Journal article

Extending supply chains and improving immunization coverage and equity through controlled temperature chain use of vaccines

One way to strengthen immunization supply chains is to expand the use of vaccines in a controlled temperature chain (CTC). A method for increasing vaccine access and coverage, especially among hard-to-reach populations, CTC permits certain vaccines used in single antigen delivery strategies or campaign scenarios to be kept outside of the traditional cold chain of +2 °C to +8 °C for a short period of time under monitored and controlled conditions that are appropriate to the stability of the antigen. A CTC typically involves a single excursion of the vaccine into ambient temperatures not exceeding +40 °C for the duration of a specific number of days just prior to vaccine administration Dedicated training and supervision is an integral part of the CTC approach, ensuring health workers are not subject to confusion between vaccines eligible for removal from the cold chain and those not. CTC use of vaccines is currently limited to campaigns and special strategies; where vaccines are administered in isolation of other EPI vaccines. The CTC approach also uses two specific and complementary temperature monitoring tools: (1) a peak threshold temperature indicator which allows for brief- though all the same harmful- exposures to high temperatures to be detected and (2) the VVM which measures accumulated heat exposures during unintentional cold chain excursions and is limited to a calibration for an upper temperature limit of +37 °C. CTC therefore not only formally allows for cold chain excursions through the regulatory approval process, but also extends their flexibility and improves the associated temperature monitoring. A growing and compelling body of evidence shows CTC offers valuable opportunities for maximizing supply chain efficiencies, safeguarding cold chain investments, and protecting more children and families from vaccine-preventable diseases.

Languages

  • English

Publication year

2017

Journal

Vaccine

Volume

17

Type

Journal article

Categories

  • Supply chain & logistics

Tags

  • Controlled temperature chain (CTC)
  • Coverage monitoring
  • Distribution system
  • Equity
  • VVM

Topic references

CTC_JOURNAL

TitleAuthorYearTypeLanguage
A cluster randomized non-inferiority field trial on the immunogenicity and safety of tetanus toxoid vaccine kept in controlled temperature chain compared to cold chainRebecca F. Grais, Primitive Gakima, Paul Baoundoh, Mbaihol Tamadji, Martha H. Roper, Florence Fermon, Céline Langendorf, Camille Domicent, Aitana Juan-Giner, Simona Zipursky2014Journal articleEnglish
A field based evaluation of adverse events following MenAfriVac® vaccine delivered in a controlled temperature chain (CTC) approach in Benin Christoph Steffen, Evariste Tokplonou, Philippe Jaillard, Roger Dia, Marie N Deye Bassabi Alladji, Bradford Gessner2014Journal articleEnglish
An economic evaluation of the controlled temperature chain approach for vaccine logistics: evidence from a study conducted during a meningitis A vaccine campaign in TogoMercy Mvundura, Patrick Lydon, Abdoulaye Gueye, Ibnou Khadim Diaw, Dadja Essoya Landoh, Bafei Toi, Anna-Lea Kahn, Debra Kristensen2017Journal articleEnglish
Antivenoms, hepatitis B vaccine and oral polio vaccine can be considered for storage and handling outside the cold chain following the innovative 'controlled temperature chain' approachShereen H. Mohamed, Osama A. Hady, Mona T. Kashef, Hamdallah Zedan2022Journal articleEnglish
Benefits of using vaccines out of the cold chain: Delivering Meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in BeninSimona Zipursky, Mamoudou Harouna Djingarey, Jean-Claude Lodjo, Laifoya Olodo, Sylvestre Tiendrebeogo, Olivier Ronveaux2014Journal articleEnglish
Can thermostable vaccines help address cold-chain challenges? Results from stakeholder interviews in six low- and middle-income countriesDebra D. Kristensen, Tina Lorenson, Kate Bartholomew, Shirley Villadiego2016Journal articleEnglish
Cost-effectiveness of the controlled temperature chain for the hepatitis B virus birth dose vaccine in various global settings: a modelling studyNick Scott, Anna Palmer, Christopher Morgan, Olufunmilayo Lesi, Wendy Spearman, Mark Sonderup, Margaret Hellard2018Journal articleEnglish
Countries’ interest in a hepatitis B vaccine licensed for the controlled temperature chain; survey results from African and Western Pacific regionsDörte Petit, Carole Tevi-Benissan, Joseph Woodring, Karen Hennessey, Anna-Lea Kahn2017Journal articleEnglish
Economic benefits of keeping vaccines at ambient temperature during mass vaccination: the case of Meningitis A vaccine in ChadPatrick Lydon et al.2014Journal articleEnglish
Evidence of Extended Thermo-Stability of Typhoid Polysaccharide Conjugate VaccinesFang Gao, Alastair Logan, Sarah Davis, Barbara Bolgiano, Sjoerd Rijpkema, Gopal Singh, Sai D. Prasad, Samuel Pradeep Dondapati, Gurbaksh Singh Sounkhla2021Journal articleEnglish
Extending supply chains and improving immunization coverage and equity through controlled temperature chain use of vaccinesRaja Rao, Debra Kristensen, Anna-Lea Kahn2017Journal articleEnglish
Impact of Controlled Temperature Chain (CTC) approach on immunization coverage achieved during the preventive vaccination campaign against meningitis A using MenAfriVac in Togo in 2014Dadja Essoya Landoh, Anna-Lea Kahn, Anani Lacle, Kodjovi Adjeoda, Bayaki Saka, Issifou Yaya, Danladi Ibrahim Nassoury, Assima Kalao, Makawa-Sy Makawa, Nsiari-Mueyi Joseph Biey, Andre Bita, Yaovi Temfa Toke, Petit Dörte, Lucile Imboua, Olivier Ronveaux2017Journal articleEnglish
Use of controlled temperature chain and compact prefilled auto-disable devices to reach 2030 hepatitis B birth dose vaccination targets in LMICs: a modelling and cost-optimisation studyChristopher P. Seaman, Christopher Morgan, Jess Howell, Yinzong Xiao, Wendy Spearman, Mark Sonderup2020Journal articleEnglish

VVM-CTC

TitleAuthorYearTypeLanguage
Assessing the potency of oral polio vaccine kept outside of the coldchainSimona Zipursky et al.2011Journal articleEnglish
Benefits of using vaccines out of the cold chain: Delivering Meningitis A vaccine in a controlled temperature chain during the mass immunization campaign in BeninSimona Zipursky, Mamoudou Harouna Djingarey, Jean-Claude Lodjo, Laifoya Olodo, Sylvestre Tiendrebeogo, Olivier Ronveaux2014Journal articleEnglish
Extending supply chains and improving immunization coverage and equity through controlled temperature chain use of vaccinesRaja Rao, Debra Kristensen, Anna-Lea Kahn2017Journal articleEnglish
Vaccines beyond the cold chain - Simona ZipurskyEPELA, World Health Organization (WHO)2013GuidanceEnglish