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Menang O, Kuemmerle A, Maigetter K, Burri C. Strategies and interventions to strengthen pharmacovigilance systems in low-income and middle-income countries: a scoping review. BMJ Open 2023; 13:e071079. [PMID: 37709326 PMCID: PMC10503375 DOI: 10.1136/bmjopen-2022-071079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 07/27/2023] [Indexed: 09/16/2023] Open
Abstract
OBJECTIVES The slow progress of pharmacovigilance (PV) in low-income and middle-income countries (LMIC) raises questions about core challenges on the growth of PV, and the appropriateness of strategies used so far to develop PV. Therefore, this scoping review aims to describe strategies and interventions to strengthen PV in LMIC and to propose recommendations for future investments in PV capacity building. INCLUSION CRITERIA Publications included were primary studies, articles, policy and guideline papers, describing interventions to strengthen PV in LMIC. METHODS The review was conducted following the Joanna Briggs Institute (JBI) guidelines on conducting scoping reviews. Literature searches were performed in MEDLINE, EMBASE, Web of Science, PDQ-evidence, CINAHL and other relevant websites from January 1990 to January 2021. Two reviewers independently screened titles, abstracts and full texts. One reviewer performed data extraction and descriptive analysis, which were reviewed by two other reviewers. RESULTS 10 922 unique titles were screened and 152 were eligible for full text review. Of these, 57 and an additional 13 reports from grey literature fulfilled eligibility criteria for inclusion in the review. These were grouped into two categories: (1) Interventions aimed at increasing PV knowledge and adverse drug reactions (ADR) reporting (45 papers), primarily education of healthcare professionals (HCP), alone or in combination with other interventions such as mobile and electronic reporting and (2) Interventions aimed at strengthening various components of the national PV system (25 papers), describing strategies or mixed interventions implemented at the national level, targeting different components of the national PV system. CONCLUSIONS Results of this review suggest that educating HCP on ADR reporting is the most common approach to build PV capacity in LMIC. Though important, education alone is insufficient and should ideally be organised within the holistic framework of strengthening national PV systems, with a focus on also building capacity for advanced activities such as signal detection.
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Affiliation(s)
- Olga Menang
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Andrea Kuemmerle
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Karen Maigetter
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
| | - Christian Burri
- Swiss Tropical and Public Health Institute, Allschwil, Switzerland
- University of Basel, Basel, Switzerland
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Ogundele OA, Fehintola FO, Salami M, Usidebhofoh R, Abaekere MA. Prevalence and patterns of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria: a facility-based cross-sectional survey. Osong Public Health Res Perspect 2023; 14:291-299. [PMID: 37652684 PMCID: PMC10493703 DOI: 10.24171/j.phrp.2023.0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This study aimed to examine the prevalence and pattern of adverse events following childhood immunization and the responses of mothers in Ile-Ife, South West Nigeria. METHODS This descriptive cross-sectional study was conducted among 422 mothers of children aged 0 to 24 months attending any of the 3 leading immunization clinics in Ile-Ife, Nigeria. The respondents were selected using the multi-stage sampling technique. Data were collected using a pretested structured interviewer-administered questionnaire and analyzed using IBM SPSS ver. 26.0. The chi-square test was used to test associations, while binary logistic regression was used to determine the predictors of mothers' responses to adverse events following immunization (AEFIs). A p-value of <0.05 was considered statistically significant. RESULTS The mean age of the respondents was 29.99±5.74 years. About 38% of the children had experienced an AEFI. Most mothers believed that the pentavalent vaccine was the most common cause of AEFIs (67.5%). Fever (88.0%) and pain and swelling (76.0%) were the most common AEFIs. More than half of the mothers (53.7%) administered home treatment following an AEFI. Younger mothers (odds ratio [OR], 2.43; 95% confidence interval [CI], 1.20-5.01), mothers who delivered their children at a healthcare facility (OR, 3.24; 95% CI, 1.08-9.69), and mothers who were knowledgeable about reporting AEFIs (OR, 2.53; 95% CI, 1.04-7.70) were most likely to respond appropriately to AEFIs. CONCLUSION The proportion of mothers who responded poorly to AEFIs experienced by their children was significant. Therefore, strategies should be implemented to improve mothers' knowledge about AEFIs to improve their responses.
