Challenges of cold chain quality for routine EPI in south-west Burkina-Faso: An assessment using automated temperature recording devices.

BACKGROUND: Abnormal temperatures are a major issue for vaccines within the Expanded Program of Immunization in tropical climates. Prolonged exposure to temperatures outside the standard +2 °C/+8 °C range can impact vaccine potency. METHODS: The current study used automatic temperature recording devices (Testostore 171-1©) to monitor cold chain in remote areas of Western Burkina Faso. A series of 25 randomly selected health centers representing 33% of the existing 176 EPI facilities in Western Burkina Faso were prospectively assessed for eight months in 2015. Automatic measurements were compared to routine temperature loggers and vaccine vial monitors (VVM). RESULTS: The median age for all refrigerators was 9 years with 10/25 (42%) older than 10 years. Adverse temperatures were recorded in 20/24 (83%) refrigerators and ranged from -18.5 °C to +34.2 °C with 12,958/128,905 (10%) abnormal hourly records below +2 °C and 7357/128,905 (5.7%) above +8 °C. Time of day significantly affected the rate of temperature excursions, with higher rates from 00 am to 06 am (p < 0.001) for low temperatures and 10-12 am (p < 0.001) and 13-16 pm (p < 0.001) for high temperatures. Abnormal temperatures lasted from 1 h to 24 h below +2 °C and 13-24 h above +8 °C. Standard manual registers reported only 182/2761 (7%) inadequate temperatures and VVM color change detected only 133/2465 (5%) disruptions. Reliability of the refrigerators ranged from 48% to 98.7% with a median of 70%. Risk factors for excursions were old age of the refrigerators, the months of April and May, hours of high activity during the day, and health staff-associated factors such as inappropriate actions or insufficient knowledge. CONCLUSION: Important cold chain reliability issues reported in the current study in Western Burkina Faso raise concern about vaccine potency. In the absence of systematic renewal of the cold chain infrastructure or improved staff training and monitoring, antibody response assessment is recommended to study levels of effective immunization coverage.

[Use of SMS to ask mothers to come to vaccination sessions in Bobo-Dioulasso]. / Recours aux SMS pour convoquer les mères aux séances de vaccination à Bobo-Dioulasso.

Even though the expanded programme for immunization (EPI) coverage at national level is high in Burkina (95% of fully vaccinated children), mothers of children following EPI in Health Centres (HC) would benefit from being reminded of EPI sessions by sending SMS (short message service) to their own mobile phone, or through mobile phone of a family member living in the same compound. SMS could be sent through Computerized Immunization Registers (CIR), hosted by HC computers. 210 mothers of children aged 0 to 5 years were chosen at random and questioned if they owned a mobile phone, if they could read a SMS, or, if not, what language they would understand if a voice SMS was sent. They were also asked if a family member could receive, read and transmit the message, if mothers did not own a mobile phone. They were also asked if they are willing to give their telephone number to HC. 94% of mothers could be reached through written or voice SMS, sent to their own or family member's mobile phone. 100% of mothers would be willing to give their telephone number to their HC to improve their ability to come at the right time for vaccination sessions. SMS reminders, delivered through CIR, should improve EPI attendance and management of sessions in HC, especially in epidemic context.

[Mansonelliasis identified by a cervicovaginal smear at the university hospital center of Bobo-Dioulasso (Burkina Faso)]. / Frottis cervicovaginal révélant une mansonellose au centre hospitalier universitaire de Bobo-Dioulasso, Burkina Faso

INTRODUCTION: Mansonella perstans is a genus of filaria that is often asymptomatic or responsible for unspecific symptoms. M. perstans microfilariae are uncommon on cervicovaginal smears. CASE: We report the case of a woman with pruritis and eosinophilia. Microfilariae of M. perstans were observed on both cervicovaginal and blood smears. The patient was successfully treated with a combined single dose of 400 mg of albendazole and ivermectin (150 µg/kg). CONCLUSION: We described here an atypical and rare localization of M. perstans. The routine examination of cervicovaginal smears of women admitted to Bobo-Dioulasso Hospital for screening of cervical neoplasia should allow us to determine the frequency of this parasitosis and propose appropriate treatment.

[Medico-legal conditions of recognition and compensation of occupational asthma in Sénégal]. / Conditions médico-légales de reconnaissance et d'indemnisation de l'asthme professionnel au Sénégal.

The aims of this study were to appreciate how frequent asthma was named in the legal list of worker's compensation, state hazards and occupations involved and appreciate conditions required for a legal recognition of the disease. The study consisted of a review of the legal list of occupational diseases of all tables where asthma was stated. Medical, technical and administrative criteria allowing compensation were looked for. Asthma was listed in 12 among the 67 tables; causal substances listed were known as sensitizers and included mainly organic and metallic compounds. Numerous occupations were concerned in all primary, secondary and tertiary sectors. Medical conditions refered to "all asthma confirmed by functionally respiratory tests or regenerated by a new exposure". Time length of declaration was seven days. Variety of occupations concerned and numerous substances involved should invite to look for occupations in all patients with asthma. Physicians should be aware of theses legal conditions in order to recognize better occupational asthma and ease it legal compensation.

