Post0217 FAST CHAIN + CC DOCUMENTS 17 January 2000
CONTENTS
1. FAST CHAIN, TECHNET'99 DISCUSSSIONS AND A NEW DOCUMENT
2. COLD CHAIN DOCUMENTS POSTED TO WHO WEBSITE
1. FAST CHAIN, TECHNET'99 DISCUSSSIONS AND A NEW DOCUMENT
Hans Everts, WHO/V&B, responds to the Technet'99 Sub-Group on the Fast
Chain draft recommendations. [A version of which is posted below] Allan
Bass, TECHNET Forum, comments on his understanding of the Fast Chain
discussions discussions at the plenary session and raises some additional
matters. [The reply from Hans will be posted tomorrow.]
While we are all sorry that the oral polio vaccine crisis forced Hans,
among others, to miss the Technet'99 consultations, we have the continuing
opportunity to complete these important discussions on the TECHNET Forum.
A new DRAFT document: "Making use of VVMs: Flexible Vaccine Management for
NIDS, SNIDs, and Mop-ups is available for download.
Got to the website:
ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/Coldchain/
and click on the file: Fastchain-Jan2000.PDF
or get the file by by email to: [[email protected]][email protected][/email]
with the message: get technet Fastchain-Jan2000.PDF
* Hans requests our early comments, before 31 January 2000, please!
Action, comments and additions please: [[email protected]][email protected][/email]
or use your reply button
___________________________________________________________________________
From: [[email protected]][email protected][/email]
Date: Thu, 06 Jan 2000 17:32:49 +0100
To:
Subject: Fast chain
Apologies for not having been in Harare. The OPV crisis prevented me
unfortunately from going.
I have read the comments on the fast chain guideline and I must admit that
I am a bit confused.
First of all, because the people the text [of the Fast Chain document] was
shared with in an earlier stage (John LLoyd, Modibo, Michel, Terry,
Alaisdair, Robert Steinglass, Mikko) all proposed a number of changes, but
were finally quite positive. This is rather different from the conclusion I
read from the working group on the fast chain, which is: "The draft in its
present form should not be taken any further".
This is especially confusing, because a name for a revised version is
proposed in the following point in the Technet draft report.
Anyway, let me answer a number of comments I received previously and in the
Technet report.
I agree that ideally we should have a properly updated complete training
guideline for VVMs. I also agree that if we would have such a guideline,
the 'fast chain' module could be reduced to a few pages. However, in the
field I am regularly confronted with a number of problems that require an
immediate solution:
1) people who hardly know the VVM
2) people who know the VVM, but at the most use it as passive monitoring
tool, rather than for active planning
3) countries that for NIDs continue to built cold chains, that are
oversized or badly adapted to the routine
4) large proportions of populations that are still not reached with the
cold chain as implicit or explicit excuse
We have less than 1 year to eradicate polio. We need something right now
for the countries.
Perhaps it can be regretted that we move from the specific to the general
rather than starting with a general guideline, followed by a targeted
supplement. However, I believe that the only inconvenience is that we will
eventually end up with 2 guidelines that will partly overlap. I do not
think that is confusing and I think the inconvenience is worth the price
for being able to print something next week, rather that by the end of
2000.
I could add another argument. We have all encountered resistance in
countries to improve their campaign planning, which is often too
'traditional', and through which large parts of the population are still
missed. It will take considerable time to change long established 'dogma'.
Is it not possible that by pushing the VVM use at this stage specifically
for polio, it will become easier to introduce it at more general level?
People are during polio NIDs directly confronted with the limitations of
the cold chain and the VVM offers them a specific operational and very
practical solution.
Is it not possible that by providing a practical specific solution for a
practical specific problem people will easier learn the general issue,
that when we would ask them to study a general guideline and apply it to a
specific problem? In particular, because we will only have VVMs on other
vaccines in 1 or 2 years. I agree that a general guideline should be ready
by then, but I do not think it is appropriate to teach people about VVM use
for vaccines that are not yet equipped with them, and not provide them a
practical solution for problems they are immediately confronted with.
I agree that the 'fast chain' concept was confusing in the text and the
title and that fast chain and VVM were mixed. I do not think the fast chain
concept should be dropped completely, but I have disentangled it from the
VVM.
The added cold chain calculation was appreciated during several workshops,
especially because it follows, or tries to follow, a logical step-by-step
explanation, rather than an automatic spread sheet approach. I hope to
create an understanding of the process after which people can make their
spread sheets on basis of their specific conditions, but maybe I am wrong
and naive there.
