Aefi1 2024.pptx adverse effect following immunization

Adverse effect following immunization

1. Adverse Events Following Immunization (AEFI) Dr Basil Varghese MD Community Medicine Fellowship in family Medicine

2. An adverse event following immunization (AEFI) is any untoward medical occurrence which follows immunization, and which does not necessarily have a causal relationship with the usage of the vaccine The adverse event may be any unfavorable or unintended sign (e.g. Abscess following vaccination), abnormal laboratory finding (e.g. Thrombocytopenia following measles vaccination) symptom or disease (e.g. Disseminated BCG infection following BCG vaccination). Definition of AEFI

3. Common, self-limiting reactions, u sually occur within a few hours of injection and resolve after short period of time and pose little danger Examples: pain, swelling at injection site, fever, irritability, malaise etc. Minor For purpose of reporting, AEFIs can be minor, severe and serous. Severe Serious Can be disabling and rarely life threatening do not lead to long-term problems Examples of severe reactions include non-hospitalized cases of anaphylaxis that has recovered, high fever (>102-degree F), etc. Death Inpatient hospitalization Persistent or significant disability AEFI cluster Congenital anomaly Evokes significant parental / community concern Types of AEFI for Reporting

4. MINOR REACTIONS Caused when recipient’s immune system reacts to antigens / other vaccine components (adjuvant, excipient, stabilizer, preservative) contained in the vaccine These are part of the body’s immune response and occur more often than severe, but usually self remitting Usually occur within a few hours of injection Resolve after short period of time and pose little danger Local Pain Swelling Redness Itching at injection site Systemic Fever Irritability Malaise

5. Vaccine Local reactions Systemic reactions (pain, swelling, redness) Fever > 38°C Irritability, malaise and systemic symptoms BCG 90% – 95% – – Hepatitis B Adults up to 15%, Children up to 5% 1 – 6% – Hib 5 – 15% 2% – 10% Measles/MR/MMR ~ 10% 5% – 15% 5% (Rash) Pertussis (DTwP) 3 up to 50% up to 50% up to 55% Pnemucoccal conjugate 5 ~ 20% ~ 20% ~ 20% Tetanus/DT/aTd ~ 10% 4 ~ 10% ~ 25% Minor vaccine reactions, treatments and rates associated with childhood vaccines

6. SEVERE REACTIONS Usually do not result in long-term problems rarely life threatening Examples include NON- HOSPITALIZED CASES of : Seizures Allergic reactions and anaphylaxis High fever( >102-degree F), Severe local reaction (swelling extending beyond nearest joint) Injection site abscess Persistent crying more than 3 hours, etc. HHE Severe Reactions

7. SERIOUS REACTIONS Death Inpatient hospitalization Persistent or significant disability AEFI cluster Congenital anomaly Significant parental / community / media concern Serious Reactions Vaccine Reaction & hospitalised BCG Dissemination of BCG infection OPV Vaccine associated paralytic poliomyelitis (VAPP ) DTwP (Pentavalent) Prolonged crying and seizures HHE Measles/MR Febrile seizures Thrombocytopenia Anaphylaxis Examples

8. AEFI Cluster Clusters of events is two or more cases of the similar adverse event related in time, place or vaccine administered. Clusters can be usually associated within: a particular provider or health facility a vial/vials of vaccine that has/have been Inappropriately prepared Contaminated Inappropriately stored (e.g. freezing vaccine during transport)

9. This is utilized for Causality Assessment by State and National AEFI Committees WHO cause specific definition of AEFIs

10. This is utilized for Causality Assessment by State and National AEFI Committees WHO cause specific definition of AEFIs

11. This is utilized for Causality Assessment by State and National AEFI Committees WHO cause specific definition of AEFIs

12. This is utilized for Causality Assessment by State and National AEFI Committees WHO cause specific definition of AEFIs

13. This is utilized for Causality Assessment by State and National AEFI Committees WHO cause specific definition of AEFIs

14. Non stérile injection Reconstitution error Injection at incorrect site Vaccine transported/ stored incorrectly Contraindication ignored What are potential causes for immunization errors?

15. Coincidental events are inevitable when vaccinating children, especially during a mass campaign Expected coincidental events can be estimated by evaluating: Normal incidence of disease and death in this age group Coverage and timing of immunizations. Immediate investigation is critical to: Respond to community’s concern about vaccine safety Maintain public confidence in immunization 5 Coincidental event Coincidental events require rapid follow up

16. Take Home Messages ֎ AEFI does not mean it is only because of vaccine or vaccination process ֎ All types of adverse events to be reported ֎ AEFI can be reported after any vaccine whether * It is in UIP schedule or not * It is given in government or private setting * Beneficiary is child or adult ֎ Report an AEFI anytime irrespective of time duration * between vaccination and adverse event or * between adverse event and reporting ֎ Follow program guidelines strictly to prevent * Immunization error related reactions * Anxiety related reactions

17. PHC level S. No. 1 Batch size ( Approx ) 50 (average) 2 Participants Health supervisors Health workers – ANMs (regular and contractual) ASHAs Anganwadi workers 3 Resource persons MO, district AEFI nodal officer, district AEFI committee members Timeline Within one month after district workshop

18. Guidelines on Use of Syrup Paracetamol (post-vaccination)

19. Thank You