smallpox vaccine and vaccination in the intensified ... - libdoc.who.int

11. VACCINATION IN THE INTENSIFIED PROGRAMME 573
Plate 11.15. WHO bifurcated needles and plastic containers. The top of one container has been unscrewed
so that it can be packed with needles. Holes are provided in the bottom to allow excess water to be removed
after sterilization by boiling. Sterile needles are shaken one at a time through the hole in the conical lid.
greatly simplified the vaccinators' work. Sub-
sequently the WHO Regional Office for
South-East Asia produced similar containers,
and after 1971 they were widely used in all
WHO-assisted national smallpox eradication
programmes. It is interesting to note that
local producers in Bangladesh, India and
Pakistan, in which smallpox was endemic,
devised a plastic container made of high-
density polyethylene which withstood boil-
ing, whereas efforts made by the Smallpox
Eradication unit at WHO Headquarters to
persuade plastics manufacturers in Switzer-
land and the USA to produce such containers
were unsuccessful.
Packaging and instruction sheets
Initially the packaging and instruction
sheets provided with donated vaccine varied,
since they followed the regulations of the
donor countries. Usually the multiple press-
ure or scarification method was described,
instructions were given about sterilizing the
skin and the numerous and complex contra-
indications to vaccination were listed.
With the introduction of the bifurcated
needle, a simple set of instructions in English
and French was included in each box of
vaccine. In addition, the contraindications to
the use of vaccine in endemic countries were
simplified in accordance with the policy of
the Smallpox Eradication unit, as follows: "In
endemic smallpox regions or in areas geo-
graphically proximate only individuals who
are severely ill are not vaccinated." This
contraindication was included to avoid vacci-
nation being blamed if the patient died. Later
some countries making donations on a bi-
lateral basis-for example, India-prepared
their own instruction sheets along the same
lines.
As the programme progressed, manu-
facturers were encouraged to provide the
vaccine and the diluent in separate packages,
so that only the vaccine needed to be stored in
refrigerated space, something that was always
in short supply in developing countries.
Jet Injectors
Jet injectors (trade name Ped-o-Jet) played
an important role during the initial phase of
the Intensified Smallpox Eradication Pro-
gramme. They were used to ensure rapid
vaccination coverage with satisfactory take
rates in national smallpox eradication pro-
grammes in Brazil, Zaire, countries in western
and central Africa, and to a small extent in
several other countries. In all these countries