Oman
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Inde
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Tétanos
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Polio
Coqueluche
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Post0227 LOGISTICS, SURVEILLANCE & DISEASE CONTROL 14 February 2000
CONTENTS
1. SURVEIILANCE LOGISTICS: SUGGESTION DURING TECHNET
2. DRAFT TECHNET'99 SUB-GROUP RECOMMENDATIONS: LOGISTICS OF DISEASE CONTROL
3. NEW PUBLICATIONS
4. POLIO CONTROL NEWS
1. SURVEIILANCE LOGISTICS: SUGGESTION DURING TECHNET
The threaded emails below continue the discussions of TECHNET Forum
Posts0196-0198 on logistics for surveillance and the role and function of
Stop Teams and more, and follows up on the face to face discussions at
Technet'99 Harare.
Thanks to Maureen Birimingham, WHO/V&B, Alasdair Wylie, Ellyn Ogden, USAID,
and Robert Steinglass, BASICS II for sharing this discussion. Thanks also
to Marcus Hodge for his work on the draft module, and Philippe Duclos for
working on the checklist. Sorry to have delayed this posting which was
awaiting agreement from all participants.
Action, comments and additions please: [[email protected]][email protected][/email]
or use your reply button
___________________________________________________________________________
From: [[email protected]][email protected][/email]
To: [[email protected]][email protected][/email]
Date: 22 December 1999 11:51
Subject: your suggestion during Technet
Alidade: In addition to the logistics module, we are also revising
the protocol to evaluate surveillance (which includes the same
checklist). Philippe Duclos is taking the lead on the latter while
Marcus Hodge (along with Mojtaba Haghgou) the lead on the former.
With regard to the items regarding routine immunization you rightfully
suggested should be included in the checklist for surv review/visits:
We felt that instead of including those specific items in the checklist, a
paragraph should be included in the evaluation protocol stating more
generally, that a select set of operational issues should be reviewed
during the site visits. We felt that the choice of which things to check
were rather context specific and it was better to emphasize the importance
of including some of these, but not to be so specific about which items to
check.
---
From: Alasdair Wylie
To: [[email protected]][email protected][/email]
Date: 22 December 1999 17:22
Subject: Re: your suggestion during Technet
Thanks Maureen. Clearly what needs to be checked in respect of routine
programme logistics may vary from place to place, but the feeling of the
group which put together the recommendation for Technet was that especially
from a polio eradication perspective there is a core list of OPV/VVM
related checks which should always be made by anyone making a facility
visit
for AFP surveillance (or, for that matter, for any other reason); this we
kept as short as possible.
The principle that this should be done is in accordance with the content of
training of STOPpers by CDC and of Surveillance Medical Officers in
WHO/SEARO. If the core list is accepted as essential, however, it follows
that they should part of a checklist otherwise a) there is the risk that
practice may not follow principle, b) there is no way of knowing if it is
being done or not, and c) most important, if it is being done knowing what
is found so that responsible local/district officials can have the
information and act on it.
Best regards
Alasdair
---
Subject: Re: your suggestion during Technet
Author: "Robert Steinglass" at inet
Date: 12/22/99 3:19 PM
Dear Alasdair and Maureen,
Gosh. I sure hope that this can be reconsidered. With some 55 items
already on the checklist (if I recall correctly), it doesn't seem to me too
much to add the 3 most essential (and simple) logistics items (developed at
TECHNET in Harare) which are crucial if we expect to improve the quality of
NIDs and logistics in general. Right now, the only time many health
facilities ever get visited is as a result of NID preparation and
surveillance. The meeting in Geneva last week on the effects of polio
eradication on health systems development was pretty clear in that
opportunities presented by polio eradication need to be seized more
deliberately to improve health systems - and in this case immunization. I
think it would be a serious missed programmatic opportunity not to include
a few logistics questions - - not only to improve the logistics for the
routine EPI but to improve implementation of the NID itself.
