Work Instruction for Management of Adverse Event Following

Immunization (AEFI)

Document No: AEFI/HWC

Date of Issue :
SCI....J..

Version/lssue No: 0I Effective Date: .24L2O24.

Work Instruction

For

Management Of

Adverse Event Following Immunization (AEFI)

DABLI

Page 1 of 20
Sabinm Yasm
CommunityHealth Officr
ile Dabli HWC
Mornoi BPHC,Goalpara
 has been reviewed and approved, and
The signatures below certify that this procedure

that the Signatories are aware of all the requirements contained herein and are
demonstrate

committed to ensuring their provision.

Page 2 of 20 Saaina Yasmin

Community I Health Oticer
ile DabliHWC
Mornoi BPHC,Goaipara
 Name Position Signature

Prepared By

Approved By

Amendment Note:

Context Revision Date

Page
No

Note: Prior to use, ensure this document is the most recent issued

reviewed to ensure continuing relevance to the systems and process

This procedure is its

that it describes. A record of contextual additions or omissions is given below:

Page 3 of 20 Sabina Yasi

CommunityHealth Oficer
i/e Dabli HWC
Momoi PIC, Goalpara
S.No. Content
I. Purpose, Scope, Responsibility

2. Basic Definitions

3 Service Delivery Frame Work

4
Management of AEFI

5. Common AEFI & Their Management

6. Initial management of Anaphylaxis by ANM

7. Anaphylaxis Kit

8 Reporting of AEFI

9 References

Page 4 of 20
Sabina Yasmin
Community Health Ofticer
ile Dabli HWC
Mornoi BPHC.Goalnara
 I.
Purpose:

To ensure that immunization services are provided at Health and Wellness Centre safely.

in a consistent manner without compromising the quality of services.

b. To ensure that HWCs staff should ldentify common adverse events, manage an adverse

event when it occurs.

C. List the responsibilities of health service providers in minimizing AEFls

2. Scope:

The document provides basic and necessary information to provide adverse events following

Immunization (AEFIs), Types of AEFIs, managing AEFIwhen it occurs, described responsibilities of

health service providers in minimizingAEFIs, reportingof AEFI.

3. Responsibility:

SI. Staff
Responsibility

ASHA 1. Awareness generation and community mobilization

2. Ensure follow-up visits to beneficiaries to identify minor vaccine

reactions or AEFIs

2 MPW-FIM I. Planning for Immunization

2. Managing the Cold chain

3. Receiving the vaccine carrier and logistics

4. Preparing and conducting the immunization session

5. Communicating with caregivers

6. If any AEFloccurs following use of any vial, do not use that vial; mark

it and retain safely for AEFl investigation.

7. Primarily Management & ensure recordingof all AEFls in the Block AEFI

register

8. Capacity building of ASHAs and AWWs to perform their roles in AEFI

3 CHO Overall supervision of all the processes related to immunization and manage

and report AEFl to appropriate level.

I. Planning for Immunization

2. Managing the Cold chain

3. Communicating with caregivers

4. Recording, Reporting and tracking of AEFl cases

5. Capacity building of ANM, ASHAs and AVwWs to perform their roles

in AEFI

Page 5 of 20 Gabinn Yami

CommunityHealth Oficer
ieDabli HWC
Momoi BPHC,Goalpara
Page 6 of 20
Sabin Yasm
Community I lealth Oficer
VeDabli HWC
Mornoi BPHC,Goalpara
Definitions: -

What is AEFI: -

any untoward medical

• Adverse event following immunization (AEFI) is defined as

and which does not necessarily have a causal

occurrence which follows immunization

relationship with the usage of the vaccine.

or unintended sign, abnormal laboratory
The adverse event may be any unfavourable

finding, symptom or disease.

coincidental i.e. unrelated tovaccine or vaccination
• Majority of the adverse event are
have occurred after
but have to be reported as the symptoms or signs
process
vaccination

Types of AEFI: -
and serious
For purpose of reporting, AEFIs can be minor, severe

Type of AEFI Definition

reactions, usually occur within a few hours of

Minor Common, self-limiting

danger.
and resolve after short period of time and pose
little
injection

site, fever, irritability, malaise etc.

Examples: pain, swelling at injection

do not result death, hospitalization

Severe AEFIs that are not minor but in

are categorized as severe. Eg. Non-hospitalized cases of

or disability

episodes (HHEs), persistent

seizures, hypotonic hyporesponsive
reaction, injection site abscesses,
screaming, anaphylaxis, severe local

intussusception, etc.

