Effective Vaccine Management Research Articles

Vaccine storage and stock management practices in Vihiga County, Kenya.

Effective vaccine management is crucial to maintain vaccine potency. To achieve this, elements, such as temperature management, stock management, infrastructure, cold chain equipment and waste management, need to be properly implemented. Therefore, this study was conducted to assess the vaccine storage and stock management practices in public health facilities within Vihiga County. A descriptive cross-sectional design was used. Eighty-six public health facilities were selected and one staff involved in handling vaccines from each facility participated in the study. The study utilised survey questionnaires and observational checklists to collect data. All facilities visited use standard vaccine requisition forms for ordering and receiving vaccines and physical stock counts are done in all facilities. The majority of immunising healthcare workers knew how to condition icepacks 88.4%; however, 57.0% did not know all the heat-, cold- and light-sensitive vaccines. Status of vaccine equipment, knowledge of healthcare workers and stock management practices were positively associated with vaccine cold chain management at 52.8%. Knowledge of vaccine handlers and stock management practices should be improved to enhance effective vaccine management. Besides, there is a need for the County Government of Vihiga to purchase sufficient WHO-recommended refrigerators.

IJCM_212A: Assessment of Effective Vaccine Management in Government Health Facilities of Jammu district

Background: The success of immunization depends highly on the level of cold chain maintenance. For effective implementation and success of the Universal Immunisation Programme, proper maintenance of Cold Chain needs a great focus. In 2010, WHO and UNICEF launched the Effective Vaccine Management (EVM) initiative. EVM is a tool which assesses immunization supply chain logistics management. Objectives: To evaluate the performance of Immunization supply chain in cold chain points of Government Health Facilities (HF) of Jammu district Methodology: A facility based cross-sectional study was conducted in Jammu district of UT of J&K. The assessment was done during November 2021– October 2022 using WHO-UNICEF EVM assessment standalone questionnaire generated on EVM assessor app. Sample size and site selection were done using the WHO EVM site selection tool(v1.7-March 2014). A total of 31 HFs were assessed including Divisional Vaccine Store (SN) Results: None of the health facilities reached the WHO recommended overall score of >80%. The criterion scores showed that Facility infrastructure and equipment (E4) and waste management (E9) for District Vaccine Store (LD) was 83% & 86%. Vaccine management (E8) score for SN level & Government Hospital was 88% & 82%. Rest of the CCPs scored less than 80% for all the criteria(E2-E9). The scores of distribution of vaccines and dry goods (E7) were very low for Primary Health Centres (PHC) and Health & Wellness Centres (H&WC) i.e., 39% and 25%. The scores for all the categories(C1-C6) for various CCPs were below 80%. Management criteria scores for supportive supervision(M3) was 0% for all CCP except LD &PHC Conclusion: The overall performance of cold chain in Jammu district was below the recommended level. Supportive supervision, provision of safe disposal pits, power backup, micro plan, training of Cold Chain Handlers and provision of vaccine transportation facility can help in effective vaccine management

A STUDY ON COLD CHAIN MAINTENANCE AND VACCINE MANAGEMENT PRACTICES OF URBAN GOVERNMENT HEALTH FACILITIES IN JABALPUR DISTRICT, INDIA

