Vaccine Handling Research Articles

Immunogenicity and safety of an 18-month booster dose of the VLA15 Lyme borreliosis vaccine candidate after primary immunisation in healthy adults in the USA: results of the booster phase of a randomised, controlled, phase 2 trial

Incidence rates of Lyme borreliosis, a tickborne disease attributed to infection by Borrelia species, are increasing, and limitations to existing treatments potentiate the possibility of severe outcomes. Nevertheless, there are no licensed vaccines for Lyme borreliosis prevention in humans. This study investigated the immunogenicity and safety of a booster dose of VLA15, an investigational outer surface protein A (OspA)-based Lyme borreliosis vaccine that has previously shown safety and immunogenicity when administered as a primary vaccination series, following a primary VLA15 vaccination series. We report the results of the booster phase of a randomised, observer-blinded, placebo-controlled, multicentre, phase 2 study that enrolled healthy adults aged 18-65 years from five US clinical study centres to receive 135 μg or 180 μg VLA15 or placebo at months 0, 2, and 6 in the main study phase. Participants who received 180 μg VLA15 in the main study phase and did not have relevant protocol deviations were eligible for the booster phase (months 18-30). Participants were randomly reassigned (2:1) to receive an intramuscular injection of a VLA15 booster or placebo 1 year after the completion of primary vaccination (month 18) via a randomisation list generated by an unmasked statistician with a block size of six. Individuals involved in data safety monitoring, rerandomisation, vaccine handling, and vaccine accountability were unmasked; the study sponsor and statisticians were only unmasked after analysis of data up to 1 month after booster administration. All other individuals remained masked throughout the booster phase. The outcomes for the booster phase were the immunogenicity (evaluated in the booster per-protocol population) and safety (evaluated for all participants who received the booster) of the booster dose up to month 30. The study is registered at ClinicalTrials.gov (NCT03970733) and is completed. Between Feb 4 and March 23, 2021, 58 participants (28 men and 30 women) were screened, randomly assigned, and received VLA15 (n=39) or placebo (n=19). One participant in the placebo group was lost to follow-up. The IgG geometric mean titres for each OspA serotype (serotypes 1-6) in the VLA15 group peaked at 1 month after the booster dose (1277·0 U/mL [95% CI 861·8-1892·3] to 2194·5 U/mL [1566·8-3073·7] vs 23·6 U/mL [18·1-30·8] to 36·8 U/mL [26·4-51·3] in the placebo group [p<0·0001 for all serotypes]), remained elevated at month 24 (137·4 U/mL [95·8-196·9] to 265·8 U/mL [202·9-348·2] vs 22·3 U/mL [17·7-28·0] to 29·1 U/mL [20·8-40·6] in the placebo group; p<0·0001 for all serotypes), and declined by month 30 (54·1 U/mL [38·6-75·7] to 101·6 U/mL [77·6-133·1] vs 21·9 U/mL [18·0-26·6] to 24·9 U/mL [19·0-32·6] in the placebo group; p<0·0001 for all serotypes except serotype 1 [p=0·0006]). Solicited local adverse events were reported more frequently in the VLA15 group (35 [92%, 95% CI 79-97] of 38 participants) than the placebo group (six [32%, 15-54] of 19 participants; p<0·0001) after booster vaccination. There was no significant difference in the frequency of solicited systemic adverse events between groups (20 [59%, 42-74] of 34 participants in the VLA15 group vs six [38%, 18-61] of 16 participants in the placebo group). Related unsolicited adverse events (none severe) were reported by two (5%, 1-17) of 39 participants in the VLA15 group and none (0%, 0-17) of 19 participants in the placebo group. There were no severe solicited local or systemic adverse events or deaths during the study. A booster dose of VLA15 is safe and induces substantial anamnestic immune responses against all six OspA serotypes. As with previously investigated OspA-based Lyme borreliosis vaccines, waning immune responses were observed with VLA15, and annual boosters might therefore be required. Valneva.