An AEFI will be considered serious if it results in death, requires

Serious

hospitalization, results in persistent or significant disability/incapacity

(two or more cases) of AEFIs occur in a geographical

or a cluster

area.

Cause specific type of AEFI

Definition
Type of AEFI
product-related An AEFI that is caused or precipitated by a vaccine due to onel
Vaccine

Ireaction or more of the inherent properties of the vaccine product

An AEFI that is caused or precipitated by a vaccine that is due to

Naccine quality defect-related

reaction (Both & 2 were one or more quality defects of the vaccine product, including its

earlier categorised in Vaccine administration device as provided by the manufacturer

Reaction)
An AEFI that is caused by inappropriate vaccine handling,
|Immunization error-related
or administration and thus by its nature is

reaction (formerlyprescribing

Page 7 of 20
Sabin Yasmn
CommunityHealth Oficer
i/e Dabli HWC
Mormoi BPHC,Goalpara
'programme error") preventable

Immunization anxiety-related An AEFl arising from anxiety aboutthe immunization

reaction (formerly "injection

reaction")

Coincidental event An AEFI that is caused by something other than the vaccine

product, immunization error immunization anxiety

Page 8 of 20
Sabin Yami
CommunityHealth Officer
i/e Dabli HWC
Mornoi BPHC,Goalpara
Service Delivery framework: -

of staf to minimize the AEFIcases at Community

Following are the role and responsibilities

and HWCs: -

At Community level by ASHA: -

AEFIs after the vaccination session, using e

I. Follow up with beneficiaries to identify

beneficiaries' list provided by the ANM.

2. Inform the adverse event immediately by telephone
to concerned ANM, MO, etc.
3. Assist in referral of any suspected cases

4. Assist the team investigating the event

5. Supportin building community confidence

At Sub Centre Level: -

By ANM: -

reactions. For example,

I. Screen each beneficiary for contraindications to avoid serious

there of serious allergy to a vaccine or

vaccines are contraindicated if is a possibility

its components.Live vaccines should not be given to immune deficient children.

Prior to starting vaccination at the RIsite, the

2. Follow best immunization practices.

ANM must note down (in vaccinator's logistics diary) the following particulars. This

willhelp mitigate AEFIs at session site level:

a. Manufacturer's name

b. Expiry date
C. Batch number
d. VVM status (for new and partially used vaccines)

e Date on the label of partially used vaccine (in case ofOVP)

f. In case of reconstituted vaccines, date and time on the label.

3. Ensure that vaccine vial septum has not been submerged in water or contaminated in

any way.

4. Use Measles, BCG and E vaccine within 4 hours of reconstitution.

5. Never carry and use reconstituted vaccine from one session site to another.

6. Do not store other drugs or substances in the lLR. These refrigerators are only meant
for vaccines.

7. After injection, do not attempt tore-cap or bend the needle.

8. Ask the beneficiaries to wait for half an hour after vaccination to observe for any AEFL

Page 9 of 20
Sabim Yasm
Community Health Oficer
i/e Dabii HWC
Mornoi BPHC, Goalpara
 of children vaccinated during the session to the AWWIASHA and
9. Provide a list

be follow up and report AEFIs (if any) to her, CHO and the
request them to alert,

concerned MO,.

are entered in the immunization card counterfoils.

T0. Ensure reasons for dropouts

|I. Share details all AEFIs (serious/severe and minor) with the CHOand MOICin the
meeting. Ensure details of all serious/severe and minor cases are
weekly block level

entered in the AEFI case register maintained at the block PHC (see Figure I for

suggested format for AEFI Case Register).

response to the guidance
12. Assist in investigation of AEFIs and take corrective action in

from the MO (PHC)

By Community Health Officer (CHO):

to the ANMs/vaccinators in the field. This
1. Supervise and provide hands-on training

on transport and concerned officials in case

includes provision of information referral

of crisis.

community for adverse events during supervisory visits to immunization

2. Monitor the

sites or SCs. Also monitor and ensure follow-up of beneficiaries by HWs. Ensure

reasons for dropouts are entered in the counterfoils.

Encourage the HWs to report AEFIs. Serious/severe AEFIs should be notified

3.

immediately by the fastest means possible.

