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  1. 1
    040536

    Storage temperatures for unfrozen vaccines 0-8 degrees C [memorandum]

    Moreno E

    [Unpublished] 1986 Jan 8. [1] p. (HPM/EPI C12/20/1)

    The Pan American Health Organization/World Health Organization (PAHO/WHO) has changed its initial recommendation concerning the temperatures for storing unfrozen vaccines to 0 degrees Centigrade to 8 degrees Centigrade from the previous recommendation of not below 4 degrees Centigrade (with an upper limit of 8 degrees Centigrade). Most, but not yet all, current Expanded Program on Immunization (EPI) documents carry this new recommendation, and it will be revised in old documents as they are updated. This decision has been the source of several heated debates among the technical staff. 2 factors swayed the decision to make this change: In some links of the cold chain, which depend on ice, there is no alternative but to allow a lower limit of 0 degrees Centigrade; and the result of studies of temperatures required to freeze DPT before freezing occurs. The change makes the current recommendation consistent with current practice and does not appear to pose a threat to the potency of the DPT, DT, or T vaccines. Some diluent may freeze at 0 degrees Centigrade, but this only causes a problem if freezing breaks the diluent vial. This has not been observed at 0 degrees Centigrade, although it has occurred at lower temperatures. 1 of the reasons for the debates over making this change is that it violates the principle of giving clear and consistent advice to the health workers carrying out the operations. Yet, in this case the feeling is that due to the various considerations explained, the new recommendation is justified.
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  2. 2
    267341

    Primary health care bibliography and resource directory.

    Montague J; Montague S; Cebula D; Favin M

    Geneva, Switzerland, World Federation of Public Health Associations [WFPHA], 1984 Aug. vii, 78 p. (Information for Action)

    This bibliograph contains 4 parts. Part 1 is anannotated bibiography covering the following topics: an overview of health care in developing countries; planning and management of primary health care (PHC): manpower training and utilization; community participation and health education; delivery of health services, including nutrition, maternal and child health, family planning, medical and dental care; disease control, water and sanitation, and pharmaceutical; and auxiliary services, Part 2 is a reference directory covering periodicals directories, handbooks and catalogs, in PHC, as well as computerized information services, educational aids and training programs, (including audiovisual and other teaching aids), and procurement of supplies and pharmaceuticals. Also given are lists of international and private donor agencies, including development cooperation agencies, and directories of foundations and proposal writing. Parts 3 and 4 are the August 1984 updates of the original May 1982 edition of the bibliography.
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  3. 3
    037992

    Strengthening the vaccine cold chain.

    Cheyne J

    WORLD HEALTH FORUM. 1982; 3(4):436-40.

    In this discussion of strengthening the vaccine cold chain, attention is directed to the following: preventing breakdowns (ensuring good performace, delivery and installation, and training users in maintenance) and repairing equipment (planning a maintenace system and suppliers of spare parts). Keeping vaccines continuously cold as they travel from the factory to the place where they are used calls for a "cold chain" of referigerators and cold boxes. In tropical countries with unreliable electricity supplies and without vehicles to carry the vaccines, this cold chain is highly vulnerable to interruption, with consequent loss of vaccine potency. Although the UN International Chilren's Emergency Fund, the World Health Organization, and many other agencies have spent hundreds of thousands of dollars in the past few years on equipment and training, vaccines continue to be damaged. Refrigeration engineers have produced many new ideas for keeping vaccines cold, including: refrigerators that regquire only 8 hours of electricity per day; an almost unbreakale lamp glass for use in kerosene refrigerator; freezers that can produce 40 kgof ice per day for cold boxes; and freezers that use bottled gas as fuel and are specially designed for making ice packs for cold boxes. Yet, the cold chain still fails. In a typical vaccine cold chain, between 30-50% of refrigerators and freezers are not working, due in part to refrigerators have a very short working life in tropical climates. The following recommendations should be followed whien buying and installing refrigerators or freezers for cold chain: mmake sure their performace is good enough; make sure the equipment is delivered and installed in good condition; and train users to look after the equipment properly. Even a perfectly maintained refrigerator or freezer eventually wiull break down. In a properly orgaized cold chain, the individual resonaible should then contact a repair workshop. Refrigerator and freezer repairs can be done in developing countries. The guidelines for ensuring prompt repairs consider both planning a maintenance system and storing the spare parts where they will be used. There are 2 options for ministries of health who want to improve their cold chain repair work: they can award a contract for the work to a private compan; they can do the work themselves. All the work that has been done on training, tool kit design, and spare parts is based on the assumption that countries have a national policy on maintenace and repair of cold chain rquipment. This is the responsibility of the ministry of health, and there must be a commiTMENT TO THIS POLICY IN THE HIGHEST LEVELS OF THE MINISTRY.
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  4. 4
    038285

