1
Prayer
Heavenly Father,
We praise and glorify your name as we start our Basic EPI and Cold
Chain Management Training today,
We are thankful for the beautiful morning that you have given us
and also for bringing everyone here safely
Guide us throughout this 3-day activity and may our work be
pleasing to you
All these we pray in the name of your Son, Jesus.
Amen
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
4
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and
Logistics Management Training
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
6
Serbisyong Salud Bikolnon
Republic of the Philippines
Department of Health
Center for Health Development- Bicol
i
Family Health Cluster
Monrey Isaiah C. Mancilla, MD
Family Health Cluster
House Rules
1. Training will start at exactly 08:00H each day
2. Cellular Phones should be in silent mode. LIMIT the usage of your CP to urgent
concerns ONLY.
3. NO ONE is ALLOWED to sleep during the training (you may take s short nap during
lunch break)
4. Check in and check out time
5. Assignments will be given each day, everyone is expected to submit the output the
following day
6. Adult learning design
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
88
Serbisyong Salud Bikolnon
Day 2 Schedule
8:00 - 8:15
Recap of Day 1
FHC
8:15 – 12:00
Cold Chain
Management
Mancilla
12:00 – 1:00
Lunch
1:00 – 5:00
NIP Program
Updates
Mancilla
5:00 – 5:30
Recap of Day 2
FHC
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
99
Serbisyong Salud Bikolnon
Objectives
At the end of this chapter, the health worker should be able to:
• Understand the vaccine cold chain system
• Identify the vaccines in the national immunization schedule
and their recommended storage temperatures;
• Understand the roles and functions of the PHN and Midwife
as EPI Manager/Coordinators and Cold Chain Manager at
RHU
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccines
• temperature-sensitive biological products
• protection against vaccine preventable diseases
(VPDs)
• safety and potency of vaccine is dependent on
cold chain system
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
11
Serbisyong Salud Bikolnon
COLD CHAIN SYSTEM
Manufacturer
Is the system of ensuring
National
depot
potent
vaccines are kept
from the point of manufacture
to the point of administration
and stored at correct
temperatures through out the
chain.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Region / districts
Health facility
12
Serbisyong Salud Bikolnon
COLD CHAIN SYSTEM
Manufacturer
Is the system of ensuring
National
depot
potent
vaccines are kept
from the point of manufacture
to the point of administration
and stored at correct
temperatures through out the
chain.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Region / districts
Health facility
Serbisyong Salud Bikolnon
COLD CHAIN SYSTEM
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
14
Serbisyong Salud Bikolnon
Cold Chain Elements
• Material / Equipment
• Transport
• Financial resources
• Norms and standards
• Human Resource
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Slow Chain:
COLD
CHAIN
EQUIPMENT
Cold Rooms, Refrigerators and Freezers
Chest-type Refrigerator
Vertical Refrigerator
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
16
Serbisyong Salud Bikolnon
Fast Chain:
COLD
CHAIN
EQUIPMENT
Transportation of Vaccines & Diluents
Vaccine
carrier
Vaccine cold box/
Transport box
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Ice packs
17
Serbisyong Salud Bikolnon
Monitoring of Vaccine Equipment
• Ensure that the room is well
ventilated and protected from
direct sunlight and heat;
• Place refrigerators or freezers
about 12 inches away from the
wall to facilitate air circulation
and to avoid continuous running
of the motor, which may
damage it.
• Place the refrigerator on
wood blocks 1 to 2 inches thick
to keep it from moving.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
18
Serbisyong Salud Bikolnon
Monitoring of Vaccine Equipment
Ensure that each piece of
equipment is permanently
connected to an electrical outlet. If
there is no power supply, unplug
the socket if voltage regulator is not
used.
Use a voltage regulator if there are
three or more refrigerators or
freezers in an area with regular
power fluctuations.
Keep doors and lids firmly shut.
Open the door only when you have
to take out or store a vaccine.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
19
Serbisyong Salud Bikolnon
Fast Chain:
Monitoring
of
Vaccine
Equipment
Transportation of Vaccines & Diluents
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
20
Serbisyong Salud Bikolnon
Fast Chain:
Monitoring
of
Vaccine
Equipment
Transportation of Vaccines & Diluents
Defrost the refrigerator whenever frost
becomes more than ¼ inch thick.
May place bottles of water in the
refrigerator to help maintain storage
temperatures. Bottles of water should be
labelled NOT FOR DRINKING.
Do not keep food or drinks in the
refrigerator.
Defrost and clean refrigerators or freezers
regularly.
Do not stack or put any item on top of the
equipment
21
Monitoring ofFast
Vaccine
Equipment:
Chain:
REGULAR
tasks:
Transportation
of Vaccines
& Diluents
Daily: Make sure that the temperature inside the refrigerator or freezer
is between +2ºC and +8ºC and -15ºC and -25ºC, respectively. For this
purpose, always keep a thermometer inside the refrigerator.
Weekly: Check the ice formation on the freezer.
If the ice is thicker
than ¼ inch, defrost the freezer.
Monthly:
Keep the condenser and compressor clean. Remove any dirt
or dust with a soft brush.
Monthly:
a)
b)
Check the surface of the refrigerator for any of the following:
Damaged surface and part
Rusted part
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
22
Serbisyong Salud Bikolnon
Monitoring ofFast
Vaccine
Equipment:
Chain:
PERIODIC
tasks:
Transportation
of Vaccines
& Diluents
• (tasks to perform whenever necessary):
Clean the refrigerator inside and out using a damp cloth and mild
detergent.
Clean the door gasket and powder it with talcum to prevent it from
sticking.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
23
Serbisyong Salud Bikolnon
Monitoring of Vaccine Equipment
After each use:
Clean the cold boxes or vaccine carriers thoroughly
with soft cloth and leave the lids open to allow
complete drying.
