcelos, Débora Amorim de; Santos, Alberto Matos dos; Nascimento, Jéssica Carvalho; Silva, Camila Tahis dos Santos; Menezes, Andreia Freire de; Barreiro, Maria do Socorro Claudino; Ferreira, Camila Belo Tavares; Silva, Glebson Moura

doi:10.1590/1413-81232024297.02242024EN

Débora Amorim de Vasconcelos

conception and design of the study

analysis and interpretation of results

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marcelo Déda Chagas s/n. 49107-230 São Cristovão SE Brasil. deborah_vasconcelos1989@hotmail.com

https://orcid.org/0000-0003-2221-4109

Alberto Matos dos Santos

conception and design of the study

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marcelo Déda Chagas s/n. 49107-230 São Cristovão SE Brasil. deborah_vasconcelos1989@hotmail.com

https://orcid.org/0000-0002-7359-8942

Jéssica Carvalho Nascimento

data analysis and interpretation

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Ciências Aplicadas à Saúde, Universidade Federal de Sergipe. Lagarto SE Brasil.

https://orcid.org/0000-0001-7141-6706

Camila Tahis dos Santos Silva

data analysis and interpretation

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Enfermagem e Saúde, Universidade Federal da Bahia. Salvador BA Brasil.

https://orcid.org/0000-0003-2434-2817

Andreia Freire de Menezes

conception and design of the study

analysis and interpretation of results

writing

critical review of the manuscript

Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marcelo Déda Chagas s/n. 49107-230 São Cristovão SE Brasil. deborah_vasconcelos1989@hotmail.com

https://orcid.org/0000-0002-2972-8236

Maria do Socorro Claudino Barreiro

conception and design of the study

analysis and interpretation of results

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marcelo Déda Chagas s/n. 49107-230 São Cristovão SE Brasil. deborah_vasconcelos1989@hotmail.com

https://orcid.org/0000-0001-9823-4638

Camila Belo Tavares Ferreira

conception and design of the study

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Informação e Comunicação em Saúde, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil.

https://orcid.org/0000-0002-1423-513X

Glebson Moura Silva

conception and design of the study

analysis and interpretation of results

writing

critical review of the manuscript

approved the final version of the manuscript and are responsible for all aspects of it, including ensuring its accuracy and integrity

Programa de Pós-Graduação em Enfermagem, Universidade Federal de Sergipe. Av. Marcelo Déda Chagas s/n. 49107-230 São Cristovão SE Brasil. deborah_vasconcelos1989@hotmail.com

https://orcid.org/0000-0002-4977-2787

Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Data base	Search strategy DOI
MEDLINE	https://doi.org/10.1079/searchRxiv.2023.00147
Embase	https://doi.org/10.1079/searchRxiv.2023.00146
LILACS	https://doi.org/10.1079/searchRxiv.2023.00145
CINAHL	https://doi.org/10.1079/searchRxiv.2023.00144
Scopus	https://doi.org/10.1079/searchRxiv.2023.00143

Authors (Year)	Database/Periodical	Title	Country/Language of publication	Goal	Study population
Sebastian, Parthasarathi e Ravi (2021)¹⁸18 Sebastian J, Parthasarathi G, Ravi MD. Impact of educational intervention on the best immunization practices among practicing health care professionals in a south Indian city. Ther Adv Vaccines Immunother 2021; 9:25151355211032590.	MEDLINE/Therapeutic Advances in Vaccines and Immunotherapy	Impact of educational intervention on the best immunisation practices among practicing health care professionals in a south Indian city	India/English	To assess the outcome of an educational intervention for healthcare professionals on the safe and quality use of vaccines.	323 health professionals (121 doctors, 77 nurses and 125 pharmacists).
Musa, Parakoyi e Akanbi (2006)¹⁹19 Musa OI, Parakoyi DB, Akanbi AA. Evaluation of health education intervention on safe immunization injection among health workers in Ilorin, Nigeria. Ann Afr Med 2006; 5(3):122-128.	Embase/Annals of African Medicine	Evaluation of Health Education Intervention on Safe Immunisation Injection among Health Workers in Ilorin, Nigeria	Nigeria/English	To assess the effect of health education intervention on knowledge and standard of practice of safe immunisation injection among health workers in static immunisation centre.	102 health professionals (50 Community health extension workers, 14 Community health officers, 28 nurses/midwives and 10 Junior community health extension workers); 50 participants received the education intervention and 52 did not.
Mallik et al. (2011)²⁰20 Mallik S, Mandal PK, Chatterjee C, Ghosh P, Manna N, Chakrabarty D, Bagchi SN, Dasgupta S. Assessing cold chain status in a metro city of India: an intervention study. Afr Health Sci 2011; 11(1):128-133.	MEDLINE/African Health Sciences	Assessing cold chain status in a metro city of India: an intervention study	India/English	To assess changes in cold chain status and cold chain handlers’ cold chain maintenance awareness and skills after the intervention.	20 cold chain handlers.
McKeirnan et al. (2018)²¹21 McKeirnan KC, Frazier KR, Nguyen M, MacLean LG. Training pharmacy technicians to administer immunizations. J Am Pharm Assoc 2018; 58(2):174-178.	MEDLINE/Journal of the American Pharmacists Association	Training pharmacy technicians to administer immunisations	United States/English	To evaluate the effectiveness of an immunisation training program for pharmacy technicians on technicians' self-reported confidence, knowledge and number of vaccines administered	30 pharmacy technicians.
Lee et al. (2012)²²22 Lee S, Lim HS, Kim O, Nam J, Kim Y, Woo H, Noh W, Kim K. Vaccine storage practices and the effects of education in some private medical institutions. J Prev Med Public Health 2012; 45(2):78-89.	MEDLINE/Journal of Preventive Medicine and Public Health	Vaccine Storage Practices and the Effects of Education in Some Private Medical Institutions	South Korea/English	To inspect actual vaccine storage status and awareness, and compare them before and after education was provided.	39 health professionals (20 doctors, 12 nurses, 2 pharmacists, 3 nursing auxiliaries and 2 pharmacy auxiliaries).
Holla, Borker e Bhat (2013)²³23 Holla N, Borker S, Bahat S. Vaccination sessions; challenges and opportunities for improvement: experiences from Karnataka. Ann Trop Med Public Health 2013; 6(5):559-564.	CINAHL/Annals of Tropical Medicine and Public Health	Vaccination sessions; challenges and opportunities for improvement: Experiences from Karnataka	India/English	To assess the operational knowledge regarding routine immunisation among medical officers and the outcome of supportive supervision sessions in select immunisation sites.	195 medical officers.

