EXPANDED PROGRAMME
ON IMMUNIZATION
Dr.Qazi Afsar Anwar
Assistant Director EPI (Logistics)
Khyber Pakhtunkhwa
Provincial EPI Cell, KP
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Cold Chain system of EPI
System that ensures
1.Potency
2.Quality
3.Safety
of Vaccines by maintaining the correct
temperature from Manufacturer to
Children/Women
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What is the cold chain?
♦ Vaccines are sensitive to heat and must be kept cold
from the time they are manufactured until they are used.
♦ The equipment and people that keep vaccines cold
during their journey are together called the cold chain.
♦ The cold chain is only as strong as its weakest link.
We are all part of that chain.
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How long is the cold chain?
♦ Manufacturer to airport; cold storage at airport
♦ Transport at the correct temperature from airport to
storage in central, regional and district stores and in
health centers
♦ Transported at the correct temperature to outreach sites
♦ Kept at correct temperature during immunization sessions
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COLD CHAIN SYSTEM PAKISTAN
Vaccine Manufacturer
National Vaccine store,
NIH-Islamabad
Provincial Vaccine store
Punjab, Sindh, KPK,
Balochistan, AJK and FANA
District Vaccine store
Tehsil, Bhu, Rhc, FC facilities
Vaccinators/EPI service providers
Children and Women
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Cold Chain System Activities
in Vaccine Facilities
1.
2.
3.
Receipt
Storage
Delivery
Receipt
Delivery
Storage
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Loading Vaccine Refrigerators
♦ Put vaccines and diluents on the top and middle shelves
of the main section
♦ OPV and measles vaccine on the top shelf
♦ BCG, Pentavalent and TT vaccines on the middle
shelves
♦ Diluents next to the vaccines with which they were
supplied
♦ Arrange the boxes of vaccine in stacks between which
the air can move.
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Choosing a Refrigerator and Freezer
1. Temperature Zone, the average temperature during the
hottest/coldest months should be taken as criteria for the
determination of the zones.
There are three temperature zones for which cold chain refrigerators
and freezers will be classified:
• Hot zone,
0C to +43C
• Temperate zone,
0C to + 32C
• Cold zone,
-5C to +32C
2. Vaccine storage capacity, how much vaccines must be stored
at 0-+8C or -20C
3. Ice pack freezing capacity, how many icepacks should be
frozen per 24 hours
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Conti……………..
4. Power source, electricity, kerosene or bottled gas. Is supply
Continuous or not
5. Holdover time, How many hours will the vaccine remain
below 10C
6. Reliability, Repair facilities and spare parts are available
7. Price, Which refrigerator meets requirements at the lowest
cost
8. Training, Are the users and those in charge of maintenance
of equipment properly trained
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What to do when a vaccine refrigerator is out
of order
If your vaccine refrigerator stops working, first protect the
vaccines and then repair the refrigerator.
Protecting the vaccines
Move the vaccines to another place until the refrigerator is
repaired. If you think that the problem will last only a short
time, you may use a cold box or vaccine carrier lined with
conditioned ice-packs for temporary storage. For a longer
duration, use another refrigerator. Always keep a freezer
indicator with the freeze-sensitive vaccines to monitor
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eventual freezing.
Restoring the refrigerator to working order
Check the power, gas or kerosene supply. If there is no
power, make other arrangements (e.g. store the vaccine in
a household refrigerator) until power is restored. If there is
no gas or kerosene, get it as soon as possible.
If a lack of power, gas or kerosene is not the problem,
repair the refrigerator or report to your repair technician or
supervisor.
Record the breakdown on the daily temperature recording
chart.
Note: Concerning the routine maintenance and the
servicing of refrigerators, WHO technical manuals exist for
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each kind of refrigerator.
All the vaccines should be stored in the
basket provided with the refrigerator
1.
Measles,BCG and OPV in the bottom only
2.
Freeze-sensitive vaccines (Penta, TT) in the top only.
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Different Types of
Refrigerators/Freezers
D Chest freezer
e
e
p
ILR Mk 074
Solar Powered
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General rules about refrigerators
♦ Opening the refrigerator door raises the temperature.
♦ Before you open the door, plan what you are going to
do.
♦ When you open the door, do what you have to do
quickly and close the door as soon as possible.
♦ Try not to open the refrigerator door more than three
times a day.
