Annexure IV-B B

FORM 1 a Calculation of No. of registered infants under care among infants born between 1st of January 2014 to 31st of December 2014 (eligible for BCG vaccination in year 2014)

Number of Number of registered Number of infants born between 1st of January 2014 to 31st of December 2014 MOH area pregnant infants under care* mothers (A) Registered Registered after 3 Came newly into the Left the area Died registered within 3 months months of birth to area & registered to date^^ to date^^ in year 2013 of birth date^^ to date^^

(AA) A = (V+W+X) - (Y+-Z) (V)**** (W)**** (X) (Y) (Z) Form1 b Coverage of BCG vaccination among infants born between 1st of January 2014 to 31st of December 2014 and protection of their mothers from Tetanus and Rubella vaccination at the time of delivery MOH BCG** Maternal TT Maternal area Rubella

(G) (H) (AA) (F) (A) (B) (C) (D) (E) Coverage Number of Number of according to mothers mothers Number of Number of Number of Number & Number of Registered Estimated protected from protected from Number registered estimated vaccinations % of age vaccines TT at the time of Rubella at the of infants births for according to appropriate given infants births delivery time of delivery pregnant under 2014 BI registers vaccinations according under care according to according to mothers care * according to to Q/ EPI * pregnant pregnant registered BI return mothers mother in year registers** registers registers 2013 /mothers cards /mothers cards (D/A)*100 (C/A)* 100 (C/B)* 100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for BCG- 24 hours to date^^ -to the date of compilation of data for the review

***TT & Rubella immunizations of pregnant mothers of children born between 01st January 2014 – 31st December 2014 should be obtained from Pregnant Mothers Registers/512b or mothers cards ) V & W **** -For the infants born to the mothers who were under care/ residing within the area at the time of delivery FORM 2 a Calculation of No. of registered infants under care among infants born between 1st of November 2013 to 31stof October 2014 (eligible for OPV1/ PVV1 vaccination in year 2014)

Number of Number of registered Number of infants born between 1st of November 2013 to 31st of October 2014 MOH pregnant infants under care* Registered within Registered after 3 Came newly into the Left the area Died area mothers 3 months of birth months of birth area & registered to date^^ to date^^ registered in to date^^ to date^^ 2013 (AA) (A) (V)**** (W)**** (X) (Y) (Z)

A = (V+W+X) - (Y+-Z) Form 2b Coverage of OPV1 /PVV 1 vaccination among infants born between 01st of November 2013 to 31st of October 2014

MOH Coverage of OPV1 /PVV 1 area (AA) (A) (B) (C) (D) (E) Number of according to pregnant Number of Number Number of Number of Number of Registered Estimated Age Number of mothers registered of vaccinations age vaccines registered infants births appropriate vaccines infants estimated according to appropriate given in 2013 under ness given as under births BI registers vaccinations according care* per Q/ EPI care* For 2014 according to to Q/ EPI returns BI registers** return (C/A)* 100 (C/B) *100 (D/A) *100 (C/E) *100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for PVV 1 / OPV1- Two weeks FORM 3 a Calculation of No. of registered infants under care among infants born between 01st of July 2013 to 31stof June 2014 (eligible for OPV3/ PVV3 vaccination in year 2014)

Number of Number of registered Number of infants born between 1st of July 2013 to 31st of June 2014 MOH pregnant infants under care* Registered within Registered after 3 Came newly into the Left the area Died area mothers 3 months of birth months of birth area & registered to date^^ to date^^ registered in to date^^ to date^^ 2013 (AA) (A) (V)**** (W)**** (X) (Y) (Z)

A = (V+W+X) - (Y+-Z) Form 3b Coverage of OPV3 /PVV 3 vaccination among infants born between 01st of July 2013 to 31stof June 2014

MOH Coverage of OPV3 /PVV 3 area (AA) (A) (B) (C) (D) (E) Number of according to pregnant Number of Number Number of Number of Number of Registered Estimated Age Number of mothers registered of vaccinations age vaccines registered infants births appropriate vaccines infants estimated according to appropriate given in 2013 under ness given as under births BI registers vaccinations according care* per Q/ EPI care* For 2014 according to to Q/ EPI returns BI registers** return (C/A)* 100 (C/B) *100 (D/A) *100 (C/E) *100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for PVV 3 / OPV3- Two weeks FORM 4a Calculation of No. of registered infants under care among infants born between 1st of April 2013 to 31st of March 2014 (eligible for LJEV vaccination in year 2014)

