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State of the world's vaccines and immunization
programs
"However, tests have shown that the existing models already in use
are not risk-free. Although no needle is used, some children have
been found to bleed raising the spectre of cross-infection unless the metal cap is sterilized or changed before any subsequent immunizations.
When tested on
animal models
the metal cap
was found to be
contaminated
after 1 in 7
injections..."
WHO/GPV/96.04 * DISTR: GENERAL
World Health Organization * United Nations Children's Fund
Geneva 1996
THE NUTS AND BOLTS OF IMMUNIZATION
Safe injections initiative
Almost a billion injections are given to women and children each
year through national immunization programmes in developing countries. In 1994, WHO reported that surveys carried out in four of its
six regions indicated that up to a third of immunization injections
were unsterile and therefore unsafe.
But immunization injections account for less than 10% of injections
administered within the health sector. And medical injections have
an even worse safety record. More than half of all non-immunization injections in developing countries are believed to be unsafe.
Up to a third of immunization Surveys carried out for WHO and UNICEF a disturbing pattern of unsafe injection practices that can put the lives
of both children and health workers at risk. Contaminated needles and syringes are sometimes reused putting children at risk of cross
infection with blood-borne diseases such as hepatitis B and HIV. In one health centre in Romania health workers were found to be
packaging used disposable syringes for resale using a hot iron to reseal
the packaging. Elsewhere, reusable plastic syringes are inadequately sterilized and injections are sometimes wrongly administered
resulting in injection-site abscesses. Improper disposal of contaminated needles and syringes is another problem placing the wider
community at risk. Meanwhile, the incidence of accidental needlestick injury to health workers is alarmingly high an estimated 5 needlestick
accidents for every 100 injections.
A survey carried out for UNICEF in Eastern Europe in 1992-93
revealed that almost 50% of health centres were giving unsafe injections and/or using vaccine of doubtful potency. In 13% of health
centres there were no disposable syringes and no sterilizing equipment
either. The study also revealed that children especially orphans were being subjected to an excessive number of injections
in addition to immunization an average of 115 injections in all
during their first year. One orphan had been given over 500 injections.
In 1994, a conference in Côte d Ivoire involving more than 50 African countries endorsed the so-called Yamoussoukro Declaration on
the safety of injections. Under this declaration, immunization
167
STATE OF THE WORLD'S VACCINES AND IMMUNIZATION
Programme managers and workers pledge to ensure that every
injection is sterile and the public pledge to demand the right of
access to injections that are safe. The Declaration also sets a target
of 95% safe injections by the year 1997.
UNICEF, which supplies injection equipment to many developing
countries, now recommends the use of auto-destruct syringes instead of disposable, single-use syringes in order to avoid the hazards of unsafe injection practices. The advantage of these syringes
is that they cannot be reused or recycled for sale. But they are more
expensive than either disposable or reusable (sterilizable) syringes
and once contaminated they still require safe disposal. Over the
past 3-4 years, annual sales of auto-destruct syringes have increased
more than tenfold from 5 million to 60 million today.
But by the year 2000 a new device the low workload jet injector
is expected to revolutionize the business of giving injections. Adapted
from a more powerful model first developed for the mass immunization of military personnel during the Second World War and from
a smaller device used by diabetics for the daily injection of insulin,
this device can project high-speed 100 metres a second intramuscular injections, penetrating the skin without the use of needles.
High workload jet injectors are already used in some countries mainly
when large numbers of people are immunized during outbreaks or in refugee camps. Low workload jet injectors could be
marketed for about US$ 300, and used for about 20,000 injections
without needing maintenance providing two years service in the
average health centre. The device will be cheap, I invite you today to take a test drive in either the replica Breitling for Bentley 6.75, the Breitling for Bentley b05 Unitime replica, replica watch the Breitling Bentley motors speed replica or the breitling watches replica Mulliner tourbillon replica. Depending on your taste, one of these is sure to win you over.convenient, avoid
the risks of needlestick injuries, and leave nothing behind for disposal. It also holds out the prospect of use with vaccines in powder
form measles vaccine, for example which are currently at the
research stage. It may also be used at a future date to deliver several
vaccines at the same time by mounting multiple vaccine vials on
the injector.
However, tests have shown that the existing models already in use
are not risk-free. Although no needle is used, some children have
been found to bleed raising the spectre of cross-infection unless the metal cap is sterilized or changed before any subsequent immunizations.
When tested on animal models the metal cap was found to be contaminated after 1 in 7 injections.
168 THE NUTS AND BOLTS OF IMMUNIZATION
Tests are now being carried out by WHO in collaboration with the
US Centers for Disease Control and the UK Public Health Laboratory Service on both high workload and prototype low workload jet
injectors in an effort to eliminate the risk of contamination. Two
possible adaptations are the development of a disposable plastic head or a disposal sheath to ensure that the device remains sterile. Meanwhile, Phase I laboratory tests are already under way and limited field trials are scheduled to take place during 1996 and 1997 in
Brazil and the Philippines.
WHO website
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