4. Analyse the reported AEFIs in the SC monthly reports and keep track of HWs who
have not reported any AEFI over a period of time.

5. Assist the investigation team in conducting the investigation.

Page 10 of 20
Sabinn Yasmiu
Cornmunity Health Oticer
i/c Dabli HWC
Momoi BPHC,Goalpara
Management of AEFI: -

When a serious or severe adverse event occurs, ANM should immediately:

Provide immediate first aid: lay child flat; ensure airway is clear. If child is unconscious,

put in semi-prone position.

• Refer tothe MO (PHC) or nearest AEFI management centre for prompt treatment.
Accompany the patient if needed.

• Inform the CHO and MO (PHC)at the healch centre immediately by the fastest means

possible e.g. telephonically.

Report and assist in investigation of AEFIs.
• Treat minor/non-serious AEFIs symptomatically as per following:

Minor vacane reactions Treatment When to report

Locl reaction (pain, swelling Cold cloth at injection ste In case of n abscess
redness) Give Paracetamol
Fever > 38.5° C Give extra fluids W hen accompanied by
Give tepid spongng other symptoms
Give Paracetamol
malaise and systemic
Irritability,
Give extrafluids W hen severe or unusua
symptoms Give Par acetamol

Fiqure 1- Minor Reactions due to vaccines

Page 11 of 20
Sabina Ys
CommunityHealth Officer
le Dabli HWC
MornoiBPHC, Goal para
COMMON AEFI & THEIR MANAGEMENT
Treatment Vaccines involved
Adverse event Signs & symptoms, reporting
Fever below 1020 F/<390 Symptomatic:
Any Vaccine
Fever C

(low/medium grade) may be listed in

AEFI register as minor AEFI if medical Paracetamol

care was sought

Several local Redness and/or swelling around the Symptomatic Any Vaccine

with
reactions injection site and one or more of the treatment
following. analgesics.

Swelling beyond the nearest joint

is
Pain, redness and swelling of more Antibiotic

than 3 days duration inappropriate.

Require hospitalization

Local reactions of lesser intensity

occur commonly and are trivial and do

not need to be reported. Settles

spontaneously within a few days to a

week.
Infection site Fluctuant or draining fluid-filled lesion lncise and drain Any vaccine

abscess at the site of injection (e.g., purulent, anti-inflammatory

inflammatory signs, fever, culture), (e.g. Syp.

sterile abscess if not reported and buprofen)

if
investigated as serious, if hospitalized Antibiotics

for treatment. bacterial

Care AlI
Seizures Occurrence of generalized Supportive especially

convulsions that are not accompaniedParacetamol and pertussis

by focal neurological signs or cooling if febrile containing

vaccine (DPT,
symptoms. rarely

Febrile seizures; temperature anticonvulsants Penta),measles

elevated >100.4° F/ >38°C (rectal)

Afebrile seizures: if temperature

normal self-limiting.

Persistent Inconsolable continuous crying lasting Settles within a day DPT, penta
or so
inconsolable 3 hours of longer accompanied by

Screaming high-pitched screaming

Analgesics may help
of sudden onset occurring Episode is transient Mainly DPT,
Hypotonic Event
and Penta
Hypo within 48 (usually less than 12) hours self-limiting rarely

and lasting from one others

responsive of vaccination

hours, children Does not require

Episode (HHE) minute to several in

age. All of specific treatment

or shock younger than 10 years of

collapse the following must be present:

Page 12 of 20
Saina ame
Community Health Oficer
ieDabli HWC
Momoi BiPHC,Goalpara
 Limpness (hypotonic) Not
Reduced responsiveness (hypo contraindication

responsive) for further doses of

Pallor or cyanosis the vaccine

Differential diagnosisfor Breath holding spell,Convulsion and Anaphylaxis

Breath holding spell Convulsion Anaphylaxis

Triggering factor Triggered by sudden Illness, fever, Any drug including

fright/ pain / injury to medication, or injury vaccine, food, insect

head: Occur in young bite etC.

