Quantitative Risk Assessment for Salmonella in Lettuce (Lactuca sativa) Consumed in Benin, West Africa

The present study aims at quantitatively assessing the risk associated with Salmonella in lettuce (Lactuca sativa) consumed in Benin (West Africa). To that end, a survey was conducted involving 550 respondents to determine the conditions under which the product is handled along the supply chain and its consumption pattern. The prevalence and concentration of Salmonella in lettuce were collected from the literature. The consumption data and the data on Salmonella concentrations in lettuce were combined to estimate the exposure to Salmonella using a probabilistic risk assessment method. The @Risk software package (Palisade USA) was used to run Monte Carlo simulations with 10,000 iterations. Three dose-response models were used to assess the risk of salmonellosis. Different scenarios were tested to identify factors that could influence the risk of salmonellosis. The results showed that lettuce is exposed to temperature abuse under inappropriate hygienic conditions. In 90% of the cases, the exposure to Salmonella was between 3 and 7 log CFU/serving. The risk of salmonellosis per serving varied from 7.7% to 95% depending on the dose-response used with the scenario taking into account the current handling conditions of the lettuce. In contrast, when considering the scenario where the cold chain is respected along the supply chain, the risk of salmonellosis varied from 0% to 3.3% depending on the dose response used. The study highlights the importance of the cold chain, good agricultural practices and good hygienic practices to reduce exposure to Salmonella through the consumption of lettuce and thus the risk of salmonellosis.

Assessment of Delivery of Routine Immunization in Kashmir: A Qualitative Study

Introduction: Immunization is one of the splendid public health interventions that remarkably reduced child morbidity, mortality, and disability. Despite attaining substantial immunization coverage in Kashmir, assessment of the immunization system is quintessential for sustaining the gains and exploring the gaps. Objective: To assess the gaps in the delivery of routine immunization services in Kashmir Valley. Method: In-depth face-to-face interviews were conducted with thirty-two (32) important stakeholders, who were purposively selected as they play an active role in the planning and implementation of the Immunization Program and devise strategies at different levels of healthcare delivery. At the state level, SEPIO and SMO were interviewed at the District level, DIO/Deputy CMO was interviewed in all ten (10) districts of Kashmir Valley. From all ten Districts, two Medical-Blocks were selected from each District, and one Block Medical Officer and one Medical Officer were interviewed alternatively from each Medical-Block. Results: The thematic qualitative analysis approach was used and the analysis process generated five themes. Each of these themes included many sub-themes. 1. Factors facilitating the implementation of Routine Immunization (RI), 2. Limitations and deficits related to knowledge, attitude, monitoring, 3. Constraints encountered in the implementation of (RI) program, 4. Difficulties in the implementation of RI revealed by respondents, 5. Transformational steps to bridge gaps in the delivery of Immunization (RI) Conclusion: There were visible deficits related to knowledge, attitude, and monitoring among health professionals. Certain constraints encountered in the implementation of the program were financial constraints in the training of health care professionals and human resources constraints. The study showed the need for transformational steps to bridge gaps in the delivery of the Immunization (RI), which included regular monitoring and review meetings, teamwork and peer learning, training, and improvement in cold chain maintenance

Perda de imunobiológicos e sua repercussão na gestão do programa estadual de imunizações, Ceará-Brasil / Loss of immunobiologicals and their repercussion in the management of the state immunization program, Ceará-Brasil / Pérdida de inmunobiológicos y su repercusión en la gestión del programa estatal de inmunización, Ceará-Brasil

