1.) Which single design limitation most threatens valid estimates of sensitivity and representativeness? How would you address it within six weeks?
– It was the lack of involvement of private healthcare providers, resulting in under-reporting and incomplete documentation. When this data was missed, it means the community awareness of AEFI report would be low. Therefore, I would suggest including them by implementing a fast-track training for staff in these centers. For example, scheduling the workshop for the key staff responsible for detecting and reporting AEFI. Then, providing them the necessary tools for detection and documentation. Direct consultation should also be offered to support the fast track process.
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.
– Since the lack of participation and low awareness was mentioned, a feedback loop could be implemented. It can be a regular monthly requirement for health center leaders to submit their reports to the central database. A simple summary from the central system should be produced and distributed so that the stakeholders can see their contribution, and also can help monitor vaccine safety data. The trade-off is this practice can add more workload to the local staff as well.
The key indicators could be: the proportion of complete reporting, and the timeliness of reporting.
3.) For a newly introduced vaccine, should the AEFI case definition be temporarily broadened to maximize early signal detection?
– Yes, which means that more inclusive case definition will increase sensitivity, which is important for a new vaccine. The trigger could be for example the standardized reporting rate is achieved, and the decision would be made baked on the judgement of the National Committee.
