1. EPI Review- 2014 MOH Area:…………………………….

2. Background information 1-MOH area 2-DPDHS area 3-Estimated Population for the year 2014 4-Actual Population for the year 2014 5-Reasons for differences in actual and estimated populations 6-Crude Birth Rate for District 2014 7-Crude Birth Rate for Province 2014 8-Estimated Number of Births in the year 2014 Based on the Actual Population Based on the Estimated Population District BR Provincial BR 9-Number of Immunizations performed in the year 2013 (institutions and field) (Sum of relevant data from four Q/ EPI returns, 2014) PVV1PVV2PVV3 10-Number of pregnant mothers registered for the area in 2013 11-Number of actual births reported for the area in 2014 12- Number of infants registered for the area in 2014 13-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 2014 to 31 st of December 2014 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 2013 (A) Number of registered infants under care * (B) Number of estimated births for 2014 (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 2014 to 31 st of December 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)

6. Coverage of OPV1 /PVV 1 vaccination among infants born between 01 st of November 2013 to 31 st of October 2014 Vaccine (AA) Number of pregnant mothers registered in year 2013 (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 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 2013 to 31 st of October 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)

7. Coverage of OPV3 /PVV 3 vaccination among infants born between 01 st of July 2013 to 31 st of June 2014 Vaccine (AA) Number of pregnant mothers registered in year 2013 (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 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 2013 to 31 st 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)

8. Coverage of LJEV vaccination among infants born between 01 st of April 2013 to 31 st of March 2014 Vaccine (AA) Number of pregnant mothers registered in year 2012 (A) Number of registered infants under care* (B) Number of estimated births For 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 LJEV Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of April 2013 to 31 st of March 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)

9. Coverage of MMR1 vaccination among infants born between 1 st of January 2013 to 31 st of December 2013 Vaccine (AA) Number of pregnant mothers registered in year 2012 (A) Number of registered infants under care* (B) Number of estimated births For 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 MMR1 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of January 2013 to 31 st of December 2013 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)

10. Coverage of DPT4/OPV4 vaccination among infants born between 1 st of July 2012 to 30 th June 2013 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 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 2012 to 30 th of June 2013 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)

11. Coverage of MMR2 vaccination among infants born between 1 st of January 2011 to 31 st of December 2011 Vaccine (AA) Number of pregnant mothers registered in year 2010 (A) Number of registered infants under care* (B) Number of estimated births 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 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 2011 to 31 st of December 2011 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)

12. Coverage of DT/OPV5 vaccination among infants born between 1 st of January 2009 to 31 st of December 2009 Vaccine(AA) Number of pregnant mothers registered in year 2008 (A) Number of registered infants under care * (B) Number of estimated births for 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* 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)

13. VaccinePHMM areas with low immunization coverages (%) according to estimated births registered infants under careage appropriate immunizations PHM area% % % BCG (ex.) 123123 %%% 123123 %%% 123123 %%% 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 )

14. VaccinePHMM areas with high immunization coverages (%) according to estimated births registered infants under careage appropriate immunizations PHM area% % % BCG (ex.) 123123 %%% 123123 %%% 123123 %%% 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 )

15. 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 ……………………………………….

16. Coverage of aTd vaccination among school children in grade 7 & other grades during 2014 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 2014 1 2 3 4 5 6 7 8 9 10 Clinics Total

17. Comparison of coverage’s of antigens according to the advancing birth cohorts Vaccine(AA) Number of pregnant mothers registered in respective years (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 vaccinations 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 according to Q/ EPI returns 2014 % Coverage according to Registered 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 YEAR No. of doses BCG 2014 PVV1 2013( 4Q) 2014( 1,2,3 Q) PVV3 2013( 3,4 Q) 2014( 1,2Q) LJEV 2013-(2,3,4 Q) 2014 – (1Q) MMR1 2013 DPT 4 2012-(3,4 Q) 2013-(1.2 Q) MMR2 2011 DT 2009 aTd

18. Number of immunizations performed and difference against the antigen which ever has the highest number of immunizations(PVV1, PVV2, PVV3) during infancy ( 1 st year of life) in MOH area by antigen in 2014 ( Please include another bar for number of LJEV given to the children who have completed one year in the current cohort)

19. Antigen Book balance as of 31 st December 2013 (A) Total receipts during 2014 (B) Book balance as of 31 st of December 2014 (C ) No of doses discarde d due to expiry or cold chain failure during 2014 (D) Total number of doses used during 2014 for vaccination ( E)= (A+B)-(C +D) Highest book balance in a given time during the year 2014 (F) No. of Immunizations Performed by clinics/ schools/ estates/GPs ( Based on the four EPI quarterly Returns for year 2014) ( G ) No. of doses Distributed to Clinics/schools /GPs (Based on the MOH Office vaccine movement register for year 2014) ( H ) Usage % ( I )= G/E * 100 Wastage % ( J )= (100- I ) B.C.G Penta DPT OPV LJEV DT TT aTd MMR Other Form 11 Status of vaccine wastage in the MOH area by antigen in 2014

20. Antigen Book balance as of 31 st December 2013 (A) Total receipts during 2014 (B) Book balance as of 31 st of December 2014 (C ) No of doses discarded due to expiry or cold chain failure during 2014 (D) Total number of doses used during 2014 for vaccination ( E)= (A+B)-(C+D) Highest & Lowest book balances in a given time during the year 2014 No. of Immunizatio ns Performed by clinics/ schools/ estates/GPs ( Based on the four EPI quarterly Returns for year 2014) ( G ) No. of doses Distributed to Clinics/ schools/ GPs (Based on the MOH Office vaccine movement register 2014 ( H ) Usage % ( I )= G/E * 100 Wastage % ( J )= (100- I ) Highest (F1) Lowest (F2) B.C.G Penta DPT OPV LJEV DT TT aTd MMR Form 11 Status of vaccine wastage in the MOH area by antigen in 2014

21. Adverse events following immunization (A.E.F.I.) No. of Monthly AEFI Returns expected to be sent to the Epidemiological Unit during 2014 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 2014

22. AntigenType of AEFINumber of AEFI Reported (A) No of doses administered† (B) AEFI Rate ( C ) (C =(A)/(B)*100000 National Rates for 2014 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 2014

23. Information regarding cold chain equipment in MOH office in 2014 Please bring the temperature charts and printouts of data lodger recordings for year 2014 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) Refrigerator 1 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)

24. Calculation of minimum 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 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

25. Incidence of infant deaths, neo natal deaths and their causes – 2014 **Please use national Infant mortality rate 9.9 per 1000 live births to calculate the estimated number of infant deaths for year 2014 ( 7.4 Neonatal mortality rate-75% of Infant mortality ) 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

26. Notification and investigation of EPI target diseases- 2014 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