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

Background information 1-MOH area 2-RDHS area 3-Estimated Population for the year Actual Population for the year Reasons for differences in actual and estimated populations 6-Crude Birth Rate for District Crude Birth Rate for Province Estimated Number of Births in the year 2015 Based on the Actual Population Based on the Estimated Population For District BR For Provincial BR 9-Number of Immunizations performed in the year 2015 (institutions and field) (Sum of relevant data from four Q/ EPI returns, 2015) PVV1PVV2PVV3 10-Number of pregnant mothers registered for the area in Number of actual births reported for the area in Number of infants registered for the area in The most probable number of births for the MOH area*

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

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 2015 to 31 st of December 2015 and the protection of their mothers from Tetanus and Rubella vaccination at the time of delivery Vaccine(AA) Number of pregnant mothers registered in year 2014 (A) Number of registered infants under care * (B) Number of estimated births for 2015 (C) Number of vaccinations according to BI registers/pregn ant mother registers /mothers cards (D) Number & % of age appropriate vaccinations according to BI registers** (E) Number of vaccines given according to Q/ EPI return Coverage according to Registered infants under care * Estimated births Formula (D/A)*100(C/A)* 100(C/B)* 100 BCG TT Rubella Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of January 2015 to 31 st of December 2015 Registered within 3 months of birth (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)

Coverage of OPV1 /PVV 1 vaccination among infants born between 01 st of November 2014 to 31 st of October 2015 Vaccine (AA) Number of pregnant mothers registered in year 2014 (A) Number of registered infants under care* (B) Number of estimated births For 2015 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers* * (E) Number of vaccines given according to Q/ EPI return Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI return Formula (D/A)*100(C/A) *100(C/B) *100(C/E)*100 PVV1 OPV1 Number of registered infants under care* (A) A = (V+W+X) - (Y+Z) Number of infants born between 1 st of November 2014 to 31 st of October 2015 registered within 3 months of birth (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)

Coverage of OPV3 /PVV 3 vaccination among infants born between 01 st of July 2014 to 31 st of June 2015 Vaccine (AA) Number of pregnant mothers registered in year 2014 (A) Number of registered infants under care* (B) Number of estimated births For 2015 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers* * (E) Number of vaccines given according to Q/ EPI return Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI return Formula (D/A)*100(C/A) *100(C/B) *100(C/E)*100 PVV3 OPV3 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 01 st of July 2014 to 31 st of June 2015 registered within 3 months of birth (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)

Coverage of MMR1 vaccination among infants born between 01 st of January 2014 to 30 th of June 2014 (at 1 year) 01 st July 2014 to 31 st March 2015 (at 9 months) Vaccine (A) Number of registered infants under care* (B) Number of estimated births For 2014 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers** (E) Number of vaccines given according to Q/ EPI return Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI returns Formula (D/A)*100(C/A)* 100(C/B)* 100(C/E) *100 MMR at 1 year MMR at 9 months Birth cohort Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) registered within 3 months of birth (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) MMR at 1 year MMR at 9 months

Coverage of LJEV vaccination among infants born between 01 st of April 2014 to 30 th of June 2014 (at 9 months) 01 st July 2014 to 31 st December 2014 (at 1 Year) Vaccine (A) Number of registered infants under care* (B) Number of estimated births For 2014 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers** (E) Number of vaccines given according to Q/ EPI return Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI returns Formula (D/A)*100(C/A)* 100(C/B)* 100(C/E) *100 LJEV (at 9 months) LJEV ((at 1 year) Birth cohort Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) registered within 3 months of birth (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) LJEV at 9 months LJEV at 1 year

Coverage of DPT4/OPV4 vaccination among infants born between 1 st of July 2013 to 30 th June 2014 Vaccine(AA) Number of pregnant mothers registered in year 2012 (A) Number of registered infants under care* (B) Number of estimated births 2013 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers* * (E) Number of vaccines given according to Q/ EPI return % Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI returns Formula (D/A)*100(C/A)* 100(C/B) *100(C/E)* 100 DPT4 OPV4 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of July 2013 to 30 th of June 2014 registered within 3 months of birth (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)

Coverage of MMR2 vaccination among infants born between 1 st of January 2012 to 31 st of December 2012 Vaccine (AA) Number of pregnant mothers registered in year 2011 (A) Number of registered infants under care* (B) Number of estimated births 2012 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers* * (E) Number of vaccines given according to Q/ EPI return Coverage of according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI returns Formula (D/A)*100(C/A)* 100(C/B) *100(C/E) *100 MMR2 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of January 2012 to 31 st of December 2012 registered within 3 months of birth (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)

Coverage of DT/OPV5 vaccination among infants born between 1 st of January 2010 to 31 st of December 2010 Vaccine(AA) Number of pregnant mothers registered in year 2009 (A) Number of registered infants under care * (B) Number of estimated births for 2010 (C) Number of vaccinations according to BI registers (D) Number & % of age appropriate vaccinations according to BI registers* * (E) Number of vaccines given according to Q/ EPI return % Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI returns Formula (D/A)*100(C/A)* 100(C/B)* 100(C/E) *100 DT OPV5 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of January 2009 to 31 st of December 2009 registered within 3 months of birth (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)

