Knowledge and Perceptions of Adverse Events Following Immunization among Healthcare Professionals in Africa: A Case Study from Ghana

[Experiences and Challenges of the Ecuadorean National Advisory Commission on Serious Events Supposedly Attributable to Vaccination or Immunization, 2020-2023Experiências e desafios da Comissão Consultiva Nacional sobre Eventos Supostamente Atribuíveis à Vacinação ou Imunização graves do Equador, 2020-2023]

Objective

To describe the experiences of the National Advisory Commission on Serious Events Supposedly Attributable to Vaccination or Immunization (ESAVI) implemented in Ecuador for the period 2020-2023.

Methods

A report analyzing the implementation, operations, and results of the National Advisory Commission on Serious ESAVI in Ecuador was prepared. A quantitative analysis of vaccination records was carried out, as well as a qualitative analysis based on expert interviews, reflecting the direct experiences and operational challenges faced by the members of the Commission.

Results

Implementation of the Commission has allowed for the systematic recording and analysis of serious ESAVIs. Of 256 reported cases, 139 were analyzed: 59% were considered coincident events; 16.6%, unclassifiable; 6.5%, indeterminate; 5%, stress-related; 3.6% as events related to a programmatic error; and 9.4% as vaccine-related, which included allergic reactions, Guillain-Barré syndrome, and thrombosis, among others. The experts highlighted the need to improve staff training and technology infrastructure, and noted that the Commission played a crucial role in monitoring vaccine safety, as well as in increasing public confidence in vaccination processes.

Conclusions

The National Advisory Commission has played an essential role in vaccine safety surveillance in Ecuador by ensuring reporting, causality analysis, and investigation of serious ESAVIs. Challenges were identified and will need to be addressed to maintain public trust in immunization programs.

Enhancing Pharmacovigilance in Côte d'Ivoire: Impact of GSK's Training and Mentoring Pilot Project in the Abidjan Region

INTRODUCTION

Pharmacovigilance (PV) in sub-Saharan Africa relies on passive surveillance but underreporting of adverse events (AEs) by health care professionals (HCPs) is a major challenge. A PV enhancement project was implemented to address this in Côte d'Ivoire.

OBJECTIVE

To improve safety surveillance of medicines through PV training and mentoring of HCPs in selected health care facilities (HCFs).

METHODS

This collaborative project between national PV stakeholders, GSK, and PATH was implemented from September 2018 to February 2020 in Abidjan region, Côte d'Ivoire. Trained PV focal points provided training and regular mentoring of HCPs. Key performance indicator (KPI) categories for AE reporting were the volume of AE reports, efficiency of report transmission and data entry, quality of reports, and quality of the central (Vigilance Unit) response to AE reports.

RESULTS

Overall, 1427 HCPs at 91 HCFs were trained. In the 8 months before implementation, 33 AE reports were received versus 85 after 3 months and 361 after 18 months of implementation (71 [83.5%] and 278 [77.0%], respectively, from Abidjan). The KPIs with the highest proportions were: AE reports received centrally (100%), complete AE reports (69.0%), AE reports entered into the local PV database within 48 h (99.6%), and AE reports entered into the global database, VigiBase (86.7%). Report notification within 72 h, causality assessment, and serious AE reporting had proportions below 20%; feedback to reporters was provided for only 0.4% of reports.

CONCLUSION

Regular PV trainings and mentoring improved AE reporting in Côte d'Ivoire but further enhancement is required to improve passive safety surveillance.

Vaccination Utilization and Subnational Inequities during the COVID-19 Pandemic: An Interrupted Time-Series Analysis of Administrative Data across 12 Low- and Middle-Income Countries

BACKGROUND

During and after the SARS-CoV-2 (COVID-19) pandemic, many countries experienced declines in immunization that have not fully recovered to pre-pandemic levels. This study uses routine health facility immunization data to estimate variability between and within countries in post-pandemic immunization service recovery for BCG, DPT1, and DPT3.

METHODS

After adjusting for data reporting completeness and outliers, interrupted time series regression was used to estimate the expected immunization service volume for each subnational unit, using an interruption point of March 2020. We assessed and compared the percent deviation of observed immunizations from the expected service volume for March 2020 between and within countries.

