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  1. Narayana Holla
  2. équipement de la chaîne du froid
  3. dimanche 28 février 2016

Dear viewers

In one of the Training of Trainers programme in 1990’s at Chennai, a resource person told that ‘ASA’ – Attention, Suspicion and Authority are the 3 important elements of any good surveillance.

Through high sensitivity, observational capacity, timely reporting often rare syndromes were discovered; new clinical signs innovated in the past. Lay reporting, rumor reporting, reporting any unusual events by the regular reporting centres were encouraged for adequate surveillance.

In the Feb 2016 Pulse polio, on booth day, Group D Mrs Mala regularly handling the cold chain observed and unusual event wherein VVM of a few vials rapidly converted and reached discard point between 4 to 6 hrs which she / we had not experienced in the past.

We were not able to find any visible / logical reason for this and shared with the MO / RCHO / State and the Centre – both the Govt and Development partners on same evening – 21 Feb 2016. We are indebted for the prompt response and the reply and now sharing with the TechNet viewers.

Pièces jointes
Michel Zaffran Réponse acceptée

Thanks for sharing.

Have you recorded the details of the lot numbers and expiry datesof the vials in question? And if so were they the same as the lot numbers and expiry dates of the other vials for which the VVM did not change

the other thing to look at is whether all vials had the same history in the cold chain (same duration at each store since arrival in the EPI cold chain system from the manufacturer, same storage points and same transport arrangements including vaccine carriers etc..).

In other words, for these differences in behaviour to materialise, one should first suspect a different "history" of the vials which would explain that some reach discard at a different time than others because their heat exposure capital had been consumed before hand

In the unlikely event that the history is entirely identical,i would refer the matter to the vaccine producer as there could have been also some different history in exposure at the manufacturing and labelling site

Finally the vaccine manufacture,after investigation may wish to raise the matter with the VVM producer. However given the very tight quality control procedure in place,I personally doubt that this is the result of a manufacturer defect

Narayana Holla Réponse acceptée

Dear Michel Zaffran

Thanks for the response.

VVM on the vials of same batch / mfg date / exp date / all the 86 vials collected on same date and time from the district experiencing same thermal environment - of which only a very few responded in a different way - reaching discard stage much faster than usual, all other vials took normal time for conversion - this surprised the Cold Chain Handler which she had not experienced in the past. I had seen ~5-6 years back, different vials of HepB of same batch/manufacture etc packed within the same carton having VVM with different shades - a few in discarded stage. At that time I was not a member of TechNet, hence could not share for brainstorming. However I used the photo in the training programmes whenever I had the chance. This photo again an unusual event; probably as minimal as AEFIs is attached though I dont have the exact date and time of the photo.
As of now I have lot of limitations in exploring more reasons, whatever me and CCH could see 'macroscopically' in the PHC we shared for the experts to explore the possibilties. Hope though unusual may not be too uncommon. Experts in this field working at molecular levels may have more scientifc answers for similar situations. May be a food for thought.
regards and best wishes
Pièces jointes

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