Vaccines: Which Ones Can I Trust?

As an American Nurse Practitioner living in Africa, I miss the security the FDA (Food and Drug Administration) regulating the medications.  Here are some criteria I use to help decide if a vaccine is reliable:

Do I trust the Manufacturer and Brand?

Is it on the WHO pre-approved immunization list? If it is on the list, then that’s the best option.

If I can’t locate in-country an immunization that is on the list, the next best thing is an immunization from a manufacturer that is on the list. Does the manufacturer perform quality controls?

Government immunizations are often purchased or donated from reliable manufacturers that are on the WHO pre-approved list.

Has the cold chain been maintained? Vaccines need to be kept at a set temperature (refrigerated) from the factory to time of injection.  

Government immunization techs are trained to maintain the cold chain.  Each site should have refrigeration, back up electricity, and be closely monitored.  Busy sites are best, because the multi-dose vials are emptied faster and don’t get as warm.

Private pharmacies should also have refrigeration with back up power source. Also, they should offer assurances that they transport imported immunizations, maintaining cold chain.

Vaccines from Serum Institute of India have a quality control sticker that changes if the cold chain has not been maintained.

Is the packaging sealed and unexpired?

Multi-dose vials at government sites may be open, but should be used up within 30 days of opening.

Check expiration dates on all vaccines. Don’t accept if expired.

Am I following the correct schedule?

DO NOT give vaccines before the allotted time period has passed. For instance, if there are to be 4 weeks between doses and the vaccine is given at 3 weeks it is considered invalid.  

While the first three round of immunizations are very similar all over the world, the schedule (timing between doses) varies between countries. Your home country may not consider a dose valid if it doesn’t follow the same schedule. Malawian citizens should follow the Malawian schedule.

Government techs are trained to follow the Malawian schedule.  If you are following a different schedule, please do so under the supervision of a health care provider. You can call ABC Community Clinic to schedule a well-child appointment with me to discuss immunizations.

Is the immunization being given in the correct route?

Most immunizations are given in the muscle. For babies, the side of the thigh is best-and the needle comes in at 60 to 90 degree angle. 

Some immunizations are given in the fat (SC): MR, MMR, and Varicella. The tech should squeeze up some fat on the back of the thigh and come in at a 30 degree angle.

The TB skin test is given just under the skin and must make a bubble.

Rotavirus is always given by mouth (drops). Polio is usually given by mouth (drops). One dose in the series of Polio is given in the muscle.

Has the vaccine been properly documented?

Sometimes the government adds to the immunization schedule before they have updated the record books. Look for the following:

MR – Currently the government is providing the combination MR (measles and rubella), but some books just have measles listed. Make sure to write in MR if that what is given.

Polio- One of the doses of polio in the immunization schedule is given the IM route instead of by mouth. Note this in your book.

In most countries where children need to show proof of immunization to go to school, the rule is that if it is not documented then it is not given. Therefore, make sure that all immunizations are recorded at the time they are administered.

Titers are the best evaluation of immunity.

Healthcare providers often draw titers (a lab that tests antibodies for various illnesses) to determine if they are properly immunized against various illnesses they could come into contact with before they start working in health care.  If in doubt about the reliability of a previously administered vaccine then have titers drawn when returning to your home country.

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