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

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Investigation

Communication Strategy

Investigation Final report

Central level

Se

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AE

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Y

N

AEFI Severe & death case

Coordinate timely investigation

Final report

Causality assessment

Compile reports

Imp

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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