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AEFI Dhamija
This document discusses adverse events following immunization (AEFI) in India. It provides background on AEFI surveillance in the country and outlines the national guidelines for AEFI case investigation, recording, and reporting. It also describes the composition and roles of the national, state, and district AEFI committees responsible for monitoring, investigating, and responding to AEFI cases in India. These committees are multidisciplinary and include representatives from health departments, medical colleges, and partner organizations. The document presents data on reported serious AEFI cases in India from 1999 to 2011 and discusses the impact of AEFI on immunization programs.
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AEFI Dhamija
- 1. Adverse Events Following Immunization: Updates and Issues Dr. Navneet Kumar Dhamija Asstt. Commissioner – Immunization Ministry of Health & FW, Govt. of India Mobiles : 8826772555, 9911220066 Office : 23062993, 23062126, 23062728 E-mail : ImmunizationAC@gmail.com
- 2. Concepts • Background • AEFI surveillance • National Guidelines • Case investigation • Recording and Reporting • AEFI committees
- 3. Adverse Event FollowingImmunization A medical incident that takes place after an immunization, causes concern and is believed to be caused by immunization
- 4. Serious AEFI: WHO standarddefinition for drug and vaccine adverse events is : “Any untoward medical occurrence that results in death, hospitalization or prolongation of hospitalization, persistent or significant disability/incapacity, or is life threatening” Additional AEFIs that need systematic causality assessment - AEFIs that may be caused by a programme error, e.g., a cluster of bacterial abscesses; - Serious unexplained AEFI occurring within 30 days after vaccination and not listed in product label; - Events causing significant parental or community concern.
- 5. Pre-vaccine Increasing Confidence: Disease Eradication Coverage Loss Return (vaccination stops?) “Incidence” Vaccine Outbreak Coverage Adverse Events: real/perceived ? Eradication Maturity of immunization programme Impact of AEFI on immunization programs
- 6. Reported Serious AEFICases (1999 – 2011) 395 400 350 301 300 199 AEFI state 250 workshops 200 170 150 100 80 48 82 50 29 32 3 9 9 0 0 r) 99 00 01 02 03 05 07 08 09 10 04 06 Ap 19 20 20 20 20 20 20 20 20 20 20 20 n- Ja ( 11 20 *data does not include serious AEFI cases reported in Japanese Encephalitis campaigns conducted in endemic states Data as on 20th April 2011
- 7. AEFI Surveillance AEFIs identified by existing surveillance Unreported, undetected AEFIs
- 8. Members of NationalAEFI Committee • National Immunization Program Manager (Asstt.Commissioner-Imm.) – Member Secretary • An Eminent Epidemiologist/Public Health Specialist / Pediatrician – Nominated as Chairman by MoHFW, GoI • Senior Scientist from DHR / ICMR, Govt. of India • Director – National Centre for Disease Control • Sr. Officer from National Drug Authority ( DCGI ) • Pediatrician of Medical College • Microbiologist of Medical College
- 9. Members of NationalAEFI Committee... • Pathologist of Medical College • Pharmacologist / Toxicologist of Medical College • Neurologist of Medical College • Forensic Medicine expert of Medical College • National Level Cold Chain Officer • Representative of IDSP • Members from professional bodies like IAP/IMA • Representatives from partner agencies can be on panel as ex-officio members and should be invited , when required
- 10. Sub-committees of National AEFICommittee... • Causality assessment sub committee • Operational group sub committee • Investigation sub committee • Media management sub committee
- 11. Members of StateAEFI Committee • SEPIO – Member Secretary • Epidemiologist/Public Health Specialist • Representative from Drug Authority • Pediatrician ( preferably of Medical College ) • Microbiologist ( preferably of Medical College ) • Pathologist ( preferably of Medical College ) • Neurologist ( preferably of Medical College ) • Forensic Medicine expert ( preferably of Medical College )