VaccinePHMM areas with low immunization coverages (%) according to estimated births registered infants under careage appropriate immunizations PHM area% % % BCG (ex.) %%% %%% %%% TT( Maternal) Rubella(Maternal) PVV1/OPV1 LJEV MMR1 DPT4/OPV4 MMR2 DT/OPV5 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 )

VaccinePHMM areas with high immunization coverages (%) according to estimated births registered infants under careage appropriate immunizations PHM area% % % BCG (ex.) %%% %%% %%% TT( Maternal) Rubella(Maternal) PVV1/OPV1 LJEV MMR1 DPT4/OPV4 MMR2 DT/OPV5 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 )

Identified PHMM areas with low immunization coverages for estimated births Action taken PHM area 1…………………………………. PHM area2……………………………………. PHM area3 ………………………………….. 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 age appropriate immunizations Action taken PHM area 1…………………………………… PHM area2………………………………………. PHM area3 ……………………………………….

Coverage of aTd vaccination among school children in grade 7 & other grades during 2015 by PHI areas & clinics NoPHI areaNumber on roll in grade 7 Number of children immunized in grade 7 % of immunized children in grade 7 Number of children immunized in other grades( or from other areas) Total number immunized in year Clinics Total

Antigen Book balance as of 31 st December 2014 (A) Total receipts during 2015 (B) Book balance as of 31 st of December 2015 (C ) No of doses discarded due to expiry or cold chain failure during 2015 (D) Total number of doses used during 2015 for vaccination ( E)= (A+B)-(C+D) Highest & Lowest book balances in a given time during the year 2015 No. of Immunizatio ns Performed by clinics/ schools/ estates/GPs ( Based on the four EPI quarterly Returns for year 2015) ( G ) No. of doses Distributed to Clinics/ schools/ GPs (Based on the MOH Office vaccine movement register 2015 ( H ) Usage % ( I )= G/E * 100 Wastage % ( J )= (100- I ) Highest (F1) Lowest (F2) B.C.G Penta DPT OPV IPV LJEV DT TT aTd MMR Form 11 Status of vaccine wastage in the MOH area by antigen in 2015

Adverse events following immunization (A.E.F.I.) No. of Monthly AEFI Returns expected to be sent to the Epidemiological Unit during No. of Monthly AEFI Returns sent No. of Monthly AEFI Returns sent in time No of “Nil” returns sent Type of AEFINumber ReportedNo Investigated% Investigated Injection site abscess BCG lymphadenitis Severe local reactions Encephalitis/Encephalopathy Meningitis Seizures (Febrile + Afebrile) Anaphylaxis Persistent Screaming HHE Types of AEFIs reported during 2015

AntigenType of AEFINumber of AEFI Reported (A) No of doses administered† (B) AEFI Rate ( C ) (C =(A)/(B)* National Rates for 2015** BCGBCG lymphadenitis PentaSeizures (Febrile + Afebrile) Anaphylaxis Persistent Screaming HHE Allergic reaction MeaslesSeizures (Febrile + Afebrile) Anaphylaxis Allergic reaction MMRSeizures (Febrile + Afebrile) Anaphylaxis Allergic reaction Parotitis JESeizures (Febrile + Afebrile) Anaphylaxis Allergic reaction Encephalitis/Encephalop athy Meningitis Other* Rates of AEFIs reported during 2015

Information regarding cold chain equipment in MOH office in 2015 Please bring the temperature charts and printouts of data lodger recordings for year 2015 to the review. RefrigeratorWorking order (Yes/No) Year of manufacture Capacity (liters) Thermometer in working Order (Yes/No) Data lodger in working Order (Yes/No) Freeze tag in working order (Yes/No) Temp. Chart maintained daily during the reporting period (12 months) (Yes/No) ILR Refrigerator 2 Freezer 1Were there any cold chain breakdowns during the reporting period? (If yes, please describe such situations) 2Who is in charge of the refrigerator and vaccine? 3Who is in charge of the daily recording of temperature? 4How often data lodger printout are being taking? 6How many print outs available in the file for the year under review? 7Were there situations vaccines exposed to sub zero temperatures? 8Were there any mismatch in temperature recordings and data lodger recordings? (If yes, please describe such situations with possible reasons)

Incidence of infant deaths, neo natal deaths and their causes – 2015 **Please use national Infant mortality rate 9.9 per 1000 live births to calculate the estimated number of infant deaths for year 2015 ( 7.0 Neonatal mortality rate-70% of Infant mortality ) No. Estimated** No. Reported% ReportedNo. Investigated% Investigated No. of live births Infant Deaths Neonatal Deaths Causes 1. Prematurity 2. Congenital Abnormalities No of infant deaths temporally associated with vaccination

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