Examine all surfaces and repair cracks or straps
immediately.
During and between use:
Keep cold boxes and vaccine carriers away from
direct sunlight.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
24
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Activity:
Divide into 6 groups:
Each group will be given a picture
TASK (10mins):
Identify gaps and challenges/cold chain
issues
Provide solution(s) for each
Discuss the findings and monitoring
findings in plenary (3-5mins each)
Open forum
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise on COLD CHAIN Management:
Exercise on COLD
CHAIN Management:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise on COLD CHAIN Management:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise on COLD
CHAIN Management:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise on COLD CHAIN Management:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise on COLD
CHAIN Management:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Proper defrosting of refrigerators
For Electric/Solar-powered equipment:
• Remove the vaccine and store it in another working refrigerator or cold box with ice
packs.
• Switch off the refrigerator and pull out the plug. Open the refrigerator and freezer
doors.
• Remove all ice packs from the freezer.
• Open the drain plug at the bottom of the chest type.
• Put a bowl or tray in front or underneath to collect the ice and water.
• Remove loose ice by hand only. Avoid using tools or sharp instruments.
• Clean the refrigerator thoroughly and let it dry.
• Reconnect the power plug and turn the refrigerator on
• Wait until the refrigerator is running at the correct temperature before replacing the
vaccines.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Proper defrosting of refrigerators
• Remember:
• Do not remove frost or ice with a knife or any other sharp
instrument. Doing so can easily damage the refrigerator.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Inventory of Cold Chain Equipment and Devices
• Refer to GOOGLE DOCS
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
Guiding Principles
for Vaccine and Cold Chain Management
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
36
Serbisyong Salud Bikolnon
Objectives
At the end of this chapter, program and cold chain managers
will be able to understand and apply the basic principles and
importance various vaccine management guideline and
policies as follows:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Objectives
• Vaccine Wastage and
Wastage Factor
• Multi-Dose Vial Policy
(MDVP)
• Buffer Stock
• Bundling of vaccines and
immunization supply
• The Shake Test
• First Expiry First Out
(FEFO) Principle
• Vaccine Vial Monitor
• Conditioning Ice Packs
• Minimum and Maximum
Stock Level
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Multi-Dose Vial Policy
(MDVP)
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Multi-Dose Vial Policy
All opened WHO-prequalified multi-dose vials of
vaccines should be discarded at the end of the
immunization session, or within six (6) hours of
opening, whichever comes first, unless the
vaccine meets all four of the criteria listed
below.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Multi-Dose Vial Policy
If the vaccine meets the following four criteria, the opened vial can
be kept and used for up to 28 days after opening.
1. The vaccine is currently prequalified by WHO.
2. The vaccine is approved for use for up to 28 days after opening the vial, as
determined by WHO.
3. The expiry date of the vaccine has not passed.
4. The vaccine vial has been, and will continue to be, stored at WHO- or
manufacturer-recommended temperatures; furthermore, the vaccine vial
monitor, if one is attached, is visible on the vaccine label and is not past its
discard point, and the vaccine has not been damaged by freezing.
HepB, Td, bOPV and IPV
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Guidelines:
–HepB, Td, bOPV and IPV are vaccines covered by
MDVP
–All reconstituted vaccines should be discarded six
hours after opening or at the end of immunization
session whichever comes first. These are BCG,
MR, MMR, JE
–Flu vaccine without VVM should be discarded 7
days after opening
–All single dose vaccines are not covered by MDVP
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Vaccine Vial Monitors
(VVM)
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
How VVMs work?
• Vaccine Vial Monitors (VVMs) are heat–
sensitive chemicals applied to the vial label
or the cap
• VVMs show whether the vial has been
exposed to excessive heat since leaving the
manufacturing site
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
VVM Stage
USE VIAL WHEN THE SQUARE IS
WHITE OR LIGHTER THAN THE
CIRCLE
PRIORITIZE THE
USE OF THE VIAL
DISCARD VIAL WHEN THE SQUARE
IS AS DARK AS THE CIRCLE, OR
DARKER THAN THE CIRCLE
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
VVM reaction rate (OPV)
Number of days before the VVM
reaches the discard point at different
24/24hr temperatures
At:
+ 37°C ……………………. 2 days
+ 25°C …………………….. 7 days
+ 4°C ………………………. 180 days
(six months)
- 20°C ……………………… 2 years
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Why VVMs are important ?
VVMs can:
• prevent delivery and administration of heatdamaged vaccine
• reduce vaccine wastage
• indicate cold chain problems
• serve as a tool to manage vaccine stocks
• facilitate immunization outreach
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Questions frequently asked:
Does VVM measure the potency of vaccines?
- No! VVM measures only the heat exposure with time.
- VVM does not give information on other factors.
Can change of colour in one vial show the
situation in the other vials?
No! The information may not be extended to the other vials
with or without VVM.
I kept one vial of vaccine with VVM in my
pocket for 20 days and VVM was still intact
(colour did not change). Why?
Do not put vaccine in your pocket! They should be kept in
refrigerators!
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Questions frequently asked (cont.):
Does VVM change colour as soon as exposed to t° >8°C?
No, vaccine can be exposed to temp. > 8°C for limited time.
If vaccine is back in fridge, does colour reverse back?
No! VVM colour change is irreversible.
If vaccine is frozen, does VVM colour change?
No! VVM colour does not change if Temperature is kept below 0°C.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Questions frequently asked (cont.):
Are VVMs for OPV the same as for other antigens?
No! VVM is usually specific for each vaccine.
If VVM does not reach discard point, can vaccine be used after
expiry date ?
No! Expired vaccine should NEVER been used !
If we have VVM on all vaccine vials, do we have to keep
other temperature monitoring devices in the
refrigerators?
