KNOW ABOUT SAFE VACCINE
PRACTICES
The WHO and the health ministries of
different governments have provided
guidance about measures relating to safe
vaccine practices and cold chain
maintenance.
Some of the measures are listed below:
1. Vaccine refrigerators……..loading of different vaccines, cold
chain maintenance, contingency plan during power failures.
2.
Avoiding unsafe vaccine practices.
3. Correct
technique and route of administration of
various vaccines.
4. Monitoring
potency of vaccines with the VVM.
VACCINE REFRIGERATORS
Half the total space in the refrigerator should be left empty
to allow air to circulate around the vaccines and diluents to
keep them cool. Always keep a thermometer in the
refrigerator and record the temperature twice daily.
LOADING A VACCINE REFRIGERATOR
 Vaccines, diluents and icepacks should be kept in a
refrigerator that is used only to store them.
 Do not put vaccines on door shelves. The temperature
is too warm to store vaccines, and when the door is
opened shelves are instantly exposed to room
temperature.
 Do not keep expired vaccines, NOR vaccines with
VVMs that have reached or are beyond their discard
point, NOR reconstituted vaccines for more than six
hours or until the end of an immunization session in
the refrigerator. Discard them immediately according
to national guidelines
 Food and drinks should not be stored in a vaccine
refrigerator.
 Do not open the refrigerator door frequently since this
raises the temperature inside the refrigerator.
LOAD FRONT LOADING REFRIGERATOR WITH
FREEZER ON TOP AS FOLLOWS:
1. Measles, MR, MMR, BCG, and OPV on the top shelf.
2. DTP, DT, Td, TT, HepB, DTP-HepB,Hib,DTPHepB+Hib,meningococcal,yellow fever, and JE vaccines on
the middle shelves ; and
3. Diluents next to the vaccine with which they were supplied.
COLD BOXES AND VACCINE CARRIERS
Should be lined with ice-packs and used for keeping the vaccines
and diluents cold during transportation and /or short period storage
as for an immunization session.
How to load a cold box
Remember that DPT, DT, Td, TT and hepatitis B vaccines must not be frozen
(refer to Table 1).
If vials of these vaccines make direct contact with frozen icepacks in a cold box,
they may easily freeze and the vaccine will be destroyed. To avoid such damage:
icepacks should not be taken from a freezer and placed directly in a cold box
containing these vaccines; leave icepacks for a few minutes until water droplets
appear on their surface before putting them in the cold box;
place a layer of plastic foam, cardboard or similar packaging material
between the vaccine packets or vials and the icepacks. This will act as an
insulating barrier, and protect vaccinesfrom freezing.
For other vaccines, i.e., OPV, Measles and Mumps, these precautions are not
necessary, andicepacks may be placed in a cold box direct from the freezer.
During sessions, it is not recommended to keep vaccines on ice –
packs or in cups filled with ice to keep vaccines cool. During
sessions, stick the vaccine and diluent vials into the foam pad to
keep them cool and to protect them.
REVISED WHO/EPI POLICY ON THE USE OF OPENED
VACCINE VIAL
Vaccine
BCG
DPT/DT/TT
OPV
Hepatitis B
MMR/MR
Yellow Fever
Hib
Doses/vial
10 doses
10 doses
10 doses
Single dose
Single dose
Single dose
Single dose
Time
6 hours
Up to 7 days
Up to 3 days
Up to 7 days
6 hours
6 hours
Maxim.24 hours
The following table shows the sensitivity of
different vaccines to heat and freezing:
RANGE
Most sensitive
Least sensitive
VACCINE
OPV
Measles, MR,MMR
DTP,DTP-HepB, DTPHIB
DTP-HepB +Hib, YF
BCG
Hib, DT
Td, TT, HepB, JE
The following table shows the routes of
administration and injection sites of different
vaccines:
Diluents must never be frozen
BCG and measles vaccines must not be frozen
after reconstitution.
In addition to being temperature-sensitive, several vaccines are also highly
sensitive to strong light, and thus need to be kept in the dark as far as possible.
BCG and Measles are those most affected. These vaccines must never be
exposed to sunlight, and are given some protection by being supplied in vials of
dark brown glass to reduce the penetration of light. This alone will not prevent
light damage however, and great care must be taken to protect them during use.
As with loss of potency due to heat, any loss of potency due to light is also
permanent and irreversible.
IMPORTANT!
Measles, BCG and mumps vaccines must be reconstituted only with the diluent
provided by the manufacturer of the vaccine in use.
Never use other diluent.
Diluent must be cold, between 0 and 8 degrees Celsius, before being mixed with the
vaccine.
When reconstituted, the vaccine must be used within 6 hours, and any remainder
discarded
At the health facility level
e.g., at the Children’s Polyclinic
- keep all your vaccines for a maximum of 1 month:
- store all vaccines at 0 to +8 o C.
Vaccine shake test
This test is designed to determine whether adsorbed vaccines (DPT, DT, Td, TT
or hepatitis B) have been frozen. After freezing, the vaccine is no longer a
uniform cloudy liquid, but tends to form flakes. Sedimentation occurs faster in a
vaccine vial which has been frozen than in a vaccine vial from the same
manufacturer which was never frozen.
(The medical information in this article is provided as an information resource only,
and is not to be used or relied on for any diagnostic or treatment purposes. This
information is not intended to be patient education, does not create any patientphysician relationship, and should not be used as a substitute for professional
diagnosis and treatment. If you suspect that your child has a medical problem or
condition, please contact your paediatrician.)
For Further information on safe vaccine practices please refer
www.iapcoi.com.
Written By
Dr. A. Priya Margaret.