RESULTS

Six countries experienced significant service volume declines for at least one vaccine as of October 2022. The shortfall in BCG service volume was ~6% (95% CI -1.2%, -9.8%) in Guinea and ~19% (95% CI -16%, 22%) in Liberia. Significant cumulative shortfalls in DPT1 service volume are observed in Afghanistan (-4%, 95% CI -1%, -7%), Ghana (-3%, 95% CI -1%, -5%), Haiti (-7%, 95% CI -1%, -12%), and Kenya (-3%, 95% CI -1%, -4%). Afghanistan has the highest percentage of subnational units reporting a shortfall of 5% or higher in DPT1 service volume (85% in 2021 Q1 and 79% in 2020 Q4), followed by Bangladesh (2020 Q1, 83%), Haiti (80% in 2020 Q2), and Ghana (2022 Q2, 75%). All subnational units in Bangladesh experienced a 5% or higher shortfall in DPT3 service volume in the second quarter of 2020. In Haiti, 80% of the subnational units experienced a 5% or higher reduction in DPT3 service volume in the second quarter of 2020 and the third quarter of 2022.

CONCLUSIONS

At least one region in every country has a significantly lower-than-expected post-pandemic cumulative volume for at least one of the three vaccines. Subnational monitoring of immunization service volumes using disaggregated routine health facility information data should be conducted routinely to target the limited vaccination resources to subnational units with the highest inequities.

Best practice implementation on reporting of coronavirus disease 2019 vaccine adverse events following immunization in Uasin Gishu County, Kenya

OBJECTIVES

This project's aim was to implement vaccine safety surveillance best practices to improve reporting of adverse events following immunization (AEFI) during coronavirus disease 2019 (COVID-19) vaccination roll out in Uasin Gishu County.

INTRODUCTION

Weak vaccine safety surveillance systems in developing countries has contributed to underreporting of AEFIs undermining public confidence in immunization efforts, contributing to low uptake of vaccines critical in the fight against communicable diseases.

METHODS

The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice was utilized. Preimplementation and postimplementation audit cycles carried out utilized six best practice recommendations. Context-specific strategies and resources were used to address the gaps identified.

RESULTS

Less than half of the AEFIs reported were in accordance with the local policy recommendation, and most of the AEFIs reported were submitted in a timely manner in the baseline and follow-up cycle. Slight improvement was recorded in the number of health facilities with AEFIs reporting forms. An improvement of 33.7% was recorded in the number of health workers providing COVID-19 vaccination services who had received education and practical training on vaccine pharmacovigilance.

CONCLUSION

Underreporting and delayed submission of COVID-19 vaccine AEFI was evident among the healthcare providers offering COVID-19 vaccination services, the majority of healthcare providers had received training on vaccine pharmacovigilance, and AEFI hard copy reporting forms were not adequate in the health facilities. Public education on vaccine safety before administration of vaccine needs emphasis in order to improve reporting of AEFI.

Adverse events following immunization associated with coronavirus disease 2019 (COVID-19) vaccines: A descriptive analysis from VigiAccess

This study assessed adverse events following immunizations (AEFIs) reported on COVID-19 vaccines in VigiAccess and determined the reporting trends across all continents of the world. The study was cross-sectional quantitative in design. VigiAccess was searched on 10 November 10 2021 for reported adverse events following the introduction of COVID-19 vaccines. After entering the search term, "COVID-19 vaccines" in VigiAccess, AEFIs associated with nine approved brands of COVID-19 vaccines had been documented in the database. Data were captured among age groups, sex, and continents of the world and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Overall, 2,457,386 AEFIs had been reported in VigiAccess at the time of the search. No causal associations could be established between the vaccines and the AEFIs. The public accessing VigiAccess data should therefore be made aware of this in order to not falsely attribute AEFIs to COVID-19 vaccines when assessing the database.