Yes! VVM does not replace other temperature monitoring devices
(thermometers, freeze-indicators, Fridge-tags, etc.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Questions frequently asked (cont.):
If indications on temperature monitors are different than
VVM, which ones to consider ?
VVM! Since VVM has the historical exposure to heat from the
manufacturer to the point.
Should we treat vials with VVMs with darker square differently ?
Yes! Use the vial before the other vials that VVM is intact!
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Questions frequently asked (cont.):
Does VVM has other functions?
Yes, VVM shows status of each vial and allow health staff to:
§ Which vial to use first (FEFO but also close to discard point first)
§ Identify cold chain problems
§ Reduce wastage and using vaccine in case of cold chain failure as long
as VVM is OK.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
VVM should NOT be anymore just
a design on the vial label.
VVM should be used as a monitoring
tool !!
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Activity:
A picture will be shown on the screen:
TASK (3mins):
Decide as either to USE or DISCARD the
following vials based on the VVM
Open forum
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise
Use vs Discard?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise
Use vs Discard?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise
Use vs Discard?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise
Use vs Discard?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise
Use vs Discard?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Wastage
•
loss, erosion or damage or through
careless or extravagant use
•
wastage occur in both open and
unopened vial
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
61
Serbisyong Salud Bikolnon
Causes of Wastage
Vaccine wastage in unopened
vials
• Expired
•
• VVM indicating discard point
•
• Exposure to heat or freezing
temperatures
•
• Breakage
Vaccine wastage in unopened vials•
• Missing inventory
•
• Theft
• Discarding unused vials returned from an •
outreach session
•
•
•
Vaccine wastage in opened
vials
Discarding remaining doses at end of session not in
accordance with the multi-dose vial policy (MDVP).
Not being able to draw the number of doses indicated on
the label of a vial
Poor reconstitution practices
Opened vials
Vaccine submerged
wastage in opened vials in water
Suspected contamination
Patient reaction requiring more than one dose
Administration of incorrect dosage
Improper reconstitution of vaccines
Very few children showing up during immunization
session
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
62
Serbisyong Salud Bikolnon
Ways to reduce Wastage
• Maintain proper stock management
• Develop a micro plan to ensure efficiency of immunization
service delivery
• Ensure compliance on MDVP
• Monitor VVM and expiration date regularly
• Follow First-Expiry-First-Out (FEFO) principle unless there is a
change of VVM color reaching the discard point
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
63
Serbisyong Salud Bikolnon
Ways to reduce Wastage
• Monitor and record cold chain temperature for each cold chain
equipment twice daily, including weekends and holidays.
• Ensure vital information is recorded when receiving, storing and
distributing vaccines.
• Monitor, maintain, and routinely repair cold chain equipment.
• Perform shake test to rule out suspicion that vaccines have been frozen.
• Strictly follow standard protocol for transporting vaccines.
• Ensure a functional contingency plan is in place in case of power failure
or cold chain equipment breakdown. Perform a dry run at least once a
year to maintain readiness.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
64
Serbisyong Salud Bikolnon
Calculating Wastage Rate (WR)
Formula for computing the vaccine Wastage Rate (WR):
WR = Number of doses supplied - Number of dose administered x 100
Number of doses supplied
Example: A facility received 200 doses of a vaccine. Of this, 150 doses were
administered.
WR = 200 – 150 X 100 = 25%
200
Interpretation: 25% of the vaccine supplied to the facility is wasted.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
65
Serbisyong Salud Bikolnon
Calculating Wastage Factor (WF)
The formula for computing wastage factor based on defined wastage rate is
as follows:
Wastage Factor (WF) =
__100___
100-WR
Example: Assume that the wastage rate of a vaccine is 25%. Using the formula,
the WF will be:
WF =
100
= 1.33
100-25
Interpretation: This means that for every administered dose of this particular
antigen, 1.33 dose is needed to compensate for the 25% wastage.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Wastage Rate and Wastage Factor
Wastage 5% 10% 15% 20% 25% 30% 40% 45% 50% 55% 60%
Rate
(WR)
1.05
1.11
1.18
1.25
1.33
1.43
1.67
1.82
2.0
2.22
2.5
Wastage
factor
Penta,
PCV,
Vaccines HPV,
Rota,
PPV
HepB,
IPV,
Td,
Flu,
bOPV,
MMR,
MR,
JE
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
BCG
Serbisyong Salud Bikolnon
Supplies
Size
Wastage
Factor
Usage
Auto-Disabled
0.05 ml, g26 BCG
Syringe with needle
1.11
Auto-Disabled
0.5 ml, g23
Syringe with needle
HepB, Penta, PCV, IPV,
MMR, MR, JE, Td, TT, HPV,
PPV, Flu
1.11
Mixing Syringe with
5 ml. g20
needle
BCG, MR, MMR, JE
1.11
Safety Collector Box 5 liter
All syringes/needles
1.11
Dropper
Depends on
bOPV
manufacturer
68
1.11
• Represents a certain percentage of the total
doses of a particular delivery period.
• Varies depending of facility level
• a.k.a. Minimum Stock
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Ideal Buffer Stock Level
Cold chain level
Equivalent
Ideal Buffer Stock
percentage of
level (equivalent
the annual
supply in months)
requirement
Minimum Recommended
Buffer Stock Level*
Buffer Stock
(equivalent
supply in
months)
Equivalent
percentage of
the annual
requirement
Distribution
cycle to the
lower level
store
National
6 months
50%
3 months
25%
Quarterly
Regional
Provincial/City/District
6 months
3 months
50%
25%
3 month
1 month
25%
8.33%
Quarterly
Monthly
8.33%
1 month 8.33%
Municipality/RHU/ 1 month
HC/MHC/BHS
N/A
70
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Minimum and Maximum
stock level
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Minimum and Maximum stock level
Principles:
Minimum = Buffer Stock
Maximum = Supply for the delivery period + Buffer
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Calculating and Requesting
Vaccines and Safe Injection
Supplies
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Variables in Estimating Annual Vaccine
Requirement
1.
