Barriers to healthcare workers reporting adverse events following immunization in four regions of Ghana

Geopharmacosurveillance of reporting rates of events supposedly attributable to vaccination or immunization against COVID-19

to analyze the spatial distribution of the reporting rate of events supposedly attributable to vaccination or immunization against COVID-19 and factors associated with achieving the target recommended by the Global Vaccine Action Plan.

ecological study that considered notifications from 853 municipalities in the state of Minas Gerais. A total of 34,027 notifications recorded in the e-SUS Notifica system were analyzed. Getis-Ord Gi* and Geographically weighted regression were performed to identify spatial clusters, compliance with at least 10 notifications and factors correlated with spatial distribution.

a heterogeneous distribution of reporting rates was observed throughout the state. A total of 20.3% of municipalities did not meet the recommended reporting target. The municipalities in the Northwest, Jequitinhonha and Vale do Aço macro-regions had the highest reporting rates in the state, while those in the East, East South and West macro-regions had the lowest rates. The number of nursing professionals per inhabitant (regression coefficient= 0.644; p< 0.01) and the percentage of families living in rural areas (regression coefficient= -0.013; p< 0.01) were associated with reporting rates.

the presence of clusters of low reporting rates highlights the need to implement integrated strategies adapted to the particularities of each region to enhance event reporting surveillance.

Assessment of Pharmacovigilance Across University Hospitals in Morocco

INTRODUCTION

Despite the increased scrutiny on vaccine safety following the coronavirus disease 2019 (COVID-19) pandemic, Morocco's Centre of Antipoison and Pharmacovigilance (CAPM) remained concerned that the pharmacovigilance system in Morocco was insufficiently implemented, including limited adverse event (AE) reporting, poor data use, and inconsistent training nationwide.

OBJECTIVES

We sought to assess the status of pharmacovigilance activities (PAs) prior to formally institutionalizing them across university hospital centers (UHCs), given their position as the main providers of healthcare in Morocco and key sources for reporting serious AEs.

METHODS

We assessed seven UHCs (housing 30 hospitals) in 2023 using a structured questionnaire with pharmacovigilance focal points developed from the World Health Organization's indicators of pharmacovigilance and the Global Benchmarking Tool. Data were grouped into 28 PAs and scored from 0 (not implemented) to 3 (fully implemented). We then calculated an implementation rate for each site on the basis of percent of PAs fully implemented (≥ 70%, well established; > 40% to < 70%, partially implemented; and ≤ 40%, not implemented). A desk review was also performed at the sites. Using the results of the assessment, three working groups of pharmacovigilance stakeholders developed recommendations to be formally adopted by UHCs.

RESULTS

Basic elements of pharmacovigilance (notification forms and VigiFlow® or Excel databases) were present at all the UHCs assessed. In total, 14 hospitals (47%) had well-established PAs, including advanced activities such as signal detection of adverse events following the use of medicines and vaccines, as well as causality assessment; 9 hospitals (30%) were partially implementing pharmacovigilance, and 7 hospitals (23%) had no established activities or very basic activities. Within four UHCs, activities had not been implemented at the same level from one hospital to another and vaccine vigilance was largely deprioritized. The working groups made recommendations for improving collaboration, standardizing procedures, and outlining a new organizational structure for pharmacovigilance, which was institutionalized by a formal agreement among UHCs in July 2023.

CONCLUSIONS

The assessment revealed a subgroup of centers with well-established AE signal detection and causality assessment abilities, which could play a leading role in the country. After the site assessment, our collaborative approach of bringing together focal points to identify next steps and generate buy-in helped to formalize pharmacovigilance across centers.

Adverse reactions of four multi-targeted tyrosine kinase inhibitors: a descriptive analysis of the WHO-VigiAccess database

Background

The introduction of multi-targeted tyrosine kinase inhibitors (MTKIs) such as axitinib, lenvatinib, sorafenib, and sunitinib has greatly broadened the available treatment options for Renal Cell Carcinoma (RCC). The study aims to compare the nature of the adverse reactions associated with these four MTKIs to identify which medication poses the least risk for personalized patient management, thus enabling more accurate clinical drug oversight.

