Incidence of immunization errors in the state of Minas Gerais, Brazil: a cross-sectional study, 2015-2019

Donnini, Deborah Amaral; Silva, Carlos Miguel Bolognani; Gusmão, Josianne Dias; Matozinhos, Fernanda Penido; Silva, Roberta Barros; Amaral, Gabriela Gonçalves; Guimarães, Eliete Albano de Azevedo; Oliveira, Valéria Conceição de

doi:10.1590/S2237-96222022000300008

Brasil

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Original article • Epidemiol. Serv. Saúde 31 (3) • 2022 • https://doi.org/10.1590/S2237-96222022000300008 linkcopy

Incidence of immunization errors in the state of Minas Gerais, Brazil: a cross-sectional study, 2015-2019

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective: To evaluate the incidence of immunization errors in the public health service of the state of Minas Gerais, Brazil.

Methods: This was a cross-sectional study, based on errors reported on the National Immunization Program Information System between 2015 and 2019. A descriptive analysis and calculation of the incidence for the state's health macro-regions were performed.

Results: A total of 3,829 notifications were analyzed. Children younger than 1 year old were the most affected (39.1%) and the intramuscular route accounted for 29.4% of the errors. The most frequently reported error was administration of vaccines outside minimum and maximum recommended ages (37.7%). There was a higher incidence of errors in Vale do Aço (26.5/100,000) and Triângulo do Norte (22.6/100,000) macro-regions.

Conclusion: Immunization errors showed a heterogeneous incidence among the macro-regions of the state of Minas Gerais, between 2015-2019, and the administration of vaccines outside minimum and maximum recommended ages was the most frequently reported error.

Keywords: Vaccination; Drug-Related Side Effects and Adverse Reactions; Medication Errors; Patient Safety; Primary Health Care; Descriptive Epidemiology

Vaccine	Recommended age	Recommended minimum interval between doses	Maximum age
BCG^a	At birth	Single dose	4 years 11 months 29 days
HB^b first dose	At birth	30 days	1 month
OHVR^c	2 and 4 months	30 days	1^st dose: until 3 months 15 days
OHVR^c	2 and 4 months	30 days	2^nd dose: until 7 months 29 days
Pentavalent^d (DTP + HB^b + Hib)	2, 4 and 6 months	30 days between the 1^st, 2^nd and 3^rd dose of pentavalent. The 3^rd dose should not be administered before 6 months old	6 years 11 months 29 days
Polio (IPV^e)	2, 4 and 6 months	30 days between the 1^st, 2^nd and 3^rd dose of IPVe. 6 months between the 3^rd dose of IPV^e and the 1^st booster dose of OPV^f	4 years 11 months 29 days
Polio (OPV^f)	15 months and 4 years	6 months between the 3^rd dose of IPV^e and the 1^st booster dose of OPV^f. 6 months between the 1^st and 2^nd booster dose of OPV^f	4 years 11 months 29 days
Pn10^g	2, 4 and 12 months	30 days between 1^st and 2^nd dose. 60 days between the 2^nd dose and the booster dose at 12 months	4 years 11 months 29 days
MenC^h	3, 5 and 12 months	30 days between 1^st and 2^nd dose. 60 days between the 2^nd dose and the booster dose at 12 months	4 years 11 months 29 days
YFⁱ	9 months and 4 years*	30 days between doses of YFⁱ	-
MMR^j	12 months and 15 months***	30 days of interval of YFⁱ* vaccine	-
HA^k	15 months	-	4 years 11 months 29 days
DTP^l	15 months and 4 years	6 months between the 3^rd dose of pentavalent and the 1^st booster dose of DTPl. 6 months between the 1^st and 2^nd booster dose of DTP^l	6 years 11 months 29 days
VZV^m	15 months and 4 years	30 days of interval of MMR^j and YF*** vaccines	6 months 11 months 29 days
HPVⁿ	Boys: from 11 to 14 years and girls: from 9 to 14 years	2 doses with minimum interval of 6 months	Under 15 years old
ACWY^o	11 and 12 years	Single dose	-
DT^p	From 7 years old	3 doses with recommended interval of 60 days and minimum of 30 days	-
dTpa^q	Pregnant women	1 dose at each pregnancy (from the 20 weeks pregnant)	-

Variable	n	%
Age group (in years)
< 1	1,497	39.1
1-4	735	19.2
5-9	213	5.6
10-19	435	11.4
20-59	767	20.0
≥ 60	183	4.7
Route of administration
Intramuscular	1,127	29.4
Subcutaneous	1,065	27.8
Oral	304	7.9
Intradermal	158	4.2
Not specified	1,175	30.7
Immunization errors
Handling errors	4	0.1
Dilution errors	79	2.1
Vaccine administered outside the recommended age	1,435	37.5
Inadequate interval between doses/vaccines	270	7.1
Administration errors	131	3.4
Type of immunobiological product used	313	8.2
Expired immunobiological product	246	6.4
Repeated doses^a	231	6.0
Vaccine not recommended during pregnancy^a	414	10.8
Other	706	18.4