Challenges and lessons learned from four years of planning and implementing pharmacovigilance enhancement in sub-Saharan Africa

Pharmacovigilance (PV) systems in many countries in sub-Saharan Africa (SSA) are not fully functional. The spontaneous adverse events (AE) reporting rate in SSA is lower than in any other region of the world, and healthcare professionals (HCPs) in SSA countries have limited awareness of AE surveillance and reporting procedures. The GSK PV enhancement pilot initiative, in collaboration with PATH and national PV stakeholders, aimed to strengthen passive safety surveillance through a training and mentoring program of HCPs in healthcare facilities in three SSA countries: Malawi, Côte d’Ivoire, and Democratic Republic of Congo (DRC). Project implementation was country-driven, led by the Ministry of Health via the national PV center or department, and was adapted to each country’s needs. The implementation phase for each country was scheduled to last 18 months. At project start, low AE reporting rates reflected that awareness of PV practices was very low among HCPs in all three countries, even if a national PV center already existed. Malawi did not have a functional PV system nor a national PV center prior to the start of the initiative. After 18 months of PV training and mentoring of HCPs, passive safety surveillance was enhanced significantly as shown by the increased number of AE reports: from 22 during 2000–2016 to 228 in 18 months to 511 in 30 months in Malawi, and ~ 80% of AE reports from trained healthcare facilities in Côte d’Ivoire. In DRC, project implementation ended after 7 months because of the SARS-CoV-2 pandemic. Main challenges encountered were delayed AE report transmission (1–2 months, due mainly to remoteness of healthcare facilities and complex procedures for transmitting reports to the national PV center), delayed or no causality assessment due to lack of expertise and/or funding, negative perceptions among HCPs toward AE reporting, and difficulties in engaging public health programs with the centralized AE reporting processes. This pilot project has enabled the countries to train more HCPs, increased reporting of AEs and identified KPIs that could be flexibly replicated in each country. Country ownership and empowerment is essential to sustain these improvements and build a stronger AE reporting culture.

Barriers to healthcare workers reporting adverse events following immunization in Zhejiang province, China

Objectives

A cross-sectional survey was conducted among healthcare workers (HCWs) to assess their knowledge, attitude, and reporting behavior in adverse event following immunization (AEFI) surveillance as well as to identify barriers.

Methods

A simple random sample of 170 vaccination clinics was selected and one HCW was informed to participate in this survey in each selected vaccination clinic. The survey was developed using a secure online platform and consisted of a structured online questionnaire. The distributions of the respondents’ characteristics were presented. Training status, knowledge, attitude, and reporting behavior were compared between sub-groups of HCWs. Barriers and suggestions on AEFI reporting were also summarized.

Results

Of the 170 surveyed HCWs, 61.76% received the training on AEFI surveillance while 15.88% had no AEFI training at all. The higher level of knowledge and the more positive attitude and reporting behavior on AEFI surveillance were observed among HCWs with the longer working duration on AEFI surveillance, or among HCWs who received the training. The most critical barrier to reporting an AEFI was ‘not being sure if the AEFI is related to the vaccine’ (122, 71.76%). Other barriers were: ‘I do not want to raise unnecessary public alarm about a vaccine’ (105, 61.76%); ‘reporting form or other method being too complicated’ (65, 38.23%).

Conclusion

The study findings highlighted the need to prioritize training on AEFI surveillance for HCWs. It is recommended that the development of the targeted interventions to strengthen AEFI surveillance system be required based on the barriers found in this study.

Understanding and experience of adverse event following immunization (AEFI) and its consequences among healthcare providers in Kebbi State, Nigeria: a qualitative study

Background

Vaccines used in the national immunization program are relatively safe and effective. However, no vaccine is perfectly safe. Therefore, adverse reactions may occur. This study aimed to investigate the understanding and experience of Adverse Event Following Immunization (AEFI) among healthcare workers and Routine Immunization (RI) officers.

Methods

Phenomenological qualitative study was conducted between June and September 2019, using a semi-structured question guide in Kebbi State, Northwest Nigeria. Face-to-face interviews were conducted with 12 RI providers, eight Expanded Program on Immunization (EPI) officers, and eight Disease Surveillance and Notification Officers. Thematic analysis was used to analyze the data. The interviews were transcribed and translated, then manually analyzed thematically.

