POST 00484E : PROTECTION OF MORE COLD-SENSITIVE VACCINES

POST 00484E : PROTECTION OF MORE COLD-SENSITIVE VACCINES Follow-up on Posts 00391E, 00400E, 00412E, 00419E, 00428E, 00475E, 00480E and 00482E 8 August 2002 _____________________________________________________________ Apart from contributions from G R Baru (mailto:[log in to unmask]), formerly from UNICEF/India , Robert Steinglass (mailto:[log in to unmask]) from BASICS, USA and Anthony Battersby (mailto:[log in to unmask]) from FBA Health Systems Analysts, UK, this posting contains a reiteration by WHO of guidelines concerning handling of reconstituted measles vaccine that have to be kept on ice. _____________________________________________________________ I would like to share my following comments on Mr Robert & Mr Anthony’s observations: 1- Yes, condition of ice packs is the key factor. In order to prevent T-series/Hep.-B vaccine from freezing we need to keep the "Hard Frozen" ice packs ( frozen at -20°C) out of the DF for some time (10-15 minutes) till we see some vapors on the surface of ice packs. We need to whip/dry the ice packs and put in the cold box/vaccine carrier. 2- We should wrap only T-series vials with paper (not OPV/measles). 3- By wrapping T-series vials with papers may prevent the vials from freezing in vaccine carriers in winter season, not in cold boxes where large number of ice packs are loaded. 4- Storage of T-series vaccines in original packing of smaller cartons may also prevent vials from freezing in Cold Boxes. 5- My understanding is that rising temperature of reconstituted measles vials may only lower the potency of vaccine. Measles vaccine may become lethal only due to biological reasons. (Correct me if I am wrong). Always encourage the use of cold chain storage/transportation equipment recommended under EPI program. G R Baru _______________________________________________________________ I think it would be useful for WHO/HQ to weigh in with a reply to the many questions which are being raised from the field. A close reading of the current POST 00482E, and the one before that which inspired all these e-mails, indicates the desirability for WHO to provide some authoritative guidance. There were many questions raised in this useful exchange of opinions. Once again, I repeat my own question: "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?" Thank you. Robert _________________________________________________________________ Almost every year somewhere in the world children die because reconstituted measles vaccine has been inappropriately stored. If we now contemplate allowing reconstituted measles to be kept at higher temperatures, the probability is that more children will die. The hotter it is the quicker the result of contamination becomes lethal. Robert is correct we need some definitive and clear guidelines from WHO. At least a confirmation that the guidelines set down in the 80s still apply. The storage conditions for vaccines are based upon the vaccines' biological characteristics, I am not aware that those characteristics have changed in the last few years. Some vaccines are spoilt by freezing, others by high temperatures even for short periods. Programmes have to adjust to manage these constraints and those pushing for more activity have to understand that these constraints are real. We have to accept that the insurance we have against weak management is “rigorously applied and simply understood operating proceduresâ€