Methods

Employing a retrospective descriptive analysis methodology, this research concentrated on four commercially available MTKIs. Reports pertaining to these medications were sourced from the WHO-VigiAccess database. The data gathering process involved collecting comprehensive information on various parameters, such as age demographics, gender, and the geographical distribution of patients associated with the ADR reports. Furthermore, the study explored disease systems and symptoms that were documented alongside the adverse reactions, as outlined in the annual ADR reports produced by the WHO. To assess the relationship between these four MTKIs and the linked AEs, both the Proportional Reporting Ratio (PRR) and the Reported Odds Ratio (ROR) were utilized.

Results

At the time of the search, a total of 123,818 AEs associated with the four MTKIs had been documented in the VigiAccess database. The common ADRs for these four MTKIs include diarrhoea, fatigue, death, hypertension, nausea, asthenia, weight decreased, and vomiting. Gastrointestinal disorders and general disorders and administration site conditions emerged as the SOCs with the highest number of adverse signals, both ranking first in terms of frequency. The elevated ROR (1.08) and PRR (1.06) values associated with gastrointestinal disorders in patients treated with sorafenib suggest a higher incidence of such adverse events compared to those observed with axitinib, lenvatinib, and sunitinib.

Conclusion

Recent comparative observational research suggests that the ADR reports submitted to the WHO and the FDA for these medications highlight both common and specific ADRs. It is essential for clinical practitioners to develop personalized treatment strategies that consider the adverse effects linked to different medications, alongside the unique circumstances of their patients, thus encouraging the responsible use of these MTKIs.

Adverse event profile of lomustine and temozolomide: a descriptive analysis from WHO-VigiAccess

Introduction

In gliomas, various oncogenic factors can lead to an imbalance between cell proliferation and apoptosis. Lomustine inhibits tumor cell growth by disrupting DNA replication and repair mechanisms. In contrast, temozolomide, an imidazole tetrazine compound, promotes cell apoptosis through DNA alkylation. The present study aimed to systematically analyze and compare the adverse drug reactions (ADRs) associated with lomustine and temozolomide, as reported in the World Health Organization (WHO) VigiAcess database.

Methods

Utilizing a retrospective descriptive analysis design, this study focused on two commercially available anti-glioma drugs. ADR reports pertaining to these medications were collected from the WHO-VigiAccess database. The data collection process involved gathering detailed information on various parameters, including age groups, gender, and geographical distribution of patients involved in the ADR reports. Additionally, the study examined the disease systems and symptoms reported alongside the adverse reactions, as recorded in the annual ADR summaries generated by the WHO. By calculating the proportion of adverse events reported for each drug, this investigation provided a comparative analysis of both the similarities and differences in the adverse reactions observed across the two anti-glioma drugs.

Results

At the time of the search, a total of 22,854 adverse events (AEs) associated with the two anti-glioma drugs were documented in the VigiAccess database. Lomustine exhibits a higher reporting rate concerning blood and lymphatic system disorders, gastrointestinal disorders, and hepatobiliary disorders. In contrast, Temozolomide has a higher reporting rate for general disorders and administration site conditions, nervous system disorders, and skin and subcutaneous tissue disorders. The top five types of AEs for anti-glioma drugs are as follows: general disorders and administration site conditions (8,825 cases, 38.61%), blood and lymphatic system disorders (7,369 cases, 32.24%), gastrointestinal disorders (5,614 cases, 24.56%), nervous system disorders (5,047 cases, 22.08%), and investigations (4,855 cases, 21.24%).

Conclusion

The present comparative observational study indicates that these inhibitors are associated with both common and specific adverse reactions, as documented in ADR reports. Clinicians should formulate individualized treatment plans that consider the adverse reactions linked to various drugs and the specific conditions of each patient, thereby promoting the rational use of these costly medications.

Barriers and strategies to improve vaccine adverse events reporting: views from health workers and managers in Northern Ghana

Background

The increasing incidence of novel vaccine-preventable diseases, such as COVID-19, has led to an increase in the development of vaccines globally. Vaccine hesitancy has risen due to fears of vaccines causing harm. African health systems have generally relied on spontaneous reporting of adverse events following immunisation (AEFIs) to monitor vaccine safety.

Objectives

This study explored the views of healthcare professionals and managers regarding barriers and strategies to improve AEFI reporting in northern Ghana.

Methods

This study used a qualitative research design where in-depth interviews were conducted with health professionals and managers in five administrative regions in northern Ghana between March and August 2021. The purposive sampling method was used to select districts and participants. The interviews were audio recorded, transcribed, and coded into themes using QSR NVivo V.12 software before thematic content analysis.

