ABSTRACT
Vaccines are urgently needed to control the COVID-19 pandemic. To gradually increase the vaccination rate among residents, temporary vaccination clinic for COVID-19 plays an important role. It should be located in an area with convenient transportation and concentrated population. Functional zones including waiting and inquiry, registration and notification, injection, observation and emergency room should be established. All vaccine recipients’ information should be uploaded to the national immunization information system. Medical staff at the temporary vaccination clinic should be professionally trained. A cautious disinfection and wiping are essential for the temporary vaccination clinic.
Vaccines are urgently needed to control the COVID-19 pandemic. The vaccination of COVID-19 aims at protecting some susceptible groups, increasing population vaccination rate, gradually establishing community immunity barrier, and eventually eliminating the virus spread.Citation1–5 In Zhuhai, China, all residents from 18 to 59 are able to apply for the vaccines on-line.
A temporary vaccination clinic was established in Zhuhai Municipal Sports Center, an area with convenient traffic and concentrated residents. The stadium was especially modified to establish necessary functional zones, including waiting & inquiry zones, registration & notification zones, injection zones, and observation & emergency zone (). Previous on-line applications are required to walk in the clinic. At entrance, residents with no epidemiological history or fever are randomly assigned to one of the 20 waiting zones, and the essential information of entrants is obtained at the entrance. Each waiting zone is equipped with medical staff for probable inquiry. Screens on the wall display hygiene education videos repeatedly. After waiting for about 2 minutes, the vaccine recipient is sent to the corresponding registration & notification zone, where an informed consent indicating occasional discomfort that may arise has to be signed. The vaccine recipient’s information is uploaded to the national system on the internet. 5 G Telecom Technology is applied to guarantee stable network signal. The registration process costs only about 1 minute. After registration, the vaccine recipient arrives at the injection desk. Each registration desk and injection desk is separately enclosed in one cubicle. A desktop refrigerator is equipped for each injection desk for vaccine storage. The information of each injected vaccine is also uploaded to the national system. The injection process costs only about 1 minute.
Figure 1. The mobile cabin vaccination site for COVID-19 in Zhuhai, China. a. The waiting zone; b. The registration and notification zone; c. Injection zone; d. The observation zone
After injection, the vaccine recipient is sent to the corresponding observation zone. The observation areas are also separated from each other in order to prevent psychogenic adverse reactions. Physicians make their rounds in the observation zones for inspection. After being observed for 30 minutes, vaccine recipients without any discomfort may leave. Vaccine recipients with adverse reactions are sent to the adjacent emergency rooms. Ambulances are docked by the exit of the room. First aid medicine, equipment, and medical staff are equipped for the emergency rooms and ambulances. Adverse events following immunization (AEFI) are registered into the national system within 48 hours. It would be reported within 2 hours if severe AEFI occurs.
The temporary vaccination clinic undergoes frequent disinfection and wiping, which are recorded accordingly. Air sterilizing machines are installed in every corner of the stadium (functioning at least three times a day, 2 hours each time). Several dozens of ultraviolet radiation facilities are also used (at least twice a day, 1 hour each time). Chlorine disinfectant with a concentration of 500 mg/L is used to disinfect the ground, tables and chairs, door handles, refrigerator handles, inoculation console, etc. (at least three times a day). And 75% alcohol is used to disinfect the computer keyboard, mouse, scanning gun, etc. (at least two times a day, or immediately after use). All the wastes including used cotton swabs are strictly collected, disposed, and recorded (number of cotton swab packages).
The key implementation components that helped ensure success of this temporary vaccination clinic lie in fine collaboration and professional management. The work was directed by the Party Committee of Zhuhai People’s Hospital Medical Group. Participating departments included Medical Administration Department, Nursing Department, Prevention Healthcare Department, Information Technique Department, Publicity Department, etc., responsible for information collection, medical staff scheduling, site security, fire control, emergency management, infection prevention, medical equipment supply, etc. Lessons learned included a good leadership, support from some other administrations (such as the police providing security, neighborhood committee providing volunteers), and education on residents enhancing their awareness on the necessity of vaccination. All these factors could help to accomplish the vaccination task in a quicker time. The biggest challenge encountered is how to determine the optimal ratio of physicians and nurses. In the beginning, two physicians combined with one nurse were assigned for the registration & injection of one patient. But it was found to be unable to maximize efficacy. After repeated trial and test, the solution was found to be one physician combined with two nurses for one patient’s registration & injection.
On March 27, 2021, the clinic administered the first dose. The temporary vaccination clinic is open for 12 hours a day. Each zone completes at least 150 doses, with over 3000 doses by all the 20 zones each day. Up to April 20, 2021, over 1.4 million doses have been administered by Zhuhai Municipal Sports Center temporary vaccination clinic, combined with other 23 temporary vaccination clinics, 25 permanent vaccination clinics, and many mobile vaccination teams in Zhuhai. Zhuhai became the first prefecture city in China with COVID-19 vaccination coverage over 80% in the targeted population aged from 18 to 59 years old. This clinic is still operating and it is estimated that by three months all doses will have been delivered. A higher local vaccine coverage can create a solid barrier against COVID-19. And free vaccinations, would increase the utility of vaccinating, resulting in a higher probability of vaccinating.Citation6 Combined with other existing literature where temporary vaccination clinics are described,Citation7,Citation8 the experience of temporary vaccination clinic for COVID-19 in Zhuhai, China could be shared by other areas currently providing immunization services against COVID-19.
This temporary vaccination clinic could also be put into the specific context of vaccination against tropical diseases. Many highly endemic infectious diseases of tropical countries are becoming global burdens, such as Japanese encephalitis, leprosy, dengue fever, etc., with over 4 billion people living at risk of infection, becoming a potential threat to travelers to endemic areas.Citation9 In the absence of antiviral intervention, vaccination is the only strategy to develop long-term sustainable protection against infection of these diseases.Citation10 And the impact of vaccine could be maximized by its wide application to the public health system in such temporary vaccination clinics. So this COVID-19 vaccination clinic could also be utilized to meet needs in tropical diseases and other health area in tropical medicine, specifically.
Authors contributions
Lu LG proposed the study. Liu JW, Li ZH and Cui M performed the research. Jin H, Chu J, Zhao W, Ye Q, Zhan MX, and Han XL wrote the first draft. All of the authors contributed to the design and interpretation of the study and to further drafts. Lu LG, Liu JW, Li ZH and Cui M are the guarantors.
Disclosure of potential conflicts of interest
No potential conflicts of interest were disclosed.
Acknowledgments
We thank Zhuhai Health Bureau for providing the necessary support for our study.
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