Project timeline and selection of health facilities
This paper aims to describe the process and results of the influenza immunization campaign for health care workers, and highlight key findings and recommendations for further expansion of influenza vaccination in Vietnam. The immunization campaign was conducted from January to May 2017 in selected health units. Criteria for selecting these sites were that the health facilities (i) were willing and supportive of influenza vaccination; (ii) were representative of the region; and (iii) had staff committed to implementing the project. In this demonstration project, health care workers were defined as all medical and non-medical staff of health facilities including permanent and contract personnel. Immunization is on voluntary basis for health units as well as health care workers.
According to the original plan, ten hospitals and preventive medicine centers were selected in four cities/provinces, one in each of the four medical regions, North, Central, Central Highlands and South. They are listed below:
- National Hospital for Tropical Diseases (Hanoi),
- Bach Mai Hospital (Hanoi),
- National Hospital for Obstetrics and Gynecology (Hanoi),
- National Institute of Hygiene and Epidemiology (Hanoi),
- Khanh Hoa General Hospital (Khanh Hoa)
- Dak Lak General Hospital (Dak Lak),
- Cho Ray Hospital (Ho Chi Minh City),
- Tu Du Hospital (Ho Chi Minh City),
- Hospital for Tropical Diseases of HCM City (Ho Chi Minh City),
- Pasteur Institute - HCM City (Ho Chi Minh City)
Of the ten sites, four sites had certified trained immunizers; these staff conducted the influenza immunization sessions at both their own facilities and the other six sites.
Preparatory activities
In preparation for the campaign, a workshop on planning for the immunization program was conducted with all participating sites to discuss the implementation plan, logistic preparations, and administrative and technical requirements in the campaign. A critical activity for preparation was determining how many health care workers were at each health facility were willing to get immunization, who were required to sign up in a registration list. Most of the sites announced the vaccination campaign through briefings, posted the information on the facility’s staff website, and/or sent notifications and registration forms by email or hard copy to all departments. At each site, a focal person was assigned to collect and consolidate lists of registered health care workers from all departments. Upon having the full registration list, sites informed MOH of the quantity of vaccines they needed.
Vaccines
Vaccine for this project, funded by the Cooperative Agreement IP000821 between U.S. CDC and the General Department of Preventive Medicine (GDPM), was Influvac, single-dose pre-filled syringe influenza vaccine manufactured by Abbott Biologicals B.V., Netherlands containing the northern hemisphere 16/17 formulation with an expiry date of June 30, 2017. [13]
Vaccine transportation and storage plan
MOH had Phuc Thien Pharmaceutical Joint Stock Company distribute the 11,000 vaccine doses to the sites. The cold chain was maintained with temperature checks during storage, delivery, and receipt, which were documented. The cold chain system of the National Extended Program for Immunization was in place at two sites; other sites used their own cold chain system.
On a vaccination session day, vaccines were transported from cold storage to immunization sites in standardized cold boxes as per regulations. Unused vaccine at the end of the session was returned to cold storage. After each site completed their vaccinations, the vaccination team made a final record of vaccine used and any unused doses were later reallocated to other sites. The reallocation prioritized sites in the same province to minimize transportation costs. It was reported by all sites that the storage of influenza vaccines for this demonstration project did not cause any changes or impacts to the storage plan of other vaccines or the overall plan of the existing cold chain systems.
Immunization sessions
Vaccination teams were set up to carry out immunization; each team included one officer to list vaccine recipients and distribute vaccination certificates after immunization, one physician to screen participants, and one vaccinator. Smaller sites used one team, the largest sites used three teams, but most commonly, two teams were established for the immunization sessions. To avoid overcrowding, different departments came for immunization at different times. All sites reported that the arrangement for the campaign did not significantly affect their routine professional work.
Reporting and monitoring of immunization
All immunization sites were required to send a daily summary after each vaccination session and a final report by the end of the immunization campaign. The daily summary included a list of the day’s vaccine recipients and any AEFI cases with appropriate details. AEFIs were monitored for 30 minutes at the immunization site or were reported to the immunization hotline within 24 hours after vaccinations, with daily summaries compiled into an all-site database. These requirements are in consistent with Ministry of Health’s reporting requirements for routine immunization activities.
To ensure the timeliness and quality of reporting, each site assigned one person to consolidate daily the list of vaccine recipients, and coordinate the number of vaccines needed, used and remaining. If the number of health care workers vaccinated was lower than expected, reminders were sent out to registered HCWs; and the site also made extra efforts to encourage HCWs to come for vaccination. This helped the site to reach as many registered HCWs as possible, and even reached HCWs who had not registered for vaccination. The timeliness of daily summaries and final reports from sites to MOH made transfer of left-over vaccines to other sites possible, greatly reducing vaccine wastage.
MOH sent staff to all sites to provide technical support and monitor activities. U.S.CDC joined MOH to monitor at some immunization sites. The monitoring and technical oversight helped identify drawbacks and implement timely adjustments.
Communication campaign
At each site, registered HCWs were provided a written summary about influenza and influenza vaccine. Some site leaders organized all-hands meetings where they advocated for the influenza vaccination campaign, highlighted the importance of vaccine and encouraged staff to get immunized. During the vaccination session, vaccination staff advised HCWs on the benefits of influenza vaccine and its possible side effects. After getting the shot, each health care worker got a certificate of immunization (each site designed its own certificate). However, because all communication materials developed by MOH for this campaign were not completed before the vaccination started, most sites noted a lack of adequate communication materials, resulting in some HCWs not understanding the purpose of the vaccination campaign and the benefits of influenza immunization, and not registering or coming for vaccination.