Public health response to intentional inappropriate vaccination practices by a Vaccines for Children provider — New Jersey, 2008

Background: On December 31, 2007, local authorities notified Ocean County Health Department and the New Jersey Department of Health and Senior Services (OCHD/NJDHSS) of intentional inappropriate vaccination practices (IVPs) by a Vaccines for Children (VFC) provider. VFC provides no-cost vaccines for eligible populations of children. IVPs can result in susceptibility to vaccine-preventable diseases (VPDs), necessitate revaccination campaigns, and cost $20 million/year. OCHD/NJDHSS investigated the physician's practice to identify the affected population and ascertain the need for a revaccination campaign.

Methods: OCHD/NJDHSS analyzed 2001–2007 county-level VPD incidence data to identify trends; data before 2001 were unavailable. Using the physician's medical records, investigators identified recorded vaccination events (RVE) during 1999–2007, which were matched to VFC distribution records to obtain vaccine expiration dates. Non-VFC distribution records were unavailable.

Results: Investigators identified no increase in VPD incidence. The physician administered 7,027 total vaccinations to 1,067 patients (median age: 8 years; range: 2 weeks–26 years, median vaccinations/patient: 4; range 1–25); 880 (13%) vaccinations were matched to VFC vaccine lots delivered to the physician. Of the 880 vaccines, 77 (9%) vaccines, administered to 64 (6%) of the patient population, were expired when administered.

Conclusions: Because 87% of RVE could not be matched to distribution records, and because investigators confirmed administration of expired vaccine to 6% of the patient population, OCHD/NJDHSS recommended revaccination of the entire patient population. State agencies contacted patients, VFC providers, and schools to promote revaccination. Emphasis should be placed on detecting IVPs to reduce revaccination campaigns and associated costs.