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Affiliation(s)
| | | | - Mubarak Salami
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Rahmat Usidebhofoh
- Department of Community Health, Obafemi Awolowo University, Ile-Ife, Nigeria
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Aborigo RA, Welaga P, Oduro A, Shaum A, Opare J, Dodoo A, Ampadu H, Gidudu JF. Optimising reporting of adverse events following immunisation by healthcare workers in Ghana: A qualitative study in four regions. PLoS One 2022; 17:e0277197. [PMID: 36538549 PMCID: PMC9767370 DOI: 10.1371/journal.pone.0277197] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/21/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Despite the emphasis on reporting of Adverse Events Following Immunisation (AEFIs) during didactic training sessions, especially prior to new vaccine introductions, it remains low in Ghana. We explored the factors underlying the under-reporting of AEFI by healthcare workers (HCWs) to provide guidance on appropriate interventions to increase reporting. METHODS We conducted an exploratory descriptive in-depth study of the factors contributing to low reporting of AEFI among HCWs in four regions in Ghana. Key informant interviews (KII) were held with purposively selected individuals that are relevant to the AEFI reporting process at the district, regional, and national levels. We used KII guides to conduct in-depth interviews and used NVivo 10 qualitative software to analyse the data. Themes on factors influencing AEFI reporting were derived inductively from the data, and illustrative quotes from respondents were used to support the narratives. RESULTS We conducted 116 KIIs with the health managers, regulators and frontline HCWs and found that lack of information on reportable AEFIs and reporting structures, misunderstanding of reportable AEFIs, heavy workload, cost of reporting AEFIs, fear of blame by supervisors, lack of motivation, and inadequate feedback as factors responsible for underreporting of AEFIs. Respondents suggested that capacity building for frontline HCWs, effective supervision, the provision of motivation and feedback, simplification of reporting procedures, incentives for integrating AEFI reporting into routine monitoring and reporting, standardization of reporting procedures across regions, and developing appropriate interventions to address the fear of personal consequences would help improve AEFI reporting. CONCLUSION From the perspectives of a broad range of key informants at all levels of the vaccine safety system, we found multiple factors (both structural and behavioural), that may impact HCW reporting of AEFI in Ghana. Improvements in line with the suggestions are necessary for increased AEFI reporting in Ghana.
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Affiliation(s)
- Raymond Akawire Aborigo
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
- * E-mail:
| | - Paul Welaga
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
| | - Abraham Oduro
- Navrongo Health Research Centre, Research and Development Division, Ghana Health Service, Navrongo, Ghana
| | - Anna Shaum
- Center for Global Health, Global Immunisation Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Joseph Opare
- The Ghana Second Year of Life Vaccine Platform (2YL), Accra, Ghana
| | - Alex Dodoo
- The African Collaborating Centre for Pharmacovigilance, Accra, Ghana
| | - Hilda Ampadu
- The African Collaborating Centre for Pharmacovigilance, Accra, Ghana
| | - Jane F. Gidudu
- Center for Global Health, Global Immunisation Division, Centers for Disease Control and Prevention, Atlanta, GA, United States of America
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Tchio-Nighie KH, Mpoh MM, Tchokomeni H, Koutio Douanla IM, Ntsekendio PN, Dieumo FFK, Ateudjieu J. Drug Safety Monitoring in Health Programs of Cameroon. JOURNAL OF PHARMACOVIGILANCE 2022; 10:10000385. [PMID: 37559896 PMCID: PMC7614915 DOI: 10.35248/2329-6887.22.10.385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND Data are needed to serve as evidence in planning the strengthening of pharmacovigilance in health programs administering drugs to populations. The present study was proposed to map the distribution of pharmacovigilance units in health programs, assess the availability of key resources, the implementation of key pharmacovigilance activities and identify needs of involved actors. METHODS It was a cross sectional descriptive study targeting all health programs of the Cameroon Ministry of Public Health