Availability, storage, handling and administration of vaccines in community pharmacies: Southwest Nigeria as a case study

Background: Vaccines have been instrumental in thwarting the spread of infectious diseases and have been a major public health success. Community pharmacies are a critical resource for success of any immunization programme. However, pharmacists’ involvement in immunization programme in Nigeria has not been thoroughly investigated. This study assessed the involvement of pharmacists in immunization services.Methodology: A cross-sectional survey was conducted among community pharmacists, using a structured pre-tested questionnaire. The survey tool, which consisted of 72-item questions spread over five different domains, assessed vaccine availability in community pharmacies and pharmacist’s knowledge on vaccine. This (knowledge) addresses vaccine handling and administration as well as storage. The questionnaire was administered to selected community pharmacies by a combination of physical interview and electronic version through Google form link sent to pharmacist’s WhatsApp platform. Association between patients’ socio-demographics and some variables of interest was determined using Chi-square statistic.Result: One hundred and ninety-one (191) pharmacists responded to the questionnaire (99.5% response rate). About half, one hundred and three (53.93%) of the respondents were aged between 31 and 50 years. One hundred and twenty-nine (67.54%) of the pharmacists had B.Pharm degree as the highest level of education. There was a significant association between pharmacists’ age (χ2 = 30.5, p&lt;0.01), years of experience (χ2 = 25.9, p&lt;0.01), level of education (χ2 = 19.6, p&lt;0.05) and knowledge on vaccine handling and administration. Also, significant association (p&lt;0.01) existed between pharmacists’ age (χ2 = 45.1), years of experience (χ2 = 45.3), level of education (χ2 = 31.6) and knowledge of vaccine storage. Furthermore, there was a significant association (p&lt;0.01) between being trained as a vaccine administrator and level of knowledge on vaccine storage (χ2 = 57.8) as well as handling and administration (χ2 = 45.2).Conclusion: Pharmacists’ level of education and training (as vaccine administrator) were key factors in pharmacists’ involvement in immunization care service.

Knowledge, attitudes, and practices of vaccinators about expanded programs on immunization: a cross-sectional study.

The periodic evaluation of knowledge, attitudes, and practices (KAP) of healthcare workers, including vaccinators, concerning expanded programs on immunization (EPI) is very crucial for a better healthcare system. This study was carried out to assess the KAP of vaccinators about the EPI, including cold storage of vaccines and their practices related to vaccine cold chain management. A cross-sectional study was conducted from January 2022 to June 2022 among registered vaccinators in the twin cities (Islamabad and Rawalpindi) of Pakistan. A structured self-administered questionnaire (English and Urdu) was developed as per the Pakistan national EPI policy and strategic guidelines 2022 and World Health Organization (WHO) guidelines, as well as from earlier studies (Cronbach's alpha value of 0.734). The final questionnaire consisted of closed-ended questions in four sections, including sociodemographic information, knowledge (with dichotomous variables of yes/no), attitudes (with a 5-point Likert scale ranging from strongly agree to strongly disagree), and handling of vaccines and cold chain management. Completed questionnaires were entered into Microsoft Excel and then imported into SPSS version 25 for statistical analysis. A total of 186 vaccinators completely filled out their questionnaires, with a 97.9% response rate. More than half of the participants (57.5%) had no training related to EPI. Most of the respondents had a moderate to poor level of knowledge regarding EPI. The overall attitude was positive, and 57% of the participants strongly agreed that the national immunization programs can significantly contribute to the decrease in morbidity and mortality rates among children. In the current study, participants showed good practices toward EPI, vaccine storage, and cold chain management. The majority (93.5%) of the participants checked the expiry of vaccines at regular intervals to maintain the first expiry first out (FEFO) in their healthcare setting. In conclusion, most of the vaccinators had moderate to poor knowledge, a positive attitude, and good practices toward EPI, vaccine cold storage, and cold chain management. Lack of training among vaccinators on EPI was also observed. These findings have suggested that continuous training, education, and regular supervision of vaccinators in EPI are important for maximum immunization effectiveness and coverage.

Veterinary Vaccines: Unlocking the Power of Immunization for Livestock Health — A Review

Vaccines are all biological substances produced from living things and administered to trigger the host’s body defense system to develop immunity against a specific pathogen from which they were produced. They work by stimulating either humoral or cell-mediated immunity, or both, to differentiate. There are several types of vaccines, like live attenuated, killed, or inactivated vaccines, cell membrane compounds, or toxoids. Vaccines are important for disease prevention, enhancing the efficiency of food production, and reducing or preventing transmission of zoonotic and foodborne infections to people. Even though vaccination is the most powerful and cost-effective weapon of disease prevention, there are several factors such as alterations in the vaccines, maternal antibodies, immunosuppression, wrong timing of vaccination, missing booster vaccination, inadequate dosage, and adjuvants used in the vaccine that can cause vaccine failure. Therefore, Care should be taken in vaccine handling, storing, transporting, and administering; care should be taken in the timing of vaccination; serotypes of agents should be identified before preparing vaccines; and there should be a training program for people who are involved in vaccination, vaccine storage, and handling activities to ensure vaccine potency and maximize effectiveness.