2.
3.
4.
5.
6.
7.
Total Population (Projected)
Target Population
Recommended Number of Doses
Number of Doses per vial
Wastage Factor
Distribution cycle
Recommended Buffer Stock
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Formula for estimating Annual Vaccine Requirements
Eligible Population = Total Population x
Multiplying Factor
Annual Requirement = ( EP x D ) x Wf + BS
(no. of doses/vial )
EP
=
Eligible Population (TP and 2.7%)
D
=
Number of doses required per target
WF
=
Wastage Factor
BS
=
Buffer Stock
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Note:
Buffer Stock should be
calculated once only and
can be replenished
whatever is used
Serbisyong Salud Bikolnon
Formula for estimating safe injection supplies
Number of 0.05 ml or 0.5 ml auto-disable syringe (ADS) required annually
AD Syringes = Eligible Population X Required # of Doses x Wastage Factor
Calculate the number of 5 ml mixing syringe required annually
Mixing Syringes = Eligible Population × Required #of Doses per Vial × Wastage
Factor
No. of Doses per vial
Calculate the number of safety boxes required annually
Safety Collector Boxes = Total AD Syringes+Mixing Syringes x Wastage Factor
100
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Activity:
Group per municipality:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise:
Instructions:
Calculate vaccine needed for a projected
population of 100,000
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Bundling of vaccines and Immunization Supply
Bundling is the concept of a theoretical bundle
which must comprise of the following:
•AD syringes
•Mixing Syringes
•Droppers
•Safety Boxes
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise:
Instructions:
Calculate bundled vaccination logistics for a
target population of 100,000
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise:
Instructions:
Calculate bundled Vaccine and vaccination
logistics for the target population of your
municipality.
(GOOGLE DOCS)
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Ordering vaccines
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Precautions to be considered
All orders of vaccines must be made taking into account the
following considerations:
Make sure that the available storage capacity is adequate
Ensure that the storage of vaccines complies with recommended
standards
Make sure that the inputs/supplies necessary for conservation (ex
Wick, oil...) Administration (diluents, syringes, needles,...) are
requested
Ensure to follow the recommendation for bundling of supplies
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Components of the vaccine and safe injection supplies
request
Previous month’s stock
• Vaccine
• Quantity of Previous stock
• Quantity received from previous order
• Quantity damaged, expired, loss, etc.
• Current stock
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Components of the vaccine and safe injection supplies
request
Estimation of Current Order:
• Quarterly/Monthly requirement
• Buffer stock
• Recommended stock level
• Current Order/request
• Remarks
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Exercise - Ordering
Instructions:
(GOOGLE DOCS)
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Sample Vaccine Stock Card
VACCINE STOCK CARD
Quantit
y
Receive
d (in
vials)
Dose per vial
Name of Vaccine
Generic Name
Storage
Locatio
n
Brand Name
Manufacturer
Property
Date
Transfer Receipt
(mm/dd/yyyy)
No.
Q U A N T I T Y (in vials)
To Whom Received/Issued
Balance
Received
Expiry Date/
Lot No.
Beginning Balance
Issued
QUANTITY VVM
(in Dose) STATUS
Qty
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
5,000
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Remarks
Issued by/Verified by
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Serbisyong Salud Bikolnon
Frequency of Ordering Vaccines
PHO Albay
PHO Camarines Norte
PHO Camarines Sur
PHO Catanduanes
PHO Masbate
PHO Sorsogon
CHO Iriga
CHO Legazpi
CHO Naga
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Receipts of Vaccines and Safe
Injection Supplies
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Actions on pre-arrival and arrival of commodities
Actions
Vaccines pre-arrival checklist
Inform details of vaccine arrival and distribution.
Vaccines arrival checklist
Check completeness of documents of the vaccines:
 Air way bill
 Bill of lading
 Way bill
 Packing list
 Invoice receipt
Open the boxes and check the temperature (if accompanied
by temperature monitoring device) and the presence and
condition of ice packs.
Check status of the ice packs. If the icepacks are either fully
melted or frozen hard inform immediate supervisor for
appropriate action.
Check VVM status and note any color change and include in
the report.
National
Regional
Provincial /
City
RHU/ BHS
Yes
Yes
Yes
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
N/A
Yes
N/A
N/A
N/A
Yes
Yes
Yes
N/A
N/A
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Actions on pre-arrival and arrival of commodities
Provincial /
RHU/ BHS
City
Actions
National
Regional
Check expiry date and lot number of each vaccine type.
There may be more than one expiry date and lot number of
a single vaccine type in the consignment.
Count the vaccines and compare the quantity recorded in
the documents.
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Fill-in the Vaccine Arrival Report (VAR) including condition of the
vaccines and submit to appropriate source.
Yes
Yes
Yes
N/A
Immediately transfer and organize the vaccines in the cold
room/freezer room or vaccine refrigerator/freezer.
Record the vaccine quantity received, lot number, expiry
date, status of VVM etc. in the vaccine control card or stock
card
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Yes
Prepare and submit report to Supervisor.
Immediately report any concern to the next higher level.
Actions upon receipt of shipments
• Check ice pack condition
•
•
•
•
Frozen
Not frozen but cold
Not frozen and warm
No ice packs
• Quantity
• Status of VVM
• Temperature record upon receipt
• General condition of shipment
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine arrival report
VAR serves as the confirmation of receipt of vaccines
Contents:
Arrival details
Quantity
Lot number
Expiration date
Number of boxes
Types of documents
• Invoice
• Bill of lading
• Packing list
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Storing Vaccines and Safe
Injection Supplies
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
General Guidelines for Proper Storage of Vaccines,
Injections, Devices and Other Supplies
• Clean and disinfect storeroom regularly, to discourage harmful insects
and rodents from entering the storage area.