administering drugs/vaccines to the population. Data were collected using semi structured questionnaire administered face to face to key persons in charge of drug safety monitoring or drug management in health programs. RESULTS Out of the 09 health programs involved in drug distribution, 07 consented to participate. Five out of them (71.4%) claimed to have existing pharmacovigilance units. Office space, computers, operating budget, data analysis software and a trained staff were available in 28.6%, 42.9%, 42.9%, 14.3%, 00.0%, and 42.9% of the health programs respectively. One of the 7 health programs (14.3%) declared conducting detection/notification of adverse events following exposure drugs, 2 (28.6%) conduct causality assessment and 3 (42.8%) conduct analysis of pharmacovigilance data. All health programs proposed to prioritize the allocation of budget and qualified personnel and the training of existing personnel as key interventions to improve drugs/vaccines safety monitoring in health programs. CONCLUSION The study reports limited coverage of Cameroon health programs with activities leading to drugs and vaccine safety monitoring. Suggested actions have to be taken into account when attempting to improve the situation.
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Affiliation(s)
- Ketina Hirma Tchio-Nighie
- Department of Health Research, M.A. SANTE (Meilleur Acces auxSoins de Sante), Yaounde, Cameroon
- Department of Public Health, University of Dschang, Dschang, Cameroon
| | - Maurice Mbwe Mpoh
- Department of Pharmacy, Drugs and Laboratories, Ministry of Public Health of Cameroon, Yaounde, Cameroon
- Department of Drugs and Population's Health, Bordeaux, France
| | - Herve Tchokomeni
- Department of Health Research, M.A. SANTE (Meilleur Acces auxSoins de Sante), Yaounde, Cameroon
- Department of Statistics, Sub-Regional Institute of Statistics and Applied Economics, Yaounde, Cameroon
| | - Ingrid Marcelle Koutio Douanla
- Department of Health Research, M.A. SANTE (Meilleur Acces auxSoins de Sante), Yaounde, Cameroon
- Department of Public Health, University of Dschang, Dschang, Cameroon
| | - Paul Nyibio Ntsekendio
- Department of Health Research, M.A. SANTE (Meilleur Acces auxSoins de Sante), Yaounde, Cameroon
- Department of Public Health, University of Dschang, Dschang, Cameroon
| | - Frank Forex Kiadjieu Dieumo
- Department of Health Research, M.A. SANTE (Meilleur Acces auxSoins de Sante), Yaounde, Cameroon
- Department of Economics and Management, University of Yaounde I, Yaounde, Cameroon
| | - Jerome Ateudjieu
- Department of Health Research, M.A. SANTE (Meilleur Acces auxSoins de Sante), Yaounde, Cameroon
- Department of Public Health, University of Dschang, Dschang, Cameroon
- Department of Health Operations Research, Ministry of Public Health of Cameroon, Yaounde, Cameroon
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Laryea EB, Frimpong JA, Noora CL, Tengey J, Bandoh D, Sabblah G, Ameme D, Kenu E, Amponsa-Achiano K. Evaluation of the adverse events following immunization surveillance system, Ghana, 2019. PLoS One 2022; 17:e0264697. [PMID: 35231049 PMCID: PMC8887767 DOI: 10.1371/journal.pone.0264697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 02/16/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health issue. Ghana's Adverse Events Following Immunization surveillance started in 1978 with the objective to promptly detect and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the system to assess its attributes, usefulness and system's performance in meeting its objectives. METHODS A case of AEFI was defined as any untoward medical event occurring within 28 days after vaccination and may not necessarily have causal relationship with the vaccine use. We reviewed surveillance data and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC's Updated Guidelines for Evaluating Public Health Surveillance Systems, we assessed the system's attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews. RESULTS In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without any disruption in the function of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was higher than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/16) Community Health Nurses interviewed indicated "fear of being victimized" as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics. CONCLUSION The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. We recommend training and supportive supervision to improve timeliness of reporting, data completeness and acceptability.
