Practical considerations for the successful introduction of Inactivated Polio Vaccine IPV 2 Contents What are the WHO recommendations How to successfully introduce IPV How to effectively prepare healthcare workers for IPV introduction ID: 751220
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Slide1
June 2015
Making the most of every immunization contact
Practical considerations for the successful introduction of Inactivated Polio Vaccine (IPV)Slide2
2
ContentsWhat are the WHO recommendations?
How to successfully introduce IPV?How to effectively prepare healthcare workers for IPV introduction?Slide3
3
DefinitionsMultiple injections: administering three or more injectable vaccines at the same immunization contact.
Healthcare worker: professional health worker such as nurse, physician, professional midwife, etc., or can also be a community health worker or member.Slide4
4
ContentsWhat are the WHO recommendations?
How to successfully introduce IPV?How to effectively prepare healthcare workers for IPV introduction?Slide5
5
What are the WHO recommendations for IPV?
WHO Polio Position Paper. Weekly Epidemiological Record. January 2014: http://www.who.int/wer/2014/wer8909.pdf?ua=1 (PDF)By 2015All countries To add
IPV
into routine schedules
At, or soon after, 14 weeks of age
Vaccine
schedule
option
# doses
Age
at each dose
Interval between doses
IPV
1
At
14 weeks, or soon after
N/ASlide6
7/9/2015
6Considerations when adding IPV to the scheduleWHO recommendations should always inform planning decisions, considered in the context of other programme factors: Other injectable new vaccines at the same visit, e.g.
pentavalent, pneumococcal vaccine (PCV), others.Studies of health worker and caregiver attitudes indicating that multiple injections may affect acceptance of recommended vaccines (e.g. apprehension about pain or potential side effects). Understanding concerns can inform communication and training strategies to mitigate.Strength of routine services, e.g. if high number of drop outs, optimize existing earlier contacts to administer vaccines.Slide7
7
What are the WHO recommendations for pneumococcal conjugate vaccine (PCV)?
NowAll countries To add PCV into routine schedulesAt, or soon after, 6 weeks of age
Vaccine
schedule
options
# doses
Age
at each dose
(examples)
Interval between primary doses
PCV
3+0
6, 10, 14 weeks
2, 4,
6 months
At
least 4 weeks
PCV
2+1
6, 14 weeks + 9-12 months
2, 4 months + 9-12 months
At least 8 weeks
WHO recommendations for routine immunization
: summary tables (May 2014)
http://www.who.int/immunization/policy/immunization_tables/en
/
Slide8
8
What are the WHO recommendations for rotavirus?
NowAll countries To add rotavirus into routine schedulesAt, or soon after, 6 weeks of age
Vaccine
schedule
options
# doses
Age
at each dose
(examples)
Interval between primary doses
Rotarix
2, with DTP
6, 10 weeks
2, 4 months
At least 4 weeks
Rotateq
3, with DTP
6, 10, 14 weeks
2, 4,
6 months
At
least 4 weeks
WHO recommendations for routine immunization
: summary tables (May 2014)
http://www.who.int/immunization/policy/immunization_tables/en
/
Slide9
7/9/2015
9Example of a routine immunization schedule with IPVIPV can be co-administered with other vaccines including:OPV, DTP, Hib, hepatitis B,
pentavalent, rotavirus or pneumococcal conjugate vaccines (PCV) 1.Co-administration of OPV and IPV has resulted in good immune responses to all 3 poliovirus types2. * Some countries use a 2-dose schedule for rotavirus vaccines and a 2+1 schedule for PCV.1. Global Advisory Committee on Vaccine Safety (GACVS; December 2013). Weekly Epidemiological Record, 14 Feb 2014: http://www.who.int/wer/2014/wer8907.pdf?ua=1 (PDF)2. WHO Polio Position Paper. Weekly Epidemiological Record.
January 2014:
http://
www.who.int/wer/2014/wer8909.pdf?ua=1
(PDF)Slide10
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Safety of IPVIPV and IPV-containing vaccines have an excellent safety profile1When used in combination with other vaccines, IPV is very safe2
There is no proven causal relationship to any adverse events, other than minor local redness, induration, and tenderness1. Global Advisory Committee on Vaccine Safety (GACVS; December 2013). Weekly Epidemiological Record, 14 Feb 2014: http://www.who.int/wer/2014/wer8907.pdf?ua=1 (PDF)2. WHO Polio Position Paper. Weekly Epidemiological Record. January 2014: http://www.who.int/wer/2014/wer8909.pdf?ua=1 (PDF)Slide11
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Many countries have immunization schedules where children receive three or more injections at one visitSeveral countries (including high and low income) have been using immunization schedules that require three or more injectable vaccines at the same contact for over a decade with no problems.Data from these countries has reinforced the well-established record of safety and acceptance of multiple injections at the same visit.
Studies are underway in some developing countries to compile further data on the perceptions and acceptance of multiple injections.Recent studies in Tanzania and South Africa reported very high rates of acceptance of multiple injections, despite some expressed caregiver concerns, demonstrating that concerns can be addressed with effective communication and immunization practices.Slide12
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ContentsWhat are the WHO recommendations?
