This document provides information about adverse events following immunization (AEFI), specifically addressing toxic shock syndrome (TSS) and anaphylaxis. It discusses program errors as a common cause of AEFI and outlines proper vaccine handling, storage, and administration to minimize errors. The document also describes signs and symptoms of TSS and anaphylaxis, as well as their treatment, including use of epinephrine, IV fluids, antibiotics, and management of affected organ systems. It emphasizes the importance of rapid transport and treatment of serious AEFI cases.

1. What Happened- What to Do? Toxic Shock Syndrome after immunization With a bit more on serious AEFI

3. Only licensed vaccines ( by DCGI) are used in the Immunization Programme in India .•Every batch of vaccine manufactured undergoes various safety tests at Central Research Institute Kasauli. • Vaccines are transported at recommended temperatures from the manufacturers to the stores and beneficiaries in cold chain • At the end user level VVM Vaccine Vial Monitors is used to monitor exposure to temperatures. • Only trained Health workers Operational details on 2 nd Opportunity for Measles Vaccination Measles Media Workshop Gauhati Assam 2 nd November 2010 Remember:

4. • A medical event that takes place after immunization, causes concern in the community and is believed to be caused by the immunization. • Program errors account for more than 95% of the total AEFI. Adverse Event following immunization Operational details on 2 nd Opportunity for Measles Vaccination Measles Media Workshop Gauhati Assam 2 nd November 2010

5. Program Error : (>95%) Due to error in vaccine preparation, handling or administration . Examples : 􀂃 1.Use of wrong or expired vaccine. 􀂃 2.Incorrect reconstitution or using reconstituted vaccine after 4 hrs. 􀂃 3.Use of wrong injection technique 􀂃 4.Using frozen freeze sensitive vaccines AEFI 2 nd November 2010

6. • Emphasis in vaccinator training about safe injection practices for zero programme errors • All PHCs will work as AEFI management centres • Additional sites at private sector clinics also to work as AEFI management centres • AEFI trays provided down to PHC level • Doctors at above sites trained in AEFI management • VHSCs will be empowered to transport the serious AEFI cases to the nearest AEFI Management centre • Wherever required, private practitioners will be identified for AEFI management & will also be trained on AEFI • Involvement of professional bodies Immunization Handbook for Medical Officers 2008 Training for Medical Officers

7. Toxic Shock syndrome Immunization Handbook for Medical Officers 2008

11. • Use Measles and BCG vaccine within 4 hours of reconstitution. If they could not be used with in 4 hours then reconstituted vials should be discarded, irrespective of number of doses remaining in the vials. ……… .When a severe adverse event occurs, the health worker should immediately contact the Medical Officer and if needed should accompany the patient. Immunization Handbook for Health workers 2006 Training for Field Workers 2006

16. Contents of an AEFI Treatment kit

21. If already unconscious, place the patient in the recovery position and ensure that airway is clear. Assess heart rate and respiratory rate (if the patient has a strong carotid pulse, he/she is probably not suffering from anaphylaxis). If appropriate, begin cardiopulmonary resuscitation (CPR). Give adrenaline 1:1000 (See below for correct dose for age or weight) by deep intramuscular injection into the opposite limb to that in which the vaccine was given. (Subcutaneous administration is acceptable in mild cases) and give an additional half dose around the injection site (to delay antigen absorption). If the patient is conscious after the adrenaline is given, place his/her head lower than the feet and keep the patient warm. Give Inj. Hydrocortisone IM or slow IV per dosage chart below. Give oxygen by face mask, if available. Call for professional assistance but never leave the patient alone. Call an ambulance (or arrange other means of transport, after the first injection of adrenaline, or sooner if there are sufficient people available to help you. Measles catch-up campaign planning and implementation guidelines 2010

22. Immunization Handbook for Medical Officers 2008 If there is no improvement in the patient’s condition within 10-20 minutes, of the first injection, repeat the dose of adrenaline up to a maximum of three doses in total. Recovery from anaphylactic shock is usually rapid after adrenaline.

24. Measles catch-up campaign planning and implementation guidelines 2010

25. WHO 1997

26. WHO 1997

27. WHO 1997