Module 9: Pharmaceutical Interventions
Trainee Exercises
Exercise 1: Prioritizing Prophylaxis Group Discussion
Instructions. Access to prophylaxis can be a difficult issue. Take a few minutes to discuss the
questions below, considering your local supplies, resources and response plan.
Time allotted: 25 minutes
Question 1.
a. How will rapid response teams decide who receives prophylaxis? That is, who should be
included in your population at risk?
b. If there are one or two cases in a village, would you suggest prophylaxis for the entire
village? Or just close contacts? Who needs to get the drugs?
c. What are some of the ethical implications to this question? How will the rapid response team
effectively distribute drugs in an environment of fear and panic? (slide 16-17)
Question 2. What are some practical issues to consider when administering antivirals to contain an
outbreak? For example, what materials or resources will you need?
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Exercise 2. Dispensing Clinic Problem Solving Exercise
Introduction. Medications must be taken as soon as possible after the onset of symptoms or
exposure. To set up a clinic designed to dispense medications to a large number of people, you must
calculate how many people must be processed through a dispensing clinic per hour, considering the
total amount of people in your population.
Time allotted: 15 minutes
Calculations
To calculate the number of people who must be processed through a dispensing site per hour, you must
examine the following:
[A] = The total population size
[B] = Number of hours to dispense/vaccinate to entire population
[C] = Number of clinic sites available
[D] = The number of patients per hour which must be vaccinated or receive prophylaxis/treatment.
[D] can be calculated using the equation below.
[A] ÷ [B] ÷ [C] = [D]
Instructions. Read the information below and discuss a best guess for what each parameter might
be in your local area. As a group, work out the equation and share the results with the rest of the
class.
Question 1. [A] Total population. The number of people in the entire population in the calculation
takes into account that everyone receives medication or is vaccinated. Planning for a large scale
event requires preparing to protect the entire population within your jurisdictional boundaries. It
will be easier to scale down your procedures if the event proceeds to be on a smaller scale. (Rather
than the opposite). Therefore, concentrate your planning efforts for the worst case scenario.
What is the total number of people in your geographic area? ______________________
Question 2. [B] Hours to dispense/vaccinate to entire population: For antivirals to be effective
against influenza, they should be taken as soon as possible at the onset of symptoms. Assume that
you must dispense to the population during a period of 24 hours. You must subtract the amount of
time it will take for a mass dispensing clinic to open its doors to the public. For example, if it will
take 4 hours to staff and equip a clinic, then you must subtract 4 hours from 24, leaving 20 hours for
letter [B].
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Considering time required to equip and staff a clinic, how long will you have to dispense
antivirals to the entire population? ____________________________________________
Question 3. [C] Number of sites. Now you must consider how many sites you will have available
to set up and staff as a clinic. Have you explored what types of sites would be best to use in a mass
clinic event? Think about how many of these sites can be used and staffed for a mass clinic and use
this number for [C].
How many clinic sites will dispense antivirals? ___________________________________
Question 4. [D] Number of patients to be processed per hour. The answer from the mathematical
calculation will tell you how many people your clinic will need to dispense medications to in an
hour. This means operating 24 hours a day. One thing to note is that if you have fewer available
sites, your efficiency level would need to increase, meaning you would need to double or even triple
the amount of patients you are capable of processing per hour.
Number of patients to be processed per hour ([A] ÷ [B] ÷ [C]) is ____________________
Question 4 Example Calculation
[A] Total population: 1000
[B] The time required for start a clinic is 4 hours, and you have 24 hours to dispense to the
population (=20 hours to dispense after opening the clinic).
[C] 2 available clinic sites
[1000] ÷ [20] ÷ [2] = [25]
[D] The amount of patients which need to be processed per hour is: 25.
5. Discuss the following issues concerning mass dispensing clinics with your group.
a. Is the number calculated for letter [D] reasonable? Are available resources able to manage
this dispensing/vaccination capacity under normal operating procedures? Or do we need to
look at ways to accomplish this?
b. What sites are available for a mass clinic event? Think about where people would easily
report to when advised by government or public health leaders. Is the facility large enough
to handle the masses? Issues of traffic flow to the mass clinic must be considered. Clinic
flow plans must be evaluated as well.
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c. What is the mechanism for receiving antivirals and transporting to locations where supplies
are needed? How are these supplies requested? Who is responsible for making the request?
d. Consider alternative strategies at the village level for mass dispensing of drugs for
prophylaxis.
 Use of village schools or other central buildings
 Household-based dispensing
 Will directly observed therapy (DOT) need to be implemented?
 Prophylaxis will need to be taken daily for at least 10 and more likely 20 - 30 days.
Consider the implications for compliance and monitoring.
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Exercise 3. Adverse Event Reporting
Introduction. Adverse event reporting is another task which will be a heavy burden during a
pandemic. In this exercise, you will become familiar with the World Health Organization
guidelines and forms for reporting adverse events. You will use this exercise to focus on the
existing infrastructure in your area and how to expand its capacity. You will review and update the
communication networks that would be used for reporting an adverse event, and identify the
individuals or agencies that you should contact, and identify who will be responsible for these
efforts.
Time allotted: 20 minutes, or as time allows
Instructions.
The WHO Field Guide Surveillance for Adverse Events Following Immunization, including the
template for case reporting should be provided as a guide. Appendix D contains a reporting form for
an individual adverse event. Look over these documents and make comments and
recommendations specific to your country’s operating protocols. If there is an existing mechanism
in place, use what is in place in your country then use the documents as a guide to compare or
reference.
Question 1. Identify who is the responsible person or agency for reporting adverse events and how
reporting is to be done.
Question 2. What comments or recommendations do you have about the adverse reporting forms
and mechanisms?
Question 3. What impact will adverse event reporting will have during a mass dispensing clinic?
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