The development of world trade and fresh-keeping technology has led to the rapid development of international cold chain logistics. However, the novel coronavirus epidemic continues to spread around the world at the present stage, which challenges disease transmission control and safety supervision of international cold chain logistics. Constructing an Import Cold Chain Logistics Safety Supervision System (ICCL-SSS) is helpful for detecting and controlling disease import risk. This paper constructs an evaluation index system of ICCL safety that comprehensively considers the potential risk factors of three ICCL processes: the logistics process in port, the customs clearance process, and the logistics process from port to door. The risk level of ICCL-SSS is evaluated by combining the Extension Decision-making Model and the Entropy Weight Method. The case study of Shanghai, China, the world\'s largest city of ICCL, shows that the overall risk level of ICCL-SSS in Shanghai is at a moderate level. However, the processes of loading and unloading, inspection and quarantine, disinfection and sterilization, and cargo storage are at high risk specifically. The construction and risk assessment of ICCL-SSS can provide theoretical support and practical guidance for improving the safety supervision ability of ICCL regulation in the post-epidemic era, and helps the local government to scientifically formulate ICCL safety administration policies and accelerate the development of world cold chain trade.

A new nonthermal food pasteurization approach is here presented for the first time, proposed to be called low-pressure long-time (LPLT) pasteurization or moderate pressure pasteurization (MPP) by hyperbaric inactivation (HI). To test this novel pasteurization process on raw milk, MPP by HI was carried out at three different pressure levels (150, 200 and 250 MPa), over 24 h, at naturally variable uncontrolled room temperature (≈20 °C) and compared with high pressure processing (HPP) at 600 MPa (one cycle for 90 s and a second cycle of 120 s) followed by storage under refrigeration for 21 days. Based on the results obtained, MPP at 250 MPa over 24 h caused higher microbial inactivation on total aerobic mesophiles (TAM), lactic acid bacteria (LAB) and Enterobacteriaceae (ENT) (of at least 2.2, 1.7 and 1.3 log CFU/mL, respectively) than HPP (1.1, 1.0 and 1.2 log CFU/mL, for the same microorganisms). Moreover, MPP showed a clear reduction of inoculated microorganisms to below the detection limit, in only 16 h for all pressures with reductions of at least 5.7, 5.4 and 5.5 for Listeria innocua, Salmonella senftenberg, and Escherichia coli, respectively. Additionally, during preservation under refrigeration, MPP samples (200 MPa and 250 MPa), maintained lower TAM/LAB/ENT compared to HPP, being the counts below the quantification/detection limit for at least 21 days for MPP by HI. MPP (200 MPa and 250 MPa) resulted also in counts below the detection limit for the inoculated microorganisms up to at least 21 days under refrigeration. The results of MPP by HI are very promising as a new nonthermal food pasteurization, since over 5 log reduction of vegetative bacteria were achieved, with counts maintained below the quantification/detection limit for at least 21 days under refrigeration.

In this study, we evaluated the temperature requirements for home delivery in Taiwan by considering food safety risks of chilled shrimp that may be contaminated with Vibrio parahaemolyticus. Pathogenic V. parahaemolyticus was chosen because it was the main cause of foodborne outbreaks originating from contaminated seafood in Taiwan. The risk of becoming ill due to consumption of raw shrimp was estimated to be 7.3 × 10-3 per serving, estimated based on the real-time temperature profile. Lowering the maximum temperature to 7 °C during transit and cooking shrimps at 100 °C for 5 min could reduce the risk by more than 94%. These interventions, therefore, were suggested to be used as an integral part of temperature management control in the home delivery cold chain. These findings can help food authorities to institute temperature management policies and regulations to prevent broken cold chains and reduce food safety risks. PRACTICAL APPLICATION: This research may be applicable to home delivery services that deliver low-temperature food products, such as seafood products.