    Cold chain: solar refrigerator field tested.

    EPI NEWSLETTER. 1983 Apr; 5(2):2-4.

    The Health Ministries of Colombia and Peru, in collaboration with the Expanded Program on Immunization (EPI)/Pan American Health Organization (PAHO) and the Centers for Disease Control (CDC), have begun field testing a solar-powered vaccine refrigerator. The aim of the fields trials is to determine whether solar refrigerators can maintain the temperatures required for vaccine storage (+4-8 degrees Celsius) and produce ice at a rate of 2 kg/24 hours under different environmental conditions. these refrigerators would be particularly useful in areas that lack a consistent supply of good quality fuel or where the electrical supply is intermittent or nonexistent. Full appraisal of this technology will require 2 years of field testing; Colombia and Peru expect to complete testing in 1985. To date, 5 models have passed CDC-developed specifications, all of which are manufactured in the US. PAHO/WHO recommends that health ministries should consider the following guidelines in considering the purchase of a particular system: the initial purchase should be for a limited quantity (about 5) of refrigerators to permit field testing; solar panels should meet specific criteria; consideration should be given only to those models that have passed qualification tests; each unit should be fully equipped with monitoring devices and spare parts; and a trained refrigerator technician should be available to repair the equipment.
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  5. 5
    031664

    [The Expanded Programme on Immunization: the results of its realization, problems and prospects] Rashirennaia Programma Immunizatsii: resultaty osushchestvleniia, problemy i perspektivy.

    Litvinov SK; Henderson RH; Galazka AM; Lobanov AV

    ZHURNAL MIKROBIOLOGII, EPIDEMIOLOGII I IMMUNOBIOLOGII. 1985 Feb; (2):114-20.

    A report to interested physicians in the USSR explained the progress of and problems associated with the World Health Organization (WHO) expanded immunization program, set up by resolution in 1974, to inoculate every child in the world up to age 1 against measles, pertussis, tetanus, polio, diphtheria, and tuberculosis by 1990. The program called for distribution of DTP anatoxin, live polio and measles virus, and Calmette-Guerin bacillus. By 1983, 50% of children in Europe, America, the Peoples Republic of China, and the immediately contiguous areas had been vaccinated against polio and DTP, but in developing countries the figures were only 24% and 31% respectively, and only 26% and 14% for measles and tuberculosis respectively. The decision was made in 1983 to concentrate more effort and resources on establishing national health programs by training higher level administrative workers and technicians to work at the local level in storing and delivering vaccines, and operation and maintenance of the refrigeration equipment, which is of vital importance in tropical regions. Refrigeration equipment has been developed recently to meet the unique conditions of the developing nations, periodic comprehensive evaluation of program implementation is conducted, and a series of laboratory and field studies are now underway to improve efficiency of implementation by improving the thermal stability of vaccines and the refrigeration chain, increasing availability of vaccines to the population, and improving the economy of operations. Audits show that vaccine losses now account for only 14% of expenditures, with 45% going for labor. Almost 80% of all costs are now being met by the countries involved. Thus, international cooperation has been instrumental in the results of the expanded immunization program.
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  6. 6
    040102

    Expanded Programme on Immunization: global overview.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1985. [19] p. (EPI/GAG/85/WP.1)

