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Vaccination practices and complications of malpractice among children under 5 years of age in Tabuk and Riyadh cities, Saudi Arabia, May 1995 to August 1996.


Two sisters developed abscesses after receiving a DPT vaccine on 21/12/1416 given in a PHCC in the index area (Tabuk city). The younger sister expired due to septicemia shock two days following the vaccine in a government hospital. The preventive medicine department of the Ministry of Health requested the Field Epidemiology Training Program to investigate. To better estimate the extent and the prevalence of deviation from correct sterile techniques during childhood vaccination, we surveyed vaccination nurses from primary health care centers in a large city (Riyadh population= 3,126,219 persons). We discovered the practice of leaving a needle inserted in rubber sealed multidose vaccine vials in the index area.


In the index area we looked for thigh, gluteus, and deltoid abscesses in children under 5 years of age who had incision and drainage in all governmental and private health centers and hospitals from May 1995 to June 1996. We administered a questionnaire on vaccination practices to the vaccinating nurses in all 13 PHCCs in the index area. In the study area we took a random sample of 14 health centers from 57 health centers. We also administered a questionnaire on vaccination practices to the vaccinating nurses in these selected centers. We distributed settling plates (blood agar) in the vaccination rooms of 8 health centers for one hour to estimate the number of colonies of airborne microorganisms that could fall into the hub of the needle.


In the index area we identified 11 abscesses at the vaccination site for children under 5 years of age. We found 30% of the vaccinating nurses in the index area and 56% of the nurses in the study area left one needle inserted in multidose vaccine vial. The results from settling plates in the study area indicated that 8.6 organisms would enter into the hub of a needle left in a multi-dose vaccine vial per 100 hours of exposure to vaccination room air. In the study area sample, 25% of nurses washed hands before vaccination and 90% used alcohol swabs to disinfect the vaccination site.


Leaving a needle inserted in a multidose vial is equivalent to having the vaccine exposed to the air in the vaccination room and could lead to the contamination of the vial's contents. Rigid adherence to correct sterile techniques is essential to prevent untoward reactions to vaccinations.