Mantenimiento de la cadena del frío para las vacunas: una revisión sistemática

Evaporative Cooling Hydrogel Packaging for Storing Biologics Outside of the Cold Chain

Stabilizing thermolabile pharmaceuticals outside of the cold chain has the potential to alleviate some of the logistical and monetary burden of providing health care access in the developing world. Evaporative cooling hydrogel packaging is designed to extend the storage stability of existing pharmaceutical products without the need for reformulation. Hydrogels with high water content and reversible hydrophilicity offer a promising platform for reducing storage temperatures without refrigeration. As a model, poly(N-isopropylacrylamide) is selected as a basis for creating a potentially low cost and easy-to-fabricate hydrogels.

[Vaccine cold chain interruption in a primary care center and economic evaluation]

OBJECTIVES

Cold chain control is one of the most important facts to ensure the effectiveness of vaccines links, which requires specific material and human resources for management. The principal objective is to evaluate the interruptions in cold chain of the last 6 years and the possible cost savings that would result in further improvements.

METHOD

A retrospective and descriptive study based on a review of all cold chain interruptions during the last 6 years, at Valdefierro Primary Health Center.

RESULTS

We had 5 interruptions, the maximum temperature reached was 23.1±3.4°C and the longest interruption lasted 25.2±20.7hours. 1611 vaccines were affected and 165 discarded. Total economic loss was 2.098,10 € and 33.611,64 € were savings. The electrical failure was the disruption cause in 5 cases.

CONCLUSIONS

Equipment and staff are essential. The center did some corrective actions, such as minimizing refrigerator time control, minimum stock control, considering population changes, and the center has requested a electrical supply system.

Cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro

A cobertura vacinal nos chamados "países em desenvolvimento" ainda está aquém da esperada. Ela é um importante indicador de saúde das populações e da qualidade da atenção dispensada pelos serviços. O presente estudo descreve os resultados de um inquérito domiciliar para estimar a cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro, da coorte nascida em 2005. A metodologia usada é a preconizada pela Organização Pan-Americana da Saúde para a realização de inquéritos de cobertura vacinal. Os dados obtidos no presente estudo de cobertura vacinal demonstram que é baixa a proporção de crianças vacinadas, ao se considerarem as metas preconizadas pelo Programa Nacional de Imunização, na faixa etária de maior risco para as doenças imunizáveis. Para os estratos nas capitais do Nordeste, encontramos as piores coberturas nos dois extremos dos estratos socioeconômicos. A avaliação da cobertura vacinal contribui para detectar se a população infantil encontra-se imunizada, além da identificação de pontos frágeis das atividades de vacinação.

Strengthening vaccination policies in Latin America: an evidence-based approach

Despite many successes in the region, Latin American vaccination policies have significant shortcomings, and further work is needed to maintain progress and prepare for the introduction of newly available vaccines. In order to address the challenges facing Latin America, the Commission for the Future of Vaccines in Latin America (COFVAL) has made recommendations for strengthening evidence-based policy-making and reducing regional inequalities in immunisation. We have conducted a comprehensive literature review to assess the feasibility of these recommendations. Standardisation of performance indicators for disease burden, vaccine coverage, epidemiological surveillance and national health resourcing can ensure comparability of the data used to assess vaccination programmes, allowing deeper analysis of how best to provide services. Regional vaccination reference schemes, as used in Europe, can be used to develop best practice models for vaccine introduction and scheduling. Successful models exist for the continuous training of vaccination providers and decision-makers, with a new Latin American diploma aiming to contribute to the successful implementation of vaccination programmes. Permanent, independent vaccine advisory committees, based on the US Advisory Committee on Immunization Practices (ACIP), could facilitate the uptake of new vaccines and support evidence-based decision-making in the administration of national immunisation programmes. Innovative financing mechanisms for the purchase of new vaccines, such as advance market commitments and cost front-loading, have shown potential for improving vaccine coverage. A common regulatory framework for vaccine approval is needed to accelerate delivery and pool human, technological and scientific resources in the region. Finally, public-private partnerships between industry, government, academia and non-profit sectors could provide new investment to stimulate vaccine development in the region, reducing prices in the long term. These reforms are now crucial, particularly as vaccines for previously neglected, developing-world diseases become available. In summary, a regionally-coordinated health policy will reduce vaccination inequality in Latin America.

Prática da enfermagem na conservação de vacinas

Objetivo: Identificar o conhecimento e o cumprimento das recomendações técnicas do Programa Nacional de Imunização sobre a conservação dos imunobiológicos nas Unidades Básicas de Saúde de um município da região Centro-Oeste de Minas Gerais. Metodos: Estudo descritivo transversal realizado em 26s Unidades Básicas de Saúde abrangendo 21 enfermeiros e 49 avaliadores de enfermagem entrevistados. Resultados: Foram observadas algumas deficiências que podem interferir na eficácia do Programa Nacional de Imunização, tais como, manutenção da rede de frio inadequada, desconhecimento da conduta técnica de limpeza quinzenal, desconhecimento das vacinas que podem sofrer congelamento sem risco de inativação e falta de ambientação da bobina de gelo reciclável. Conclusão: Foram sugeridos investimentos na formação, informação e capacitação dos profissionais responsáveis pela prática de conservação dos imunobiológicos.

[The vaccine cold chain in a Valencian health department (Spain)]

OBJECTIVE

To evaluate the cold chain in the vaccination points of a health department in the autonomous region of Valencia, including training of the staff responsible for the cold chain.

METHOD

We performed a crosssectional study to review all the vaccination points (n = 50, with 68 refrigerators) of a health department in the autonomous region of Valencia. A structured questionnaire was used to gather information on the characteristics of the vaccination center, the staff responsible for the cold chain, the infrastructure and control of the elements composing the cold chain, the procedures used in vaccine conservation and handling, and knowledge of the staff.

RESULTS

The response rate was 100%. Most of the refrigerators were domestic refrigerators without alarm systems to alert staff to technical failure or electrical cuts (76.7%), open door alarm (98.5%), external thermometer (92.6%), automatic defrosting facilities (76.5%), internal temperature sensors or connection to emergency circuits (85.3%). Temperatures were mostly in the correct range (83.9%) and the vaccines were correctly located (88.2%). At least one staff member was responsible for the vaccines in all centers. Food was found in 33.8% of the refrigerators, vaccines were conserved on the vaccination table on the day of vaccination in 32.4%, and the temperature chart was not recorded daily in 75%.

CONCLUSION

The appropriate temperature was maintained in five out of every six refrigerators. However, the vaccine infrastructure in primary care centers, as well as training of the staff responsible for the cold chain, should be improved.