POST 01056E : USE OF ALCOHOL FOR VACCINE INJECTIONS
Follow-up on Posts 01029E, 01036E, 01044E and 01051E
20 February 2007
_______________________________
I thought that the last posting would end the debate on this topic.
But three more contributions were received.
The first is from Augustine Akubue (mailto:[email protected])
from Nigeria. The second is from Oleg Benesh
(mailto:[email protected]) from Moldova. And finally, a short comment
from Lydie Maoungou Minguiel (mailto:[email protected]) from Congo.
_______________________________
It is important to note that despite the entire good scientific guess
on the effect of Alcohol on immunization, no properly documented
research has been carried out to support the claims or compare the
AEFIs associated with each procedure.
However, my experience in the field shows that most vaccinators
carrying out outreach in Africa use alcohol as a matter of choice.
Most people think that alcohol will be better than water just as traditions.
In Nigeria, water is better in use than alcohol as many health
facilities cannot afford alcohol at all times. Majority of patients
living in villages do not take care of themselves hence water being a
universal solvent will wash out dirt easier than alcohol.
Alcohol when used in children with abnormally soft skin leads to skin
excoriations.
I observed that one health personnel who used alcohol instead of
water in one remote village during an outreach immunization visits
resulted in many injection abcesses. This got reduced immediately he
introduced water instead of alcohol.
It is worthy of remark that the most important factor is the method
of cleaning the site than what is used to clean the site. Some health
personnels do not know how to clean injection site. Many clean the
site many times on two directions with one swab.
I therefore advise all to stress on the cleaning procedures
especially in Africa where many parents do no bathe their children regularly.
Augustine Akubue
-----------------------------
Dear all,
The discussion on the use of alcohol for vaccine injections may come
up repeatedly because injection is a medical intervention affecting
integrity of the human body that might be accompanied by a range of
risks, including the risk of introducing infection.
Ethanol swabs are used in Moldova for vaccination injections for more
than 40 years and we could not see any clusters of adverse event
following its use.
There are two main circumstances when alcohol swabs use might be
justified for injections (including vaccination injections):
1. Clean the injection site prior to injection
2. Protecting the injection site from infection and bleeding after
injection is done.
To me is not acceptable to clean the site only when dirty as the
microbial contamination of the site CAN NOT be detected visually.
Applying a standard cleaning precautionary measure I consider A MUST,
and I would not accept personally any injection before a precaution
to prevent possible infection is taken?
I also would like to ask how often the injection site is bleeding
after injection. According to my observations it is a rare case for
intra-cutaneous injections (BCG) and almost universal after
subcutaneous or intramuscular injections. I would like to ask whether
a child should leave the vaccination place with a bleeding injection
site. And if not - let's decide how to approach it.
I would appreciate the discussion addresses the alternative
ways/methods/tools these two concerns are safely met.
It is well known any drug can be the same time a poison if not
appropriately used. The cited article on methanol use is a good example.
To me the main problem is ensuring appropriate training of staff
delivering health services (including vaccinations) on appropriate
use of technology and appropriate logistical support to allow its
implementation. I am not a supporter of promoting unjustified
over-simplified techniques. Yes, such techniques can allow reaching
high coverage, but I would not like the price we pay for is safety.
Alcohol swabs, if properly used, beside cleaning the site have also
some anesthetic effect and injection is less painful to the child and
they are less exposed to the stress during the injection.
Let me do not support the concern cited below: ... there is a
potential for containers of alcohol-soaked swabs to become
germ-breeding sites due to alcohol concentrations reducing over time
(a particular risk in hot climates) with a resulting risk of cross
infection....
First, if the swabs become germ-infected, that is good for children
whose vaccination sites got clean of those germs.
Secondly, safe vaccination programs have to address proper handling
and disposal of biologically hazardous waste. I do not see any
problem swabs are collected into safety boxes together with syringes
and are disposed off afterwards following the country waste disposal policy.
I also would understand that alcohol can inactivate live vaccines if
there is a direct exposure of the vaccine to the alcohol. But is
there any evidence the alcohol applied on the skin can inactivate the
injected vaccine into the tissues?
With best regards,
Oleg Benes
Medical epidemiologist,
Republic of Moldova
-------------------------------
Hello to all,
I share Serge's opinion, I have not seen any study on this topic.
Thank you,
Lydie
______________________________________________________________________________
All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services.
The comments made in this forum are the sole responsibility of the writers and do not in any way mean that they are endorsed by any of the organizations and agencies to which the authors may belong.
______________________________________________________________________________
Visit the TECHNET21 Website at http://www.technet21.org
You will find instructions to subscribe, a direct access to archives, links to reference documents and other features.
______________________________________________________________________________
To UNSUBSCRIBE, send a message to : mailto:[email protected]
Leave the subject area BLANK
In the message body, write unsubscribe TECHNET21E
______________________________________________________________________________
The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org)
______________________________________________________________________________
There are no replies made for this post yet.