    This year's progress and evaluation report of the Expanded Program on Immunization (EPI) includes background information, a summary of the progress, actions needed to realize the EPI goal, and a draft resolution for consideration by the executive board. The EPI has its basis in resolution WHA27.57, adopted by the World Health Assembly in May 1974. General program policies, including the EPI goal of providing immunizations for all children of the world by 1990, were approved in resolution WHA30.53, adopted in May 1977. In 1982, the Assembly warned that progress would have to be accelerated to meet the 1990 goal and urged Member States to act on a 5-point program (resolution WHA35.31). Immunization, one of the most cost-effective of all health services, remains tragically underutilized. In the developing world, excluding China, less than 40% of infants receive a 3rd dose of DPT or polio vaccine, in part because it is only now being introduced in some programs, and over 3 million children still die annually from measles, neonatal tetanus, and pertussis, while over 250,000 children are crippled by poliomyelitis. The 1st point of the World Health Assembly 5-point action program calls for the promotion of EPI in the context of primary health care, with special emphasis on involving communities as active partners in the program and on delivering immunization with other health services so that they are mutually supportive. The use of "channelling" strategies and immunizations days currently are providing powerful stimuli to community participation in a number of programs. Points 2 and 3 of the action program stress the need to invest adequate human and financial resources in EPI. Support for immunization programs, both from within national programs and from external resources, has increased markedly. More support is coming from many organizations long associated with EPI, and the number of collaborators is growing. Point 4 of the action program calls for ensuring that programs are continuously evaluated and adapted so as to achieve high immunization coverage and maximum reduction in target-disease deaths and cases. Evaluation continues to be a priority for EPI. Point 5 calls for the pursuit of research as a part of program operations. Investments in research on the cold chain have resulted in a marked increase in the range and quality of products now available on the market. In the European Region the coverage goal of EPI has been largely achieved. Dramatic progress has been made in the Region of the Americas since the beginning of EPI. The Southeast Asia Region has made steady progress since the start of EPI. In the Western Pacific Region the main program constraints relate to strengthening the cold chain and to improving the quality of vaccines. Progress in increasing immunization coverage has been very good in most of the Eastern Mediterranean Region, and there has been extensive use of national program reviews and meetings of national managers in supporting country programs. Progress in the African Region has been satisfactory in many countries and exemplary in a few. Management capacity within national programs remains the most severe global constraint for EPI.
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  7. 7
    166570

    Enhancing reproductive health commodity security.

    Feedback. 2001; 26(3):18.

    Reproductive ill health, especially for women living in developing countries accounts for a significant proportion of the overall disease burden. However, progress in improving reproductive health will depend upon the access, availability, affordability, and quality of these RH commodities. Commodity security is the adequate supply and choice of quality RH related supplies for every person who needs them. Despite commodity requirements are increasing dramatically, there has been an inconsistent and unpredictable trend in commodity financing. Hence, the UN Population Fund (UNFPA) has taken a leading role in enhancing RH commodity security. Two conferences have been held to address emerging issues related to enhancing RH commodity security, including essential RH communities, strategic plan for ensuring RH security, and strengthening national capacity for commodity management. This paper discusses these each of the issue given.
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  8. 8
    281426

    Global Consultation on the Health Services Response to the Prevention and Care of HIV / AIDS among Young People. Achieving the Global Goals: Access to Services. Technical report of a WHO consultation, Montreux, Switzerland, 17-21 March 2003. A WHO technical consultation in collaboration with UNAIDS, UNFPA, and YouthNet.

    Global Consultation on the Health Services Response to the Prevention and Care of HIV / AIDS among Young People. Achieving the Global Goals: Access to Services (2003: Montreux)

    Geneva, Switzerland, World Health Organization [WHO], Department of Child and Adolescent Health and Development, 2004. [80] p.

