1) Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
In my opinion, the single design limitation most threatens valid estimates of sensitivity and representativeness would be personal bias of routine immunization (RI) providers who reported to the next level and not all facilities are conducting routine immunization, not all facilities are reporting, and not all cases are captured in the documentation. I would like to address it by mapping, enhancing standardization, providing training, implementing active reporting, monitoring, supervision and data quality checks, analyzing and feedback within 6 weeks.
2) Using the CDC surveillance attributes, propose one low-cost intervention to increase sensitivity. State the expected trade-offs and list 2–3 indicators to detect impact from the intervention.
I would like to propose SMS reporting system from caregivers and CHWs to report AEFIs in real time. Automated dashboard developed and monitored and conducted follow up by RI officer or LGA officer. The expected trade-offs are false positives and data noise.
The indicators are as follows:
i) AEFI reporting rate per 10,000 doses
ii) Proportion of reports investigated within 48 hours
iii) Proportion of ineligible case
3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
Yes, the AEFI case definition should be temporarily broadened to maximize early signal detection for a newly introduced vaccine. However, I would trigger to revert to the prior definition based on time, workload, and positive predictive value.