Robert
Robert Steinglass
Immunization Team Leader
BASICS
1600 Wilson Blvd., 3F
Arlington, VA 22209
USA
voice: 1-703-312-6800
fax: 1-703-312-6900
e-mail: [[email protected]][email protected][/email]
---
From: , on 12/23/1999 7:46 AM:
I think there is some confusion. There is no disagreement that
opportunities should be seized to check logistics/operations whenever out
in the field. There is no disagreement that active surveillance visits
for polio should check routine issues. There is no disagreement that even
surveillance reviews shouldn't check other issues (logistics, safety,
issues
for several diseases). We are suggesting that we add a paragraph stating
such, but that the actual items to check may vary from country-to-country
and should be adapted accordingly.
Please note that the protocol I mentioned is for a one-off evaluation of
surveillance (which might be multi-disease, might be focused on polio or
measles or something else) is different from active surveillance visits
(which is routine/ongoing) for AFP/polio. This protocol is meant to be
quite generic.
---
Subject: re: Re[2]: your suggestion during Technet
Author: "Ellyn Ogden" at inet
Date: 12/23/99 1:07 PM
Maureen/Alasdair:
I appreciate being cc'd on this discussion. It is certainly good to read
that there is no disagreement that logistics/operations need to be checked
by surveillance officers.
It seems like this is a dissemination issue: how do we get this checklist
into the hands of surveillance officers quickly?
1.) The logistics module should include the checklist; but this module
won't necessarily get into the hands of the surveillance officers;
2) The Assessment tool is a one-off evaluation protocol that ought to
include aspects of the management information system needed for effective
surveillance. The tool should be able to assess the current capability of
the system to monitoring the cold-chain, vaccine wastage,
stockflow/stockout, etc. and determine how well this information is being
shared/used by surveillance officers. But this too doesn't seem like the
best mechanism for disseminating the checklist that Alasdair is proposing.
3.) What other mechanisms are there? Is it possible to issue a supplement
to the polio field guide? A one-page "Technical Update" for surveillance
officers/polio eradication program staff? other?
In addition to the short essential list of things Alasdair suggested, I
would also add a few. I have very little "logistics experience" yet I've
tried to make a point of stopping for 15 minutes at the cold stores and
asking the following questions. I include the responses in my trip reports
and in my debriefings with MOH staff. I don't know if it helps solve the
problems, but it gives the logistics people a sense that they are part of
the bigger program; shows someone is interested in their role in the
program/health worker motivation; and offers the potential to raise issues
outside of the "regular channels" that they need to work within.
Ellyn's FAQs
-- are there stockouts of vaccine (how frequent, how long, responsiveness
of system to fill requests)?
-- is the power supply regular? frequency of outages? is there a backup
generator? who's responsible for checking?
-- what proportion of equipment functioning?
-- what proportion of equipment needs repairs? how long have they been
waiting?
-- ask to see the temperature records
-- ask if they note the condition of the VVM when they accept the
vaccine/disburse the vaccine
-- what is their role during NIDs? were they included during
microplanning?
FYI, from experience I know that if something is described in a paragraph
it is less likely to get the attention it deserves -- lists are much better
for people with little time to absorb and digest information.
I would propose that you consider crafting a list that would include two
categories:
"Strongly recommended" and "Recommended."
This would still let countries pick and choose, while at the same time
prioritizing those elements that WHO/Technet/Polio program considers
essential and fundamental to the program. A paragraph could be used to
provide information on the impact of poor performance and provide guidance
on what to do with the results.
Thanks to everyone for trying to push this forward.
regards,
Ellyn
---
From: [[email protected]][email protected][/email]
To: [[email protected]][email protected][/email] ;
[email protected] ; [[email protected]][email protected][/email]
Date: 03 January 2000 18:51
Subject: Re[4]: your suggestion during Technet
Philippe: As you are taking the lead on finalizing the surveillance
evaluation module, perhaps we could put in a supplement checklist as
an example of other important things to check related to routine
immunizations when out in the field.
