AEFI Immunization Basics

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1. Adverse Events Following Immunization (AEFI)‏ 2. Learning Objectives <ul><li>Identify common adverse events.…
  • 1. Adverse Events Following Immunization (AEFI)‏
  • 2. Learning Objectives <ul><li>Identify common adverse events. </li></ul><ul><li>Prevent adverse events from occurring in your service delivery area. </li></ul><ul><li>Manage an adverse event. </li></ul>At the end of the unit, you should be able to:
  • 3. Contents <ul><li>What is an Adverse Event following Immunization (AEFI)? </li></ul><ul><li>Types of AEFIs </li></ul><ul><li>Elicitation of past history of AEFIs </li></ul><ul><li>Minimizing AEFIs in your area </li></ul><ul><li>Types of AEFIs to report </li></ul>
  • 4. What is an AEFI ? <ul><li>A medical event that </li></ul><ul><li>takes place after an immunization </li></ul><ul><li>causes concern </li></ul><ul><li>is believed to be caused by immunization </li></ul><ul><li>ranges from mild side effects to life-threatening, but rare, illnesses </li></ul>
  • 5. Is it really safe? <ul><li>No vaccine is 100% safe and without any risks. </li></ul><ul><li>Prepare parents for side effects </li></ul>
  • 6. Types of AEFIs <ul><li>Programmatic error </li></ul><ul><li>Vaccine reaction </li></ul><ul><li>Coincidence </li></ul><ul><li>Injection reaction </li></ul><ul><li>Unknown </li></ul>
  • 7. 1. Programmatic error <ul><li>Event caused by error in vaccine selection, storage, preparation, handling, or administration (95% and Preventable)‏ </li></ul><ul><ul><li>Wrong vaccine used, </li></ul></ul><ul><ul><li>Vaccine reconstituted incorrectly </li></ul></ul><ul><ul><li>Needle left in vial </li></ul></ul><ul><ul><li>Wrong technique used </li></ul></ul><ul><ul><li>Expired vaccine used </li></ul></ul><ul><ul><li>Reconstituted vaccine not discarded after 4 hours. </li></ul></ul><ul><ul><li>Freezing of freeze-sensitive vaccines (DPT, DT, TT)‏ </li></ul></ul>BCG injection given sub-cutaneously instead of Intradermally: local lymphadenitis and abcess
  • 8. Types of Programmatic Errors Programmatic Errors Possible Adverse event that may occur <ul><li>Non-sterile injection: </li></ul><ul><li>Improperly sterilizing syringe and needle </li></ul><ul><li>Contaminated vaccine or diluent </li></ul><ul><li>Re-use of reconstituted vaccine at subsequent sessions </li></ul><ul><li>Wiping the needle with a swab </li></ul><ul><li>Administering injection over clothes </li></ul><ul><li>Infection such as local abscess at site of injection, sepsis, toxic shock syndrome or death. </li></ul>Re-use of disposable syringe and needle <ul><li>Transmission of blood-borne infections such as Hep B, HIV, Hep C </li></ul><ul><li>Reconstitution Error/ Wrong vaccine preparation </li></ul><ul><li>Reconstitution with incorrect diluent </li></ul><ul><li>Drug substituted for vaccine diluent </li></ul><ul><li>Inadequate shaking for T- series vaccines </li></ul><ul><li>Vaccine ineffective </li></ul><ul><li>Negative effect of drug, e.g. insulin causing death </li></ul><ul><li>Local abscess </li></ul><ul><li>Injection at incorrect site </li></ul><ul><li>BCG given sub-cutaneously </li></ul><ul><li>DPT/DT/TT given superficially </li></ul><ul><li>Injection into buttocks </li></ul><ul><li>Local reaction or abscess </li></ul><ul><li>Local reaction or abscess </li></ul><ul><li>Sciatic nerve damage </li></ul>Vaccine transportation/storage incorrect <ul><li>Local reaction from frozen vaccine </li></ul><ul><li>Vaccine ineffective </li></ul>Contraindications ignored <ul><li>Avoidable serious reaction </li></ul>
  • 9. 2. Vaccine Reaction Rare event caused by inherent properties of vaccine, not by Programmatic error. Child has an allergic reaction to Vaccine.