Objetivo: Identificar a ocorrência de perdas físicas e técnicas de imunobiológicos no estado do Ceará e seu impacto financeiro. Métodos: Pesquisa do tipo exploratório-descritiva, retrospectiva, com abordagem quantitativa. Para as perdas físicas foram avaliados 511 formulários de registro de desvio de qualidade em imunobiológicos; para as perdas técnicas, considerou-se todas as doses de vacinas que não foram utilizadas depois de expirado o prazo de validade, após abertura do frasco, assim como as doses não aplicadas. Resultados: As perdas totais atingiram 12,5 milhões de doses de imunobiológicos, representando um gasto de R$42,8 milhões. O principal motivo das perdas físicas durante o período estudado foi à queda de energia, representando 55,84%. A pesquisa não demonstrou evidência de relação direta entre as perdas totais de vacinas e as coberturas vacinais. Conclusão: Apesar do elevado número de doses desperdiçadas e do impacto financeiro proporcionado, apenas duas vacinas, BCG e hepatite B ultrapassaram o padrão estabelecido pela OPAS; para resolver a problemática da falta de energia, medidas de prevenção devem ser viabilizadas, como a instalação de grupos geradores e a correta execução dos protocolos de contingência recomendados pelo PNI. (AU)

Objective: To identify the occurrence of physical losses and immunobiological techniques in the state of Ceará and its financial impact. Methods: Exploratory-descriptive, retrospective research with a quantitative approach. For physical losses, 511 quality deviation registration forms were evaluated in immunobiologicals; for technical losses, we considered all doses of vaccines that were not used after the expiry date, after opening the bottle, as well as the doses not applied. Results: Total losses reached 12.5 million doses of immunobiologicals, representing an expense of R $ 42.8 million. The main reason for physical losses during the period studied was the power outage, representing 55.84%. The research showed no evidence of a direct relationship between total vaccine losses and vaccine coverage. Conclusion: Despite the high number of missed doses and the financial impact provided, only two vaccines, BCG and hepatitis B exceeded the standard established by PAHO; to solve the problem of power outages, preventive measures must be put in place, such as the installation of generator sets and the correct execution of the contingency protocols recommended by the PNI. (AU)

Objetivo: Identificar la ocurrencia de pérdidas físicas y técnicas inmunobiológicas en el estado de Ceará y su impacto financiero. Métodos: Investigación exploratoria-descriptiva, retrospectiva con enfoque cuantitativo. Para pérdidas físicas, se evaluaron 511 formularios de registro de desviación de calidad en inmunobiológicos; para pérdidas técnicas, se consideraron todas las dosis de vacunas que no se utilizaron después de la fecha de caducidad, después de abrir el frasco, así como las dosis no aplicadas. Resultados: Las pérdidas totales llegaron a 12,5 millones de dosis de inmunobiológicos, lo que representó un gasto de R $ 42,8 millones. El principal motivo de las pérdidas físicas durante el período estudiado fue el corte de energía, que representó el 55,84%. La investigación no mostró evidencia de una relación directa entre las pérdidas totales de vacunas y la cobertura de vacunas. Conclusion: A pesar del alto número de dosis omitidas y el impacto económico proporcionado, solo dos vacunas, BCG y hepatitis B superaron el estándar establecido por la OPS; para solucionar el problema de los cortes de energía se deben implementar medidas preventivas, como la instalación de grupos electrógenos y la correcta ejecución de los protocolos de contingencia recomendados por el PNI. (AU)

Avaliação da cadeia de frio do transporte de vacina: estudo transversal em Minas Gerais, Brasil / Evaluation of the cold chain of vaccine transportation: cross-sectional study in Minas Gerais, Brazil

Estudo transversal de abordagem avaliativa do grau de implantação da cadeia de frio durante o transporte de vacina do nível regional para municípios. Avaliamos 53 rotas de transporte de vacina de municípios de Minas Gerais. Para a coleta de dados, utilizamos um questionário estruturado e o monitoramento das temperaturas das caixas de vacina encaminhadas aos municípios através do data logger. O grau de implantação foi definido por meio de um sistema de escores, com pesos diferenciados para indicadores em cada dimensão avaliada. Os escores obtidos a partir da soma dos pontos dos indicadores foram transformados em percentuais, com referência à pontuação máxima possível. A seguir, foram definidas as categorias para o grau de qualidade: "adequado", "parcialmente adequado" e "não adequado". Os dados foram digitados no programa Epidata 3,0 e analisados no EPI-INFO 7.0, GraphPad Prism 5 e BioEstat 5.0, Excel. Realizamos análise univariada com cálculo das frequências, medidas de aferição e dispersão. A cadeia de frio durante o transporte de vacina não está adequadamente implantada na maioria dos municípios avaliados. Em vinte e dois municípios as vacinas foram expostas a temperaturas abaixo de +2°C, sendo que em seis destes a temperatura variou de 0°C a +0,5°C. O transporte de vacina apresenta falhas que podem comprometer a qualidade dos imunobiológicos.