Results

The study found that lack of feedback is the main regulatory-level factor affecting reporting adverse events. Health system-level factors, such as limited knowledge of reporting AEFIs, a lack of training, difficulties in using electronic application software to complete AEFI forms, and fear of punishment, significantly affect AEFI reporting. At the patient/community level, the main factors affecting AEFI reporting are the distance to health facilities and transportation costs. However, participants suggested continuous AEFI education, sensitisation of health workers and patients, timely feedback, and effective stakeholder collaboration among front-line health workers, health managers, and the national pharmacovigilance authority could improve AEFI reporting in Ghana.

Conclusions

Reporting of AEFIs contributes to improving vaccine safety, surveillance systems and prompt case management. However, the study identified multiple key factors at the regulatory, health system, and patient levels affecting AEFI reporting. Thus, improvements in line with these suggestions, including effective stakeholder engagement, are necessary to increase AEFI reporting.

Documenting capacity and existing gaps in reporting adverse events following immunisation in Northern Ghana: a quantitative cross-sectional survey of healthcare workers

Background

Immunisation remains an indispensable tool in preventing infectious diseases. A robust pharmacovigilance system assures the public of vaccine safety, particularly in countries like Ghana where there is relatively low reporting of adverse events following immunisation (AEFIs). We explored the experiences of health workers in Ghana to ascertain the existing capacity for data collection and information reporting flows for health events associated with vaccination in the country.

Methods

We conducted a cross-sectional quantitative survey among healthcare workers (HCWs) in Ghana between December 2020 and April 2021. We documented their experiences with regard to knowledge, perceptions and practice of reporting AEFIs to the national pharmacovigilance centre (Ghana Food and Drugs Authority).

Results

Out of 851 participants, 49.2% said their institutions had processes for AEFI reporting. Additionally, 25% of participants had encountered an AEFI within the past year. Out of this number, 55% reported the AEFI. Only 31.2% of community health nurses (vaccinators) considered AEFI reporting part of their job description. Most HCWs (59.34%) had fair to poor knowledge of AEFIs. The main factors affecting AEFI reporting were heavy workload and lack of time (54.1%) and unavailability of reporting forms (57.5%). Only 2% of participants were aware AEFIs could be reported online. Logistic regression analysis revealed female gender as a negative factor influencing AEFI reporting. Training (p<0.0001) and profession (p=0.006) significantly influenced knowledge level of AEFIs. Results of the multiple binary logistic regression indicate that the age and profession of HCWs are the main factors influencing knowledge of reporting AEFIs.

Conclusion

The vaccine pharmacovigilance system in Ghana can be strengthened with targeted regular training on AEFI reporting, guidelines for reporting in all health facilities and prompt feedback from the national pharmacovigilance centre to health workers.

Efficacy and feasibility of SMS m-Health for the detection of adverse events following immunisation (AEFIs) in resource-limited setting-The Zimbabwe stimulated telephone assisted rapid safety surveillance (Zm-STARSS) randomised control trial

INTRODUCTION

The mHealth active participant centred (MAPC) adverse events following immunisation (AEFI) surveillance is a promising area for early AEFI detection resulting in risk minimisation. Passive (spontaneous) AEFI surveillance is the backbone for vaccine pharmacovigilance, but has inherent drawbacks of under reporting, and requires strengthening with active surveillance methods.

AIM

The Zimbabwe stimulated telephone assisted rapid safety surveillance (Zm-STARSS) randomised controlled trial (RCT) sought to evaluate the efficacy and feasibility of AEFI detection using a short message service (SMS) and computer assisted telephone interview (CATI) approach.

METHOD

A multicentre Zm-STARSS RCT enrolled consented adult vaccinees or parents or guardians of children receiving vaccines, including COVID-19 vaccines, at study vaccination clinics. At enrolment study participants were randomised to either SMS-CATI group or control group. SMS prompts were sent on days 0-2 and 14 post-vaccination to SMS-CATI group to ascertain if a medically attendance or attention due to an Adverse event following immunisation (AEFI) had occurred. However, no SMSs were sent to the control group. SMS-CATI group who responded "Yes" to SMS prompts were interviewed by research healthcare workers (RHCWs) who completed a CATI to determine if an AEFI had occurred whilst an AEFI in control group was determined from passive AEFI reporting channels. The primary study outcome was the AEFI detection rate in the SMS-CATI group compared to the control group.

