The Cold Chain and Logistics: What does anything else matter if the vaccine isn’t good?

The Cold Chain and Logistics: What does anything else matter if the vaccine isn’t good? STOP Briefing The Cold Chain Which are most sensitive to heat? Which you never want to freeze? D o N o t F r e e z e (OPV, Measles, MR, MMR, BCG can be frozen, but not diluents) 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 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 What 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 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 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 hours after adding diluent ... 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... 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... 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