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  3. Tuesday, 28 July 2009
Oral Polio Delivered Safely Without Icepacks in Recent Study by Ariane Halm, EPIET (European Programme for Intervention Epidemiology Training), and Olivier Ronveaux, WHO Optimizerecently completed a study with the World Health Organization (WHO) Country Office and the Ministry of Health in Mali to determine the feasibility of using oral polio vaccine (OPV) out of the traditional cold chain temperatures during a National Immunization Day campaign. In four health areas, thirty-nine vaccination teams successively transported OPV in the vaccine carrier with icepacks (keeping the vaccine at cold chain temperatures) and without icepacks in order to evaluate the outcome of transporting the vaccines without ensuring a continuous cold chain. The practice at ambient temperature was limited to a maximum of one outreach day. The study concluded successfully, with no major problems or deviations to the methodology. A total of 14,913 children were vaccinated in the study areas. About half of the vials (54%) were transported in vaccine carriers without icepacks, and all of these vials were still usable as indicated by the vaccine vial monitors at the time of the last administered dose despite ambient temperatures ranging from 25° to 40°C (mean of 27°C). Wastage rates were lower for the vials traveling without icepacks because they did not have the problems usually caused by melting ice and icepacks (e.g., moisture on the label making it unreadable, vials contaminated with water, etc.). Health workers also reported that the ambient temperature transport facilitated preparation and implementation activities, reduced the weight they needed to carry, and required less time (possibly resulting in more children being immunized). Direct costs for the ambient temperature transport were lower, primarily because icepacks did not need to be resupplied. The study suggests that ambient temperature transport of OPV may provide a safe alternative in geographically challenging settings or where cold chain material cannot be made available. However, vaccines transported in ambient temperature must come with vaccine vial monitors and staff must be adequately trained to interpret them. This study adds evidence to the possibility that ambient temperature supply chains may be one of the solutions to address constraints in cold chain space that are likely to occur with new vaccine introduction. A paper on this experience is being submitted for publication in a scientific journal. We invite you to comment on or post a question relating to this article by clicking the “post reply” button on this page. You will have to log in or register, but the process is very simple. To link back to the Optimize e-newsletter, click here. [img width=228]http://www.technet21beta.org/components/com_agora/converter/uploads/user_photos/dsc00735.jpg[/img] [img width=228]http://www.technet21beta.org/components/com_agora/converter/uploads/user_photos/dsc00751.jpg[/img] [img width=228]http://www.technet21beta.org/components/com_agora/converter/uploads/user_photos/dsc00675.jpg[/img] [img width=228]http://www.technet21beta.org/components/com_agora/converter/uploads/user_photos/dsc00725.jpg[/img] Photo Courtesy : Olivier Ronveaux
TechNet Admin Accepted Answer
Admin
Thanks for clarification on the issue. I do agree that we should avoid manipulating the policies and practices untill suported by the scientific evidences that a heat stable OPV is produced.Dr. Hassan KhanWHO/Polio Sudan
  1. more than a month ago
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Michel Zaffran Accepted Answer
I very much agree with the recommendation that we should focus on heat stable vaccines. This, in fact, is the focus chosen in the work that is currently on-going through the WHO-PATH (Optimize) collaboration looking for instance at hepatitis B vaccine. The OPV example however shows that, even with a very heat labile vaccine such as OPV, if appropriate precautions are taken, if the VVM is well understood and well used, then some level of CONTROLLED flexibility can be added to simplify the logistics of campaigns. I would like to stress however that we have simply documented an existing practice and shown that it was technically valid and brought benefits to the health workers . Our intent is not to propose that new policies be developped for vaccines that are very heat sensistive Regards Michel Zaffran (Senior Adviser, WHO/IVB and Director WHO/PATH project Optimize)
  1. more than a month ago
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TechNet Admin Accepted Answer
Admin
Dear Friends, If we risk going towards the discard point, the potency certainly has a decline. The focus of future research needs to be on Heat Stable Vaccines, which don't need the cold chain, Till then Out of Cold Chain is an adventurous proposititon. We don't have facilites for antibody titer demermination in developing country settings.Though it a good development, we should not jump to conclusions- NIDs / SIAs are repetitive events and if few doses lose potency, we know that another round is there next month, but routine immunisation is once in lifetime event. Vaccine efficacy was found to be very low in western UP (India), and part of the problem could be poor cold chain due to lack of electricity and other support required for cold chain systems. If a heat stable vaccine is available, this will definitely improve matters. Rajesh
  1. more than a month ago
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Michel Zaffran Accepted Answer
The purpose of this study was to add to the body of evidence that is being generated to determine whether new policies and guidelines can be developped on the use and storage of vaccines at higher temperatures than the traditional 2-8°C , but still under controlled conditions. Such guidelines have not so far been issued by WHO but work is underway and is being discussed by the WHO Technology and Logistics Advisory Committee (TLAC). Several countries however have already initiated strategies which take vaccines such as Hepatitis B beyond the existing cold chain to increase outreach for the delivery of the birth dose. To specically address your question, the correlation between the potency of OPV and the VVM reading has been studied by the NIBSC in the UK aat the request of WHO. The report of this study was published under the reference WHO/V&B/99.11 (http://whqlibdoc.who.int/hq/1999/WHO_V&B_99.11.pdf) regards Michel Zaffran
  1. more than a month ago
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TechNet Admin Accepted Answer
Admin
This findings have a great potential in reducing costs incurred in buying fuel for generators for production of ice-packs for transportation of vaccines during SIAs and probably more so in locations where the ambient temperatures are not even as high as that of Mali. Some brief questions though: Was the potency of the OPV vaccine assessed only on the VVM reading or was any laboratory test conducted on vaccines exposed to such temperatures? Can this strategy be applied 'globally' or do we have to await some further scientific clarification and endorsement from WHO?.
  1. more than a month ago
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