I agree with Ellyn that a paragraph is less likely to be noticed then
perhaps an example "supplemental checklist" in an annex with a
footnote stating how this must be adapted to situation at hand.
Thanks to all for your useful comments.
____________________________________*______________________________________
2. DRAFT TECHNET'99 SUB-GROUP RECOMMENDATIONS: LOGISTICS OF DISEASE CONTROL
During Technet'99 the Sub-Group prepared these recommendations on the
logistics of disease control.
___________________________________________________________________________
DRAFT 2 Recommendation 9/12/99
(Re: Session 2 Logistics of Disease Control)
Supervision tasks during AFP surveillance:
1. In line with WHO's approach to the training and posting of Surveillance
Medical Officers and CDC's approach to the training of "STOP"
epidemiologists for AFP surveillance* , all visits made for AFP
surveillance to health facilities which store vaccine should include a
minimum list of vaccine inspection checks.
2. The proposed list is:
How many doses of OPV in stock?
Are all vials within expiry date?
Are all VVMs before discard (end) point (stage 1 or 2)?
If No, how many vials with VVM at stage 3 ; at stage 4. ?
3. The results of this check, (along with the results of the other AFP
supervisory visit tasks/checks) must be given to the District level public
health/medical officer responsible for supervision of the facility
concerned.
4. The supervisory checklist in the draft "New logistics for surveillance
module" (Technet.99/Session 2/ WP4 Annex 4) should include, in addition
to the existing component "Evidence of a good reverse cold chain" , a
component "Evidence of good vaccine cold chain" with the above list of
checks.
---------------------------------------------------------------------------
Role of the STOP Teams
---------------------------------------------------------------------------
* "The STOP teams are expected, while doing their routine AFP
surveillance work, to inspect refrigerators, look at the OPV and the VVMs
(teach about VVMs if the staff is unaware) and keep a record of their
findings which are then given to the MOH/WHO. They are also taught to look
at the cold boxes for specimen transport to ensure that they have a proper
cold box (reverse cold chain). All of this is considered a vital part of
the surveillance system."
____________________________________*______________________________________
3. NEW PUBLICATIONS
___________________________________________________________________________
Date: Thu, 27 Jan 2000 14:28:16 -0500
From: Meagan Cooke
The following books are currently available from the Pan American Health
Organization.
"Hantavirus in the Americas: Guidelines for diagnosis, treatment,
prevention and control." -- This comprehensive manual begins by describing
the different hantaviruses known in the Americas and their reservoirs,
rodent ecology and zoology, and the epidemiology of human disease in the
Region. Upon this foundation, the manual describes the disease's clinical
manifestation and diagnosis and presents guidelines for HPS surveillance,
treatment, and case management. It also provides detailed, easy-to-follow
instructions for preventing infection in the home, hospital, and
laboratory, as well for cleaning rodent-infested areas. The importance of
educating health professionals and the general public about the disease is
stressed through examples of communication strategies used in different
countries of the Region. The publication also provides an overview of
communication tools that can be adapted to educate diverse populations
about HPS and other communicable diseases.
An essential tool for anyone involved in hantavirus prevention, control,
treatment, or health education activities, "Hantavirus in the Americas"
contains useful, stand-alone annexes, such as sample case report forms,
guidelines for safe handling and transfer of specimens, educational
resources, and descriptions of prevention campaigns undertaken by countries
in the Region. The book's handy format allows for quick reproduction and
distribution of the annexes and infection prevention and control measures.
ISBN 92 75 13047 7, US$ 14.00, 65 pp.
"Measles Eradication--Field Guide." -- This publication outlines PAHO's
strategy for becoming and remaining measles-free and also provides valuable
background information about measles in a concise format and
easy-to-understand language. Its seven chapters cover such subjects as the
epidemiology of measles, clinical aspects of the disease, proper handling
and delivery of measles vaccines, and methods of laboratory confirmation of
measles infection. The rationale and activities related to the vaccination
strategy are explained in depth. The largest section of the book is devoted
to surveillance for measles cases and gives guidelines for case
investigation, outbreak response, and other components of an effective
surveillance system. Attached as appendices are numerous examples of forms
that can be copied and modified as needed for local surveillance purposes.