• Store injection safety commodities in a dry, well-lit, well-ventilated
storeroom.
• Protect the storeroom from too much moisture and dampness.
• Keep functional fire safety equipment functional at all times
• Vaccines should be well labeled and segregated.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
General Guidelines for Proper Storage of Vaccines,
Injections, Devices and Other Supplies
• Limit storage area access to authorize personnel.
• Stack cartoons at least 10 cm off the floor, 30 cm away from the
walls and other stacks, and no more than 2.5 meters high.
• Arrange cartoons with arrows pointing upwards and with
identification labels and expiry dates clearly visible.
• Store health commodities to facilitate “First Expiry First Out” (FEFO)
procedures and stock management.
• Store health commodities away from chemicals, flammable products
and hazardous materials.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
General Guidelines for Proper Storage of Vaccines,
Injections, Devices and Other Supplies
• Separate damaged and expired health commodities from usable
commodities.
• Keep narcotics and other controlled substances in locked and safe
place.
• Store flammable products separately with appropriate safety
precautions.
• Check both the VVM and the expiration date before using vaccines
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Recommended Storage
Temperature of Vaccines and
Diluents
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine type
Vaccine composition
No. doses per
vial
VVM Type
Required routine doses
Wastage rate
(wastage factor)
Remarks
Negative Storage Temperature (-15°C to -25°C)
bOPV
Polio (live attenuated)
20
2
3 doses
25% (1.33)
Store at -15°C to -25°C at the national, regional, provincial/city
levels. For RHU/HC/BHU store at +2°C to +8°C temperature
Positive Storage Temperature (+2°C to +8°C)
MMR
Measles, mumps and rubella
5
14
2 doses
25% (1.33)
Can be safely stored at -15°C to -25°C or +2°C to +8°C
temperatures
MR
Measles and rubella
10
14
2 doses
25% (1.33)
Can be safely stored at -15°C to -25°C or +2°C to +8°C
temperatures
BCG
Bacillus Calmette Guerin
20
30
1 dose
50% - 75% (2.00 2.50)
Not damaged by freezing but ampoules may break
HepB
Hepatitis B
10
30
1 dose
15% (1.18)
Damaged by freezing
Pentavalent
Diphtheria, Pertussis, Tetanus-Hepatitis BHaemophilus influenzae type b
1
14
3 doses
5% (1.05)
Damaged by freezing
Td
Tetanus and diphtheria
10
14
2 doses per target
15% (1.18)
Damaged by freezing.



2 doses for pregnant woman
1 dose for Grade 1
1 dose for Grace 7
IPV
Polio (inactivated)
10
7
1 dose
15% (1.18)
Damaged by freezing
PCV13
Pneumococcal conjugate
1
30
3 doses
5% (1.05)
Damaged by freezing
JE
Japanese encephalitis
5
14
1 dose
25% (1.33)
Can be safely stored at -15°C to -25°C or +2°C to +8°C
temperatures
HPV
Human papilloma
1
30
2 doses
5% (1.05)
Damaged by freezing
Rotavirus
Rotavirus
1
None
2 doses
5% (1.05)
Damaged by freezing
Dengue
Dengue
5
None
3 dose
25% (1.33)
Damaged by freezing
PPV
Pneumococcal polysaccharide
1
None
1 dose
5% (1.05)
Damaged by Freezing. For Senior Citizens
Flu
Influenza
10
None
1 dose
15% (1.18)
Damaged by freezing. For Senior Citizens
101
WHO recommended vaccine storage conditions
Central
Regional
Province
City
Maximum storage period
3 months
3 months
Vaccine
6-12 months
bOPV
BCG
JE
Measles
MMR
MR
Pentavalent
Hepatitis B
PCV13
Rotavirus
Dengue
Td - Adolescent
HPV
Td - Pregnant Women
PCV23
Influenza
Store at -15°C to -25°C. bOPV is the only vaccine that can be safely
frozen and unfrozen repeatedly.
Store these lyophilized vaccines
RHU/MHC
BHS
1 month
Per vaccination session
Store at +2°C to +8°C
at +2°C to +8°C . Under exceptional
circumstances, they can be temporarily stored at -15°C to -25°C (if there is a
temporary shortage of storage space). Never freeze diluent.
Store at +2°C to +8°C
Store at +2°C to +8°C
Diluent: If diluent is included in the vaccine packaging, store it between +2°C to +8°C. However, if diluent is supplied separately,
it can be stored outside the cold chain but must be cooled before use, preferably for a day or for a period sufficient to ensure
Vaccine , Cold Chain and Logistics Management Training of
that the vaccine
8/15/2018 and diluent are both at temperatures between +2°C to +8°C when they are reconstituted. Never freeze
102 diluent.
Trainers - August 14-17, 2018
Sensitivity of vaccines to various conditions
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Causes of Heat exposure
Causes of heat exposure
During storage
 Electrical power failures causing
breaks in the cold chain.
 Cold chain equipment breakdown
(refrigeration system or solar
power system).
 Storing vaccines in non-medical
cold chain equipment like
domestic refrigerators or freezers
which are not designed for heat
and freeze sensitive vaccine.
 Wrong thermostat setting.
 Broken door seal.
Recommended actions.
 Install standby generators to provide backup power in large vaccine
stores.
 Use appropriate cold rooms, freezer rooms, refrigerators, freezers, cold
boxes and vaccine carriers for storage of EPI vaccines. WHO/UNICEF
PQS compliant equipment are highly recommended.
 Choose a power source (electricity or solar) that is appropriate to the
location and the climatic conditions.
 Conduct routine monitoring, recording and analysis of cold chain
temperatures collected from temperature monitoring devices.
 Set thermostat correctly.
 Replace old and broken door seal.
 Develop and implement contingency plans.
