EPI and VPD Review 2019 MOH Area 1

EPI and VPD Review- 2019 MOH Area: ……………….

1 -MOH area Background information 2 -RDHS area 3 -Estimated Population for the year 2019 4 -Actual Population for the year 2019 5 -Reasons for differences in actual and estimated populations 6 -Crude Birth Rate for District 2019 7 -Crude Birth Rate for Province 2019 8 -Estimated Number of Births in the year 2019 Based on the Actual Population Based on the Estimated Population For District BR For Provincial BR 9 -Number of Immunizations performed in the year 2019 (institutions and field) (Sum of relevant data from four Q/ EPI returns, 2019) PVV 1 10 -Number of pregnant mothers registered for the area in 2018 11 -Number of actual births reported for the area in 2019 12 - Number of infants registered for the area in 2019 13 -The most probable number of births for the MOH area* PVV 2 PVV 3

Background information……cont Approved number 14 -PHMs 15 -PHIs 16 -SPHMs 17 -PHNS 18 -SPHI 19 -MOHs/AMOHs 20. MCH Clinics Number available Average Population covered by each category / clinic Population Range

Area Map indicating access to immunization (Please present a map indicating immunization clinics and population served by each clinic )

Coverage of BCG vaccination among infants born between 1 st of January 2019 to 31 st of December 2019 and the protection of their mothers from Tetanus and Rubella vaccination at the time of delivery Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Vaccine Formula BCG TT Rubella Number of infants born between 1 st of January 2019 to 31 st of December 2019 Registered within 3 months of birth (V)**** (AA) Number of pregnant mothers registered in year 2018 Registered after 3 months Came newly into the area of birth to date^^ & registered to date^^ (W)**** (X) Left the area to date^^ (A) (B) (C) (D) (E) Number of Number & % Number of registered estimated vaccinations of age vaccines infants under births for according to BI appropriate given care * 2019 registers/pregn vaccinations according ant mother according to to Q/ EPI registers BI registers** return /mothers cards (D/A)*100 (Y) Died to date^^ (Z) Coverage according to Registered infants under care * Estimated births (C/A)* 100 (C/B)* 100

Coverage of OPV 1 /PVV 1/FIPV 1 vaccination among infants born between 01 st of November 2018 to 31 st of October 2019 Number of registered infants under care* (A) A = (V+W+X) - (Y+Z) Vaccine Formula PVV 1 OPV 1 FIPV 1 Number of infants born between 1 st of November 2018 to 31 st of October 2019 registered within 3 months of birth (V)**** (AA) (A) Number of Number pregnant of mothers registered infants in year under care* 2018 (B) registered after 3 months came newly into the of birth to date^^ area registered to date^^ (W)**** (X) (C) (D) left the area to date^^ (Y) (E) Number of Number & % Number estimated vaccinations of age of Registered births according to appropriate vaccines infants For 2019 BI registers vaccinations given under care* according to according BI registers* * to Q/ EPI return (D/A)*100 (C/A) *100 Died to date^^ (Z) Coverage according to Estimated births Number of vaccines given as per Q/ EPI return (C/B) *100 (C/E)*100

Coverage of OPV 2 /PVV 2/FIPV 2 vaccination among infants born between 01 st of Sptember 2018 to 31 st of August 2019 Number of registered infants under care* (A) A = (V+W+X) - (Y+Z) Vaccine Formula PVV 2 OPV 2 FIPV 2 Number of infants born between 01 st of Sptember 2018 to 31 st of August 2019 registered within 3 months of birth (V)**** (AA) (A) Number of Number pregnant of mothers registered infants in year under care* 2018 (B) registered after 3 months came newly into the of birth to date^^ area registered to date^^ (W)**** (X) (C) (D) left the area to date^^ (Y) (E) Number of Number & % Number estimated vaccinations of age of Registered births according to appropriate vaccines infants For 2019 BI registers vaccinations given under care* according to according BI registers* * to Q/ EPI returns (D/A)*100 (C/A) *100 Died to date^^ (Z) Coverage according to Estimated births Number of vaccines given as per Q/ EPI return (C/B) *100 (C/E)*100