Introduction: Efficient cold chain and vaccine logistics management are made possible by the health system's processes, practices, and policies, which are evaluated by Effective Vaccine Management, a diagnostic tool. A significant number of urban Jabalpur children receive vaccinations from a government health facility.The aim of the study wasto Assessthe cold chain maintenance and vaccine management practices at urban government Cold Chain Points of Jabalpur district.Methods:A cross-sectional study was carried out at all of 13 urban government ColdChain Points across Jabalpur district. Globally validated World Health Organization -United Nations International Children's Emergency Fund Effective Vaccine Management tool was used for this study. Criteria wise and Consolidated Effective Vaccine Management scores were calculated as per World Health Organization guidelines. Results: All the urban service point stores or cold chain points scored more than the target 80% in two criteria: storage capacity and building. The consolidated criteria score of all the cold chain points in urban Jabalpur, criteria like maintenance, stock management, management information system, and supportive functions, were lagging behind the 80% mark. Low scores in maintenance, stock management, and management information system and supportive functions criteria are somehow a setback for all the preparationand hard work done towards optimal vaccine management and supply chain in the area. Conclusion: The overall performance of the urban cold chain points in Jabalpur district was far better as compared to the state-level effective vaccine management assessment done in Madhya Pradesh in 2011 and 2016. Planned preventive maintenance for buildings and equipment needs to be strengthened. Issues like Lack of information for stock management, need for periodic refresher trainings are to be emphasized.

Increasing the Coverage and Quality of Immunization Programs by Implementing Effective Vaccine Management (EVM) in Central Java

Immunization programs are highly dependent on an effective and efficient supply chain system for storing, transporting, and distributing vaccines. This ensures that the right products are available in the right place, at the right time, and under the right conditions to provide efficient health services to the public. This study aims to evaluate the implementation of Effective Vaccine Management (EVM) in Central Java and identify its obstacles. This study used a quantitative method with a cross-sectional approach. A descriptive analysis of vaccine management was carried out in 35 regencies/cities in Central Java. The population comprised EVM programmers in Central Java selected using the total sampling technique. Data were collected using the World Health Organization (WHO) assessment tools and in-depth interviews with pharmacy departments or person in charge of immunization programs in each regency/city. The results showed that five of the 35 regencies/cities had an average score of 80% and above across nine assessment indicators, but no region met the WHO standards of 80% across all the criteria assessed. The overall EVM assessment revealed that 20% of the regencies/cities fell into the low category, 65.7% in the medium category, and 14.3% in the high category. Each region had different problems in fulfilling the nine criteria of EVM assessment, such as inadequate infrastructure, lack of periodic vaccine stock recording, absence of standard operating procedures, and insufficiently trained officers. Therefore, support is needed from the Central Java Provincial Government in providing support to the regions with regular monitoring and evaluation of the EVM implementation. Additionally, officers need to be trained regarding proper vaccine management.

Assessment of vaccine management performance in health facilities of Mwanza Region, Tanzania: a cross-sectional study

BackgroundEffective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels and enhance the development of continuous improvement plan to strengthen the system. This study was conducted to determine the vaccine management performance in Health Facilities of Mwanza Region, Tanzania.MethodsThis was a descriptive cross-sectional study that was carried out in 102 health facilities providing immunization services from eights districts of Mwanza Region in Tanzania. The World Health Organization (WHO) effective vaccine management assessment tools were used to collected data. Both quantitative and qualitative (through key informant interviews) approaches were used. The quantitative data were analysed using the existing WHO criteria for analysing effective vaccine management assessment data, while deductive thematic analysis was used for the qualitative data.ResultsThe finding shows that the overall score for vaccine management performance was 53% which is below the WHO acceptable minimum score of 80%. None of the health facilities had reached the benchmark but only 67% had an average performance (> = 50–< 80%). The highest health facility score was 76% and the lowest being 27%. Among the categories assessed, the highest score was on information technology with 72%, while the lowest was on standard operating procedures with a score of 43%. The major challenges which contributed to low performance were lack of training, low knowledge about vaccine management practices, unavailability of standard operating procedures (SOPs), and limited financial resources to support operations for vaccine management practices. Skills gap, incomplete stock records and management, as well as low availability of SOPs were the key challenges reported that affected vaccine management practices.ConclusionsEffective vaccine management performance was low across all districts under the study. Increasing personnel capacity and ensuring availability of resources to support operations were reported as key interventions in improving vaccine management practices. Hence, effectively working on continuous improvement plan with key highlighted actions is highly recommended to all actors from national level to sub-national level managers and healthcare workers as frontline vaccine handlers.