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Affiliation(s)
- Eunice Baiden Laryea
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Joseph Asamoah Frimpong
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
- * E-mail:
| | - Charles Lwanga Noora
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - John Tengey
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Delia Bandoh
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - George Sabblah
- Department of Pharmacovigilance, Food and Drugs Authority, Accra, Ghana
| | - Donne Ameme
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Ernest Kenu
- Ghana Field Epidemiology and Laboratory Training Program, Department of Applied Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
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Ishaku SG, Umeh G, Adzu B, Onimisi A, Dauda M, Iyal HA, Iliyasu N, Sunday DJ, Daikwo J, Yates SM, Ibrahim II, Samaila LH, Abdullahi B, Parom SK, Maiwashi KY, Zakari F, Nuhu KS. Adverse event following vaccine surveillance in Kaduna State, Northwestern Nigeria (January 2018 -June 2019): analysis of health facility´s records. Pan Afr Med J 2021; 40:268. [PMID: 35251462 PMCID: PMC8856967 DOI: 10.11604/pamj.2021.40.268.26961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 12/01/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Adverse Events Following Immunization (AEFI) are one of the main reasons for inadequate immunization coverage in Kaduna State, and AEFI underreporting serves as a barrier to achieving goals of global pharmaco-vigilance for vaccine. The purpose of this study is to estimate the completeness of variables in the AEFI line-listing forms, calculate AEFI reporting rates by Local Government Areas & vaccine type and profile the reported cases according to their reactions. METHODS we conducted a descriptive, cross-sectional, retrospective study of primary surveillance records. We calculated AEFI reporting rates in the State and Local Government areas and AEFI Vaccine reaction rates to the various antigens. We used Binary logistic regression to determine the association between gender and vaccine reactions. RESULTS seven thousand eight hundred and twenty-four (7,824) AEFI cases were reported. The completeness of variables on the filled AEFI line-list varied from 21% to 100%. The State had a high AEFI reporting rate of 9.09 per 10,000 administered doses. Fever (<38oC) was the main AEFI reaction. Severe AEFI cases accounted for only 0.89% of the total reported cases. Pentavalent vaccine was the suspect antigen responsible for the highest number of AEFI cases, with a vaccine reaction rate of 44.77 per 10,000 doses. The Zaria Local Government area had the highest AEFI reporting rate, while the Sanga Local Government area had the lowest AEFI reporting rate in the State. The difference between genders in the number of reported AEFI cases was not statistically significant (p>0.05). There were 35% higher odds of occurrence of bleeding among males than among females (aOR: 1.354; P-value: p=.012; 95% CI: 1.070-1.715; Nagelkerke-R2-: 0.003). The other reactions were not significantly related to gender. CONCLUSION our study shows a higher occurrence of severe AEFI in subjects undergoing pentavalent vaccine. Thiscaused the highest incidence of AEFI. There was no significant association between gender and AEFI reactions.
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Affiliation(s)
- Sambo Godwin Ishaku
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria,,Corresponding author: Sambo Godwin Ishaku, World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria.
