vendredi 19 janvier 2007
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POST 01042E : VVM USE Follow-up on Posts 01028E and 01035E 19 January 2007 _______________________________________ In reaction to Subhash Choudhury's anecdote on VVM use, five contributions were received, from 1. Anil Varshney (mailto:[email protected]) from India 2. Enrique Cuevas (mailto:[email protected]) 3. Hans Everts (mailto:[email protected]) from WHO/Geneva 4. Henrique Menezes d'Alva (mailto:[email protected]) or (mailto:[email protected]) from WHO/Angola. Henrique also sends two pictures taken during a polio campaign showing VVMs on polio vials. 5. Idrissa Yalcouy (mailto:[email protected]) presently at WHO _______________________________________ Dear Subhash, This practice is perfectly OK, as it secures the vaccines and maintains them at appropriate temperature in a domestic refrigerator. This also has reduced wastages. But this practice is only possible in urban areas and not while the staff goes house to house or in rural areas where refrigerators may not be many. rgds Dr Anil Varshney (Domestic refrigerators are recommended for storage of vaccine with proper precautions) ------------------------- Based in my experience since I have been working with the Polio eradication, I believe this practice is correct respecting two major rules: a) to store the remaining vials separately and well identified b) to use them as a priority in the next vaccination session if VVM did not cross stage II. Again and repeatedly, what is the most important to avoid this practice is; to prepare your session with accurate micro planing, highlighting the target population in order to have the exact amount of doses during the session Enrique Cuevas Former WHO Polio Consultant and Former National EPI Officer at UNICEF in Haiti ------------------------- Referring to the comments by Subhash C Choudhury on India, I think the vaccinators made a wise decision. The advantage of the VVM is not only to passively monitor the cold chain, but at least if not more important, to actually find solutions to problems in operational campaign implementation, beyond simply stopping the vaccination. There is a lot of - undocumented - experience, in particular in the African Region in the use of VVM for polio campaigns: 1) use of non-PIS (PQS) quality vaccine carriers to conduct polio SIA 2) teams not returning to their base for renewal of ice after it has melted and therefore being able to continue vaccination 3) vaccine carriers with only 1 or 2 icepacks, rather than 4, in particular for urban teams 4) teams splitting up at markets and bus stations, while one member keeps the vaccine carrier and the other simply relies on the VVM 5) teams going to remote villages, beyond the cold life of the vaccine carrier 6) teams keeping the vaccine cool by other means, like digging a hole in the ground, keeping it in clay pots, etc.. All these experiences may not be useful or necessary everywhere, but so far Asian countries have taken a much more conservative attitude towards proactive use of VVM as operational planning and implementation tool rather than as a mere monitoring tool. I have seen teams split up on markets taking advantage from the VVM in India, but that is considered an exception to be prevented, rather than the seed of a new operational approach. Applying VVM in a proactive way, including vaccine out of the cold chain, is a change in paradigm from the top-down classical cold chain. Progress is certainly not as much as I would have liked it to be, but I do believe that at least the mental paradigm change has taken place, even though it is only put into practise sporadically. When I did Out of Cold Chain presentations late 20th and beginning 21st century, I risked my life, whereas now, people may still not implement it and be skeptical, but there is an openness that did not exist earlier. Hans Everts WHO Geneva Technical officer EPI ------------------------------------ PHOTOS Dear Mr Choudhury and Technet Colleagues, Many thanks to have shared with us this supposed trouble faced by our colleagues in India. I'll propose to re-check before all the operational conditions of the all cold chain equipments where those OPV vaccines were stored. According our experiences in Angolan EPI activities, and, if those vaccines were well stored as recommended before the campaign it's NO way to find them with all VVMs changed at mi-day, even that under bad weather conditions and in addition with melted Ice pack into vaccine carrier. The problems suppose to be procured at storage conditions of those vaccines before starting the vaccination campaign (see some pictures gotten at end of day in one of Angolan polio NID; campaign was conducted under bad weather conditions with temperature above 35degree C). In other hand I'll propose our Colleagues to use "large cold boxes with frozen ice pack" during the vaccination campaign to support the field vaccinators instead of the practice of using "domestic refrigerator". Have all the best for this new Year 2007. Kindest regards. Eng."Henrique MENEZES D"ALVA EPI Logistician / Vaccine Manager WHO-Angola Luanda-Angola -------------------------------------- Hello Mr. Subhash C Choudhury, bonjour As a field person, I think that there is a need to analyse the positive and negative sides of this initiative taken by the vaccinators in the field to put vaccine vials in a domestic refrigerator located in a commercial booth. Positive side: By putting vaccine vials in a domestic refrigerator, one avoids wastage and it slows down the passage of VVM to stage 3. Negative side: Inside the domestic refrigerator, the vaccines might be in contact with food products or other products that could contaminate the vaccines. We all know that the ideal is to have well frozen icepacks (well conditioned as far as freeze-sensitive vaccines are concerned) to maintain vaccines under good conditions inside the vaccine carrier. But it is a different story altogether in the field due to various reasons. In many countries health centres lack electricity, gas or kerosene to make enough icepacks, above all during mass campaigns. That's why health workers have to resort to intermediate solutions. In conclusion, I'd like to say that if the refrigerator is very clean and does not contain other products likely to contaminate the vaccines, I believe one could use it long enough to vaccinate a few children to avoid ending up with vaccines with VVMs at stage 2 or beyond. But if the refrigerator already contains others products that could contaminate vaccines, it is better not to use it. Mr. Subhash C Choudhury, if some of your colleagues do not agree with this solution, they certainly have their reason. Sincere greetings Mr. Idrissa YALCOUYE, Consultant Vaccines and Cold Chain Management, OPS-WHO Haiti ______________________________________________________________________________ All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. 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