Cross-sectional study aimed to evaluate the degree of cold chain implementation during vaccine transport from regions to municipalities. We evaluated 53 vaccine delivery routes in municipalities from the state of Minas Gerais. For data collection, we utilized a structured questionnaire and data logger in order to monitor the temperature inside the vaccine coldboxesthatwere distributed to thesemunicipalities through the data logger device. The degree of implementation was defined by means of a scoring system, with differentscores of different weights attributed to indicators for each rated dimension. The scores obtained from the sum of indicator points were transformed into percentages and referenced to the maximum possible score. The categories for quality grades were then defined as: "adequate", "partially adequate" and "not adequate". The data were entered in the Epidata 3.0 program and analyzed with EPI-INFO 7.0, GraphPad Prism 5 and BioEstat 5.0, Excel. We conducted univariate analysis to calculate frequencies,standardized measures and dispersion. Cold chain implementation during vaccine transport was found to be inadequate in the majority of the municipalities evaluated. In twenty-two municipalities, vaccines were exposed to temperatures below +2ºC and in six of these twenty-two,temperatures varied from 0oC to +0.5ºC. The vaccine transportation reveals shortcomings that could potentially compromise the immunobiologicals quality.

Risk management of imported cold-chain foods during the COVID-19 pandemic / 上海预防医学

Since July 2020， nucleic acids of novel coronavirus SARS-CoV-2 were frequently detected in cold chain food imported to China， making imported food being a potential risk to the COVID-19 outbreak. Based on the epidemiological characteristics of SARS-CoV-2， imported cold-chain food and their packaging may become the carriers of SARS-CoV-2 in long-distance cross-border transportation. In each aspect of stakeholders including governmental supervision， manufacturers and consumers， China should strengthen the risk management of imported cold-chain food to ensure the safety， especially pay attention to the health protection of industry workers in close contact with cold -chain food.

Shanghai mode of precise control of imported cold-chain food for during the COVID-19 epidemic / 上海预防医学

In order to strictly control and prevent the risk of the coronavirus disease 2019 （COVID-19） transmission through imported cold-chain foods， Shanghai has implemented many multiple countermeasures， including “Three PointsIntermediate Sites， One Transit Cold Storage” and “Four Drive Linkage”. Shanghai cold-chain information traceability system and other operating mechanisms have been established， according to the guidance of “One Single Plan”. The multilevel， overall， traceable， life cycle and whole processand closed-loop control regulatory system， called “Shanghai mode of control” for imported cold-chain food has been basically formed， which would facilitate precise regulation and management of create an accurate management system for imported cold-chain foods.

Management of vaccine cold chain delivery by international organizations / 上海预防医学

Most of serious vaccine-related adverse events in China are believed to be due to the poor management of vaccine cold chain delivery.It is an urgent need to strengthen the vaccine management system.To obtain a more comprehensive understanding of the management of vaccine cold chain delivery, including practical experience in specific regions and its supervision, we reviewed the documents/guidelines/literature, published by the WHO, GAVI and UNICEF in recent ten years, on vaccine cold chain delivery.The current study serves a good reference for the regulation, policy formulation and optimization of vaccine management.

Application of Internet of Things in clinical blood management based on RFID technology / 中国输血杂志