RESULTS

A total of 4560 participants were enrolled after signed informed consent, all were encouraged to report AEFIs and randomised automatically on 1:1 basis into two arms SMS CATI intervention group (n = 2280) and a control passive AEFI surveillance group (n = 2280) on day 0. A total of 704 (31 %) participants responded to the SMS prompts, with 75 % (528/704) indicating "No" and 25 % (176/704) reporting "Yes" to seeking medical attention or attendance post-immunisation. 69 % (121/176) completed a CATI survey but in only 36 % (44/121) was the AEFI confirmed. There were no AEFIs reported in control group participants. The detection rate of a AEFI associated with medically attendance or attention using the SMS-CATI methodology was 2 % (44/2280) on an intention to treat cohort.

CONCLUSION

Despite the low SMS response and CATI completion rate, we demonstrated that Zm-STARSS SMS system improves AEFI detection compared to passive AEFI surveillance. We recommend that this and similar approaches are explored further using cost-effective multi-channel digital approaches for holistic pharmacovigilance to improve AEFI detection in Low Middle-Income Countries (LMICs) for all vaccines.

Barriers to optimal AEFI surveillance and documentation in Nigeria: Findings from a qualitative survey

Effective spontaneous AEFI reporting is the first step to ensuring vaccine safety. Half of the global population lives in countries with weak vaccine safety monitoring systems, especially in the African, Eastern Mediterranean, and Western Pacific regions. Further, Immunisation services have been upscaled without commensurate effective AEFI surveillance systems. Hence, this study aims to comprehensively investigate the impediments to an effective AEFI surveillance system. Given the programmatic and regulatory implications, understanding these impediments would facilitate the development and implementation of policies and strategies to strengthen the AEFI surveillance system in Nigeria. A qualitative research design (using a grounded theory approach) was employed by conducting ten key informant interviews and two Focus Group Discussion sessions among the study population to identify the barriers impeding optimal AEFI surveillance and documentation in Nigeria. This study found that the AEFI surveillance system is in place in Nigeria. However, its functionality is sub-optimal, and the potential capacity is yet to be fully harnessed due to health systems and socio-ecological impediments. The identified impediments are human-resource-related issues- knowledge gaps; limited training; lack of designated officers for AEFI; excessive workload; poor supportive supervision and attitudinal issues; caregiver's factor; governance and leadership- moribund AEFI committee; lack of quality supervisory visit and oversight and weak implementation of AEFI policy guidance. Others include funding and logistics issues- no dedicated budget provision and weak referral mechanism; insecurity; socio-economic and infrastructural deficits- poverty, geographical barriers, limited ICT skills, and infrastructure; and poor feedback and weak community engagement by the health workers. Findings from this study provide empirical evidence and serve as an advocacy tool for vaccine pharmacovigilance strengthening in Nigeria. Addressing the impediments requires health system strengthening and a whole-of-the-society approach to improve vaccine safety surveillance, restore public confidence and promote vaccine demand, strengthen PHC services, and contribute to attaining UHC and SDGs.

Characteristic analysis of adverse reactions of five anti-TNFɑ agents: a descriptive analysis from WHO-VigiAccess

