Background With over 80% of children worldwide vaccinated, concerns about vaccine safety continues to be a public health issue. Ghana’s Adverse Events Following Immunization surveillance started in 1978 with the objective to promptly detect and manage AEFI cases either real or perceived. Periodic evaluation of the surveillance system is critical for optimal performance; hence we evaluated the system to assess its attributes, usefulness and system’s performance in meeting its objectives. Methods A case of AEFI was defined as any untoward medical event occurring within 28 days after vaccination and may not necessarily have causal relationship with the vaccine use. We reviewed surveillance data and procedures for the period 2014 to 2018 and interviewed key stakeholders. Adapting the CDC’s Updated Guidelines for Evaluating Public Health Surveillance Systems, we assessed the system’s attributes and usefulness. We performed summary descriptive statistics on quantitative data and directed content analysis on information gathered from interviews. Results In all, 2,282 AEFI cases including 476 (21%) serious cases (life threatening events) were reported for the period. The highest case detection rates of 61.45 AEFIs per 100,000 surviving infants was recorded in 2018. Reporting forms were modified to accommodate new indicators without any disruption in the function of the system. At the national level, completeness of 100 randomly sampled reporting forms (100%) and was higher than the region (27%) but timeliness (50%) was lower than the region (83%). All (16/16) Community Health Nurses interviewed indicated “fear of being victimized” as the reason for underreporting, nonetheless, the system was useful as it made them cautious when vaccinating children to prevent reactions. Data on AEFI surveillance was also useful in guiding training needs and provision of vaccination logistics. Conclusion The AEFI surveillance system is useful at all levels but partially meeting its objective due to underreporting. We recommend training and supportive supervision to improve timeliness of reporting, data completeness and acceptability.

Background On 6th June 2019, Afigya Kwabre North District Health Administration reported suspected foodborne illness involving primary school pupils at Boamang Kyerekrom D/A Primary School. Investigation was done to identify risk factors and implement control and preventive measures. Methods We conducted active case search and a retrospective cohort study. A case was a person from Boamang presenting with fever, diarrhea, or/and vomiting from 29th May to 7th June, 2019. Data was collected using questionnaires and review of health records. Environmental assessment was done. Stool sample of the last reported case and saltpeter used to prepare okro by food vendor was sent to the laboratory for investigation. All other diarrheal cases had being given antibiotics upon our arrival. Risk ratio was estimated to determine food with highest risk of causing illness. Results Of 312 people interviewed, 96 pupils were affected (AR = 30.8%). Common symptoms were fever, nausea, vomiting, abdominal pains and bloody diarrhea. There was no fatality. All cases were found to have eaten from a kenkey seller on the school premises. Risk ratio was highest (6.7) among those who took okro with the kenkey. Salmonella typhi was isolated in the stool of the last reported case. Cases were distributed across four (4) neighboring communities in Boamang. Conclusions Salmonella typhi was identified in the stool and the saltpeter. We recommend training of health staff on Integrated Disease Surveillance and Response (IDSR). Key messages Foodborne illness outbreak

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