Key lessons learned from the immunization supply chain of Malawi, an African country using EVM2.0

ObjectivesA country’s immunization system's effectiveness depends on its supply chain's efficacy. To assess the challenges of maintaining an efficient vaccine supply chain, Malawi conducted its assessment using The EVM2.0 tool (Effective Vaccine Management). MethodsIt is a cross-sectional study in which all EVM requirements were assessed between September and October 2021. Data were collected from eighty-two randomly selected sites using the site selection tool of the EVM. Data were entered into the EVM assessment tool 2.0 version 1.12 for analysis. This tool generates performance indicators and criteria scores for assessed sites, compared with a WHO minimum score of 80%. ResultsOverall criteria scores across all levels of the immunization supply chain showed a statistically significant mean difference of 5.92 (t = 2.58, P = 0.02). Comparative overall mean criteria scores across different levels of the immunization supply chain showed no statistically significant difference for primary (p = 0.76), sub-national (p = 0.69), and lowest distribution stores (p = 0.12). However, a substantial gap was found in the overall mean scores of the health facility’s service point (SP) (t = 4.12, P = 0.001). The overall category scores across all immunization supply chain levels did not show a statistically significant difference. However, among individual category scores, Infrastructure (76 %), Equipment (67 %), Policies and procedures (62 %), Financial (47 %), and Resources (64 %) were found to be below the WHO minimum score. ConclusionThough the 2021 Malawi EVM assessment findings are promising, they still identified the gaps to be improved to ensure the vaccine availability in the right amount, at the right time, and at the right cost.

Ensuring vaccine potency and availability: how evidence shaped Gavi's Immunization Supply Chain Strategy

BackgroundIn 2014, Gavi and partners developed a global Immunization Supply Chain (iSC) Strategy, 2015–2020, which prioritized functioning cold chain equipment (CCE) and additional storage capacity. In 2016, Gavi launched the Cold Chain Equipment Optimization Platform (CCEOP) as a funding mechanism to improve CCE availability. In 2018, Gavi commissioned an evaluation of CCEOP in Guinea, Kenya and Pakistan. The global iSC Strategy has recently been revised, drawing on findings from effective vaccine management assessments and practical experiences. This case study presents the CCEOP evaluation and how its findings reinforced the revision of the iSC strategy.MethodsThe CCEOP evaluation used a prospective mixed-methods research design in all three countries involving key informant interviews at multiple levels of the health system, document reviews, direct observation (as and when possible), and a health facility assessment.ResultsResults show that CCEOP was effective at increasing the number of available and reliable CCE, and establishing improved management processes using the project management team (PMT) approach for country management systems and the service bundle provider approach for installation and maintenance. CCEOP also extended the iSC and immunization services in countries. The evaluation results also show gaps in the overall supply chain system, including CCE maintenance.DiscussionGavi has recently revised its iSC strategy, which has addressed gaps identified through assessments and practical experiences from stakeholders. Results of the CCEOP evaluation reinforce many of these findings. The strategy now provides more emphasis on supporting the fundamental infrastructure and establishing strong processes for maintenance. It also emphasizes strategic planning and forward thinking for iSC decisions, building on the processes established for the PMT through CCEOP. The original iSC strategy was an impetus for the establishment of CCEOP. The new strategy reflects shifting trends and priorities to fill gaps identified through practical experience, advocated for by stakeholders and thought leaders engaged in the iSC, and validated by the evaluation. It demonstrates the importance of aligning stakeholders with clear objectives and a sound strategy.

