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Sadru G, Makhado M, Swalehe O, Banzimana S, Asingizwe D, Maru SM. Assessment of vaccine management performance in health facilities of Mwanza Region, Tanzania: a cross-sectional study. J Pharm Policy Pract 2023; 16:144. [PMID: 37968760 PMCID: PMC10648312 DOI: 10.1186/s40545-023-00651-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 11/06/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels and enhance the development of continuous improvement plan to strengthen the system. This study was conducted to determine the vaccine management performance in Health Facilities of Mwanza Region, Tanzania. METHODS This was a descriptive cross-sectional study that was carried out in 102 health facilities providing immunization services from eights districts of Mwanza Region in Tanzania. The World Health Organization (WHO) effective vaccine management assessment tools were used to collected data. Both quantitative and qualitative (through key informant interviews) approaches were used. The quantitative data were analysed using the existing WHO criteria for analysing effective vaccine management assessment data, while deductive thematic analysis was used for the qualitative data. RESULTS The finding shows that the overall score for vaccine management performance was 53% which is below the WHO acceptable minimum score of 80%. None of the health facilities had reached the benchmark but only 67% had an average performance (> = 50-< 80%). The highest health facility score was 76% and the lowest being 27%. Among the categories assessed, the highest score was on information technology with 72%, while the lowest was on standard operating procedures with a score of 43%. The major challenges which contributed to low performance were lack of training, low knowledge about vaccine management practices, unavailability of standard operating procedures (SOPs), and limited financial resources to support operations for vaccine management practices. Skills gap, incomplete stock records and management, as well as low availability of SOPs were the key challenges reported that affected vaccine management practices. CONCLUSIONS Effective vaccine management performance was low across all districts under the study. Increasing personnel capacity and ensuring availability of resources to support operations were reported as key interventions in improving vaccine management practices. Hence, effectively working on continuous improvement plan with key highlighted actions is highly recommended to all actors from national level to sub-national level managers and healthcare workers as frontline vaccine handlers.
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Affiliation(s)
- Green Sadru
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
- Immunization and Vaccine Development (IVD), Ministry of Health, Dodoma, Tanzania
| | | | | | - Stany Banzimana
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- EAC Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda.
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Flavia A, Fred B, Eleanor T. Gaps in vaccine management practices during vaccination outreach sessions in rural settings in southwestern Uganda. BMC Infect Dis 2023; 23:758. [PMID: 37924008 PMCID: PMC10625286 DOI: 10.1186/s12879-023-08776-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/31/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Outreach efforts were developed to bolster people's access to and use of immunization services in underserved populations. However, there have been multiple outbreaks of diseases like measles in Uganda, prompting policy makers and stakeholders to ask many unanswered questions. This research study was created to uncover the discrepancies between vaccine management practices at immunization outreach sessions in rural South Western Uganda compared with existing standards. METHODS The observational qualitative study, was done in 16 public health facilities across four districts of Uganda. Data were collected using in-depth interviews, facility record reviews, and observation. We assessed the vaccine management procedures before immunization session, transportation used, set up at the outreach site, management practices during the outreach session and packing of vaccines - according to World Health Organization immunization practice recommendations. The data were transcribed, coded and categories were formed and triangulated. Themes were generated based on a socio-ecologic framework to gain a better understanding of healthcare provider practices during immunization sessions. RESULTS Fifty-one individuals were interviewed; four Assistant District Health Officers, four cold chain technicians, 15 focal persons for the Expanded Program on Immunization, and 28 health care providers. The respondents' mean age was 35, 43 (84.3%) were females and 24 (47.1%) had a diploma. 11 (69%) outreaches were conducted at a distance of 5-12 km from the health facility and 7 (44%) were conducted in a building. For 8 outreaches (50%) health facility staff did not check the vaccine vial monitor status before the outreach while 12(75%) did not keep the vaccine hard lid cover closed during the sessions. The main areas of concern were insufficient vaccine integrity monitoring, improper handling and storage practices, deficient documentation, and inadequate vaccine transportation. These were similar across immunization outreach sites regardless of vaccine preventable disease outbreaks occurrences. The majority of these gaps were located at the individual level but were enabled by policy/environmental factors. CONCLUSIONS There are poor vaccine management procedures during outreach sessions contrary to established guidelines. Specific tactics to tackle knowledge deficiencies, health worker attitude, and fewer equipment shortages could improve compliance to guidelines.
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Affiliation(s)
- Atwiine Flavia
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, P.O. BOX 1410, Mbarara, Uganda.
| | - Bagenda Fred
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, P.O. BOX 1410, Mbarara, Uganda
| | - Turyakira Eleanor
- Department of Community Health, Faculty of Medicine, Mbarara University of Science & Technology, Mbarara, P.O. BOX 1410, Mbarara, Uganda
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Erassa TE, Bachore BB, Faltamo WF, Molla S, Bogino EA. Vaccine Cold Chain Management and Associated Factors in Public Health Facilities and District Health Offices of Wolaita Zone, Ethiopia. J Multidiscip Healthc 2023; 16:75-84. [PMID: 36660041 PMCID: PMC9843497 DOI: 10.2147/jmdh.s385466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 12/29/2022] [Indexed: 01/13/2023] Open
Abstract
Background Vaccines are medical products with a short shelf life and are easily damaged by deviations in temperature from the recommended ranges. Vaccines lose their quality if the cold chain system is not properly managed. Cold chain management is still a major challenge in developing countries, including Ethiopia. Thus, this study aimed to assess vaccine cold chain management and associated factors at public health facilities and district health offices. Methods A facility-based cross-sectional study design was applied from March 1-28, 2021. One hundred and thirty-six health institutions were selected by simple random sampling method. Data was collected using the observation check list and interviewer-administered pre-tested structured questionnaires. Data was analyzed using SPSS version 25. The binary logistic regression was employed and those variables with a p-value less than 0.25 in the bivariate analysis were used for multivariable logistic regression. Then multivariate analysis at a p-value <0.05 and AOR with 95% CI was used to measure the degree of association between independent variables and the outcome variable. Results The study indicates that 83 (61%) public health facilities had good cold chain management practice at 95% CI (52.2-68.4). Experience greater than 2 years (AOR=2.8, 95% CI=1.13-6.74), good knowledge on cold chain management (AOR=3.02, 95% CI=1.2-7.4), training on cold chain management (AOR=1.86, 95% CI=1.36-9.84), and supportive supervision on cold chain management (AOR=2.71, 95% CI=1.1-7.14) were statistically significantly associated with good cold chain management practice. Conclusion The result of the study indicated that there was low cold chain management practice in the study area. Strengthening the knowledge of healthcare workers and supportive supervision on cold chain management by giving training and monitoring their practice toward cold chain management may help to improve the cold chain management practice.