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Storage Principles
♦ Vaccines must not be kept:
– In the door compartments of domestic refrigerators
– In the salad trays at the bottom of the refrigerator
– In contact with the evaporator plate
♦ Must not be confused with other heat sensitive
pharmaceuticals
♦ Diluents must be stored at the same temperature
at the point of use. This prevents damage to the
potency of the vaccine
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Contingency Plans
♦ Each facility should have a contingency plan for power
failures and these must be visible – placed on the fridge
♦ It must be include an alternative storage area/place and
it must be adequate
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Walk-in Type Cold Room
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Combination Walk-in Type Cold/Freezer Room
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Cold chain monitoring
equipment: thermometers
♦ Health centre staff use dial thermometers, as
recommended by WHO to monitor the temperature of
refrigerators, cold boxes and cooler boxes.
♦ Max-min thermometers are not recommended as
training is required
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Type of Vaccine Thermometer
Dial type Thermometer
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Type of Vaccine Thermometer
Bar type Thermometer
(read safety zone as 20 to 80 C & not as 00 to 80)
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Maintaining cold boxes and vaccine carriers
Vaccine carriers and cold boxes must be well dried after their
use. If they are left wet with their lids closed, they will become
mouldy. Mould may affect the seal of the cold boxes and
vaccine carriers. If possible, store cold boxes and vaccine
carriers with the lid open, when not being used.
Knocks and sunlight can cause cracks in the walls and lids of
cold boxes and vaccine carriers. If this happens the vaccines
inside will be exposed to heat.
If a cold box or vaccine carrier wall has a small crack you
may be able to repair it with adhesive tape until you can get
an undamaged one.
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Packing a cooler box
1. Take all the frozen ice packs you need from the freezer
and condition them.
2. Put ice packs against each of the four sides of the cold
box or vaccine carrier.
3. Take all the vaccines and diluent you need from the
main section of the refrigerator and close the door.
4. Put the vaccines and diluent in the middle of the cold
box or carrier. Vials may be kept in their boxes or
packed without them, depending on how many vials
you need.
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Cold box and Vaccine Carriers
Cold box
Vaccine carrier with vaccine vials in foam pad
Cold Chain & Vaccine Management Training
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Keeping things cool in the field
♦ Keep the lid tightly on the vaccine carrier in transit.
♦ Keep cold boxes and vaccine carriers in the shade. Do
not leave a cold box or vaccine carrier in a vehicle that
is standing in the sun. Take it out of the vehicle and put
it in the shade.
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Ice packs
♦ Ice packs are flat, square plastic bottles that can be filled
with water and frozen. The required number in a
particular cold box or vaccine carrier varies.
♦ Every health centre should have two sets of ice packs,
one being frozen while the other is in use.
♦ Condition the ice packs before use
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Ice packs
0.4 liters
0.6 liters
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Vaccines sensitive to heat
OPV
Most sensitive
Measles
BCG
Least sensitive
TT
Pentavalent
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Vaccines sensitive to cold
Most sensitive
Pentavalent
TT
Least sensitive
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Recommended Storage Temperature for Vaccines
Vaccines
Level/Max stock in months
National
6 months
OPV
BCG
Measles
Penta
TT
Provincial
3 months
District
Facility
2 months 1 month
-15°C to -25°C
+ 2°C to + 8°C
Note:
1.BCG and Measles can be stored and transported at +2°C to +8°C. It is not
harmful to store them at minus temperature but it is unnecessary.
2.Diluent vials must never be frozen, they must be stored and transported at
+2°C to + 8°C when packed together with the vaccine.
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What is a vaccine vial monitor?
A vaccine vial monitor (VVM) is a label containing a heatsensitive material which is placed on a vaccine vial to
register cumulative heat
exposure over time.
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VVM (Vaccine Vial Monitor)
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Reading a Vaccine Vial Monitor
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Cold Chain Monitor (CCM)
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Cont……..
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PESHAWAR – PROVINCIAL VACCINE STORE
Empty units
Non-operational ILRs stockpiled
around the store
Refrigerated vans for collecting vaccines from NIH
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Some recommendations at each level
after the assessment
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1.
Provision of Freeze tag for all freeze
sensitive vaccines
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2.Completing of cold chain monitor at
federal, provincial and district level
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3.
Observe strictly vaccine ordering and
stock keeping
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4.
Designate & train cold chain staff at all
levels
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5.
Observe Multi dose vial policy
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6.
Perform Ice pack conditioning for freeze
sensitive vaccines
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7.
Adapt an effective vaccine distribution
system
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8.
Monitor stock and expiry dates
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Vaccine and Cold Chain Monitoring
Devices
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You are the guardian of your
vaccines