Discussions marquées : IPV

Intermittent inadequate vaccine supply – one of the causes of negative drop out

Dear viewers Short supply of vaciines requiring multiple doses is one of the causes of accentuating negeative dropout rate, making the indicator invalid for programme review. India introduced two fractional doses of 0.1mL intra-dermal IPV in the National Immunization Schedule (NIS) since April 2016 as an end game strategy of Polio Eradication. It is supplied as multi dose vial of 50 doses per vial [0.1mL per dose – 5mL vial] & 25 doses [0.1mL per dose – 2.5mL]. From the first experiences of the first 5 vials we learnt that 61.6% doses were sacrificed [154 doses were sacrificed out of 250 doses in 5 vials]. Soon we received 25 doses per vial and the wastage became NIL [0%] in the CHC and Medical College. This month we again got 50 doses per vial. With this, to minimize “sacrificing” of precious vaccine and being supported by the midlevel managers, 3 Aces [ANMs, AWWs and ASHAs] stared mobilizing all those who are below one year and missed IPV due to short supply. With this ‘movement’ of clearing the backlog to close population immunity gap & to make optimum use of the vaccine, we observed that first dose IPV administered along with 3rd dose of OPV and Pentavalent was recorded in the ‘cell’ meant for IPV 2nd dose. This will give an accentuated negative IPV1 & IPV2 dropout. India is unique for unity in diversity. In the past, similar errors occurred when OPV supply was inadequate in 2012 in Jharkhand. Solution: Sustained Supportive Supervision, hands on orientation, learning by doing and working together approach by the supervisors, technical assistants and development partners goes a long way in quality data maintenance and programme implementation. The attached illustration is shared and the viewers may get similar observations in the field.  Regards Holla and the team  

Lesson learnt from PHC Kollamogru: Year April 2016 to March 2017.

Dear viewers Sharing the following with the viewers who are the true Polio Eradicators / planners / managers / authorized implementers & policy makers of the programme Good intentions alone are not enough for the successful outcome. Intention of healing is always good but it can produce stricture with consequent obstruction and dilatation of proximal part leading to long term complications. Since April 2016, GOI introduced two doses of Inactivated Polio Vaccine as an endgame strategy of Global polio eradication. Routine Immunization is one of the biggest national programmes in operation. Service providers are trained and reoriented on a regular basis in the public sector. In good performing planning units, coverage of any new vaccine will be at par with that of all other antigens. But due to causes and constraints beyond the scope of author to understand, supply of IPV was regularly irregular and inadequate created very low coverage. For the effective impact on the community, ≥85% sustained vaccination coverage is required. What will be the epidemiological impact with coverage as low as 65% of the first dose and 30% of the 2nd dose, with >70% population immunity gap on Polio Eradication is a real concern. This is the true story of one very good performing Planning units; what will be the cumulative effect of ~28,000 Planning Units of India – 2nd most populous country??

Positive thinking: Failure as a precursor for success

Dear members and viewers of technet viewers We wish to share the following and hope to achieve something by clearing the backlog of infants accumulated for receving 1st and 2nd doses of fractional doses of 0.1mL IPV intradermally, sice April 2016. For curative service providers CPM stands for Chlor pheniramine maleate – an antihistamine but for public health personnel CPM is Critical Path Method: “the longest path of the network, if any activity along the critical path is delayed, the entire project will be delayed” as we studied from Park’s textbook of Preventive and Social Medicine. In the last week of October, we posted a “mini ViMOSA” – dreaming to clear 80 to 85% of backlog of 57 infants of PHC Guthigar for IPV: 35 for the 1st dose and 22 for 2nd dose accumulated since April 2016. We also prepared similar list of sister planning unit – PHC Kollamogru with 44 backlog infants: 32 for the 1st dose and 12 for the 2nd dose of IPV accumulated since April 2016. MOH is common to both the PHCs. We were all set for mobilizing to clear the backlog to their nearest vaccination session sites. We assumed that we would somehow be able to get 4 vials of 25 ID doses per vial. But we could not get even a single vial extra, on the contrary there was shortage and the backlog grew by “accretion”. 7 states and one UT (Odisha, Maharastra, Telangana, Andhra, Karnataka, Kerala, Tamilnadu and Puduchery) comprising 94 lakhs infants with >85% BCG coverage was selected for administering 0.1mL IPV intradermally. We thought, ~85% coverage of IPV has to be attained for achieving the objectives of introducing IPV in the UIP. On the contrary, as of now there is a huge gap of ~65% between the first doses of Pentavalent/OPV and IPV at 6 weeks and ~80% between 3rd doses of Pentavlent/OPV and IPV at 14 weeks in the above two good performing planning units. All other planning units of 7 states and one UT may be experiencing the same. We found that the “SHORT SUPPLY” is the CPM and hope the supply will improve in the near future so that the present cohort of infants born since April 2016 will complete the ‘eIPV’ course before their first birth day. By missing one “CPM”, we utterly failed and our dream got shattered in November but not disheartened because we are going to achieve something in the Christmas month of December. Silver line: In December we will be getting 2 vials (50 doses) extra which we wish to use for clearing the backlog of 2nd dose of IPV on priority as these infants have to come only once for completing ‘eIPV’ course. We thought of sharing our failure also with the technet-21 members and viewers for thinking & acting positively. Holla and team