【Objective】 To explore and evaluate the application of blood intelligent management platform (scheme) based on the Internet of Things(IoT)in the clinical blood management for hospitals. 【Methods】 Based on radio frequency identification technology (RFID), smart blood refrigerators, IoT blood shipping containers, automated blood bank systems, smart blood management software, etc. were developed and integrated as an IoT blood intelligent management platform (scheme). The blood storage, management software and hardware systems were organically combined, and the blood storage equipment was moved forward to the clinical departments to solve the concerns of clinicians. 【Results】 The in-depth integration of IoT technology, RFID and refrigeration technology has built an RFID-based IoT blood management solution, which integrates blood storage, transfusion, and quality control management, also realizes the entire process of supervision and traceability of clinical blood transfusion. The forward movement of blood bank to the clinical departments and the implementation of electronic cross-matching streamlined and optimized the clinical blood flow. The waiting time of patient′s for blood transfusion was shortened from (40±10) min to less than 2 min. The whole process of cold chain logistics ensured the storage quality of blood products issued, so that the clinical departments can return the untransfused blood and Blood Transfusion Department can reissue it to other hospitals. 【Conclusion】 IoT blood intelligent management based on RFID realizes the intelligent management of clinical blood transfusion and blood information traceability. The forward movement of blood bank to the clinical departments improves the efficiency of clinical blood transfusion, avoids the waste of blood source, and ensures the safety of blood transfusion. It is worth promoting in the whole process of blood transfusion.

Preliminary application of drones in emergency blood delivery / 中国输血杂志

【Objective】 To explore the viability and advantages of drones in blood emergency delivery. 【Methods】 The delivery of emergency blood by drones to the Second People′s Hospital of Yuhang District(referred as Yuhang Hospital) and the Second Affiliated Hospital of Zhejiang University Medical College (referred as Binjiang Hospital) was analyzed retrospectively. The 8: 00-24: 00 traffic condition, at the interval of 2h, of working days were inquired by Baidu Map in order to compare the driving time with drone flight time. The temperature of RBCs and platelets during drone flight were monitored, and take-off and landing temperature were compared. 【Results】 47 deliveries (a total of 192 bags, 295 U) of suspended RBCs and 35 deliveries (a total of 113 bags, 159.5 therapeutic dose) of platelets were, respectively, conducted to Yuhang Hosital and Binjiang Hospital. Two transfer stations for battery charging were needed during the delivery to Yuhang Hospital, and the average one-way time by driving was similar with by drones(50 vs 55 min), without any superiority in time-efficiency. Binjiang Hospital, however, benefited from this drone delivering(driving 10mins vs drone 6 mins). As round-trip delivery for emergency blood was saved, it’s economical for the hospital to get the time-sensitive blood timely. The temperature of suspended RBCs and platelets during flight was between 2.1~7.9 ℃ and 20.2~24.2 ℃, with temperature difference at 0.3~3.7 ℃ and 0.3~3.6℃, respectively. 【Conclusion】 Drones, with good application prospects, can be applied in emergency blood delivery, and further study is needed to improve the time-efficiency and cold chain monitoring system.

Assessment of cold chain equipments and their management in government health facilities in a District of Delhi: A cross-sectional descriptive study

Background: Cold chain equipments (CCEs) at health facilities (HFs) are an essential part of the immunization supply chain (ISC). The CCEs in government HFs of Delhi were never assessed using the World Health Organization-United Nations Children's Fund (WHO-UNICEF) Effective Vaccine Management (EVM) tool except that of state vaccine store during National EVM assessment 2013. Objectives: The objective of the study was to assess the CCEs and their management in government HFs using the WHO-UNICEF EVM tool in a district of Delhi. Methods: The assessment was done during December 2017朚arch 2018 in one randomly selected district of Delhi. Sample size and site selection were done using the WHO EVM site selection tool. A total of 29 HFs were assessed along with District Vaccine Store. Questions on CCEs in EVM tool 1.0.9 were used for data collection. Results: Out of 56 electrical CCEs, 8.9% were nonfunctional, 48.2% were noncompliant with WHO standards, 5.4% were not chlorofluorocarbon free, 4.7% did not have temperature monitoring device, and 18.8% did not have stabilizer. Eighty-six percent of passive containers were compliant with the WHO standards. The storage capacity of electrical vaccine storage equipment was insufficient in 3.4%, passive container capacity in 65.5%, and ice packs preparation and storage capacity in 24.1% of HFs. There was no planned preventive maintenance of CCEs and no standard operating procedures for emergency event management. Conclusion: There was a shortage of vaccine storage, ice packs preparation and storage, and passive container capacity. Many CCEs used in ISC of assessed sites were noncompliant to the WHO standards. There was no PPM of CCEs and no guidelines for emergency event management.