Immunogenicity and safety of an intradermal ChAdOx1 nCoV-19 boost in a healthy population

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a global pandemic. Two doses of an inactivated SARS-CoV-2 vaccine (CoronaVac) have been shown to be insufficient to protect against variants of concern (VOCs), while viral vector vaccines remain protective against the infection. Herein, we conducted a preliminary study to evaluate the safety and immunity in an adult population who received the conventional 2 dosage-regimen of inactivated SARS-CoV-2 vaccine; with an additional intradermal ChAdOx1 nCoV-19 reciprocal dosage (1:5). An Intramuscular ChAdOx1 nCoV-19 booster was also included as a control. Immediate and delayed local reactions were frequently observed in the fractional intradermal boost, but systemic side effects were significantly decreased compared to the conventional intramuscular boost. The anti-RBD-IgG levels, the neutralising function against delta variants, and T cell responses were significantly increased after boosting via both routes. Interestingly, the shorter interval elicited higher immunogenicity compared to the extended interval. Taken together, a reciprocal dosage of intradermal ChAdOx1 nCoV-19 booster reduces systemic adverse reactions and enhances non inferiority humoral and cellular immune responses compared to a full dose of intramuscular boosting. These findings provide for an effective vaccine management during the shortages of vaccine supply.

Strengthening pre-service training of healthcare workers on immunisation and effective vaccine management: the experience of Kenya Medical Training College.

Pre-service health training institutions have a key role in training qualified medical and nursing staff deployable in immunisation programmes, making them capable of addressing complex situations, sustaining routine immunisation and introducing new vaccines and technologies. The incorporation of immunisation-related content into nursing and midwifery education is essential to improve and strengthen immunisation service delivery, disease surveillance, logistics, communication and management practices. Clinical and public health training incorporating learning objectives on immunisation that are specific to the Expanded Programme on Immunisation (EPI), will enable students to develop a firm basis of core knowledge and skills in immunisation. To assist health training institutions in the African Region and to facilitate the systematic revision of EPI curricula, two prototype curricula, one for medical and one for nursing/midwifery schools, were developed by WHO/AFRO, NESI/University of Antwerp and other partners in 2006 and revised in 2015. Kenya Medical Training College (KMTC) has been at the forefront in revising and updating their institutional EPI curriculum for the pre-service Kenyan Registered Community Health Nursing programme based on the EPI prototype curriculum. Building on the successful strengthening of the EPI curriculum, KMTC will now embark on improving education and training for effective vaccine and cold chain management for selected training programmes. The different steps taken by KMTC to strengthen EPI teaching and learning can support other health training institutions who are willing to integrate the content of the EPI prototype curriculum in their own institutional curricula by adapting them to the local context.

Strengthening the immunization supply chain through EVM assessment: Comparing India's two successive national assessments.

Effective immunization supply chain (iSC) is crucial for safe and timely transport of potent vaccines to the beneficiary. India's iSC, with a network of ~29,000 cold chain points (CCP), measures its quality standards using the World Health Organization-United Nations International Children's Emergency Fund (WHO-UNICEF) global tool on effective vaccine management (EVM). The two national EVM assessments (EVMA) were conducted in 2013 and 2018. This study helps to see the impact of policies and practices through EVMA in maintaining an efficient iSC for effective implementation of immunization program. We conducted a desk analysis using EVMA reports to summarize and compare the findings of the two studies. Cut-off of 80% was considered ideal for each category/criteria score. Both EVMA 2013 and 2018 were conducted using Android-based global EVM tool, though across a wider sample of CCP. Maximum and minimum changes in scores were sub-national and lowest distribution (16% each) and national buffer stores (7%), respectively. Maximum and minimum improvements were seen in vaccine management (29%) and MIS and supportive functions (3%), respectively. The improvement was statistically significant for the overall scores (P = 0.02), primary (P = 0.01), subnational (P = 0.02), and lowest distribution stores (P = 0.03). Among the 36 recommendations of 2013 assessment, 78% and 22% were fully and partially implemented (or ongoing), respectively. Implementation of EVM recommendations has significantly led to improvement and continues to provide a benchmark for iSC and its processes. Follow-up assessments every 3-5 years can further help to evaluate iSC and ascertain the impact of recommendations.