    Young people (10-24 years) are at the centre of the HIV epidemic in terms of transmission, impact, vulnerability and potential for change. The global goals on young people and HIV/AIDS that have now been endorsed in a wide range of fora reflect both the strong public health, human rights and economic reasons for focusing on young people, and also the concern and commitment of governments around the world to direct resources to the prevention and care of HIV/AIDS among adolescents and youth. In order to contribute to the growing clarity about what needs to be done to achieve these global goals, and to strengthen the collaboration between a range of UN and NGO partners committed to accelerated health sector action, WHO organized a technical consultation on the health services response to HIV/AIDS among young people, in collaboration with UNAIDS, UNFPA, UNICEF, and YouthNet, in Montreux, from 17 to 21 March 2003. The consultation sought to obtain consensus around evidence-based health service interventions for the prevention and care of HIV among young people; effective strategies for delivering these interventions, the essential characteristics of successful programmes; and the strategic partnerships and actions at global and regional levels that will be required to stimulate and support action in countries. It is now widely accepted that the prevention and care of HIV/AIDS among young people will require a range of interventions from a range of different sectors. The health sector itself will be responsible for a number of different interventions, through a range of health system partners. The consultation brought together UN, NGO and academic partners, and provided the opportunity for these diverse actors to review the evidence for action: what was understood by “evidence”, the available evidence about increasing young people’s access to priority services, and what could reasonably be inferred or extrapolated from the available evidence from other age groups. (excerpt)
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  9. 9
    069835

    Chile: update on teen reproductive health project.

    POPULATION. 1991 Dec; 17(12):3.

    This article describes the recent activities of the Centre for Adolescent Reproductive Medicine at the University of Chile, which receives UNFPA support under a project aimed at establishing a center for training in adolescent reproductive health. The project, a collaboration of the government and UNFPA, focuses on biological and social issues related to adolescents' reproductive problems, as well as on family relationships. The project is also designed to train health personnel in adolescent reproductive health and support university research into adolescent health and fertility. The Centre used UNFPA funds to improve its facilities, provide training, and increase research and education on teen health. A university bulletin reports that last year, the Centre provided 6936 consultations for teens and increased its outreach activities through the use of educational courses and mass media. The Center also recruited 17 professional trainers in adolescent reproductive medicine, built an annex to its main building, and established a library that specializes on adolescence. Furthermore, UNFPA provided the Centre with medical equipment such as a fetal heartbeat monitor, the necessary paraphernalia to perform vaginal endoscopy for adolescents, and other specialized diagnostic instruments for child and adolescent gynecology. The article explains that teenage pregnancy is common problem in Latin America. According to a 1988 study, 1/3 of all women aged 15-17 living in Santiago (which contains about a 1/3 of Chile's population) had been pregnant at least once.
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  10. 10
    072823

    The hospital in rural and urban districts. Report of a WHO Study Group on the Functions of Hospitals at the First Referral Level.

    World Health Organization [WHO]. Study Group on the Functions of Hospitals at the First Referral Level

    WORLD HEALTH ORGANIZATION TECHNICAL REPORT SERIES. 1992; (819):i-vii, 1-74.

    In 1992, the WHO Study Group on the Functions of Hospitals at the First Referral Level compiled a report on the functions of the hospital in rural and urban districts. It advocates that the 1st referral level hospital should be integrated into the district health care system, which is administered by a district health council. This approach strengthens primary health care and uses hospital resources to promote health. The most pressing need for this approach to work is changing people's attitudes and motivation. Various obstacles invariably slow this integration process such as resistance by central and local government officials and inadequate funding. The district hospital should help people to find health rather than just cure disease. Further it must accept the fact that it is not the center of the health system. This means a redistribution of both finance and effort. Governments need to improve the decentralization process to facilitate integration. The study group proposes a step by step methodology to integrate the health system. The 1st step is creating a district health council with representatives from the district health office, the hospital, other sectors of the health care system, and the community. The council determines the community diagnosis including population trends, patterns of morbidity and mortality, and disease and risk distribution by age and location. It also needs to review health services in the district. The council can divide these services into preventive, promotional, curative, rehabilitative, and organizational services. It also must reassess distribution of resources including people, buildings, equipment, and materials. The council must draft a plan and deliberate on implementing the plan. Once the council has taken these steps, it can then implement, monitor, and evaluate the plan and its results.
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  11. 11
    041360

    Status of cold box testing and buyers' guide: update, December 1984.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. 24 p. (EPI/CCIS/84.4)

