TechNet-21 - Forum

Ce forum est un lieu d'échange où les membres peuvent poser des questions, partager leurs expériences, coordonner des activités, et discuter les récentes avancées en matière de vaccination.
  1. Narayana Holla
  2. Service de livraison
  3. dimanche 22 mai 2016

For realizing the above, identifying maximum causes of gap and operating good practices for mitigation is essential to meet the global vaccination targets by 2020.


We made video recording and still photos for presenting in the monthly Academic Society Meeting for teaching purpose, to prevent avoidable agony to the infants and to administer antigenic dose of intra-dermal vaccines: BCG/IPV. All professionals including pediatricians have expressed that administering intra-dermal BCG is a skilled process. The movements of the newborn/infants are unpredictable. The skilled de-professionals accomplish intra-dermal administration more satisfactorily. We took the opportunity of administering intra-dermal IPV for reorienting the service providers.


Pièces jointes
Omesh K. Bharti Réponse acceptée
Respected Sir,
                           I am still not clear what is the policy of GOI in relation to ID IPV vs IM IPV.

Regards,
 
Dr. Omesh Kumar Bharti
M.B.B.S.,D.H.M.,M.A.E.(ICMR), Epidemiologist
Principal Investigator, Thalassemia Project,
State Institute of  Health and Family Welfare 
Parimahal. Shimla-171009
Himachal Pradesh, India. 
+91-9418120302
 
 http://www.tandfonline.com/eprint/VvEMwKbGA7X55I4QTwPx/full

 
  1. il y a plus d'un mois
  2. Service de livraison
  3. # 1
Narayana Holla Réponse acceptée

Dear Sir

Thanks for responding Sir.

0.05 ml is half the quantity of 0.1 ml. Often 0.05 is expressed as 0.5 which is 10 times of 0.05 and 5 times of 0.1 ml. For this reason I wrote 0.05ml is equivalent to one drop and 0.1 ml is equivalent to 2 drops. The master trainer of Jharkhand used to tell the trainees: 0.05 is 5 paise of one rupee and 0.5 is 50 paise of one rupee.

Instructions for the service providers in the training was to administer 0.1 ml of Inactivated Polio Vaccine (IPV) intradermally (ID) just like that of BCG but to the right upper arm - in the deltoid area. 2 doses, the first along with the 1st dose bivalent OPV and pentavalent at 6 weeks and the 2nd dose of IPV along with 3rd dose of bOPV and pentavalent at 14 weeks.

Karnataka is one the selected states administering 2 doses of IPV intradermally(ID) 0.1 ml (equivalent to 2 drops) sice April 2016 as a part of end game strategy of polio eradication.

Remaining states to administer 0.5 ml (=half ml equivalent to 10 drops in quantity) once when the child comes for 3rd dose of bOPV and Pentavalent intra-muscularly(IM) to the right thigh for operational uniformity.

With regards

Holla

  1. il y a plus d'un mois
  2. Service de livraison
  3. # 2
Narayana Holla Réponse acceptée

Dear sir

Thank you very much for responding and sharing your valuable experiences in administering ARV. This inspired us to measure the actual diameter of the wheal on administering 0.05 ml equivalent to one drop of BCG vaccine to newborn within 24 hrs.

We simply calibrated a sticker in mm /cm and placed a little above the site of injection to measure the diameter as accurate as possible taking a still picture soon after withdrawing the needle. The diameter is approximately>5mm for 0.05 ml of vaccine.

We wish to measure the same for 0.1 ml Inactivated Polio Vaccine equivalent to 2 drops in volume administering to >42 days old infant and for administering 0.1 ml ARV probably for higher age as opportunity of getting a dog bite cases of infant is rare.

If you can enrich us on the methodology of measuring the diameter we wish to try and we do not know whether these age groups are comparable as there may be anatomical differences.

The idea of administering to one more site when there is difficulty in obtaining required diameter is really helpful, practicable, hence it may be included in the operational guidelines of BCG/IPV intradermal administration for universal acceptance & application as and when / where applicable if not included already. Proactively it was practiced but pediatrician cum District Immunization Officer raised a small concern from parents accepting double pricks.

with best regards

Pièces jointes
  1. il y a plus d'un mois
  2. Service de livraison
  3. # 3
Omesh K. Bharti Réponse acceptée

Dear Sir,

For intradermal rabies vaccine we give 1 inch above the deltoid insertion, so directions are very clear. I donot know what are the instructions in intradermal IPV ? Also please let me know if in entire state of Karnatka the ID IPV is being given. As for as volume is concerned our experience show that 0.1ml is appropriate volume and for 0.5ml volume the skin fails to takeup the volume and moreover when recommendation is 0.1ml why are we thinking of 0.5ml or raising questions about effective seroconversion. I wanted to know that ID IPV is being given on GOI recommendation. Also I agree with you that syringe with needle is better tolerated than injectors. We use 40 unit insulin syringe for ID rabies vaccination and its excellently tolerated by small kids as well while BCG syringe is blunt and painful and also spills over.

Just shared my thought with you,

Regards,

Omesh Kumar Bharti, Shimla, Himachal, India

+91-9418120302

  1. il y a plus d'un mois
  2. Service de livraison
  3. # 4
Dr A S Bose Réponse acceptée

Thanks to Dr Holla for this excellent snapshot.Can you please confirm if India is following a 2-dose fractional IPV (fIPV) schedule in routine immunization at 6 and 14 weeks?

