1) ) Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
Single design limitation threatens the validity of sensitivity and representatives. In the articles, the main problem is under-reporting of AEFI cases. It can affect the sensitivity for being delaying of information, incomplete data. Regarding to representatives, data could not represent the whole cases because of under-reporting and may interpret as false case load. In impact, it might mis-regard as not an important issue.
In the next six month, we can fix to improve real time reporting by establishing the electronic reporting system and can train the health staff to use the mobile reporting system. Moreover, we can train the health staff the technical competency to investigate and identify the AEFI cases in immunization.
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.
Regarding to low cost intervention;
Expected trade off; we can consider and ensure the system as the following;
1) Simplicity: reporting, data collection format should be simple and understandable for health staff. It should not be extra workload for them
2) Timeliness: Real time reporting is critical for AEFI cases. The defined channel must be reflected on ground situation. Delay report can not be used to develop effective response.
3) Data quality; The reported data must be fulfilled with standard data quality. Incomplete and missing data may take time and cause backward to interpret the cases.
we can set integrated reported indicator as 1) number of AEFI case in your health facilities; 2) Number of notified AEFI cases within 24hr in the monthly or quarterly report of Health information management system (HMIS) routine report.
3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
It is absolutely needed to broad the early detection when newly vaccine is released in the community. It can be reverted when sensitivity and Predict value positive rate are dramatically decrease after analyzing the system, root causes, workload, data quality.