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Affiliation(s)
- Tsegaye Eka Erassa
- Maternal, Neonatal, Child Helath and Nutrition Directorate, Wolaita Zone Health Department, Wolaita Sodo, Ethiopia
| | | | - Wolde Facha Faltamo
- Department of Epidemiology and Biostatistics, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Simegn Molla
- School of Public Health, Wolaita Sodo University, Wolaita Sodo, Ethiopia
| | - Efa Ambaw Bogino
- Department of Dermatovenereology, Wolaita Sodo University, Wolaita Sodo, Ethiopia,Correspondence: Efa Ambaw Bogino, Email
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Marco-Dufort B, Janczy JR, Hu T, Lütolf M, Gatti F, Wolf M, Woods A, Tetter S, Sridhar BV, Tibbitt MW. Thermal stabilization of diverse biologics using reversible hydrogels. SCIENCE ADVANCES 2022; 8:eabo0502. [PMID: 35930644 PMCID: PMC9355364 DOI: 10.1126/sciadv.abo0502] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 06/21/2022] [Indexed: 06/15/2023]
Abstract
Improving the thermal stability of biologics, including vaccines, is critical to reduce the economic costs and health risks associated with the cold chain. Here, we designed a versatile, safe, and easy-to-use reversible PEG-based hydrogel platform formed via dynamic covalent boronic ester cross-linking for the encapsulation, stabilization, and on-demand release of biologics. Using these reversible hydrogels, we thermally stabilized a wide range of biologics up to 65°C, including model enzymes, heat-sensitive clinical diagnostic enzymes (DNA gyrase and topoisomerase I), protein-based vaccines (H5N1 hemagglutinin), and whole viruses (adenovirus type 5). Our data support a generalized protection mechanism for the thermal stabilization of diverse biologics using direct encapsulation in reversible hydrogels. Furthermore, preliminary toxicology data suggest that the components of our hydrogel are safe for in vivo use. Our reversible hydrogel platform offers a simple material solution to mitigate the costs and risks associated with reliance on a continuous cold chain for biologic transport and storage.
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Affiliation(s)
- Bruno Marco-Dufort
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
| | | | - Tianjing Hu
- Nanoly Bioscience Inc., Denver, CO 80231, USA
| | - Marco Lütolf
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
| | - Francesco Gatti
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
| | - Morris Wolf
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
| | - Alex Woods
- Nanoly Bioscience Inc., Denver, CO 80231, USA
| | - Stephan Tetter
- Laboratory of Organic Chemistry, ETH Zurich, 8093 Zurich, Switzerland
| | | | - Mark W. Tibbitt
- Macromolecular Engineering Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, 8092 Zurich, Switzerland
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Xie X, Xie B, Xiong D, Hou M, Zuo J, Wei G, Chevallier J. New theoretical ISM-K2 Bayesian network model for evaluating vaccination effectiveness. JOURNAL OF AMBIENT INTELLIGENCE AND HUMANIZED COMPUTING 2022; 14:1-17. [PMID: 35813275 PMCID: PMC9253264 DOI: 10.1007/s12652-022-04199-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/15/2022] [Indexed: 05/30/2023]
Abstract
Aiming at the difficulty in obtaining a complete Bayesian network (BN) structure directly through search-scoring algorithms, authors attempted to incorporate expert judgment and historical data to construct an interpretive structural model with an ISM-K2 algorithm for evaluating vaccination effectiveness (VE). By analyzing the influenza vaccine data provided by Hunan Provincial Center for Disease Control and Prevention, risk factors influencing VE in each link in the process of "Transportation-Storage-Distribution-Inoculation" were systematically investigated. Subsequently, an evaluation index system of VE and an ISM-K2 BN model were developed. Findings include: (1) The comprehensive quality of the staff handling vaccines has a significant impact on VE; (2) Predictive inference and diagnostic reasoning through the ISM-K2 BN model are stable, effective, and highly interpretable, and consequently, the post-production supervision of vaccines is enhanced. The study provides a theoretical basis for evaluating VE and a scientific tool for tracking the responsibility of adverse events of ineffective vaccines, which has the value of promotion in improving VE and reducing the transmission rate of infectious diseases.
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Affiliation(s)
- Xiaoliang Xie
- School of Mathematics and Statistics, Hunan University of Technology and Busin Ess, Changsha, 410205 China
- Key Laboratory of Hunan Province for Statistical Learning and Intelligent Computation, Hunan University of Technology and Business, Changsha, 410205 Hunan China
| | - Bingqi Xie
- School of Mathematics and Statistics, Hunan University of Technology and Busin Ess, Changsha, 410205 China
- Institute of Big Data and Internet Innovation, Hunan University of Technology and Business, Changsha, 410205 China
| | - Dan Xiong
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
| | - Muzhou Hou
- School of Mathematics and Statistics, Central South University, Changsha, 410083 China
| | - Jinxia Zuo
- School of Mathematics and Statistics, Hunan University of Technology and Busin Ess, Changsha, 410205 China
- Institute of Big Data and Internet Innovation, Hunan University of Technology and Business, Changsha, 410205 China
| | - Guo Wei
- Department of Mathematics and Computer Science, University of North Carolina at Pembroke, Pembroke, NC 28372 USA
| | - Julien Chevallier
- IPAG Business School (IPAG Lab), 184 boulevard Saint-Germain, 75006 Paris, France
- University Paris 8 (LED), 2 rue de la Liberté, 93526 Saint-Denis, France
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Soleimani S, Rashid S. Correlation Study of the Most Important Environmental Influencing Factors on the Razi MMR Vaccine. ARCHIVES OF RAZI INSTITUTE 2021; 76:1203-1211. [PMID: 35355762 PMCID: PMC8934101 DOI: 10.22092/ari.2021.352200.1550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 03/16/2021] [Indexed: 06/14/2023]
Abstract
Measles, mumps, and rubella (MMR) are among the most important viral infectious diseases in Iran and neighboring countries. After using a trivalent vaccine for these three diseases for a long time, in recent years, these diseases have been significantly controlled in Iran. One of the important points of storing the vaccine is that the vaccine strains are highly temperature-sensitive viruses. Due to tropical climatic conditions in Iran, the cold chain may not be achievable during the storage and transmission of the MMR vaccine. Therefore, the efficacy of the vaccine may be affected. This study aimed to evaluate the MMR vaccine potency at different temperatures (stress tests) and frequent light exposures. All quality control tests in the form of stability studies were performed on the samples from three consecutive batches produced during a full-scale Razi production. The samples were stored at 2-8, 22-25, 35-37, and 42-45°C in specific time intervals, exposed to frequent light, and underwent freezing/thawing conditions. According to the results, the storage of the vaccine at high temperatures caused a decrease in potency and increased moisture content in the vaccine vials. The best temperature for maintenance and transportation of MMR is 2-8°C. The time and frequency of light exposure may affect the vaccine potency. Based on the sensitivity of the vaccine strains to environmental conditions, the development of plans for storage and transportation of vaccines in different situations and training the vaccine injection staff seem necessary.