MOH area Number of Number of registered Number of infants born between 1st of April 2013 to 31st of March 2014 pregnant infants under care* Registered Registered after 3 Came newly into the Left the area Died mothers (A) within 3 months months of birth to area & registered to date^^ to date^^ registered in of birth date^^ to date^^ 2012 (AA) A = (V+W+X) - (Y+-Z) (V)**** (W)**** (X) (Y) (Z) Form 4b

Coverage of LJEV vaccination among infants born between 1st of April 2013 to 31st of March 2014

MOH area (AA) (A) (B) (C) (D) (E) Coverage of LJEV according to Number of Number of Number of Number of Number of Number of Registered Estimated Age Number of pregnant registered estimated vaccinations age vaccines infants births appropriateness vaccines mothers infants births according to appropriate given under care* given as registered under For 2013 BI registers vaccinations according per Q/ EPI in 2012 care* according to to Q/ EPI returns BI return registers** (C/A) *100 (C/B)* 100 (D/A)* 100 (C/E) *100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for LJEV- one month FORM 5a Calculation of No. of registered infants under care among infants born between 1st of January 2013 to 31st of December 2013 (eligible for MMR1 vaccination in year 2014)

MOH area Number of Number of registered Number of infants born between 1st of January 2013 to 31st of December 2013 pregnant mothers infants under care* Registered Registered after Came newly into Left the area Died registered in 2012 (A) within 3 months 3 months of the area & to date^^ to of birth birth to date^^ registered date^^ to date^^ (AA) A = (V+W+X) - (Y+-Z) (V)**** (W)**** (X) (Y) (Z) FORM 5b Coverage of MMR1 vaccination among infants born between 1st of January 2013 to 31st of December 2013

MOH (AA) (A) (B) (C) (D) (E) Coverage of MMR1 area according to Number of Number of Number of Number of Number of Number of Registered Estimated Age Number of pregnant registered estimated vaccinations age vaccines infants births appropriateness vaccines mothers infants births according to appropriate given under care* given as registered under For 2013 BI registers vaccinations according per Q/ EPI in 2012 care* according to to Q/ EPI returns BI registers** return

(C/A) *100 (C/B) *100 (D/A)* 100 (C/E) *100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for MMR1- one month FORM 6a

Calculation of No. of registered infants under care among infants born between 1st of July 2012 to 30th of June 2013(eligible for DPT4/ OPV4 vaccination in year 2014) MOH Number Number of registered Number of infants born between 1st of July 2012 to 30st of June 2013 area of infants under care* Registered within Registered after 3 Came newly into the Left the area Died pregnant (A) 3 months of birth months of birth area & registered to date^^ to date^^ mothers to date^^ to date^^ registered in 2011 (AA) A = (V+W+X) - (Y+-Z) (V)**** (W)**** (X) (Y) (Z) FORM 6b

Coverage of DPT4/OPV4 vaccination among infants born between 1st of July 2012 to 30th of June 2013

MOH (AA) (A) (B) (C) (D) (E) Coverage of DPT4/OPV4 area according to Number of Number of Number of Number of Number of Number of Registered Estimated Age Number pregnant registered estimated vaccinations age vaccines infants births appropriateness of mothers infants under births according to appropriate given under care* vaccines registered care* For 2012 BI registers vaccinations according given as in 2011 according to to Q/ EPI per Q/ BI return EPI registers** returns (C/A)* 100 (C/B) *100 (D/A)* 100 (C/E) *100

Total

*Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for DPT4/ OPV4- one month FORM 7a Calculation of No. of registered infants under care among infants born between 1st of January 2011 to 31st of December 2011 (eligible for MMR2 vaccination in year 2014)

MOH Number of Number of registered Number of infants born between 1st of January 2011 to 31st of December 2011 area pregnant mothers infants under care* Registered within Registered after 3 Came newly into the Left the Died registered in 2010 (A) 3 months of birth months of birth area & registered area to date^^ to date^^ to date^^ to date^^

