BAD PRACTICES IN MEASLES VACCINATION

Monday, 5th of May 2008

                             CSU 08/2010: Bad Practices in Measles Vaccination

 As the world moves towards a global eradication target for measles,
 probably no earlier than 2011, it is useful to see whether the service
 delivery mechanisms for measles vaccination are ready.
 
 COLD VACCINE, WARM DILUENT
 
 In a review of reports from Africa and other regions, available at
 www.who.int/immunization_delivery/systems_policy/VMAT_Indicators.pdf
 Andrew Garnett notes the following mistakes in the handling of diluent,
 used with measles and other vaccines:  ‘12% of health facilities are giving
 reconstituted vaccines without cooling the diluent first. Mismanagement of
 diluents is a long-standing and frequently observed phenomenon, and it
 appears that this problem continues.’
 
 FAILING TO DISCARD RECONSTITUTED VACCINE AFTER SIX HOURS
 
 The same report noted that in 183 service points evaluated, 86 percent
 discarded reconstituted vaccine within six hours of reconstitution.
 
 What happens in the other 14 percent of cases? Although not completely
 documented, the rare cases where held over vaccine provokes toxic shock
 syndrome in vaccinees are not only often fatal, but also severely damaging
 to the reputation of the vaccination programme. Commenting on reports of
 postvaccination deaths among measles vaccinees in Tamil Nadu, T. Jacob John
 observed the following: ‘There are two potential problems if reconstituted
 vaccine is kept longer [than six hours]. The virus content may fall since
 temperature-stability is low in liquid state–this will affect the efficacy
 of vaccine. The second problem is bacterial contamination. If contaminated
 while puncturing the cap the liquid vaccine acts as a rich bacterial
 culture medium.’ [full text at www.indianpediatrics.net/june 2008/477.pdf
 ].
 
 
 QUERYING VACCINATION HISTORY
 
 No vaccinator or registrar should query the measles vaccination history of
 any child of eligible age during a measles campaign. To do so is inimical
 to good campaign management. Not only does it slow down the screening
 process, but it also deprives the child who failed to seroconvert at 9
 months of the benefits of revaccination.
 
 
 PUTTING AN END TO BAD PRACTICES
 
 We already do training and supervision to assure that such practices as
 these come to an end. To stamp them out, the solution is more training,
 more supervision, and perhaps more independent monitoring of vaccination
 sites during measles campaigns.
 
 Good reading.
 
 BD