My first experience at vaccinating a child...as part of a Vaccination Outreach Programme in Rural India

Hello everyone!
This is my very first post here. I am a 3rd year Student of Medicine(M.B.B.S) studying at KVG Medical College & Hospital, Sullia, India.
Attched is a PDF file which is the original document...Please go through that as it has pictures. Whatever text that follows this is a copy from the PDF file.

Thanks for your time and have a great day!


I feel elated to have been given an awe-inspiring opportunity to be a part of a vaccination outreach programme for which I shall be ever grateful to our PSM professor Dr.V.Narayana Holla, M.D who leaves no stone unturned in inspiring us and walks that extra mile to encourage us to evolve into better doctors. If not for him, none of this would have been possible.
It all started on the morning of 7th September during our PSM department posting hours, when Dr.Holla told us about the vaccination programme and emphasised on the importance of practical knowledge in the field of medicine. Motivated by his thought-provoking words, I was filled with enthusiasm to be a part of this trip. Upon approaching him, he was more than happy to see us eagerly coming forward for it and thus began the preparation for our amazing trip.
Thrilled by this exhilarating opportunity, I brushed up on the NIS and read up on the methods of administering the different kinds of vaccines and all the necessary details and equipped myself with the much needed knowledge on vaccinating a child as per the NIS.
The next morning, I was all geared up to go, my eyes gleamed with anticipation and I was excited to experience something new. Little did Iknow what was in store for me. On an honest note, a part of me died a little seeing the vehicle in which I was to travel. But nothing could waver my excitement, not even the thought of an edgy journey. I remained undeterred by the rugged roads, still charged. And my agony paid off when I reached my destination after a long tiresome travel.
The first place I went to was an Anganwadi Centre (in Koojimale estate) that filled me with awe, looking at the cheerful kids of 2-5 years of age. The Anganwadi Centre was located amidst the green, lush hilly area of Koojimale. Also present there were mothers waiting to get their infants vaccinated. This being a remote area and the outreach being held only once every month, there was a considerably large crowd that neededvaccinations. That moment of excitement, the noble feeling of being a doctor that crept in when I looked at the kids and their mothers, is something my words fail to explain. At the Anganwadi Centre, the Anganwadi worker, helper and the Teacher were present.
Under the guidance of a proficient ANM and Dr.Sharanya, I learnt the skill of administering vaccines (I.M, Subcut, I.D, and Oral). At the Anganwadi, we administered 10 vaccines to a total of 6 children. Vaccinations given here were – bOPV + Pentavalent1 – 1 Child, bOPV + Pentavalent2 – 2 Children, , Measles1 – 2 Children, DPT 1st booster + bOPV + Measles2 – 1 Child, 1 lakh units Vit.A + Measles1 – 2 children, and 2 lakh units of Vit. A+ Measles2 – 1 Child. After administering these vaccines, every child was given a routine general examination.
After vaccinating everyone at the Anganwadi, we left for the second destination – Kadamakallu Anganwadi Centre. Here we visited the Government School and found that there was just one 10 year old child to be vaccinated (TT10). Here, I vaccinated the child. As we were about to leave, an infant was brought who needed the bOPV + Pentavalent3 + IPV. This child was vaccinated by the ANM as well as Niranjan Murthy.
I took great pride in administering the vaccine (an injection) for the very first time. The feeling was inexplicable. I look forward to being a part ofsuch programmes in the months to come. It was not just an amazing experience but also an opportunity to learn a lot of new things and most importantly I got a peek into the life of a doctor and now I think I know what it feels like to be one. My heartfelt thanks to Dr.Holla for his persistent encouragement and I also extend my gratitude to the college for its support (I hope they add such trips to the curriculum!)
Lanson Brijesh Colaco
7th Term, Phase 3, MBBS
KVG Medical College & Hospital, Sullia.