Coverage of OPV 3 /PVV 3 vaccination among infants born between 01 st of July 2018 to 30 th of June 2019 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Vaccine Formula PVV 3 OPV 3 Number of infants born between 01 st of July 2018 to 30 th of June 2019 registered within 3 months of birth (V)**** (AA) (A) Number of Number pregnant of mothers registered infants in year under care* 2018 (B) registered after 3 months came newly into the of birth to date^^ area registered to date^^ (W)**** (X) (C) (D) left the area to date^^ (Y) (E) Number of Number & % Number estimated vaccinations of age of Registered births according to appropriate vaccines infants For 2019 BI registers vaccinations given under care* according to according BI registers* * to Q/ EPI return (D/A)*100 (C/A) *100 Died to date^^ (Z) Coverage according to Estimated births Number of vaccines given as per Q/ EPI return (C/B) *100 (C/E)*100

Coverage of MMR 1 vaccination among infants born between 01 st of April 2018 to 31 st of March 2019 No. of infants born between 01 st of April 2018 to 31 st of March 2019 Number of registered infants under care* (A) registered within 3 months of birth A = (V+W+X) - (Y+-Z) Vaccine Formula MMR 1 (V)**** registered after 3 months of birth to date^^ (W)**** came newly into the area registered to date^^ (X) left the area to date^^ (Y) Died to date^^ (Z) (AA) (B) (C) (D) (E) Coverage Number of Number & % Number of according to pregnant estimated vaccinations of age vaccines of mothers registered births according to appropriate given registered infants for BI registers vaccinations according to Registered Estimated Number of in year 2018 according to Q/ EPI under infants births vaccines 2017 BI return care* under care* given as registers** per Q/ EPI returns (D/A)*100 (C/A)* 100 (C/B)* 100 (C/E) *100

Coverage of LJEV vaccination among infants born between 1 st of January 2018 to 31 st of December 2018 No. of infants born between Number of registered infants under care* (A) 1 st of January 2018 to 31 st of December 2018 registered within 3 registered after 3 months of birth to date^^ A = (V+W+X) - (Y+-Z) Vaccine Formula LJEV (V)**** (W)**** came newly into the area registered to date^^ (X) left the area to date^^ (Y) Died to date^^ (Z) (AA) (B) (C) (D) (E) Coverage according to Number & % Number of of age of of of estimated vaccinations appropriate vaccines pregnant registered births according to vaccinations given mothers infants For BI registers according to according Registered Estimated Number of registered under infants births vaccines 2018 BI to Q/ EPI in year care* under care* given as per registers** return 2017 Q/ EPI returns (D/A)*100 (C/A)* 100 (C/B)* 100 (C/E) *100

Coverage of DPT 4/OPV 4 vaccination among infants born between 1 st of July 2017 to 30 th June 2018 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Vaccine Formula DPT 4 OPV 4 Number of infants born between 1 st of July 2017 to 30 th of June 2018 registered within 3 months of birth (V)**** registered after 3 months came newly into the of birth to date^^ area registered to date^^ (W)**** (X) left the area to date^^ (Y) Died to date^^ (Z) (AA) (B) (C) (D) (E) % Coverage according to Number of Number & % Number registered estimated vaccinations of age of of infants births according to appropriate vaccines pregnant Registered Estimated Number of under BI registers vaccinations given mothers infants births vaccines care* 2017 according to according registered under given as per BI registers* * to Q/ EPI in year care* Q/ EPI return 2016 returns (D/A)*100 (C/A)* 100 (C/B) *100 (C/E)* 100

Coverage of MMR 2 vaccination among infants born between 1 st of January 2016 to 31 st of December 2016 Number of registered infants under care* registered within 3 months of birth (A) A = (V+W+X) - (Y+-Z) Vaccine Formula MMR 2 Number of infants born between 1 st of January 2016 to 31 st of December 2016 (V)**** registered after 3 months came newly into the of birth to date^^ area registered to date^^ (W)**** (X) left the area to date^^ (Y) Died to date^^ (Z) (AA) (B) (C) (D) (E) Coverage of according to Number of Number & % Number pregnant of vaccinations of age of mothers registered estimated according to appropriate vaccines Registered Estimated Number of registered infants births BI registers vaccinations given infants births vaccines in year under 2016 according to according given as 2015 care* BI registers* * to Q/ EPI under care* per Q/ EPI returns (D/A)*100 (C/A)* 100 (C/B) *100 (C/E) *100