 Use SOPs to standardized day-to-day operations and training of staff to
follow the SOPs and equipment manufacturers’ user manuals.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Causes of Heat exposure
Causes of heat exposure
During transport
 Passive container packed with too
few or inappropriately sized coolant
packs.
 Delivery or outreach trip exceeding
the passive container’s cold life.
 Vehicle breakdown.
 Refrigeration system breakdown for
refrigerated vehicles.
 Parking vehicles in direct sunlight.
Recommended actions.
 Use correct number and size of ice packs as
recommended by the manufacturer.
 Use cold box and vaccine carrier with long cold
life for specific applications.
 Maintain and servicing vehicles for transport of
vaccines.
 Park vehicles in a shaded area.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Causes of Heat exposure
Causes of heat exposure
Recommended actions.
During immunization sessions
 Exposure of vaccines to
high temperature during
immunization sessions.
 Use foam pad to keep vaccines cool during
immunization sessions.
 Use WHO/UNICEF PQS compliant vaccine
carrier and appropriate number of ice packs.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Causes of Freeze exposure
Causes of freeze exposure
During storage
Recommended actions.
 Storing freeze-sensitive vaccines close to the  Arrange vaccines appropriately in the refrigerator.
surface of the evaporator ofCauses
theofrefrigerator
or  Adjust thermostat
freeze exposure
Recommended actions.
setting using manufacturers’
During storage
cooler.
instruction in adjusting.

Storing freeze-sensitive vaccines close to the surface
Arrange vaccines appropriately in the refrigerator.
 Incorrect thermostat adjustment
inrefrigerator or cooler.   Use
of the evaporator of the
vaccine
provided by the
Adjust
thermostat baskets
setting using manufacturers’

Incorrect thermostat adjustment in refrigerator or
instruction in adjusting.
refrigerator or walk-in walk-in
coolers
with
adjustable
coolers with
adjustable
thermostats.
 manufacturer.
Use vaccine baskets provided by the

Failure to use baskets supplied with ice-lined
manufacturer.
thermostats.
be Use
PQS
compliant
refrigerators for
refrigerators allowing freeze-sensitive vaccines to
Use WHO/UNICEF
WHO/UNICEF PQS compliant
refrigerators
for
stored outside the manufacturer’s designated safe
storing vaccines.
 Failure to use baskets supplied
with ice-lined
storing
vaccines.
storage zone.

Conduct routine monitoring, recording and

Storing freeze-sensitive vaccines in domestic
analysis of cold chain temperatures collected from
refrigerators allowing
freeze-sensitive
vaccines Conduct
monitoring, recording and
refrigerators in close proximity to the evaporator
temperature routine
monitoring devices.
plate.
to be stored outside the
manufacturer’s

Recognize damaged vaccines through shake test
analysis
of cold chain temperatures collected from
Defective thermostat.
but not applicable to IPV.
designated safe storage zone.
 temperature
Replace correct specification
thermostat.
monitoring
devices.
 Storing freeze-sensitive vaccines in domestic  Recognize damaged vaccines through shake test
refrigerators in close proximity to the
but not applicable to IPV.
evaporator plate.
 Replace correct specification thermostat.
 Defective thermostat.
Causes of Freeze exposure
Causes of freeze exposure
Recommended actions.
During transport
 Packing freeze-sensitive vaccines in 
passive containers with
unconditioned ice-packs.
 Transporting freeze-sensitive vaccines 
in refrigerated vehicles that are poorly
maintained and/or incorrectly packed.
Use correct number of conditioned
ice packs in packing freeze-sensitive
vaccines.
Correct use of cold boxes and
vaccine carriers for vaccine
transport.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
The Shake Test
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Temperature Monitoring Devices
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Different types of temperature monitoring devices
Integrated Digital
thermometer
• provides an
instantaneous reading
of temperature
located in the control
panel
• Measures the coldest
point of the cabinet
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Control Panel
Serbisyong Salud Bikolnon
Thermometer
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Temperature Monitoring and
Recording
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Cold Chain Temperature Monitoring
• Accurate and comprehensive temperature records are key component
of good storage and distribution
• Cold Chain temperature should be checked and recorded twice
daily, seven day a week including weekends and holidays
• Temperature readings should be recorded in a standard
recording form
• Data must be analyzed and reviewed
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Importance of temperature monitoring
Temperature monitoring
•
Safety of vaccine
•
Freeze prevention
•
Minimize wastage
•
Improved stock management
•
Equipment performance
•
Quality assurance
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Temperature Monitoring Chart Used per Cold Chain Equipment
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Action points for cold rooms & vaccine refrigerator
Temperature Readings
Actions
Temperature between +2°C andNormal situation. No action necessary.
+8°C
Temperature at or below 0°C
Vaccine at risk. Take immediate action to correct the low temperature
and ensure that the problem does not arise again. Carry out a shake
test to establish if any has been frozen. Submit a report.
Temperature between +8°C andCheck cause. No further action is necessary if there has been a
+10°C
temporary power failure. Check that the refrigeration unit is working.
Take appropriate action if the temperature is outside the normal range.
Temperature above +10°C
Vaccine at risk. Immediately implement the agreed contingency plan
and submit a report.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Action
points
for
cold
rooms
&
vaccine
refrigerator
Action points for freezer rooms and freezers
Temperature Readings
Actions
Temperature between -Normal situation. No action necessary.
25°C and -15°C
Temperature below -25°C Adjust thermostat. Check that the temperature is within the
normal range at the time of the next inspection.
Temperature above -15°C Check cause. No further action is necessary if there has been a
temporary power failure. A temporary rise to +10°C is
permissible following an extended power cut. Check that the
refrigeration unit is working.
Temperature above +10°CVaccine at risk. Immediately implement the agreed contingency
plan and submit a report.