children

Clinical Features Child becomes pale, Child cries. swollen eyes,

groans Urticaria,

loses, consciousness, loudly. Tonic phase - face, generalized rash;

develops facial flushing body is rigid, with noisy breathing from

yanosis, may clenched teeth. Lips airways obstruction;

become sweaty, or may turn blue. Tachycardia;

weak

stiffen, have a few body Clonic phase carotids;

jerks or loose bladder resumes shallow

contro| breathing; arms and Loss of consciousness;

legs jerk quickly and little response in prone

rhythmically: pupils' position

contract and dilate

Duration Episodes are brief and Generally, lasts -3 With early and
lasts less than minute minutes, Seizure appropriate
lasting more than five intervention,

minutes requires anaphylaxis can pass

emergency medical within a few hours. If

help progressesto a serious

stage, recovery may

take a few days. May
cause death within

minutes or hours after

onset if appropriate
steps are not taken

Chill will regain Child relaxes, may lose Potential fatal if not
Recovery
consciousness, control of bowel or recognised and treated

recognises people but bladder. Regains appropriately SOon

may seem sleepY consciousness slowly. after onset. Recovery
May appear drowsy. may take days.

Page 13 of 20 Sabin
CommunityHealth Officer
ilc Dabli HWC
Mornoi BPHC,Goalpaza
 confused, anxious, or

depressed.

Differential diagnosis for Mild and Severe allergic reactions

Mild allergic reactions Severe allergic reactions / Anaphylazis

Onset and Fast onset immediately Quick onset, progresses quickly in severity

progression following vaccination, does

not progress in severity not
life threatening

Signs and Itching, redness, mucosal In addition to dermatological involvement

symptoms involvement (swelling of lips, as in mild allergic reactions, the case may
face, eyes)tingling sensation progress quickly to involve other systems
in mouth, abdominal pain such as cardiac (persistent dizziness, pale

appearance, sudden collapse) or

respiratory system (difficulty / noisy

breathing, swelling / tightness of throat,

difficulty in talking /hoarse voice, wheeze).

Requires symptomatic ANM can safely administer single dose of

treatment and refer to adrenaline intramuscularly before referring

medical officer for further the case immediately to appropriate health

management safety
Management
Many of the initial symptomsand signs are similar in both mild allergic

reactions and severe allergic reactions/anaphylaxis. ANM may administer a

single dose ofadrenalineinjection at the first sign or symptomssuggestive of

allergy or anaphylaxis

Page 14 of 20 Sabin Yasmn

CommunityHealth Otfioer
ilc Dabii HWC
Mormoi BiPHC, Goalpar
Initial management of Anaphylaxis by ANM
AFTER IMMUNIZATION LET THE PARENTS OR GUARDIANS VWAIT FOR 30 MINUTES.

Suspect* Anaphylaxis in a case with following symptoms and signs.

& rapid progression of >=1 signs &

Early onset (within few minutes to 6 bours)
cardiovascular and dermatological
Symptoms of any of the two systems (Respiratory,
/mucosal)

Respiratory:
Swelling of tongue, lip, throat, uvula, larynx

Dificulty in breathing

Stridor (harsh vibrating sounds during breathing)

with whistling or rattling sound in the chest)

Wheezing (breathing
lips etc.)
Cyanosis ((bluish discoloration of arms and legs, tongue, ears,

Grunting (noisy breathing)

CardiovRSCular:
Step 1: (fainting, dizziness)
Decreased level /loss of consciousness
Assess Case
Low blood pressure (measured hypotension)

Tachycardia (increased heart rate, palpitation)

Dermatological or mucosal:

urticaria (raised red skin lesion, rash with itching)

Generalized

Generalized erythema (redness of skin)

itchy/ painful swelling of subcutaneoustissues

Local or generalized Angioedema-
such as upper eyelids, lips, tongue, face etc.
skin rash
Generalized pruritus (itching) with
vomiting and
diarrhea, abdominal cramps, nausea,
Other signs/symptoms:anxiety,
sneezing or rhinorrhea.

Manage anaphylaxis

parents/ relatives
Reassure patient,
by deep IM route
one dose of injection Adrenaline
Immediately administer the patient to
for ambulance to transport
Step 2: Seek help to immediately arrange Hospital)
Administer (PHC/CHC/DistrictHospital/Civil
the nearest health facility
one dose of the patient alone
Donot leave lower
adrenaline he/she should be kept in supine position wvith
If Datient is conscious,
deep IM than head
limbs raised higlher position
he/she should be kept in
left lateral
If patient is unconscious,