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Affiliation(s)
- S Soleimani
- Razi Vaccine and Serum Research Institute, Agricultural Research Education and Extension Organization (AREEO), P.O. Box 31975-148, Karaj, Iran
| | - S Rashid
- Razi Vaccine and Serum Research Institute, Agricultural Research Education and Extension Organization (AREEO), P.O. Box 31975-148, Karaj, Iran
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Evaluation of Cold Chain Management Performance for Temperature-Sensitive Pharmaceuticals at Public Health Facilities Supplied by the Jimma Pharmaceuticals Supply Agency Hub, Southwest Ethiopia: Pharmaceuticals Logistic Management Perspective Using a Multicentered, Mixed-Method Approach. Adv Pharmacol Pharm Sci 2021; 2021:5167858. [PMID: 34557673 PMCID: PMC8455189 DOI: 10.1155/2021/5167858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/02/2021] [Indexed: 11/21/2022] Open
Abstract
Background Effective and efficient cold chain management maximizes utilization of healthcare resources, reduces cold chain products wastage, and improves the quality of health services. It eventually guarantees that clients receive cold chain products they need at service delivery points. The objective of this study was to evaluate cold chain management performance for temperature-sensitive medicines at public health facilities in Southwest Ethiopia supplied by the Jimma Pharmaceuticals Fund and Supply Agency hub. Method and Materials. The study used an institution-based cross-sectional study design. Forty-seven (47) public health facilities in Southwest Ethiopia were evaluated using checklists adopted from the Logistic Indicators Assessment Tool, Vaccine Management Assessment Tool, and Logistic System Assessment Tool. Results The study revealed that the mean availability of essential cold chain products was 72.1 ± 14.8% while the average stock-out rate was 26.2 ± 8.6%. The median stock-out duration was 23 ± 21 days for all visited public health facilities. Two hundred and sixty-three (43.06 ± 15.3%) of the public health facilities' stock records were found accurate, and the wastage rate due to expiration was 9.2 ± 7.8% for all visited health facilities. Thirty public health facilities (63.8 ± 36.2%) had acceptable storage conditions. Conclusions and Recommendations. Supply chain performance at the study facilities was not adequate overall, and focused efforts need to be directed at managing the availability of critical cold chain medicines. Some cold chain management challenges demand the attention of the top management, while the rest can be addressed by operational management at the facilities through provision of appropriate training and supervision of the cold chain pharmaceutical handlers.
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Feyisa D. Cold Chain Maintenance and Vaccine Stock Management Practices at Public Health Centers Providing Child Immunization Services in Jimma Zone, Oromia Regional State, Ethiopia: Multi-Centered, Mixed Method Approach. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:359-372. [PMID: 34326678 PMCID: PMC8314926 DOI: 10.2147/phmt.s312039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/06/2021] [Indexed: 11/23/2022]
Abstract
Background Cold chain maintenance is the spine of an immunization program. Objective To examine the status of cold chain maintenance and evaluate knowledge of cold chain handlers and practices of vaccine management at public health centers providing immunization services in Jimma zone. Methods An institutional-based cross-sectional study supplemented with a qualitative method was conducted in 41 randomly selected health centers providing immunization service in districts of Jimma zone from October 31 to November 30, 2019. Pre-tested self-administered questionnaires and observation checklists developed from an effective vaccine management assessment tool (EVMAT) were used to collect quantitative data. Key informants were selected using the purposive sampling technique and an in-depth interview was conducted. Quantifiable data were analyzed using SPSS version 20 and chi-square was used to test the presence of association (p-value <0.05). Qualitative data were analyzed by thematic analysis and triangulated with quantitative findings. Results All public health centers had at least functional ice-lined refrigerators while 28 (68.3%) public health centers had functional deep freezers. Of the cold chain handlers, 120 (82.9%) had fair knowledge. Vaccine storage was appropriate per the World Health Organization's vaccine storage code in ice-lined refrigerators in 11 (24.4%) public health centers. Cold chain handlers’ years of service, types of training, availability of funds for cold chain maintenance, and availability of cold chain equipment at public health centers showed the presence of significant association with vaccine cold chain management practice. Conclusion The majority of cold chain handlers showed inadequate knowledge while a significant number showed poor practice of preserving the vaccines’ cold chain. Cold chain maintenance was not adequate in public health centers, necessitating attentive efforts of providing proper management of vaccine cold chains at immunization delivery points.
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Affiliation(s)
- Diriba Feyisa
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, Mizan-Tepi University, Mizan-Aman, Ethiopia
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Nissan H, Ukawuba I, Thomson M. Climate-proofing a malaria eradication strategy. Malar J 2021; 20:190. [PMID: 33865383 PMCID: PMC8053291 DOI: 10.1186/s12936-021-03718-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/30/2021] [Indexed: 11/10/2022] Open
Abstract
Two recent initiatives, the World Health Organization (WHO) Strategic Advisory Group on Malaria Eradication and the Lancet Commission on Malaria Eradication, have assessed the feasibility of achieving global malaria eradication and proposed strategies to achieve it. Both reports rely on a climate-driven model of malaria transmission to conclude that long-term trends in climate will assist eradication efforts overall and, consequently, neither prioritize strategies to manage the effects of climate variability and change on malaria programming. This review discusses the pathways via which climate affects malaria and reviews the suitability of climate-driven models of malaria transmission to inform long-term strategies such as an eradication programme. Climate can influence malaria directly, through transmission dynamics, or indirectly, through myriad pathways including the many socioeconomic factors that underpin malaria risk. These indirect effects are largely unpredictable and so are not included in climate-driven disease models. Such models have been effective at predicting transmission from weeks to months ahead. However, due to several well-documented limitations, climate projections cannot accurately predict the medium- or long-term effects of climate change on malaria, especially on local scales. Long-term climate trends are shifting disease patterns, but climate shocks (extreme weather and climate events) and variability from sub-seasonal to decadal timeframes have a much greater influence than trends and are also more easily integrated into control programmes. In light of these conclusions, a pragmatic approach is proposed to assessing and managing the effects of climate variability and change on long-term malaria risk and on programmes to control, eliminate and ultimately eradicate the disease. A range of practical measures are proposed to climate-proof a malaria eradication strategy, which can be implemented today and will ensure that climate variability and change do not derail progress towards eradication.
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Affiliation(s)
- Hannah Nissan
- Grantham Research Institute for Climate Change and the Environment, London School of Economics and Political Science, London, UK.
