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Sri C.B.S. Venkata Ramana, IAS Commissioner of Family Welfare & Ex-officio SecretaryDr. R. Gopal Krishna Rao Joint Director (CHI)
A.E.F.I. Surveillance in Andhra Pradesh
Immunization Activity in AP
Implementing department: Commissionerate of Family WelfareInfrastructure:
– Rural – PHCs 1490, Sub-centres 12552
– Urban – PP units 82, area hospitals 56, Medical college hospitals 36, UHPs 60
Immunization Activity in AP contd..
Special features– Hep-B vaccine introduced in RI since 2002.– AD syringes in use for all vaccination injections.– Safety boxes and needle cutters in use for safe disposal.
Beneficiary groups– OPV, DPT, BCG, Hep-B and Measles – 1.54 M.– DT – 1.74 M., TT pregnant women – 1.8 M.
Extent and pattern– Every month – at institutions/SCs – sessions – children. At villages
(outreach sites) – sessions – children. At Headquarters – Wednesday – children & FW. At outreach – Saturday – children & FW.
AEFI surveillance in AP
1. Progress from 2002 to 2004: 5 members trained at GTN, Colombo (2003)Most of the DIOs are trained (the trained DIOs keep changing on transfers or on promotion)SOPs, Forms and Guidelines developed and communicatedRevised G.O. issued forming AEFI team (expert committee) in 10 medical colleges vide G.O.Ms.No.596 Dt.14-12-2004 (1 team for 2-3 districts).Team/expert committee = 1 Epidemiologist + 1 Paediatrician + 1 Microbiologist from medical college.
Constitution of state committee
Constituted as per GO Ms 596 Dt.14-12-2004, the committee is as follows:– Joint Director (MCH), O/o. CFW.– Professor & HOD, Niloufer Hospital.– Representative from State Drugs Control
Administration– AEFI Coordinator appointed by WHO
AEFI – selected conditions
Occurring within 24 hours of immunization
Anaphylactoid reaction, Anaphylaxis Persistent (more than 3 hours) inconsolable screaming Hypotonic hyporesponsive episode (HHE) Toxic shock syndrome (TSS)
Occurring within 5 days of immunization
Severe local reaction Sepsis Injection site abscess
Occurring within 15 days of immunization
Seizures (6-12 days for measles; 0-2 days for DTP) Encephalopathy (6-12 days for measles; 0-2 days for DTP)
Occurring within 3 months of immunization
Acute flaccid paralysis (4-30 days for OPV recipient) Brachial neuritis (2-28 days after tetanus containing vaccine) Thrombocytopaenia (15-35 days after measles)
Occurring between 1 and 12 months after BCG immunization
Lymphadenitis Disseminated BCG infection Osteitis/Osteomyelitis
Within 30 days after immunizaion
Any death, hospitalization, or other severe and unusual events that are thought by health workers or the public to be related to immunization
Reporting channels
HCW
DIO/DM&HO
Hospital (Govt/Pvt)
MO (PHCs)
RIT
SEPIO
GOI
Community Level
District Level
ANM & MPHA
M.O. PHC
Physician RRT + DIO
DIO/ DM&HO
Hospital & private clinics
AEFI Committee
SEPIO
Commissioner FW
AEFI investigation team
State Level
Proposed AEFI reporting system
AEFI C
linic
o-E
pid
. D
ata
-(AE
FI
Fo
rma
t)
Investigation
Communication Strategy
Investigation Final report
Central level
Se
ve
re
AE
FI/D
ea
th
Y
N
AEFI Severe & death case
Coordinate timely investigation
Final report
Causality assessment
Compile reports
Imp
lem
en
t co
rrec
tive
m
ea
su
res
if an
y
Y
N
Fu
rthe
r da
ta
Collect Prelim. Data & Report
AEFI Investigation
Present Status:Deaths and other events reported - Yearly figures indicatedAll deaths/other events investigated
2005 2004 2003 2002
Deaths Other events
Deaths Deaths Deaths
Deaths reported Year wise 11 2 13 8 6
Total Investigated 11 1 13 8 6
Investigated by RIT 11 1 11 5 -
AEFI Investigation contd..