Step 3: Refer Refer to higher center

immediately
Call for ambulance timely
for
at the health facility
Inform MO about the case before arriving

management
card in block letters
on immunization
Step 4: Document suspected anaphylaxiS
Document against
vaccines administered

suspected
anaphylaxis
Page 15 of 20
Sabin Yasm
COticer
Community Health

ile Dabli HWC

Mornoi BPHC, Goalpara
 Kit
Anaphylaxis

The ANM ensureto

will
maintain an
anaphylaxis kit at session
kit will be as follows: site. The contents of anaphylaxis

S. Contents

|
Job aid for Quantity
recognizing
anaphylaxis; dose chart for
per age adrenalineas INos
2 ml ampoule of adrenaline (1:1000
(adrenaline ampoules aqueous solution) 3 nos
may also label as epinephrine)
3 Tuberculin syringes (Iml) or
insulin syringe
needle of 40 units) (without fixed 3noS
4 24G/25G needles (linch)
3 nos.
Swabs
3 nos.
6 Updated contact information of
DIO, Medical Officer(s) -
PHCICHC, referral centre and local of
ambulance services
7 Adrenaline
administrationrecord slips

Reporting of AEFI

1. Immediately inform all serious/severe AEFIs by telephone / in person.

2. Provide details of all AEFIs your area on
in a weekly basis. Submit weekly NIL report
only after making efforts to look for these events in the children recently vaccinated.

3. Notify detailed information of all serious, severe and minor AEFIs to be recorded in

the block AEFI register (Figure-I)

4. Communicate and share the results of investigation with the community whenever
instructed by the medical officer

Week Name Name of Father's Age Date of Name of AEFI

Category Case Entered
No of n2me vaccination vaccines noted (serious/ seenb
r2ccinee in case
SC given (sympt severe/ MOIC
reporting
oms) minor) (Yes/No) form

(Yes/No)

Figure 2- Block AEFI Register

20 Sakin Yasi
Page 16 of

Commuityalth Oficer
i/e Dabli HWC
MornoiBPHC,Goalpaza
Page 17 of 20 Saina Yai
CommunitylHealth Oflicer
ilc Dabli HWC
Momoi BPHC,Goalpara
 CASE REPORTING FORM (CRF)

AEFI

AEFI
Case ID:

Case lD:IND (CO-AEFI)

To

:IND (AEFI)
/
be filled

/
by doctor and sent
|
to District Im munization

(from SAFE-VAC)

(from Co-WIN
Officerwithin

-
24

SAFE-VAC, for COVID-19

hou
"Mandat
ory Fields

vaccines)

Cection A: Re porter and notifier detaile

this form Reporting Date

Nane of doctor reporting/filling
when this form isprepare d)
num bert (date
Contact phone
/ interviewed.
E mail case visited and examined
D ate
se nt posting Designation
place of pre or interviewed)
posting when the case visited
Addre ssof pre sent (date

/Gov ernment
(Name): (ple ase circle): ASHA/AWW /He alth worker
Notified by esgnation of no
/ Parent/ Corm munity/Media/Others
practitioner or hospital
doctor/Private
d
Date notifie
to reporting docto Specify:
(datewhen the case informed

site: Facility/
Addre ss of session Health
Facility/ Qutreach/Private
Place of Vaccination*: Govt He alth

orUrban are a others (spe

Village
purchase d / Others (sp ecify):
Block Name Gove rnment supplv / Privately
Source of vaccine:
District

State (MI,Pulse Polio, MR, JE, COVID

/Carn paign
in: Routine Immunization
Vaccina tion
pate ofVaccination
19)/ Others (spe cify)

outre ach mobile / others (spe

Time ofVaccination AM/PM Type of Session Site: Fixed/

B: Patient details
Section

Patient Name

Male Female
Sex*
days
Date Birth DD/MMYYY Aze:years_Months

Mothers Name

Spouse/F ather's Name

No. etc)
(Street nanne, house nurnber, village, block, Tehsil, PIN No., 7elephone
Complete Addre ss* with landmarks

F
p H
be by MO incharge or DI0 of area whee
to the AER case during this session (to filled

C: Detais of vaccine(s) and diluent(s) administered

Section
took place) Date & Time of No. of OTHER
vaccination
vaccine beneficianes who
Dose no. (birth / zero
Narne of vaccines
Name of
Batch / Lot Mfg Expiry
re constitu tion/ receive dvaccine
administe redto this / gd/
/1"/ Manufact urer/ No date date SAME Vial
case (write vaccine
& 2 openingvaccine from
booster1 /booster Brand Name* this se ssion
diluent details in
/carnpaign)*
SE parate rows)