    Since 1979, vaccine hand carriers, cold boxes, and vaccine packaging have been submitted by the World Health Organization (WHO) for laboratory testing at the Consumers Association Laboratories, Harpenden Rise, UK, and UNIVALLE, Cali, Colombia. The tests results have been summarized in this document in order to inform users and buyers of the equipment available as to its performance capacities and to serve as a guide to the selection of equipment most suited to specific conditions. Detailed tables list all equipment which has been tested. The equipment is divided into categories on the basis of vaccine storage capacity, and the following major features are listed: external dimensions (in centimeters); vaccine in storage capacity (in litres); number of icepacks necessary (as used during the tests); cold life at an ambient temperature of +43 degrees Centigrade; weight fully loaded (in kilograms); and durability (under rough handling conditions). Equipment has been subjected to 2 main types of routine test: performance or temperatur rise test; and durability or drop test. In the course of testing, a number of interesting observations were made, including: using more icepacks than specified will lengthen the cold life of a container without harming the vaccine but also will increase weight load and decrease the vaccine storage capacity; icepacks are more quickly frozen in "icepack freezers" as opposed to chest type domestic freezers; some boxes had problems with lid fastenings, which came undone on impact; and 5 factors should be taken into consideration in the purchase of any box, that is, vaccine storage capacity, cold life, weight fully loaded, durability, and price.
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  12. 12
    041363

    Protocol for a cold chain review using vaccine cold chain monitors.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1985. 8 p. (EPI/CCIS/85.2)

    This protocol provides a method for using Vaccine Cold Chain Monitors to make periodic reviews of a national cold chain. This protocol is based on experience that has been gained from information from 31 countries and from cold chain reviews in India and Tunisia. The purpose of a cold chain review is to make a nationwide or regionwide review of the effectiveness of the vaccine cold chain; and to find out how best to redirect cold chain development efforts into the areas that most need help. A review method is outlined and should be modified according to local conditions. A cold chain review should take about 7 months to complete and should be timed to precede or coincide with a wider EPI and primary health care review. A timetable is included. For the review: monitor cards are distributed with vaccine shipments from the manufacturers so that cards reach all cold chain stores; at each store in the cold chain and at each transport link, the cold chain monitor arriving with vaccines is checked, and any failures registered by the indicators are recorded on the monitor card; monitor cards are returned to a central office for sorting and analysis; and the results of this analysis then are used as a guide to identify and strengthen the weakest links in the cold chain. How many cold chain monitors are needed for a review depends on the size of the study area and the extent to which the monitors will be used. In general, each dispensary and outreach immunization session should receive at least 1 monitor card that has traveled through the cold chain from the central store during the study period. An extensive training program is needed before the review can begin. All health workers who will handle vaccines during the study must receive some training on how to fill in and interpret the readings on the monitors. Once the materials have been written, this training should be conducted in 3 steps for regional and district supervisors and maternal and child health staff and health assistants who work in health posts and outreach centers. The analysis of the results can be organized in many different ways. Each monitor that has been returned from a health center can have up to 23 items of information on it.
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  13. 13
    041366

    [New cold chain monitor to be introduced on 1 January 1985] Introduction d'une nouvelle fiche de controle de la chaine du froid le 1er Janvier 1985.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. [2] p. (EPI/CCIS/84.6)

    As of January 1, 1985, a new and simpler vaccine cold chain monitor will be distributed with vaccines supplied by the UN International Children's Emergency Fund (UNICEF) and the World Health Organization (WHO). This new monitor (available in Arabic, English, French, and Portuguese) has the same function as the previous monitor, but it has 3 new features. These are: temperatures above 10 degrees Centigrade are monitored by a strip indicator that has only 3 windows, marked A, B, and C, and temperatures above 34 degrees Centigrade are monitored by a disk indicator; a simplified interpretation guide has been added to the bottom of the card; and the back of the card has some instructions on the use of the indicator. As previously, the new cold chain monitor will be activated by the vaccine manufacturer and sent with the vaccine to the central store. The storekeeper should complete the top part of the card. The monitor then is sent with the vaccine down the cold chain. The top part of the card should be completed at each level of the cold chain -- when the vaccine arrives in the store and again when the vaccine is dispatched. In the cold chain, the vaccine cold chain monitor has 2 functions: to monitor any temperatures above 10 degrees Centigrade so that the cold chain can be improved; and to give the person responsible for caring for the vaccine some guidance on whether to use the vaccine or not.
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  14. 14
    040875

    EPI in the Americas. Report to the Global Advisory Group Meeting, Alexandria, Egypt, 22-26 October 1984.

