Dear Technet Moderator,
Last week Mojtaba brought to our attention some issues that are still pending a resolution. I would like to add to the list two other issues that to me are extremely important:
Revision of the Controlled Temperature Chain (CTC).....
The CTC concept was first dealt with in the TLAC committee and then in the committee that succeeded TLAC, i.e. IPAC. The official meeting reports of TLAC and IPAC can be obtained from the WHO web page, and I will be referring to these reports, particularly the report on the last TLAC meeting held in September 2009, in which my colleague Soren Spanner and I proposed:
1.1 Moving to a "cool chain"
1.1.1 Use of domestic refrigerators at the Healthcare Centre Level
1.1.2 Use of cool rooms at healthcare facility level
1.1.3 Use of eutectic packs to avoid freezing
1.1.4 TLAC Findings, Conclusions, and Recommendations on the "Cool Chain"
Soren and I used the term "Cool Chain", but in the same meeting the term "Controlled Temperature Chain" (CTC) was coined. The key rationale was that the stability of most vaccines is such that they may safely be kept at +20°C to +25°C for up to one month without significant loss of potency. Please see Tables 9 and 10 in the WHO publication: "Temperature Sensitive Vaccines", published in 1996. However, also the fact that the new vaccines already introduced into EPI and those to come, will take up immensely more space than the traditional 6 antigens, was important to us. For my own part I believed that the VVM would facilitate the implementation of our proposals, but it turned out that the VVMs are only used on 30% of the vaccines used in immunization programs, and that VVMs are not being used by PAHO. Please see relevant TLAC and IPAC reports.
Soren on his part proposed the use of domestic refrigerators at the Healthcare Centre level, and I proposed the use of cool rooms (walk-in units without refrigeration equipment, but with a simple air condition unit, bringing the cost of a WIC down to one third), at the same level. Anyone interested in our proposals can read the TLAC report of the September 2009 meeting, or even better our very detailed proposal, presented in our own writing, which is attached.
Implementation of our proposals would imply changing the temperature range at which our vaccines are presently to be kept: 2-8 degrees Celsius. WHO is therefore set to move cautiously with the implementation of CTC, and in this respect I propose that interested readers read the meeting report of the IPAC meeting held in November 2010.
However, since November 2010, WHO/IPAC has not published anything regarding CTC, i.e., in 2011, nothing at all is reported regarding CTC.
Would it be too much to request information from WHO on progress in implementation of CTC as CTC will have far reaching consequences for the cold chain?
Revision of the multi-dose vial policy (MDVP) and related topics ..
This topic has been pending for the last many years according to relevant TLAC and IPAC reports. It has been on the agenda of all TLAC and IPAC meetings, particularly the first IPAC meeting in June 2010, from which I copy:
[/b]
3.1 Background [b]
The 2002 "Multi-Dose Vial Policy" (MDVP) was created to allow health workers to keep opened vials of indicated vaccines - where it was safe to do so - for subsequent immunization sessions, provided that certain cold chain and handling requirements were met. Dr Eggers listed new challenges faced with use of MDVP. New, multi-dose, liquid vaccines containing varying amounts of new preservative may be mistakenly kept for longer time periods than optimal, as health workers generally associated liquid vaccines with those that could be kept. Also, fractional doses may be used from a single-dose unpreserved vial, thus rendering vaccine unsafe, if kept. In other cases, adequately preserved new combination vaccines may be mistakenly discarded, thus rendering MDVP too wasteful. These challenges mandated a need for MDVP revision, including development of a new visual cue that should enable a vaccinator, just by looking at the vial, to clearly distinguish between a vial that can be kept and one that has to be discarded regardless of formulation.
Full reading of the relevant IPAC reports will impress on the reader, how complicated EPI work has become. WHO/IPAC has reported very well on the progress of work regarding revision of MDVP, but one also gets the impression that there is a long way to go still.
Implementation of CTC and revision of MDVP are to me two very important pending issues, and I recommend anyone interested in EPI work to read the publicly available TLAC and IPAC reports.
Regards,
Mogens Munck
The cool chain concept