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
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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.
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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
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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. Ãœmit
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 Ãœmit 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
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