- International Research Institute for Climate and Society, Columbia University, Palisades, NY, USA.
| | - Israel Ukawuba
- Mailman School for Public Health, Columbia University, New York, NY, USA
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Adverse events following immunization: Findings from 2017/2018 measles vaccination campaign, Nigeria AEFI reporting in 2017/2018 measles vaccination campaign. Vaccine 2021; 39 Suppl 3:C82-C88. [PMID: 33714655 DOI: 10.1016/j.vaccine.2021.02.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 02/19/2021] [Accepted: 02/26/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION An Adverse event following immunization (AEFI) is an untoward medical occurrence following immunization and which may not have a necessary causal relationship with the usage of a vaccine. The World Health Organization categories AEFI into two; serious and non-serious. An AEFI is considered serious if it is life-threatening, requires inpatient hospitalization or results in death. The measles vaccine is safe and effective however because it is a live-attenuated injectable vaccine it is more prone to AEFI as compared to non-injectable vaccines when given in large numbers over a short period as is the nature of measles mass vaccination campaigns (MVC). This article describes Nigeria's experience on AEFI reporting during the 2017/2018 Measles vaccination campaign (MVC). METHODS We reviewed various materials which included the Open Data Kit (ODK) which is an open source smartphone-based data collecting tool, operations room reports, measles campaign tally sheets, AEFI line listing forms, the post measles campaign coverage survey report and the report of the AEFI national expert committee review of the 2017/2018 Nigeria measles MVC. RESULTS A total of 6,214 suspected cases of AEFI were line listed from all 36 states and the Federal Capital Territory(FCT) during the 2017/2018 MVC with Fever(38%) and pain at injection site the (30%)most common reports. Overall, 99.7% AEFIs were reported to be non-serious AEFIs, with almost all cases resolved fully with no long-term sequalae.. The national incidence of suspected AEFI per 100,000 population was 16.3 with subnational incidence highest in Kebbi state (101.3/100,000) and lowest in Bayelsa state (0.8/100,000). CONCLUSION Adequate AEFI reporting, Investigation and management remains important in managing the risk of a disruption of mass campaigns. The deployment of supervisors during campaign may play an important role in improving the identification and reporting of suspected AEFI. Further inquiries about AEFIs during the post campaign coverage evaluation also played a role in improving AEFI reporting and documentation. The real-time, on the spot, follow up by the national operations team helped with decision making and intervention including AEFI investigations and assessments.
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Dadari I, Ssenyonjo J, Anga J. Effective vaccine management through social behavior change communication: Exploring solutions using a participatory action research approach in the Solomon Islands. Vaccine 2020; 38:6941-6953. [PMID: 32943266 DOI: 10.1016/j.vaccine.2020.08.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 08/19/2020] [Accepted: 08/20/2020] [Indexed: 10/23/2022]
Abstract
Addressing vaccine management bottlenecks, including high vaccine wastage rates, has traditionally been addressed through health worker training and other didactic methods of technical assistance or support as required. It has been shown, though, that the high level of technical skills, expertise, and responsibility required in vaccine handling and management cannot be achieved by mere didactic learning. While gains have been made in vaccine management and handling with these approaches, there remain challenges of high vaccine wastage rates and poor vaccine management practices across the board. Interestingly, approaching vaccine management through social behavior change has not been documented. Through Participatory Action Research (PAR), which is increasingly being used in health sciences, we explore an attempt at strengthening vaccine management and thus reducing high vaccine wastage rates by working together with health workers to identify plausible, realistic solutions to vaccine management through social behavior change. Select health workers directly involved with the immunization program in the four major provinces of the Solomon Islands were identified purposively to use action media and come up with concepts and materials for social behavior change communication that will have an impact on effective vaccine management and reducing wastages. This is the first documented use of such methodology in addressing vaccine management issues.
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Affiliation(s)
- Ibrahim Dadari
- United Nations Children's Fund (UNICEF) Pacific, UN Joint Presence, ANZ Haus, P.O. Box 1786, Honiara, Solomon Islands; College of Public Health, University of South Florida, 13201 Bruce B. Downs Blvd, MDC 56, Tampa, FL 33612, USA.
| | - Jude Ssenyonjo
- United Nations Children's Fund (UNICEF) Pacific, UN Joint Presence, ANZ Haus, P.O. Box 1786, Honiara, Solomon Islands; Department of Allied Health Sciences, University of Connecticut, Storrs, CT, USA.
| | - Jenniffer Anga
- Ministry of Health and Medical Services, Honiara, Chinatown, Solomon Islands.
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Chojnacky M, Rodriguez AL. Effect of thermal ballast loading on temperature stability of domestic refrigerators used for vaccine storage. PLoS One 2020; 15:e0235777. [PMID: 32639973 PMCID: PMC7343171 DOI: 10.1371/journal.pone.0235777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/22/2020] [Indexed: 02/02/2023] Open
Abstract
Vaccine temperature control failures represent a significant public and private healthcare cost. Vaccines damaged by excessive heat or freezing lose their effectiveness, putting public health at risk. Some vaccine administration programs recommend placing water bottles inside domestic refrigerators used for vaccine storage as a thermal ballast, to mitigate temperature excursion risks. However, the effect of variable thermal ballast loading on refrigerator performance has not been thoroughly quantified or documented, and generalized programmatic recommendations are subject to end-user interpretation. Here we show that a thermal ballast load comprising ten to fifteen percent of the total refrigerator storage volume provides a measurable effect on domestic refrigerator temperature stability during power outage events, maintaining vaccine temperatures between 2 °C and 8 °C for 4 to 6 hours without power. Thermal ballast usage does not reliably reduce the frequency or severity of temperature excursions caused by repeated door opening, accidental "door left open" events, or refrigerator defrost cycle activation. Use of a moderate thermal ballast load is a practical strategy for mitigating temperature excursions risks in areas with frequent or protracted power outages, but the practice has limited benefit in other adverse scenarios. Empowering providers to make informed decisions about the use of thermal ballast materials supports better, safer vaccine management.