  • 10. True AEFIs <ul><li>Mild Reactions </li></ul><ul><ul><li>Common </li></ul></ul><ul><ul><ul><li>Pain & swelling </li></ul></ul></ul><ul><ul><ul><li>Fever </li></ul></ul></ul><ul><ul><ul><li>Irritability & malaise </li></ul></ul></ul><ul><ul><li>Self-limiting, hardly requiring even symptomatic treatment </li></ul></ul><ul><ul><li>Important to reassure parents </li></ul></ul><ul><li>Severe reactions </li></ul><ul><ul><li>Rare </li></ul></ul><ul><ul><ul><li>Include seizures, thrombocyto-paenia, hypotonic hypo-responsive episodes, persistent inconsolable screaming </li></ul></ul></ul><ul><ul><li>Largely self-limiting and do not lead to long-term problems </li></ul></ul><ul><ul><li>Anaphylaxis, while potentially fatal, is treatable without any long-term effect </li></ul></ul>
  • 11. 3. Coincidence Event not caused by the vaccine (a chance association)‏ Child shows signs of measles a few days/ weeks after DPT vaccine is given.
  • 12. 4. Injection reaction Event is caused by pain from (or fear about) the injection itself. Child screams and faints at the sight of the needle.
  • 13. 5. Unknown Cause of event cannot be determined. Child develops respiratory infection or fever a few days after Injection.
  • 14. Elicit past history of AEFIs Ask parents about history of any adverse reaction following earlier vaccinations, such as convulsion after DPT vaccination.
  • 15. How to minimize AEFIs? <ul><li>Use separate site for each vaccine. </li></ul>
  • 16. <ul><li>Use one syringe and one needle for each injection. </li></ul><ul><li>Use auto-disable syringes for all immunization injections. </li></ul>How to minimize AEFIs?
  • 17. <ul><li>Reconstitute vaccines only with diluents supplied by the manufacturer for that vaccine. </li></ul>How to minimize AEFIs?
  • 18. <ul><li>Use Measles and BCG vaccine within 4 hours of reconstitution. If they could not be used with in 4 hours then reconstituted vials should be discarded, irrespective of number of doses remaining in the vials. </li></ul><ul><li>Keep diluents of BCG and measles vaccine separate from other potentially harmful liquids. </li></ul>How to minimize AEFIs?
  • 19. <ul><li>Do not keep needles in the rubber cap (stopper) of vaccine vials. This can cause toxic shock syndrome, a deadly and completely avoidable adverse event . </li></ul>How to minimize AEFIs?
  • 20. <ul><li>Do not store other drugs or substances in the ice-lined refrigerator or deep freezer. These refrigerators are only meant for vaccines. </li></ul>How to minimize AEFIs?
  • 21. <ul><li>DON’T PANIC! </li></ul><ul><li>THINK before you act </li></ul><ul><li>Then act SWIFTLY </li></ul><ul><li>Be clear, simple, straightforward </li></ul><ul><li>BE HONEST AT ALL TIMES </li></ul><ul><li>Seek prompt treatment </li></ul>What to do if AEFI occurs?
  • 22. Why Monitor AEFIs? <ul><li>To help keep public’s confidence in the immunization programmes </li></ul><ul><li>To know risks and how to handle such an event when it occurs </li></ul><ul><li>To know the frequency </li></ul><ul><li>To enable Corrections – Programmatic / quality of vaccines </li></ul><ul><li>To forecast AEFIs </li></ul>
  • 23. What to Report? <ul><li>All abscesses </li></ul><ul><li>Serious events requiring hospitalizations </li></ul><ul><li>Deaths </li></ul>
  • 24. What not to Report? Minor Reactions due to vaccines Mild vaccine reactions Treatment When to report Local reaction (pain, swelling, redness)‏ <ul><li>Cold cloth at injection site </li></ul><ul><li>Give Paracetamol </li></ul><ul><li>In case of an abscess </li></ul>Fever > 38.5 0 C <ul><li>Give extra fluids </li></ul><ul><li>Wear cool clothing </li></ul><ul><li>Give tepid sponging </li></ul><ul><li>Give Paracetamol </li></ul><ul><li>When accompanied by other symptoms </li></ul>Irritability, malaise and systemic Symptoms <ul><li>Give extra fluids </li></ul><ul><li>Give Paracetamol </li></ul><ul><li>When severe or unusual </li></ul>
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