Thank you sir, for the valuable reply.
In general, service providers in the private sector neither have the opportunity to undergo detailed Routine Immunization training / reorientation, nor they feel that there is an absolute necessity. Regular supportive supervision by the Govt in collaboration with development partners usually do not cover private sector thus there are gaps in the operational aspects and the immunization schedule too. As a blessing in disguise, Aarogya Bandhu Scheme got winded up and the skilled ANMs with a decade of service got relived, of which two well trained ANMs were absorbed to deliver vaccination services of WHO/GOI standard. They are trained in newborn vaccination, Multi-dose vial policy (open vial policy), cold-chain maintenance, documentation, strengthening the Govt etc.
Being in Medical College, we have ample time for research / innovations, keenly observed the way in which BCG/IPV were administered intradermally and mutually learnt how easy/difficult it is. Even the skilled person has some element of panicky till the end of administering 0.05 ml (equivalent to 1 drop) of BCG to the newborn; 0.1 ml IPV (equivalent to 2 drops) along with 1st dose of bOPV and Pentavalent to >42 day old infants.
0.1 ml AD syringe has its unique advantages but for the lacerated puncture from which a fraction of fractional dose is regurgitated by the tense wheal holding 2 drops of IPV, often blood stained (one closer photo is attached). This loss can be overcome by using syringe with fine needle.
One of the frequently asked questions in the training was adequacy of immunogenicity with fractional dose and was well answered that 2 doses of 0.1ml has better or at least the same immunogenicity as that of one Intradermal 0.5 ml dose which can be fully & easily administered at >14 weeks . If a fraction of fractional dose is lost while administering, will this produce same immunogenicity?
Since "bOPV" and "t IPV" are administered simultaneously, measuring the antibody of P1/P3 discretely for OPV/IPV and P2 may overlap. My knowledge in immunology is very minimal to dream of this. We shared the observations with the local Block MO for minimizing immunity gap.
With regards
Holla