TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. prabirkc
  2. Supply chain and logistics
  3. Thursday, July 13 2017, 06:13 AM

Dear Friends,

This week, we have seen two patients with diphtheria in our district Bilaspur in chhattisgarh. One was a 6 year old boy from Kharasiya village who came sick to the regional medical college with heart failure and inability to swallow liquids. He could not get the much needed Anti diphtheritic serum which could have saved him, and he died after 48 hours. The other child is a 13 year old girl from village Ghonghadih who came with fever and inability to swallow any fluids or food and had a bull neck swelling. As I write, even 48 hours after having admitted her in our hospital and tried everything to procure the drug from reaching out to the district and the state health authorities, to trying out in the pharmaceutical manufacturers in the other cities of Chhattisgarh, West Bengal and Maharashtra and Delhi, and drawing a blank. The two infectious diseases hospitals in Delhi and Mumbai said that they have the drug but want the patients to come and get admitted with them, but would not dispense it to us. However, that is an impossibility for people to travel to these cities. Meanwhile, this child admitted with us is getting worse today than when she was admitted. Finally the child got a dose from Indore

I am also reminded of another 4 people with diphtheria in the last 2 years of which 3 died . All 4 could not get this drug because it was not available.

While even occurence of such sporadic cases of diphtheria should concerns us, i wish to highlight the unavailability of life saving drugs. Unavailability of medicines directly impedes right to health and adversely affects the patients right to life (as enshrined in our Constitution). Needless to say, the State in turn has the responsibility to ensure that availability of these life saving drugs even in the remote areas or districts within their territory.

At least at a state level, the drugs controller should ensure that such drugs should be available at all times in some volumes, small as they may be. The fact that they are required infrequently, and that some stocks may expire before they are needed cannot be reasons that they are not given importance.The upstream problem with poor supplies is the lack of interest in producing these drugs due to poor demand for them.

Though the Central Government has published a National Treatment Guidelines, 2016, there seems to be little effort been made to ensure the availability of medicines enlisted under the treatment program. Both the centre and state should commission domestic manufacturers to produce, in the larger interest of public health.

 

Yogesh

Dear colleague,

It breaks my heart to read your post about children dying of diphtheria.  I have also seen children die of this preventable disease and had to interview their mothers in an outbreak investigation back in the Dominican Republic in 2004 (you can read anout this outbreak here: https://www.ncbi.nlm.nih.gov/pubmed/26758220 ). 

The global shortage of Diphtheria Anti-Toxin (DAT) is of uttermost concern. WHO's Strategic Advisory Group of Experts on Immunization (SAGE) discussed this issue and made recommendations in April 2017 (see here, bottom of the page: http://www.who.int/immunization/sage/meetings/2017/april/presentations_background_docs/en/ and here http://www.who.int/immunization/sage/meetings/2017/april/3_Diphtheria_anti_toxin.pdf?ua=1 )

While the supply of DAT is solved, we need to continue doing our best to vaccinate, even catch-up children who may have missed their 3 basic DTP before their first birthday. Three doses of DTP cost less than 1 US dollar and can continue saving lives.

References
  1. https://www.ncbi.nlm.nih.gov/pubmed/26758220
  2. http://www.who.int/immunization/sage/meetings/2017/april/3_Diphtheria_anti_toxin.pdf?ua=1
  3. http://www.who.int/immunization/sage/meetings/2017/april/presentations_background_docs/en/


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