Surveillance System Evaluation for COVID-19 Vaccine Associated Adverse Events following Immunization (AEFI) Sindh Pakistan 2021: Descriptive evaluation study
ABSTRACT
Background:
In February 2021, a mass vaccination campaign commenced in Sindh province in response to the COVID-19 epidemic. An adverse-events following immunization surveillance system (AEFI-SS) was established to monitor the adverse event following vaccination.
Objective:
We evaluated the AEFI-Surveillance System with the objectives to identify the strengths and weaknesses and suggest recommendations.
Methods:
In May-June 2021, a Descriptive evaluation study was done in Sindh-Pakistan. CDC’s updated guidelines for evaluation of surveillance system-2001 were followed to measure the qualitative, quantitative, and utility attributes of the AEFI-SS. Key stakeholders were identified based on their involvement in AEFI-SS and were interviewed. Case investigation proformas for AEFI were randomly reviewed for data quality, timeliness, and completeness. Sensitivity was calculated. Each attribute was rated as good, fair, and poor, based on a scoring legend.
Results:
The Surveillance system was useful to identify n=7147 cases of AEFI effectively. Timeliness of all AEFI cases was good and was found100%as all cases were reported within 24 hours. WHO-approved case definition was being used for the identification of AEFI cases and had a simple flow of information. AEFI-SS was good in data quality and completeness (100%), data collection tools were filled by trained medical officers. Sensitivity was 100%, predictive value positive (PVP) was not calculated due to the absence of a laboratory component. Good representativeness as >80% of the population is covered by 1004 vaccination centers. System was found stable as resources of the health department government of Sindh were being used. AEFI-SS was paper-based and deficient in a feedback mechanism.
Conclusions:
Province Sindh has an appropriate surveillance mechanism for AEFI detection and management for the ongoing COVID-19 vaccination surveillance system. The representativeness can be increased by the involvement of the private health sectors. Establishment of a feedback mechanism and digital data transformation and integration of the AEFI system with EPI is recommended.
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