Awareness of vaccine cold chain handlers about vaccine cold chain in district Etawah

Background: Vaccine potency can be lost when exposed to non-recommended temperatures. Hence for the proper running of the universal immunization programme (UIP) factors like vaccine cold chain and vaccine management wants great focus and attention skills and knowledge of the vaccine cold chain handlers so for good implementation of UIP vaccine cold chain handlers are important.Methods: This was an observational cross-sectional study. Study duration was carried out from October 2017 to March 2018. All the 16 cold chain handlers of district Etawah were interviewed.Results: All 16 (100.0%) were male and 1 (6.3%), 2 (12.5%), 8 (50.0%) and 5 (31.3%) of the respondents were high schools, intermediate, graduate, and post-graduate respectively. It had been observed that the hundred percent of the cold chain handlers with the knowledge of vaccine cold chain. It has been observed from the study that 15 (93.7%) cold chain handlers had knowledge of temperature range for vaccine storage.Conclusions: Quality of immunization program depends upon cold chain management at peripheral health institutions. In our study, we have found that most of the vaccine handlers were reported to have appropriate knowledge regarding the cold chain.

Avaliação da temperatura de produtos lácteos expostos em unidades produtoras de frio de hipermercado / Temperature evaluation of milk products exposed in hypermarket cold producing units

O presente trabalho teve por objetivo, avaliar a temperatura de produtos lácteos expostos nas unidades produtoras de frio e a temperatura de três expositores refrigerados que acondicionavam os produtos, em um hipermercado do noroeste do Estado de São Paulo. Foram mensuradas temperaturas durante 25 dias, de quatro produtos, manteiga, requeijão, creme de leite e leite pasteurizado, acondicionados em expositores resfriados e foi avaliada ainda a temperatura registrada no termostato dos expositores dos respectivos produtos. Foi possível observar que os resultados dos produtos lácteos analisados se apresentavam dentro dos padrões estabelecidos pela legislação vigente e respeitando a temperatura de conservação especificada no rótulo dos produtos e todas as verificações realizadas apresentaram temperaturas negativas. É possível concluir que o frio produzido pela câmara fria avaliada foi satisfatório para manutenção de produtos de origem animal perecíveis e que os expositores avaliados demonstraram no visor externo temperaturas também eficientes para manutenção da qualidade sensorial, físicas, químicas e microbiológicas dos produtos expostos.

The objective of the present research was to evaluate the temperature of milk products exposed in the cold production units and the temperature of three refrigerated display units that packaged the products in a hypermarket from the northwest of São Paulo State. Temperatures were measured during 25 days of four products, butter, curd, cream and pasteurized milk, conditioned in refrigerated display units and the temperature registered in the thermostat of the exhibitors of the respective products was also evaluated. It was possible to observe that the results of the dairy products analyzed were within the standards established by the current legislation and respecting the storage temperature specified on the product label and all the checks performed presented negative temperatures. It is possible to conclude that the cold produced by the cold chamber was satisfactory for the maintenance of perishable products of animal origin and that the evaluated exhibitors showed in the external display temperatures also efficient for maintaining the sensorial, physical, chemical and microbiological quality of the exposed products.

Assessment of vaccine management in cold chain points of Jashpur and Sarguja districts of Chhattisgarh

Background: It has been observed that besides intensification of routine immunization, more strategic interventions are essential to strengthen the different aspects of immunization services like cold-chain management and monitoring/supportive supervision. The present study was considered as a part of ongoing UNICEF funded project on Supportive Supervision of Routine Immunization in Jashpur and Sarguja districts undertaken by the Department of Community Medicine, GMC Rajnandgaon with the objectives to assess the status of cold chain equipment and logistics management practices, knowledge and practice of cold chain handler (CCHs) about cold chain equipment and logistics management.Methods: A cross-sectional facility based study was conducted from August 2017 to February 2018. Among 18 cold chain points (CCPs), 9 from Jashpur and 9 from Sarguja district were considered for analysis using structured questionnaires provided by UNICEF.Results: In 83.33% CCPs cold chain technician or annual maintenance contract/computer-mediated communication service provider visit for preventive maintenance in the last 4 months. Vaccine CCHs carries out the daily and weekly planned preventive measures as per the checklist in 83.33% CCPs during our visit. In all CCPs iced line refrigerator (ILR) and deep freezer (DF) were placed as per specified guidelines. In 66.66% CCPs there was documentation of monthly review of temperature records. In all CCPs visited standard vaccine and logistics stock/issue registers were available.Conclusions: Most of the components of cold chain and logistics management practices were satisfactory while there is a gap in other components which needs to be improved by means of ongoing project of strengthening of SSRI in both districts.