(AA) A = (V+W+X) - (Y+-Z) (V)**** (W)**** (X) (Y) (Z) Form 7b Coverage of MMR2 vaccination among infants born between 1st of January 2011 to 31st of December 2011

Coverage of MR+MMR2 MOH (AA) (A) (B) (C) (D) (E) according to area Number of Number of Number Number of Number of Number of Registere Estimated Age Number of pregnant registered of vaccinations age vaccines mothers d infants births appropri vaccines infants under estimated according to appropriate given registered under ateness given as in 2010 care* births BI registers vaccinations according care* per Q/ EPI For 2011 according to to Q/ EPI returns BI registers** return

(C/A) *100 (C/B) *100 (D/A)* (C/E)* 100 100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for MMR2 - one month FORM 8a

Calculation of No. of registered infants under care among infants born between 1st of January 2009 to 31stof December 2009(eligible for DT/ OPV5 vaccination in year 2014)

MOH area Number of Number of registered Number of infants born between 1st of January 2009 to 31st of December 2009 pregnant infants under care* Registered within 3 Registered after 3 Came newly into the Left the area Died mothers (A) months of birth months of birth area & registered to date^^ to date^^ registered in to date^^ to date^^ 2008 (AA) A = (V+W+X) - (Y+-Z) (V)**** (W)**** (X) (Y) (Z) FORM 8b

Coverage of DT/OPV5 vaccination among infants born between 1st of January 2009 to 31stof December 2009 MOH area (AA) (A) (B) (C) (D) (E) Coverage of DT/OPV5 according to Number of Number of Number of Number of Number of Number Registered Estimated Age Number of pregnant registered estimated vaccinations age of infants under births appropriaten vaccines mothers infants births according to appropriate vaccines care* ess given as per registered under care* For 2009 BI registers vaccinations given Q/ EPI in 2008 according to according returns BI registers** to Q/ EPI return (C/A)* 100 (C/B)* 100 (D/A) *100 (C/E)* 100

Total *Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date )

**Age appropriate vaccination for DT/ OPV5 - one month Form 9

Coverage of aTd vaccination among children in grade 7 during 2014

No MOH area Number on Number of children % of immunized Number of Total number roll in immunized in children in children immunized in grade 7 grade 7 grade 7 immunized in year 2014 other grades 1

2

3

4

5

6

7

8

9

10

Total Form 10 Comparison of vaccine coverage according to the advancing birth cohorts Vaccine (AA) (A) (B) (C) (D) (E)

Number of Number of Number of Number of Number of DPT 1 doses Number of % Coverage pregnant registered estimated vaccinations given according to Q/ EPI vaccines according to mothers infants births ( for given return for the years of given registered under care respective according to respective birth cohorts according in *( for birth cohorts BI registers under review to Q/ EPI respective respective under review ) returns Registere Estimated Number of vaccines years birth cohorts 2012 d births births given as per Q/ EPI under YEAR NO OF returns for the years of review ) DOSES respective birth cohorts (C/A) *100 (C/B) *100 under review (C/E)* 100 BCG 2014

PVV1 2013( 4Q) 2014( 1,2,3 Q) PVV2 2013( 3,4 Q) 2014( 1,2Q) LJEV 2013-(2,3,4 Q) 2014 – (1Q) MMR1 2013

DPT 4 2012-(3,4 Q) 2013-(1.2 Q) MMR2 2011

DT 2009 aTd

*Number of registered infants under care = (Number registered within 3 months of birth + Number registered after 3 months of birth to date+ Number newly came into the area & registered to date ) – (Number left the area to date + number died to date ) Form 11 Number of immunizations performed and difference against the antigen which ever has the highest number of immunizations(PVV1, PVV2, PVV3) during infancy ( 1st year of life) in RDHS area by antigen in 2014 Prepare and present a Bar Chart as given in the example below, based on data in four consolidated EPI quarterly returns of 2014 Form 12

