TYPES OF AEFI
MILD AEFI- Is defined as incident or reaction that is not serious. Most vaccine induced reactions are mild and transient, most frequently being soreness at the injection site and mild fever.
SERIOUS AEFI- is defined as those events that:
• Result in death
• Result in hospitalization or prolongation of existing hospitalization (e.g. seizures, encephalopathy, and aseptic meningitis).
• Result in persistent or significant disability or incapacity (e.g. paralysis).
• It is life threatening.
AEFI PRESENTATION
Vaccine reactions may be classified into:
a) Common minor reactions.
b) Rare more serious reactions.
Most vaccine reactions are mild and settle on their own. The serious ones are rare and in general do not result in long term problems.
Common minor reactions following immunization include:
• Local reactions like redness at injection site, pain and swelling.
• Fever <38 degrees centigrade.
• Irritability.
• Malaise.
• General apathy.
These symptoms results from normal body reaction to a vaccine or its components. The rare, more serious vaccine reactions include:-
✓ Convulsion.
✓ Anaphylactic shock.
✓ Severe allergic reactions e.g. generalized Urticaria and angioedema.
✓ Encephalopathy.
CAUSES OF AEFI
Programme errors
1- Overdose of vaccine given.
2- Inadequate shaking of vaccine before it is given.
3- Immunization injected in wrong place or plane.
4- Use of reused syringes and needles.
5- Used needles handled carelessly.
6- Drugs accidentally substituted for vaccine.
7- Vaccine or diluents contaminated due to poor technique.
8- Vaccine stored incorrectly.
9- Contraindications ignored.
10. Using vaccines beyond their discard points.
Programmatic errors can be avoided by observing for the following:
1- Reconstituting vaccine only with the appropriate diluents from the same manufacturer.
2- Apply correctly the multi-dose vial policy.
3- Do not store anything else in the vaccine fridge except the vaccine.
4- Inject vaccine in the proper place and plane at all times.
5- Completely investigate each AEFI and take corrective measures.
Coincidental AEFIs
These are events caused by something other than programme errors and individual reactions to vaccine. A coincidental event means that the medical incident would have occurred even if the individual had not been immunized. Coincidental events are unrelated to immunizations or vaccines in any way except for the time that they occur. The best evidence to support a conclusion that a medical incident is coincidental is that the same event has been diagnosed in people who have not been immunized.
Unknown causes of AEFI
These are the events that occur due to an unknown cause. As more research on AEFIs is undertaken, events previously categorized as unknown will more appropriately fall into programme related, vaccine-induced, or coincidental causes thereby reducing the number of events categorized as unknown.
BARRIERS TO REPORTING AEFIs
Health workers may not report AEFI for one or more of these reasons:
1- Not considering the event as related to immunization.
2- Not knowing about the reporting system and process.
3- Lethargy, procrastination, lack of interest or time, lack of appropriate reporting forms.
4- Fear that the report will lead to personal consequences.
5- Guilt about having caused harm and being responsible for the event.
6- Hesitate about reporting an event when not confident about diagnosis.
Health worker must be encouraged to report adverse event without fear of penalty. It should be clear to the supervisors and the health workers that the aim of reporting is to improve systems or provide further training and not to blame individuals.
2.4 DESCRIBE HOW TO TRACE DEFAULTERS
The reasons why mothers default immunizations appointments includes:-
1- Travelling distance to the clinic which according to them is too far from their houses.
2- Lack of money
3- Ignorance due to improper feed backs from health workers (immunizers.)
4- Family crisis leading to divorce, while the baby is still young.
5- Cultural believes.
6- Injection reactions at the site of immunization.
7- Attitude of health workers.
8- Lack of vaccine in the facility.
HOW TO TRACE DEFAULTERS
1- Through home visits.
2- Through facility immunization register.
3- Though home based cards.
4- Through the record of VVHW.
5- Through phone calls.
6- During campaigns (IPDs, SIDs).
SOLUTION TO FACTORS MILITATING IMMUNIZATION DEFAULT AGAINST
1. Establishment o
2. f more outreach posts and other health facilities.
3. Establish baby tracking and default tracing exercise
4. Promulgate immunization laws and regulations.
5. Health education.