Advancements in monitoring adverse events following immunization in Iraq: Insights from the CIVIE project 2022–2023

Adverse Events Following Immunization (AEFI) surveillance is crucial for ensuring vaccine safety and maintaining public trust. In Iraq, AEFI monitoring faced limitations for years due to a paper-based reporting system, low reporting rates and inadequate data management. This study describes the advancements in AEFI surveillance implemented through the COVID-19 International Vaccine Implementation and Evaluation (CIVIE) project between 2022 and 2023 and the effects on acute events monitoring. A descriptive cross-sectional study was conducted using secondary data from Iraq's Expanded Program on Immunization and related reports. Key interventions included transitioning from paper-based to electronic reporting, training over 2250 healthcare workers and introducing enhanced passive surveillance. These measures led to a significant increase in AEFI reporting, with 510,702 cases documented in 2023, compared to only 17,320 in 2022. Minor AEFIs constituted 99.93 % of the total reported cases in 2023, while serious events remained underreported. The pentavalent vaccine was associated with the highest percentage of AEFIs. Despite the notable improvements, challenges such as regional disparities in reporting and limited hospital-based AEFI surveillance persist. The study highlights the impact of digital transformation and capacity building on vaccine safety monitoring. Further efforts are needed to integrate AEFI reporting into all healthcare settings, enhance case-based monitoring, and strengthen national immunization data systems to align with global standards. Expanding sentinel sites in hospitals and ensuring continuous workforce training will be critical for sustaining improvements in Iraq's vaccine safety surveillance system.