Health macro-region of Minas Gerais state		2015	2016	2017	2018	2019	Total
Sul	DA^a	1,358,770	1,172,935	1,827,014	1,676,080	1,364,739	7,399,538
	ie^b	36	61	97	138	133	465
	IR^c	2.6	5.2	5.3	8.2	9.7	6.2
Centro Sul	DA^a	373,400	320,636	568,321	609,088	367,798	2,239,243
	ie^b	3	3	15	29	116	166
	IR^c	0.8	0.9	2.6	4.7	31.5	7.4
Centro	DA^a	3,313,133	2,823,093	4,460,980	3,867,078	3,181,872	17,646,156
	ie^b	84	115	204	173	230	806
	IR^c	2.5	4.0	4.5	4.4	7.2	4.5
Jequitinhonha	DA^a	227,336	160,669	284,157	197,085	172,382	1,041,629
	ie^b	5	12	18	15	7	57
	IR^c	2.1	7.4	6.3	7.6	4.0	5.5
Oeste	DA^a	570,380	525,381	822,539	717,814	619,164	3,255,278
	ie^b	16	33	55	97	68	269
	IR^c	2.8	6.2	6.6	13.5	10.9	8.3
Leste	DA^a	365,302	303,120	576,272	341,185	346,025	1,931,904
	ie^b	3	2	10	10	16	41
	IR^c	0.8	0.6	1.7	2.9	4.6	2.1
Sudeste	DA^a	796,230	702,297	1,273,795	990,293	621,976	4,384,591
	ie^b	14	21	26	43	80	184
	IR^c	1.7	2.9	2.0	4.3	12.8	4.2
Norte	DA^a	934,762	714,015	1,173,550	828,613	732,807	4,383,747
	ie^b	44	26	35	33	88	226
	IR^c	4.7	3.6	2.9	3.9	12.0	5.2
Noroeste	DA^a	362,110	275,505	420,099	393,825	323,306	1,774,845
	ie^b	4	3	7	5	9	28
	IR^c	1.1	1.0	1.6	1.2	2.7	1.6
Leste do Sul	DA^a	302,559	260,432	614,566	415,056	365,493	1,958,106
	ie^b	13	11	15	34	30	103
	IR^c	4.2	4.2	2.4	8.1	8.2	5.3
Nordeste	DA^a	394,653	352,008	770,705	434,198	390,461	2,342,025
	ie^b	4	5	9	7	18	43
	IR^c	1.0	1.4	1.1	1.6	4.6	1.8
Triângulo do Sul	DA^a	369,329	347,976	531,873	438,174	393,480	2,080,832
	ie^b	37	20	73	72	73	275
	IR^c	10.0	5.7	13.7	16.4	18.5	13.2
Triângulo do Norte	DA^a	734,883	633,674	832,001	1,001,145	725,908	3,927,611
	ie^b	13	91	185	167	432	888
	IR^c	1.8	22.2	59.5	1.8	22.2	22.6
Vale do Aço	DA^a	259,760	231,004	209,691	200,028	145,226	1,045,709
	ie^b	20	13	97	30	117	277
	IR^c	7.6	5.6	46.2	14.9	80.5	26.5

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Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 (61) 3315-3464 - Brasília - DF - Brazil
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[TFN4] a) BCG: Bacillus Calmette-Guérin vaccine; b) HB: hepatitis B vaccine; c) OHVR: oral human rotavirus vaccine; d) Pentavalent (DTP+HB+Hib): diphtheria, tetanus, pertussis, hepatitis B adsorbed vaccine (recombinant) and Haemophilus Influenzae B (conjugate); e) Poliomyelitis (IPV): injectable, trivalent inactivated poliovirus vaccine; f) Poliomyelitis (OPV): bivalent attenuated oral poliovirus vaccine (OPV); g) Pn10: pneumococcal conjugate vaccine 10-valent; h) MenC: meningococcal C conjugate vaccine; i) YF: yellow fever vaccine; j) MMR: measles, mumps and rubella virus vaccine; k) HA: hepatitis A vaccine; l) DTP: triple bacterial vaccine (diphtheria, tetanus and pertussis combination vaccine); m) VZY: attenuated varicella vaccine; n) HPV: human papillomavirus vaccine 6, 11, 16 and 18 (recombinant); o) ACWY: ACWY meningococcal vaccine (conjugate); p) DT: adult diphtheria and tetanus adsorbed vaccine; q) dTpa: adult diphtheria, tetanus and pertussis adsorbed vaccine (acellular). Notes: * People from 5 to 59 years of age: one single dose should be administered; ** People from 5 to 29 years of age who are not vaccinated or with an incomplete vaccination schedule should recieve or complete the two-dose schedule of triple viral, with a minimum interval of 30 days between doses. People from 30 to 59 years of age who are not vaccinated should recieve a triple viral dose; ***When they are not administered simultaneously and with a 30-day interval between yellow fever and triple viral vaccines for children under 2 years of age.