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Adverse Event Following Immunization
Adverse Event Following Immunization
Adverse Event Following Immunization
Following Immunization
(AEFI)
ANSDC 1
Objectives
At the end of the session participants will be
able to:
1. Know the principles of immunization
2. Define AEFI
3. Enumerate the different types of AEFI
4. Know the management of some AEFI events
5. Discuss the AEFI reporting system
ANSDC 2
Principle of Immunization
• No vaccine is completely safe nor effective
• Benefits range from partial to complete
protection
• Goal of vaccine development
– Achieve highest degree of protection with
lowest rate of untoward effects
• Process of immunization is a potential
source of adverse events
– Should not deviate from recommended routes to
avoid unnecessary local or systemic effect
– Ensure optimal efficacy
ANSDC 3
What is an AEFI?
• Adverse Event Following Immunization
(AEFI) is any serious event or condition that
follows after immunization and is believed to
be caused by immunization
ANSDC 4
Classification of Adverse Events
Following Immunization
1. Vaccine reactions - caused by the inherent
properties of the vaccine
2. Program error - some error in the immunization
process
3. Coincidental - event that happens after
immunization but not caused by the vaccine - a
chance association
4. Injection reaction - anxiety-related reaction from
fear or pain of injection rather than the vaccine
5. Unknown - event’s cause cannot be determined
ANSDC 5
1. Vaccine Reactions
ANSDC 6
Dosage of Paracetamol
9 months up to 3
years (4 – 14 kg) 1/4 5 ml (1 tsp)
3 years up to 7 years
old (14 – 25 kg) 1/2 10 ml (2 tsp)
ANSDC 7
Anaphylaxis
ANSDC 8
Early Signs of Anaphylaxis
ANSDC 9
Anaphylaxis VS Faint
Faint Anaphylaxis
Onset Usually at the time or soon Within the first few
after the injection minutes after injection
Skin Pale, sweaty, cold and clammy Red, raised and itchy
rash; swollen eyes, face;
generalized rash
Respira-tory Normal to deep breaths Noisy breathing from
airways obstruction
(wheeze or stridor)
Cardio-
vascular Bradycardia Tachycardia
Transient hypotension Hypotension
Gastro-
intestinal Nausea/vomiting Abdominal cramps
Neuro-
logical Transient loss of consciousness, Loss of consciousness,
good response once in prone little response once in
position prone position
ANSDC 10
Management of Anaphylaxis
Dose of Epinephrine
Age (in years)
(1:1000)
Less than 1 year old 0.05 ml
1 year old 0.1 ml
2 years old 0.2 ml
3 – 4 years old 0.3 ml
5 – 7 years old 0.4 ml
ANSDC 11
2. Program Errors
ANSDC 12
Program Errors Leading to Adverse Events
Programme Errors Adverse Events
Non-sterile injection Infection
• reuse of disposable syringe or (e.g. local suppuration at injection
needle site, abscess, cellulitis, systemic
• Improperly sterilized syringe infection, sepsis, toxic shock
or needle syndrome, transmission of blood
• Contaminated vaccine or borne virus (HIV, hepatitis B or
diluent hepatitis C).
• Reuse of reconstituted
vaccine at subsequent session
Immunization injected in
wrong site
• Subcutaneous instead of Local reaction or injection site
intradermal for BCG abscess
• Too superficial for toxoid
vaccine (DPT, DT, TT)
• Buttocks Sciatic nerve damage (+ ineffective
vaccine-hepatitis B)
ANSDC 14
How to Avoid Program Errors
15
3. Coincidental Events
• Health Worker
• Concerned Citizen
• Parent
• Teacher
ANSDC 20
ANSDC 21
ANSDC 22