Immunisation compliance and incidence of adverse events

Anushka Prabhudesai; Santosh Kondekar

doi:10.4103/jpai.jpai_14_20

ORIGINAL RESEARCH ARTICLE

Year : 2020 | Volume : 9 | Issue : 2 | Page : 64-67

Immunisation compliance and incidence of adverse events

Anushka Prabhudesai, Santosh Kondekar
Department of Pediatrics, TNMC and BYL Nair Hospital, Mumbai, Maharashtra, India

Date of Submission	12-Nov-2019
Date of Decision	23-Dec-2019
Date of Acceptance	29-Nov-2020
Date of Web Publication	27-Apr-2021

Correspondence Address:
Dr. Santosh Kondekar
Department of Pediatrics, TNMC and BYL Nair Hospital, Mumbai - 400 008, Maharashtra
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpai.jpai_14_20

Abstract

Introduction: Immunization coverage rate is the percentage of the target population that has received the last recommended dose for each vaccine recommended in the national schedule and is one of the best indicators of public health outcome and service and vaccines are important tools in preventing infectious diseases. Aim and Objective: The aim and objective were to assess the immunization compliance and adverse event following immunization (AEFI). Methodology: The present retroprospective observational study was carried out by collecting response of prevalidated immunization compliance and adverse event questionnaire from parents who brought their children for vaccination up to the age of 5 years. This survey asked about immunization compliance and AEFI. Results: A total of 188 randomly selected parents were interviewed about their child's immunization compliance and AEFI. Out of the selected parents, 86.17% agreed for the necessity of vaccines against vaccine preventable disease (VPD) and 13.83% were unaware of the necessity of vaccination. Knowledge about severity of VPDs was known to only 56.38% of parents and 13.82% of parents did not have knowledge of severity or harmfulness of VPDs. Approximately 71.8% of parents were good compliant, while 28.2% were some compliant with immunization schedule during the 6 months of the study period. Discussion: Missed opportunities resulted in subsequent late immunization. The most common errors occurring in this sample were missed opportunities for Bacillus Calmette–Guérin (BCG) vaccination, as most of the children did not get BCG vaccination at birth and superfluous administration of oral polio vaccine observed due to the National Pulse Polio Immunization Program. A consequence of not adhering to the recommended childhood immunization schedule was that doses were given too late. Conclusion: Efforts to improve compliance with immunization schedule are recommended to optimize VPDs.

Keywords: Adverse event following immunization, immunization compliance, immunization coverage

How to cite this article:
Prabhudesai A, Kondekar S. Immunisation compliance and incidence of adverse events. J Pediatr Assoc India 2020;9:64-7

How to cite this URL:
Prabhudesai A, Kondekar S. Immunisation compliance and incidence of adverse events. J Pediatr Assoc India [serial online] 2020 [cited 2023 Oct 3];9:64-7. Available from: http://www.jpai.in//text.asp?2020/9/2/64/314810

Introduction

Immunization coverage rate is the percentage of the target population that has received the last recommended dose for each vaccine recommended in the national schedule and is one of the best indicators of public health outcome and service and vaccines are important tools in preventing infectious diseases.^[1],[2] Parental awareness and decisions regarding immunization and vaccine safety are of utmost importance for successful immunization programs.^{[1],[2],[3],[4]} Immunization, however, can lead to adverse events (AEs) ranging from more commonly mild to rarely life-threatening AEs. To prevent and control adverse events following immunization (AEFIs), effective monitoring systems, aimed to collect AEs and to distinguish true vaccine adverse reactions from coincidental events, are important to check for rare or unusual reactions to new vaccines which are rarely assessed during prelicensing studies.^[5],[6] Therefore, postlicensure surveillance of AEFI is important to continuously monitor the safety of vaccines which are routinely used in the general population.^[7],[8],[9] To improve parent awareness and therefore immunization compliance, good knowledge regarding vaccination is required and the most important factor affecting this is the communication between parents and sources of information or immunization providers.^{[9],[10],[11],[12],[13],[14]}

Aim and objective

The aim and objective were to assess the immunization compliance and AEFI.

Methodology

The present retroprospective observational study was carried out by collecting response of prevalidated immunization compliance and AE questionnaire from parents who brought their children for vaccination up to the age of 5 years [Table 1] and[Table 2]. This survey asked about immunization compliance and AEFI. After obtaining informed consent from parents, co-investigator explained to them the questions and response from them was noted as Yes (A), Can't Say (B), and No (C) for immunization compliance. Each option of response was given marks A – 2, B – 1, and C – 0 for the purpose of analysis. Scale for evaluation used as 0–7 (noncompliance), 8–14 (some compliance), and 15–22 (good compliance). They were also asked about reasons for not bringing their child for vaccination. AE following immunization experienced by the parent to their child was noted as Yes or No. Incidence rate of AE was calculated by the total number of children who experienced AE after vaccination out of the total number of average ten thousand children in a defined period of 6 months [Table 3] and [Table 4]. Then, the results were interpreted in terms of tables and graphs. Whether children got their vaccinations according to the scheduled date was calculated by the Vaccination Assessment Table.

