Buku Ajar Ilmu Penyakit Paru

viii.265 hlm.; 24 c

Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions

OBJECTIVES: To document and characterize freezing temperatures in the Indonesian vaccine cold chain and to evaluate the feasibility of changes designed to reduce the occurrence of freezing. METHODS: Data loggers were used to measure temperatures of shipments of hepatitis B vaccine from manufacturer to point of use. Baseline conditions and three intervention phases were monitored. During each of the intervention phases, vaccines were removed progressively from the standard 2-8 °C cold chain. FINDINGS: Freezing temperatures were recorded in 75% of baseline shipments. The highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centres. Interventions reduced freezing, without excessive heat exposure. CONCLUSIONS: Inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia. Simple strategies exist to reduce freezing - for example, selective transport and storage of vaccines at ambient temperatures. The use of vaccine vial monitors reduces the risk associated with heat-damaged vaccines in these scenarios. Policy changes that allow limited storage of freeze-sensitive vaccines at temperatures >2-8 °C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity

Maintaining Polio-Free Status in Indonesia during the COVID-19 Pandemic

Indonesia’s polio-free status as well as the 2023 global polio eradication target have been threa- tened by disruptions to immunization services caused by the coronavirus disease (COVID-19) pandemic and related restrictions. n Fear of contracting COVID-19, human resource diversion, and travel restrictions posed barriers to delivering polio immunization services during the pandemic. n To resume polio vaccination efforts and maintain polio-free status, Indonesia health authorities need to take action to: 8 Maximize vaccine service reach by mapping children who have not been vaccinated and monitor the vaccine supply chain 8 Integrate vaccine delivery with pandemic response efforts 8 Mobilize communities for advocacy and education 8 Adjust programs to address human resource, physical, and financial resource gaps 8 Strengthen monitoring and evaluation and surveillance effort