Oral Polio Delivered Safely Without Icepacks in Recent Study
by Ariane Halm, EPIET (European Programme for Intervention Epidemiology Training), and Olivier Ronveaux, WHO
recently completed a study with the World Health Organization (WHO) Country Office and the Ministry of Health in Mali to determine the feasibility of using oral polio vaccine (OPV) out of the traditional cold chain temperatures during a National Immunization Day
campaign. In four health areas, thirty-nine vaccination teams successively transported OPV in the vaccine carrier with icepacks (keeping the vaccine at cold chain temperatures) and without icepacks in order to evaluate the outcome of transporting the vaccines without ensuring a continuous cold chain. The practice at ambient temperature was limited to a maximum of one outreach day.
The study concluded successfully, with no major problems or deviations to the methodology. A total of 14,913 children were vaccinated in the study areas. About half of the vials (54%) were transported in vaccine carriers without icepacks, and all of these vials were still usable as indicated by the vaccine vial monitors at the time of the last administered dose despite ambient temperatures ranging from 25° to 40°C (mean of 27°C). Wastage rates were lower for the vials traveling without icepacks because they did not have the problems usually caused by melting ice and icepacks (e.g., moisture on the label making it unreadable, vials contaminated with water, etc.). Health workers also reported that the ambient temperature transport facilitated preparation and implementation activities, reduced the weight they needed to carry, and required less time (possibly resulting in more children being immunized). Direct costs for the ambient temperature transport were lower, primarily because icepacks did not need to be resupplied.
The study suggests that ambient temperature transport of OPV may provide a safe alternative in geographically challenging settings or where cold chain material cannot be made available. However, vaccines transported in ambient temperature must come with vaccine vial monitors
and staff must be adequately trained to interpret them.
This study adds evidence to the possibility that ambient temperature supply chains may be one of the solutions to address constraints in cold chain space that are likely to occur with new vaccine introduction.
A paper on this experience is being submitted for publication in a scientific journal.
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Photo Courtesy : Olivier Ronveaux