POST 01061E : VVM USE Follow-up on Posts 01028E, 01035E, 01042E, 01050E and 01053E 3 March 2007 _______________________________ This posting starts with a contribution from Giridhara Babu ([log in to unmask]" eudora="autourl"> mailto:[log in to unmask]) from India, followed by a comment from Josoa Ralaivao ([log in to unmask]" eudora="autourl"> mailto:[log in to unmask]) from Madagascar. Then Ãœmit Kartoglu ([log in to unmask]" eudora="autourl"> mailto:[log in to unmask]) from WHO Headquarters is sending a long and important document that develops a new approach of VVMs interpretation. At the same time he replies to Idrissa YalcouyÃ© and to this contribution of Giridhara Babu. As it is relatively heavy, it is hosted temporarily on our site and you can download it directly from : http://www.technet21.org/fichiers_Word/VVM-Interpretation.doc (550K) Finally, Diana Chang Blanc shares an article related to this topic, "Relationship between vaccine vial monitors and cold chain infrastructure in a rural district of India", by Y. Samant, H. Lanjewar, L. Block, D. Parker, B. Stein and G. Tomar ; Rural and Remote Health 7: 617 (Online) 2007. It is available online at : http://www.rrh.org.au/publishedarticles ... nt_617.pdf _______________________________ Thanks for the comments made regarding VVM use. I personally think that VVM is the best invention made in the recent history of Medicine, which has larger implications of doing common good to all without any discrimination. Whoever discovered it first, should receive Noble for Peace (since it is so universal in nature) and WHO has to share the any greater award for convincing whole lot of nations to follow this standard. However each great invention, greater scientific advancement comes with some limitation attached to it. Thanks to Mr.Hans Everts for useful points. I would like to answer regarding the objections against icepacks. 1. Use of ice packs is ideal under ideal conditions. But, the strict guideline to adhere the use of icepack leads to many confusions in the field. The innovations (with right intention but guided by lack of rational knowledge) by field personnel leads to use of ice blocks rises out of necessity to match lack of ice packs in the field. In India, a team which covers a booth and 250 houses in a day (for 4-6 days) require around 24-30 frozen ice packs just to maintain the cold chain within vaccine carrier. 2. There are not enough ice packs supplied all the time to sustain such huge requirement throughout the country. 3. Sometimes in the field, people use frozen ice packs to keep the vaccine outside at the cost of ice packs required to maintain cold chain for the rest of vials in the carrier. 4. National Polio Surveillance Project- India, a joint collaboration of WHO and Govt of India has come out with guideline of not to use ice packs based on all these limitations in the field. I agree with Dr.Vijay Kiran who has mentioned that a hand book on the cold chain would be useful to start with. However I feel that, conscious effort has to be put into streamlining the awareness and knowledge among private practitioners. Wider inter sectoral collaboration with with premier agencies involved in Pediatricians and other health care providers will have to ensure the VVM use everywhere. The issue raised by Idrissa is worrying in nature. Further classifications and staging of VVM complicates the matters in field. My appeal to Mr.Hans Everts and respected scientists at WHO to come out with VVM and similar tools for other vaccines for uniform adherence to standards in provision of immunization services. Finally, there is another point I want to draw your attention to. VVM reflects only the external cold chain status. We are appreciative of VVM as we are worried about loss of potency of vaccine. VVM is only a indirect indicator of the potency. I would like to know whether there are any studies done to correlate with the stage of VVM and potency of vaccine. I was informed by one of the medical colleges at Bangalore,India who kept Polio vaccines outside a window during summer for 2 days and the VVM never changed from stage 2 onwards. I really do not doubt about VVM, but we should have certain answers to all questions including this. With regards Dr.Giridhara R Babu Future Faculty Programme, PHFI currently at School of Public health, UCLA, Los Angeles -------------------------- As an EPI logistician, I am interested in these discussions. Congratulations to all who have contributed. As for me, I find that VVM makes vaccine management a lot easier, from the planning stage up to service delivery for all strategies (fix, outreach, mobile and mass campaigns). With all these benefits, I can safely say that VVM has contributed to the reduction of vaccine wastage, and shows that with optimum utilization it avoids adverse secondary effects until now Josoa RALAIVAO Specialist Access to Health Services Delivery , SantÃ©Net / USAID Antananarivo Madagascar______________________________________________________________________________ All members of the TechNet21 e-Forum are invited to send comments on any posting or to use the forum to raise a new discussion or request technical information in relation to immunization services. 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