    Pan American Health Organization [PAHO]

    [Unpublished] 1984. 15 p.

    This discussion of the Expanded Program on Immunization (EPI) in the Americas covers training, the cold chain, the Pan American Health Organization's (PAHO) Revolving Fund for the purchase of vaccines and related supplies, evaluation, subregional meetings and setting of 1985 targets, progress to date and 1984-85 activities, and information dissemination. All countries in the Region of the Americas are committed to the implementation of the EPI as an essential strategy to achieve health for all by 2000. During 1983, over 2000 health workers were trained in program formulation, implementation, and evaluation through workshops held in Argentina, Brazil, Cuba, El Salvador, and Uruguay. From the time EPI training activities were launched in early 1979 through 3rd quarter 1984, it is estimated that at least 15,000 health workers have attended these workshops. Over 12,000 EPI modules have been distributed in the Region, either directly by the EPI or through the PAHO Textbooks Program. The Regional Focal Point for the EPI cold chain in Cali, Colombia, continues to provide testing services for the identification of suitable equipment for the storage and transport of vaccines. The evaluation of solar refrigeration equipment is being emphasized increasingly. PAHO's Revolving Fund for the purchase of vaccines and related supplies received strong support from the UN International Children's Emergency Fund (UNICEF), which contributed US $500,000, and the government of the US, which contributed $1,686,000 to the fund's capitalization. These contributions raise the capitalization level to US $4,531,112. Most countries are gearing their activities toward the increase of immunization coverage, particularly to the high-risk groups of children under 1 year of age and pregnant women. To evaluate these programs, PAHO has developed and tested a comprehensive multidisciplinary methodology for this purpose. Since November 1980, 18 countries have conducted comprehensive EPI evaluations. 6 countries also have had followup evaluations to assess the extent to which the recommendations from the 1st evaluation were implemented. At each subregional meeting, participants met in small discussion groups to review each other's work plans and discuss appropriate targets for the next 2 years. Immunization coverage has improved considerably in the Americas over the last several years. Figure 2 plots the incidence rates of polio, tetanus, diphtheria, whooping cough, and measles from 1970-83 in the 20 countries which make up the Latin American subregion. If all countries meet their 1985 targets, immunization coverages for DPT and polio will range from 60-100%, with most countries attaining coverages of over 80%. For measles, 1985 targets range from 50-95%, and from 70-99% for BCG. The main vehicle for dissemination of information is the "EPI Newsletter," which publishes information on program development and epidemiology of the EPI diseases.
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  15. 15
    041355

    Vaccine cold chain monitor.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1985. 10 p. (EPI/CCIS/85.1/Rev.1)

    This document describes the new, simplified version of the Vaccine Cold Chain Monitor Card that is being packed with vaccines supplied by WHO and UNICEF. The card, which has 2 monitors that turn blue if the temperature rises, serves as an effective monitor of the cold chain during shipment and gives health workers guidance on whether to use the vaccines they receive. The new monitor card has only 4 windows for registering temperature changes and has the instructions for interpreting the readings on the card. To retain potency, vaccine should be kept at a temperature of 8 C or less at all times. Also provided in this document is information for health workers on how to use the card in routine onforwarding of shipment and action to take in the event of a break in the cold chain; an additional section provides information for vaccine manufacturers and distributors on what to do when packing monitor cards with vaccine despatched and how to store vaccine cards. The cards are available in 5 languages--Arabic, English, French, Portuguese, and Spanish--at a price of 415 Swiss francs/100 cards.
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  16. 16
    041358

    Summary report: UNICEF Cold Chain Survey 1981.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1981. 9 p. (EPI/CCIS/81.14)