Authors (Year)	Type of educational interventions	Instrument for assessing effectiveness of educational intervention	Outcome
Sebastian, Parthasarathi and Ravi (2021)	Educational sessions using an educational module with content on immunisation process (storage and transport of immunobiologicals, AEFIs, vaccine administration, waste disposal and related problems).	Validated pre-test and post-test questionnaire.	Post-intervention assessment found statistically significant improvements at all stages of the immunisation process involving prevention and management of AEFIs, including storage (p-0.001), transport (p-0.001), administration, including waste disposal (p-0.001), AEFI monitoring and reporting (p-0.001) and knowledge of AEFIs (p-0.001). AEFI reporting improved by 30% after the education sessions.
Musa, Parakoyi and Akanbi (2006)	Training with content: safe injection, injection waste disposal and dangers of unsafe injection.	Pre-test and post-test questionnaire.	There were statistically significant improvements (p < 0.05) post-intervention in post-immunisation event prevention by vaccine administration, as the case group showed better knowledge of safe injection than the control. Improvements were also found in safe injection practices at the control group’s health centres, but these were not statistically significant, except as regards single use of syringes to draw the vaccine for each patient.
Mallik et al. (2011)	In-depth training on cold chain with PowerPoint presentation and detailed discussion, followed by practical training, with field visits, on cold chain temperature monitoring, including interpretation of vaccine vial monitor, agitation testing, preventive maintenance and emergency contingency plan.	Post-intervention questionnaire and visual assessment of cold chain pre- and post-intervention.	Outcomes following the education intervention were significant (p < 0.05) in preventing AEFIs (internal condition of cold chain equipment, vaccine placement, temperature maintenance and designation of a cold chain handler at each point in the cold chain). Cold chain handlers’ awareness and skills were unsatisfactory as regards heat- and col-sensitive vaccines, preventive maintenance, correct contingency plan and holiday temperature monitoring.
McKeirnan et al. (2018)	Training programme in immunisation administration, comprising a home study and live training with content including basic immunisation concepts, vaccine schedule, defaulter tracing, documentation and immunisation process. The home study comprised a presentation narrated by way of a Panopto video platform and the live training also consisted in presenting content and conducting vaccine administration practices until competence was acquired.	Pre-test and post-test questionnaire and number of immunisations administered by technicians and AEFIs after training.	25 pharmacy technicians completed the home and live training and the 29 who took the home study assessment passed with greater than 70% competency on the first attempt. Technicians self-reported increased confidence with immunisation skills between the pre-training and post-training surveys. From December 2016 to May 2017, the technicians administered 953 immunisations with 0 adverse events reported.
Lee et al. (2012)	Individual guidance and distribution of educational leaflets with content on vaccine storage precautions.	Pre- and post-intervention questionnaire and checklist.	Mean checklist score after education was 9.74 out of 15 (p < 0.001). Prior to the intervention, participants committed a series of immunisation errors relating to cold chain precautions, while following the intervention, there were improvements in storage temperature recording (p = 0.016), vaccine storage in the centre of the cold box (p = 0.004), storage of vaccines with other medicines and non-medical items (p = 0.031). Mean questionnaire score after education was 10.48 out of 14 (p < 0.001).
Holla, Borker and Bhat (2013)	Supervisory support and training sessions on immunisation routine with content on the national immunisation schedule, cold chain management, safe injection, waste disposal and AEFIs.	Pre- and post-test questionnaire and supervision.	Doctors’ overall knowledge improved after the immunisation routine training session to prevent program component errors, including safe vaccination, cold chain precautions and knowledge of AEFIs. Mean pre-test score was 30.65% and post-test, 48.68% (p < 0.001) overall. Supervisory support was also useful in improving immunisation routine sessions, where 100% performance was obtained in use of correct diluents.

Study	Questions									Classification
Study	1*	2**	3***	4⁺	5⁺⁺	6⁺⁺⁺	7^&	8^&&	9^&&&
Sebastian, Parthasarathi and Ravi (2021)	Y	Y	Y	N	N	NC	Y	Y	Y	Moderate risk
Musa, Parakoyi and Akanbi (2006)	Y	Y	Y	Y	Y	Y	Y	Y	Y	Low risk
Mallik et al. (2011)	Y	Y	Y	N	N	NC	Y	Y	Y	Moderate risk
McKeirnan et al. (2018)	Y	Y	Y	N	N	Y	Y	N	N	Moderate risk
Lee et al. (2012)	Y	Y	Y	N	Y	Y	Y	Y	Y	Low risk
Holla, Borker and Bhat (2013)	Y	Y	Y	N	N	NC	Y	Y	Y	Moderate risk

[1] Chief editors:

Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva

Brasil

Brasil

Educational interventions for the prevention and management of adverse events following immunisation: a systematic review

Abstract