Table 1: Question-wise response of parents about immunization compliance

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Table 2: Overall representation status of immunization compliance

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Table 3: Tabular representation showing adverse event following immunization

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Table 4: Incidence rate of adverse event following immunization

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Results

A total of 188 randomly selected parents were interviewed about their child's immunization compliance and AE following immunization. Out of the selected parents, 86.17% agreed with the necessity of vaccines against vaccine-preventable disease (VPD) and 13.83% were unaware of the necessity of vaccination. Knowledge about the severity of VPDs was known to only 56.38% of parents and 13.82% of parents did not have knowledge of severity or harmfulness of VPDs. In the educational domain, 98.93% of parents read all the information given in the vaccination card and 1.07% of parents were illiterate and could not read the vaccination card. Instructions given by the doctor about immunization were followed by 75% and 17.02% did not follow. Out of the selected parents, 57.97% gave their children vaccine according to schedule date and 30.85% of parents said no; 11.17% parents gave can't say as the answer. Parents who vaccinated their child later than the recommended age were 43.08%. None of the parents extra vaccinated their child to compensate for prior invalid vaccination. Parents who vaccinated their child from multiple centers to avoid missing doses were 16.48%, while 81.91% did not vaccinate from multiple centers. Awareness that vaccine should be taken on the scheduled date was only 64.89% and 27.65% of people were not aware of this. Out of 188 parents, 3 parents missed the vaccination of their child and 177 parents did not miss any of the doses [Figure 1].

Figure 1: Overall graphical representation of immunization compliance

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Some AEs after immunization were reported suc as fever, allergic reaction, pain, and swelling at the injection site after Bacillus Calmette–Guérin (BCG); fever, pain, swelling, and local erythema after diphtheria, pertussis, tetanus, while there were no reports of AEs like paralytic polio after polio vaccination, anaphylactic reaction after hepatitis B virus (HBV) vaccination, febrile convulsion after measles vaccination, and high-grade fever after measles vaccination. Fever and allergic reaction in 34.57% and pain and swelling in 22.87% occurred after BCG vaccination. The most commonly experienced AE found in children was fever after DPT vaccination observed in 62.23%; pain swelling after DPT vaccination in 34.57% and pain at the injection site after HBV vaccination experienced by 38.29% of children. The incidence rate of fever after DPT vaccination was highest, i.e., 11.5, and pain and swelling after DPT was 6.5. The incidence rate of fever and allergic reaction after BCG and pain and swelling after BCG were 6.5 and 4.3, respectively. The incidence rate of pain at the injection site after HBV was 7.2% [Figure 2] and [Figure 3].

Figure 2: Showing percentage of adverse event occurrence after immunization

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Figure 3: Incidence rate of adverse event following immunization

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Out of 188, only 14 children completed their vaccination according to their respective ages on scheduled dates. Oral polio vaccine (OPV) 0 dose completed on or before the scheduled date were only 100 children, concurrently HBV 1, OPV 1, DPT 1, OPV 2, DPT 2, HBV 2, OPV 3, DPT 3, HBV 3, measles vaccination, and measles, mumps, and rubella vaccination completed on or before by 90, 103, 103, 67, 67, 81, 49, 49, 42, 33, and 11 children, respectively. Vaccination compliance dramatically decreases with the increasing age of the children. Child illness, vaccination center far away, and inconvenient timing for vaccination were some of the reasons for noncompliance as told by parents. Overall compliance status in the vaccination outpatient department (OPD) was good compliance (71.8%). Some compliance was found in 28.2% and not a single parent was found to be noncompliant.

Discussion

With this small observational retroprospective study, we interviewed randomly selected 188 parents presenting for vaccination of their children at pediatric OPD about immunization compliance and AEFI for a period of 6 months. It was observed that up to date status of immunization did not correspond to appropriate immunization. Invalid immunization is frequently administered resulting in under immunization. Missed opportunities resulted in subsequent late immunization. The most common errors occurring in this sample were missed opportunities for BCG vaccination as most of the children did not get BCG vaccination at birth and superfluous administration of OPV observed due to the National Pulse Polio Immunization Program. A consequence of not adhering to the recommended childhood immunization schedule was that doses were given too late. This practice may result in an unnecessary risk of adverse reaction and more susceptibility to VPDs. In this study, only 14 children had completed their schedule by the due date of vaccination. The most common reasons for lack of compliance included lack of knowledge about where to get the immunization done, a child being ill at the time of appointment, inconvenient time, vaccination center being far away, and financial problems. In the studies Immunisation in children, a study of temporal trend in a defined area by Vegad and Chansoria and Reasons for delayed vaccination by Singh et al., illness in children was found as a major reason for delay in vaccination. In a study by Kumar et al. Immunization status of children admitted to a tertiary-care hospital of north India, the most common reason for partial immunization was lack of knowledge about subsequent doses.^{[15],[16],[17],[18]}

Therefore for improving immunization compliance, initiatives must be taken into account like improving quality and quantity of vaccination delivery services, increase community participation and education, reduce vaccine cost, improve surveillance for coverage and diseases, and form and strengthen partnership among vaccination providers.

The most common AE found was fever after DPT vaccination, while some AEs such as convulsion after DPT, anaphylaxis after HBV, and febrile convulsion after measles were not found.

Conclusion

Approximately 71.8% of parents were good compliant, while 28.2% were some compliant with immunization schedule during the 6 months of the study period. Efforts to improve compliance with immunization schedule are recommended to optimize VPDs.

Limitations of the study

The data obtained were not enough to validate the results from any other study. A large sample group may have yielded results that were more accurately reflective of the population as a whole.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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