I hope the attached version answers a number of concerns expressed by John,
Terry, Alaisdair and Robert.
Comments are welcome. I hope to send the document this month to the
printer.
Regards
---
Subject: Re: Fast chain
Author: Allan Bass
Date: 7-Jan-2000 10:44
Dear Hans,
First- My best wishes for the New Century! I hope that you had a good
X-Mass/NYE.
Yes, we very much missed you at Harare - large parts of the discussion were
much poorer without you. We heard about the OPV shortage! Bad timing... And
WHO announced that it is US$1,000,000,000 short for this year's polio
eradication activities....
* My understanding from the plenary discussions was that fast chain should
be seen in the context of all of our other Cold Chain Guidance, and that
there was a desire to have easy to use planning tools/worksheets. I did not
think it was negative - but - the concern over the effect of the targeted
polio strategies on the sustainability of the routine PHC & EPI was
evident.
** On other matters: You had planned to have the new PIS at the printers in
December 1999. Is that done? I hope not - we did not discuss the need for
mandatory low temperature protection - specifically 0'C cutouts. Soren
Spanner has posted something on that last week. I join him in feeling that
this is an urgent matter.
regards,
allan
___________________________________________________________________________
FACSIMILE
WORLD HEALTH ORGANIZATION VACCTNES AND BIOLOGICALS
CH - 1211 GENEVA 27 - SWITZERLAND Tel: 41(22) 791441.8791441.8
FACSIMILE: 41 (22) 7914193
FACSIMILE. 41 (22) 7910746 Internet address: [[email protected]][email protected][/email]
---
Page 1 of 4 pages Date, 7 January 2000
From- Mr Hans Everts To: Mr Allan Bass
University of Queensland, Medical School, Brisbane, QLD
TEXT
Dear Allan.
As promised in my e-mail, these are the copies of the recommendations.
Apparently there are several versions in circulation. I am not sure
which is the final one.
Regards
Hans Everts
---
DRAFT 7112199
Discussion of working group on "Fast Chain", lunch 7/12
(note: prepared before "VVM Update" presentation 8/12)
The group feels that:
1 . First priority must be given to ensuring good understanding and use
of VVMs for better and more flexible management of vaccine (at present,
OPV) distribution for both NIDs and routine immunization.
2. Combining the "fast chain" concept with VVM guidelines for NIDs, as in
the WHO/HQ draft 'Fast Chain for NIDS" paper, is not helpful and has caused
confusion. . The draft, in its present form should not be taken further.
3. A suitable working title for a revised paper could be. 'Making good
use of VVMS: Flexibility in managing vaccines for NIDs and routine
immunization". It should provide concise guidance for managers/supervisors.
4.1 Based on field observations since the last Technet, attention (still)
needs to be paid to training on VVMs, (including training of new staff as
soon as they are posted), to management and supervision issues related to
use of VVMs, to recording of VVM status on receipt and despatch of vaccine,
and to evaluation of results of training.
5. Lessons learned from the introduction of OPV VVMs since 1996, in
particular the apparent failure of "cascade" training in many places and
the lack of attention to management issues, must be very carefully
considered in planning the introduction of VVMs for other vaccines.
6. The development of a vial freezing indicator for DPT/adsorbed
vaccines/HepB are a high priority, as are the actions related to Low
Temperature Protected refrigerators discussed at Technet 98.
7. These (3,4,5,6) to be pursued as appropriate in Session 4 "VVM
Update" discussion, during a further working group meeting lunchtime
Wednesday 8/12, and during the subgroup F work on Thursday 9/12.
group members:
R. Hoseini WHO/SEAR0
M. Dicko WHO/AFRO
A. Pbuyan UNICEF India
S. Kone WHO Cote d'lvoire
T. Hart IT Power India
A. Wylie W1.10 Temp. Adviser
S. Spanner WHOISEAR0
A. Battersby FBA
G. Larsen WHON&BIATT
E. Ogden USAID Washington
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2. COLD CHAIN DOCUMENTS POSTED TO WHO WEBSITE
New and revised documents have been posted to the WHO V&B Document Centre
website: http://www.who.int/gpv-documents/
Action, comments and additions please: [[email protected]][email protected][/email]
or use your reply button
___________________________________________________________________________
Subject: cold chain documents posted
Author: girardete at whohq6
Date: 22/12/1999 18:28
pls note/advise your front page focal point:
1. New documents posted on doc centre website:
1.1 Quality of the cold chain: WHO-UNICEF policy statement on the use
of vaccine vial monitors in immunization services, WHO/V&B/99.18, in
English and French
1.2 Safety of injections: WHO-UNICEF joint statement on the use of
auto-disable syringes in immunization services, WHO/V&B/99.25, in
English. This replaces the former version WHO/EPI/LHIS/97.04 Rev.1.
