Ministry of Health and Family Welfare, New Delhi, India.
National Polio Surveillance Project, World Health Organization Country Office for India, New Delhi, India.
Bull World Health Organ. 2019 May 1;97(5):328-334. doi: 10.2471/BLT.18.218370. Epub 2019 Feb 28.
In 2016, the World Health Organization (WHO) announced a global shortage of inactivated poliovirus vaccine that was expected to last until 2020 at least. In response, WHO's Strategic Advisory Group of Experts on Immunization recommended that countries consider a strategic shift to fractional-dose inactivated poliovirus vaccine, which involves a new dosing schedule (i.e. administered at 6 and 14 weeks of age) and has a different mode of delivery than full-dose inactivated poliovirus vaccine (i.e. intradermal rather than intramuscular). Introduction of fractional-dosing requires careful planning and management to ensure adequate vaccine supplies, to prevent wastage, to provide training for health workers, and to ensure accurate record-keeping. In early 2016, given the global vaccine shortage and a limited supply from domestic manufacturers, India's Expert Advisory Group on polio recommended the staggered introduction of fractional-dosing. India was the first country to introduce fractional-dose inactivated poliovirus vaccine into routine immunization, initially in eight states in 2016. Following a rapid assessment of its initial implementation, fractional-dosing was extended and, by June 2017, all Indian states were covered. Here we summarize India's experience with the introduction, discuss the challenges faced and the strategies used to address them, and report on the outcomes achieved. We also describe the lessons learnt, especially managing vaccine supplies and wastage, monitoring and supervision, and training needs. As the use of fractional-dose inactivated poliovirus vaccine is dose-sparing and reduces the cost of the immunization programme, it will remain an important part of India's long-term strategy for polio vaccination.
2016 年，世界卫生组织（世卫组织）宣布全球短缺灭活脊灰病毒疫苗，预计至少要到 2020 年才能缓解。为此，世卫组织免疫战略咨询专家组建议各国考虑将疫苗接种策略转向使用低剂量灭活脊灰病毒疫苗，这种疫苗采用新的接种时间表（即分别在 6 周龄和 14 周龄时接种），且接种方式与全剂量灭活脊灰病毒疫苗不同（即皮内注射而非肌内注射）。采用低剂量接种需要精心规划和管理，以确保有充足的疫苗供应，防止浪费，为卫生工作者提供培训，并确保准确的记录保存。2016 年初，鉴于全球疫苗短缺且国内制造商的供应有限，印度脊髓灰质炎问题专家咨询小组建议分阶段引入低剂量接种。印度是第一个将低剂量灭活脊灰病毒疫苗纳入常规免疫接种的国家，最初于 2016 年在 8 个邦引入。在对其初步实施情况进行快速评估后，扩大了低剂量接种范围，到 2017 年 6 月，所有邦都已实施。在此，我们总结了印度在引入低剂量接种方面的经验，讨论了所面临的挑战及其应对策略，并报告了取得的成果。我们还介绍了吸取的教训，特别是疫苗供应和浪费管理、监测和监督以及培训需求。由于低剂量灭活脊灰病毒疫苗的接种剂量较低，且降低了免疫规划的成本，因此它将仍然是印度脊髓灰质炎疫苗接种长期战略的重要组成部分。