Cholera is a diarrheal disease that produces rapid dehydration. The infection is a significant cause of mortality and morbidity. Oral cholera vaccine (OCV) has been propagated for the prevention of cholera. Evidence on OCV delivery cost is insufficient in the African context. This study aims to analyze Shanchol vaccine delivery costs, focusing on the vaccination campaign in response of a cholera outbreak in Lake Chilwa, Malawi.
The vaccination campaign was implemented in two rounds in February and March 2016. Structured questionnaires were used to collect costs incurred for each vaccination related activity, including vaccine procurement and shipment, training, microplanning, sensitization, social mobilization and vaccination rounds. Costs collected, including financial and economic costs were analyzed using Choltool, a standardized cholera cost calculator.
In total, 67,240 persons received two complete doses of the vaccine. Vaccine coverage was higher in the first round than in the second. The two-dose coverage measured with the immunization card was estimated at 58%. The total financial cost incurred in implementing the campaign was US$480275 while the economic cost was US$588637. The total financial and economic costs per fully vaccinated person were US$7.14 and US$8.75, respectively, with delivery costs amounting to US$1.94 and US$3.55, respectively. Vaccine procurement and shipment accounted respectively for 73% and 59% of total financial and economic costs of the total vaccination campaign costs while the incurred personnel cost accounted for 13% and 29% of total financial and economic costs. Cost for delivering a single dose of Shanchol was estimated at US$0.97.
This study provides new evidence on economic and financial costs of a reactive campaign implemented by international partners in collaboration with MoH. It shows that involvement of international partners\' personnel may represent a substantial share of campaign\'s costs, affecting unit and vaccine delivery costs.

BACKGROUND: Cameroon\'s cities have a growing concentration of target children not adequately covered by routine immunization programmes.
METHODS: We conducted a descriptive cross-sectional study, based on exhaustive sampling of legal health care facilities offering routine immunization services in the health district of Djoungolo (city of Yaoundé). The evaluation of the immunization programmes was based on the \"Reaching Every District\" approach.
RESULTS: Out of the 70 health care facilities that participated in the study, 3 (4.3%) had an updated microplan for routine immunization. Out of the 63 (89.4%) health care facilities with functional refrigerator, 12 (19.0%) vaccinated employing a fixed strategy on daily basis. Fifty-seven (81.0%) health care facilities did not conduct immunization sessions employing advanced strategy. Community participation in routine immunization programs was effective in 1 out of 12 districts health areas. A steadily updated vaccine tracking curve was available in 6 (8.5%) health facilities.
CONCLUSIONS: The \"Reaching Every District\" approach implemented in Djoungolo health care district doesn\'t provide adequate coverage of a maximum rate of targeted children. The effectiveness of realistic microplanning, the regularity of vaccination sessions employing fixed and advanced strategies, action-oriented data monitoring, community revitalization plan to promote immunization are ways to improve the provision of vaccination services in this district.

BACKGROUND: Adverse temperature recording in vaccine\'s cold chain is a major issue worldwide and this condition is known to compromise the quality of vaccines very rapidly. In Cameroon, with tropical climate, vaccines exposure to abnormal temperatures is very common. This study was conducted to identify factors associated to abnormal temperature recording in cold chain in the North West region.
RESULTS: A total of 65 vaccinating health facilities were visited for the study from eight health districts. Concerning type of health facility, 48 (73.8%) of the health facilities were governmental facilities. About 50 (76.0%) of the facilities had a functional thermometer. Among the 50 health facilities with functional thermometer, abnormal temperatures were registered in 10 (20%) health facilities during data collection and 12 (24%) in the 2 months preceding collection. Factor significantly associated with abnormal temperature recording was the absence of an alternative power source (OR = 6.5, p = 0.03).
CONCLUSIONS: The absence of an alternative source of power was significantly associated with abnormal temperature exposure in the 2 months preceding data collection. To improve on the quality of vaccines administered in North West region, each vaccinating health facility must have at least two sources of power supply.