Introduction: Tumor necrosis factor (TNF) inhibitors (adalimumab, infliximab, etanercept, golimumab, and certolizumab pegol) have revolutionized the treatment of severe immune-mediated inflammatory diseases, including rheumatoid arthritis, Crohn's disease, psoriatic arthritis, ankylosing spondylitis, and ulcerative colitis. This study assessed adverse drug reactions (ADRs) after the use of TNFα inhibitors in VigiAccess of the World Health Organization (WHO) and compared the adverse reaction characteristics of five inhibitors to select the drug with the least risk for individualized patient use. Methods: The study was a retrospective descriptive analysis method in design. We sorted out five marketed anti-TNFα drugs, and their ADR reports were obtained from WHO-VigiAccess. Data collection included data on the age groups, sex, and regions of patients worldwide covered by ADR reports, as well as data on disease systems and symptoms caused by ADRs recorded in annual ADR reports and reports received by the WHO. By calculating the proportion of adverse reactions reported for each drug, we compared the similarities and differences in adverse reactions for the five drugs. Results: Overall, 1,403,273 adverse events (AEs) related to the five anti-TNFα agents had been reported in VigiAccess at the time of the search. The results show that the 10 most commonly reported AE manifestations were rash, arthralgia, rheumatoid arthritis, headache, pneumonia, psoriasis, nausea, diarrhea, pruritus, and dyspnea. The top five commonly reported AE types of anti-TNFα drugs were as follows: infections and infestations (184,909, 23.0%), musculoskeletal and connective tissue disorders (704,657, 28.6%), gastrointestinal disorders (122,373, 15.3%), skin and subcutaneous tissue disorders (108,259, 13.5%), and nervous system disorders (88,498, 11.0%). The preferred terms of myelosuppression and acromegaly were obvious in golimumab. Infliximab showed a significantly higher ADR report ratio in the infusion-related reaction compared to the other four inhibitors. The rate of ADR reports for lower respiratory tract infection and other infections was the highest for golimumab. Conclusion: No causal associations could be established between the TNFα inhibitors and the ADRs. Current comparative observational studies of these inhibitors revealed common and specific adverse reactions in the ADR reports of the WHO received for these drugs. Clinicians should improve the rational use of these high-priced drugs according to the characteristics of ADRs.

Best practice implementation on reporting of coronavirus disease 2019 vaccine adverse events following immunization in Uasin Gishu County, Kenya

OBJECTIVES

This project's aim was to implement vaccine safety surveillance best practices to improve reporting of adverse events following immunization (AEFI) during coronavirus disease 2019 (COVID-19) vaccination roll out in Uasin Gishu County.

INTRODUCTION

Weak vaccine safety surveillance systems in developing countries has contributed to underreporting of AEFIs undermining public confidence in immunization efforts, contributing to low uptake of vaccines critical in the fight against communicable diseases.

METHODS

The JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit tool for promoting change in healthcare practice was utilized. Preimplementation and postimplementation audit cycles carried out utilized six best practice recommendations. Context-specific strategies and resources were used to address the gaps identified.

RESULTS

Less than half of the AEFIs reported were in accordance with the local policy recommendation, and most of the AEFIs reported were submitted in a timely manner in the baseline and follow-up cycle. Slight improvement was recorded in the number of health facilities with AEFIs reporting forms. An improvement of 33.7% was recorded in the number of health workers providing COVID-19 vaccination services who had received education and practical training on vaccine pharmacovigilance.

CONCLUSION

Underreporting and delayed submission of COVID-19 vaccine AEFI was evident among the healthcare providers offering COVID-19 vaccination services, the majority of healthcare providers had received training on vaccine pharmacovigilance, and AEFI hard copy reporting forms were not adequate in the health facilities. Public education on vaccine safety before administration of vaccine needs emphasis in order to improve reporting of AEFI.

Optimising reporting of adverse events following immunisation by healthcare workers in Ghana: A qualitative study in four regions

INTRODUCTION

Despite the emphasis on reporting of Adverse Events Following Immunisation (AEFIs) during didactic training sessions, especially prior to new vaccine introductions, it remains low in Ghana. We explored the factors underlying the under-reporting of AEFI by healthcare workers (HCWs) to provide guidance on appropriate interventions to increase reporting.

METHODS

We conducted an exploratory descriptive in-depth study of the factors contributing to low reporting of AEFI among HCWs in four regions in Ghana. Key informant interviews (KII) were held with purposively selected individuals that are relevant to the AEFI reporting process at the district, regional, and national levels. We used KII guides to conduct in-depth interviews and used NVivo 10 qualitative software to analyse the data. Themes on factors influencing AEFI reporting were derived inductively from the data, and illustrative quotes from respondents were used to support the narratives.

RESULTS

We conducted 116 KIIs with the health managers, regulators and frontline HCWs and found that lack of information on reportable AEFIs and reporting structures, misunderstanding of reportable AEFIs, heavy workload, cost of reporting AEFIs, fear of blame by supervisors, lack of motivation, and inadequate feedback as factors responsible for underreporting of AEFIs. Respondents suggested that capacity building for frontline HCWs, effective supervision, the provision of motivation and feedback, simplification of reporting procedures, incentives for integrating AEFI reporting into routine monitoring and reporting, standardization of reporting procedures across regions, and developing appropriate interventions to address the fear of personal consequences would help improve AEFI reporting.