Immunogenicity and Safety of an Intradermal BNT162b2 mRNA Vaccine Booster after Two Doses of Inactivated SARS-CoV-2 Vaccine in Healthy Population.

Effective vaccine coverage is urgently needed to tackle the COVID-19 pandemic. Inactivated vaccines have been introduced in many countries for emergency usage, but have only provided limited protection. Heterologous vaccination is a promising strategy to maximise vaccine immunogenicity. Here, we conducted a phase I, randomised control trial to observe the safety and immunogenicity after an intradermal boost, using a fractional dosage (1:5) of BNT162b2 mRNA vaccine in healthy participants in Songkhla, Thailand. In total, 91 volunteers who had been administered with two doses of inactivated SARS-CoV-2 (CoronaVac) were recruited into the study, and then randomised (1:1:1) to received different regimens of the third dose. An intramuscular booster with a full dose of BNT162b2 was included as a conventional control, and a half dose group was included as reciprocal comparator. Both, immediate and delayed adverse events following immunisation (AEFI) were monitored. Humoral and cellular immune responses were examined to observe the booster effects. The intradermal booster provided significantly fewer systemic side effects, from 70% down to 19.4% (p < 0.001); however, they were comparable to local reactions with the conventional intramuscular booster. In the intradermal group after receiving only one fifth of the conventional dosage, serum Anti-RBD IgG was halved compared to the full dose of an intramuscular injection. However, the neutralising function against the Delta strain remained intact. T cell responses were also less effective in the intradermal group compared to the intramuscular booster. Together, the intradermal booster, using a fractional dose of BNT162b2, can reduce systemic reactions and provides a good level and function of antibody responses compared to the conventional booster. This favourable intradermal boosting strategy provides a suitable alternative for vaccines and effective vaccine management to increase the coverage during the vaccine shortage.

Cold Chain Maintenance and Vaccine Stock Management Practices at Public Health Centers Providing Child Immunization Services in Jimma Zone, Oromia Regional State, Ethiopia: Multi-Centered, Mixed Method Approach.

BackgroundCold chain maintenance is the spine of an immunization program.ObjectiveTo examine the status of cold chain maintenance and evaluate knowledge of cold chain handlers and practices of vaccine management at public health centers providing immunization services in Jimma zone.MethodsAn institutional-based cross-sectional study supplemented with a qualitative method was conducted in 41 randomly selected health centers providing immunization service in districts of Jimma zone from October 31 to November 30, 2019. Pre-tested self-administered questionnaires and observation checklists developed from an effective vaccine management assessment tool (EVMAT) were used to collect quantitative data. Key informants were selected using the purposive sampling technique and an in-depth interview was conducted. Quantifiable data were analyzed using SPSS version 20 and chi-square was used to test the presence of association (p-value <0.05). Qualitative data were analyzed by thematic analysis and triangulated with quantitative findings.ResultsAll public health centers had at least functional ice-lined refrigerators while 28 (68.3%) public health centers had functional deep freezers. Of the cold chain handlers, 120 (82.9%) had fair knowledge. Vaccine storage was appropriate per the World Health Organization's vaccine storage code in ice-lined refrigerators in 11 (24.4%) public health centers. Cold chain handlers’ years of service, types of training, availability of funds for cold chain maintenance, and availability of cold chain equipment at public health centers showed the presence of significant association with vaccine cold chain management practice.ConclusionThe majority of cold chain handlers showed inadequate knowledge while a significant number showed poor practice of preserving the vaccines’ cold chain. Cold chain maintenance was not adequate in public health centers, necessitating attentive efforts of providing proper management of vaccine cold chains at immunization delivery points.

No COVID-19 vaccines on trash! Exploring effective vaccine management in the Philippines.

No COVID-19 vaccines on trash! Exploring effective vaccine management in the Philippines.

