TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.

Discussions tagged Diphtheria

Updated Vaccine-Preventable Diseases (VPD) Surveillance Standards Released

WHO has released the updated surveillance standards for more than 20 vaccine-preventable diseases. Each disease is its own self-contained chapter, available in color and in black and white (for ease of printing).  There is also an introductory chapter detailing some of the basics of surveillance.  French and Russian translations will be available in the coming months.  
https://www.technet-21.org/en/library/explore/vaccines-and-delivery-technologies/4942-vaccine-preventable-diseases-surveillance-standards    

Appropriate age for Td vaccine

Dear TechNet members, We would like to know the appropriate age for Td vaccine and whether what we are practising is right. As per the manufacturer’s leaflet (Serum Institute of India), Td vaccine is for primary vaccination and revaccination of children older than 7 years. However, in Bhutan, we are giving at 6 years also.  Our immunization schedule for DTP containing  and Td vaccine is as follows: DTP-HepB-Hib (Pentavalent) at 6, 10 and 14 weeks. DTP at 24 months Td at 6 and 12 years Td at pregnancy Best regards, Chandralal

Shortage of Anti Diphtheric Serum

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

2015 WHO/UNICEF Estimates of National Immunization Coverage (WUENIC) and supporting visualizations

The latest WHO and UNICEF estimates of immunization coverage show that 86% of the world’s children received the required 3 doses of diphtheria-tetanus-pertussis containing vaccines (DTP3) in 2015, a coverage level that has been sustained above 85% since 2010.As a result, the number of children who did not receive routine vaccinations has dropped to an estimated 19.4 million, down from 33.8 million in 2000.However, this progress falls short of global immunization targets (90% or more DTP3 vaccination coverage at the national level, and 80% or more in all districts in all countries) by 2015.
Read the full storyhere, and have a look at thisanimated map to see how global DTP3 coveragechanges from 2000 to 2015.
A short presentation with some highlights is posted here.
Want more detail? All the raw data can be foundhere.

High Immunization Coverage but Delayed Immunization Reflects Gaps in Health Management Information System (HMIS) in District Kangra, Himachal Pradesh, India—An Immunization Evaluation

Background: Complete and timely childhood immunization is one of the most cost-effective interventions in improving child survival in developing countries. Computerized HMIS has been recently introduced to collect aggregated data on service beneficiaries in Himachal Pradesh. HMIS provides coverage estimates for immunization while information on timeliness is currently not available. Hence we conducted a study to validate coverage and assess the timeliness of immunization in Kangra District of Himachal Pradesh. We surveyed mothers (224) of children aged 12 - 23 months (as on January 2008) and selected 32 clusters in the district between January and March 2008. Design/Methods: We conducted a cross sectional survey and selected 32 clusters by probability proportional to size method whereas seven eligible children per cluster were randomly selected. We interviewed mothers using a structured interview schedule, examined immunization card & looked for Bacillus Calmette Guierre (BCG) Scar. Vaccination after 30 days from national schedule was considered “delayed”. We computed proportions of children completely immunized, immunization delayed, frequency of reasons for delay and 95% Confidence Interval (CI) for significance of associated factors. We conducted a case control analysis of factors associated with timely immunization by taking timely immunized children as cases and delayed immunized ones as controls. Results/Outcome: Reported coverage was universal (100%). Validated full immunization coverage was 94.2% by card/record & 99% by history. Only 29.5% (CI = 20.6% - 37.4%) of children were fully immunized as per schedule (delay less than 30 days). Median delay was 21 days for BCG, 28 days for Diptheria Pertussis Tetanus (DPT 3) and 25 days for measles. Among those with delayed vaccinations, reasons were forgetfulness (36%), lack of correct knowledge (27%) & mother gone to parents’ home (27%) & insufficient children in a camp to open full dose BCG vial (22%). Our case control analysis of timely vaccinated versus delayed vaccination revealed that “precall” (reminder) was significantly [OR = 0.1, CI = 0.2 - 0.5] protective against delayed vaccination. Logistic Regression of delay > 30 days revealed that having returned unimmunized from immunization camp earlier due to insufficient children to open vaccine vial (because of high wastage factor) was significantly associated with delayed immunization (p = 0.0000), while knowledge of date of immunization camp was significantly protective from delayed immunization (p = 0.0026). 68% of the children were having at least one immunization delayed over 30 days from recommended schedule, while the proportion of children whose immunization was delayed by over 90 days was 9.4%. Conclusions: Validated field coverage estimates are lower than reported which can be due to inclusion of children of migrants in numerator & not in the denominator. High proportion of children (>70%) were delayed, suggesting implications for WHO’s strategy of measles control & national Tuberculosis (TB) control programmes, as 4.5% of them had suffered from measles. To avoid delays we recommend (i) use of mono dose vials for BCG; (ii) precall notice to mothers; (iii) modification of HMIS software to track immunization status and timeliness of individual beneficiaries rather than aggregate numbers. the link: http://www.scirp.org/journal/PaperInformation.aspx?PaperID=55741#.VS_k8fmUdG0 Regards, Omesh Bharti Shimla, India +91-9418120302

INFORMATION NOTE: Vaccine vial monitor (VVM) assignments for different WHO-prequalified vaccines

WHO and UNICEF have jointly prepared an information bulletin which addresses varied implications of different types of vaccine vial monitors (VVMs), notably VVM category type 7 (VVM7) and VVM category type 14 (VVM14), on vaccines such as the Inactivated Polio Vaccine (IPV) and the fully-liquid Diphtheria-Tetanus- whole cell Pertussis-Hepatitis B-Haemophilus influenzae type b (DTP-HepB-Hib, commonly referred to as pentavalent). The note is directed to countries that are currently supplied by UNICEF Supply Division with these specific presentations of vaccine. The information is intended for WHO/UNICEF staff, as well as EPI managers or other partner agencies which support immunization programmes.

Both the english and french versions are attached here.
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