Status of vaccine usage and wastage in the district for year 2014 by antigen

Antigen Book Total Book No of doses Total number Highest book Total No. of Usage Wastage balance at receipts balance at discarded at of doses balance at Immunizations % % the all at the the all the all MOH utilized by all the MOH Performed in MOH all MOH offices due MOOH during offices year 2013 offices as MOH offices as to expiry or 2014 for in a ( Based on of 31st offices of 31st of cold chain vaccination given time the4 EPI December during December failure during quarterly 2013 2014 2014 during 2014 the year Returns sent 2014 by the MOOH for year 2014)

(A) (B) (C ) (D) ( E)=(A+B)-(C +D) (F) ( G ) ( I )=(G/E)*100 ( J )=(100- I ) B.C.G

Penta

DPT

OPV

LJEV

DT

TT aTd

MMR

Other Form 13 a: Adverse events following immunization (A.E.F.I.) in year 2014

MOH area No. of No. of No. of Total No. of Total No. of AEFI Monthly AEFI Monthly AEFI “Nil” Monthly AEFI** reported investigated( %) Returns Returns received AEFI returns received in time received

Total

** Injection site abscess, BCG lymphadenitis, Severe local reactions ,Encephalitis/Encephalopathy ,Meningitis Seizures (Febrile + Afebrile) Anaphylaxis ,Persistent Screaming ,HHE Form 13 b : Rates of AEFIs reported in the district during 2014

Antigen Type of AEFI Number of No of doses AEFI Rate National AEFI administered† Rates for reported ( C ) 2014 (A) (B) (C ) =(A)/(B)*100000 BCG BCG lymphadenitis

Penta Seizures (Febrile + Afebrile) Anaphylaxis Persistent Screaming HHE Allergic reaction

Measles Seizures (Febrile + Afebrile) Anaphylaxis Allergic reaction

MMR Seizures (Febrile + Afebrile) Anaphylaxis Allergic reaction Parotitis

JE Seizures (Febrile + Afebrile) Anaphylaxis Allergic reaction Encephalitis/Encephalopathy Form 14a Incidence of infant deaths, neo natal deaths and their causes in the district – 2014

**Please use national Infant mortality rate (9.0 per 1000 live births) to calculate the estimated number of live births for year 2014 MOH area Estimated No. Estimated No. Estimated No. No of infant deaths No. of infant % of infant deaths of live births of infant of neonatal reported deaths investigated deaths deaths investigated

Total

Form 14 b

Causes No. reported % 1. Prematurity 2. Congenital Abnormalities 3. 4. 5. 6. Total Form 15 Notification and investigation of EPI target diseases- 2014 Disease No. No. No, % Investigated No. of special % of special Reported Investigated* confirmed (D) investigation investigation forms forms sent sent (F) (A) (B) (C) (D)=(B)/(A)*100 (E) (F)=(E)/(C)*100 Whooping Cough

Tetanus

NNT

Measles

Rubella

CRS

AFP

Encephalitis

Meningitis

Mumps

Total

*No. Investigated = No. reported – No. not attended by a MOH/PHI OR *No. investigated = (Number confirmed+ Number identified as a non notifiable disease+ Number unable to trace+ Number belongs to other MOH area+ Number re notified) District and Provincial Birth Rates to be used for calculation of estimated number of births for year 2014 ( Source- Registrar General ‘s Department )

Districts District Birth Rate 2013 Provincial Birth Rate 2013 per 1000 population per 1000 population

Colombo 16.1 15.5 Gampaha 14.6 15.5 Kalutara 15.8 15.5 Kandy 19.6 19.8 Matale 19.4 19.8 Nuwara Eliya 20.5 19.8 Galle 17.1 18.0 Matara 16.2 18.0 Hambantota 20.7 18.0 Jaffna 17.3 18.9 Kilinochchi 25.5 18.9 Mannar 19.5 18.9 Vavuniya 20.3 18.9 Mulativu 11.9 18.9 Batticaloa 20.0 21.1 Ampara 22.6 21.1 Trincomalee 20.8 21.1 Kalmunai 22.6 21.1 Kurunegala 17.0 19.1 Puttalam 21.1 19.1 Anuradhapura 19.3 18.9 Polonnaruwa 18.6 18.9 Badulla 18.7 19.2 Moneragala 19.6 19.2 Ratnapura 18.5 17.4 Kegalle 16.3 17.4

Sri Lanka 17.9 17.9