Adverse Events Following Immunization (AEFI) Reporting in Urban and Rural Bangladesh

Complete reporting and management of adverse events following immunization (AEFIs) helps maintain the quality of vaccine delivery and monitor vaccine safety. We assessed AEFI reporting of Bangladesh with neighboring and high resource countries and also between rural and urban providers in Bangladesh. We calculated AEFI rates per 100,000 injectable vaccine doses from national vaccination program (2010-2014) between urban and rural providers using a z-test for two proportions. Non-abscess AEFI rates were used to assess reporting differences, while abscess rates indicated vaccine delivery quality. We compared Bangladesh’s AEFI data with reports from neighboring and high-resource countries. Of 97,620,629 reported vaccine doses, 8,003 AEFIs were recorded; 4,763 (60%) were non-abscess AEFIs, and 3,240 (40%) were abscesses. AEFIs were most frequently reported for pentavalent (12/100,000 doses), followed by BCG (6/100,000), and measles-rubella (3/100,000) vaccines. Non-abscess AEFI rates were higher in rural (5.3/100,000 doses) than urban areas (2.3/100,000 doses, p<0.001), while abscess AEFI rates were higher across all vaccines in rural areas (3.5/100,000 doses vs 2.3/100,000 doses, p<0.001). Overall reported AEFI rates (pentavalent: 7.6/100,000, BCG: 1.7/100,000, MR: 2.6/100,000) were lower than in other countries. Low rates in both urban and rural area of nonabscess AEFI compared with expected rates inherent for each vaccine suggested underreporting of AEFIs in Bangladesh. Despite likely underreporting of AEFIs, abscess AEFI rates were higher than several other countries, suggesting attention should be focused not only on the reporting of AEFIs, but also on the quality of vaccine delivery in Bangladesh, particularly in urban areas.