Vaccine Abbreviations and Acronyms Contribute to Errors

Advances in immunization technology and knowledge of diseases have led to an ongoing stream of new vaccines. The large number of them and their long, often complex, nonproprietary (generic) names have spurred the use of abbreviations, most often in the form of acronyms that attempt to describe the vaccine components.

The CDC Advisory Committee on Immunization Practices (ACIP) provides a list of standardized abbreviations or acronyms for FDA-approved vaccines (see www.cdc.gov/vaccines/acip/committee/guidance/vac-abbrev.html). The list includes vaccines, but not all (eg, nonroutine vaccines such as typhoid, yellow fever, rabies, and others) are included. According to the CDC, the abbreviations and acronyms are intended to provide a uniform approach to referencing vaccines in ACIP recommendations in publications such as US immunization schedules. The CDC believes that this list will promote accuracy, consistency, and convenience and will reduce errors and ambiguity in vaccine labeling, medical practice, and scientific publications. However, health care practitioners do not appear to be specifically encouraged to use the standard abbreviations when prescribing immunizations or documenting administration on an immunization record.

The Institute for Safe Medication Practices National Vaccine Errors Reporting Program (ISMP VERP) contains many cases of repetitive mix-ups among vaccines that reporters felt were caused by similar abbreviations or acronyms. For example, 1 report involved confusion between Hib (Haemophilus influenzae type b conjugate vaccine, PedvaxHIB) and HPV (in this case, the correct abbreviation is 9vHPV for human papillomavirus 9-valent vaccine, recombinant, Gardasil 9). During an office visit, a health care practitioner administered 9vHPV to a 2-month-old baby who was supposed to receive Hib. This is not the first report of a mix-up between these 2 vaccine abbreviations, but it is the first that involved an infant.

Mix-ups among vaccine abbreviations or acronyms most frequently reported to the ISMP VERP from September 2012 to February 2017 included:Tdap and DTaP

• DT and Td
• MMR and MMRV
• PCV13 and PPV23, or PCV and PPV
• Hib and HepB
• HepA and HepB
• DTaP-HepB-IPV, DTaP-IPV/Hib, and DTaP-IPV
• HPV and IPV
• HPV and HBV (HBV was used to abbreviate hepatitis B vaccine [HepB])
• MCV and MMR (MCV4 is the correct abbreviation)
• VAR and HZV
• HPV and Hib
• HepA or HepB and HPV4 (4vHPV is the correct abbreviation)

Consider the following recommendations to reduce the risk of vaccine errors associated with abbreviations and acronyms:

• If vaccine abbreviations or acronyms are permitted, allow only current CDC-approved abbreviations and acronyms to be used.
• Establish standard order sets or protocols for frequently administered vaccines that include the vaccine’s brand name, if applicable, and full nonproprietary name on forms and computer screens. If CDC-approved vaccine abbreviations or acronyms are permitted, follow the CDC recommendations to list both the full nonproprietary names and brand names, if needed, along with the approved abbreviations or acronyms on all order sets and computer systems to reinforce their correct use.
• Review all standard order sets and protocols for vaccines at least annually, and update the order sets as conditions warrant (eg, change in hepatitis B vaccine brands).
• If CDC-approved vaccine abbreviations or acronyms are permitted in electronic formats, configure the display to allow viewing of the full brand and nonproprietary vaccine names when hovering over the vaccine abbreviation or acronym.
• On vaccination records and medication administration records, list the vaccine brand name, if applicable, and the full nonproprietary name of the vaccines administered. In electronic formats, nonproprietary names may be provided by hovering over the vaccine abbreviation or acronym if space is an issue.
• Use patient vaccination records with enough space to list full vaccine names. Give patients a copy of the larger, provider immunization record with full vaccine names, even if wallet-sized immunization cards with CDC abbreviations are provided.
• Regulators and vaccine experts should explore the risk of errors caused by vaccine abbreviations and acronyms and ultimately establish safer alternatives to relying on the use of error-prone abbreviations.

Dr. Gaunt is a medication safety analyst and the editor of ISMP Medication Safety Alert! Community/ Ambulatory Care Edition.