POST 00482E : PROTECTION OF MORE COLD-SENSITIVE VACCINES
Follow-up on posts 00391E, 00400E, 00412E, 00419E, 00428E, 00475E and 00480E
31 July 2002
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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
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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
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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
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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
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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
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