Freeze-preventive passive containers – technical resources

Pat Lennon

This page features background information and guidance on freeze prevention in the immunization supply chain, also known as the cold chain, as it relates to passive containers. Section 1 provides a high-level overview of the impact of freezing vaccines, and Section 2 shares passive technologies that prevent freezing in passive containers and related activities. Sections 3 and 4 contain literature on the effects of freezing temperatures on vaccine potency and instances of freezing in the cold chain. The final section gives additional resources supporting the introduction of new freeze-preventive passive containers.

  1. Freeze prevention and why it is important
  2. New freeze-preventive technologies
  3. Literature on vaccine potency
  4. Examples of freezing in the cold chain
  5. Additional information and resources

1. Freeze prevention and why it is important

The following resources underscore the negative effects of exposing vaccines to freezing temperatures.

Above Zero: Strategies to Prevent Vaccine FreezingPATH2013TrainingEnglish
Effects of freezing on vaccine potencyPATH2003GuidanceEnglish
Freezing temperatures in the vaccine cold chain: A systematic literature reviewCarib Nelson, Dipika M. Matthias, Joanie Robertson, Michelle M. Garrison, Sophie NewlandJournal articleEnglish
Is freezing in the vaccine cold chain an ongoing issue? A literature reviewAdama Sawadogo, Anupa M. George, Benjamin Schreiber, Celina M. HansonJournal articleEnglish

2. New freeze-preventive technologies

The following table contains the activities stakeholders are engaged in to prevent freeze exposure in the supply chain.

3. Literature on vaccine potency

The following resources underscore the negative effects of exposing vaccines to freezing temperatures.

Assessing the potency and immunogenicity of inactivated poliovirus vaccine after exposure to freezing temperaturesAbhijeet Anand, Cynthia J. Snider, Dexiang Chen, Diana Kouiavskaia, Edmond F. Maes, Eric Stevens, Howard E. Gary Jr., Jacqueline Fournier-Caruana, Jessica A. White, Konstantin Chumakov, M. Steven Oberste, Marcus Estrada, William C. WeldonJournal articleEnglish
Cold chain study: danger of freezing vaccinesP. MilhommeJournal articleEnglish
Comparison of hepatitis B vaccine coverage and effectiveness among urban and rural Mongolian 2-year-oldsAnn Marie Kimball, Arslan Rinchin, J. Khulan, James S. Edstam, Nyamkhuu Dulmaa, Pagbajabyn NymadawaJournal articleEnglish
Effects of freezing on DPT and DPT-IPV vaccines, adsorbedA. Bell, D. Scheifele, R. DimayugaJournal articleEnglish, French
Factors affecting the immunogenicity and potency of tetanus toxoid: implications for the elimination of neonatal and non-neonatal tetanus as public health problemsA. Galazka, F. van Loon, S. Cochi, V. DietzJournal articleEnglish
Hepatitis B vaccineArlene A. McLean, Raymond Shaw Jr.Journal articleEnglish
Hepatitis B vaccine in healthy hospital employeesR. Normand, R. Silberman, S. A. KlotzJournal articleEnglish
Performance and potency of tetanus toxoid: implications for eliminating neonatal tetanusF. van Loon, J. B. Milstien, J. Bennett, S. Cochi, V. DietzJournal articleEnglish
Physical, chemical and immunological stability of CHO-derived hepatitis B surface antigen (HBsAg) particlesDvorah Diminsky, Marian Gorecki, Neomi Moav, Yechezkel BarenholzJournal articleEnglish
Storage at -3 degrees C for 24 h alters the immunogenicity of pertussis vaccinesChristina Ann Boros, D. M. Roberton, M. Hanlon, Michael Steven GoldJournal articleEnglish

4. Examples of freezing in the cold chain

The following resources provide examples of freezing in the cold chain.

Evaluation of an outside-the-cold-chain vaccine delivery strategy in remote regions of western ChinaRen Q, Xiong H, Li Y, Xu R, Zhu C2009Journal articleEnglish
Evidence of Vaccine Freezing in the Cold Chain: Literature ReviewPATH2003RepositoryEnglish
Frequent exposure to suboptimal temperatures in vaccine cold-chain system in India: results of temperature monitoring in 10 statesAmbujam Nair Kapoor, Balraj Singh, Devegowda Ravishankar, Kalyanranjan Mukhopadhyay, Kamlesh Parmar, Karumanagounder Kolanda Swamy, Manoj V. Murhekar, Pramit Ghosh, Raja Dodum, Rajesh Sisodiya, Ramaratnam Subramanian, Sailaja Bitragunta, Somorjit Ningombam, Srihari Dutta, Tana Takum, Varsha SinghJournal articleEnglish
Investigating cold-chain system and efficacy of vaccines reaching the end user in Turkey and related regulationsA. Yekta Özer, Hamza ÖzdemirJournal articleEnglish
Use of cool water packs to prevent freezing during vaccine transportation at the country levelBirhan Altay, Denis Maire, Peter Bollen, Serge Ganivet, Stephane Guichard, Umit Kartoglu, Venkat AiyerJournal articleEnglish
Visual Indicators on Vaccine Boxes as Early Warning Tools to Identify Potential Freeze DamageDiane Tipping, Jillian Wood, Maria C. Chernock, Ronald Angoff2015Journal articleEnglish

5. Additional resources

This section contains additional information and related resources.

Aide-mémoire for prevention of freeze damage to vaccinesWorld Health Organization (WHO)2019GuidanceEnglish
Cold chain innovations - learnings from field evaluations of freeze protection and energy harvesting (16th TechNet Conference)Abdoulaye Gueye, Sandeep Kumar, Surendra Uranw2020PresentationEnglish
Expanded Polystyrene Recycling Association of India websiteExpanded Polystyrene Recycling Association of India2019GuidanceEnglish
Freeze-Preventive Vaccine Carrier: Frequently Asked QuestionsPATH2018GuidanceEnglish
Freeze-Preventive Vaccine Carriers: A Job Aid For Health Workers and Cold Chain LogisticiansPATH2017User guideEnglish
Guidance on selecting, commissioning and using freeze-preventative vaccine carriersWorld Health Organization (WHO)2021GuidanceEnglish
How to dispose of Thermogard gel ice packsThermogard2019GuidanceEnglish
Koolit® and KoolTemp® DisposalCold Chain Technologies2019RepositoryEnglish
Products obtained during combustion of polymers under simulated incinerator conditions: II. PolystyreneF. W. Karasek , M. L. Parsons , R. A. Hawley-Fedder Journal articleEnglish
Temperature sensitivity of vaccinesWorld Health Organization (WHO)2006GuidanceEnglish
Vaccine Carrier Cold Life and Vial Freezing: Laboratory Testing ReportPATH2019ReportEnglish
Vaccine Management Handbook: How to monitor temperatures in the vaccine supply chainWorld Health Organization (WHO)2015GuidanceFrench
Vaccine Management Handbook: How to use passive containers and coolant-packs for vaccine transport and outreach operationsWorld Health Organization (WHO)2015GuidanceEnglish, French

Photos left to right: PATH/Simona Zipursky, PATH/Tina Lorenson, PATH/Tina Lorenson.