Maximizing the effectiveness of a pediatric vaccine formulary while prohibiting extraimmunization

Abstract

The growing-complexity of the United States Recommended Childhood Immunization Schedule has resulted in as many as five required injections during a single well-baby office visit. To reduce this number, vaccine manufacturers have developed combination vaccines that immunize against several diseases in a single injection. At the same time, a growing number of parents are challenging the safety and effectiveness of vaccinating children. They are also particularly concerned about the use of combination vaccines, since they believe that injecting a child with multiple antigens simultaneously may overwhelm a child's immune system. Moreover, combination vaccines make it more likely that extraimmunization (i.e., administering more than the required amount of vaccine antigens) occurs, resulting in greater concerns by parents and vaccine wastage costs borne by an already strained healthcare system. This paper formulates an integer programming model that solves for the maximum number of vaccines that can be administered without any extraimmunization. An exact dynamic programming algorithm and a randomized heuristic for the integer programming model is formulated and the heuristic is shown to be a randomized xi-approximation algorithm. Computational results are reported on three sets of test problems, based on existing and future childhood immunization schedules, to demonstrate their computational effectiveness and limitations. Given that future childhood immunization schedules may need to be solved for each child, on a case-by-case basis, the results reported here may provide a practical and valuable tool for the public health community.

Vaccination errors reported to the Vaccine Adverse Event Reporting System, (VAERS) United States, 2000–2013

“…Those studies have found: that commonly reported errors involved wrong vaccine or improper dosing; adverse health outcomes were uncommon [3]; that about10-35% of young children had at least 1 invalid dose administered [4,5]; and that a voluntary, team approach was effective in improving error reporting [6]. Several other studies have reported on specific vaccination errors including: extra immunization [7,8]; improper spacing of vaccine doses [9]; improper route [10,11]; expired vaccine [12]; improper storage [13] wrong drug administered [14]; and contraindication errors [15]. Other publications have highlighted possible contributors to errors, such as names and abbreviations which can soundalike and packaging that can look alike [16,17].…”

Finite-Time Performance of Local Search Algorithms: Theory and Application

“…In the area of asset allocation problems, the primary application of such research has been to vaccine formulary design optimization. Hall et al (2008a) formulate an integer programming model that solves for the maximum number of vaccines that can be administered without any extraimmunization for pediatric immunization. An exact dynamic programming algorithm and a randomized heuristic for the integer programming model is also formulated and the heuristic is shown to be a harmonic approximation algorithm.…”