Task#5: A health worker during immunization outreach session at Ntambaruka village in Nkasi district Tanzania

Freezer without a temperature monitoring device

Refrigerator with a faulty temperature meeter

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Temperature monitoring devices in refrigerator

Temperature monitoring devices in refrigerator at health facility in Kano, Nigeria

While the VVM and expiry dates of the vaccine are good, fridge tag reading has shown series of negative temperature excursions which indicates exposure of vaccines to temperature below the minimum limit for extended period.
Good understanding of VVM and other temperature monitoring device is necessary by all health care workers involve in vaccine management at all level to ensure quality of vaccines.

#10: Yourself showing a vial of vaccine with VVM in very good condition (NAGLAA)

Photos taken at health centers showing a vial of OPV with VVM in very good condition (photo 1, 2)

and open OPV vial with darker VVM

#5: A health worker in immunization outreach (NAGLAA)

5- A health worker in immunization outreach

These photos were taken in Syrian refugee camp in Kurdistan in 2014, health workers administrating OPV as immediate response the Polio Middle East Outbreak

Number 4: Refrigerator with vaccines organised

Bivalent OPV and Rotarix picked from a fridge at a vaccination clinic in Rumphi district. Both VVM changes are quite obvious but not yet reached discard point . There were 40 vials of rotatrix and five OPV vials. The VVM   of the same status . The bOPV  has VVM 2 and rotarix has VVM 7. Due to frequent power cuts, OPV and rotarix are fast changing the VVM status.

Number 6. A health worker giving a vaccination with the VVM visible on the vial

Number 6. A health worker about to give a TTV  vaccination

VVM on TTV:  A student nurse (health care worker)  holding an open vial  of TTV ready to give a dose during an MCH clinic. This is at a clinic in Rumphi district, Northern Malawi. The picture taken on 3 April 2017

A health worker in immunization outreach (TRANG)

1. Immunization measle and rubella (MR) vaccines at post health in Viet Nam.
The immunization is ỏganization two days per  month for all children aged 9-14 years.

2. Health workers issue immunization certificates.

Vaccine dispatch from a storage facility TRANG)

 1. Vaccine Quinvaxem (made in Korea) is sponsored by Gavi. Vaccine are transported from Korea to Viet Nam.

 2. Vaccines are transported from the Noi Bai airport to the Primary store.

3. Vaccines are packed in many boxes.

4. Temperature electronic device (Q-tag)  have in each box.

Vaccines priority to use (TRANG)

 Quinvaxem use priority because the expridate. VVM status 2.

#3 - Vaccine dispatch from a storage facility (NAGLAA)

Vaccine dispatch from district storage facility to health center. the photo shows the health worker uploading the vaccine in open truck.

#4 - Storage vaccine in health post (TRANG)

This photo was taken during a surveillance voyage to use in the market.

Vaccine Quinvaxem, the stage I for Immunization day.

This located too far away from the vaccine storage, where will be supply  a TCW50 fridge. Vaccine will be store in this for 2-3 days.

At the end of the Immunization day, vaccine will be delivered to the central storage

.

#4 - A refrigerator with vaccines organised showing VVM labels attached on the vials (BONAVENTURA)

A picture showing twelve (12) vials of DTP-HepB-Hib vaccines stored in the vaccine refrigerator at a health facility. All VVMs labels were at usable stage and some were given to children during visit day.

Observation:

During observation it was found that there were two (2) batches of vaccine but the health worker were not aware. One is expiring on Oct 2017 and the other on Apr 2018.

Recommendation:

Health workers were mentored on effective vaccine management and proper stock rotation so as to minimize wastage at service delivery points. Also, they were mentored on proper recording of arrivals and issues on the vaccine ledgers, with all important information such as batch numbers, VVM status, expiry dates etc.

#6 - Different types of temperature monitoring devices in a vaccine refrigerator (Fridge-tag2 and VVM) (BONAVENTURA)

A picture taken at health facility refrigerator showing two temperature monitoring devices used.

The Fridge-tag2, indicates a temperature reading of 3.6 degree centigrade during a day and time of visit (indicated on the device). This device shows that, for the past 29 days there was no alarm (high or low) recorded by the respective cold chain equipment (RCW50EG from Dometic). However, the device can show a maximum of 60 days temperature records if its USB is plugged into a computer/laptop for further data analysis.

Above it is 20 vials of PCV13 vaccine stored in a box. All VVM lables on the vial caps indicates a usable stage.

I really felt very happy to find a well functioning vaccine refrigerator and good temperature monitoring practice of the healthcare worker.

PREVENTION IS BETTER THAN CURE!!

#7 - A health worker giving a vaccination with visible VVM label attached on the ampoule/vial (BONAVENTURA)

This picture was taken after requesting consent and explaining it's purpose to the vaccinator and mother of the child. It is showing a vaccinator giving Rotarix vaccine with VVM label attached on the ampoule to a child during session. This was the first visit of a child to immunization services in the country.

#2 Primary or intermediate vaccine storage facility showing vaccines in storage – show a vial with VVM (CHINDO AHMAD)

Chindo Ahmad Supportive Supervision Experience.

Routine Immunization (R.I) vaccine in VVM stage 2

Immunization Plus Days bOPV Vaccine in VVM stage 1



Observation:

Above are two different VVM stages of vaccine supplied by NW zonal cold store to one of the states under it in Nigeria as their allocations for both R.I and campaign purposes. the first picture is a vial from the R.I bOPV vaccine which are all in stage 2 and to be used for a period of 3 months during R.I sessions and outreaches. While the other picture is a vial from 2.7 million doses supplied for 4 days immunization campaign to the same state, same cold store and all are in stage 1.


Recommendation:

When I observed these, the cold chain officer was directed to exchange all the R.I bOPV vaccine in VVM stage 2 with the same quantity from Immunization Plus Days bOPV Vaccine in VVM stage 1 in order to avoid the risk of those R.I vaccines going to stage 3 during the 3 months consumption period.

#2 Primary or intermediate vaccine storage facility showing vaccines in storage – show a vial with VVM (CHINDO AHMAD)

the above picture is a display of measles vaccine vials with different stages of VVM but all were returned unopened vials after Routine Immunization (RI) session in the same ziplog. However, it is expected that all must have gone through the temperature history.