[Cost of tetanus toxoid injection using a jet-injector (Imule) in collective immunization in Senegal: comparison with injection using a syringe and resterilizable needle]. / Coût de l'injection d'anatoxine tétanique par injecteur sans aiguille(Imule) lors dúne vaccination collective au Sénégal: comparaison avec l'injection par seringues et aiguilles restérilisables.

Needle-less jet injectors were developed by the US army after World War II. Their principal use, however, has been in the administration of lyophilized vaccines from multidose vials to at-risk populations in developing countries. In 1983, a hepatitis B epidemic occurred among customers of a beauty clinic in California (USA) following the use of jet-injectors, demonstrating a clear risk of cross-contamination associated with this technique. As a result, the WHO and Unicef stopped recommending jet-injectors for collective immunizations in developing countries. To eliminate the risk of contamination, Pasteur Mérieux Sérums et Vaccins (now Aventis Pasteur) developed, in 1990, jet-injectors for use with single-use vaccine cartridges. These injectors were tested for tetanus toxoid, DTP, influenza, hepatitis A and typhoid Vi vaccination. The immunogenic reaction was as strong and the injection as well tolerated as for injections using a standard needle and syringe. The additional cost of the Imule technique was evaluated in a district-wide (127,000 inhabitants) tetanus toxoid immunization program at Velingara, Senegal in 1993. The total cost was estimated to be 1.51 FF (76 F CSA, 0.32 US dollars) for one dose of tetanus vaccine given by needle and syringe and 2.41 FF (121 F CSA, 0.56 US dollars) for one dose given by Imule. Thus, the additional cost of injection by ImuleTM was 0.90 FF (45 F CSA, 0.21 US dollars). The cost of cross infection in sub-Saharan Africa has been estimated to be 2.37 FF (118 F CSA, 0.55 US dollars) per injection if injection practices are not supervised. Therefore, the Imule technique may be considered to be cost-effective. However, the technique is still not completely reliable, as shown by the total breakdown of four jet injectors during this vaccination session. Lyophilized vaccines have also not been tested in the field. Vaccinators prefer Imule, training is easy and immunization can be carried out on a day-to-day basis with no vaccine wastage. Imule is not yet in mass production, which would reduce costs. In the face of the ever-increasing risk of cross-contamination during vaccination sessions in sub-Saharan Africa, the Imule technique deserves considerable attention.

Description et analyse d'une epidemie de rougeole a Bobo-Dioulasso; octobre 1995-mai 1996

De decembre 1995 a mai 1996; une epidemie de rougeole est survenue dans la ville de Bobo-Dioulasso; Burkina Faso. Des investigations ont ete realisees dans le but de mieux comprendre les caracteristiques et les determinants de cette epidemie. Une enquete exhaustive a ete realisee dans les formations sanitaires urbaines pour documenter tous les cas de rougeole mentionnes sur les registres de consultations. Tous les centres de vaccination ont ete visites pour evaluer leur plateau technique et la qualite de leurs prestations. Enfin; une enquete cas-temoins appariee sur l'age et le domicile (386 paires cas-temoins) ainsi qu'un sondage de couverture vaccinale selon le protocole OMS classique de 30 grappes ont complete les investigations par echantillonnage dans la population generale. Entre le 1er octobre 1995 et mi-mai 1996; 3768 cas de rougeole ont ete diagnostiques; soit un taux d'incidence cumule de 9;7 pour mille (34;6 pour mille avant 1 an; 28;9 pour mille de 1 a 4 ans; 10;7 pour mille de 5 a 14 ans et 4;8 pour mille a partir de 15 ans). L'epidemie a demarre fin novembre; debut decembre 1995; par des petits foyers dans un secteur central et dans deux secteurs peripheriques. A partir de mi-janvier 1996; elle s'est brutalement propagee et amplifiee dans le reste de la ville; pour culminer en mars et s'eteindre en mai

[Description and survey of a measles epidemic in Burkina Faso]. / Description et enquête lors d'une épidémie de rougeole au Burkina Faso.

Measles remains a major cause of child and infant mortality in Africa. Burkina Faso was the first country in Africa to run mass measles vaccination campaigns. The "Commando" vaccination program in 1984 immunized children aged between 9 months and 6 years old. The EPI was then implemented across the whole country; and with particular emphasis on the North Central region (with the help of two Non Governmental Organizations). Coverage cluster surveys were conducted in 1987 and 1989. In addition, a community-based evaluation of the immunization program and a serological survey were run in January 1989. A measles epidemic started in March 1989 in the Eastern province (Namentenga) of the North Central region and lasted until the rainy season. A survey reported 230 cases of which a large proportion were adults. Vaccine efficacy (85%) was normal. Index cases were from a neighbouring province. Epidemiological and serological surveys in 1989 indicated that the circulation of the wild type virus had been low since the 1984 "Commando" vaccination program. The epidemic was due to unsatisfactory vaccinal coverage (53%) which had further declined (35%). Consequently the primary health care system is being mobilized to improve vaccinal coverage.