There is also an extensive bibliography arranged by subject.
The practical information contained in this manual will benefit public
health personnel and medical practitioners at all levels. The field guide
is an essential tool for anyone involved in administering or carrying out
vaccination programs, both in the Americas and elsewhere. ISBN 92 75 13041
8, US$ 14.00, 70 pp.
Both titles are also available in Spanish.
For more information, contact PAHO at
email: [[email protected]][email protected][/email]
fax: (202) 206-0869
web: publications.paho.org
Meagan Cooke
Publications Program
Pan American Health Organization
525 Twenty-third Street, NW
Washington, DC 20037
http://publications.paho.org/
e-mail: [[email protected]][email protected][/email]
____________________________________*______________________________________
4. DISEASE CONTROL NEWS
___________________________________________________________________________
"Woman Has State's First Measles Case Since 1998"
Associated Press (02/06/00)
The first case of measles in Ohio since 1998 has been detected in a college
student at Columbus State Community College. The disease could have
infected her classmates or co-workers, as measles is airborne and is
highly contagious. Symptoms include high fever, large spots and rash.
The two-dose vaccine for measles is recommended for anyone born after
1957; measles was so widespread before that year, that most people
contracted the disease and now immune to it.
---
"Afghanistan: Measles Epidemic"
New York Times (www.nytimes.com) (02/05/00) P. A5;
Crossette, Barbara
An outbreak of measles in a remote part of Afghanistan has killed 100
people, according to the United Nations. The epidemic started in the
northern Samangan Province, a region which saw heavy fighting between the
Taliban and the opposition alliance in 1999.
---
"Gates-Funded Vaccine Drive Woos Allies"
Reuters (01/31/00)
The Children's Challenge, a vaccination drive funded by Microsoft
Chairman Bill Gates and other business leaders and agencies, is asking for
donations to help inoculate children across the globe against common
diseases. The drive was launched by the Global Alliance for Vaccines and
Immunizations, and the Bill and Melinda Gates Foundation has already
pledged $750 million over five years to help. According to World Health
Organization Director-General Gro Harlem Brundtland, it costs $17 a child
to protect them against polio, diphtheria, tuberculosis, pertussis,
measles, and tetanus,. Almost 3 million children die every year from
vaccine-preventable diseases.
---
"Protein on TB Bacteria May Hold Key to New Treatment"
Reuters Health Information Services (01/31/00)
Researchers, led by Dr. James Sacchettini of Texas A&M
University, have found that a protein complex called antigen 85c
can show potential targets for tuberculosis (TB) vaccines or
drugs. Sacchetini's team studied the structure of antigen 85c
and discovered how the protein helps TB infect immune system
cells. The current TB vaccine is often not effective, but the
new information may help make a better vaccine. The researchers
report their findings in the February issue of Nature Structural
Biology (2000;7:94-95,141-143).
---
"15-Year Follow-Up Shows BCG Vaccine Is Not Effective in India"
Lancet (11/06/99) Vol. 354, No. 9190, P. 1619; Kumar, Sanjay
Findings from a 15-year follow-up of a large randomized study of
the BCG vaccine conducted in Chingleput district, India, indicate
that BCG provides no protection to adults and only slight
protection--about 27 percent--in children against pulmonary
tuberculosis (TB). The original study involved 280,000 people of
various ages who were given Danish 1331 and French 1173P2 strains
of BCG. The groups did not exhibit any significant difference in
TB rates. The researchers concluded the vaccine was unlikely to
reduce transmission rates. In response to the new findings,
which confirmed follow-up analysis done at 7.5 years, V.
Ramalingaswami, former director-general of the Indian Council of
Medical Research (ICMR), noted the data did not address whether
the vaccine was effective against childhood forms of TB, such as
tuberculous meningitis and miliary tuberculosis. ICMR deputy
director-general Lalit Kant disregarded the findings and said the
BCG vaccine had helped reduce the incidence of childhood forms of
TB.
