South Sudan conducts first phase of meningitis A campaign using a CTC

What is a CTC?

In March 2016, South Sudan conducted the first phase of a meningitis A campaign, using a controlled temperature chain (CTC) in areas of Terekeka and Kapueta East counties. A CTC enables vaccines, which have been licensed for CTC, to be stored and transported at temperatures outside the traditional 2°C to 8°C cold chain for limited periods of time, under monitored and controlled conditions.

 

The challenge of using the standard cold chain

Using a vaccine in a CTC can help to overcome standard cold chain challenges, such as the need to transport ice-packs long distances. This payam (district) supervisor was obliged to transport ice-packs on his motor cycle to payams that did not use the CTC approach. The size and the weight of the cold box made his long journey difficult and wasted many hours that he could have spent on supervision.

 

CTC training

Before the campaign began, extensive planning was performed to ensure the CTC approach was implemented successfully. In this picture, a National Ministry of Health supervisor in Terekeka county instructs vaccinators on how to use a vaccine in a CTC. All campaign supervisors and vaccinators received thorough training to ensure they were able to monitor heat exposure and the number of days a vaccine spends in a CTC. 

 

The peak temperature threshold indicator

Used in a CTC, the MenAfriVac® meningitis A vaccine and its diluent can be removed from the 2°C to 8°C cold chain, immediately before use, for a single period of time not exceeding four days. During this period it can be stored, transported and administered at temperatures up to 40°C. To monitor whether vaccines have been exposed to temperatures of 40°C or more, vaccinators and health-care workers use a peak temperature threshold indicator, placed inside the vaccine carrier, that must accompany the vaccines at all times. This indicator is a card with a sticker that changes colour from light grey to black as soon as the temperature exposure has exceeded +40°C. 

 

 

 

Vial marking

In addition to monitoring temperatures using the peak temperature threshold indicator, each evening, vaccinators marked the vaccine vial with one line to keep track of the number of days each vial has spent in the CTC. This allowed them to ensure vaccines were kept in a CTC only as long as they were allowed.

 

 

 

 

Supervision

A WHO supervisor provides feedback to vaccinators on how to correctly fill-in the CTC monitoring sheet. Most vaccinators understood quickly the concept and the advantages of the CTC approach. The monitoring of the approach, such as writing down the number of vaccine vials that spent a certain number of days in the CTC, was, however, sometimes challenging. Close supervision, especially at the beginning of the campaign, was provided to ensure that vaccinators correctly filled out the CTC monitoring sheet. This enabled them to identify which vaccines have been kept in the CTC the longest and therefore must be used first.

 

 

 

 

 

The importance of microplanning

A County Health Department supervisor prepares a microplan as part of the MenAfriVac campaign. Using the vaccine in a CTC enables vaccinators to stay in the field for several consecutive days, as they do not have to return the vials into the cold chain every evening. Vaccinators therefore follow a carefully prepared microplan. This was an important but also challenging exercise in South Sudan, where reliable population data is difficult to obtain. 

 

 

 

 

 

 

Logistical benefits of CTC

A team supervisor transports vaccines during the MenAfriVac campaign. Vaccinators in South Sudan welcomed this new approach for vaccine management, as it saved them from burdensome journeys to renew ice stocks and from transporting heavy vaccine carriers long distances. This team supervisor is glad to be able to transport the small and light vaccine carrier on his bicycle, to bring additional vaccines to his teams.

 

 

 

 

 

Mission accomplished

Residents of Terekeka county attend an immunization session conducted as part of the country’s MenAfriVac campaign. Using vaccines in a CTC helps reach marginalized populations living in poorly-served rural or remote areas. In South Sudan, almost 200,000 people were vaccinated using a CTC in 2016.