A Retrospective Study of Outbreak and Vaccination on Measles Inflammation

Background: Measles is a highly infectious viral disease as a significant global public health concern, particularly in low-income countries with inadequate healthcare facilities. This study determined the prevalence and risk factors of measles infection, vaccination rates, and surveillance effectiveness in Babylon and Karbala provinces of Iraq from 2020 to 2022. Method: Surveillance data on suspected and confirmed measles cases were collected and analyzed using descriptive statistics and multivariate logistic regression models. Results: Results showed that males, children aged 1-10 years, and residents of rural areas, particularly Ain Al-Tammr/Karbala, were more susceptible to measles. 93 confirmed measles cases were reported, with 13 in Babylon and 80 in Karbala. Non-vaccinated individuals had a significantly higher risk of infection. The study found 11 confirmed cases among vaccinated and unknown individuals, while 71 cases were among non-vaccinated individuals. Vaccine efficacy varied, indicating challenges in achieving effective community immunity. Poor vaccination coverage was attributed to administrative issues, inadequate resources, and vaccine hesitancy. Males were disproportionately affected compared to females. Conclusion: The study demonstrated the importance of strengthening vaccination programs, improving surveillance systems, and enhancing public awareness to combat measles outbreaks and reduce morbidity and mortality, especially among vulnerable populations. Improvements in vaccine coverage, proper vaccine handling, and prompt reporting of suspected cases are all necessary to eliminate measles from Iraq, with a special focus on the provinces of Babylon and Karbala.

A risk science perspective on vaccines.

Vaccines can be seen as one of the greatest successes in modern medicine. Good examples are the vaccines against smallpox, polio, and measles. Unfortunately, vaccines can have side effects, but the risks are considered by the health authorities and experts to be small compared to their benefits. Nevertheless, there are many who are skeptical of vaccination, something which has been very clearly demonstrated in relation to the COVID-19 disease. Risk is the key concept when evaluating a vaccine, in relation to both its ability to protect against the disease and its side effects. However, risk is a challenging concept to measure, which makes communication about vaccines' performance and side effects difficult. The present article aims at providing new insights into vaccine risks-the understanding, perception, communication, and handling of them-by adopting what is here referred to as a contemporary risk science perspective. This perspective clarifies the relationships between the risk concept and terms like uncertainty, knowledge, and probability. The skepticism toward vaccines is multifaceted, and influenced by concerns that extend beyond the effectiveness and safety of the vaccines. However, by clarifying the relationships between key concepts of risk, particularly how uncertainty affects risk and its characterization, we can improve our understanding of this issue.

Effectiveness of Vaccines and Barriers Against Effective Cold Chain Systems

Vaccination is often considered a cost-effective strategy for the prevention and control of most infectious diseases or vaccine-preventable diseases. Poverty, ignorance, cultural belief and practices, locality of residence, level of awareness on vaccine safety and lack of access to health care facilities are among the obstacles to vaccination leading to low vaccine coverage. Low vaccine coverage among young children across remote and rural areas, slums and riverine areas is not a reflection of the health and social-related Sustainable Development Goals. Poor handling of vaccines has been identified as one of the reasons for the reduction in vaccine effectiveness at the time of administration. Cold chain is the system of transporting, storing and distributing vaccines in a viable state at the recommended temperature from the point of manufacture to the point of use. Some factors contributing to the weakness of the cold chain are delays during transportation, quality of refrigerators, method of storage, period of storage at the health facility, improper use of refrigerators, equipment breakage, lack of trained personnel capable of managing the cold chain, unreliable power sources and limited resources (material, financial, and human). Mediscope 2023;10(1): 38-41

Evaluation of Cold Chain Equipment Platform Solar Fridges Project in Upper Nile State Republic of South Sudan

