POST 00499E : PROTECTION OF MORE COLD-SENSITIVE VACCINES

POST 00499E : PROTECTION OF MORE COLD-SENSITIVE VACCINES Follow-up on Posts 00412E, 00419E, 00428E, 00475E, 00480E, 00482E, 00484E, 00490E, 00491E AND 00494E 8 September 2002 ________________________________________________________ Carla Lee (mailto:[log in to unmask]) from CDC makes a statement on reconstituted measles vaccine on behalf of her institution. Then Andy Tucker (mailto:[log in to unmask]) contributes comments and questions based on his experience in Cambodia. ________________________________________________________ On behalf of the Global Measles Branch of CDC, I'd like to respond to a comment made by Robert Steinglass on post 00494E, par.2. CDC fully supports existing WHO UNICEF recommendations that require that reconstituted measles vaccine be kept at 2-8 degrees C and used by the end of the session regardless of the type of vaccine or the number of doses remaining in the vial." (WHO Policy Statement : The use of opened vials of vaccine in subsequent immunization sessions, and CDC's Epidemiology & Prevention of Vaccine Preventable Disease--The Pink Book 4th. Edition) Carla Lee ___________________________________________________________ I just want to clarify and follow up on Carib Nelson's original question, which was whether a "cool" chain (using "cool" packs rather than ice packs or wet ice) was sufficient in regard to reconstituted vaccines. Ümit Kartoglu has made it clear that this is unacceptable, that these vaccines must be kept on ice (or presumably ice packs) during the 6 hours after reconstitution, right?. By the way, I have not witnessed measles or BCG being placed on ice or ice packs during sessions (Oddly enough, I have witnessed TT being kept on ice during a fixed session.) I think this policy is poorly implemented, probably due to poor knowledge of it or people thinking that the vaccine will generally be given in such a short time that it doesn't matter (I agree this is probably the attitude of campaigns.), and this includes us at the technical advisor level as well as national counterparts and logisticians/ supervisors. In Cambodia, health workers generally keep vaccine out of the ice during outreach by placing in the holes in the piece of foam at the top of the vaccine carrier or on some surface. I would assume that the ice/packs below help keep vaccine in the foam "cool" but that this is also unacceptable according to WHO policy (which needs to be publicized!), right? I agree that storage racks would be great for protecting vaccine and helping MDVP implementation. It is true that this would increase the use of cold chain capacity, but there does not seem to be a shortage of that at the health center level, where 1 week of vaccine is stored in a cold box and 1-2 vials of each vaccine are taken to an outreach session. The studies that Ümit presented also make it clear that "cool" packs can keep vaccine safe and usable, and I presume that this will only apply to vaccine deliveries, not for conducting outreach, right?. Also, it might be interesting to study how using "cool" packs affects vaccines and/or VVMs during multiple deliveries [e.g, in Cambodia, we have delivery from central to province, province to district (up to 3 months later), and district to (up to 1 month later)], not just one time, though we might assume that if it survives a several day delivery than it should be able to survive several 1-day or less journeys. Andy Tucker, MPH Program Associate Children's Vaccine Program at PATH, Phnom Penh, Cambodia ________________________________________________ ----------------------------------------------------------------------------- -------------- 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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