Coverage of DT/OPV 5 vaccination among infants born between 1 st of January 2014 to 31 st of December 2014 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Vaccine Number of infants born between 1 st of January 2014 to 31 st of December 2014 registered within 3 months of birth (V)**** registered after 3 months came newly into the area of birth to date^^ registered to date^^ (W)**** (X) (AA) (B) (C) (D) Number of Number & % pregnant registered estimated vaccinations of age mothers infants births for according to appropriate registered under care * BI registers vaccinations in year 2014 according 2013 to BI registers* * left the area to date^^ (Y) (E) Number of vaccines given according to Q/ EPI return Died to date^^ (Z) % Coverage according to Registered Estimated infants under births care* Number of vaccines given as per Q/ EPI returns Formula (D/A)*100 DT OPV 5 (C/A)* 100 (C/B)* 100 (C/E) *100

PHM areas with low immunization coverages (Please include the data for the 3 PHMM areas where the lowest immunization coverages have been reported under each category) Vaccine PHMM areas with low immunization coverages (%) according to estimated births PHM area BCG (ex. ) TT( Maternal) Rubella(Maternal) PVV 1/OPV 1/FIPV 1 PVV 2/OPV 2/FIPV 2 PVV 3/OPV 3 MMR 1 LJEV DPT 4/OPV 4 MMR 2 DT/OPV 5 registered infants under care % PHM area % 1 % 2 % 3 % 1 2 3 % % % age appropriate immunizations PHM area % 1 2 3 % % %

PHM areas with high immunization coverages (Please include the data for the 3 PHMM areas where the highest immunization coverages have been reported under each category) Vaccine PHMM areas with high immunization coverages (%) according to estimated births PHM area BCG (ex. ) TT( Maternal) Rubella(Maternal) PVV 1/OPV 1/FIPV 1 PVV 2/OPV 2/FIPV 2 PVV 3/OPV 3 MMR 1 LJEV DPT 4/OPV 4 MMR 2 DT/OPV 5 registered infants under care % PHM area % 1 % 2 % 3 % 1 2 3 % % % age appropriate immunizations PHM area % 1 2 3 % % %

Action taken to overcome the low immunization coverages according to estimated births & according to low age appropriate immunizations (Based on previous year EPI review) Identified PHMM areas with low immunization coverages for estimated births PHM area 1…………………. Action taken PHM area 2…………………. PHM area 3 …………………. . Identified PHMM areas with low immunization coverages for age appropriate immunizations PHM area 1………………… PHM area 2……………………. PHM area 3 ……………………. Action taken

Coverage of a. Td vaccination among school children in grade 7 & other grades during 2019 by PHI areas No PHI area 1 2 3 4 5 6 7 8 9 10 11 Clinics ( If PHI area is unknown/not marked but children are attending to schools located in your MOH area) Total Number of % of vaccinated on roll vaccinations children in in given to children grade 7 in grade 7 (In Schools + clinics) (A) (B) (C )=(B)/(A)*100% Number of vaccinations given to children in other grades (D) Number of Total number vaccinations given to vaccinated in children who came year 2019 from other areas or attend schools located outside the MOH area (E) (F)=(B)+(D)+(E)

Coverage of HPV vaccination among female children who were in grade 6 in year 2019 ( but vaccinated from 1 Q 2019 to date ) by PHI areas 1 2 3 4 5 6 7 8 9 Clinics ( If PHI area is unknown/not marked but children are attending to schools located in your MOH area) Total Number of vaccinations given to children who came from other areas or attend schools located outside the MOH area Number of HPV 2 doses given in both schools & clinics in (Dc)=Total (Dc)=(Da+Db) (Db) 2020 (D) (Da) 2019 (Ba) 2019 Number of HPV 1 given HPV 1 coverage of female children in both schools and year 2019 cohort in grade 6 in clinics in year 2019 (A) (B) (C)= (Bc) / (A)*100 (Bc=Total (Bc)=(Ba+Bb) PHI area (Bb) 2020 No HPV 2 coverage of year 2019 cohort (E)= (Dc) / (A)*100