BACKGROUND: A cold chain is a temperature-controlled supply chain with uninterrupted chain of activities that maintain a given temperature range that keep and maintain the quality of vaccines. Vaccines move through complex procedures and processes that require special attention and care. Effective cold chain systems require efficient end-to-end vaccine storage, handling, and stock management to maintain vaccines under strict temperature control of between 2 &amp;deg;C and 8 &amp;deg;C (for almost all vaccines). &#x0D; &#x0D; METHODS: A descriptive cross-sectional study design and mixed (qualitative and quantitative) research approach is employed to conducting the research. Data were collected through face to face in-depth interviews and questionnaires from Vaccinators and key persons from IPs. Prior to data collection, ethical approval was obtained from national Ministry of Health, Directorate of planning and M&amp;amp;E, and the University of Rwanda, Research Committee Board. Accordingly, data were collected after seeking the personal consent sought from the participants. &#x0D; &#x0D; RESULTS: The key findings from this study showed that the cold chain coverage has been improved compared to the result obtained in EPI coverage survey conducted in 2017. The results revealed that inadequate availability of EPI cold technicians, lack of fridge spare parts, trained staff, and adequate vaccine forecasting was the major challenges at county and the health facility level. &#x0D; &#x0D; CONCLUSIONS: The main factor that contributed positively in strengthening vaccines supply chain system in the Upper Nile State was the substantive increase in cold chain coverage. However, the role of the CCEOP in improving immunization coverage is still doubted due to lack of regular preventive maintenance, spare parts, and EPI technicians. The major challenges that affect the vaccines relevance, effectiveness, efficiency and sustainability were found to be mainly poor vaccines handling, due to inadequate knowledge on cold chain management.

Improving Vaccination Rates in the Clinical Setting.

Pediatric providers can consider using the 5 P's paradigm for process improvement to optimize vaccination rates in the clinical settings: People, Processes, Pharmacy principles, Pain prevention, and Presumptive vaccine communications. Maintaining high clinical setting vaccination rates requires hiring and training the right people with vaccination details for the population being served, perfecting safe vaccine delivery processes including when and where to vaccinate, using pharmacy principles for proper vaccine storage and handling, operationalizing proper pain prevention for consistent care, and providing clear presumptive vaccine communications for success. A dedicated role of Vaccine Specialist or a clearly defined Vaccine Champion serves as the content expert of the 5 P's in the clinical setting who is critical to improving and sustaining high vaccination rates. The 5 P's Checklist for increased vaccination rates can be a tool for success in achieving and sustaining high vaccination rates in clinical settings such as ambulatory clinics, pharmacies, and school-based vaccination events. [Pediatr Ann. 2023;52(3):e89-e95.].

Development of an organisational model for the preparation of the mRNA-bnt162B2 vaccine: the experience of the Clinical Galenics Laboratory of the Hospital Pharmacy of the Mauriziano Hospital, Turin

The centralised preparation of the mRNA-bnt162B2 vaccine at the Clinical Galenics Laboratory of the Hospital Pharmacy of the Mauriziano Hospital in Turin is an organisational model designed to guarantee the quality of the drug to be administered, the safety of both the vaccinee and the vaccinating personnel, and the traceability of all operations performed. The preparation in ready-for-use syringes individually packaged and labelled, according to the Good Manufacturing Practice (GMP) of the Official Pharmacopoeia, was entrusted to the Biomedical Laboratory Technician (BLT) under the responsibility of the Hospital Pharmacist. In compliance with the GMP, the model was developed through dedicated premises, specific staff training and written procedures concerning the handling of vaccines. The entire production process was guaranteed by: a Hospital Pharmacist and two interchangeable BLTs, one preparer and one assistant. They were necessary to maintain the aseptic technique and the cross-checking of all operations. Labels were prepared showing qualitative-quantitative composition, batch and expiry date, validity of the preparation, pharmacist's signature. The label applied to each syringe, together with the daily work plan, ensured traceability of the process at every stage. The efficient model proposed has always proved adaptable to the changes that characterised the vaccination campaign. From 27/12/2020 to 31/03/2022 a total of 48.017 doses were prepared. The centralisation of the vaccine preparation in the Clinical Galenics Laboratory of the Hospital Pharmacy also reduced handling errors, as well as the waste from unused residues, which proved to be only 0.08%.

