Post 00593e : Shake Test

POST 00593E : SHAKE TEST Follow-up on POSTS 00571E, 00574E, 00575E, 00579E and 00590E 17 August 2003 ________________________________________ This posting contains 3 contributions. The first is from Dr. Sam Okinor (mailto:[log in to unmask]) from WHO/AFRO followed by that of Samuel Kaamau (mailto:[log in to unmask]) from EPI/Kenya. Finally, Kohl (mailto:[log in to unmask]) from Glaxo Smith Kline Biologicals presents three slides illustrating by the shake test the effect of freezing on DTP-HepB vaccine. The slideshow is attached making this posting rather heavy! ________________________________________ This is a very interesting discussion on the "Shake Test". I would like to refocus our attention on the practical aspects of the safety of the vaccine when applied to the child. While still running the programme at country and lower level, our emphasis was on safety first and so the teaching was that 1. Once the staff at that lowest level on opening the fridge sees and suspects that the vaccine has been frozen or sees that it is frozen or is not fully sure that the vaccine grossly appears as normal as usual, then that vaccine should not be used. If an alternative vaccine is available it should then be used. BUT the staff suspicion should not go unreported to the next level usually the supervisor and preferably vaccine put aside clearly labeled for further scrutiny. 2. Should the staff be competent in the "Shake " test that as far as my experience goes takes time to master and needs fairly repeated practice then the staff should go ahead and carry out the test. If the staff is still not convinced in any way, the safety factor must be applied i.e. the vaccine should not be used. The bottom line for all this is that it takes very long to build the confidence of the community in immunisation and its benefits but takes one incident for this to literally CRASH!!! 3. As for the time the control vial should be frozen, I do fully agree with the comments of in that it depends on the vial size, the manufacturer, the type of fridge and a host of other factors. Again the bottom line is that the control vial should be frozen solid. My own practical tests done in the late 80s when I was very much involved in teaching at the district and lower levels revealed that if the vial was not fully frozen, the test would not be very clear for teaching purposes hence our insistance that once the staff is not sure then staff should not go ahead to use the vaccine. I am sure that persons who are still involved at lower levels may have more recent experiences. Sam _____________________________________ After going through the discussions on shake test I strongly feel that we should emphasize to the health workers that the control vial should be solidly frozen and ensure all the liquid inside the vial is completely frozen without any possible pocket inside. I think the issue of how and how long may confuse the health workers. The question is why bring this issue now when most of the EPI programmes are over 20yrs and not much complaints have been received from the operational staff at health facility level. Sam Kamau, National EPI Logistician, Kenya ____________________________ I annex 3 powerpoint slides with frozen versus non-frozen DTP-HepB 10 dose or DTP-HepB+Hib (2 dose vials). I left the vaccine overnight in the freezer at my home. I do believe that the freezing effect is very visible and the sedimentation rate very fast in the frozen samples as opposed to the non-frozen ones. Very best regards, Director Worldwide Vaccinology & Vaccine Education & Training _______________________________________________________________ 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 , Canada (http://www.ccisd.org) ______________________________________________________________________________ ##text##