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Arranging Vaccines
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
EXERCISE
Vaccine arrangement
HepB
Pentavalent
Flu
PCV
HPV
IPV
MCV
OPV
Td
BCG
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Water Packs
OPV and
MCV
BCG, Penta
TT, Diluents
Water packs
Open vials should be put in a
box labelled "use first."
Formation gestion vaccin TOLAGNARO 10-15
AOUT 09
Penta TT
TT
Penta Penta Penta
BCG
BCG
OPV MR MMR
TT
OPV
OPV MR MMR OPV
Water Packs
Water
Accumu
lateurs
Packs
Arranging
vaccines in top
opening
refrigerator
For
à
congeler
Freezing
Water Packs
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Arranging Vaccine

In baskets with thermometer
- vaccine safe

No baskets, no thermometer
- vaccine at risk
Correct and incorrect use of ice-lined refrigerators
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Don’ts when storing vaccines
• Do not store food or drink
• Do not store Diluent in warmer places
• Do not open the door unless necessary
• Do not store vaccines in freezer (RHU)
• Do not keep expired vaccines or VVM on discard point
• Do not keep reconstituted vaccines after six hours
• Record wasted vaccines
• Do not store vaccines in the door shelves
• Freeze sensitive vaccines not in contact or close with evaporator
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
Distribution and Transport of
Vaccines and Safe Injection
Supplies
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Supplies Distribution Plan
Actions Before Shipment
Shipper
• Adequate number of ice packs
• Ensure that no freeze-sensitive vaccines will be
exposed to freezing
• Documents are complete
• Notice of shipment
Recipient
• Ensure adequate storage space
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Actions During Shipment
• Avoid exposure to direct sunlight
• Take the Quick and safest route
• Contingency plan
• Extra ice packs
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Devices for transporting vaccines
How to arrange vaccines in transport box and
vaccine carrier
• Ensure that the inner compartment of the transport box and vaccine carrier is
clean
• Line the conditioned ice packs or cool water-packs in the cold boxes and/or
vaccine carriers
• Put an electronic freeze tag indicator with the vaccines if conditioned ice packs
are used (if available)
• Put vaccines and diluents in their primary packaging or in a plastic bag in the
middle of the cold box or vaccine carrier to protect them from damage.
• Place foam pad in the top of the container if vaccine carrier is used.
• Close tightly the lid of the cold box or vaccine carrier.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
How to arrange vaccines in transport box and
vaccine carrier
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Freezing and conditioning Ice Packs
Ice packs are leak-proof containers, complying with
PQS, that are used to pack vaccines during transport
or during immunization session
Three forms of Ice Packs
•Frozen
•Cool
•Conditioned
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Conditioned Ice pack
is the recommended
form of ice pack used
in packing vaccines
Serbisyong Salud Bikolnon
Freezing Ice Packs
• Fill the icepack container with tap water leaving a little
air space at the top, and put the cap tightly
• Hold each icepack upside down and squeeze it to
ensure it does not leak
• Put the icepacks upright or on their sides in the freezer
so that the surface of each icepack is touching the
evaporator plate and close the door tightly
• Leave icepacks in the freezer for at least 24 hours to
freeze solid
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Ice Pack Conditioning
• Ice pack conditioning is a
process of removing ice
packs from a freezer at 25°C and kept at room
temperature long enough
to allow the ice packs’
core temperature to rise
to 0°C.
Steps in conditioning Ice Packs
• Remove ice packs from the freezer
compartment and keep them at room
temperature until the ice melts.
• Shake the ice packs one at a time
every few minutes
• Once you hear the water moving
inside, the ice packs are ready to be
loaded into the cold box or vaccine
carrier.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Quality of Vaccine Storage
Key Points:
1. Availability and use of temperature
monitoring device
2. Temperature monitoring twice daily 7 days a
week
3. Temperature trends should be analyzed
regularly
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Key points in storing and transporting vaccines
Most vaccines can be stored at + 2 to + 8 zero C,
only some vaccines can be stored at (-15) to (-25) degree C
Potency can be lost due to heat damage and
freezing damage
Most common cause of freeze exposure is
during transport due to unconditioned icepacks
Once vaccine potency lost, it cannot be
regained
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
The Shake Test
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Vaccine, Cold Chain and Logistics
Management Training
The Philippines 2019
COLD CHAIN
Contingency Plan
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Most Common Emergencies in Cold Chain
Breakdown of equipment, vehicle
Power cut
Freezing of freeze-sensitive vaccines
Darkening of VVM color
Stock out (Delay in vaccine arrival)
Unplanned delivery of large quantities of vaccines to a facility
with limited storage capacity
Absence of person responsible
Destruction vaccines due to natural calamities or poor
maintenance of building
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Elements of an emergency plan
• Ensure that all affected vaccines are placed in the recommended
storage temperature of +2°C to +8°C as soon as possible;
• Identify alternative locations where vaccines can be safely stored
or where ice can be obtained at short notice;
• Prepare and maintain at least two emergency response plans;
• Post emergency contact details of key personnel at location
where they can be accessed at all times;
• Clearly describe initial and follow-up actions that can be
implemented both inside and outside working hours; and
• Review the plan at least once a year to ensure that it is still valid.
Elements of a Contingency Plan
1. Ensure that all staff know how to
follow safe storage rules in an
emergency:
– Freeze-sensitive vaccines. Maintain
vaccines at +2°C to +8°C.
– Freeze-dried vaccines packed with
diluents. Maintain vaccines and
diluents at +2°C to +8°C.
– Freeze-dried vaccines packed
without diluents. Maintain vaccines
at +2°C to +8°C. Store diluents at
room temperature as normal.
Elements of a Contingency Plan
2. Identify a range of contingency options (the following
are four examples:)
– Move the vaccine to another public service cold store.
– Borrow or hire a refrigerated vehicle.
– Move the vaccine to a private sector cold store.