Also, as far as I know, fIPV for use in cVDPV2 outbreaks would be a single dose administration as distinct from fIPV use in routine immunization.

Some newer delivery strategies for intra-dermal IPV injections are being tried out - adapters, needle free devices etc.

It would be very useful if some Technet member could add an update on these.
Thanks and regards,
Anindya Bose

  1. il y a plus d'un mois
  2. Service de livraison
  3. # 5
Omesh K. Bharti Réponse acceptée
Dear Sir,
                  When we started intra-dermal anti-rabies clinics in Himachal, the same logic was given that is, who would train and how efficacy would be ensured etc. People learned from each other keeping in mind one principal that after ID there should be 3-4 mm pepule and if not then inject again near the previous site. Now all over Himachal we have hundreds of vaccinators giving ID antirabies vaccination in the field.

We must start ID IPV as not only this is more effective, cost effective but is a scarce resource and should not be wasted.

Thanks and regards,
 
Dr. Omesh Kumar Bharti
M.B.B.S.,D.H.M.,M.A.E.(ICMR), Epidemiologist
Principal Investigator, Thalassemia Project,
State Institute of  Health and Family Welfare 
Parimahal. Shimla-171009
Himachal Pradesh, India. 
+91-9418120302
 
 http://www.tandfonline.com/eprint/VvEMwKbGA7X55I4QTwPx/full

 
  1. il y a plus d'un mois
  2. Service de livraison
  3. # 6
Narayana Holla Réponse acceptée

Thank you sir, for the valuable reply.

In general, service providers in the private sector neither have the opportunity to undergo detailed Routine Immunization training / reorientation, nor they feel that there is an absolute necessity. Regular supportive supervision by the Govt in collaboration with development partners usually do not cover private sector thus there are gaps in the operational aspects and the immunization schedule too. As a blessing in disguise, Aarogya Bandhu Scheme got winded up and the skilled ANMs with a decade of service got relived, of which two well trained ANMs were absorbed to deliver vaccination services of WHO/GOI standard. They are trained in newborn vaccination, Multi-dose vial policy (open vial policy), cold-chain maintenance, documentation, strengthening the Govt etc.

Being in Medical College, we have ample time for research / innovations, keenly observed the way in which BCG/IPV were administered intradermally and mutually learnt how easy/difficult it is. Even the skilled person has some element of panicky till the end of administering 0.05 ml (equivalent to 1 drop) of BCG to the newborn; 0.1 ml IPV (equivalent to 2 drops) along with 1st dose of bOPV and Pentavalent to >42 day old infants.

0.1 ml AD syringe has its unique advantages but for the lacerated puncture from which a fraction of fractional dose is regurgitated by the tense wheal holding 2 drops of IPV, often blood stained (one closer photo is attached). This loss can be overcome by using syringe with fine needle.

One of the frequently asked questions in the training was adequacy of immunogenicity with fractional dose and was well answered that 2 doses of 0.1ml has better or at least the same immunogenicity as that of one Intradermal 0.5 ml dose which can be fully & easily administered at >14 weeks . If a fraction of fractional dose is lost while administering, will this produce same immunogenicity?

Since "bOPV" and "t IPV" are administered simultaneously, measuring the antibody of P1/P3 discretely for OPV/IPV and P2 may overlap. My knowledge in immunology is very minimal to dream of this. We shared the observations with the local Block MO for minimizing immunity gap.

With regards

Holla

Pièces jointes
  1. il y a plus d'un mois
  2. Service de livraison
  3. # 7
Dr. Karan Singh Sagar Réponse acceptée

Dear Dr Holla, this is an important aspect that you have raised. Giving intradermal injection is probably the most difficult for most vaccinators. With BCG we could still tell based on scar (in case of correct technique) if the injection was given correctly and given the fact that BCG's efficacy is also questionable, it really was not much of a concern. Butfor IPV we don't have that luxury, the vaccine is an important part of global efforts for polio eradication and if this is not given properly, it can impact the program adversely. It will be very crucial that the vaccinators understand it and are trained well and supervised so that they master the technique of ID injections. But do we have that kind of resources to train and supervise each and every worker? Probably not!! So we have to depend on sample sero surveys to see the resultsof this and if it is not workingthen change the strategy.

  1. il y a plus d'un mois
  2. Service de livraison
  3. # 8
Narayana Holla Réponse acceptée

Intradermal administration of inactivated polio vaccine - A photo

Dear viewers

As per endgame strategy, tOPV is ‘pulled out’ and bOPV is ‘pushed in’ and administering Injectable Inactivated Polio Vaccine (IPV) intradermally at the right upper arm for operational uniformity started since April in Karnataka – India.

Due to some reasons, in this month administration of IPV to a large extent is limited to fixed session sites at the facility. In north India proportion of home delivery is considerably high and hence many ANMs confidently administer BCG intradermally. But in South states and in Karnataka, >97% are institutional deliveries and hence almost all newborns receive BCG intradermally at birthing facility. Hence many field staffs are less confident in administering vaccine intradermally. In the induction training all were told to administer 0.1 ml IPV just like BCG but to the right upper arm – deltoid area.

For training purpose, in our vaccination centre at KVG Medical College we took a few photos taken on 29-04-2016. One of which showing a typical wheal / pue-d-orange we wish to share with the viewers.

regards

Pièces jointes
  1. il y a plus d'un mois
  2. Service de livraison
  3. # 9


Cette discussion ne contient encore aucune réponse.
Soyez le premier à y répondre !