First experiences from the ‘FIRST’ IPV vials

Dear viewers
Out of inquisitiveness, we studied the usage of the First IPV vial of 5 facilities and got many things to learn from the service providers of 3 attached planning units, one First Referral Unit and the vaccination clinic of our own College. These lessons are universal and hence can certainly help the policy makers to make necessary revisions / refresh training for the benefit of innocent infants.
Following are the observations:

Average beneficiaries per month for 3 planning units were 11 / 18 & 24; requiring
Actual doses administered were 8; 11; 11 in 3 PHCs; 14 in the tertiary care hospital. 46 doses of 1st vial were administered in the First Referral Unit (FRU) which is centrally located at the Block: total of 90 doses from 5 vials (5×50=250 doses) were administered. Due to accidental touching of the needle/spillage of vaccine due to sudden jerky movement of the child, 6 doses got “wasted”. Remaining 154 doses were “sacrificed” on completing 28 days since the starting day as per MDVP/Open Vial Policy.
Number of times the septum pricked ranged from 8 to 48 per vial.
Number of trips made by the vial ranged from 3 to 14 and the temperature excursions (TEs) ranged from 6 to 28.
On video recording and viewing the intradermal procedure for study purpose to assess the training need, we observed that:
The tense wheal with satisfactory diameter expelled fractions of fractional dose of the vaccine through needle puncture.
Where the diameter was less than 5mm, vaccine comfortably got lodged in thesubcutaneous space and no leakage.

BCG & IPV on "Wheals"

Dear viewers
We wish to share our very short study finding with the TechNet viewers for further input and mutual sharing of experiences for the global benefit of closing the imuunization gap.
Introduction of a newer vaccine or any change in vaccination policy provides an opportunity to train / reorient the service providers to revamp the efficiency for immunizing the vaccinated.
Responses by the TechNet members and global Immunization specialists inspired us to take-up a short study in the vaccination centre in our College. Initially we experienced – intra-dermal administration of just a drop of BCG vaccine=0.05ml especially to a newborn within 24 hrs was really difficult as the skin is too thin and delicate accentuated by the unpredictable movement but now we find it ‘not so difficult’ and administer with confidence.
The skin of 1½ month infant is a little more grown but the quantity of vaccine to be administered is 0.1ml=2 drops, double the 0.05ml.
On satisfactorily administering vaccines intradermally, we ‘dreamt’ of measuring the dimensions of the wheal accurately; enough for operational purpose.
Intra-dermal administration of vaccine raises a tense blanched Peau d’orange ‘bleb/wheal’, stays for a few fractions of a second. We measured the diameter instantly on pushing the vaccine completely by pausing the video and taking print screen, edited for making slides, taking care to maintain the accuracy of measurement. Following are the pictures, 3 each for BCG and IPV.

Close the immunization gap: Intradermal administration of vaccines

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.

Global switch in oral polio vaccines: live tracking of progress

From 17 April to 1 May, the globally synchronised switch from trivalent oral polio vaccine (tOPV) to bivalent oral polio vaccine (bOPV) is taking place in 155 countries and territories. This will be followed by an intensive monitoring and validation phase through to 18 May.
To follow progress as countries stop use of tOPV and complete their national validation reporting requirements, a live web site has been launched to share real time updates and related stories. The site features interactive maps updated daily, tracking the status per country, and is linked to the polio endgame objective 2 website with more details on the overall Polio Eradication Strategic Plan.
At the time of writing, implementation of the switch and subsequent monitoring activities were progressing smoothly in countries that had already stopped use of tOPV.
Removal of the type 2 component from OPV marks a major historic milestone; it is testimony to the progress being made towards a polio-free world and to the commitment of all countries that this dream may one day become reality.

Global polio vaccine switch confirmed for April 2016

The Strategic Advisory Group of Experts on immunization (SAGE) convened by WHO on 20 October 2015 has confirmed that the globally coordinated withdrawal of the type 2 component in the oral poliovirus vaccine (OPV) will take place in April 2016. SAGE’s landmark decision follows the endorsement by the World Health Assembly (WHA) in May 2015, when Ministers of Health from 194 member states adopted a resolution on the global effort to eradicate polio, as part of the Polio Endgame Strategy. In a milestone towards the switch, wild poliovirus (WPV) type 2 was recently declared as eradicated worldwide. WPV type 3 has not been detected globally since November 2012, and the only remaining endemic WPV type 1 strains are now restricted to Pakistan and Afghanistan. The globally synchronized switch is therefore of great significance for the polio eradication programme with tremendous public health benefits. Countries have already demonstrated an exceptional level of commitment to meeting the timelines of the Polio Endgame. In the lead-up to April 2016, countries should begin to intensify their preparations to be ready to switch nationwide from trivalent oral polio vaccine (tOPV) to bivalent OPV (bOPV) on any one day in the window from 17 April to 1 May 2016. It is also critical that countries meet established deadlines to protect populations by moving the world towards destruction of WPV2 type 2 stocks or their appropriate containment in designated ‘poliovirus essential’ facilities. The requirements for containment are detailed in the Global Action Plan III and steps for countries are summarized here. For more information on the OPV switch and reference materials to guide switch implementation, communications, training, and monitoring, please consult the OPV switch section on the Polio Endgame objective 2 website. In addition, the summary report from the SAGE meeting that confirmed the switch date is available here, and a statement from the Global Polio Eradication Initiative can be found here. Any questions on the switch can be directed to Alejandro Ramirez Gonzalez (ramirezgonzaleza@who.int) or Lisa Menning (menningl@who.int).
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