POST 01056E : USE OF ALCOHOL FOR VACCINE INJECTIONS Follow-up on Posts 01029E, 01036E, 01044E and 01051E 20 February 2007 _______________________________ I thought that the last posting would end the debate on this topic. But three more contributions were received. The first is from Augustine Akubue (mailto:firstname.lastname@example.org) from Nigeria. The second is from Oleg Benesh (email@example.com) from Moldova. And finally, a short comment from Lydie Maoungou Minguiel (mailto:firstname.lastname@example.org) from Congo. _______________________________ It is important to note that despite the entire good scientific guess on the effect of Alcohol on immunization, no properly documented research has been carried out to support the claims or compare the AEFIs associated with each procedure. However, my experience in the field shows that most vaccinators carrying out outreach in Africa use alcohol as a matter of choice. Most people think that alcohol will be better than water just as traditions. In Nigeria, water is better in use than alcohol as many health facilities cannot afford alcohol at all times. Majority of patients living in villages do not take care of themselves hence water being a universal solvent will wash out dirt easier than alcohol. Alcohol when used in children with abnormally soft skin leads to skin excoriations. I observed that one health personnel who used alcohol instead of water in one remote village during an outreach immunization visits resulted in many injection abcesses. This got reduced immediately he introduced water instead of alcohol. It is worthy of remark that the most important factor is the method of cleaning the site than what is used to clean the site. Some health personnels do not know how to clean injection site. Many clean the site many times on two directions with one swab. I therefore advise all to stress on the cleaning procedures especially in Africa where many parents do no bathe their children regularly. Augustine Akubue ----------------------------- Dear all, The discussion on the use of alcohol for vaccine injections may come up repeatedly because injection is a medical intervention affecting integrity of the human body that might be accompanied by a range of risks, including the risk of introducing infection. Ethanol swabs are used in Moldova for vaccination injections for more than 40 years and we could not see any clusters of adverse event following its use. There are two main circumstances when alcohol swabs use might be justified for injections (including vaccination injections): 1. Clean the injection site prior to injection 2. Protecting the injection site from infection and bleeding after injection is done. To me is not acceptable to clean the site only when dirty as the microbial contamination of the site CAN NOT be detected visually. Applying a standard cleaning precautionary measure I consider A MUST, and I would not accept personally any injection before a precaution to prevent possible infection is taken? I also would like to ask how often the injection site is bleeding after injection. According to my observations it is a rare case for intra-cutaneous injections (BCG) and almost universal after subcutaneous or intramuscular injections. I would like to ask whether a child should leave the vaccination place with a bleeding injection site. And if not - let's decide how to approach it. I would appreciate the discussion addresses the alternative ways/methods/tools these two concerns are safely met. It is well known any drug can be the same time a poison if not appropriately used. The cited article on methanol use is a good example. To me the main problem is ensuring appropriate training of staff delivering health services (including vaccinations) on appropriate use of technology and appropriate logistical support to allow its implementation. I am not a supporter of promoting unjustified over-simplified techniques. Yes, such techniques can allow reaching high coverage, but I would not like the price we pay for is safety. Alcohol swabs, if properly used, beside cleaning the site have also some anesthetic effect and injection is less painful to the child and they are less exposed to the stress during the injection. Let me do not support the concern cited below: ... there is a potential for containers of alcohol-soaked swabs to become germ-breeding sites due to alcohol concentrations reducing over time (a particular risk in hot climates) with a resulting risk of cross infection.... First, if the swabs become germ-infected, that is good for children whose vaccination sites got clean of those germs. Secondly, safe vaccination programs have to address proper handling and disposal of biologically hazardous waste. I do not see any problem swabs are collected into safety boxes together with syringes and are disposed off afterwards following the country waste disposal policy. I also would understand that alcohol can inactivate live vaccines if there is a direct exposure of the vaccine to the alcohol. But is there any evidence the alcohol applied on the skin can inactivate the injected vaccine into the tissues? With best regards, Oleg Benes Medical epidemiologist, Republic of Moldova ------------------------------- Hello to all, I share Serge's opinion, I have not seen any study on this topic. Thank you, Lydie ______________________________________________________________________________ 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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