1. EPI Review- 2011 MOH Area:…………………………….

2. Background information 1-MOH area 2-DPDHS area 3-Estimated Population for the year 2011 4-Actual Population for the year 2011 5-Reasons for differences in actual and estimated populations 6-Crude Birth Rate for District 2011 7-Crude Birth Rate for Province 2011 8-Estimated Number of Births in the year 2011 Based on the Actual Population Based on the Estimated Population District BR Provincial BR 9-Number of Immunizations performed in the year 2011 (institutions and field) (Sum of relevant data from four Q/ EPI returns, 2011)] PVV1PVV2PVV3 10-Number of actual births reported for the area in 2011 11-The most probable number of births for the MOH area*

3. Background information……cont Approved number Number available Average Population covered by each category / clinic Population Range 12-PHMs 13-PHIs 14-SPHMs 15-PHNS 16-SPHI 17-MOHs/AMOHs 18. MCH Clinics

4. Area Map indicating access to immunization (Please present a map indicating immunization clinics and population served by each clinic )

5. Coverage of BCG vaccination among infants born between 1 st of January 2011 to 31 st of December 2011 and the protection of their mothers from Tetanus and Rubella vaccination at the time of delivery Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z) Vaccine (A) Number of registered infants under care * (B) Number of estimated births for 2011 (C) Number of vaccinations according to BI registers/pregnant 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(C/A) 100(C/B) 100 BCG** TT*** Rubella***

6. Coverage of DPT1/Hep B1/OPV1 /PVV 1 vaccination among infants born between 01 st of November 2010 to 31 st of October 2011 Vaccine (A) Number of registered infants under care* (B) Number of estimated births For 2011 (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 (C/A) 100(C/B) 100(C/E)100 PVV1 OPV1 Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z)

7. Coverage of Measles/MMR1 vaccination among infants born between 01 st of April 2010 to 31 st of March 2011 Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z) Vaccine (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 birthsNumber of vaccines given as per Q/ EPI returns FORMULA (C/A) 100(C/B) 100(C/E) 100 Measles + MMR1

8. Coverage of LJE vaccination among infants born between 1 st of January 2010 to 31 st of December 2010 Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z) Vaccine (A) Number of registered infants under care* (B) Number of estimate d 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 (for children who have completed one year in the current cohort)** Coverage according to Registered infants under care* Estimated births Number of vaccines given as per Q/ EPI returns FORMULA (C/A) 100(C/B) 100(C/E) 100 LJEV

9. Coverage of DPT4/OPV4 vaccination among infants born between 1 st of July 2009 to 30 th June 2010 Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z) Vaccine (A) Number of registered infants under care* (B) Number of estimated births 2009 (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* (C/A) 100 Estimated births (C/B) 100 Number of vaccines given as per Q/ EPI returns (C/E) 100 DPT4 OPV4

10. Coverage of MR/MMR2 vaccination among infants born between 1 st of January 2008 to 31 st of December 2008 Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z) Vaccine (A) Number of registered infants under care* (B) Number of estimated births 2008 (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* (C/A) 100 Estimated births (C/B) 100 Number of vaccines given as per Q/ EPI returns (C/E) 100 MR+ MMR2

11. Coverage of DT/OPV5 vaccination among infants born between 1 st of January 2006 to 31 st of December 2006 Number of registered infants under care* (A) A = (w+X) - (Y+-Z) Number of infants registered as a birth (W)newly came into the area (X) left the area(Y)Died(Z) Vaccine (A) Number of registered infants under care * (B) Number of estimated births for 2006 (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* (C/A) 100 Estimated births (C/B) 100 Number of vaccines given as per Q/ EPI returns (C/E) 100 DT OPV5

12. VaccinePHMM areas with low immunization coverage (%) according to estimated births registered infants under care age appropriate immunizations PHM area% % % BCG TT( Maternal) Rubella(Maternal) PVV1/OPV1 Measles+ MMR1 LJEV DPT4/OPV4 MR+MMR2 DT/OPV5 PHM areas with low immunization coverage

13. Coverage of aTd vaccination among school children in grade 7 during 2011 by PHI areas 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 Total number immunized in year 2011 1 2 3 4 5 6 7 8 9 10 Total