DIO to investigateTSS, BCG lymphadenitis, cluster of abscess, sepsis, hospitalizations
RIT/expert committee to investigateDeaths, major AEFI causing public concernFor investigation of deaths – within 48 hours
Laboratory investigation
Present practices– Lift the sample from the
site– Send to CRI, Kasouli (the
used vial along with 5 un-used vials of the same batch)
Results received from CRI, Kasouli in 30 days
Referral labsCRI, Kasouli
Review of AEFI
Being done at State level and district levelSEPIO compiles the data and forwards to GOI by email
Arrangements already in place
Investigation system established– DIOs trained, RITs trained– HCWs, Pharmacists trained
Forms and formats readySOPs readyVLF captures AEFIs at PHC levelSupportive supervision educates the HCWs on AEFI Supportive supervision captures AEFIs
Current barriers to reporting
Not all HCWs are aware of What to report, Where to report Fear of Punishment Compensation issue -?Efforts are still on way to educate every Health Worker to report a case of AEFI be it a minor or major event
VLF - I
Date Day yu
Name of the Sub Center
Dose wise BCG Measles DT ADS BCG Large Small
I II III B I II III B I II III PW1 PW210,16 2 ml 5 ml
1 Issued
Consumed
Returned
2 Issued
Consumed
Returned
3 Issued
Consumed
Returned
4 Issued
Consumed
Returned
5 Issued
Consumed
Returned
6 Issued
Consumed
Returned
Signature of PHC Incharge
Reasons for not
conducting a session
Person carrying vaccine
Day of taking vaccine from PHC
AEFI occurance,
if anyReconstitut
ion
SyringesVaccines
Vaccine Issue and Monitoring Format per each Session at PHC
Safety Boxes
OPV DPT Hep B TT
AEFI form no.1
1. Name of the Sub center / PHC / Hospital
2. Name of the Patient / Vaccinee
3. Date of Birth/Age of the Patient / Vaccinee :
4. Name and address of Parent / Guardian
5. Adverse Event
6. Incriminated vacine with batch no. if available
7. Date of vaccination
8. Date of onset
9. Date of reporting
10. Name & designation of the notifying person
11. Signature of the notifying person
AEFI NOTIFICATION FORM
Sex: M / F
AEFI REPORT FORM
Demographic DetailsName of the Patient Date of birth (dd/mm/yy): Sex: *ID No
Male/Female:Father's Name Family NameMother's Name Religion /CasteAddress: Post.OfficeVillage PHC /UHC / CHC / Others SpecifyMandal District:Health Facility:
*Vaccine(s) given Route Site Batch Number Manufacturer Expiry date
*Name and dose number e.g.DPT - 2, opv - 2, diluent too, if reconstituted
Date Immunized Date AEFI noticed Date of report
Tick boxes Anaphylaciod reaction (acute hypersensitivity reaction) AnaphylaxisPersistent( More than 3 hours) inconsolable screaming HHEToxic shock syndrome (TSS) Severe local reaction SepsisInjection site abscess (bacteria/sterile / not clear)
Encephalopathy (6-12 days for measles/MMR; 0-2 days forDPTAcute flaccid paralysis (4 -30days for OPV recipient, 4-75 days for contact)Brachial neuritis (2-28 days after tetanus containing vaccineThrombocytopenia (15-35 days after measles/MMR)Lymphadenitis Disseminated BCG infectionOsteitis/Osteomyelitis
Others(Specify)
Recovered Yes / No Hospitalized Yes / No Died Yes / No Provisional DiagnosisInvestigation needed: Yes / NoYes / No DIO informed .Yes /No.if yes, Date:
*ID No. Dist / PHC / SC / Sl. No / 03
Signature of the Medical Officer.Phone No,
Feed back from DIO / SEPIO Date Final report received: Assessment of cause:
AEFI form no. 2
Certainty: Likely & certain / Probable/ Possible/ Unlikely / Unrealted/ Unclassifiable
Reporter : Health worker / CBO / Media/ Parent/ Others - specify
Seizures, including febrile seizures (6 - 12 days for measles : 0-2 days for DPT)
Other severe and unusual events that are thought by health workers or public as related to immunisation
Past medical history (including history of similar reaction or other allergies)
Any other relevant information
Similar adverse events in the community
Family history of similar events/allergy anaphylaxis
Brief description of the event
AEFI form no. 3 PHC levelName of the PHC/Hospital Name of the District Month Year
No.Name of the
patient/vaccinee Age SexName of the
Parent/Guardian Village AEFI
Vaccine with Batch
no. D.O.V* D.O.O* DOR* D.O.N*
1
2
3
4
5
6
7
8
9
Date: Name of the reporting officer : Signature
* D.O.V - Date of Vaccination D.O.O - Date of Onset D.O.R - Date of Report D.O.N - Date of Notification
AEFI MONTHLY REPORT FORM (LINE LISTING)
To be prepared in duplicate. Send one copy to the supervising officer and retain other copy for reference.
Age Sex : M / F
Cold chain: Present storage condition (Status of ice packs)
VVM Status Temp. of DF / ILR
Storage of vaccine before it arrived at health facility
Lab results
Treatment Given
Diagnosis(Provisional) by treating physician
Out come
About the Vaccine
Past Medical History
Address Name of Patient
Father's Name Mother's name
AEFI INVESTIGATION FORM
Investigation ID. No AEFI report ID Date of Investigation
Result of Autopsy (if done)
AEFI form no. 4
Family History of allergies / similar episode
Immunisation HistoryAbout the Patient
Present
About the eventHistory
Clinical description
Disposal of used needles
Disposal of partially used vaccine
Diluent Storage
Reconstituition:
Streilization of syringes
Training status of Health Worker
Supervisory Check Yes / No
No. of immunisations on the day of event : Normal / Greater than normal / Any other
Cold chain system as relevant
Immunisation Procedure:
Confidence level about diagnosis:
Date: Signature of the Coordinator of Investigation / DIO:…………..
Names & Designation of the team members conducting investigation
Recommendations
Certain / Probable / Possible
Cause of AEFI: Programme error / Vaccine reaction /Coincidental / Injection reaction / Unknown
Further Investigations suggested:
Working Hypothesis:
Time Kept
Details of similar illness in those who received same vaccine
Details of similar illness in un-vaccinated persons in the same area
About other People from community
Observation of a session (If it is conducted on the day of visit)
CONCLUSION
Assessment of serviceVaccine Storage
Vaccine and Diluent distribution
Process