AVALIAÇÃO DA TEMPERATURA DE PRODUTOS LÁCTEOS EXPOSTOS EM UNIDADES PRODUTORAS DE FRIO DE HIPERMERCADO / Temperature evaluation of milk products exposed in hypermarket cold producing units

O presente trabalho teve por objetivo, avaliar a temperatura de produtos lácteos expostos nas unidades produtoras de frio e a temperatura de três expositores refrigerados que acondicionavam os produtos, em um hipermercado do noroeste do Estado de São Paulo. Foram mensuradas temperaturas durante 25 dias, de quatro produtos, manteiga, requeijão, creme de leite e leite pasteurizado, acondicionados em expositores resfriados e foi avaliada ainda a temperatura registrada no termostato dos expositores dos respectivos produtos. Foi possível observar que os resultados dos produtos lácteos analisados se apresentavam dentro dos padrões estabelecidos pela legislação vigente e respeitando a temperatura de conservação especificada no rótulo dos produtos e todas as verificações realizadas apresentaram temperaturas negativas. É possível concluir que o frio produzido pela câmara fria avaliada foi satisfatório para manutenção de produtos de origem animal perecíveis e que os expositores avaliados demonstraram no visor externo temperaturas também eficientes para manutenção da qualidade sensorial, físicas, químicas e microbiológicas dos produtos expostos

The objective of the present research was to evaluate the temperature of milk products exposed in the cold production units and the temperature of three refrigerated display units that packaged the products in a hypermarket from the northwest of São Paulo State. Temperatures were measured during 25 days of four products, butter, curd, cream and pasteurized milk, conditioned in refrigerated display units and the temperature registered in the thermostat of the exhibitors of the respective products was also evaluated. It was possible to observe that the results of the dairy products analyzed were within the standards established by the current legislation and respecting the storage temperature specified on the product label and all the checks performed presented negative temperatures. It is possible to conclude that the cold produced by the cold chamber was satisfactory for the maintenance of perishable products of animal origin and that the evaluated exhibitors showed in the external display temperatures also efficient for maintaining the sensorial, physical, chemical and microbiological quality of the exposed products

Cold chain time- and temperature-controlled transport of vaccines: a simulated experimental study

Effects of delivery and storage conditions on concentrations of amino acids and carnitines in neonatal dried blood spots / 浙江大学学报·医学版

OBJECTIVE@#To explore effects of different delivery and storage conditions on concentrations of amino acids and carnitines in neonatal dried blood spots (DBS), so as to provide evidence for improving accurate and reliable detection by tandem mass spectrometry.@*METHODS@#A total of 1 254 616 newborn DBS samples in Newborn Screening Center of Zhejiang Province were delivered and stored at room temperature (group A, @*RESULTS@#The concentrations of amino acids and carnitines in the three groups were skewed, and the differences in amino acid and carnitine concentrations among groups were statistically significant (all @*CONCLUSIONS@#Cold-chain logistics system and storage in low temperature and low humidity can effectively reduce degradation of some amino acids and carnitines in DBS, improve the accuracy and reliability of detection, and thus ensures the quality of screening for neonatal metabolic diseases.

