Evaluation of Reporting Adverse Events Following Immunization in Selected Bangladeshi Cities

Background: The response of an immunization program to adverse events increases community trust. Bangladesh Expanded Program on Immunization (EPI) has been conducting surveillance to detect and manage adverse events following immunization (AEFI) from city corporations since 2003. We evaluated the simplicity, timeliness, data quality, acceptability, flexibility, stability, and usefulness of AEFI surveillance in Bangladesh.

Methods: We conducted AEFI surveillance evaluation in city corporations of Bangladesh, using mixed methods from January 1, 2014, to April 30, 2015. We used the US Centers for Disease Control and Prevention (CDC) surveillance evaluation tool developed in 2001. An adverse event was defined as a medical incident after an immunization caused concern and was thought to be caused by vaccination. According to performace of AEFI reporting in 2013, we selected Dhaka North, Chattogram, Khulna, Rajshahi and Sylhet city corporations for the in-depth interviews. We interviewed field workers, EPI supervisors, and medical officers about their reporting practices. We performed descriptive analysis of surveillance data and thematic analysis of interviews.

Results: A total of 129 AEFIs were reported by the AEFI surveillance from city corporations in 2013. Timeliness of weekly AEFI submission was 0% – to 46%. Interviews with EPI supervisors identified common factors were delay in getting reports from hospital AEFI reporting sites, shortage of manpower, excessive workloads, and paper based reporting. Common incompleteness was found in address of the child (18%) and parent information (11%). Aacceptance of AEFI surveillance was higher in nongovernmental organization (NGO) reporting sites than in hospitals and private clinics. Most field workers did not received AEFI training in previous five years.

Conclusion: Although AEFI surveillance was simple, flexible, stable, and useful, the evaluation identified gaps in timeliness, completeness and acceptability of AEFI reporting. We recommended electronic reporting (e-mail), and dedicated AEFI training for field workers upon recruitment to improve timeliness, data quality, and overall acceptability of the surveillance.