Development of an organisational model for the preparation of the mRNA-bnt162B2 vaccine: the experience of the Clinical Galenics Laboratory of the Hospital Pharmacy of the Mauriziano Hospital, Turin

The centralised preparation of the mRNA-bnt162B2 vaccine at the Clinical Galenics Laboratory of the Hospital Pharmacy of the Mauriziano Hospital in Turin is an organisational model designed to guarantee the quality of the drug to be administered, the safety of both the vaccinee and the vaccinating personnel, and the traceability of all operations performed. The preparation in ready-for-use syringes individually packaged and labelled, according to the Good Manufacturing Practice (GMP) of the Official Pharmacopoeia, was entrusted to the Biomedical Laboratory Technician (BLT) under the responsibility of the Hospital Pharmacist.In compliance with the GMP, the model was developed through dedicated premises, specific staff training and written procedures concerning the handling of vaccines. The entire production process was guaranteed by: a Hospital Pharmacist and two interchangeable BLTs, one preparer and one assistant. They were necessary to maintain the aseptic technique and the cross-checking of all operations. Labels were prepared showing qualitative-quantitative composition, batch and expiry date, validity of the preparation, pharmacist’s signature. The label applied to each syringe, together with the daily work plan, ensured traceability of the process at every stage.The efficient model proposed has always proved adaptable to the changes that characterised the vaccination campaign. From 27/12/2020 to 31/03/2022 a total of 48.017 doses were prepared. The centralisation of the vaccine preparation in the Clinical Galenics Laboratory of the Hospital Pharmacy also reduced handling errors, as well as the waste from unused residues, which proved to be only 0.08%.

Assessment on Vaccine Supply Chain and Logistics Systems in the Case of Ethiopian Pharmaceuticals Supply Agency JIMMA Branch

Immunization helps save lives, protects serious illness and is recognized as one of the most effective public health intercessions and available today. However, the success of the programs depends heavily upon the immunization supply chain management including storage, transportation, and handling of vaccines in a proper manner. It was, therefore, important to assess the immunization supply chain and logistics practice. The study was conducted at the EPSA Jimma branch. Purposive sampling methods were used because the hub has completed the Woreda level vaccine transition and have a better experience in vaccine management. Moreover, all staffs (7) who directly engage in vaccine management were a respondent in this study. The primary data was collected using structured questionnaires and Standard checklist observation. In addition, secondary data was collected from documents and recordings from the manual and electronic recording tools. Qualitative and quantitative data were collected and analyzed according to their type. For the analysis of the quantitative data descriptive statistics supported by SPSS software version 20 was applied, and for qualitative data, document analysis was done. SPSS mean and the standard deviation was used to calculate and show the expert's experience on immunization supply chain practices, and frequency and percentage were considered to present the respective practices. The result showed that there are rooms for improvement to ensure recommended good storage. The branch has sufficient positive (+20C to +80C) storage capacity, but the available negative storage volume only covers 65% of the negative storage capacity needed. Respondents were agreed on bundling practice during the distribution of vaccines, Disagree on Refrigerated vehicle pre cold before loading of vaccines, whereas strongly disagree on the temperature of vaccine is always monitored during transportation and availability of an adequate number of the vehicle for transportation of vaccines for which respondents remained neutral. The study strongly indicates the need to improve vaccine logistics supply chain management practices, especially in vaccine storage and handling and temperature monitoring. EPSA and development partners working on vaccine logistic and supply chain management should have intensified their technical and material support to improve the vaccine management practices.

Barriers to vaccine use in small ruminants and poultry in Tanzania.

Vaccination is an important disease prevention and control measure; however, vaccine adoption by livestock farmers in Tanzania is still low. This cross-sectional study examined the challenges to vaccine use faced by livestock owners and animal health professionals (AHPs) in Tanzania. A questionnaire was administered to 216 households that kept small ruminants and poultry and 19 AHPs’ data were collected electronically via the survey platform Qualtrics, and descriptive statistics were performed. Households with poultry reported vaccinating mostly against Newcastle disease (91.7%), fowl pox (48.1%) and Gumboro disease (37.0%), whilst households with small ruminants reported contagious caprine pleuropneumonia (62.2%), sheep and goat pox (17.1%), foot-and-mouth disease (7.3%) and peste des petits ruminants (7.3%). The households’ decision to vaccinate was mostly influenced by knowledge of diseases (82.4%), disease history on the farm (69.4%) and vaccine price (63.4%). Most households (54.6%) experienced challenges when purchasing vaccines, including high vaccine cost (78.0%), long distance from vaccine source (61.0%) and vaccine unavailability (21.2%). The findings suggest that improving the knowledge of livestock owners regarding the priority diseases and the benefits of vaccination, establishing more vaccine suppliers, improving vaccine distribution and access and training AHPs and households on appropriate vaccine storage and handling are necessary to improve vaccine adoption and ensure vaccine quality and effectiveness.

