global training network programmeworld health organization a medical incident that takes place after...
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Global Training Network ProgrammeWorld Health Organization
WHAT IS AN ADVERSE EVENT FOLLOWING WHAT IS AN ADVERSE EVENT FOLLOWING IMMUNIZATION (AEFI)?IMMUNIZATION (AEFI)?
A medical incident that takes place after an immunization, causes concern, and is believed to be caused by immunization
Vaccine reaction - caused by vaccine’s inherent properties
Programme error - caused by error in vaccine preparation, handling, or administration
Coincidental - happens after immunization but not caused by it a chance association
Injection reaction - anxiety or pain of injection not vaccine
Unknown - cause cannot be determined
Global Training Network ProgrammeWorld Health Organization
VACCINE REACTIONSVACCINE REACTIONS
Common, minor reactionsvaccine stimulates immune systemsettle on their ownwarn parents and advise how to manage
Rare, more serious reactionsanaphylaxis (serious allergic reaction)vaccine specific reactions
Global Training Network ProgrammeWorld Health Organization
Irritability, malaise & systemic symptoms
COMMON, MINOR REACTIONSCOMMON, MINOR REACTIONS
Fever >38C
BCG
Hib
HepBMeasles/MMRPolio (OPV)
DTP(pertussis)
Tetanus
90-95%
5-15%
Adults: 15%; Children: 5%
~10%
-
Up to 50%
~10%*
-
2-10%
-
5-15%
<1%
Up to 50%
~10%
-
-1-6%
5% rash
<1%**
Up to 55%
~25%
* Rate of local reactions likely to increase with booster doses, up to 50-85%
** Symptoms include diarrhoea, headache, and/or muscle pains
Vaccine Local reaction (pain, swelling, redness)
Global Training Network ProgrammeWorld Health Organization
MANAGEMENT OF COMMON, MINOR REACTIONSMANAGEMENT OF COMMON, MINOR REACTIONS
Local reactioncold cloth at injection siteparacetamol
Fever >38°Cgive extra fluidstepid sponging paracetamol
Irritability malaise and systemic symptomsgive extra fluidsparacetamol
Global Training Network ProgrammeWorld Health Organization
RARE, MORE SERIOUS REACTIONSRARE, MORE SERIOUS REACTIONS
0.76-1.3 (1st dose)0.17 (subsequent doses)0.15 (contacts)
4-30 daysVaccine-associated paralytic poliomyelitis (VAPP)
Risk is higher for first dose, adults, and immunocompromised
OPV
333331-50
5-12 days15-35 days0-1 hour
Febrile seizuresThrombocytopaeniaAnaphylaxis
Measles/MMR
1-25
0-1 hour1-6 weeks
AnaphylaxisGuillain Barré syndrome
Hep B
Nil knownHib
100-10001-7002
2-6 months1-12 months1-12 months
Suppurative lymphadenitisBCG osteitisDisseminated BCG
BCG
Rate per million doses
Onset interval
ReactionVaccine
Global Training Network ProgrammeWorld Health Organization
RARE, MORE SERIOUS REACTIONS (2RARE, MORE SERIOUS REACTIONS (2))
1000-60 000
570570
200-1
0-24 hours
0-3 days0-24 hours
0-1 hour0-3 days
Persistent (>3 hrs) inconsolable screamingSeizuresHypotonic, hyporesponsive episode (HHE)Anaphylaxis/shockEncephalopathy
DTP
Nil extra to tetanus reactionsTetanus-diphtheria
5-101-66-10
2-28 days0-1 hour1-6 weeks
Brachial neuritisAnaphylaxisSterile abscess
Tetanus
Rate per million doses
Onset interval
ReactionVaccine
Global Training Network ProgrammeWorld Health Organization
RARE, MORE SERIOUS REACTIONS (3)RARE, MORE SERIOUS REACTIONS (3)
500-4000 in infants<6 months
5-20
7-21 days
0-1 hours
Post-vaccination Encephalitis
Allergic reaction/anaphylaxis
Yellow fever
10-1000
1-2.3
Serious allergic reaction
Neurological event
Japanese encephalitis
Rate per million doses
Onset intervalReactionVaccine
Global Training Network ProgrammeWorld Health Organization
RARE, MORE SERIOUS REACTIONSRARE, MORE SERIOUS REACTIONS
BCG
Hib
HepB
Measles/MMR/MR
Suppurative lymphadenitis BCG osteitis Disseminated BCG infection
1 in 1000 to 1 in 10 000 1 in 3000 to 1 in 100 million ~1 in 1 million
None known
Anaphylaxis 1 in 6-900 000
Febrile seizures Thrombocytopaenia Severe allergic reaction Anaphylaxis Encephalopathy
1 in 3000 1 in 30 000 ~1 in 100 000 ~1 in 1 million <1 in 1 million
Reaction Incidence
Global Training Network ProgrammeWorld Health Organization
RARE, MORE SERIOUS REACTIONS (2)RARE, MORE SERIOUS REACTIONS (2)
Tetanus
Pertussis (DTP-
whole cell)
Reaction IncidencePolio(OPV)
Vaccine associated paralytic poliomyelitis
Risk is higher for first dose, adults, and immunocompromised
1 in 2.4-3.3 million doses
1 in 750 000 first dose compared to 1 in 5.1 million for subsequent doses
Brachial neuritis Anaphylaxis
0.5-1 in 100 000 1 in 100 000 to 1 in 2 500 000
Persistent inconsolable screaming Seizures Hypotonic, hyporesponsive episode (HHE) Anaphylaxis Encephalopathy (Note: Risk may be zero)
1 in 15 to 1 in 1000 1 in 1750 to 1 in 12 500
1 in 1000 to 1 in 33 000
1-6 in million
0-1 in 1 million