– Obtain ice from a commercial ice maker and store this
inside the cold room or freezer room, in plastic or
metal containers. Closely monitor the room
temperature and keep the ice supply replenished
until repairs are carried out.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Elements of a Contingency Plan (cont.)
• Prepare and maintain two contingency plans based
upon these options.
– Contingency plans should be discussed and agreed
beforehand with all the staff and other parties
involved.
– Confirm the plan in writing. Keep a copy in the
vaccine store. Make sure your staff know where it
is.
– Check alternative stores: in good condition,
adequate space and capable of maintaining
vaccine at the correct temperature.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Elements of a Contingency Plan (cont.)
– Do not wait until an emergency occurs. Rehearse
the plans before they are needed (Vaccine should
not be physically moved during rehearsals, but all
key procedures should be simulated).
– Prepare a list of emergency contact names,
addresses and telephone numbers and post a copy
of the list in the vaccine store. Keep the list up to
date.
– Make sure that emergency contacts can be made
both inside and outside normal working hours.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Elements
of a Contingency
Plan of a Contingency
(cont.)nt.)
Elements
of a Contingency
PlanPlan
(cont.)
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
I AM RESPONSIBLE FOR THESE VACCINES
_____________________________
Name in Print
MY ALTERNATE’S NAME IS:
_____________________________
Name in Print
IN CASE OF EMERGENCY, TAKE VACCINES TO:
_____________________________
Name in Print & Designation
_____________________________
Address
_____________________________
Telephone Number
Steps in Addressing Cold Chain Problems
1. Describe the problem:
Do this by determining the following:
• The highest temperature to which each type of vaccine was exposed
• The estimated period between the failure and the time at which the highest
exposure temperature was reached
• The number of doses affected for each type of vaccine and their expiry
dates.
• The status of thermometer in the refrigerators or freezers
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Steps in Addressing Cold Chain Problems
2. Determine the cause of the failure by using the information obtained about
the problem, thus identifying its cause.
3. Take action:
Here are specific pointers to remember:
• Send the information gathered to the cold chain manager or supervisor,
who will decide whether the affected vaccine should be used, tested for
potency, or discarded.
• Mechanical or electrical emergencies can occur at any time of the day or
night. If the equipment needs repair, inform the technician. To be prepared
for the next emergency, undertake the following actions:
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Steps in Addressing Cold Chain Problems
a. Fill empty portions of the main compartment with covered containers of
water and those of the freezer with ice packs.
b. Ensure that there are enough transport boxes for all vaccines and that the
required number of ice packs are frozen at all times.
c. Always keep spare fuses and spare fuse wires in stock and know where these
are kept.
d. If you plan to be absent or go on leave, train your alternate to follow these
emergency procedures.
e. If possible, look for another source of frozen ice packs, which would be
available to you during either a mechanical or an electrical failure.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Steps in Addressing Cold Chain Problems
f. Similarly, find another refrigerator within the town or in the neighboring area,
which is not likely to suffer the same power failure as your location, and obtain
permission to use it. (Ice cream vendors or cold storage merchants may have
refrigerators or ice.)
g. Obtain permission to use another refrigerator in the building for temporary
storage in case of a mechanical failure.
Note: Do not open the refrigerator during power cuts. Vaccine refrigerators
have six to 12 hours’ holdover time only.
h. Identify a local technician who can make minor emergency repairs, and know
where he lives and works and how to contact him.
Steps in Addressing Cold Chain Problems
i. Know the persons who hold the keys that you will need in case you need to
check your refrigerator after working hours. Be sure to inform them properly
why you need to check the refrigerator.
j. Instruct the night watchman to inform you after working hours if there is
power interruption in the building for more than two hours. Make sure he
knows where to get in touch with you.
k. Inform your supervisor of the above arrangements.
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
In Case of Power Cut
In Case of Mechanical Failure
1. Do not open the refrigerator
1.Prepare the transport box with conditioned ice packs
2. If there is a gen. set- look for the personnel in-charge
2. Immediately transfer the vaccines to the Cold boxes
3.Call the electric Cooperative and know the duration of 3.Contact a local technician for the immediate check up and
the brownout.
repair of the ref.
4.If the brownout is longer than 2 hrs. transfer the vaccine 4.If the repair will is more than 5 days, Transfer the vaccine
to the transport box w/ a conditioned ice packs
to the another refrigerator.
5. If the brownout is more than 24 hrs., transfer vaccines
to nearest cold chain facility
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Most common emergencies in Cold Chain
Breakdown of equipment, vehicle
Power cut
Freezing of freeze-sensitive vaccines
Darkening of VVM color
Stock out (Delay in vaccine arrival)
Unplanned delivery of large quantities of vaccines
to a facility with limited storage capacity
Absence of person responsible
Destruction vaccines due to natural calamities or
poor maintenance of building
Activity:
Draft contingency plan for EACH of the most
common causes of cold chain emergencies
(Assignment)
Groups will be picked in random to present their
contingency plan output in plenary
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
Serbisyong Salud Bikolnon
Breakdown of equipment, vehicle
a)
b)
c)
Can a refrigerator be used nearby?
Is the refrigerator big enough to safely
store the vaccine?
Is transport available to get to the
refrigerator, and has permission been
given to use the refrigerator?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
(Is there an Alternative?)
(Is it Adequate?)
(Is it Available?)
Serbisyong Salud Bikolnon
If the person responsible for the refrigerator is absent
a)
b)
c)
Is there an alternate staff member?
Can the alternate staff perform
all the necessary tasks?
Is the alternate staff present
in the health center?
Department of Health Center for Health Development- Bicol
Department of Health Center for Health Development- Bicol
Family Health Cluster
(Is there alternative?)
(Is it Adequate?)
(Is it Available?)
Serbisyong Salud Bikolnon
170
Maraming salamat po!