14. Comparison of coverage’s of antigens according to the advancing birth cohorts Vaccine(A) Number of registered infants under care *( for respective birth cohorts under review ) (B) Number of estimated births ( for respective birth cohorts under review ) (C) Number of vaccination s given according to BI registers (D) Number of DPT 1 doses given according to Q/ EPI return for the years of respective birth cohorts under review (E) Number of vaccines given accordin g to Q/ EPI returns 2011 % Coverage according to Registere d births (C/A) 100 Estimated births (C/B) 100 Number of vaccines given as per Q/ EPI returns for the years of respective birth cohorts under review (C/E) 100 YEARNO OF DOSES BCG2011 PVV1 2010( 4Q) 2011( 1,2,3 Q) Measles/ MMR1 2010-(2,3,4 Q) 2011 – (1Q) LJEV 2010 DPT 4 2009-(3,4 Q) 2010-(1.2 Q) MR/MMR22008 DT 2006 aTd

15. Number of immunizations performed and difference against the antigen which ever has the highest number of immunizations(PVV1, PVV2, PVV3,Measles/MMR1) during infancy ( 1 st year of life) in MOH area by antigen in 2011 Please include another bar for number of LJEV given to the children who have completed one year in the current cohort too*** ***LJEV immunizations given for children who have completed one year in the current cohort = Total LJEV given - (Number of LJEV given for infants who have completed nine months according to the new schedule + LJEV given for children who missed out in previous years)

16. Status of vaccine wastage in the MOH area by antigen in 2011 Antigen Book balance as of 31 st Dec 2010 (A) Total receipts during 2011 (B) Book balance as of 31 st of Dec 2011 (C ) No of doses discarded due to expiry or cold chain failure during 2011 (D) Total number of doses used during 2011 for vaccination ( E)= (A+B)-(C +D) Highest book balance in a given time during the year 2011 (F) No. of Immunizations Performed by clinics/ schools/ estates/GPs ( Based on the four EPI quarterly Returns for year 2011) ( G ) No. of doses Distributed to Clinics/schools /GPs (Based on the MOH Office vaccine movement register for year 2011) ( H ) Usage % ( I )= (G/H)*100 Wastage % ( J )= (100- I ) B.C.G Penta DPT OPV Measles LJEV MR DT TT aTd MMR

17. Adverse events following immunization (A.E.F.I.) No. of Monthly AEFI Returns expected to be sent to the Epidemiological Unit during 2011 12 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 2011

18. AntigenType of AEFINumber of AEFI Reported (A) No of doses administered† (B) AEFI Rate ( C ) (C =(A)/(B)*1000 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/Encephalopathy Meningitis Other* Rates of AEFIs reported during 2011

19. Information regarding cold chain equipment in MOH office in 2011 Please bring the temperature charts and printouts of data lodger recordings for year 2011 to the review. Refrigerator Working order (Yes/No) Year of manufacture Capacity (liters) Thermometer in working Order (Yes/No) Data lodger in working Order (Yes/No) Temp. Chart maintained daily during the reporting period (Yes/No) Refrigerator 1 Refrigerator 2 Ice pack 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)

20. Information regarding maximum refrigerator capacity required for storage of vaccines for MOH area Vaccine (A) Average monthly consumption* (B) Maximum No. of doses to be retained in the refrigerator at a given time (C) = (B) X 2 Volume per dose in cm3 (D) Volume required for storing maximum number of doses at a given time in cm3** (E) (E)=(C )X ( D) BCG1.2 BCG diluents0.6 DPT3.0 PVV19.4 OPV1.5 Measles3.0 MS diluents3.06 MR3.0 MR diluents3.06 MMR3.0 MMR diluents 3.06 DT2.0 TT2.5 aTd3.0 JE2.24 JE diluents2.8 TOTAL ………… cm3 Storage volume can be converted from cm3 to liters by dividing by 1000 …………. liters

21. Incidence of infant deaths, neo natal deaths and their causes – 2011 **Please use national Infant mortality rate (8.5 per 1000 live births) to calculate the estimated number of live births for year 2011 No. Estimated** No. Reported% ReportedNo. Investigated% Investigated No. of live births Infant Deaths Neonatal Deaths Causes 1. Prematurity 2. Congenital Abnormalities 3. 4. 5. 6. 7. No of infant deaths temporally associated with vaccination

22. Incidence and investigation of EPI target diseases notified to the MOH through the routine notification system- 2011 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