POST 01042E : VVM USE
Follow-up on Posts 01028E and 01035E
19 January 2007
_______________________________________
In reaction to Subhash Choudhury's anecdote on
VVM use, five contributions were received, from
1. Anil Varshney (mailto:
[email protected]) from India
2. Enrique Cuevas (mailto:
[email protected])
3. Hans Everts (mailto:
[email protected]) from WHO/Geneva
4. Henrique Menezes d'Alva
(mailto:
[email protected]) or
(mailto:
[email protected]) from WHO/Angola.
Henrique also sends two pictures taken during a
polio campaign showing VVMs on polio vials.
5. Idrissa Yalcouy (mailto:
[email protected]) presently at WHO
_______________________________________
Dear Subhash,
This practice is perfectly OK, as it secures the
vaccines and maintains them at appropriate
temperature in a domestic refrigerator. This also
has reduced wastages. But this practice is only
possible in urban areas and not while the staff
goes house to house or in rural areas where refrigerators may not be many.
rgds
Dr Anil Varshney
(Domestic refrigerators are recommended for
storage of vaccine with proper precautions)
-------------------------
Based in my experience since I have been working
with the Polio eradication, I believe this
practice is correct respecting two major rules:
a) to store the remaining vials separately and well identified
b) to use them as a priority in the next
vaccination session if VVM did not cross stage II.
Again and repeatedly, what is the most important
to avoid this practice is; to prepare your
session with accurate micro planing, highlighting
the target population in order to have the exact
amount of doses during the session
Enrique Cuevas
Former WHO Polio Consultant and Former National EPI Officer at UNICEF in Haiti
-------------------------
Referring to the comments by Subhash C Choudhury
on India, I think the vaccinators made a wise
decision. The advantage of the VVM is not only to
passively monitor the cold chain, but at least if
not more important, to actually find solutions to
problems in operational campaign implementation,
beyond simply stopping the vaccination.
There is a lot of - undocumented - experience, in
particular in the African Region in the use of VVM for polio campaigns:
1) use of non-PIS (PQS) quality vaccine carriers to conduct polio SIA
2) teams not returning to their base for renewal
of ice after it has melted and therefore being able to continue vaccination
3) vaccine carriers with only 1 or 2 icepacks,
rather than 4, in particular for urban teams
4) teams splitting up at markets and bus
stations, while one member keeps the vaccine
carrier and the other simply relies on the VVM
5) teams going to remote villages, beyond the cold life of the vaccine carrier
6) teams keeping the vaccine cool by other means,
like digging a hole in the ground, keeping it in clay pots, etc..
All these experiences may not be useful or
necessary everywhere, but so far Asian countries
have taken a much more conservative attitude
towards proactive use of VVM as operational
planning and implementation tool rather than as a
mere monitoring tool. I have seen teams split up
on markets taking advantage from the VVM in
India, but that is considered an exception to be
prevented, rather than the seed of a new operational approach.
Applying VVM in a proactive way, including
vaccine out of the cold chain, is a change in
paradigm from the top-down classical cold chain.
Progress is certainly not as much as I would have
liked it to be, but I do believe that at least
the mental paradigm change has taken place, even
though it is only put into practise sporadically.
When I did Out of Cold Chain presentations late
20th and beginning 21st century, I risked my
life, whereas now, people may still not implement
it and be skeptical, but there is an openness that did not exist earlier.
Hans Everts
WHO Geneva
Technical officer EPI
------------------------------------
PHOTOS
Dear Mr Choudhury and Technet Colleagues,
Many thanks to have shared with us this supposed
trouble faced by our colleagues in India. I'll
propose to re-check before all the operational
conditions of the all cold chain equipments where
those OPV vaccines were stored. According our
experiences in Angolan EPI activities, and, if
those vaccines were well stored as recommended
before the campaign it's NO way to find them with
all VVMs changed at mi-day, even that under bad
weather conditions and in addition with melted
Ice pack into vaccine carrier. The problems
suppose to be procured at storage conditions of
those vaccines before starting the vaccination
campaign (see some pictures gotten at end of day
in one of Angolan polio NID; campaign was
conducted under bad weather conditions with temperature above 35degree C).
In other hand I'll propose our Colleagues to use
"large cold boxes with frozen ice pack" during
the vaccination campaign to support the field
vaccinators instead of the practice of using
"domestic refrigerator". Have all the best for this new Year 2007.
Kindest regards.
Eng."Henrique MENEZES D"ALVA
EPI Logistician / Vaccine Manager
WHO-Angola
Luanda-Angola
--------------------------------------
Hello Mr. Subhash C Choudhury, bonjour
As a field person, I think that there is a need
to analyse the positive and negative sides of
this initiative taken by the vaccinators in the
field to put vaccine vials in a domestic
refrigerator located in a commercial booth.
Positive side: By putting vaccine vials in a
domestic refrigerator, one avoids wastage and it
slows down the passage of VVM to stage 3.
Negative side: Inside the domestic refrigerator,
the vaccines might be in contact with food
products or other products that could contaminate the vaccines.
We all know that the ideal is to have well frozen
icepacks (well conditioned as far as
freeze-sensitive vaccines are concerned) to
maintain vaccines under good conditions inside
the vaccine carrier. But it is a different story
altogether in the field due to various reasons.
In many countries health centres lack
electricity, gas or kerosene to make enough
icepacks, above all during mass campaigns. That's
why health workers have to resort to intermediate solutions.
In conclusion, I'd like to say that if the
refrigerator is very clean and does not contain
other products likely to contaminate the
vaccines, I believe one could use it long enough
to vaccinate a few children to avoid ending up
with vaccines with VVMs at stage 2 or beyond.
But if the refrigerator already contains others
products that could contaminate vaccines, it is better not to use it.
Mr. Subhash C Choudhury, if some of your
colleagues do not agree with this solution, they certainly have their reason.
Sincere greetings
Mr. Idrissa YALCOUYE,
Consultant Vaccines and Cold Chain Management,
OPS-WHO
Haiti
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