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EPI VACCINES. OPV/Measles Ice packs Measles BCG, DPT TT, Hep B Water not for drinking. A. Vaccines, Dose, Schedule and Temperature Storage. Six vaccines are used to combat seven immunizable diseases:
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OPV/Measles Ice packs Measles BCG, DPT TT, Hep B Water not for drinking
A. Vaccines, Dose, Schedule and Temperature Storage • Six vaccines are used to combat seven immunizable diseases: • OPV - must be kept frozen at -15°C to -25°C • Measles vaccines - can be stored at either -15°C to -25°C or at +2°C to +8°C • BCG, DPT, TT, and Hep B vaccines - should be stored at +2°C to +8°C
All Vaccines can be stored at +2°C to +8°C (presence of solid ice) during SUPPLEMENTAL IMMUNIZATION ACTIVITIES
B. Causes of Vaccine Loss of Potency B1. Sensitivity to Heat Most sensitive • OPV • Measles • DTP, yellow fever • BCG • Hib, DT • Td, TT, Hepatitis B Least sensitive
B2. Sensitivity to Cold Most sensitive • Hepatitis B • Hib (liquid) • DTP • DT • Td • TT Least sensitive
B3. Sensitivity to light • BCG and MEASLES vaccines • sensitive to light and fluorescent light (as well as heat) B4. Expiry Date • All vaccines including diluents have an expiry date
B4. Expiry Date • End of the month - the last date by which the vaccines can be used (if not specified) • Expired vials, heat or frozen damaged vaccines or vials with VVMs beyond the discard point should be disposed immediately or labeled ‘Damaged/ expired vaccine – do not use’ and stored outside the cold chain to avoid confusion with good quality vaccines
C. Diluents • contain chemicals and additives to stabilize a specific vaccine after reconstitution • each vaccine requires a specific diluent • are not interchangeable
C. Diluents • Diluent vials/ampoules must never be frozen or allowed to be in contact with any frozen surface to avoid breakage and contamination • Freeze dried vaccines and correct diluents from the same manufacturer should be distributed and receive in matching quantities
D. Vaccine Supply and Quantity Vaccine requirement = Total population x 2.7% (Eligible Pop) x no. of doses of the particular vaccine required x wastage factor
Example: TP = 3,000 Antigen = BCG 1.Eligible Population = Total Pop. x 2.7% = 3,000 x 2.7% = 81 2. Annual Vaccine Doses Required = EP x 1 (total # of doses to immunize a child with BCG) x 2.50 (WF of BCG) = 81 x 1 x 2.50 = 202 3. No. of Annual Vials Required = Annual vaccine dose required = 202 = 20 10 (No. of doses/vial) 10
LOGISTICS REQUIREMENTS Municipality/Barangay: _____________________________ Total Population: 10,000
Reserve Stock or Buffer Stock • Quantity of vaccine that can be used for delayed supplies or sudden increases in demand • Typically 25% of the amount expected to be used during a given supply period • To avoid overstocking, this should be reviewed and adjusted for each order
Stock on Hand • Should be determined before ordering a new stock • The following should be ensured: • Adequate amounts are available • Space is available to store the stock • Vaccine is used before the expiry date • Storage duration is consistent with recommendation
Multi- Dose Vial Policy (MDVP) • OPV, DPT, TT and Hepatitis B - may be used in subsequent sessions for 4 weeks provided the following conditions are met: 1.Expiry date has not passed; 2. Vaccines are stored under appropriate cold chain conditions;
Multi- Dose Vial Policy (MDVP) • Vaccine vial septum has not been submerged in water; 4. Aseptic technique has been used to withdraw all doses; 5. The VVM, if attached, has not reached its discard point
Vaccine Vial Monitor (VVM) • one of the cold chain monitoring tools • a label that changes colour when the vaccine vial has been exposed to heat over a period of time • DO NOT measure exposure to freezing temperatures (for freeze- sensitive vaccines)
E. Vaccine Wastage • Defined as loss by use, decay, erosion or leakage or through wastefulness • Vaccine usage – defined as the proportion of vaccine issued which is administered Vaccine usage rate= No. of doses administered x 100 No. of doses supplied
E. Vaccine Wastage Wastage rate = Doses supplied - doses admin. x 100 Doses supplied • Wastage rate higher than 20% may indicate problems such as: • Repeated instances of lower than planned attendance at session • Poor stock management
E. Vaccine Wastage 3. Cold chain failure 4. Incorrect mixing of freeze dried vaccine • Incorrect dosage 6. Failure to comply with multi-dose vial policy
