lundi 5 février 2007
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Post 01050E : VVM USE Follow-up on Posts 01028E, 01035E and 01042E 5 February 2007 ________________________________________ This posting contains two contributions. The first is from Jedeth Mamora (mailto:[email protected]) from Indonesia who asks another question, bringing a new aspect to this discussion. The second is from Giridhara Babu (mailto:[email protected]) from India. ________________________________________ Dear Technet, As I understood WHO recommends the use of VVM to measure the effectivity of an antigen, especially polio. There are some events that showed color changes particularly in polio vaccine which often range from yellowish to yellow or reddish to red color. The question is : do we still refer to the VVM despite of the color changes? Some say that if the color changes to certain pH number (ex. 7.6 or above), that vaccine has to be discarded even though the VVM shows good. Is there any research studies to this particular case done before or any similar experiences happened and what is the approach/action taken? Thank you, JJ EPI Asistant Project Officer Health & Nutrition Dept Banda Aceh Zone Office Banda Aceh, Indonesia ------------------------------- Hello everyone, It is an interesting debate here. I was working with polio eradication activities for more than 5 years. In my experience, VVM is very useful in the field but efforts to complicate the process of VVM reading by the field use has to be discouraged. 1. In India and presumably in some of the countries where polio is still a major problem, it is not practical in most of the places to use refrigerator as a stand by for storage. Even if it is done in isolated urban areas, any efforts to endorse this by programme managers would leave the field in confusion. For example, if the vials are kept in refrigerator, how long will the power supply continue, what is the distance from booth to refrigerator, how many people are available in booth for this local transport of vaccine etc. It may also lead in dilution of important efforts like social mobilization done by team members. 2. The non availability of refrigerator in most of the places makes it impossible to come out with general guidelines. 3. Using frozen ice packs for keeping the vial should be strongly discouraged. This is more damaging since the cover gets peeled off and VVM cannot be read. 4. I would not worry much about most of the vaccine used by Government run programmes as at least it contains VVM and most of the workers are aware about reading it before immunizing. My worries are about few private pharma companies manufacturing the polio vaccines that are used by vast majority of Pediatricians in Urban areas of India. I am more worried about their ignorance of VVM and use of refrigerators by most of the Pediatricians to store vaccines. I have personally examined many centers in Bangalore as SMO, WHO-NPSP and found that some of the vials had no VVM and majority of the pediatricians are using refrigerators to store all vaccines. The cold hold over time and lack of uniform temperature adds on to the woes in maintaining good cold chain and this gets complicated by the absence of VVM. Majority of urban kids are immunized by these vaccine, which I think is equivalent to giving sterile water ( and not vaccine). VVM is an effective tool. But lack of uniform guidelines, regulation will make it difficult for the optimal utilisation for the community. With regards Giridhara R Babu Future Faculty Programme of Public Health Foundation of India Currently at UCLA, Los Angeles ______________________________________________________________________________ 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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