TechNet-21 - Forum

This forum provides a place for members to ask questions, share experiences, coordinate activities, and discuss recent developments in immunization.
  1. Narayana Holla
  2. Supply chain and logistics
  3. Friday, December 02 2016, 08:24 AM

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

Narayana Holla Accepted Answer

Keeping the promise

Dear viewers

By the end of Dec 2016, we wanted to clear ≥85% of IPV 1st and 2nd dose backlog accumulated since April 2016 mainly because of limited supply of vaccine.

We followed 57 backlog children – 35 for 1st dose IPV and 22 for 2nd dose IPV. PHC Guthigar team flanked by supportive supervision by the author from the KVG Medical College, cleared 91.43% (32 of 35) and 100% (22 of 22) backlog of 1st dose and 2nd dose IPV respectively. 22.72% improved by data updating as the beneficiaries availed services from CHC / KVG Medical College providing vaccination service daily on all working days. There was a delay in data collection.

Impression: On availability of vaccines, attaining and sustaining ≥95% coverage is not a problem in this area through dedicated service from the PHC and a little supportive supervision for sustained motivation.

wishing happy new year

Holla and the team

  1. more than a month ago
  2. Supply chain and logistics
  3. # 1
Narayana Holla Accepted Answer

Thank you sir for sharing the information.

Stock out of vaccines is not uncommon. India was declared as non-endemic for polio in 2012: in high risk states there was recurrent stock out of Oral Polio Vaccine – often for three consecutive months. Probably high quality NID/SNID protected the community against importation of wild virus.

From the training PPTs, it is learnt that one dose of Pentavalent costs Rs 100/- and that of IPV 0.1mL Intra-dermal dose costs < Rs 12/- [Rs 55/- for 0.5mL dose as quoted by Shan IPV]. Supply of 2.5ml vial of IPV has greatly reduced the vaccine wastage to almost zero at CHC / District Hospital / Medical College where vaccination is done on all working days as per the directions from the Government.

However a few senior pediatricians who are DIO's / RCHO's expressed their concern that pricking the septum 25 times is risky even with aseptic precautions. If one mL vial can be provided, the pricks will not be more than 10 like that of BCG. This will require 5 times the cold space of 5mL vial as the vial sizes are almost same. VVM7 remained in useable state withstanding ~50 temperature excursions. As of now we had no injection abscess / local reaction at injection site following administartion of IPV - even the 25th dose.

It is beyond our scope to understand the causes of stock out as we are working at the periphery. We are dreaming of clearing the backlog of 2 planning units (101 children as of 31st Oct 2016) attached to our college before they cross their first birth day.

The backlog has already grown to ~65% for the first dose and ~80% for the 2nd dose of IPV. Too low coverage of any vaccine may not have protective impact on the community and the objectives of endgame strategy may not be reached.

Community participation is very much appreciable. Parents are keeping a track of IPV supply and bring their infants even on completion of 3rd dose of OPV/Pentavalent. We hope to clear at least 2nd dose backlog in Dec 2016 with 2 additional vials we got.

Regards

Holla and the team

  1. more than a month ago
  2. Supply chain and logistics
  3. # 2
Narayana Holla Accepted Answer

correction please: in the last line of 4th para - 3 doses of OPV/IPV to be repalced with 3 doses of OPV/PENTAVALENT not IPV - sorry for the typo.

  1. more than a month ago
  2. Supply chain and logistics
  3. # 3
prabirkc Accepted Answer
Stock outs of IPV are occurring in states with poor coverage too
The attached picture is from a weekly Chhattisgarh EVIN report

From: TechNet-21

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.



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  1. more than a month ago
  2. Supply chain and logistics
  3. # 4


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