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Affiliation(s)
- Michal Chojnacky
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland, United States of America
| | - Alexandra L. Rodriguez
- Physical Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, Maryland, United States of America
- Department of Computer Science, University of Maryland, College Park, Maryland, United States of America
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Li K, Dong F, Gao F, Bian L, Sun S, Du R, Hu Y, Mao Q, Zheng H, Wu X, Liang Z. Effect of freezing on recombinant hepatitis E vaccine. Hum Vaccin Immunother 2020; 16:1545-1553. [PMID: 31809644 PMCID: PMC7482780 DOI: 10.1080/21645515.2019.1694327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/13/2019] [Indexed: 12/19/2022] Open
Abstract
Studies have revealed that vaccines are more often exposed to sub-zero temperatures during cold chain transportation than what was previously known. Such exposure might be detrimental to the potency of temperature-sensitive vaccines. The aim of this study was to evaluate the impact of exposure to freezing on the physicochemical properties and biological activities of recombinant hepatitis E (rHE) vaccine. Changes in rHE vaccine due to freezing temperatures were analyzed with regard to sedimentation rate, antigenicity, and antibody affinity and potency. The freezing temperature of rHE was measured, then rHE vaccine was exposed to freezing temperatures below -10°C.Significant increase of sedimentation rate was noted, according to shake test and massed precipitates. In addition, the binding affinity of rHE vaccine to six specific monoclonal antibodies was significantly reduced and the in vivo potency for eliciting a protective IgG response was also partially lost, especially for anti-HEV neutralizing antibodies. Altogether, our work indicates that exposure of rHE vaccine to a temperature below -10°C results in the loss of structural integrity and biological potency of rHE vaccine.
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Affiliation(s)
- Kelei Li
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
- Research and Development Center, Minhai Biotechnology Co. Ltd, Beijing, China
| | - Fangyu Dong
- The Second Department of Research, Lanzhou Institute of Biological Products Co. Ltd, Lanzhou, China
| | - Fan Gao
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Lianlian Bian
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Shiyang Sun
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Ruixiao Du
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Yalin Hu
- Quality Assurance Department, Hualan Biological Engineering Inc, Xinxiang, China
| | - Qunying Mao
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Haifa Zheng
- Research and Development Center, Minhai Biotechnology Co. Ltd, Beijing, China
| | - Xing Wu
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
| | - Zhenglun Liang
- Division of Hepatitis Virus Vaccines, National Institute for Food and Drug Control, Beijing, China
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Das MK, Arora NK, Mathew T, Vyas B, Devi SK, Yadav A. Temperature integrity and exposure of vaccines to suboptimal temperatures in cold chain devices at different levels in three states of India. Trop Dis Travel Med Vaccines 2020; 6:8. [PMID: 32518666 PMCID: PMC7268609 DOI: 10.1186/s40794-020-00109-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To document the temperature integrity at the vaccine storage devices at various levels in three states of India. METHODS A total of 213 health facilities including 196 facilities (district and sub-district levels) from 27 select districts and 17 division or state level vaccine stores in three states were included. At these facilities, temperature in 223 vaccine storage devices was recorded for at least 7 consecutive days using electronic temperature datalogger. RESULTS During the observation period, overall the vaccines were exposed to temperature < 0 °C for 14.8% of the storage time with 8.6, 6.7 and 18% at state/division, district and sub-district vaccine stores, respectively. The vaccines were also exposed to temperature > 8 °C for 6.6% of the storage time including 1.3, 13 and 5.1% at state/division, district and sub-district vaccine stores, respectively. Continuous episodes of temperature deviation for 45 min or longer to < 0 °C and > 8 °C was observed in 7.2 and 6.4% of the observation period, respectively. These temperature deviations were not captured by the routine temperature monitoring practice. CONCLUSION The vaccines were exposed to freezing temperature for a considerable period at all level stores, which was more than the exposure to higher temperature. To ensure vaccine potency and immunogenicity, stringent temperature integrity maintenance is needed at all levels.
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Affiliation(s)
- Manoja Kumar Das
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020 India
| | - Narendra Kumar Arora
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020 India
| | - Thomas Mathew
- Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala 695011 India
| | - Bhadresh Vyas
- Department of Pediatrics, M P Shah Medical College, Jamnagar, Gujarat 361008 India
| | - Salam Kabita Devi
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020 India
| | - Abhishek Yadav
- The INCLEN Trust International, F1/5, Okhla Industrial Area, Phase 1, New Delhi, 110020 India
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15
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Cai W, Ping L, Shen W, Liu J, Zhang M, Zhou J, Peng J, Wang M, Zhu Y, Ji G, Wang X, Ji Q, Lai C, Shi L, Che Y, Sun M. Potency of the Sabin inactivated poliovirus vaccine (sIPV) after exposure to freezing temperatures in cold chains. Hum Vaccin Immunother 2020; 16:1866-1874. [PMID: 32118517 PMCID: PMC7482872 DOI: 10.1080/21645515.2019.1709352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
With more demand for Sabin inactivated poliovirus vaccines (sIPVs) to support the global polio eradication effort worldwide, data regarding the potency characteristics of sIPV after exposure to freezing temperatures are urgently required. In the present study, the sIPVs were stored at -20°C for 24 h, 1 week, and 2 weeks in the freezer or in a vaccine carrier for 1 or 3 freeze-thaw cycle to evaluate the effect mediated by freezing temperatures that may be encountered during routine storage and transfer. The in vitro potency was then determined by a D-antigen enzyme-linked immunosorbent assay, and the in vivo potency was evaluated in Wistar rats. In the in vitro study for freezer storage groups, the D-antigen contents for all three types decreased and were lower than the release specifications after storing at -20°C for 2 weeks. After storing at -20°C for 1 week, the D-antigen contents for types I and III in combined group of a total of 45 vials, and for type II in the specific lot groups containing 15 vials decreased, but were within the release specifications. Moreover, no significant change in in vivo potency was observed. For vaccine carrier transfer groups, the D-antigen contents did not decrease after 1 freeze-thaw cycle; in contrast, it decreased, but no significant in vivo potency loss was observed after 3 freeze-thaw cycles. These results suggest that it may be possible to retain sufficient sIPV potency after short periods of freezing or freeze-thawing during transport.
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Affiliation(s)
- Wei Cai
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Ling Ping
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Wuling Shen
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Jing Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Ming Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Jian Zhou
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Jia Peng
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Mingqing Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Yun Zhu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Guang Ji
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Xiaoyu Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Qiuyan Ji
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
| | - Chao Lai
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Li Shi
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Yanchun Che
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China
| | - Mingbo Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College , Kunming, Yunnan, China.,Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases , Kunming, Yunnan, China
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16
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Bajrovic I, Schafer SC, Romanovicz DK, Croyle MA. Novel technology for storage and distribution of live vaccines and other biological medicines at ambient temperature. SCIENCE ADVANCES 2020; 6:eaau4819. [PMID: 32181330 PMCID: PMC7056310 DOI: 10.1126/sciadv.aau4819] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 12/11/2019] [Indexed: 05/10/2023]
Abstract
A novel, thin-film platform that preserves live viruses, bacteria, antibodies, and enzymes without refrigeration for extended periods of time is described. Studies with recombinant adenovirus in an optimized formulation that supports recovery of live virus through 16 freeze-thaw cycles revealed that production of an amorphous solid with a glass transition above room temperature and nitrogen-hydrogen bonding between virus and film components are critical determinants of stability. Administration of live influenza virus in the optimized film by the sublingual and buccal routes induced antibody-mediated immune responses as good as or better than those achieved by intramuscular injection. This work introduces the possibility of improving global access to a variety of medicines by offering a technology capable of reducing costs of production, distribution, and supply chain maintenance.
