Monday, 5th of May 2008 |
CSU 08/2010: Bad Practices in Measles Vaccination
As the world moves towards a global eradication target for measles,
probably no earlier than 2011, it is useful to see whether the service
delivery mechanisms for measles vaccination are ready.
COLD VACCINE, WARM DILUENT
In a review of reports from Africa and other regions, available at
www.who.int/immunization_delivery/systems_policy/VMAT_Indicators.pdf
Andrew Garnett notes the following mistakes in the handling of diluent,
used with measles and other vaccines: ‘12% of health facilities are giving
reconstituted vaccines without cooling the diluent first. Mismanagement of
diluents is a long-standing and frequently observed phenomenon, and it
appears that this problem continues.’
FAILING TO DISCARD RECONSTITUTED VACCINE AFTER SIX HOURS
The same report noted that in 183 service points evaluated, 86 percent
discarded reconstituted vaccine within six hours of reconstitution.
What happens in the other 14 percent of cases? Although not completely
documented, the rare cases where held over vaccine provokes toxic shock
syndrome in vaccinees are not only often fatal, but also severely damaging
to the reputation of the vaccination programme. Commenting on reports of
postvaccination deaths among measles vaccinees in Tamil Nadu, T. Jacob John
observed the following: ‘There are two potential problems if reconstituted
vaccine is kept longer [than six hours]. The virus content may fall since
temperature-stability is low in liquid state–this will affect the efficacy
of vaccine. The second problem is bacterial contamination. If contaminated
while puncturing the cap the liquid vaccine acts as a rich bacterial
culture medium.’ [full text at www.indianpediatrics.net/june 2008/477.pdf
].
QUERYING VACCINATION HISTORY
No vaccinator or registrar should query the measles vaccination history of
any child of eligible age during a measles campaign. To do so is inimical
to good campaign management. Not only does it slow down the screening
process, but it also deprives the child who failed to seroconvert at 9
months of the benefits of revaccination.
PUTTING AN END TO BAD PRACTICES
We already do training and supervision to assure that such practices as
these come to an end. To stamp them out, the solution is more training,
more supervision, and perhaps more independent monitoring of vaccination
sites during measles campaigns.
Good reading.
BD
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www.measlesinitiative.org www.technet21.org www.polioeradication.org www.globalhealthlearning.org www.who.int/bulletin allianceformalariaprevention.com www.malariaworld.org http://www.panafrican-med-journal.com/ |