Ways to Reduce Vaccine Wastage • Ensure compliance on MDVP • Use Vaccine Vial Monitor • Ensure vital information is recorded when vaccines are received, stored & distributed • Monitor temperature of stored vaccines 2x a day including weekends and holidays • Ensure the Earliest-Expiry-First-Out (EEFO) principle is maintained except where vaccine is nearing its VVM discard point
Ways to Reduce Vaccine Wastage • Ensure vaccines are transported following standard operating procedure • Ensure a functional contingency plan on cold chain failure exists • Monitor, maintain a routinely repair cold chain equipment • Perform SHAKE TEST
F. The “Shake Test” • Determines whether DPT, TT or Hep B has been frozen • After freezing, the vaccine is no longer a uniform cloudy liquid. It forms flakes which gradually settle to the bottom after the vial has been shaken • Sedimentations occurs faster in a previously frozen vaccine vial than a never frozen vaccine from the same manufacturer
Test Procedure Step 1 Prepare a frozen control sample: • Take a vial of vaccine of the same type, batch number and manufacturer as the vaccine you want to test. • Freeze the vial until all the contents are solid ( at least 10 hours at -10°C). • Let it thaw. • This vial is the control sample.
Clearly mark the vial so that it cannot later be used by mistake. Step 2 Choose a test sample: • Take a vial of vaccine from the same batch that you suspect has been frozen. This is the test sample.
Step 3 Shake the control and the test sample: • Hold the control sample and the test sample together in one hand and shake vigorously for 10-15 seconds. Step 4 Allow to rest: • Place the vials on a stable surface and do not move for 15-30 minutes.
Step 5 Compare the vials: • View both vials against the light to compare the sedimentation rate. 2. If the test sample shows a much slower sedimentation rate than the control sample, the test sample is probably potent and may be used.
If the sedimentation rate is similar and the test sample contains flakes, the vial under test has probably been damaged and should not be used. 4. Some vials have large labels which conceal the vial contents. This makes it difficult to see the sedimentation process.
In such cases, turn the control and reference test upside down and observe sedimentation taking place in the neck of the vial. • Frozen samples can be used for Shake Tests only when testing the same vaccine from the same manufacturers and the same lot number. • A new sample is needed for each manu-facturer and lot number.
From the refrigerator, select and use vaccines in this order: 1. Opened vials kept in the “use first” box in the refrigerator (multi-dose vial policy). 2. Unopened vaccine ampoules/vials that have been taken to outreach sessions and have been outside of the refrigerator, then returned (but not opened) to the refrigerator. 3. Vaccines with VVMs that have started to change. 4. The oldest vaccines that have not yet passed their expiry dates.
Check if vaccines are safe to useBefore you use any vaccine you must: 1. Check the labels of the vaccine and diluent. • If the label is not attached, discard the vial or diluent. 2. Check the expiry date. • You must discard vials and diluents if the expiry date has already passed.
Before you use any vaccine you must: 3. Check the vaccine vial monitor (VVM). • If it indicates the vaccine has passed the discard point, you must discard it immediately . 4. Check the freeze indicator in the refrigerator. • If it warns of freezing or you suspect that a freeze-sensitive vaccine has been frozen, you should perform the shake test.
G. Physical Inventory • Regular physical check ensures stock records and running balances are accurate and complete • Count vaccines and diluent stocks and compare to the running balance in the stock records • Spot check VVM, CCM and freeze indicator status
H. Injection Safety A safe injection is defined by the WHO as an injection that: • Does not harm the recipient • Does not expose the health staff to any avoidable risks • Does not result in waste that is dangerous to the community
Injection Equipment • Advantages of AD syringes: • can only be used once • eliminate the patient-to-patient disease transmission caused by the use of contaminated needles and syringes • save time for health workers from the heavy work of sterilization
Injection Equipment WHO — UNICEF — UNFPA joint statement on the use of auto-disable syringes in immunization services. “The auto-disable syringe which is now widely available at low cost presents the lowest risk of person-to-person transmission of blood-borne pathogens (such as HepB or HIV) because it cannot be reused. The auto-disable syringe is the equipment of choice for administering vaccines, both in routine immunization and mass campaigns.”