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MESH Headings
- Adenoviridae/genetics
- Adenoviridae/immunology
- Administration, Buccal
- Administration, Sublingual
- Animals
- Antibodies, Neutralizing/biosynthesis
- Antibodies, Viral/biosynthesis
- HEK293 Cells
- Humans
- Immunization/methods
- Influenza A Virus, H1N1 Subtype/immunology
- Influenza A Virus, H1N1 Subtype/pathogenicity
- Injections, Intramuscular
- Male
- Membranes, Artificial
- Mice
- Mice, Inbred BALB C
- Orthomyxoviridae Infections/immunology
- Orthomyxoviridae Infections/prevention & control
- Orthomyxoviridae Infections/virology
- Preservation, Biological/methods
- Temperature
- Vaccine Potency
- Vaccines, Attenuated/biosynthesis
- Vaccines, Attenuated/pharmacology
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Affiliation(s)
- Irnela Bajrovic
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Stephen C. Schafer
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
| | - Dwight K. Romanovicz
- Institute for Cellular and Molecular Biology, College of Natural Sciences, The University of Texas at Austin, Austin, TX 78712, USA
| | - Maria A. Croyle
- Division of Molecular Pharmaceutics and Drug Delivery, College of Pharmacy, The University of Texas at Austin, Austin, TX 78712, USA
- LaMontagne Center for Infectious Disease, The University of Texas at Austin, Austin, TX 78712, USA
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Ateudjieu J, Yakum MN, Goura AP, Tembei AM, Ingrid DK, Bita'a Landry B, Kenfack B, Amada L, Tadzong I, Bissek AC. EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study. BMC Public Health 2020; 20:228. [PMID: 32054484 PMCID: PMC7020570 DOI: 10.1186/s12889-020-8340-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Monitoring of the expanded program on immunization's performance is not only limited to routine periodic reports but equally includes surveys. Based on unpublished national EPI surveillance data from the past 5 years in Cameroon, the Foumban health district has reported a high number of vaccine preventable disease suspected cases. Contradictory information on the immunization coverage in this district exists from both administrative data and published literature. As a result, the objective of this study was to estimate the immunization coverage and dropout rate in age group 12-23 months and timeliness in age group 0-59 months among children in Foumban Health District (Cameroon), in 2018. METHOD This was a descriptive cross-sectional study targeting randomly selected children aged 0-59 months from Foumban health district. Data were collected by trained and supervised surveyors using a pretested questionnaire to describe the immunization coverage, timeliness and dropout rate in eighty clusters of about thirty buildings selected by stratified random sampling in July 2018. RESULTS In total, 80 clusters covering 2121 buildings were selected and all were reached (100%). A total of 1549 (81.2%) households accepted to participate in the survey and 1430 children aged 0-59 months including 294 (20.6%) aged 12-23 months were enrolled into the study. Of these 1430 children, 427 [29.9 (27.4-32.2)%] aged 0-59 months were vaccinated with evidence. In the age group 12-23 months, the immunization coverage with evidence of BCG, DPT-Hi + Hb 3 and measles/rubella were 28.6(23.4-33.9)%, 22.8 (18.1-27.6)% and 14.3 (10.3-18.1)% respectively. Within age group 0-59 months; the proportion of children who missed their vaccination appointments increased from 23.3 to 31.7% for the vaccine planned at birth (BCG) and last vaccine planned (Measles/Rubella) for the EPI program respectively. In age group 12-23 months; the specific (DPT-Hi + Hb1-3) and general (BCG-Measles/Rubella) dropout rates of vaccination with evidence were 14.1 and 50.0% respectively. CONCLUSION Documented immunization coverage, dropout rate and timeliness in Foumban Health district are lower than that targeted by the Cameroon EPI. Competent health authorities have to take necessary actions to ensure the implementation of national guidelines with regards to children access to immunization. Also, studies have to be conducted to identify determinants of low immunization coverage and delays in immunization schedules as well as high dropout rates.
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Affiliation(s)
- Jérôme Ateudjieu
- M.A. SANTE (Meilleuraccès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon.,Department of Biomedical Sciences, University of Dschang, Cameroon, P.O. Box 067, Dschang, Cameroon.,Dschang District Hospital, Dschang West region of Cameroon, Dschang, Cameroon
| | | | - André Pascal Goura
- M.A. SANTE (Meilleuraccès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Ayok Maureen Tembei
- M.A. SANTE (Meilleuraccès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | | | - Beyala Bita'a Landry
- M.A. SANTE (Meilleuraccès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Bruno Kenfack
- Department of Biomedical Sciences, University of Dschang, Cameroon, P.O. Box 067, Dschang, Cameroon.,Dschang District Hospital, Dschang West region of Cameroon, Dschang, Cameroon
| | - Lapia Amada
- M.A. SANTE (Meilleuraccès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Isaac Tadzong
- M.A. SANTE (Meilleuraccès aux soins de Santé), P.O. Box 33490, Yaoundé, Cameroon
| | - Anne Cecile Bissek
- Division of Health Operations Research, Ministry of Public Health, Yaoundé, Cameroon
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18
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Soleimani S. Determination of Factors Affecting Bivalent (Type 1 and 3) Stability of Oral Poliomyelitis Vaccine. MEDICAL LABORATORY JOURNAL 2020. [DOI: 10.29252/mlj.14.1.36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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19
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Lutukai M, Bunde EA, Hatch B, Mohamed Z, Yavari S, Some E, Chweya A, Kania C, Ross JC, Keddem C, Chandani Y. Using Data to Keep Vaccines Cold in Kenya: Remote Temperature Monitoring with Data Review Teams for Vaccine Management. GLOBAL HEALTH: SCIENCE AND PRACTICE 2019; 7:585-597. [PMID: 31852740 PMCID: PMC6927831 DOI: 10.9745/ghsp-d-19-00157] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 10/22/2019] [Indexed: 11/15/2022]
Abstract
Using technology to make data visible to stakeholders and giving those stakeholders a framework for analyzing that data for decision making improves cold chain management of vaccines in Kenya. Background: Global vaccination coverage rates have remained around 85% for the past several years. Increasing immunization coverage rates requires an effective cold chain to maintain vaccine potency. Remote temperature monitoring (RTM) technology for vaccine refrigerators has shown promise for improving the ability of supply systems to maintain optimal temperature conditions to ensure potent vaccines reach the end users. Methods: A pilot study of RTM technology and data use teams was implemented in 36 study sites in Kenya. Data were collected at baseline and endline points over a 3-month baseline and 7-month implementation period. Data included 44 qualitative interviews, process logs, meeting minutes from data use team meetings, and quantitative temperature and power data from the RTM devices. Results: The ability of cold chain equipment to maintain World Health Organization-recommended temperatures in study sites improved markedly between the baseline and implementation periods, resulting in an improvement in total time spent in the correct range from 83.9% in the baseline period to 90.9% in the intervention period and an improvement in time spent in the too cold range from 6.5% to 1.5%. Friedman tests revealed that differences in time spent in the correct range and time spent in the too cold range during the course of the study were statistically significant (P<.001 and P=.04, respectively). Qualitative and quantitative data suggest that this improvement was due to a combination of improved responsiveness to temperature excursions at the facility level, resulting from SMS alarms for temperature excursion periods, and improved ability at the management level to recognize and address recurring problems. Conclusion: The combination of using RTM technology with a structured data review process by a management team is a promising approach for improving cold chain outcomes. Future research examining the added value of each of the technological and behavioral components separately is needed.