How to successfully introduce IPV?How to effectively prepare healthcare workers for IPV introduction?Slide13
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Case study: Successful introduction of IPV in South AfricaThe South African immunization schedule is based on the available evidence and in line with WHO recommendations.Since 2009, South Africa has administered three vaccines per visit, at 6 and 14 weeks.
Successful experience with good coverage and acceptability.The country is documenting its experience to share with others.
Reference (schedule): WHO 2014 monitoring - global summary
http
://apps.who.int/immunization_monitoring/globalsummary
/
Slide14
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Brazil’s routine immunization schedule involves multiple injections.IPV is given at the 2 and 4 month contacts, with
pentavalent and pneumococcal vaccines.Case study: Successful introduction of IPV in Brazil
Reference (schedule): WHO 2014 monitoring - global summary
http
://apps.who.int/immunization_monitoring/globalsummary
/
Slide15
15
Having communication strategies that educated health workers, community leaders and professionals about the safety, effectiveness and value of multiple vaccine injections at the same contact. Having messages from health workers to caregivers about:Disadvantages of extra visits and delayed vaccinationThe safety of multiple injectionsTheir efforts to minimize painAs a result, health workers are able to understand the importance and address parent or caregiver concerns.
Successful introductions of IPV in Brazil and South AfricaHow did they achieve this? Slide16
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There has been good acceptance of multiple injections at the same visitMultiple injections were well tolerated, and help to avoid extra visits or risks of delayed vaccinationWhen administered correctly, there was only minor discomfortMultiple injectable vaccines are not associated with severe or serious adverse events
IPV coverage among infants after first year of introduction was highOther important lessons from successful introductionsSlide17
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ContentsWhat are the WHO recommendations?How to successfully introduce IPV?
How to effectively prepare healthcare workers for IPV introduction?Slide18
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The critical role of health workersThere are three things that health workers can do to reassure parents or caregivers: Be knowledgeable of all relevant data, including safety and effectiveness, and the value of providing multiple vaccines in the same visit
Provide clear responses to any caregiver questions using the evidence and recommendationsAdminister the vaccines using the recommended technique, taking necessary steps to minimize painSlide19
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The critical role of health workers:Be knowledgeable of all relevant dataKnow when to give IPV: At 14 weeks or soon afterIf starting the routine schedule late, the IPV dose should be administered at the first immunization contact
Give IPV with other life saving vaccinesSlide20
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The critical role of health workers:Provide clear responsesCommon
questionsPotential answers“Why
does my child need to receive all of these vaccines today?”
At
this age, children
are most vulnerable to polio, diphtheria, whooping cough (pertussis),
Hib
and pneumococcal disease. Scientific data indicates
that this is the best time for these vaccines to be given.
“Will my child experience more pain or discomfort?”
No, the pain or discomfort from vaccination is very brief.
Even one injection
can
cause pain or discomfort.
However, i
f you need
to come back for other injections
, there will be more times when children will experience pain or discomfort.
We don’t want your child to
be unprotected from serious diseases until you come back.
“Will vaccines given together be less effective?”
No. These vaccines
are
equally effective when given alone or with other vaccines.
“Will my child experience more or more severe adverse events?”
No. The scientific data shows that multiple injections do not lead to an increase in the number or severity of adverse events.
“Can multiple vaccines given at once “overwhelm” a child’s immune system?”
No.
Every day, children are naturally exposed to many bacteria and viruses on a daily basis. When given as recommended, vaccines
do not add a significant
burden to the immune system, and help the child to be protected.
*United States Institute of Medicine,
Adverse Events Associated with Childhood Vaccines
, 1994.
**
Wheeler
M,
Buttenheim
AM. Parental vaccine concerns, information source, and choice of alternative immunization schedules.
Human
vaccines
&
immunotherapeutics
. 2013;9:1782-1789.Slide21
21
The critical role of health workers:Administer the vaccines using the recommended techniqueSlide22
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How to successfully administer multiple injections?http://www.who.int/vaccine_safety/initiative/tech_support/Vaccine-safety-E-course-manual.pdf
IPV and PCV
given
in the outer aspect of the upper
thigh.
I
njection
sites separated by at least 2.5
cm
-- about two fingers
apart.
Pentavalent (or other)
i
n the thighSlide23
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Recommendations for minimizing pain and distress for intramuscular injectionsAdminister vaccines in order of increasing painfulnessProper positioning: Ask the caregiver to
hold the baby in his/her lapEncourage breastfeeding (if feasible and culturally acceptable) during or just before injectionInjection technique: Do not aspirateGently stretch and support the skin between thumb and forefingerPush the entire needle in at a 90 degree angle with a quick, smooth action Depress the plunger slowly and smoothly, taking care not to move the syringe aroundPull the needle out quickly and smoothly at the same angle that it went in.Discard syringe immediately in safety box.Slide24
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Summary: Advantages of providing multiple vaccine injections during the same visitProtecting children when they are at greatest risk of disease and death: Young infants can be more vulnerable to severe illness.
Fewer vaccination visits: Giving several vaccinations at the same time means caregivers do not need to make as many visits to the health center.More effective use of health resources and workers: Health workers are able to be more efficient in providing and delivering other health services.Slide25
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Summary: Successful introduction of IPVSeveral countries have successfully administered multiple injections during the same contact.
Parental concerns about multiple injections can be addressed through reassurance, clear communication and pain reducing techniques. Slide26
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Thank you!