| | - Gregory Umeh
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | - Bulus Adzu
- Department of Pharmacology and Toxicology, National Institute for Pharmaceutical Research and Development, Abuja, Nigeria
| | | | - Madubu Dauda
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | - Hadiza Aliyu Iyal
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | - Neyu Iliyasu
- Kaduna State Primary Healthcare Board, Kaduna, Nigeria
| | | | | | | | | | | | - Basirat Abdullahi
- World Health Organization (WHO), Kaduna State Office, Kaduna, Nigeria
| | | | | | | | - Kase Sarah Nuhu
- Department of Medical Laboratory Science, Kaduna State University, Kaduna, Nigeria
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Gold MS, Lincoln G, Bednarz J, Braunack-Mayer A, Stocks N. Consumer acceptability and validity of m-Health for the detection of adverse events following immunization - The Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) randomised control trial. Vaccine 2020; 39:237-246. [PMID: 33309486 DOI: 10.1016/j.vaccine.2020.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Monitoring for adverse events following immunisation (AEFI) is critical for vaccine pharmacovigilance. Given the global and expanding availability of mobile phones their utility for consumer-based vaccine safety surveillance is of interest but little is known about consumer acceptability. This study nested within the Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) randomised control trial sought to evaluate the acceptability of SMS for AEFI surveillance. METHODS The primary STARSS study was a multi-centre RCT evaluating the efficacy of repeated SMS prompts for AEFI surveillance with participants being adult vaccinees or parents of children receiving any vaccine. This nested study enrolled primary RCT participants who completed a detailed computer assisted telephone interview to determine their attitudes towards SMS-based surveillance and ascertain their knowledge and attitudes toward vaccine safety, efficacy, data privacy and use of electronic health records. Attitudes to surveillance and related behaviour were used as measures of acceptability. RESULTS 20% (1200/6555) of the participants were enrolled and 1139 completed the full-length questionnaire. 96% indicated that SMS-based surveillance after immunisation to check the safety of the vaccine "should be done" but 62% of all respondents said it should be done but consent should be sought first. Neither vaccine safety attitudes nor attitudes toward privacy were associated with opposition to SMS-based surveillance. In terms of SMS related behaviour demographic rather than attitudinal factors were associated with non-compliance. CONCLUSION Overall, the attitude towards SMS-based surveillance was very favourable. Experiencing the SMS surveillance has the effect of reducing opposition to an SMS surveillance system, and at the same time increasing the likelihood of a preference for prior consent. Detection of a vaccine safety signal could be impeded in particular demographic groups who are non-compliant and we should undertake further research to understand why these groups are non-compliant and how this can be improved.
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Affiliation(s)
- M S Gold
- Discipline of Paediatrics, Adelaide Medical School, University of Adelaide, South Australia, Australia.
| | - G Lincoln
- Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - J Bednarz
- Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Australia
| | - A Braunack-Mayer
- School of Health and Society, Faculty of Arts, Social Sciences and Humanities, University of Wollongong, New South Wales, Australia
| | - N Stocks
- Discipline of General Practice, Adelaide Medical School, University of Adelaide, Australia
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Efficacy of m-Health for the detection of adverse events following immunization - The stimulated telephone assisted rapid safety surveillance (STARSS) randomised control trial. Vaccine 2020; 39:332-342. [PMID: 33279317 DOI: 10.1016/j.vaccine.2020.11.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Passive surveillance is recommended globally for the detection of adverse events following immunisation (AEFI) but this has significant challenges. Use of Mobile health for vaccine safety surveillance enables a consumer-centred approach to reporting. The Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) a randomised control trial (RCT) sought to evaluate the efficacy and acceptability of SMS for AEFI surveillance. METHODS Multi-centre RCT, participants were adult vaccinees or parents of children receiving any vaccine at a trial site. At enrolment randomisation occurred to one of two SMS groups or a control group. Prompts on days 2, 7 and 14 post-immunisation, were sent to the SMS group, to ascertain if a medical event following immunisation (MEFI) had occurred. No SMS's were sent to the control participants. Those in the SMS who notified an MEFI were pre-randomised to complete a computer assisted telephone interview or a web based report to determine if an AEFI had occurred whilst an AEFI in the controls was determined by a search for passive reports. The primary outcome was the AEFI detection rate in the SMS group compared to controls. RESULTS We enrolled 6,338 participants, who were equally distributed across groups and who received 11,675 vaccines. The SMS group (4,225) received 12,675 surveillance prompts with 9.8% being non-compliant and not responding. In those that responded 90% indicated that no MEFI had been experienced and 184 had a verified AEFI. 6 control subjects had a reported AEFI. The AEFI detection rate was 13 fold greater in the SMS group when compared with controls (4.3 vs 0.3%). CONCLUSION We have demonstrated that the STARSS methodology improves AEFI detection. Our findings should inform the wider use of SMS-based surveillance which is particularly relevant since establishing robust and novel pharmacovigilance systems is critical to monitoring novel vaccines which includes potential COVID vaccines.