CONCLUSION

From the perspectives of a broad range of key informants at all levels of the vaccine safety system, we found multiple factors (both structural and behavioural), that may impact HCW reporting of AEFI in Ghana. Improvements in line with the suggestions are necessary for increased AEFI reporting in Ghana.

Information systems for vaccine safety surveillance

Immunization implementation in the community relies upon post-licensure vaccine safety surveillance to maintain safe vaccination programs and to detect rare AEFI not observed in clinical trials. The increasing availability of electronic health-care related data and correspondence from both health-related providers and internet-based media has revolutionized health-care information. Many and varied forms of health information related to adverse event following immunization (AEFI) are potentially suitable for vaccine safety surveillance. The utilization of these media ranges from more efficient use of electronic spontaneous reporting, automated solicited surveillance methods, screening various electronic health record types, and the utilization of natural language processing techniques to scan enormous amounts of internet-based data for AEFI mentions. Each of these surveillance types have advantages and disadvantages and are often complementary to each other. Most are "hypothesis generating," detecting potential safety signals, where some, such as vaccine safety datalinking, may also serve as "hypothesis testing" to help verify and investigate those potential signals.

Adverse events following immunization associated with coronavirus disease 2019 (COVID-19) vaccines: A descriptive analysis from VigiAccess

This study assessed adverse events following immunizations (AEFIs) reported on COVID-19 vaccines in VigiAccess and determined the reporting trends across all continents of the world. The study was cross-sectional quantitative in design. VigiAccess was searched on 10 November 10 2021 for reported adverse events following the introduction of COVID-19 vaccines. After entering the search term, "COVID-19 vaccines" in VigiAccess, AEFIs associated with nine approved brands of COVID-19 vaccines had been documented in the database. Data were captured among age groups, sex, and continents of the world and analyzed using Statistical Package for Social Sciences (SPSS) version 25. Overall, 2,457,386 AEFIs had been reported in VigiAccess at the time of the search. No causal associations could be established between the vaccines and the AEFIs. The public accessing VigiAccess data should therefore be made aware of this in order to not falsely attribute AEFIs to COVID-19 vaccines when assessing the database.

Safety culture and adverse event reporting in Ghanaian healthcare facilities: Implications for patient safety

INTRODUCTION

Recognizing the values and norms significant to healthcare organizations (Safety Culture) are the prerequisites for safety and quality care. Understanding the safety culture is essential for improving undesirable workforce attitudes and behaviours such as lack of adverse event reporting. The study assessed the frequency of adverse event reporting, the patient safety culture determinants of the adverse event reporting, and the implications for Ghanaian healthcare facilities.

METHODS

The study employed a multi-centre cross-sectional survey on 1651 health professionals in 13 healthcare facilities in Ghana using the Survey on Patient Safety (SOPS) Culture, Hospital Survey questionnaire. Analyses included descriptive, Spearman Rho correlation, one-way ANOVA, and a Binary logistic regression model.

RESULTS

The majority of health professionals had at least reported adverse events in the past 12 months across all 13 healthcare facilities. Teamwork (Mean: 4.18, SD: 0.566) and response to errors (Mean: 3.40, SD: 0.742) were the satisfactory patient safety culture. The patient safety culture dimensions were statistically significant (χ2 (9, N = 1642) = 69.28, p < .001) in distinguishing between participants who frequently reported adverse events and otherwise.

CONCLUSION

Promoting an effective patient safety culture is the ultimate way to overcome the challenges of adverse event reporting, and this can effectively be dealt with by developing policies to regulate the incidence and reporting of adverse events. The quality of healthcare and patient safety can also be enhanced when healthcare managers dedicate adequate support and resources to ensure teamwork, effective communication, and blame-free culture.

Enhanced surveillance for adverse events following immunization during the 2019 typhoid conjugate vaccine campaign in Harare, Zimbabwe

BACKGROUND

During February 25-March 4, 2019, Zimbabwe's Ministry of Health and Child Care conducted an emergency campaign using 342,000 doses of typhoid conjugate vaccine (TCV) targeting individuals 6 months-15 years of age in eight high-risk suburbs of Harare and up to 45 years of age in one suburb of Harare. The campaign represented the first use of TCV in Africa outside of clinical trials.

METHODS

Three methods were used to capture adverse events during the campaign and for 42 days following the last dose administered: (1) active surveillance in two Harare hospitals, (2) national passive surveillance, and (3) a post-campaign coverage survey.

