AEFIAdverse Events Following Immunization

For More Health Information Log On To My Website

www.vdcure.com

The vaccinators and the

supervisors at the vaccination

site will provide primary

management for AEFIs.

All sub centers should be prepare for facing any kind of AEFI with AEFI treatment kit.

Serious AEFIs:

Refer immediately to the nearest health facility/AEFI management

centre, and reported to the appropriate authority.

Transportation costs will be borne through untied funds with Village Health and Sanitation Committee

(VHSC).

AEFI Treatment Kit.

Drugs

Inj. Adrenalin (1:1000) solution – 2 ampoulesInj. Hydrocortisone (100 mg) – 1 vial

I/V fluids (Ringer lactate/Normal Saline): 1 unitI/V fluids (5% Dextrose): 1 unit

Tab Paracetamol (500 mg/125mg) - 10 tabs/Syp

Equipment

Disposable Syringe (insulin type) having 0.01 ml graduations and 26G IM needle – 2

setsDisposable Syringe (5 ml) and 24/26G IM

needle – 2 setsScalp vein set – 2 sets

IV drip set: 1 setCotton wool + adhesive tape : 1 each

At hospital setting, Oxygen support and airway intubation facility should be

available.

Info/reports/Records: Label

showing: Date of inspection, Expiry

date of Inj. Adrenaline and shortest

expiry date of any of the

components

Drug dosage tables for Inj

Adrenaline and Hydrocortisone

Recognition of anaphylaxis-1

Management of a case of anaphylaxis

• Anaphylaxis ( a very rare at ~1/one million doses of measles vaccine given) but severe and potentially fatal allergic reaction,

• When anaphylaxis occurs, the patient must be diagnosed properly, treated, and managed urgently by trained staff and transferred to a hospital setting,

• The vaccinators, paramedics and physicians should be adequately trained – to able to distinguish anaphylaxis from fainting

(Vasovagal syncope), anxiety and breath-holding spells, which are common benign reactions.

– During fainting, individual suddenly becomes pale, loses consciousness and collapses to the ground. Fainting requires no specific treatment or investigation.

– Bullet points

– Bullet Points

Recognition of anaphylaxis-2

Management of anaphylaxis

• Once diagnosis is made, consider patient being in

a potentially fatal condition, regardless of the

severity of the current symptoms.

• Begin treatment immediately,

• In addition, make plans to transfer the patient

immediately to the hospital (if not already in a

hospital setting).

• As described earlier, make easy availability of

AEFI treatment kit

Steps in management of anaphylaxisAnaphylaxis?

Assess ABC: Airway/Breathing/Circulation

Diagnosis: Look for Acute onset of illness/Life

threatening problems with A-B-C/Skin

changes

Call for help/Lie patient flat/Raise patient’s

legs/Keep airway clear/If necessary give CPR

Inj. Adrenaline IM (1:1000 solution)

Per dosage chartInj Hydrocortisone [see dosage chart]

Refer to next level, as needed

In hospital settings: Establish airway/High flow

oxygen/IV fluids

Management of anaphylaxis

• Give adrenaline 1:1000 (age appropriate dose) by deep i/m injection into opposite limb, Give an additional half dose around the injection site (to delay antigen absorption).

• If no improvement, repeat within 10-20 minutes of the first injection, up to a maximum of three doses, in total.

• Give Inj. Hydrocortisone IM or slow IV per dosage • If patient conscious after adrenaline is given, place

his/her head lower than the feet and keep the patient warm.

• Give oxygen by face mask, if available.• Mark the immunization card clearly to prevent future

repeat dose of offending vaccine. • Report anaphylaxis to the appropriate officer

Doses of Adrenaline and Hydrocortisone

Alternatively, 1:1000 adrenaline (epinephrine) at a dose of 0.01ml/kg up to a maximum of 0.5 ml injected intramuscularly (or subcutaneously in very mild cases) may be given

Note on Adrenaline dosage• 1 in 1000 solution means

– 1g of adrenaline in 1000 ml of solution

– 1000 mg of adrenaline in 1000 ml of solution

– Or, 1 mg of adrenaline in 1 ml of solution

– Or 0.01 mg of adrenaline in 0.01 ml of solution

• Adrenaline dosage is 0.01 ml/kg of body weight

• For a syringe which has 1 ml divided into 100 small divisions, each small division = 0.01 ml

– So adrenaline dosage is easy to calculate and administer with such a syringe

• Example: A child with body weight 12 Kg will need 0.12 ml of adrenaline = 12 small divisions of the syringe.

Summary• Measles vaccine is a safe and effective vaccine.

• AEFI due to programme errors must be prevented at all costs,

• Very rarely, measles vaccine can cause serious AEFI (e.g. anaphylaxis), which must be treated promptly,

• All Govt. facilities ( PHC upwards) will function as AEFI management centres with designated medical officers,

• All AEFI management centres must be fully equipped with AEFI treatment kits and protocols, prominently displayed.

• The standard guidelines should be followed in all cases.

Thank You

For More Health Information Log On To My Website www.vdcure.com