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Atkinson KM, Mithani SS, Bell C, Rubens-Augustson T, Wilson K. The digital immunization system of the future: imagining a patient-centric, interoperable immunization information system. Ther Adv Vaccines Immunother 2020; 8:2515135520967203. [PMID: 33681700 PMCID: PMC7900792 DOI: 10.1177/2515135520967203] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 09/16/2020] [Indexed: 12/31/2022] Open
Abstract
To ensure the effectiveness of increasingly complex immunization programs in upper-middle and high-income settings, comprehensive information systems are needed to track immunization uptake at individual and population levels. The maturity of cloud systems and mobile technologies has created new possibilities for immunization information systems. In this paper, we describe a vision for the next generation of digital immunization information systems for upper-middle and high-income settings based on our experience in Canada. These systems center on the premise that the public is engaged and informed about the immunization process beyond their interaction with primary care, and that they will be a contributor and auditor of immunization data. The digital immunization system of the future will facilitate reporting of adverse events following immunization, issue digital immunization receipts, permit identification of areas of need and allow for delivery of interventions targeting these areas. Through features like immunization reminders and targeted immunization promotion campaigns, the system will reduce many of the known barriers that influence immunization rates. In light of the global COVID-19 pandemic, adaptive digital public health information systems will be required to guide the rollout and post-market surveillance of the SARS-CoV-2 vaccine.
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Affiliation(s)
- Katherine M. Atkinson
- Department of Global Public Health,
Karolinska Institutet, Stockholm, Sweden, CANImmunize Inc,
Ottawa, ON, Canada
| | - Salima Saleem Mithani
- Clinical Epidemiology Program, Ottawa
Hospital Research Institute, Ottawa, ON, Canada
| | | | | | - Kumanan Wilson
- Clinical Epidemiology Program, Ottawa
Hospital Research Institute, 1053 Carling Ave, Ottawa, ON
K1Y4E9, Canada
- CANImmunize Inc, Ottawa, ON,
Canada
- Department of Medicine, University of
Ottawa, Ottawa, ON, Canada
- Bruyere Research Institute, Ottawa,
ON, Canada
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Constantine M, Cremance T, Juru TP, Gerald S, Notion GT, Peter N, Mufuta T. Evaluation of the adverse events following immunization surveillance system in Guruve district, Mashonaland Central 2017. Pan Afr Med J 2019; 31:202. [PMID: 31452827 PMCID: PMC6693787 DOI: 10.11604/pamj.2018.31.202.16573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 10/29/2018] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION An adverse event following immunisation is any untoward medical occurrence which follows vaccination. Frequency of adverse events ranges from 13% to 34% and they should be reported regardless of severity. From the beginning of 2016 to mid-2017, Guruve district in Zimbabwe did not report any AEFIs. This suggests the surveillance system may be failing to detect adverse events. We therefore evaluated the AEFI surveillance system in Guruve district. METHODS We conducted a surveillance system evaluation using the updated Centers for Disease Control guidelines for evaluating public health surveillance systems. We interviewed health workers and caregivers of babies under 2 years in Guruve district. We also reviewed all records on AEFI surveillance for the period of January 2016 to November 2017. RESULTS We recruited 31 health workers and 33 caregivers into the study. Between January 2016 and mid-2017, 39% of the caregivers had children who had suffered AEFIs and 45% of the health workers had encountered AEFIs but none had been notified. The main reasons for failure to report AEFIs included health workers' fear of personal consequences and caregivers thinking that an adverse event was not serious enough to report. Knowledge of the surveillance system was good amongst the majority of health workers. All the resources needed by the surveillance system were available. CONCLUSION We concluded that health workers in Guruve district were afraid to report adverse events following immunization and caregivers were reluctant to report mild adverse events hence the surveillance system was performing poorly and was not useful. However, the stability of the system and the good knowledge gives a good foundation for improving the surveillance system.