18 of 20 Sabin Ya
Page

Community IHealth Oficer

i/c Dabli HWC
Mornoi BPHC, Goalpara
 onD: Details of adverse eventf)

TuDe of Adverse Eve nt:

1 Serious/Severe
serious AEFI spe
2 cify:De ath/
Hospitalization/ Cluter
community/ pare ntal concern /Perdste nt or birth defect /Media,
anom aly
significant sability /Conge nital

f this is a part
of :
fa cluste: Yes/ No/Unknown
num ber other case s in the
If yes cluster

event(s). clinical (McK AS MANY Cluster iD (as generated by SAFE-VAC):

Adverse AS
APPUCABLE)
Severe local action
Fever
abscess
Seizures Injection site
Sepsis
Encephalopathy nia
Toxic shock syndrome Thrombocytope
Allergic reaction Anap hylaxis
Intussusce ption Lym phade nitis
Acute Flaccid Paralysis Hy potonic
Hypo-re sponsive Anxiety reaction
Episode (HHE)
vaccine Unexplained Death
Additional for COVID

Joint pain/swelling of re cent onset

palpitation
Painful single limb swe lling Chest pain/ fainting/
Recent E cG/Echo/angiography
changes
worse ning of existing re sp irat ory problem
ore athle ssness/ difficultyin bre athing
Alte re sensoriurm/ Loss of consciousness
Acute ssem inate d ence phalomyelitis Guillain-Barre syndrome
Menin goencephalitis
Mono-neuropathy Rashes
/Poly-neuropathy
Loss of taste/sm ell

Acute liverinjury/Acute Liver Failure Chilblain-like lesions /vasculitis

kete kidney injury/ Acute Renal Failure /Hematuria/oligu rnal Ederma Lymphadenopathy
of legs/Hypertension
Coagulation / ble eding disorder
(Thromboembolism, Hemonhage)
Worse ning of existing dise ase (Cardiac/Re Others (sp
spiratory/Liver/Kidney /Diabete setc.)

Pregnancy related events

Maternal death Fetal lo ss (abortion) anomaly in newborn

Premature deliv ery Congenital
birth Neonatal mortality

Date & ime of first sym ptom*: DD /MM/YYYY at AM/PM Hospítalization: Yes /No

Name and address of hospital:

Date & imeof hospitalization:

T DD/ MM /YYY at AM/ PM Hospital Reg. No. (OPD/Admission/Bed He ad Ticket):

if ho spit ed, outcome (encircle)*: Discharge d/ Hospitalized / LeftAgainst Me dical Adv ice (LAMA) /Absco nded/ Refemred /brought deod

Current status of patie nt:Recovered corn pletely / recov ere d with se qualae / undertreatrnent /de ath /unknown

Date & Time of Death*: DD /MM/YYYY die d) atAM/PM Post mortem done:YES/NO/Unkn
morte DD/MM/YYYY
own

Date of Post
Place of death: Home /Hospital/ On the way to ho spital Others

and mptoms after vaccination)*:

scribe AEFI (seque nce of eve nts, signs sy

Medical Officer:
Sign ature and name of Reporting

e Decision making details ursot rece vng the above

Sec tion COVID-19 vaccinejwithn 24 no

otticerto cornplete and subrnit in SAfE-VAL7 Co- MNSATLVAL (Wo

Distnct immunization
Co-WIN- SAFE -VAC:
inform ation. SAFE-VAC https://safevac.nhp.gov.in;
ed at Dis trict level:
Date report receiy

Date inves tigation planned:

ths repor
Nodal Pers on (0ffkerfonnvardin Mobile No:
DI0/ District Designation.
Date/ Seal
Name Signature.
Email id*
Office ad dre ss (with Pin code)
Complete

chi @gmail.com
Eor anv Support or help, wrtet0: aefiindia@gmall.com; safevac.

Satin Yasme
Page 19of 20
Community llcalth Otier
i/e Dabli HWC
MornoiBPHC,Goalpara
eferences

1. Immunization Handbook for Health Workers (2018)

2. Operational Guidelines nicial management of Anaphylaxis using Injection Adrenaline by
ANMs
3. AEFI Surveillance Processes- A Guidance Document for States
Guidebookof Quality Management System for AEFI Surveillance in States And
T mpiementing
Districts

End of the Document

Page 20of 20