Effective vaccine management through social behavior change communication: Exploring solutions using a participatory action research approach in the Solomon Islands

Addressing vaccine management bottlenecks, including high vaccine wastage rates, has traditionally been addressed through health worker training and other didactic methods of technical assistance or support as required. It has been shown, though, that the high level of technical skills, expertise, and responsibility required in vaccine handling and management cannot be achieved by mere didactic learning. While gains have been made in vaccine management and handling with these approaches, there remain challenges of high vaccine wastage rates and poor vaccine management practices across the board. Interestingly, approaching vaccine management through social behavior change has not been documented. Through Participatory Action Research (PAR), which is increasingly being used in health sciences, we explore an attempt at strengthening vaccine management and thus reducing high vaccine wastage rates by working together with health workers to identify plausible, realistic solutions to vaccine management through social behavior change. Select health workers directly involved with the immunization program in the four major provinces of the Solomon Islands were identified purposively to use action media and come up with concepts and materials for social behavior change communication that will have an impact on effective vaccine management and reducing wastages. This is the first documented use of such methodology in addressing vaccine management issues.

Evaluation of Application of Effective Vaccine Management in Wassit Governorate, Iraq

Background: Immunization helps save a life, protect serious illness, and improve quality of life. It is recognized as one of the most cost-effective public health interventions available around the globe. However, the success of this program is heavily dependent on strong immunization supply chain practices. Proper immunization supply chain management ensures availing potent and live vaccines to the community. Objective: To evaluate the application of effective vaccine management in health facilities of Wassit Governorate, Iraq. Subjects and Methods: It was a cross-sectional study involving a multistage sampling. A total of 45 health facilities sites were selected, as follows: one sub-national store (SN), six district store (LD), and thirty eight service point (SP) by using effective vaccine management (EVM) questionnaire, interview, reviewing the records, and observations for the agreed review period. Results: The overall scores of this assessment for all levels (SN, LD, and SP) of the supply chain 66.6% demonstrates a need for more improvement in most areas of the vaccine and supply management system as only two criteria (storage capacity E3 and vaccine management practices E8) exceeds the WHO recommended minimum score of 80%. Performance levels of one criteria (building, equipment E4) were about 72% storage temperature (E2), maintenance(E5) and stock management (E6) were between 61 and 68%, while the vaccine distribution (E7), and information management (E9) were notably very weak with performance in each category less than 60%. Conclusions: The national average percentage at all levels was below the WHO recommended minimum score of 80%. Recommendation: The future vaccine storage capacity must be recalculated and stored to enter any new vaccine, receive large quantities of the influenza vaccine, and replace vaccine refrigerators at the sector level with cold rooms to accommodate current and future increases.

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

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. 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. The assessment was done during December 2017-March 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. 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. 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.

Effective Vaccine Management: The Case of a Rural District in Ghana.

Background The Effective Vaccine Management (EVM) initiative provides the platform needed to monitor and assess the vaccine supply chain system to identify strengths and weaknesses of the system at all levels to enhance the development of improvement plan to strengthen the system. This valuation was carried out in the Tolon District of the Northern Region, Ghana. Methods A descriptive valuation of vaccine management was carried out in six vaccine stores in the Tolon District of Northern Ghana. We employed World Health Organization (WHO) assessment tools and procedures which consisted of desk reviews and interviews of cold chain managers to assess vaccine management practices in the district. Five out of the nine global assessment criteria were assessed and a minimum target level required for all criteria to meet the WHO standard was 80%. Results None of the facilities assessed met the WHO benchmark of 80% for all but one criteria assessed. With regards to temperature control, the scores ranged from 42% at Kasuliyili CHPS Centre to 77% at the district store with an average district score of 60%. Stock management ranged between 11% at Wantugu Health Centre and 75% at Nyankpala Health Centre with district average score of 32%. Effective vaccine distribution scores ranged between 13% at Kasuliyili CHPS and 46% at Nyankpala Health Centre with an average district score of 27%. Only Nyankpala Health Centre had an acceptable score of 84% for vaccine management, whereas the lowest score for this indicator was 5% at Tolon Health Centre store with district average score of 53%. Information management and supportive functions scores ranged from 0% at Tolon Health Centre to 26% at the district store with the district average score of 16%. Nineteen (90.5%) of vaccine users had poor knowledge regarding temperature control and vaccine distribution. Conclusion Effective vaccine management knowledge and practices are poor at Tonlon district and calls for urgent and pragmatic approaches such as training and re-training of vaccine users at all levels.