ASSESSING NURSE’S ATTITUDES AND PRACTICE AFTER PARTICIPATING IN A VACCINATION TRAINING PROGRAM: A QUANTITATIVE STUDY

Background: Primary healthcare nurses are pivotal to the successful uptake of immunization worldwide. Central to this, is the attitude and practice nurses may have toward vaccines during administration. It is postulated that altering knowledge towards immunization may impact both attitude and practice towards successful immunization uptake. The aim of this research was to assess nurses’ knowledge, attitude and practice after the delivery of a three-day continuing professional development program regarding administration, safe handling and delivery of vaccines. Method: This research consisted of a quantitative cross-sectional study, utilizing a self-administered survey. The survey contained questions related to immunization knowledge, attitude, and practice. Before and after attendance of an immunization program for continuing professional development, the survey was administered to nurses working in well-baby clinics, communicable diseases clinics, travel clinics and school nurses. Specific areas identified gaps in knowledge, attitude, and practice among participating nurses. Results: Results from our study suggest that attitudes and practices of participants identified a significant difference after receiving an immunization educational program that focused on administration and delivery of immunization skills. Conclusion: Continuous professional development activities such as this have shown a marked increase in the attitude and practices of nurses making it tantamount to the success of vaccine uptake. Implications for Practice: Nurses are poised to be frontline advocates for the uptake of immunization; therefore education and training needs to be provided in order for them to understand and further affect change. Keywords: Vaccine, Immunization, Knowledge, Attitude, Practice

Performance Analysis of Refrigerated Storage Chamber Using Phase Change Material

The research work aims to analyze the refrigerated storage chamber using phase change materials to solve the problem related to improper storage and handling of vaccines, blood samples and organs. This analysis focuses mainly on design and fabrication of an environment friendly refrigerated storage chamber which can be used in areas where electricity supply is erratic and to fabricate a model to maintain optimum temperature for vaccine storage, blood sample and organ storage using a phase changing material. PCMs behaves isothermally in nature, and thus gives higher density energy storage and the ability to operate in a range of temperature conditions. Three phase change materials namely acetic acid, sodium sulphate decahydrate and glycerol are used for the experimentation purpose. These phase change materials are used in frozen form. The results obtained from experimentation are verified using Ansys software. Results shows that the PCM Sodium Sulphate Decahydrate [H20Na2O14S] maintains lowest temperature in range of 1.5 – 8 degree for 350 minutes and extract maximum heat. Similarly, for server unit the temperature ranges to be maintained is 10 to 22 degree which is maintained for 1500 minute.

Recommended Adult Immunization Schedule, United States, 2022.

Recommended Adult Immunization Schedule, United States, 2022.

Vaccine Cold Chain Management at Puskesmas Level in Semarang City

At present, measles is the biggest cause of child mortality among other diseases that can be prevented by immunization. Vaccines are biological elements that have certain characteristics and require special cold chain handling of vaccines since they are produced at the factory until they are used in service units. With the wrong method of storing vaccines, it can cause damage to the vaccine causing AEFI (Post Immunization Adverse Events). Cold chain procedures must be managed properly by keeping vaccines within the recommended temperature range from the transport stage to vaccine storage. The purpose of this study was to determine how the vaccine cold chain is managed at the puskesmas level in the city of Semarang. The design of this research is cross sectional. The samples in this study were vaccine management officers and vaccine storage facilities. The sampling technique in this study was simple random. The sample size is 5 health centers in the city of Semarang. The data was collected by interviewing the puskesmas officers and observing the vaccine storage facilities at the puskesmas. From the results of the study, it was found that there were more respondents who had never received cold chain management training than those who had attended training. To increase the knowledge and skills of immunization officers, it is necessary to conduct training in accordance with the training module for immunization officers.

