The Cold Chain and Logistics:

What does anything else matter if the

vaccine isnt good?

STOP Briefing
The Cold Chain
Which are most sensitive to heat?
Which do you never want to freeze?

D
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N
o
t

F
r
e
e
z
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(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 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 childs 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