The Cold Chain and Logistics:

STOP Briefing

What does anything else matter if the vaccine isn’t good?

The Cold Chain

Which are most sensitive to heat?

Which do you never want to freeze?

(OPV, Measles, MR, MMR, BCG can be frozen, but not diluents)

Do Not

Freeze

WHO Recommended Storage Conditions for Vaccines

Cold Chain Equipment & Logistics

Refrigerators/Freezers– Generators/ Voltage Stabilizers

Cold Boxes Vaccine Carriers (Foam Pad) Ice Packs

Check condition every time you visit a facility!

Refrigerators/Freezers

Freezers (-15 to -25 degrees C)– Ice Pack Freezers (24 hours)

Refrigerators (usually w/freezer)– Electric

Ice Lined Refrigerators

– Kerosene – LP Gas– Solar

Ice Lined Refrigerators (ILRs)

Can maintain temperature for 16 hours without power if operate w/power continuously for at least 8 hours a day!

Refrigerators/Freezers

Reminders

At least 10 cm from wall Off the floor Kept clean, esp. dust in coils Out of direct sunlight Only vaccine to be stored. Opened minimal times per day Generator or kerosene = good ventilation Voltage stabilizers to avoid damage to compressors caused by

changes in electricity.

Storage of Vaccines in Refrigerators

Loading top loading refrigerators

Good or Not Good?

Good or Not Good?

What do you do?

Is it working?

Cold Boxes

•Insulated for short–term use: 2-7 days

•Used in campaigns or when refrigerator out of order

•Consideration for use and storage capacity, outside temperture, available transport

Vaccine Carriers and Ice Packs

Good or Not Good?

Effect of melted ice packs in vaccine carriers on labels

Multi dose Vials

Vials where one or more doses of vaccine are used

Multi dose vial policy ( open vial policy)– OPV, DTP, TT, DT, Hepatitis B and liquid Hib– Used in subsequent vaccination sessions as long

as the expiration date has not passed, the cold chain has been maintained and the vvm has not reached the discard point

Tools for monitoring temperature

Temperature monitoring chart for facilities

Shake Test (for freeze sensitive vaccines)

Vaccine Vial Monitor (VVM)

VVMs on Vaccines

Cold Chain in Campaign Setting

Cold Chain in Campaign Setting - Polio

Ice Pack Freezing/Assuring Power Source Sunlight is harmful for OPV vaccine Heavy reliance on VVM Usually use 4 ice packs but in some countries, fewer ice packs OK Ice is acceptable if no other choice

– Try to protect vials from wet Can keep vials out of vaccine carrier as needed until VVM turns—

especially when using vaccine carriers for more than 1 day and need to preserve the temperature.

Check VVM each time before putting drops in child’s mouth!

Cold Chain in Campaign Setting - Measles

Sunlight is harmful for measles containing vaccine Diluent should be cooled before mixing with vaccine After reconstitution

– Keep the vial out of the light– Keep the vial as cool as possible without freezing it– Use foam pad to keep open vial whenever available

Vaccine should not be pre-drawn Reconstituted vaccine discarded by 6 hours after adding diluent