Dear viewers
We wish to share our very short study finding with the TechNet viewers for further input and mutual sharing of experiences for the global benefit of closing the imuunization gap.
Introduction of a newer vaccine or any change in vaccination policy provides an opportunity to train / reorient the service providers to revamp the efficiency for immunizing the vaccinated.
Responses by the TechNet members and global Immunization specialists inspired us to take-up a short study in the vaccination centre in our College. Initially we experienced – intra-dermal administration of just a drop of BCG vaccine=0.05ml especially to a newborn within 24 hrs was really difficult as the skin is too thin and delicate accentuated by the unpredictable movement but now we find it ‘not so difficult’ and administer with confidence.
The skin of 1½ month infant is a little more grown but the quantity of vaccine to be administered is 0.1ml=2 drops, double the 0.05ml.
On satisfactorily administering vaccines intradermally, we ‘dreamt’ of measuring the dimensions of the wheal accurately; enough for operational purpose.
Intra-dermal administration of vaccine raises a tense blanched Peau d’orange ‘bleb/wheal’, stays for a few fractions of a second. We measured the diameter instantly on pushing the vaccine completely by pausing the video and taking print screen, edited for making slides, taking care to maintain the accuracy of measurement. Following are the pictures, 3 each for BCG and IPV.
Respected Dr. Narayana Holla,
I must congratulate you and your team for this excellent work. Atually to use insulin syringe, say 40 unit insulin syringe and take upto 4 units for 0.1ml is easier and painless for a small child than to use BCG syringe. Insuln syringe produces better heall and is painless as well, this is what we have learnt from ID rabies vaccination.
Also the optimum size of the wheal in rabies has been determined as 3-4 mm so I would request you to find out average size as the size you achieved would be difficult for many healt workers in the field to achieve.
Thanks and regards,
Dr. Omesh Bharti, Shimla, HP, India
09418120302
Dear sir
Thanks for the appreciation and the valuable response sir.
Our team has 2 ANMs who were working in the PHC Sampaje attached to our college for field practice. They were regularly providing vaccination services for ~10 years but chances of administering BCG vaccine was limited while on duty at PHC head quarter to newborns. I had very limited opportunity to administer BCG vaccine during internship in the outreach camp and later in 1986 but we used to take BCG technician with us on every friday for outreach camp for 100% success. Those days BCG was administered to children up to 2 years but almost all were below one year and there was no newborn vaccination.
On closure of "Arogya Bandhu" scheme, dedicated vaccination centre was opened in our College on Switch day and these two ANMs were posted for the dedicated work of vaccination. I rejuvinated the skill. Of the 6 pictures, 2 and 4 depict BCG and IPV administered by me and the rest by the two ANMs.
Maturity of the skin anatomically is different at different age and hence 3 to 4 mm bleb/wheal of 0.1ml ARV in matured skin may be more 'tall' than wide.
Policy makers may incorporate the suggestions from global specialists to use sharp needle for administering the vaccine to minimize the agony to the infants.
best regards
Holla and team
This is a very intersting discussion on intradermal immunization. I work on developing skin patches for immunization and we are always interested to understand what are the advantages and disadavantages of ID, in the field. Thank you for the information.
Dear Omesh Sir
As per the suggestion we continued recoding the diameter of the wheals and we cosistently got similar results.
Adminitsration wlth sharp needle - say using Insulin syringe is least painful, much smoother, a few infants hardly perceived the pain with minimal / no cry - enhancing the pride of
service provider in presence of care-givers.
Limitation: As of now, we did not compare our results with other planning units though it can be replicated and we did not try for ID administration of 0.1 ml Antirabies vaccine.
Hopefully, the policy makers empathetically will promote use of 0.1 ml syringes with sharp needle as it has certain advantages over 1ml syringe.
Best regards
Holla and team
Dear Sir,
Here is another study that has lower wheel size than your. Study say that "We measured bleb diameter and vaccine loss as indicators of ID injection quality, with desirable injection quality defined as bleb diameter ≥5mm and vaccine loss <10%"
Study is being attached for your kind reference please.
Can you call me when free, I shall be thankful. My mobile is 09418120302 in India.
Thanks and regards,
Omesh Kumar Bharti, Shimla
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