POST 00304 : VACCINE FREEZING CONTINUED

Post00304 VACCINE FREEZING CONTINUED 13 December 2000 CONTENTS 1. Post00299 VACCINE FREEZING CONTINUED ___________________________________________________________________________ Moderators Note The moderator has relocated yet again and is back on line. Thanks for your patience. Send your contributions to: [log in to unmask] ____________________________________*______________________________________ 1. Post00299 VACCINE FREEZING CONTINUED Our discussion of the problem of vaccine freezing, cold chain and systems management, and mechanisms to monitor and prevent vaccine freezing, continues with todays postings from Ann Kempe, SA/DHS, Terry Hart, ITPI, and Hans Everts, WHO/EPI. Ann discusses the body of knowledge and experience in this critical logistical problem in Australia - and its parallels elsewhere. Terry asks what happened to the development of new vaccine storage equipment specifications based on temperature zones - including freeze protection. These specifications were intended to guide manufacturers in the production of cold chain equipment and to guide purchasers in their equipment selection. Hans points out that manufacturers are on notice to apply solutions to the vaccine freezing problem by the end of the year 2000 and that testing specifications have been tightened to eliminate equipment which had even minor negative temperature periods during the test cycle. * Revised equipment specifications and the availability of low temperature protected vaccine storage equipment will be helpful in the long term. The field reality is that very few programs properly monitor the occurrence of vaccine freezing events and take little or no action to do so. The "no news is good news" principle is hard at work. * Improved management of the cold chain at all levels is needed. These improvements can only come about by the implementation of better systems and methods. This in turn can only be achieved through active, competency based training. Budgetary or administrative constraints in many programs prevent the wide provision of refresher training of health workers. Send your contributions to this discussion to: [log in to unmask] ___________________________________________________________________________ From: "Kempe, Ann (DHS)" To: "'Technet Moderator'" Subject: RE: Post00299 VACCINE FREEZING CONTINUED Date: Wed, 29 Nov 2000 Allan As you know a lot of effort and research has been conducted in Australia (South Australia and NT and other states) to demonstrate the problem around freezing of vaccines. A Medline search will reveal the results of this research activity. Australia has many logistical problems with cold chain that are similar to cold chain issues faced by WHO sponsored immunisation programs. We have to face the problem of vaccine transport over long distances in extremes of temperatures. I recommend any Technet reader to review to published data. At the moment one of my colleagues is undertaking research using a mouse model, to demonstrate the effect of freezing (defined by difference temperatures below 0 degrees), on DTP vaccine. The research will be published in the near future. We have demonstrated repeatedly in Australia that vaccines like DTPa, HbOC, DT, hepB and other combination vaccines are regularly compromised by "thermal abuse" when fridges run too cold and vaccines are packed into cold boxes with too many cold packs and are not monitored with a freeze watch or equivalent. I recently did a consultancy in China with Alan Schnur for the WHO, to review education needs for health workers in 4 provinces. In the field trip I was concerned at the poor understanding of managing cold chain in relation to freezing although the heat issues seemed to be addressed. The lack of monitoring with adequate CCMs was also a concern. regards Ann Kempe South Australia - Immunisation Coordinator CDC Branch; Public Health Department of Human Service PO Box 6, Rundle Mall Adelaide, SA, 5000 Australia Phone: (08) 82267177 Fax: (08) 82267197 Email: [log in to unmask] --- From: Terry Hart To: "'Technet Moderator'" Subject: RE: Post00299 VACCINE FREEZING CONTINUED Date: Sun, 3 Dec 2000 Organization: IT Power India Hi Allan, ITPI had started to do some work related to this in 98, which included definition of ambient temp boundaries in different geographic zones. We ended up after much interaction with Hans with a common understanding/agreement of what the operating boundaries for Cold, Temperate and Hot climate fridges should be. The follow on action, which to my knowledge never occurred was to prepare specs for fridges suitable for use in each zone. A price advantage was anticipated for Temperate climate fridges where specs did not need to be so stringent. We would be interested in continuing with this work. Since Soren is now in Delhi it would be particularly easy and useful to work on this jointly. Best regards Terry [Terry Hart refers to Soren Spanner, WHO/SEARO. Soren has previously posted data on vaccine freezing in a 3 year study in India as well commented to the development of equipment specifications and testing procedures.] --- From: [log in to unmask] Date: Wed, 29 Nov 2000 11:29:47 +0100 Subject: RE: Post00299 VACCINE FREEZING CONTINUED To: Technet Moderator Although I agree a lot has still to be done, I do not think we can say the ball has not been picked up. As I said in the previous message all manufacturers will have to show they dealt with the freezing problem before the end of 2000 and progress was made. In addition, whereas previously minor negative temperatures during testing were considered as marginal failure and would not prevent an appliances from being listed, this is not the case anymore. It was definitely not enough, but the ball was picked up. Hans Everts Technical Officer EPI WHO Geneva Tel: 00 41 22 791 3683 ____________________________________*______________________________________