POST 00609E : DESTRUCTION OF VACCINES
Follow-up on Posts 00603E and 00606E
5 October 2003
____________________________________________
This posting contains three contributions. The first is from Stéphane
Guichard (mailto:[log in to unmask]) from WHO. The second is from James
Patterson (mailto:[log in to unmask]) and finally, the last is from Jeanne
Mondo (mailto:[log in to unmask]) from DR Congo.
_______________
Both Stéphane and James contributions point to risks of releasing live
attenuated vaccines in the environment. I do not feel that I am in any
position to assess such risk but I question it as maybe others do.
Consequently I would like to ask if any member has precise scientific
information to share on this topic.
The Moderator
____________________________________________
I think before crushing the vial or burying it, vaccine must be
decontaminated especially live attenuated virus vaccine. A simple method
would be to boil the vial for 20 to 30 minutes.
Stéphane Guichard
Technical Officer VSQ
WHO SEARO
_____________________________________________
Having started and benefited from the East Timor discussion on vaccine
disposal some two years back, perhaps it would be useful to share the
results of our thinking/learning at that time.
In short, following the circumstances of an emergency deployment of EPI
activities in 1999/2000, there was inadvertently a massive residual of
expired and destroyed vaccines. I suspect this is important, as practically
speaking many options appeared ominous when the quantities are large. We
also directed all EPI clinics to send expired vaccines to the capital for
destruction. In such a small country this was straightforward and we
avoided designing/implementing solutions at a local level.
Indeed there was (and still is) a shortage of elegant solutions.
Nevertheless, we found the "Guidelines for Safe Disposal of Unwanted
Pharmaceuticals in and after Emergencies", provided the greatest level of
technical detail.
(http://www.who.int/medicines/library/pa ... r-99-2.htm)
Options considered.
1. Returning to vendor. This was felt to be too complicated with multiple
vaccine suppliers and too expensive with high shipping costs from a remote
island.
2. Incineration. There was no incinerator with sufficient capacity to cope
reliably with the volume of metal and glass. Further, there was fear that a
very specialised system was needed to ensure that noxious vapours would be
safely filtered. The risk of damaging the main/only incinerator with
exploding vials was also raised.
3. Breaking the vials. There are some suggestions in the guide (above) for
breaking vials and neutralising the liquid, etc. However the task still
appeared to pose some risk to both the worker and the environment
especially for such a large stock of vaccines. The consequences of
releasing quantities of live vaccines was particularly problematic.
4. Encapsulation. This was the option settled on. Under direct supervision
of health staff, the vials were layered with concrete into a 200 liter fuel
drum and welded shut. The drum was delivered to the landfill.
If faced with a similar situation, I still think encapsulation is the most
expedient solution. Further, centralising (whether regional or national)
the collection of destroyed vaccines highlighted clinics with weak cold
chain management for follow-up support and supervision.
Best regards
James Patterson
__________________________________________
The problem of destruction of vaccines and other medicines will remain with
us so long as the management of our programmes remains weak.
Some four years ago, EPI-DRCongo has experienced the deterioration of a
large quantity of vaccines, which had to be destroyed, following the
country guidelines valid at the time. The adopted destruction procedure was
as follows:
1. Inform the Department of Drugs and Medicines on the deterioration, with
the maximum details possible regarding its causes.
2. Draw up an account of stocks and its disposal, with the help of
inspectors from that same Department,
3. Incinerate and bury the debris.
4. Write a circumstantial report for the attention of the authorities.
We would like to highlight the fact that the destruction of vaccine at the
time did not follow the established standard.
Mrs. Mondo
______________________________________________________________________________
Visit the TECHNET21 Website at http://www.technet21.org
You will find instructions to subscribe, a direct access to archives, links to reference documents and other features.
______________________________________________________________________________
To UNSUBSCRIBE, send a message to : mailto:[log in to unmask]
Leave the subject area BLANK
In the message body, write unsubscribe TECHNET21E
______________________________________________________________________________
The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org)
______________________________________________________________________________
There are no replies made for this post yet.