---
"Impact of Immunisation on Pertussis Transmission in England and
Wales (Research Letter)"
Lancet (www.thelancet.com) (01/22/00) Vol. 355, No. 9200, P. 285;
Rohani, Pejman; Earn, David J.D.; Grenfell, Bryan T.
Researchers from the University of Cambridge, England, have found
that vaccination for pertussis has reduced transmission in
England and Wales. After analyzing high-resolution pertussis
notification data, the researchers found that mass vaccination
caused a significant decrease in reported cases of pertussis.
The scientists also looked at the efficacy of vaccination, and
found evidence that immunizations has reduced transmission of the
disease, not just lowered disease frequency.
---
"Diphtheria in Urban Slums in North India (Research Letter)"
Lancet (www.thelancet.com) (01/15/00) Vol. 355, No. 9199, P. 204;
Lodha, Rakesh; Dash, Nihar R.; Kapil, Arti; et al.
Cases of diphtheria in India reported in 1997 numbered 1,326. In
September 1999, four children from different families in urban
slums of northern India came to the India Institute of Medical
Sciences with diphtheria. The children had sore throat, fever,
dysphagia, and neck swelling for two to 10 days. Two children
were not immunized, and the other two had received only two doses
of the diphtheria-pertussis-tetanus vaccine. Two children died
within hours of admission because of arrhythmia. These four
cases seen within the same time frame represent a resurgence of
diphtheria, caused by a decline in immunizations, poor
conditions, and overcrowding in the slums.
---
"Progress Toward Poliomyelitis Eradication--Chad, 1996-1999"
Morbidity and Mortality Weekly Report (http://www2.cdc.gov/mmwr)
(01/28/00) Vol. 49, No. 3, P. 57
The World Health Organization resolved in 1988 to eradicate
poliomyelitis globally by the end of 2000. Chad, in central
sub-Saharan Africa, has made some progress towards this goals
since 1996, after three decades of civil war and poor health
services. In the past decade, routine infant vaccinations were
estimated at 10 percent to 25 percent; however, National
Immunization Days, begun in February 1997, have worked to
administer the polio vaccine to 90 percent of the children under
age five during each round. Chad collected information on
confirmed cases of paralytic polio, which declined from 402 cases
in 1995 to 326 in 1997. In 1999, 182 polio cases were reported
and 82 were confirmed, after the Ministry of Health (MOH) formed
the national service of integrated active surveillance in May of
1999. Chad's MOH has grown more successful in implementing
recommendations for polio vaccination, and will focus this year
on vaccinating nomadic groups and individuals in populated areas
of southern Chad.
---
"Over 700,000 Liberian Children to Get Polio Vaccine"
PANA Wire Service (01/26/00); Kahler, Peter
A polio immunization campaign in Liberia, "Polio Out of Liberia,"
has vaccinated 750,000 children since Monday. President Charles
Taylor launched the campaign Monday, stating they are determined
to eradicate polio from the country. Taylor noted that he has a
sister with the disease and knows first-hand "the devastating
affect of polio." Health Minister Peter Coleman also reported
that over 160,000 Liberian children have contracted the disease.
The immunization campaign is part of an effort to eradicate polio
worldwide.
----
"Flu Shots May Benefit Children"
Washington Post (www.washingtonpost.com) (01/27/00) P. A5
Two studies published in Thursday's New England Journal of
Medicine suggest that both healthy children and those who are at
"high-risk"--meaning those children with asthma, diabetes, or
other chronic conditions--are infected with influenza too often.
The information led the researchers to suggest that the flu
vaccine be considered for use in children; however, the
scientists from the Centers for Disease Control and Prevention
and Vanderbilt University did not give a flat recommendation for
the shot. Children are currently vaccinated for up to 16
diseases before the age of two, and questions remain about the
cost-effectiveness and logistics of vaccinating all children
against a different flu strain each year.
____________________________________*______________________________________
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