SUMMARY To determine risk factors for sporadic Vibrio parahaemolyticus gastroenteritis, we conducted a population-based case-control study in sentinel hospital surveillance areas of Shanghai and Jiangsu province, China. Seventy-one patients with diarrhoea and confirmed V. parahaemolyticus infections were enrolled, and they were matched with 142 controls for gender, age and residential area. From the multivariable analysis, V. parahaemolyticus infections were associated with antibiotics taken during the 4 weeks prior to illness [odds ratio (OR) 7·6, 95% confidence interval (CI) 1·1–54·4)], frequent eating out (OR 3·3, 95% CI 1·0–10·4), and shellfish consumption (OR 3·4, 95% CI 1·0–11·1), with population-attributable fractions of 0·09, 0·24, and 0·14, respectively. Protective factors included keeping the aquatic products refrigerated (OR 0·4, 95% CI 0·2–1·0) and pork consumption (OR 0·2, 95% CI 0·1–0·9) [corrected] .

OBJECTIVE: The authors conducted for the first time a medication error review (REMED) following a medication error occurred in an intensive care unit. The aim of this study was to assess this first REMED.
METHODS: Descriptive study.
METHODS: The analysis of the medication error, consisting in the administration of Clottafact(®) instead of Aclotine(®), was performed using the REMED method.
RESULTS: The medication error was characterized as \"proved error\" and \"missed before administration\". Four main causes were identified: poor quality of drug storage, homophony between Aclotine(®) and Clottafact(®), non-compliance with good practices, and need of hemofiltration for the patient. At least, this REMED analysis led to the establishment of four improvements measures.
CONCLUSIONS: The educational aspect of the REMED was clearly appreciated by all the different health care workers who participated to the analysis. Even if medication errors may occur at the different steps of the medication process, the REMED is a very good tool to improve the care quality and also to reduce the drug iatrogenic risk.

BACKGROUND: People who handle and regulate temperature-sensitive pharmaceutical products require the knowledge and skills to ensure those products maintain quality, integrity, safety, and efficacy throughout their shelf life. People best acquire such knowledge and skills through \"experiential learning\" that involves working with other learners and experts.
METHODS: The World Health Organization developed a weeklong experiential learning event for participants so they could gain experience in how temperature-sensitive products are handled, stored, and distributed throughout the length of the distribution supply chain system. This experiential learning method enabled participants to visit, critically observe, discuss and report on the various components of the cold chain process. An emphasis was placed on team members working together to learn from one another and on several global expert mentors who were available to guide the learning, share their experiences, and respond to questions.
RESULTS: The learning event, Pharmaceutical Cold Chain Management on Wheels, has been conducted once each year since 2008 in Turkey with participants from the global pharmaceutical industry, health care providers, national regulatory authorities, and suppliers/vendors. Observations made during the course showed that it was consistent with the principles of experiential and social learning theories. Questionnaires and focus groups provided evidence of the value of the learning event and ways to improve it.
CONCLUSIONS: Reflecting the critical elements derived from experiential and social learning theories, five factors contributed to the success of this unique experiential learning event. These factors may also have relevance in other experiential learning courses and, potentially, for experiential e-learning events.

BACKGROUND: The aim of this study was to describe the investigation of a case of meningitis in a neonatal intensive care unit in order to identify the source of infection and the associated risk factors.
METHODS: An analysis was carried out on the possible risk factors associated with the infection. E. sakazakii was detected in the batch of the powdered infant formula used during the feeding of the neonate and the initial level of contamination of the microorganism was estimated. The strains of E. sakazakii previously isolated in blood and faeces of the infected neonate and those isolated in infant formula were characterised by biotype, pulsotype and antimicrobial susceptibility.
RESULTS: E. sakazakii was detected in one opened and two unopened cases of a single batch of powdered infant formula. The E. sakazakii strains isolated in the samples of the product and those isolated in the infected neonate showed the same biochemical, antibiotic susceptibility and PFGE pattern.
CONCLUSIONS: The case of meningitis in the neonatal intensive care unit occurred as a result of the use of a powered infant formula contaminated with E. sakazakii at manufacturing level, and an inadequate preparation and storing of the reconstituted product were identified as risk factors.