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

2. The Cold Chain

3. Which are most sensitive to heat?

4. Which do you never want to freeze? (OPV, Measles, MR, MMR, BCG can be frozen, but not diluents) Do NotFreezeDo NotFreeze

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. Good or Not Good?

14. What do you do?

15. Is it working?

16. 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

17. Vaccine Carriers and Ice Packs

18. Good or Not Good?

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

20. 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

21. Tools for monitoring temperature

22. Temperature monitoring chart for facilities

23. Shake Test (for freeze sensitive vaccines)

24. Vaccine Vial Monitor (VVM)

25. VVMs on Vaccines

26. Cold Chain in Campaign Setting

27. 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!

28. 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