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Affiliation(s)
| | - Tshuma Cremance
- Provincial Medical Director, Mashonaland Central Province, Zimbabwe
| | | | - Shambira Gerald
- University of Zimbabwe, Department of Community Medicine, Zimbabwe
| | | | | | - Tshimanga Mufuta
- University of Zimbabwe, Department of Community Medicine, Zimbabwe
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Abimbola S, Keelan S, Everett M, Casburn K, Mitchell M, Burchfield K, Martiniuk A. The medium, the message and the measure: a theory-driven review on the value of telehealth as a patient-facing digital health innovation. HEALTH ECONOMICS REVIEW 2019; 9:21. [PMID: 31270685 PMCID: PMC6734475 DOI: 10.1186/s13561-019-0239-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/18/2019] [Indexed: 05/07/2023]
Abstract
By what measure should a policy maker choose between two mediums that deliver the same or similar message or service? Between, say, video consultation or a remote patient monitoring application (i.e. patient-facing digital health innovations) and in-person consultation? To answer this question, we sought to identify measures which are used in randomised controlled trials. But first we used two theories to frame the effects of patient-facing digital health innovations on - 1) transaction costs (i.e. the effort, time and costs required to complete a clinical interaction); and 2) process outcomes and clinical outcomes along the care cascade or information value chain, such that the 'value of information' (VoI) is different at each point in the care cascade or value chain. From the trials, we identified three categories of measures: outcome (process or clinical), satisfaction, and cost. We found that although patient-facing digital health innovations tend to confer much of their value by altering process outcomes, satisfaction, and transaction costs, these measures are inconsistently assessed. Efforts to determine the relative value of and choose between mediums of service delivery should adopt a metric (i.e. mathematical combination of measures) that capture all dimensions of value. We argue that 'value of information' (VoI) is such a metric - it is calculated as the difference between the 'expected utility' (EU) of alternative options. But for patient-facing digital health innovations, 'expected utility' (EU) should incorporate the probability of achieving not only a clinical outcome, but also process outcomes (depending on the innovation under consideration); and the measures of utility should include satisfaction and transaction costs; and also changes in population access to services, and health system capacity to deliver more services, which may result from reduction in transaction costs.
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Affiliation(s)
- Seye Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
- Royal Far West, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
| | - Sarah Keelan
- School of Public Health, University of Sydney, Sydney, Australia
- Royal Far West, Sydney, Australia
| | | | | | | | | | - Alexandra Martiniuk
- School of Public Health, University of Sydney, Sydney, Australia
- Royal Far West, Sydney, Australia
- The George Institute for Global Health, Sydney, Australia
- University of Toronto, Toronto, Canada
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Lei J, Balakrishnan MR, Gidudu JF, Zuber PLF. Use of a new global indicator for vaccine safety surveillance and trends in adverse events following immunization reporting 2000-2015. Vaccine 2018; 36:1577-1582. [PMID: 29454518 PMCID: PMC5857292 DOI: 10.1016/j.vaccine.2018.02.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 01/26/2018] [Accepted: 02/03/2018] [Indexed: 11/30/2022]
Abstract