Infecção por circovírus suíno associado a micotoxicose: relato de caso

Circovirus is widespread in pig farming, and mainly affects piglets increasing morbidity and mortality rates, being vaccination the most effective strategy to control one. However, for an effective vaccine response, certain factors must be considered, such as the adoption of good practices during the conservation and handling of vaccines, environmental challenges, nutritional and health status of the animals, and presence of immunosuppressive agents, such as mycotoxins, in the feed. Here, we describe a circovirus outbreak associated with mycotoxin immunosuppression that occurred in the piglets during the nursery phase at a commercial farm, which initiated with a sudden increase in the mortality of vaccinated piglets. Blood samples were collected and analyzed using RT-PCR, while the feed was subjected to mycotoxicological analysis. RT-PCR analysis revealed the presence of porcine circovirus type 2 (PCV-2) in the blood serum samples, thereby confirming the circovirus outbreak. The feed analysis revealed elevated levels of mycotoxins (deoxynivalenol, aflatoxins, and fumonisins), which were above the levels tolerated by the piglets during the nursery phase. Therefore, the contaminated feed was discarded, and a new ration was made available. Concurrently, the vaccination program was amended to normalize the mortality rate. The presence of mycotoxins in the feed could be the predisposed factor for piglet infection caused by PCV-2 and other diseases. This is an important aspect because the immunosuppressive effect of mycotoxins can alter the vaccine response, thereby making the piglets more susceptible to the diseases even after being vaccinated, although they should be immunologically protected.

Participatory control of Newcastle disease in village poultry using thermo-stable Newcastle disease vaccines in Bulle district of Gedio Zone, Southern Ethiopia

Newcastle Disease (ND) is regarded as one of the major diseases of poultry because of the devastating losses that the virulent form of the virus can impose on both commercial and village chicken. However, the disease can be controlled through the administration of effective vaccines. Almost all the commercially available vaccines require refrigeration and begin to deteriorate rapidly after 1-2 hours if left at room temperature (around 25°C). Subsequently, because maintaining an adequate supply of refrigerated facilities may be a difficult task in many developing countries with unreliable electrical supplies, the development and large scale production and utilization of an effective thermo-stable Newcastle disease vaccine seems imperative to support rural poultry industry. Participatory/action research on vaccination of village poultry against Newcastle disease (ND) was carried out in two selected villages of Bullie district of Gedio zone, southern Ethiopia; with an objective to demonstrate community based thermo-stable ND vaccination scheme and thereby; to increase the population of chicken in backyard production system. We have selected four community vaccinators, two per each village and trained on diagnosis of major poultry diseases, with the major emphasis on Newcastle disease, on preparation, handling and administration of thermo-sable ND vaccine. From the two villages, we have vaccinated 362 chicken of all age ranges of 54 households, in the two rounds. For the vaccination we have selected a site which is suitable for household members to bring their chicken for vaccine administration. We used eye drop technique to administer a vaccine, by preparing one eye drop in one dose base for all age groups. We administered a vaccine before a pick prevalence of Newcastle disease in the study area, for the remaining three months, data was collected on the mortality rate of the chicken. The result shows that, of the total vaccinated chicken (362) from the two villages on the two rounds, 51 chicken were dead due to diseases, of the cases with a clinical sign not related with Newcastle disease. The total mortality rate of 14%, in this study shows that, thermo-stable Newcastle disease vaccine applied via eye drop is the most effective method for control Newcastle disease in village chicken. Therefore; with proper use of vaccine and vaccination programs using well trained community vaccinators, we can reduce village chicken mortality highly to enhance productivity of rural community at large.

Urgent COVID-19 Vaccination of Healthcare Workers via a Quality Improvement Initiative.

A multidisciplinary team involving key stakeholders performed process mapping to develop four key drivers for vaccination success: rapid vaccine procurement, proper storage and handling, well-defined vaccine administration and follow-up plan, and system preparation. We tested interventions using plan-do-study-act cycles. We included employees and providers with direct patient care responsibilities, age 18 years or older, employed at the children's health system, or the affiliated academic medical center. We examined the total number of dose 1 and dose 2 vaccines administered for our primary outcome, and the balancing measure included the percent of wasted vaccines. Three thousand nine-hundred twenty-one healthcare personnel completed the survey, and 73% reported intent to receive the COVID-19 vaccine immediately or at a later time. After 57 clinic days, we vaccinated 83% (n = 5,231) of healthcare personnel at our institution, and 99% completed the two-dose series. Due to surplus vaccines, we vaccinated an additional 1,258 community members with 99% completion of the two-dose series. Vaccine waste was minimal 0.1%. We describe the development and implementation of a successful COVID-19 employee and community vaccination program.