Post 01050E : VVM USE
Follow-up on Posts 01028E, 01035E and 01042E
5 February 2007
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This posting contains two contributions. The first is from Jedeth
Mamora (mailto:
[email protected]) from Indonesia who asks another
question, bringing a new aspect to this discussion.
The second is from Giridhara Babu (mailto:
[email protected]) from India.
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Dear Technet,
As I understood WHO recommends the use of VVM to measure the
effectivity of an antigen, especially polio. There are some events
that showed color changes particularly in polio vaccine which often
range from yellowish to yellow or reddish to red color. The question
is : do we still refer to the VVM despite of the color changes? Some
say that if the color changes to certain pH number (ex. 7.6 or
above), that vaccine has to be discarded even though the VVM shows
good. Is there any research studies to this particular case done
before or any similar experiences happened and what is the
approach/action taken?
Thank you,
JJ
EPI Asistant Project Officer
Health & Nutrition Dept
Banda Aceh Zone Office
Banda Aceh, Indonesia
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Hello everyone,
It is an interesting debate here.
I was working with polio eradication activities for more than 5
years. In my experience, VVM is very useful in the field but efforts
to complicate the process of VVM reading by the field use has to be
discouraged.
1. In India and presumably in some of the countries where polio
is still a major problem, it is not practical in most of the places
to use refrigerator as a stand by for storage. Even if it is done in
isolated urban areas, any efforts to endorse this by programme
managers would leave the field in confusion. For example, if the
vials are kept in refrigerator, how long will the power supply
continue, what is the distance from booth to refrigerator, how many
people are available in booth for this local transport of vaccine
etc. It may also lead in dilution of important efforts like social
mobilization done by team members.
2. The non availability of refrigerator in most of the places
makes it impossible to come out with general guidelines.
3. Using frozen ice packs for keeping the vial should be
strongly discouraged. This is more damaging since the cover gets
peeled off and VVM cannot be read.
4. I would not worry much about most of the vaccine used by
Government run programmes as at least it contains VVM and most of the
workers are aware about reading it before immunizing. My worries are
about few private pharma companies manufacturing the polio vaccines
that are used by vast majority of Pediatricians in Urban areas of
India. I am more worried about their ignorance of VVM and use of
refrigerators by most of the Pediatricians to store vaccines. I have
personally examined many centers in Bangalore as SMO, WHO-NPSP and
found that some of the vials had no VVM and majority of the
pediatricians are using refrigerators to store all vaccines. The cold
hold over time and lack of uniform temperature adds on to the woes in
maintaining good cold chain and this gets complicated by the absence
of VVM. Majority of urban kids are immunized by these vaccine, which
I think is equivalent to giving sterile water ( and not vaccine).
VVM is an effective tool. But lack of uniform guidelines, regulation
will make it difficult for the optimal utilisation for the community.
With regards
Giridhara R Babu
Future Faculty Programme of Public Health Foundation of India
Currently at UCLA, Los Angeles
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