ADVERSE EVENTS FOLLOWING IMMUNIZATION AEFI

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ADVERSE EVENTS FOLLOWING IMMUNIZATION (AEFI)

• Group 1

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Immunization safety is now an emerging issue, WHY?

• Injection safety is not a guarantee in many
  countries
• Regulations related to use of medication are not
  in place
• There is inadequate monitoring of immunisation
  programmes
• Lack of sensitization on immunisation
• There is increasing number of new vaccines

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Immunization safety is now an emerging issue

• Injection safety is not a guarantee in many
  countries
• Regulations related to use of medication are in
  place
• There is inadequate monitoring of immunisation
  programmes
• Lack of senstisation on immunisation
• There is increasing number of new vaccines
• Anti-immunisation campaign lobby

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What is AEFI?

• Medical incident that takes place after an
  immunisation which causes concern and is believed
  to be caused by immuniastion (WHO)

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Categories of AEFI

• Vaccine reactions- anaphylaxis
• Programme errors-poor injection technique
• coincidental effects-malaria
• Injection reaction- pain
• Unknown

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Types of AEFI

• Common minor reactions-pain, fever,local reaction
• Rare but more serious reactions eg
  anaphylaxis,and vaccine specific reaction eg
  paralytic polio

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Intervention for Rare AEFI

• Need to acknowledge the event
• Investigate thoroughly
• Take appropriate action
• Never rash to make a decision(?costly)
• Need to put in place Nat.Regulatory body to look
  into safety and efficacy of vaccines-training,fee
  dback,create capacity to detect and assess AEFI
  and provision for post marketing surveillance

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Journalism and Health

• Media can promote or hinder the development of a
  health system/programme
• Characteristics of Media- it acts very fast, it
  is a business,sensational headlines, argue in the
  interest of the public,
• Good working relationship improves positive
  output and public image

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Why journalism and Health?

• Both work for the good of the public and are
  professions
• Both favour the children
• However, in case of AEFI media collect
  information from parents rather than health
  worker which they publish immediately
• H/workers have a negative attitude towards media

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Summary

• It is important to have a monitoring system in
  every country for AEFI
• Effective communication is important
• Prompt reporting of events is critical in the
  successful management of AEFI system
• Follow up and corrective action are essential
  including surveillance system
• Positive relationship with the media,essential
• Investigate issues before taking action

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END

• Thank you for listening

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Evaluation of Hep B immunisation Programme in
Gorin

• Group 3
• Facilitators P.Zuber,T.Manzila and A.Meheus

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Process/ Introduction

• Facilitator introduced the assignment
• Informed pax that benefits of Hep B occur 30
  years later after immunisation
• It was revealed that there was no standard tool
  (WHO) to assess the impact of Hep B
• PAX were requested to read the case study

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Learning objectives

• Describe a strategy for assessing the impact of
  Hep B immunisation including the role of
  sero-surveys
• Describe the specific Hep B coverage measures to
  be evaluated and their interpretation
• Describe the specific HBV sero-markers and their
  interpretation
• Make a presentation on the impact EPI

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Progress

• The exercise was interactive and was done in a
  stepwise manner, answering, questions as more
  information was revealed to pax

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Summary of the case study

• Gorin, in central Asia, hadstrong EPI Prog.
• Gorin had high prevalence of HBsAg 15
• Despite the high cost,G had introduced Hep B
  immunisation as Hep B disease was a leading cause
  of death in men
• In 2003,Hon MOH read an article (High Hepatitis
  markers in Kids of 5-10yrs) that concluded that
  HepB immunisation was not effective

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Summary Contd

• Hon MOH asked EPI Manager for more information
  about the impact of Hep B immunisation
• Hon MOH was upset and threatened to biopsy the
  liver/ EPI Manager if the programme did not
  protect Gorinese children
• EPI Manager in Panic sought for help from RWG
  special Consultant

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What information from E/Mnger

• Coverage,training of service providers-efficiency
  of cold chain system-stock outs-new born
  immunised-schedule-prevalence determined before
  introduction-population comparable urban vs rural
  of the sero-survey

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More information by EPI Mng

• Pre-vaccine -era- HBsAg pregnant15
• Kids 3-6yrs14 Introduced in 1990
• HepB vaccine given 24 hrs of delivery
• Coverage HepB-197,296,3,84
• Trained H/workers
• No evidence of Freezing
• Had a successful DQA

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Any more information?

• Are there similar studies
• What serological markers were looked at?
• Pax-noted- Available information was accurate
  vertical transmission, No apparent programmatic
  gaps,

Pax recommended repeat of the study in Gorin
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Comment on Gorin strategy and compare with other
regions

• Gorin strategy was correct as vertical
  transmission is common in Asia while Horizontal
  transmission is more common in Africa

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What Progr.can affect HepB immunisation

• Poor cold chain
• Injection technique(sero-conversion)- sc vs im,vs
  fatty tissue
• Low coverage
• Birth dose given beyond 4 days
• Limited facility delivery

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Similar Studies Elsewhere

• Consultant prepared a table showing - sample
  size,age bracket,coverage, prevalence before and
  after introduction
• 14 studies showed drastic reduction in chronic
  infection fromgt10 to 0-2.9 WHILE Gorin was 12
  after introduction

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Additional information arrived

• Hepatitis marker No positive positive
• HBsAg 33/225
  12
• Anti-HBs 183/225
  81
• Total Anti-HBc 7/225 2

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Interpretation of the table

• Immunisation was doing well (anti-HBs)
• ? HBsAg was so high vs ant-HBc (doesnt happen)
• Pax recommended repeat of the study in Gorin due
  to inconsistence

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Whose liver should be biopsied?

• Correct Answer gets a gift !!!!!!!
• Discuss..
• Thank u