RESULTS

Thirty-nine adverse events were identified during active surveillance, including 19 seizure cases (16 were febrile), 16 hypersensitivity cases, 1 thrombocytopenia case, 1 anaphylaxis case, and two cases with two conditions. Only 21 (54%) of 39 patients were hospitalized and 38 recovered without sequelae. Attack rates per 100,000 TCV doses administered were highest for seizures (6.27) and hypersensitivity (5.02). Only 6 adverse events were reported through passive surveillance by facilities other than the two active surveillance hospitals. A total of 177 (10%) of 1,817 vaccinees surveyed reported experiencing an adverse event during the post-campaign coverage survey, of which 25 (14%) sought care.

CONCLUSIONS

In line with previous evaluations of TCV, enhanced adverse event monitoring during an emergency campaign supports the safety of TCV. The majority of reported events were minor or resulted in recovery without long-term sequelae. Attack rates for seizures and hypersensitivity were low compared with previous active surveillance studies conducted in Kenya and Burkina Faso. Strengthening adverse event monitoring in Zimbabwe and establishing background rates of conditions of interest in the general population may improve future safety monitoring during new vaccine introductions.

Adverse Events Following BNT162b2 mRNA COVID-19 Vaccine Immunization among Healthcare Workers in a Tertiary Hospital in Johor, Malaysia

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or 2019 coronavirus disease (COVID-19), was declared as pandemic in early 2020. While several studies reported the short-term adverse events (AE) of the mRNA COVID-19 vaccines, medium-term AE have not been extensively evaluated. This study aimed to evaluate the 6-month side effect profiles of the BNT162b2 mRNA vaccine. Methods: This was a descriptive cross-sectional study conducted in a tertiary hospital. Hospital workers who received two doses of the Cominarty (BNT162b2) mRNA vaccine, six months post-vaccination, were invited to participate in this study. All participants completed a self-reported survey assessing AEs occurrence and severity, duration of onset and recovery and if they previously reported these AEs. Results: Of the 670 respondents who completed the survey, 229 (34.2%) experienced at least one AEs, with a total of 937 AEs reported during the 6-month period. After the first dose, the most common reported localized symptoms were pain (n = 106, 27.2%), swelling (n = 38, 9.8%) and erythematous (n = 12, 3.1%) at injection site. Systemic symptoms reported include fatigue (n = 72, 18.5%), fever (n = 55, 14.1%) and headache (n = 46, 11.8%). After the second dose, pain at site of injection (n = 112, 20.4%), swelling (n = 42, 7.7%) and erythematous (n = 14, 2.6%) were among the localized AE reported, while fever (n = 121, 22.1%), fatigue (n = 101, 18.4%) and headache (n = 61, 11.1%) were the most common systemic AE. The proportion of respondents who experienced moderate (first dose: 156 events; second dose: 272 events) and severe (1st dose: 21 events; 2nd dose: 30 events) AEs were higher after the second dose. Most AEs commonly resolved within 1–2 days, and none required hospitalization. No new onset of AE was observed 7 days post-vaccination. A total of 137 (59.8%) participants did not proceed to formal AE reporting. Conclusion: Most of the AEs reported were of mild to moderate intensity and short-term, consistent with those reported in previous studies. No medium-term finding was detected in the survey. AE reporting was not routinely performed, necessitating the attention of health authorities in order to enhance pharmacovigilance.

COVID-19 Vaccination in Lower-Middle Income Countries: National Stakeholder Views on Challenges, Barriers, and Potential Solutions

