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Cold Chain Logistics and Issues:

Cold Chain Logistics and Issues:. IPV Global Workshop. March 25, 2014. The Cold Chain. Which are most sensitive to heat?. Vaccines damaged by freezing. Meningococcal Pertussis Pneumococcal Tetanus Toxoid Typhoid All combination vaccines. Diphtheria toxoid Hepatitis A Hepatitis B

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Cold Chain Logistics and Issues:

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  1. Cold Chain Logistics and Issues: IPV Global Workshop March 25, 2014

  2. The Cold Chain

  3. Which are most sensitive to heat?

  4. Vaccines damaged by freezing Meningococcal Pertussis Pneumococcal Tetanus Toxoid Typhoid All combination vaccines • Diphtheria toxoid • Hepatitis A • Hepatitis B • Inactivated Poliovirus • Influenza • Liquid Hib • Liquid Japanese Encephalitis

  5. WHO Recommended Storage Conditions for Vaccines

  6. 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!

  7. 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

  8. Ice Lined Refrigerators (ILRs) Can maintain temperature for 16 hours without power if operate w/power continuously for at least 8 hours a day!

  9. 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.

  10. Storage of Vaccines in Refrigerators

  11. Loading top loading refrigerators

  12. New challenges: More storage space is required Volume of vaccine per fully immunized child* Pentavalent Pneumococcal (1st generation) 2004 +41 cm3 2009 +41 cm3 >2012** =69 cm3 =110 cm3 HPV +45 cm3 Rotavirus (1st generation) =311 cm3 Basic EPI6 vaccines 2011 +156 cm3 <2000 =28cm3 IPV +16 cm3 =266 cm3 =327 cm3 • x11 increase in vaccine volume per FIC since 2000 • The accelerated introduction of new vaccines speak volumes • Volumes affect storage, transport and paperwork * Volume also needed for Measles second dose, Tetanus, Yellow-Fever, Meningitis A, JE and vaccines provided during campaigns. ** Illustrative. Based on 1 dose vial vaccine presentations and first generation of vaccines Source: WHO/UNICEF

  13. Effective Vaccine Management

  14. The to EVM are the nine criteria Stock management

  15. 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 temperature, available transport

  16. Vaccine Carriers and Ice Packs

  17. Good or Not Good?

  18. Effect of melted ice packs in vaccine carriers on labels

  19. 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

  20. Tools for monitoring temperature

  21. Temperature monitoring chart for facilities

  22. Is it working?

  23. Vaccine Vial Monitor (VVM)

  24. Types of VVMs Available path June 2000

  25. Cold Chain in Campaign Setting

  26. Cold Chain in Campaign Setting IPV • Damaged by freezing temperatures • Cool packs or ‘conditioned ice packs’ for vaccine carrier • Reliance on VVM for monitoring vaccine potency • Vaccine administration requires training

  27. Cold Chain Challenges - SIAs • Reaching hard to reach populations • Distance and Accessibility • Seasons • Weight and volume of equipment • Capacity needs often more than routine • storage capacity limited • Costs • Health worker practices • Vaccine management and administration

  28. Resources http://www.unicef.org/immunization/index 42071.html http//www.path.org/projects/project-optimize.php http://who.int/vaccines-documents/DoxGen/H5-CC.htm www.technet21.org

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