Status of vaccine wastage in the MOH area by antigen in 2019 Antigen Book balance as of 31 st December 2018 (A) B. C. G Penta DPT OPV LJEV DT TT a. Td MMR IPV HPV Total Book receipts balance as during of 31 st of 2019 December 2019 (B) (C ) No of doses discarded due to expiry or cold chain failure during 2019 (D) Total number of doses used during 2019 for vaccination ( E)= (A+B)-(C+D) Highest & Lowest book balances in a given time during the year 2019 Highest (F 1) Lowest (F 2) No. of Usage Immunizatio doses % ns Distributed Performed to Clinics/ by clinics/ schools/ GPs estates/GPs (Based on ( Based on the MOH the four EPI Office quarterly vaccine Returns for movement year 2019) register 2019 ( I )= ( G ) ( H ) G/E * 100 Wastage % ( J )= (100 - I )

Adverse events following immunization (A. E. F. I. ) No. of Monthly AEFI Returns expected to be sent to the Epidemiological Unit during 2019 12 No. of Monthly AEFI Returns sent on time No of “Nil” returns sent Emergency tray Availability –Yes/No Taking to the clinic/school- Yes/No Types of AEFIs reported during 2019 Type of AEFI Injection site abscess BCG lymphadenitis Severe local reactions Encephalitis/Encephalopathy Meningitis Seizures (Febrile + Afebrile) Anaphylaxis Persistent Screaming HHE Deaths Nodules Number Reported No Investigated % Investigated

Antigen Type of AEFI Rates of AEFIs reported during 2019 Number of AEFI Reported (A) No of doses administered (B) BCG lymphadenitis Penta Seizures (Febrile + Afebrile) Anaphylaxis Persistent Screaming HHE Allergic reaction DPT Seizures (Febrile + Afebrile) Anaphylaxis Persistent Screaming HHE Allergic reaction MMR Seizures (Febrile + Afebrile) Anaphylaxis Allergic reaction Parotitis JE Seizures (Febrile + Afebrile) Anaphylaxis Allergic reaction Encephalitis/Encephalopathy Meningitis HPV Other* Anaphylaxis Allergic reaction Fainting attacks(syncope) AEFI Rate ( C ) (C =(A)/(B)*100000 National Rates for 2019**

Form 14: Status of cold chain maintenance Information regarding cold chain equipments in MOH office in 2019 Type No. available No. in Working order Year of manufacture Date of receipt/purchase Date of expiry Capacity(liters) ILR Freezer Domestic Refrigerator Thermometer Fridge tag Please bring the temperature charts and printouts of Fridge tag recordings for year 2019 to the review. 1 2 3 4 5 6 7 8 Were there any cold chain breakdowns during the reporting period? (If yes, please describe such situations) Who is in charge of the refrigerator and vaccine? Who is in charge of the daily recording of temperature? Has the temperature chart maintained daily during the reporting period (12 Months)? How often Fridge tag printout are being taking? How many print outs available in the file for the year under review? Were there situations vaccines exposed to sub zero temperatures? Were there any mismatch in temperature recordings and fridge tag recordings? (If yes, please describe such situations with possible reasons) Generator Availability –Yes/No In working order- Yes/No Voltage Stabilizer Availability –Yes/No In working order- Yes/No Portable oxygen cylinder Availability –Yes/No In working order- Yes/No Contingency plan Availability –Yes/No Auto start / Manual start Taking to the clinic- Yes/No

Incidence of infant deaths, neo natal deaths and their causes – 2019 **Please use national Infant mortality rate 8. 5 per 1000 live births to calculate the estimated number of infant deaths for year 2019 ( 6. 0 Neonatal mortality rate-70% of Infant mortality ) No. Estimated** No. of live births Infant Deaths Neonatal Deaths Causes 1. Prematurity 2. Congenital Abnormalities 3. 4. 5. 6. 7. No of infant deaths temporally associated with vaccination No. Reported % Reported No. Investigated % Investigated

Notification and investigation of Vaccine Preventable Diseases (VPD)- 2019 Disease No. Reported No. Investigated* No, confirmed % Investigated (A) (B) (C) (D)=(B)/(A)*100 Whooping Cough Tetanus NNT Measles Rubella CRS AFP Encephalitis Meningitis Mumps Total No. of special investigation forms sent (E) % of special investigation forms sent (F)=(E)/(C)*100