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Affiliation(s)
| | | | - Benjamin Hatch
- JSI Research & Training Institute, Inc., Boston, MA, USA.
| | | | | | - Ernest Some
- Ministry of Health, Republic of Kenya, Nairobi, Kenya
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20
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Oliveira VCD, Oliveira PPD, Castro LCD, Rennó HMS, Gonçalves DTDA, Pinto IC. Collective construction of bundle for immunobiological agents conservation best practices. Rev Bras Enferm 2019; 72:671-679. [PMID: 31269131 DOI: 10.1590/0034-7167-2018-0406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/23/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to construct collectively with nursing professionals bundle for best practices of cold chain maintenance of immunobiological agents conservation at the local level. METHOD a qualitative research of convergent care type. Bundle construction was guided by the Evidence-Based Practice criterion. Data collection was carried out from October to December 2016, through five workshops, with the participation of 21 professionals from 7 vaccination rooms of a municipality of Minas Gerais State. The framework developed by Morse and Field was adopted for data analysis. RESULTS through bundle, care is taken regarding refrigeration equipment temperature monitoring, contingency plan performance, recyclable ice coil setting and chamber use as refrigeration equipment. FINAL CONSIDERATIONS the chosen interventions began to guide the practice and promote a care based on safety and quality.
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Affiliation(s)
| | | | | | | | | | - Ione Carvalho Pinto
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto, São Paulo, Brasil
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21
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Yamoah P, Bangalee V, Oosthuizen F. Knowledge and Perceptions of Adverse Events Following Immunization among Healthcare Professionals in Africa: A Case Study from Ghana. Vaccines (Basel) 2019; 7:vaccines7010028. [PMID: 30857257 PMCID: PMC6466096 DOI: 10.3390/vaccines7010028] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/12/2018] [Accepted: 12/17/2018] [Indexed: 12/31/2022] Open
Abstract
The spontaneous reporting of suspected adverse events following immunization (AEFI) by healthcare professionals (HCPs) is vital in monitoring post-licensure vaccine safety. The main objective of this study was to assess the knowledge and perceptions of AEFIs among healthcare professionals (HCPs) in Africa, using the situation in Ghana as a case study. The study was of a cross-sectional quantitative design, and was carried out from 1 July 2017 to 31 December 2017 with doctors, pharmacists, and nurses as the study participants. A 28-item paper-based questionnaire, delivered by hand to study participants, was the data collection tool in the study. The study was conducted in 4 hospitals after ethical approval was granted. The desired sample size was 686; however, 453 consented to partake in the study. Data were analyzed using SPSS (software version 22, IBM, Armonk, NY, USA), and chi-square and binary logistic regression tests were used for tests of association between HCPs’ characteristics and their knowledge and perceptions. Detailed knowledge of AEFIs was ascertained with a set of 9 questions, with 8 or 9 correctly answered questions signifying high knowledge, 5 to 7 correctly answered questions signifying moderate knowledge, and below 5 correctly answered questions signifying low knowledge. A set of 10 questions also ascertained HCPs’ positive and negative perceptions of AEFI. Results revealed that knowledge of AEFIs was high in 49 (10.8%) participants, moderate in 213 (47.0%) participants, and low in 191 (42.2%) participants. There was no statistically significant correlation between AEFI knowledge and professions. The highest negative perception was the lack of desire to learn more about how to diagnose, report, investigate, and manage AEFI, whereas the lowest was the lack of belief that surveillance improves public trust in immunization programs. There was a general awareness of AEFIs among HCPs in this study. However, negative perceptions and the lack of highly knowledgeable HCPs regarding AEFIs were possible setbacks to AEFI diagnosis, management, prevention, and reporting. More training and sensitization of HCPs on AEFIs and vaccine safety will be beneficial in improving the situation. Future research should focus on assessing the training materials and methodology used in informing HCPs about AEFIs and vaccine safety.
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Affiliation(s)
- Peter Yamoah
- Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi 00233, Ghana.
- College of Health Sciences, University of KwaZulu Natal, Durban 4041, South Africa.
- Department of Pharmacy Practice, Faculty of Pharmacy and Pharmaceutical Sciences, Kwame Nkrumah University of Science and Technology, Accra Rd, Kumasi 00233, Ghana.
| | - Varsha Bangalee
- College of Health Sciences, University of KwaZulu Natal, Durban 4041, South Africa.
| | - Frasia Oosthuizen
- College of Health Sciences, University of KwaZulu Natal, Durban 4041, South Africa.
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22
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Maglasang PL, Butalid ML, Pastoril MF, Pratama AN, Tan EY. A cross-sectional survey on cold chain management of vaccines in Cebu, Philippines. Pharm Pract (Granada) 2018; 16:1167. [PMID: 30023026 PMCID: PMC6041204 DOI: 10.18549/pharmpract.2018.02.1167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 05/11/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Appropriate cold chain management is the foundation of safety and quality of vaccines. Objectives: This cross-sectional study was conducted to assess the cold chain management of the rural health units of Consolacion and Liloan, Cebu, Philippines on August to September 2017. Methods: Data was collected using a structured questionnaire, which was developed based on previous studies of cold chain survey. The questionnaire was administered to one personnel who is responsible for the storage and maintenance of vaccines in each public health center (PHC). Results: Of 42 targeted PHCs, only 52.4% (n=22) agreed to join in the study. The results of the study indicated that storage units and equipments were available in all 22 PHCs, even though only five of them (22.7%) stored vaccines. The majority of PHCs (90.9%, n=20) did not have access to a generator and only 9% (n=2) had a voltage stabilizer connected to the refrigerator. Refrigerators that were equipped with thermometer were only found in 68.2% (n=15) PHCs. No statistically significant relationship was found (p=0.159) between the statuses of PHCs to store vaccine and the level of knowledge of health professionals assigned to manage the vaccine. Conclusions: Primary health centers that store vaccines have at least one functional refrigerator and freezer and alternative power sources. Contingency plans in the event of mechanical and power failure as well as proper temperature monitoring are needed. Personnel handling vaccines must be updated on proper storage and transport of such like the use of cold boxes and ice packs to maintain cold chain. Improvement of cold-chain management for vaccines in Cebu City’s PHCs was necessary.
