Post00254 LOOSE ENDS : MISCELLANEOUS 30 May 2000 CONTENTS 1. CONSULTANCY OPPORTUNITY 2. ADDITIONS TO DRAFT GUIDELINES: NID QUALITY 3. RE: POLIO + NIDS TIP SHEET 4. POST00243 VACCINE FREEZING - AND CHANGING THE LOWER TEMPERATURE LIMIT 5. PROPOSED CHANGES TO PIS E3 FAMILY 6. POLIO CAMPAIGNS AND ROUTINE PROGRAMS: NIDS & EPI: OPINION V 1. CONSULTANCY OPPORTUNITY This follows a previous posting in TechnetPost00249, 8 May 2000, and has been edited for posting. Replies and expressions of interest should be sent to: Keren Winterford ___________________________________________________________________________ From: Keren Winterford To: [email=Technet@acithen.uq.edu.au]Technet@acithen.uq.edu.au[/email] Subject: Consultancy Opportunities Date sent: Fri, 19 May 2000 10:46:22 +1000 I am writing from International Development Support Services, in Australia, a subsidiary of Community Aid Abroad, Oxfam in Australia, which manages aid and development projects. We are currently wishing to field a position of cold chain logistics officer for a project which we are managing in Papua New Guinea, The Women's and Children's Health Project. I encourage you to forward to us your CV,or alternatively to suggest suitable contacts to us that you may be aware of through your work, and which you could recommend. The position would be for one year, with a possible extension, with mobilisation scheduled for June 2000. Thank you for your time and I look forward to hearing from you soon. With Kind Regards Keren Winterford ____________________________________*______________________________________ 2. ADDITIONS TO DRAFT GUIDELINES: NID QUALITY Bob Davis posted draft guidelines, Technet Forum Post00248 on 5 May 2000, for the assessment of the quality of National Immunization Days (NIDs). In todays posting Mary Reichler, CDC, provides references to her assessment work in Egypt and Pakistan. Our thanks to Carla Lee at CDC for the forward and to Mary for the details. From: Lee, Carla Sent: Wednesday, May 10, 2000 1:47 PM To: Reichler, Mary Subject: FW: Post00248 DRAFT GUIDELINES: NID QUALITY Mary, Your assessment work in Pakistan is mentioned in the technet forum Post00248 on 5 May 2000. Can you forward it on to Bob Davis and Jane Zucker, or let me know where it is, so I can make sure it gets to them. Thanks! --- From: "Reichler, Mary" To: "Lee, Carla" Cc: Subject: RE: Post00248 DRAFT GUIDELINES: NID QUALITY Date: Thu, 11 May 2000 10:33:37 -0400 Carla, The assessment of NIDs in Pakistan was published in J Infect Dis 1997;175(Suppl 1):S205-9. An assessment of NIDs in Egypt was published in Int J Epidemiol 1998;27:1083-1089. NID quality is certainly an important topic. Hope these studies are helpful. Mary Reichler ____________________________________*______________________________________ 3. RE: POLIO + NIDS TIP SHEET Ellyn Ogden, USAID, posted a tip sheet for NIDs in Technet Forum Post00241 on 11 April 2000. Peter Carrasco, PAHO, adds the suggestion of marking houses with chalk. Contributions, comments and additions please: [firstname.lastname@example.org]email@example.com[/email] or use your reply button ___________________________________________________________________________ From: "Carrasco, Mr. Peter A. (WDC)" To: "'Technet Moderator'" Subject: RE: POLIO + NIDS TIP SHEET Date: Tue, 11 Apr 2000 08:55:58 -0400 To the tip sheets, one might add that workers should use chalk to mark the houses visited and supervisors should develop a system fo X's O's for indicating children vaccinated/completed, children remaining to be vaccinated, and parents reject vaccination. It worked very well for smallpox eradication in Bangladesh/India and for polio eradication in Latin America. Also hold the supervisors accountable. Peter Carrasco ___________________________________________________________________________ Moderators note: In the 1980s chalk was effectively used in Pakistan's routine EPI to list the birth dates and doses received by all children in each household on the outside wall of their house. ____________________________________*______________________________________ 4. POST00243 VACCINE FREEZING - AND CHANGING THE LOWER TEMPERATURE LIMIT This discussion continues from Post00239 VACCINE FREEZING on 06 April 2000 and Post00231,14-15 March 2000, and Post0218 on 18 January 2000. Technet discussions have agreed on the need to prevent the freezing of vaccines in refrigerator storage. Some engineering, user, and cost constraints were identified as barriers to setting new temperature range specifications. The current EPI vaccine storage recommendation for refrigerator storage is for one month at 0 'C to +8'C. Other regions of the world and other countries recommend +2'C, or even +4'C to 8'C. Many manufacturers label their vaccine vial for storage between 0'C and 10'C. This contribution by Anthony Battersby, FBA, discusses the difference between user guidelines and equipment specifications and adds the problem of vaccine transport using ice packs. Anthony also points out the inadequacy of our current guidelines on warming ice packs to prevent freezing. ___________________________________________________________________________ Moderators note: Ice packs may be as cold as -25'C when they are removed from the freezer. The warming of ice packs to 0'C prior to loading vaccines in cold boxes will prevent the freezing of vaccines in transport under normal conditions - but is rarely done - and is rarely done properly! ___________________________________________________________________________ Mary Catlin, PATH, proposed in Post0218, 18 January 2000, that, considering zero vaccine degree storage and the risk of freezing HepB - a vaccine coming into wide routine use, that we modify the current recommendation to +2'C to +8'C on the TECHNET Forum. * Technet members have argued on both sides of this issue and have not reached a consensus. * It is clear that user instructions are different from equipment design and performance specifications. (See PIS 2000 discussions below and in previous posts) * A preference for a higher (+ 2'C or +4'C rather than 0'C) lower vaccine storage temperature limit as a user target to reduce vaccine freezing was expressed by many discussion participants. * Many discussion participants indicated the need for refrigerator thermostats to be more accurate and to not be user adjustable. Date: Tue, 18 Apr 2000 From: Anthony Battersby Subject: Post00243 VACCINE FREEZING To: Technet Moderator Dear Allan, I can see that changing the range may have an impact on the test procedures, but I am not really sure why - given that many of the appliances were designed when the specification was +4/+8 deg C. But the testing is not the point, any refrigerator will freeze if the thermostat is set too high and it is a cold day. The +2/+8 deg C range is a USER specification: their responsibility it to keep the vaccines within that 6 degree range. By changing from zero to +2 we make it quite explicit that freezing temperatures are unacceptable. This was the reason for the original +4/+8deg C range. From my recent experience the range 0/+8degC is not a good idea for transportation because it allows freezing to occur in well insulated cold boxes. A cold pack with a moist surface may still have a temperature well below zero in its core and if put into a well insulated box can result in freezing. So let us have a USER specification of +2/+8degC and make sure that we do not allow sub zero temperature in refrigerators; remembering that in future we will be storing very expensive freeze sensitive but high temperature stable vaccines like Hep B and Hib. Anthony ____________________________________*______________________________________ 5. PROPOSED CHANGES TO PIS E3 FAMILY In TECHNET Post00238, NEW! PIS 2000, 4 April 2000, Paul Malinson, WHO/EPI, requested comment on a sample Product Information Sheet for use in the revised 2000 edition. Some discussion was posted in Post00242, PIS 2000, 13 April 2000. In Post00250, Product Info Sheets - 2000, 8 May 2000, Paul posted suggested changes for the E3 PIS contents and format. In his note below, Michel Zaffran, WHO V&B, comments and raises a question about the thermostat setting. This may be problematical and is related to the discussion in Item 4, Vaccine Freezing - And Changing The Lower Temperature Limit. From: [firstname.lastname@example.org]email@example.com[/email] Date: Wed, 03 May 2000 11:34:39 +0200 To: [firstname.lastname@example.org]email@example.com[/email], [firstname.lastname@example.org]email@example.com[/email] Subject: Re: Proposed changes to PIS E3 family Proposed changes are ok with me although the thermostat setting may be awkward there. It really has a meaning together with the provision of internal temperatures achieved. It the temps are removed then the thermostat setting may better be located in the users' manual? Michel ____________________________________*______________________________________ 6. POLIO CAMPAIGNS AND ROUTINE PROGRAMS: NIDS & EPI: OPINION V Continuing the discussion which began with TECHNET Forum Post0191, with Robert Steinglass, BASICS, in an opinion piece, discussing the relationship between the accelerated polio eradication effort and the routine expanded program on immunization (EPI). Robert originally presented his views at the Global Consultation on Progress towards the Eradication of Poliomyelitis, WHO/Geneva, 2 - 3 June 1999. The discussion continued in Post0220 OPINION PART II on 24 January 20000, Post0225 NIDS & EPI: OPINION III on 3 February 2000, and in Post0229, OPINION IV, 24 February 2000 In todays posting, Bob Davis, UNICEF, enters "the fray on the side of polio eradication and polio NIDs." Date: Tue, 8 Feb 2000 11:27:30 -0800 From: [firstname.lastname@example.org]email@example.com[/email] (Robert Davis) Subject: Re:Post0225 NIDS & EPI: OPINION III To: Technet Moderator Allan, Permit me to enter the fray on the side of polio eradication and polio NIDs. Polio NIDs have been an expensive way of eradicating the disease, but there was no choice in the matter. They have not been entirely vertical, since they have in most countries assisted the rise in vitamin A administration as a preventive measure. In fact, UNIPAC shipments of vitamin A quadrupled between 1995 and 1999, partly because of Canadian grants, but also because of polio NIDs. In Kenya, Tanzania and Ethiopia, "piggy backing" measles and/or TT onto polio NIDs has permitted us to get a head start on MNT elimination and measles control and eradication in countries where these problems persist. Finally, the ICCs needed for polio eradication will prove indispensable to both GAVI and to new control and eradication initiatives in the decade now beginning. Bob Davis
TechNet-21 - Forum
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