From the Guidelines
When extra vaccine is given, the dose should not be counted, and the person should be revaccinated according to age, unless serologic testing indicates that an adequate response has been achieved. This approach is based on the recommendations of the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians (AAFP) [ 1 ]. The administration of volumes larger than those recommended can be hazardous because of excessive local or systemic concentrations of antigens or other vaccine constituents.
Some key considerations when extra vaccine is given include:
- Documenting the error, including the type of vaccine, dose, and timing
- Monitoring the patient for adverse reactions, which may include local reactions like pain or swelling at the injection site, or systemic reactions such as fever or fatigue
- Determining if the dose counts toward the recommended series or if it needs to be repeated at the appropriate interval
- Informing the patient or guardian about the error, potential side effects to watch for, and any necessary follow-up
It's also important to note that good recordkeeping, maintaining careful patient histories, and adherence to recommended schedules can decrease the incidence of adverse reactions without sacrificing immunity [ 1 ]. However, the most recent and highest quality study [ 1 ] prioritizes revaccination according to age, unless serologic testing indicates that an adequate response has been achieved, to ensure patient safety and maintain transparency and trust in the vaccination process.
From the Research
Administration of Extra Vaccine Doses
- The administration of an extra dose of a vaccine may occur due to programmatic errors, the need for a specific antigen, or uncertain vaccination histories 2.
- A study analyzing reports to the Vaccine Adverse Event Reporting System (VAERS) found that out of 366,815 total reports, 5067 (1.4%) reported an excess dose of vaccine, with 3898 (76.9%) not describing an adverse health event (AHE) 2.
Adverse Events Following Extra Vaccine Doses
- The most common adverse events (AEs) reported among excess dose reports were pyrexia (12.8%), injection site erythema (9.7%), injection site pain (8.9%), and headache (6.6%) 2.
- The percentage of AEs among these reports was comparable to all reports submitted to VAERS during the same study period 2.
Allergic Reactions to Vaccines
- Serious allergic reactions to vaccines are rare, but their underlying mechanisms and implications for clinical management should be considered 3.
- A review of allergic adverse reactions to vaccines found that individual vaccine components can cause allergic reactions, and the incidence of allergic reactions varies depending on the vaccine and population 3.
Management of Allergic Reactions to Vaccines
- For individuals with a history of severe allergic reactions to vaccines, a shared decision-making paradigm in consultation with an allergy specialist is recommended 4.
- The risk of anaphylaxis following mRNA COVID-19 vaccine administration is higher for recipients with a prior history of allergies and/or anaphylaxis 5.