Analyzing adverse side-effects of A/H1N1 vaccine in Afghanistan

In 2010 there was widespread public mistrust of the Influenza A/H1N1 vaccine in Afghanistan. To encourage vaccination, the Ministry of Public Health undertook a study to analyze the risks involved in vaccination. The purpose of this study was to demonstrate to the Afghan public that the adverse side-effects did not pose any serious health threat. In order to build public confidence in the vaccination campaign, the Ministry of Public Health analyzed the side-effects of vaccination in Afghan healthcare workers. A total of 27,100 health care workers received the A/H1N1 monovalent vaccine in the four provinces of Kabul, Nangarhar, Balkh and Herat. OpenEpi was used to draw a randomized sample of 417 people for participation in this study, which was conducted over 4 weeks in March-April 2010. Interviewers were trained in questionnaire administration and assigned districts in the four regions. 370 people interviewed were included in the final study: 25% were female, 75% male; mean age was 36 years, and range was from 16–65. Standardization of injection procedure was ensured by using best practices of injection safety for vaccination.  53% of those interviewed reported pain at the injection site, 40% reported fever in the first three days after immunization, 39% reported body pain, 33% reported tiredness, 29% reported swelling at the injection site and 28% reported redness at the injection site. More females than males suffered adverse reactions; the rates varied across provinces, ranging from 79% of females in Balkh reporting adverse side-effects to 23% in Kabul.  While the results demonstrated that a high percentage of vaccine recipients experienced adverse side-effects, all were mild, non-life threatening and resolved within a few days. No serious lasting side-effects were reported. The results of this study were shared with over 20 governmental and non-governmental stakeholder institutions, including UNICEF, WHO and relevant Afghan Ministries, and publicized through media interviews and announcements. As a result, reports from Ministry of Public Health vaccination teams showed daily increases in the number of people vaccinated to the point at which Afghanistan suffered from a vaccine shortage.