POST 00482E : PROTECTION OF MORE COLD-SENSITIVE VACCINES

POST 00482E : PROTECTION OF MORE COLD-SENSITIVE VACCINES Follow-up on posts 00391E, 00400E, 00412E, 00419E, 00428E, 00475E and 00480E 31 July 2002 ________________________________________________________________________ This posting contains four contributions, from: 1- G R Baru (mailto:[log in to unmask]) formerly from UNICEF/India 2- Robert Steinglass (mailto:[log in to unmask]) from BASICS, USA 3- Anthony Battersby (mailto:[log in to unmask]) from FBAssociates, UK 4- Anil Varshney (mailto:[log in to unmask]) from Healthcare Consultancy Services, India ________________________________________________________________________ Regarding protection of more cold sensitive vaccines ( Hep. -B), we should be very careful in handling not only more cold sensitive vaccines but all the vaccines. We should not follow any over heard or self developed procedure for storage/transportation of vaccines. We need to follow strictly the guidelines of WHO/UNICEF which stood against all the tests of the time. I would also add that we should use only those equipment for vaccine storage/transportation which have been recommended in WHO/EPI product document. During my 13 years stay in UNICEF India, I have observed that how some of the MOs, Storekeepers had been storing vaccines as per their self developed methods and spoiling vaccines about which they had no knowledge at all. As a resource person in Master Trainers training on Hepatitis-B, held at Delhi on 24-29 June, 2002 organized by PATH & MOHFW/GOI, I had shared 3-4 field level situations with the participants and asked for their comments. It was surprising that some of them were also following the wrong methods. For more details on the subject you may ask for e-mailing the details presentation on cold chain sessions from PATH India and you may get many answers on this issue in that presentation. G R Baru Ex-Project Officer(Cold Chain) UNICEF India ________________________________________________ The most heat-sensitive vaccine is not OPV, but reconstituted measles. Carib asks an important point. What are WHO's current recommendations regarding the need to keep measles vaccine cold after reconstitution? This is very topical too, as many countries are being encouraged to extend measles campaigns to logistically difficult areas. Do we need ice or not? I have to disagree with one comment. Wrapping vials in some paper does NOT protect them from freezing, if the icepacks are straight out of a very cold freezer and the container is well-insulated. This was discovered by many field staff in the 1980's when a better generation of vaccine carriers and cold boxes became available. Conditioning the icepacks is an important method to prevent freezing. Robert Steinglass ___________________________________________________ A few points: 1. You can only use OPV as a proxy if all the other vaccines have followed the same cold chain up to the moment that you wish to use OPV as a proxy. (See the extensive discussion held some years ago when VVMs were first introduced). 2. Allowing reconstituted measles to rise to a temperature of +25°C would be potentially lethal. 3. From my tests wrapping heat sensitive vaccine in "insulation" ( I used a complete layer of ambient ice packs at +20*C) does mean that it takes longer to freeze especially the case with large cold boxes. It does not prevent it happening. It certainly does not remove the need to "condition" the ice packs. Anthony Battersby _________________________________________________ This has reference to Carib Nelson`s experience of not using ICE packs in vaccine carriers sounds interesting and encouraging as well. Given the field situations, I feel this could be accepatble in mountaineous areas where ambient temperatures are low and the staff is also trained in assuring that direct exposure to heat + light is not there. However in most tropical climate like India where the ambient temperatures reach 45°C and the vaccine carriers are carried by health staff from static cold chain to the out reach by bus, foot and bicycle, the exposure of vaccine carriers to direct sunlight is unavoidable. This in itself raises the internal temperatures and if ice packs are not there the temperatures would increase further. May be Carib could guide us on the fact as to how long a vaccine can be kept at high temperature ( I presume higher the temperature less time it can be kept)is possible to know for each vaccine. The suggestion should be used with great caution in such circumstances as in long run it may lead to complacency in maintaining cold chain. The most ideal solution will be to have more thermostable vaccines and VVM on all vaccines. I have some querries and observation on VVMs which I will share in next email. Dr Anil Varshney Healthcare Consultancy Services New Delhi India ----------------------------------------------------------------------------- ----------------- CONTRIBUTIONS: Contributions to: or use your reply button! The TechNet21 e-Forum welcomes new subscribers who are involved in immunization services. SUBCRIBE: To subscribe, send an e-mail to: Leave the SUBJECT area BLANK, do not type anything. In the body text, just write: Subscribe TECHNET21E Surname Name Do not use any accents in your name and surname. UNSUBSCRIBE: To unsubscribe, send an e-mail to: Leave the SUBJECT area BLANK, do not type anything. 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