Multiple injections on the same day

Dear Jhilmil, I found the materials developed by the Michigan Department of Community Health quite useful. 1. www.aimtoolkit.org/children/immun/Giving_All_the_Doses_12_Months_and_Older.pdf 2. www.aimtoolkit.org/children/immun/Giving_All_the_Doses_Under_12_Months.pdf Based on these materials, we created FAQs and visuals ifor our "Immunization Handbook for Medical Officers" published by the Govt of India (see page 26). www.whoindia.org/LinkFiles/Routine_Immunization_Immunization_Handbook_for_Medical_Officers_.pdf Regards, Tasnim

Thanks Tasnim for these resources. In your supervisory visits have you seen health workers or parents hesitate about giving more than one injection on the same day, like measles and late DTP3 for example?

Dear Jhilmil, Health workers avoid giving multiple injections simulataneously, citing parental refusal (also perhaps reflecting their own fears). However, this is purely based on observation and anecdote. I looked for supporting literature and found two studies (both from developed countries) that seem to indicate the same thing. In case you haven't come across them, the links to the abstracts are provided below. http://archpedi.ama-assn.org/cgi/content/abstract/149/8/845 http://www.ncbi.nlm.nih.gov/pubmed/19368778 Regards, Tasnim

Jhimhil: You may wish to look at General Recommendations on Immunization: Recommendations of the Advisory Committee on Immunization Practices (U.S. Centers for Disease Control and Prevention), Morbidity and Mortality Weekly Report, Dec 1 , 2006/Vol 55/No RR-15. Pages 5-6: Simultaneous Administration and Nonsimultaneous Administration of vaccines. Available at: http://www.cdc.gov/vaccines/pubs/ACIP-list.htm#comp The General Recommendations on Immunization are currently undergoing revision and will be republished later this year. Jean Clare Smith, MD, MPH, Medical Officer, Assistant to the Director for Immunization Policy, National Center for Immunization and Respiratory Diseases, Centers for Disease Control & Prevention, Atlanta, GA 30333. ACIP web site: http://www.cdc.gov/vaccines/recs/acip

Hello Jhilmil I is nice to be talking to you again. I helped to write the new immunisation technical advice for Australia which is published as the Australian Immunisation Handbook (9th Edition) 2009. Australia has a complex immunisation schedule and our schedule includes giving multiple injections on the same day/encounter (up to 3 injections at once in some cases at 2, 4, 6 & 12 months). I have included the weblinks to the this document. The injection technique information is in Part 1 - Vaccination Procedures; Section 1.4: Administration of Vaccines). http://www.health.gov.au/internet/immunise/publishing.nsf/Content/Handbook-home The current National Immunisation Program (NIP) Schedule can be viewed at: http://www.health.gov.au/internet/immunise/publishing.nsf/content/nips I hope this adds to the discussion. I hope all is well with you. Ann Kempe Immunisation Consultant (Melbourne Australia) [email protected]

Dear Ann, Good to hear from you. Thank you for providing the links, I shall certainly look them up. The australian handbook is very concise and well designed. We refer to the it often. regards Jhilmil

Dear Dr. Smith, Thanks for providing the link to General Recommendations on Immunization, it a good resource and will definitely help us in defining key messages for health staff. US is used to giving multiple injections, however this is still new in several developing countries. I shall prepare some communication messages related to multiple injections and share with Technet community for feedback. Please do continue to provide your valuable input to the community. regards Jhilmil

Dear Moderator As you may know, since November 2007, the IMMUNIZATIONbasics project, along with other partners, continued to provide extensive technical support to the National Immunization Program (NIP) in Rwanda, helping technical staff with the preparation of the pneumococcal conjugate vaccine introduction. One of the perceived challenges for the mothers and care givers was their willingness of accepting / providing two injections to children on both thighs (one with pentavalent vaccine and another with pneumococcal conjugate vaccine), the same day at the same immunization session. To address this issue, a group discussion with mothers and individual interview with health workers were conducted in both rural and urban areas (Rwanda). The attached file summarizes the key findings and proposed key messages for mothers. Michel Othepa, MD, MPH Technical Officer IMMUNIZATIONbasics http://www.immunizationbasics.jsi.com ________ ##text##