The development of COVID-19 vaccines does not imply the end of the global pandemic as now countries have to purchase enough COVID-19 vaccine doses and work towards their successful rollout. Vaccination across the world has progressed slowly in all, but a few high-income countries (HICs) as governments learn how to vaccinate their entire populations amidst a pandemic. Most low- and middle-income countries (LMICs) have been relying on the COVID-19 Vaccines Global Access (COVAX) Facility to obtain vaccines. COVAX aims to provide these countries with enough doses to vaccinate 20% of their populations. LMICs will likely encounter additional barriers and challenges rolling out vaccines compared HICs despite their significant experience from the Expanded Programme on Immunisation (EPI). This study explores potential barriers that will arise during the COVID-19 vaccine rollout in lower-middle-income countries and how to overcome them. We conducted sixteen semi-structured interviews with national-level stakeholders from Ghana and Bangladesh (eight in each country). Stakeholders included policymakers and immunisation programme experts. Data were analysed using a Framework Analysis technique. Stakeholders believed their country could use existing EPI structures for the COVID-19 vaccine rollout despite existing challenges with the EPI and despite its focus on childhood immunisation rather than vaccinating the entire population over a short period of time. Stakeholders suggested increasing confidence in the vaccine through community influencers and by utilising local government accredited institutions such as the Drug Authorities for vaccine approval. Additional strategies they discussed included training more health providers and recruiting volunteers to increase vaccination speed, expanding government budgets for COVID-19 vaccine purchase and delivery, and exploring other financing opportunities to address in-country vaccine shortages. Stakeholders also believed that LMICs may encounter challenges complying with priority lists. Our findings suggest that COVID-19 vaccination is different from previous vaccination programs, and therefore, policymakers have to expand the EPI structure and also take a systematic and collaborative approach to plan and effectively rollout the vaccines.

Understanding reporting practices and perceptions of barriers in adverse events following immunisation surveillance: A cross-sectional survey of paediatricians in Kerala, India

PURPOSE

The role of health care professionals (HCPs) is central to adverse event following immunisation (AEFI) surveillance. A cross-sectional survey was conducted among paediatricians practising in Kerala, India, to assess their knowledge and reporting behaviour in AEFI surveillance as well as to identify barriers to reporting.

RESULTS

A random sample of 380 paediatricians were contacted of whom, 243 (63.9%) participated in the survey. The understanding scores were distributed as follows: 30.9% very high or high, 40.3% moderate, and 28.8% low. Formal training was significantly associated with higher understanding scores, and increased AEFI detection and reporting. Only 42.0% of respondents had formal training; paediatricians in the public sector had higher access to training than those in the private sector. There were 141 respondents (58.0%) who identified an AEFI in the previous year, of whom 66 (46.8%) reported it. The main barriers to AEFI reporting were: difficulties with reporting process (28.9%); fear of raising public alarm (28.1%); time constraints (22.3%); fear of personal consequences (15.7%); and belief that health authorities rarely take useful action (11.6%).

CONCLUSION

Training in AEFI surveillance should be prioritised for HCPs with greater emphasis in medical education programmes. Study showed that a user-friendly reporting mechanism and a blame-free culture are crucial to improve AEFI reporting practices.

Efficacy of m-Health for the detection of adverse events following immunization - The stimulated telephone assisted rapid safety surveillance (STARSS) randomised control trial

INTRODUCTION

Passive surveillance is recommended globally for the detection of adverse events following immunisation (AEFI) but this has significant challenges. Use of Mobile health for vaccine safety surveillance enables a consumer-centred approach to reporting. The Stimulated Telephone Assisted Rapid Safety Surveillance (STARSS) a randomised control trial (RCT) sought to evaluate the efficacy and acceptability of SMS for AEFI surveillance.

METHODS

Multi-centre RCT, participants were adult vaccinees or parents of children receiving any vaccine at a trial site. At enrolment randomisation occurred to one of two SMS groups or a control group. Prompts on days 2, 7 and 14 post-immunisation, were sent to the SMS group, to ascertain if a medical event following immunisation (MEFI) had occurred. No SMS's were sent to the control participants. Those in the SMS who notified an MEFI were pre-randomised to complete a computer assisted telephone interview or a web based report to determine if an AEFI had occurred whilst an AEFI in the controls was determined by a search for passive reports. The primary outcome was the AEFI detection rate in the SMS group compared to controls.

RESULTS

We enrolled 6,338 participants, who were equally distributed across groups and who received 11,675 vaccines. The SMS group (4,225) received 12,675 surveillance prompts with 9.8% being non-compliant and not responding. In those that responded 90% indicated that no MEFI had been experienced and 184 had a verified AEFI. 6 control subjects had a reported AEFI. The AEFI detection rate was 13 fold greater in the SMS group when compared with controls (4.3 vs 0.3%).

CONCLUSION

We have demonstrated that the STARSS methodology improves AEFI detection. Our findings should inform the wider use of SMS-based surveillance which is particularly relevant since establishing robust and novel pharmacovigilance systems is critical to monitoring novel vaccines which includes potential COVID vaccines.