Controlled temperature chain - technical resources

Anna-Lea Kahn

The controlled temperature chain (CTC) is a specific short-term approach to vaccine management that allows vaccines to be kept at temperatures above the long-term +2° to +8° C storage condition for a limited period of time under monitored and controlled conditions appropriate to the stability of the antigen. Current WHO programme conditions for CTC include a single exposure just prior to administration, tolerating ambient temperatures of at least 40°C for a limited duration of at least three days, with these temperature and time conditions included in the approved label.

This page provides a list of resources related to CTC, as well as materials developed by the CTC Working Group. The aim is to raise CTC awareness among multi-sector stakeholders and industry; engage more partners through the promotion of a common vision and strategy around CTC; encourage a constructive dialogue with manufacturers on the need for more vaccine innovations and their willingness to consider CTC labelling for new or existing vaccines; increase country uptake of CTC implementation during immunization campaigns to increase vaccine coverage and generate more data on CTC. Resources are organised by category:



Guidelines on the stability evaluation of vaccines for use under extended controlled temperature conditions, Annex 5, TRS No 999World Health Organization (WHO)2016GuidanceEnglish
Comment contrôler la température dans la chaîne d'approvisionnement en vaccinsWorld Health Organization (WHO)2015GuidanceFrench
Controlled temperature chain for vaccination in low- and middle-income countries: a realist evidence synthesisChristopher P. Seaman, Anna-Lea Kahn, Debra Kristensen, Robert Steinglass, Dijana Spasenoska, Nick Scott, Christopher Morgan2022Journal articleEnglish
Delivering MenAfriVac using the controlled temperature chain approachPATH, World Health Organization (WHO)2013Case studyEnglish, French
Hepatitis B vaccines: WHO position paper - July 2017World Health Organization (WHO)2017GuidanceArabic, Chinese, English, French, Russian, Spanish
How to monitor temperatures in the vaccine supply chainUNICEF, World Health Organization (WHO)2015GuidanceEnglish
Labelling Guidance for Controlled Temperature Chain (CTC) Qualification for Vaccine Manufacturers (2020) World Health Organization (WHO)2020GuidanceEnglish
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns : adaptation guide and facilitators guideWorld Health Organization (WHO)2013GuidanceEnglish
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns : training module for organizing immunization sessionsWorld Health Organization (WHO)2013TrainingEnglish
Use of MenAfriVac™ (meningitis A vaccine) in a controlled temperature chain (CTC) during campaigns: guidance for immunization programme decision-makers and managersWorld Health Organization (WHO)2013GuidanceEnglish, French
Utilisation du MenAfriVac™ (vaccin contre la méningite A) en chaîne à température contrôlée (CTC) pendant les campagnes - Guide à l'intention des décideurs et des administrateurs des programmes de vaccinationWorld Health Organization (WHO)2013GuidanceFrench
Utilisation du MenAfriVac™ (vaccin contre la méningite A) en chaîne à température contrôlée (CTC) pendant les campagnes - Guide d'adaptation et guide du formateurWorld Health Organization (WHO)2013GuidanceFrench
Utilisation du MenAfriVac™ (vaccin contre la méningite A) en chaîne à température contrôlée (CTC) pendant les campagnes - Module de formation pour l'organisation de séances de vaccinationWorld Health Organization (WHO)2013TrainingFrench


Journal articles

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 TogoMvundura et all2017Journal 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, Kate Bartholomew, Shirley Villadiego, Tina LorensonJournal 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



Controlled temperature chain: Strategic Roadmap for Priority Vaccines 2017-2020World Health Organization (WHO)2018GuidanceEnglish
CTC - Delivering vaccines more easilyWorld Health Organization (WHO)2015GuidanceEnglish, French
CTC FAQsControlled Temperature Chain Team2023PresentationEnglish
Immunization Practices Advisory Committee (IPAC) statement: out of cold chain (OCC) and controlled temperature chain (CTC) use of vaccinesIPAC Delivery Technologies Working Group2016GuidanceEnglish
Infographique CTCWorld Health Organization (WHO)2015Poster/infographicFrench
Questions fréquentes CTCWorld Health Organization (WHO)2015GuidanceFrench
Risk/Benefit considerations when deciding on CTCWorld Health Organization (WHO)2024Poster/infographicEnglish
South Sudan conducts first phase of meningitis A campaign using a CTCWorld Health Organization (WHO)2015ReportEnglish
What is a controlled temperature chain? (CTC) - InfographicWorld Health Organization (WHO)2015Poster/infographicEnglish