1. EPI Review- 2013 MOH Area:…………………………….

2. Background information 1-MOH area 2-DPDHS area 3-Estimated Population for the year 2013 4-Actual Population for the year 2013 5-Reasons for differences in actual and estimated populations 6-Crude Birth Rate for District 2013 7-Crude Birth Rate for Province 2013 8-Estimated Number of Births in the year 2013 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, 2013) PVV1PVV2PVV3 10-Number of pregnant mothers registered for the area in 2013 11-Number of actual births reported for the area in 2013 12- Number of infants registered for the area in 2013 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 2013 to 31 st of December 2013 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 2012 (A) Number of registered infants under care * (B) Number of estimated births for 2013 (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 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)

6. Coverage of OPV1 /PVV 1 vaccination among infants born between 01 st of November 2012 to 31 st of October 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 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 2012 to 31 st of October 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)

7. Coverage of LJEV vaccination among infants born between 01 st of April 2012 to 31 st of March 2013 Vaccine (AA) Number of pregnant mothers registered in year 2011 (A) Number of registered infants under care* (B) Number of estimated births For 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 LJEV Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of April 2012 to 31 st of March 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)

8. Coverage of MMR1 vaccination among infants born between 1 st of January 2012 to 31 st of December 2012 Vaccine (AA) Number of pregnant mothers registered in year 2011 (A) Number of registered infants under care* (B) Number of estimated births For 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 MMR1 Number of registered infants under care* (A) A = (V+W+X) - (Y+-Z) Number of infants born between 1 st of January 2012 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)

9. Coverage of DPT4/OPV4 vaccination among infants born between 1 st of July 2011 to 30 th June 2012 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 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 January 2011 to 30 th of June 2012 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 MMR2 vaccination among infants born between 1 st of January 2010 to 31 st of December 2010 Vaccine (AA) Number of pregnant mothers registered in year 2009 (A) Number of registered infants under care* (B) Number of estimated births 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 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 2010 to 31 st of December 2010 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 DT/OPV5 vaccination among infants born between 1 st of January 2008 to 31 st of December 2008 Vaccine(AA) Number of pregnant mothers registered in year 2007 (A) Number of registered infants under care * (B) Number of estimated births for 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 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 2008 to 31 st of December 2008 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. 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 LJEV MMR1 DPT4/OPV4 MMR2 DT/OPV5 PHM areas with low immunization coverage (Please include the data for the 3 PHMM areas where the lowest immunization coverages have been reported under each category )

13. Coverage of aTd vaccination among school children in grade 7 during 2013 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 2013 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(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 2013 % 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 2013 PVV1 2012( 4Q) 2013( 1,2,3 Q) LJEV 2012-(2,3,4 Q) 2013– (1Q) MMR1 2012 DPT 4 2011-(3,4 Q) 2012-(1.2 Q) MMR2 2010 DT 2008 aTd

15. 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 2013

16. Antigen Book balance as of 31 st December 2012 (A) Total receipts during 2013 (B) Book balance as of 31 st of December 2013 (C ) No of doses discarde d due to expiry or cold chain failure during 2013 (D) Total number of doses used during 2013 for vaccination ( E)= (A+B)-(C +D) Highest book balance in a given time during the year 2013 (F) No. of Immunizations Performed by clinics/ schools/ estates/GPs ( Based on the four EPI quarterly Returns for year 2013) ( G ) No. of doses Distributed to Clinics/schools /GPs (Based on the MOH Office vaccine movement register for year 2013) ( 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 2013

17. Adverse events following immunization (A.E.F.I.) No. of Monthly AEFI Returns expected to be sent to the Epidemiological Unit during 2013 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 2013

18. AntigenType of AEFINumber of AEFI Reported (A) No of doses administered† (B) AEFI Rate ( C ) (C =(A)/(B)*100000 National Rates for 2013 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 2013

19. Information regarding cold chain equipment in MOH office in 2013 Please bring the temperature charts and printouts of data lodger recordings for year 2013 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 (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)

20. 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

21. Incidence of infant deaths, neo natal deaths and their causes – 2013 **Please use national Infant mortality rate (9.0 per 1000 live births) to calculate the estimated number of live births for year 2013 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. Notification and investigation of EPI target diseases- 2013 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