    81% of developing countries responding to a 1981 cold chain survey carried out for UNICEF reported that preparations for the Expanded Program on Immunization (EPI) were complete. 64% of the responding countries indicated that Central Store facilities were adequate for the needs of the current national population, but only 28% reported that UNICEF or government purchases for new facilities were in progress. The largest discrepancy was recorded in the African region, where 44% of countries believed that central storage facilities were inadequate and only 31% had purchase orders. Overall, 61% of countries considered Regional Store facilities to be adequate, with a range from 44% in the African Region to 83% in Southeast Asia. The majority of countries of countries reported problems in terms of the quality and availability of power and fuel supplies. The most prominent problem, however, was poor transport for the cold chain, cited by 60% of countries. Specific transport problems mentioned included poor distribution of vehicles, inadequate vehicle maintenance facilities, inappropriate choice of vehicles for peripheral areas, and inefficient utilization of existing transport.
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  17. 17
    041357

    The cold chain status: June 1984.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1984. 13 p. (EPI/CCIS/84.3)

    This document summarizes the work performed during 1983 and the 1st half of 1984 to improve the vaccine cold chain for the Expanded Program on Immunization (EPI). It provides a broad outline of the work being carried out by the World Health Organization (WHO) and summarizes major equipment developments. The state of the cold chain is described under 3 headings: cold chain management, training, and equipment. In recent years, the EPI has focused much effort on strengthening the weakest spots in the cold chain. The section of the report devoted to cold chain management describes progress in the development of management aids, such as indicators to monitor the cold chain, and an equipment maintenance and spare parts project. Additionally, it summarizes the current situation with the cold chain support services and projects in the countries and draws attention to the results of recent cold chain studies. There are 5 types of chemical indicators in use in the cold chain, and in 1983 a document was issued giving an update on the current status of field trials and feedback on routine use. These indicators are outlined. Cold chain training has been provided on a continuing basis to health workers and technicians. Over the past 5 years several audiovisual aids for cold chain training have been prepared: 3 films, 7 posters, 2 slide sets, and 3 stickers. 3 courses of cold chain training are being used at this time: a revised version of "Manage the Cold Chain" from the mid-level managers course; logistics and cold chain course for primary health care; and refrigerator repair technicians course. Development of equipment for the cold chain has fallen into 3 main areas: finding and testing existing equipment, modifying existing equipment so that it will work better in tropical conditions, and developing new equipment for the cold chain that cannot be found on the open market.
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  18. 18
    041359

    Status of EPI syringe and sterilization development: August 1983.

    World Health Organization [WHO]. Expanded Programme on Immunization [EPI]

    [Unpublished] 1983. 10 p. (EPI/CCIS/83.7)

    At this time in many developing countries sterilization practices for syringes and needles which are used to provide immunizations remain unsatisfactory. Problems include the use of the same syringe to administer vaccines to different persons and inadequate sterilization methods. The project objective is to explore the economic and technical feasibility of 2 approaches to improve these problems: the development of inexpensive sterilizable plastic syringes and the development of steam sterilization methods which are effective and convenient. Laboratory tests now have been conducted on sterilizable plastic syringes from 3 manufacturers and on pressure sterilizers from 2 manufacturers. The syringes gave satisfactory performance after 200 sterilizations equivalent to about 1 year's full use. The sterilizer tests demonstrated that 20 minutes of steam pressure is adequate to achieve sterilization. Field trials are to be conducted in up to 5 countries during 1983 and 1984 and results are expected to be published by the end of 1984. 0.1 ml single dose, sterilizable plastic BCG syringes were developed by 2 manufacturers, and prototype glass 0.1 ml syringes were made by 1 manufacturer. These syringes were tested in the laboratory together with a standard 1.0 ml glass BCG syringe and 2 sterilizable plastic 1.0 ml syringes intended for use with DPT, tetanus, and measles vaccines. The results of these tests are summarized in Table 1, and the test protocol appears in Annex 1. The sole recurring problem identified by field workers was the difficulty in releasing air bubbles from the syringe. 2 manufacturers were selected out of 13 manufacturers of domestic pressure cookers who demonstrated high performance in European and North American consumer tests. Sterilizers of 2 sizes were developed by modifying domestic pressure cookers to oeprate at temperatures between +121-132 degrees centigrade. Racks were developed to suspend syringes, needles, and other immunization instruments to hold them securely during transport yet also to offer easy access during the immunization session. The sterilizers were tested for steam distribution, safety, fuel consumption, and sterilizing performance; the results are summarized in Table 2.
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