Day 2: Saturday 9 April 2012

You come into your office on Saturday morning. Several of the immunization centres are active on Saturday and you have already visited two of them. However, the vaccination centre in Chandra is closed today. On your desk there is a copy of the laboratory report for Martha Chidawayo, that has also been sent to Dr Charman. The haemogram and the peripheral smears are normal and there is no evidence of infection. A handwritten note attached to the form says:

"This all looks normal for a child of her age – she is not apparently immunodeficient, and we could not see any parasitaemia."

There is also a voice message on your answering machine saying:

"Hello, this is Jonas Willen from the Karoom Morning Bugle [local newspaper]. I would like to talk to you about the measles vaccine programme that you are conducting in the city. Could you please call me back on 07992 665200 – many thanks, hope to speak to you soon."

Select activities that you would do next.

Phone the regional health officer, to inform him of the event.

You contact the regional health officer, to tell him that you have had a possible AEFI related to the measles vaccination programme. You also inform him that you have received an information request from the local newspaper.

He thanks you for the call, and says that you should investigate all the circumstances carefully and e-mail Martha’s AEFI pre-investigation report reporting sheet to him as soon you have all the information.

He says that there have been no other reports of problems with the vaccine from other parts of the region, but he will keep a look out for anything. He invites you to communicate this information to the press and suggests that you propose him as contact person on any further information that may be requested by the media relating to information that is outside your geographical area.

  • This is a correct action to take.
    The regional health officer is the correct person in your reporting line for AEFIs and even reporting an individual case may be relevant as similar cases may have occurred in other offices that the regional health officer is overseeing.
  • Informing the regional health officer of the media request is also relevant as he may be able to provide more information to journalists seeking information at regional level.

Contact the vaccine distributor.

After 30 minutes on the phone you manage to contact Mr Yen at Yuchong Medical Supplies. You explain that you have a concern about the Klinigen measles vaccine, batch U-5773 and diluent batch SR-2781. Mr Yen confirms that the batch was distributed in Karoom in January and that they have also distributed supplies to medical centres in Cherunan, Hinandi and Hobi in March.

  • As you are primarily responsible for Karoom, contacting the distributor should in this case be rather undertaken by the regional health officer, if necessary.
  • The vaccine has been widely distributed in your city and neighbouring regions.

Switch to a different vaccine batch in your centres.

You send out a note to your various immunization centres requesting that they switch vaccine batches, so that they are not using vaccine batch U-5773, starting from Monday.

  • There is no reason to take this action at this point, as the child has fully recovered, the link to the vaccination has not been established, and no other events have been reported!
  • At this point, you are not certain that there is a problem with this vaccine batch and you already know from the Chandra clinic that the previous batch is almost exhausted.

Telephone Jonas Willen at the Karoom Morning Bugle.

You return the telephone call of Jonas Willen, a journalist on the Karoom Morning Bugle. This newspaper is published daily (Monday to Saturday) and distributed widely within Karoom.

He has heard that there has been an incident of seizures following the new measles vaccine. He wants to know whether this is true, how many cases there have been so far, and whether you plan to stop the immunization programme.

You explain to him that:

  • The programme has been instituted in response to an outbreak of measles in the north of the country. It is planned as a non-selective mass vaccination for all children under age 5 to enhance protection against measles.
  • Apart from one reported case of a girl who had a reaction a day after receiving a measles vaccine no other serious adverse events have been reported in Karoom.
  • The symptoms that the girl have been of temporary nature and that the girl has fully recovered.
  • It has not been determined whether the vaccination was related to her symptoms, or whether this was just a coincidence.

Following his question on the consequences for the immunization programme, you tell him that based on the information available, and based on the fact that at regional level no other cases have been reported, there is currently no reason to alter the immunization programme.

You ask that he reads back his notes so that you can check that they are accurate and offer him to be available for any further information requests.

  • This action is relevant.
    Responding to an information request of the media in a timely manner and with accurate and fact-based information is important.
  • Before contacting the journalist prepare yourself by having all information available that he needs to understand fully the situation.
  • You will learn more about how to communicate information effectively in Module 6.

Contact the vaccine manufacturer.

You look up the website of the vaccine manufacturer, Klinigen. There is a considerable amount of information on the vaccine, and one contact point, where you can send an e-mail if you have any concern about vaccine safety or adverse reactions. You send an e-mail notifying the vaccine manufacturer about the measles vaccine.

  • This action is not appropriate at your level and at this stage.
  • The correct action is to send a report of the AEFI to your regional health officer, and/or NRA, where it will be evaluated. They may then contact the manufacturer.