- 1.Adverse Events Following Immunization (AEFI)
2. Learning Objectives
- Identify common adverse events.
- Prevent adverse events from occurring in your service delivery
area.
At the end of the unit, you should be able to: 3. Contents
- What is an Adverse Event following Immunization (AEFI)?
- Elicitation of past history of AEFIs
- Minimizing AEFIs in your area
4. What is an AEFI ?
- takes place after an immunization
- is believed to be caused by immunization
- ranges from mild side effects to life-threatening, but rare,
illnesses
5. Is it really safe?
- No vaccine is 100% safe and without any risks.
- Prepare parents for side effects
6. Types of AEFIs
7. 1. Programmatic error
- Event caused by error in vaccine selection, storage,
preparation, handling, or administration (95% and Preventable)
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- Vaccine reconstituted incorrectly
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- Reconstituted vaccine not discarded after 4 hours.
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- Freezing of freeze-sensitive vaccines (DPT, DT, TT)
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
- Improperly sterilizing syringe and needle
- Contaminated vaccine or diluent
- Re-use of reconstituted vaccine at subsequent sessions
- Wiping the needle with a swab
- Administering injection over clothes
- Infection such as local abscess at site of injection, sepsis,
toxic shock syndrome or death.
Re-use of disposable syringe and needle
- Transmission of blood-borne infections such as Hep B, HIV, Hep
C
- Reconstitution Error/ Wrong vaccine preparation
- Reconstitution with incorrect diluent
- Drug substituted for vaccine diluent
- Inadequate shaking for T- series vaccines
- Negative effect of drug, e.g. insulin causing death
- Injection at incorrect site
- BCG given sub-cutaneously
- DPT/DT/TT given superficially
- Local reaction or abscess
- Local reaction or abscess
Vaccine transportation/storage incorrect
- Local reaction from frozen vaccine
Contraindications ignored
- Avoidable serious reaction
9. 2. Vaccine Reaction Rare event caused by inherent properties
of vaccine, not by Programmatic error. Childhas an allergic
reaction to Vaccine. 10. True AEFIs
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- Self-limiting, hardly requiring even symptomatic treatment
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- Important to reassure parents
-
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- Include seizures, thrombocyto-paenia, hypotonic hypo-responsive
episodes, persistent inconsolable screaming
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- Largelyself-limitingand do not lead tolong-term problems
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- Anaphylaxis, while potentially fatal, istreatablewithout any
long-term effect
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 ofevent
cannot be determined. Child develops respiratory infection or fever
a few days after Injection. 14. Elicit past history of AEFIs Ask
parents abouthistory of any adverse reaction following earlier
vaccinations, such as convulsion after DPT vaccination. 15. How to
minimize AEFIs?
- Use separate site foreach vaccine.
16.
- Use one syringe andone needle for each injection.
- Use auto-disable syringes for all immunization injections.
How to minimize AEFIs? 17.
- Reconstitute vaccines only with diluents supplied by the
manufacturer for that vaccine.
How to minimize AEFIs? 18.
- 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.
- Keep diluents of BCG and measles vaccine separate from other
potentially harmful liquids.
How to minimize AEFIs? 19.
- 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 .
How to minimize AEFIs? 20.
- Do not store other drugs or substances in the ice-lined
refrigerator or deep freezer. These refrigerators are only meant
for vaccines.
How to minimize AEFIs? 21.
- Be clear, simple, straightforward
What to do if AEFI occurs? 22. Why Monitor AEFIs?
- To help keep publics confidence in the immunization
programmes
- To know risks and how to handle such an event when it
occurs
- To enable Corrections Programmatic / quality of vaccines
23. What to Report?
- Serious events requiring hospitalizations
24. What not to Report? Minor Reactions due to vaccines Mild
vaccine reactions Treatment When to report Local reaction (pain,
swelling, redness)
- Cold cloth at injection site
Fever > 38.5 0 C
- When accompanied by other symptoms
Irritability, malaise and systemic Symptoms