Results

The knowledge level of healthcare providers on AEFI definition and classification varied and was suboptimal. Error during vaccination was the study participants' most frequently mentioned possible cause of AEFI. Persistent crying, fever, fainting, and swelling and tenderness at injection sites were the AEFI experienced by the healthcare providers in their careers. Block rejection, lower immunization uptake, loss of confidence in RI, attack on RI providers, discrimination of RI providers and divorce threats among spouses were the consequences of AEFI. Supportive supervision of the RI sessions, refresher training on safe injection for RI providers, and symptomatic treatment of clients with AEFI would prevent AEFI consequences. Also, educating caregivers, community sensitization, and dialogue would minimize the consequences of AEFI.

Conclusions

Evidence of a sub-optimal understanding of AEFI was established in this study. Hence, policymakers should consider regular refresher training on AEFI to ensure all RI providers have an optimal understanding of AEFI. Health education of caregivers and parents during RI sessions and community engagement should be considered to minimise AEFI consequences on the immunization program and the society.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08133-9.

Uso do Sistema de Informação de Imunização do Brasil: qual a realidade?

Introdução: A informação em saúde é essencial na tomada de decisões no âmbito das políticas públicas e tem se apresentado como instrumento essencial na interpretação de fenômenos. Assim, o estudo teve como objetivo avaliar o uso do Sistema de Informação de Imunização pelos profissionais de enfermagem. Materiais e métodos: Estudo transversal analítico realizado num município da Macrorregião Oeste de Minas Gerais, com profissionais de enfermagem por meio de um checklist validado. Para análise, utilizou-se um sistema de escores, classificado como: adequado, parcialmente adequado, não adequado e crítico. A mediana foi utilizada como medida-resumo para a análise descritiva e o Teste Qui-Quadrado de Pearson, para comparação de proporções. Resultados: Dos 104 profissionais de enfermagem, 14,4% relatam fazer uso dos registros para a gestão da informação em vacinação, 93,3% realizam o controle de estoque dos imunobiológicos, sendo esta a única atividade classificada como adequada. A produção do relatório de listagem de faltosos (39,4%), produção do relatório de cobertura vacinal (36,5%) e divulgação das informações consolidadas produzidas (17,3%) foram classificados como críticos. Não houve associações estatisticamente significativas entre as variáveis estudadas. Discussão: A subutilização das informações do sistema de informação traz consequências para os serviços de imunização, como baixas coberturas vacinais e oscilações nas proporções de abandono, além dificultar o planejamento e a tomada de decisões dos gestores das salas de vacinação. Conclusões: O uso das informações dos sistemas de informação precisa ser reconhecido pelos profissionais como necessário, útil e aplicável, sendo parte do processo de trabalho em sala de vacinação.

Understanding reporting practices and perceptions of barriers in adverse events following immunisation surveillance: A cross-sectional survey of paediatricians in Kerala, India

PURPOSE

The role of health care professionals (HCPs) is central to adverse event following immunisation (AEFI) surveillance. A cross-sectional survey was conducted among paediatricians practising in Kerala, India, to assess their knowledge and reporting behaviour in AEFI surveillance as well as to identify barriers to reporting.

RESULTS

A random sample of 380 paediatricians were contacted of whom, 243 (63.9%) participated in the survey. The understanding scores were distributed as follows: 30.9% very high or high, 40.3% moderate, and 28.8% low. Formal training was significantly associated with higher understanding scores, and increased AEFI detection and reporting. Only 42.0% of respondents had formal training; paediatricians in the public sector had higher access to training than those in the private sector. There were 141 respondents (58.0%) who identified an AEFI in the previous year, of whom 66 (46.8%) reported it. The main barriers to AEFI reporting were: difficulties with reporting process (28.9%); fear of raising public alarm (28.1%); time constraints (22.3%); fear of personal consequences (15.7%); and belief that health authorities rarely take useful action (11.6%).

CONCLUSION

Training in AEFI surveillance should be prioritised for HCPs with greater emphasis in medical education programmes. Study showed that a user-friendly reporting mechanism and a blame-free culture are crucial to improve AEFI reporting practices.