Application of electronic signature technology in management and monitoring in vaccine cold-chain / 上海预防医学

In order to ensure the safety of the vaccine cold chain to the greatest extent, the newly regulations still require daily manual recording of temperature data and operation conditions based on the configuration of the automatic temperature measurement and alarm system.Therefore, on the basis of Shanghai Vaccine Cold-chain Monitoring System, Shanghai has introduced an electronic signature technology to implement a new model of remotely checking the temperature by mobile-phone and keeping records of the electronic signature as certificates.This technology reduces the on-site workload of cold chain management personnel.It also guarantees the authority, legitimacy, and non-tampering of recorded information through blockchain certificate storage technology.The application of the electronic signature technology is compatible with technical defense and civil defense methods, and is worthy of further promotion and use.

Temperature integrity and exposure to freezing temperature during vaccine transfer under the universal immunization program in Three States of India

Temperature excursion and exposure to sub-zero temperatures may reduce the potency of the freeze-sensitive vaccines. This study assessed temperature during vaccine transfers at various levels under the Universal Immunization Program. This cross-sectional study undertaken in 21 districts of three states of India – Bihar (n = 8), Kerala (n = 8), and Gujarat (n = 5). We documented temperature inside the cold boxes and vaccine carriers using LogTag-Trix8 data loggers. In total, 110 vaccine transportation episodes were observed; 55 inter-facility transfers and 55 outreach sessions. Sizable proportions of inter-facility (9% to 35%) and outreach vaccine transfers (18%) were exposed to sub-zero temperature. The proportions of exposure to temperature to >8°C were in the range of 0.8%–11.3% for inter-facility transfers and 2.3% for outreach sessions. The vaccines were exposed to freezing temperatures for significant durations during transportation across the cold chain. Rigorous monitoring of temperature integrity is essential to ensure the delivery of potent vaccines and to avoid vaccine failure.

Evaluation of vaccine storage and cold chain management practices during intensified mission Indradhanush in community health centers of Tikamgarh district of Madhya Pradesh

Background: Vaccination is one of the most effective disease prevention strategies and potency of vaccine is dependent on effective management of cold chain at all levels of vaccine handling. An effective cold chain maintenance system is the backbone of success of any immunization program. This study was done to assess the cold chain management and vaccine storage practices in Tikamgarh district of Madhya Pradesh.Methods: Cross-sectional study was carried out using a structured questionnaire.Results: Dedicated room/space for dry storage not available in any of 03 CHCs. Dedicated table for conditioning of icepacks, dedicated clean clothes for wiping of icepacks after conditioning and power back up was available, ILR and DF were connected to separate functional voltage stabilizer and thermometers were placed correctly only in 66.6% CHCs. ILRs and DFs were properly placed, cabinet temperature of ILR and DFs was maintained in normal range in all the three (100%) CHCs. Record of power failure, records of defrosting/cleaning was maintained in temperature log book and cold chain handlers had knowledge of shake test in only 33.3% CHC.Conclusions: Proper vaccine storage and management of cold chain system is essential for immunization. In order to improve quality of immunization services there is a need of space, temperature monitoring and regular defrosting with record keeping and regular training of cold chain handlers to keep their knowledge and skills updated. Monitoring and supervision of cold chain points by DIO should be on regular basis.

Effect of mobile-based supportive supervision on cold chain point management and routine immunization service delivery

Background: Supportive supervision (SS) as a public health strategy has gathered much consideration in cold chain anagement and effective service delivery of routine immunization (RI). Objectives: In this study, an attempt was made to assess the effect of mobile-based SS strategy on cold chain point’s (CCPs) management and RI service delivery. Materials and Methods: UNICEF supported mobile-based software was used to carry out the SS in Golaghat district of Assam. A total of 15 CCPs and 18 session sites were visited 2 times each in the year 2017. Data collected in the first visit were compared with the second visit to find out whether there was any improvement in cold chain management in CCPs and at routine immunization session sites following SS. Results: We observed a significant improvement in vaccine management and infrastructure handling at CCPs from initial to the second visit. Knowledge and skills of cold chain handlers regarding cold chain management at session site were improved adequately. This substantiates successful transfer of knowledge and skills during SS. Conclusion: The observed improvements in the CCP management practices and service delivery indicate positive influence of mobile-based SS. The improvement in the skills and knowledge of health workers on different components related to CCP management could be due to successful real-time hand holding of cold chain handlers and workers through SS.