2. Document removed: Safety of injections: WHO-UNICEF policy statement
for mass imm campaigns WHO EPI LHIS 97.04 Rev.l in English, French,
Russian. These changes will be included in next monthly update of dox
posted.
libby
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Safety of injections: WHO-UNICEF joint statement on the use of auto-disable
syringes in immunization services (WHO/V&B/99.25)
Electronic copy available as of 22 Dec 1999
Hard copy available as of 20 Jan 2000. PDF 30 K
Quality of the cold chain : WHO-UNICEF policy statement on the use of
vaccine vial monitors in immunization services (WHO/V&B/99.18)
Also available in French.
English version: Electronic and hard copies available.
French version: Electronic copy available as of 22 Dec 99; hard copy
available as of 20 Jan 2000
French PDF 27 K
Guidelines for surveillance of congenital rubella syndrome and rubella -
field test version, May 1999 (WHO/V&B/99.22)
Also available in French.
Electronic copy available as of 21 Dec 1999
Hard copies available 10 Jan 2000 PDF 120 K
Strategies, policies and practices for immunization of adolescents - A
review (WHO/V&B/99.24)
Electronic copy available as of 17 Dec 1999
Hard copies available 20 Jan 2000 PDF (212K)
Translation: Revisió® ¤e documentos existentes sobre planificaci󮬊realizaciá® y evaluaciá® de estudios clí®©cos sobre vacunas (WHO/V&B/99.09)
Electronic copy available as of 17 Dec 1999
Hard copies available 20 Jan 2000 PDF (96K)
Translation: Reglamentació® ¤e vacunas: desarrollo en los organismos
actuales de reglamentació® ¦armacéµ´ica (WHO/V&B/99.10)
Electronic copy available as of 17 Dec 1999
Hard copies available 20 Jan 2000 PDF (93K)
Study of donor inputs to vaccine production
(WHO/V&B/99.21)
Electronic copy available as of 14 Dec 1999
Hard copies available 14 Dec 1999 PDF 78 K
Issues relating to the use of BCG in immunization programmes - a discussion
document (WHO/V&B/99.23)
Electronic copy available as of 14 Dec 1999
Hard copies available approx 10 Jan 2000 PDF 153 K
Translation: Test de corr鬡tion entre la pastille de contr?du vaccin et
l'activité ¤u vaccin (WHO/V&B/99.11)
Electronic copy available as of 14 Dec 1999
Hard copies available approx 10 Jan 2000 PDF 46 K
Polio News, Issue 4, June 1999
(Ordering code: WHO/EPI/PN/99.02)
Electronic copy available as of 14 Dec 1999
Hard copies available June 1999 PDF 509 K
Polio News, Issue 5, September 1999
(Ordering code: WHO/EPI/PN/99.03)
Electronic copy available as of 14 Dec 1999
Hard copies available Sept 1999 PDF 274 K
Measles Bulletin, Number 1
Electronic copy available as of 14 Dec 1999
Hard copies available Sept 1999 English : PDF 288
French: PDF 237
Translation: Distribution de vitamine A durant les joun饳 nationales de
vaccination (WHO/EPI/GEN/98.06)
Electronic copy available as of 14 Dec 1999
Hard copies available Oct 1999 PDF 225 K
Informal consultation of experts on national regulation of vaccines
(WHO/V&B/99.08)
Electronic copy available as of 19 Aug 1999
Hard copies available approx 30 Aug 1999 PDF 74 K
Review of existing documents on planning, performance and assessment of
clinical studies on vaccines (WHO/V&B/99.09)
Electronic copy available as of 19 Aug 1999
Hard copies available approx 30 Aug 1999 PDF 116 K
Regulation of vaccines: building on existing drug regulatory authorities
(WHO/V&B/99.10)
Electronic copy available as of 19 Aug 1999
Hard copies available approx 30 Aug 1999 PDF 117 K
Report of the First Meeting of Interested Partners to the Health Technology
and Pharmaceuticals Cluster, Geneva, 16-19 March 1999 (WHO/V&B/99.16)
Electronic copy available as of 19 Aug 1999
Hard copies available approx 30 Aug 1999
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