Correlates of Health Care Workers' Knowledge and HIV-Exposed Infant Immunization Counseling Practice in Northern Nigeria

BACKGROUND

Human Immunodeficiency Virus (HIV)-exposed and HIV-infected infants are at increased risk of vaccine-preventable diseases. However, little is known about health care workers' knowledge and immunization counseling practices in this population. We determined the predictors of health care workers' knowledge of vertical transmission risks, HIV exposed/infected infant immunization, and counseling practices in a tertiary center in Northern Nigeria.

METHODS

A cross-section of 297 health workers were interviewed using a structured, validated questionnaire. Knowledge and HIV-exposed infant immunization counseling practices were analyzed, and adjusted odds ratios for predictors were derived from logistic regression models.

RESULTS

Of the 297 participating health care workers, (32.3%, n=96) had adequate knowledge of HIV-exposed/infected infant immunization. Two-thirds (67%, n=199) of the participants appropriately identified the timing of infant diagnosis, while (73%, n=217) and (56.2%, n=167) correctly categorized infants as HIV-exposed and HIV-infected, respectively. Only (19.5%, n=58) participants had ever counselled a HIV-positive mother on infant immunization. Knowledge was predicted by work unit (HIV clinic vs. Obstetrics & Gynecology clinic), (Adjusted Odds Ratio (AOR) =3.78, 95% CI: 1.27-5.54), age (30-39 vs. <30 years), (AOR=2.24, 95% CI:1.19-5.67), years of experience (≥10 vs. <5), (AOR=1.76, 95% CI: 1.15-6.04), number of children (1 vs. 0), (AOR=1.73, 95% CI:1.14-4.23), infant immunization training (yes vs. no), (AOR=1.57, 95% CI:1.12-5.43), female sex (AOR = 1.17, 95% CI:1.06-2.21), profession (nurse/midwife vs. physician), (AOR=0.44, 95% CI:0.21-0.94) and previous HIV test (no vs. yes), (AOR=0.67, 95% CI:0.21-0.83).

CONCLUSION AND GLOBAL HEALTH IMPLICATIONS

Knowledge of HIV-exposed infant immunization was low and counseling practices were sub-optimal. Both immunization knowledge and counseling practices were predicted by demographic, professional, and training variables. Our findings indicate the need for educating health care workers on HIV exposed/infected infant immunization policy and improving counseling skills through capacity-building programs.

Knowledge of adverse events following immunization, its prevalence and actions of mothers of children aged 0–23 months in a tertiary health institution in Jos, North Central Nigeria

Background:

Adverse Event Following Immunization (AEFI) is any unfavorable event occurring following vaccination related to the vaccine administration and or its handling. AEFI can lead to death or a life-threatening condition requiring hospitalization with or without permanent sequel. Hence, this study was conducted to determine the knowledge of AEFI among mothers of children aged 0–23 months, its prevalence and actions of mothers of following AEFIs.

Methodology:

This was a cross-sectional study conducted among 400 mothers of children aged 0–23 months between November 2017 and April 2018 using quantitative method of data collection. IBM SPSS version 20 was used for data analysis where chi square was used as a test of association a P-value of ≤ 0.05 considered statistically significant.

Results:

The mean age of the respondents in the study was 29.0 ±5.3 years with 222 (55.5%) demonstrating good knowledge of AEFI. The prevalence of AEFI was found to be 46.5% with fever as the most experienced AEFI accounting for 90.3% of all cases experienced followed by pain and swelling mentioned by 141 (75.8%) and 26 (14.0%) respectively. Only 26 (14.5) of the mothers were adjudged to have taken appropriate action following the experience of AEFI in their children. Appropriateness of actions taken by the mothers following the occurrence of AEFI was influenced by the mother’s employment status (COR= 3.84; 95% CI=1.366–10.575; P=0.007).

Conclusion:

This study has demonstrated a sub-optimal level of knowledge of AEFI among the mothers of children aged 0–23 months with a relatively high self-reported prevalence and poor level of appropriateness of actions taken following AEFI.