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Affiliation(s)
| | | | | | - Antonius N Pratama
- Faculty Member, Faculty of Pharmacy, Universitas Jember. Jember (Indonesia).
| | - Elizabeth Y Tan
- Faculty Member, Department of Pharmacy, University of San Carlos. Cebu (Philippines).
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23
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Sow C, Sanou C, Medah C, Schlumberger M, Mireux F, Ouédraogo I, Ouédraogo SM, Betsem E. Challenges of cold chain quality for routine EPI in south-west Burkina-Faso: An assessment using automated temperature recording devices. Vaccine 2018; 36:3747-3755. [PMID: 29779921 DOI: 10.1016/j.vaccine.2018.05.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 05/12/2018] [Accepted: 05/14/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Abnormal temperatures are a major issue for vaccines within the Expanded Program of Immunization in tropical climates. Prolonged exposure to temperatures outside the standard +2 °C/+8 °C range can impact vaccine potency. METHODS The current study used automatic temperature recording devices (Testostore 171-1©) to monitor cold chain in remote areas of Western Burkina Faso. A series of 25 randomly selected health centers representing 33% of the existing 176 EPI facilities in Western Burkina Faso were prospectively assessed for eight months in 2015. Automatic measurements were compared to routine temperature loggers and vaccine vial monitors (VVM). RESULTS The median age for all refrigerators was 9 years with 10/25 (42%) older than 10 years. Adverse temperatures were recorded in 20/24 (83%) refrigerators and ranged from -18.5 °C to +34.2 °C with 12,958/128,905 (10%) abnormal hourly records below +2 °C and 7357/128,905 (5.7%) above +8 °C. Time of day significantly affected the rate of temperature excursions, with higher rates from 00 am to 06 am (p < 0.001) for low temperatures and 10-12 am (p < 0.001) and 13-16 pm (p < 0.001) for high temperatures. Abnormal temperatures lasted from 1 h to 24 h below +2 °C and 13-24 h above +8 °C. Standard manual registers reported only 182/2761 (7%) inadequate temperatures and VVM color change detected only 133/2465 (5%) disruptions. Reliability of the refrigerators ranged from 48% to 98.7% with a median of 70%. Risk factors for excursions were old age of the refrigerators, the months of April and May, hours of high activity during the day, and health staff-associated factors such as inappropriate actions or insufficient knowledge. CONCLUSION Important cold chain reliability issues reported in the current study in Western Burkina Faso raise concern about vaccine potency. In the absence of systematic renewal of the cold chain infrastructure or improved staff training and monitoring, antibody response assessment is recommended to study levels of effective immunization coverage.
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Affiliation(s)
- C Sow
- University of Ouagadougou, UFR SDS, Ouagadougou, Burkina Faso; Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso
| | - C Sanou
- Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso; Agence de Médecine Préventive (AMP), Bobo-Dioulasso, Burkina Faso
| | - C Medah
- Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso, Burkina Faso; Direction Régionale de la Santé des Hauts-Bassins, Burkina Faso
| | - M Schlumberger
- Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso
| | - F Mireux
- Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso
| | - I Ouédraogo
- Agence de Médecine Préventive (AMP), Bobo-Dioulasso, Burkina Faso
| | - S M Ouédraogo
- Institut Supérieur des Sciences de la Santé (INSSA), Bobo-Dioulasso, Burkina Faso
| | - E Betsem
- Laboratoire Mixte International de Vaccinologie (LAMIVAC), Bobo-Dioulasso, Burkina Faso; Agence de Médecine Préventive (AMP), Bobo-Dioulasso, Burkina Faso.
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Hanson CM, George AM, Sawadogo A, Schreiber B. Is freezing in the vaccine cold chain an ongoing issue? A literature review. Vaccine 2017; 35:2127-2133. [PMID: 28364920 DOI: 10.1016/j.vaccine.2016.09.070] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 09/12/2016] [Accepted: 09/14/2016] [Indexed: 10/19/2022]
Abstract
Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess 'too cold' temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to 'too cold' temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children.
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Billah MM, Zaman K, Estivariz CF, Snider CJ, Anand A, Hampton LM, Bari TIA, Russell KL, Chai SJ. Cold-Chain Adaptability During Introduction of Inactivated Polio Vaccine in Bangladesh, 2015. J Infect Dis 2017; 216:S114-S121. [PMID: 28838173 PMCID: PMC5853344 DOI: 10.1093/infdis/jiw591] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background. Introduction of inactivated polio vaccine creates challenges in maintaining the cold chain for vaccine storage and distribution. Methods. We evaluated the cold chain in 23 health facilities and 36 outreach vaccination sessions in 8 districts and cities of Bangladesh, using purposive sampling during August–October 2015. We interviewed immunization and cold-chain staff, assessed equipment, and recorded temperatures during vaccine storage and transportation. Results. All health facilities had functioning refrigerators, and 96% had freezers. Temperature monitors were observed in all refrigerators and freezers but in only 14 of 66 vaccine transporters (21%). Recorders detected temperatures >8°C for >60 minutes in 5 of 23 refrigerators (22%), 3 of 6 cold boxes (50%) transporting vaccines from national to subnational depots, and 8 of 48 vaccine carriers (17%) used in outreach vaccination sites. Temperatures <2°C were detected in 4 of 19 cold boxes (21%) transporting vaccine from subnational depots to health facilities and 14 of 48 vaccine carriers (29%). Conclusions. Bangladesh has substantial cold-chain storage and transportation capacity after inactivated polio vaccine introduction, but temperature fluctuations during vaccine transport could cause vaccine potency loss that could go undetected. Bangladesh and other countries should strive to ensure consistent and sufficient cold-chain storage and monitor the cold chain during vaccine transportation at all levels.
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Affiliation(s)
- Mallick M Billah
- Field Epidemiology Training Program Bangladesh, Institute of Epidemiology, Disease Control and Research, Dhaka, Bangladesh
| | - K Zaman
- icddr,b (formerly International Centre for Diarrhoeal Diseases Research, Bangladesh), Dhaka, Bangladesh
| | | | | | | | | | - Tajul I A Bari
- Expanded Program for Immunization, Ministry of Health and Family Welfare, Dhaka, Bangladesh
| | - Kevin L Russell
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Shua J Chai
- Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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