- 12. Members of StateAEFI Committee.... • State Cold Chain Officer • Representative of IDSP • Representative from local bodies like corporation • Members from professional bodies like IAP/IMA • Representatives from partner agencies can be on panel as ex-officio members and should be invited , when required • DIO and other Distt. AEFI Committee members where AEFI occurred – as special invitees
- 13. Members of Distt.AEFI Committee • DIO – Member Secretary • CMO of the district • Epidemiologist/Public Health Specialist • Representative from Drug Authority • Pediatrician ( preferably of Medical College ) • Microbiologist ( preferably of Medical College ) • Pathologist ( preferably of Medical College ) • Neurologist ( preferably of Medical College ) • Forensic Medicine expert ( preferably of Medical College )
- 14. Members of Distt.AEFI Committee ……. • Distt. Cold Chain Officer • Representative of IDSP • Representative from local bodies like corporation • Members from professional bodies like IAP/IMA • Representatives from partner agencies can be on panel as ex-officio members and should be invited , when required • Block-IO and other Block-AEFI Committee members where AEFI occurred – as special invitees
- 15. AEFI Committees Status District Level State Level # # # # # # JAMMU & KAS HMIR # # # # # # # # # # # # # # n = 35 n = 494 HIMACHAL PRADESH # # # # # # # # # # # # PUNJAB # # # # # # # # # # # # # # # # # # # # # # UTTARANCHAL # # # # # # # ## # # # # # # # ## # # # # # HARYANA # # # # # # # # # # # # # # # # # # # # # # # # ARUNACHAL PR. # # ## # # # # # # # # # # # # # # # SIKKIM # # # # # # # # # # # # # # # # # # # # # # # # ## # # RAJASTHAN UTTAR PRADE SH ASSAM # # # # # # # # # # # # # # # # # # # # # # # # # # # # ## # # ## # # # # NAG ALAND # # # # # # # # # # # # # # # # # # # # BIHAR # MEG HALAYA # # # # # # # # # # # # # # # # # # # # # # # # # ## # # # # # # # MANIPUR # # # # # # # # # # # # # # # # # # # # # # # # # # # TRIPURA # # # # # # # # # # # JHARKHAND # # # # # # # # # # GUJARAT MADHYA PRADESH MIZORAM # ## # # # # # # WEST BENGAL # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # # CHHATTISGARH # # # # # # # # # # # # # ORIS SA # # # # # # # # # D&N HAVELI # # # # # # # # # ## # # MAHARASHTRA # # # # # # # # # # # # # # # # # BI A R D # # # # # # # # # GULBA R A G # # ANDHRA PRADESH BI APU R J # # # # # # # BELG M AU BAGALK OT # # # # R C HU AI R # # # GOA ## DH W # AR AD G AG AD # KOPPA L # # KARNATAKA BELLARY # # HAVER I # # UTTAR KAN NAD # DAVAN AG E ER # SHI O A M G C TRAD R A HI U G # # # U UP I D ## CH CKABA LLAPUR I # TUM U K R C KM LU HI AG R KOLAR # # # # # # A&N ISLANDS BAN ALO E ( ) G R R H # ASSA N BANG ALO E ( U R ) # # # # # DAKSH I KAN N N AD R A NAG R AM A A M D YA AN # # KO G ( C O R ) DA U O G # # # PONDICHERRY # # MYSO RE C AM AR H AJN AGAR # # # # # # ## # # # TAMIL NADU # # # # # # # # # # LAK SHADW EEP KERALA # # # # # # # # # # # # # # # # # # # # # #
- 16. State AEFI Committees • Status….. Capacity building workshops State workshops conducted (1 ½ day training JAMMU & KASHMIR HIMACHAL PRADESH package developed) PUNJAB UTTARANCHAL HARYANA DELHI ARUNACHAL PR. SIKKIM • Workshops supported with NRHM funds. RAJASTHAN UTTAR PRADESH BIHAR ASSAM NAGALAND MEGHALAYA MANIPUR WEST BENGAL TRIPURA GUJARAT Technical assistance by Partners. MADHYA PRADESH JHARKHAND MIZORAM CHHATTISGARH ORISSA D&N HAVELI • >1100 officials sensitized (state & district AEFI MAHARASHTRA ANDHRA PRADESH committee). GOA KARNATAKA A&N ISLANDS • Data base regularly updated at National level. PONDICHERRY TAMIL NADU LAKSHADWEEPKERALA Includes data of > 970 serious cases (1998-2010). • National Causality assessment training conducted 2009. • Trends show improvement in reporting of serious AEFIs.
- 17. Timeliness of FirstInformation N=199 N=294 N=87 5% 3% 38% 38% 32% 34% 61% 65% 24% 2008 Within 24 hours 2009 2010 1-7 days No data Based on FIR ( Date of notification; Date of completing FIR )
- 18. Revised AEFI Surveillance andResponse Operational Guidelines Released in September 2010 By Ministry of Health and FW, Government of India, New Delhi
- 19. DIFFICULTIES ARE INTENDEDTO MAKE US BETTER, NOT BITTER Immunization Division & National AEFI Committee
- 20. Immunization Division &National AEFI Committee