Reporting of adverse events following immunization (AEFI) is a key component for functional vaccine safety monitoring system. The aim of our study is to document trends in the AEFI reporting ratio globally and across the six World Health Organization (WHO) regions. We describe the number of AEFI reports communicated each year through the World Health Organization/United Nations Children's Fund Joint Reporting Form on Immunization from 2000 to 2015. The AEFI reporting ratios (annual AEFI reports per 100,000 surviving infants) were calculated to identify WHO countries (n = 191 in 2000 and n = 194 by 2015) that met a minimal reporting ratio of 10, a target set by the Global Vaccine Action Plan for vaccine safety monitoring as a proxy measure for a functional AEFI reporting system. The number of countries reporting any AEFI fluctuated over time but with progress from 32 (17%) in 2000 to 124 (64%) in 2015. In 2015, the global average AEFI reporting ratio was 549 AEFI reports per 100,000 surviving infants. The number of countries with AEFI reporting ratios greater than 10 increased from 8 (4%) in 2000 to 81 (42%) in 2015. In 2015, 60% of countries in the WHO Region of the Americas reported at least 10 AEFI per 100,000 surviving infants, followed by 55% in European Region, 43% in Eastern Mediterranean Region, 33% in Western Pacific Region, 27% in South-East Asia Region and 21% in African Region. Overall, AEFI reporting has increased over the past sixteen years worldwide, but requires strengthening in a majority of low- and middle- income countries. The AEFI reporting ratio is useful for benchmarking and following trends over time; but does not provide information on the quality of the reporting system and does not guarantee capacity to detect and manage a vaccine safety problem at a national level. Additional efforts are required to ensure and improve data quality, AEFI reporting and surveillance of immunization safety in every country.
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Affiliation(s)
- Jiayao Lei
- Karolinska Institutet, Stockholm, Sweden
| | | | - Jane F Gidudu
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Cashman P, Macartney K, Khandaker G, King C, Gold M, Durrheim DN. Participant-centred active surveillance of adverse events following immunisation: a narrative review. Int Health 2017; 9:164-176. [PMID: 28582563 PMCID: PMC5881255 DOI: 10.1093/inthealth/ihx019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 05/24/2017] [Indexed: 11/14/2022] Open
Abstract
The importance of active, participant-centred monitoring of adverse events following immunisation (AEFI) is increasingly recognised as a valuable adjunct to traditional passive AEFI surveillance. The databases OVID Medline and OVID Embase were searched to identify all published articles referring to AEFI. Only studies which sought participant response after vaccination were included. A total of 6060 articles published since the year 2000 were identified. After the application of screening inclusion and exclusion criteria, 25 articles describing 23 post-marketing AEFI systems were identified. Most countries had a single system: Ghana, Japan, China, Korea, Netherlands, Singapore, Brazil, Cambodia, Sri Lanka, Turkey and Cameroon except the USA (2), Canada (4) and Australia (6). Data were collected from participants with and without AEFI in all studies reviewed with denominator data enabling AEFI rate calculations. All studies considered either a single vaccine or specified vaccines or were time limited except one Australian system, which provides continuous automated participant-centred active surveillance of all vaccines. Post-marketing surveillance systems using solicited patient feedback are emerging as a novel AEFI monitoring tool. A number of exploratory systems utilising e-technology have been developed and their potential for scaling up and application in low and middle income countries deserves further investigation.
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Affiliation(s)
- Patrick Cashman
- Hunter New England Population Health, Newcastle, Australia.,University of Newcastle, NSW, Australia
| | - Kristine Macartney
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Australia
| | - Gulam Khandaker
- Discipline of Child and Adolescent Health, Sydney Medical School, University of Sydney, Australia.,Marie Bashir Institute for Infectious Diseases and Biosecurity (MBI), University of Sydney, Australia.,Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Catherine King
- National Centre for Immunisation Research and Surveillance, The Children's Hospital at Westmead, Sydney, Australia
| | - Michael Gold
- University of Adelaide, Discipline pf Paediatrics, Women's and Children's Health Network, Adelaide, Australia
| | - David N Durrheim
- Hunter New England Population Health, Newcastle, Australia.,Hunter Medical Research Institute, 1 Kookaburra Circuit, New Lambton Heights, NSW, Australia
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