Seasonal transmission dynamics of measles in China.

Measles, a highly contagious infection caused by the measles virus, is a major public health problem in China. The reported measles cases decreased dramatically from 2004 to 2012 due to the mandatory measles vaccine program started in 2005 and the goal of eliminating measles by 2012. However, after reaching its lowest level in 2012, measles has resurged again since 2013. Since the monthly data of measles cases exhibit a seasonally fluctuating pattern, based on the measles model in Earn et al. (Science 287:667-670, 2000), we propose a susceptible, exposed, infectious, and recovered model with periodic transmission rate to investigate the seasonal measles epidemics and the effect of vaccination. We calculate the basic reproduction number [Formula: see text], analyze the dynamical behavior of the model, and use the model to simulate the monthly data of measles cases reported in China. We also carry out some sensitivity analysis of [Formula: see text] in the terms of various model parameters which shows that measles can be controlled and eventually eradicated by increasing the immunization rate, improving the effective vaccine management, and enhancing the awareness of people about measles.

Assessment of Cold Chain System for Routine Immunization of Primary Health centres of the Bhojpur district of Bihar

Background: Immunization is an important among activity in the Public Health Services. The vaccines are highly temperature sensitive and vaccine potency once lost cannot be restored. A well-managed cold chain will increase the efficiency of immunization and reduce vaccine wastage. An assessment of cold chain system for vaccine storage was done in the all PHCs of the study area. Aims &amp; Objectives: To evaluate the cold chain practices, with particular reference to assessing the availability of cold chain equipment, vaccine storage practices, monitoring of cold chain in primary health centres (PHCs) of Bhojpur district. Material &amp; Methods: A cross-sectional study was conducted at all the cold chain points of 14 PHCs of Bhojpur district during January to May 2015. A predesigned, pretested checklist was used by the trained investigators during their visits. The information was evaluated on the basis of important components related to the cold chain points. Results: All the PHCs had a dedicated cold chain room with sufficient number of cold chain equipment. Consolidated effective vaccine management score for cold chain points of 8 (57.1%) PHCs were average (60-79%). None of the PHCs have satisfactory score (? 80%). Vaccine storage practice and availability of complete RI micro-plan were found satisfactory at 12 (85.7%) PHCs. Maintenance of cold chain equipment were satisfactory at 10 (71%) PHCs. But, temperature monitoring. (5) (35.7%) and waste disposal related to routine immunization 3 (21.4%) PHCs were disappointing. Conclusion: The primary health centres had average performance related to the cold chain system, which is a matter of concern warranting for the cold chain monitoring. We recommend supportive supervision as the key measures in improvement of cold chain system.

Effective vaccine management and Oman's healthcare system's challenge to maintain high global standards.

The prevention of infection through vaccination has been among the most successful public health interventions. Nearly 2.5 million deaths per year globally are saved by immunization against vaccine-preventable disease (VPD) (WHO, 2013) [1]. Oman has experienced a sharp decline in VPDs over the last 40 years due to the introduction of new vaccines and the maintenance of high vaccination coverage of over 99%. The World Health Organization (WHO) and the United Nations Children's Fund (UNICEF) launched the effective vaccine management (EVM) framework to assist countries to gauge the performance of their immunization supply chains. Oman underwent the assessment in 2016 and scored the best score to date. This report looks at the process of EVM and the challenges for the Oman healthcare system to maintain high global standards.