POST 00606E : DESTRUCTION OF VACCINES
Follow-up on Post 00603E
24 September 2003
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This posting opens with a contribution by Anil Varshney
(mailto:[log in to unmask]) from India who suggests a simple protocol
for destroying unusable vaccines. Then Michel Zaffran
(mailto:[log in to unmask]) from WHO introduces Yves Chartier
(mailto:[log in to unmask]) a waste management specialist who works at the
WHO Programme for the Protection of Human Environment. Yves shares his
opinion on the topic.
Finally Ãœmit Kartoglu (mailto:[log in to unmask]) also from WHO reminds us
that it had been discussed previously. Indeed, he brings us back to Posting
00338 over two years ago. Nevertheless, it appears that the problem
persists. Parts of this posting are quoted at the end below (contributions
by EPI/East-Timor, Ãœmit and Allan Bass). For those who would prefer to read
the original posting, the following link to archives will lead you directly.
http://listes.ulaval.ca/cgi-bin/wa?A2=ind0105&L=technet21e&F=&S=&P=64
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A very important question and it has practical implications. Following is
recommended as a simple solution :
1- Make sure that all the official formalities have been undertaken such
as stock entries of wasted / expired vaccines.
2- They are separated and kept away from other medicines and vaccines
3- They are condemned for all records, and inventories are removed from
stocks
4- Crush all the vaccines vials.
5- Bury them in ground at least 3-meter deep
This will ensure that they are not reused.
Burying and condemnation should take place at regular interval say once a
year or twice a year, as an activity not only for expired vaccines but also
for other medicines and reagents & chemicals. Certain chemicals need to be
neutralized before disposal.
Hazardous chemicals and reagents should be disposed as per hazardous
chemical suggestions.
regards
Anil
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Yves Chartier who has recently joined WHO in the Programme for the
Protection of Human Environment and who will be working on waste management
is sharing his view with us. Yves has extensive experience in the field in
this area of waste management and his skills and experience will be very
welcome.
He can be reached at : mailto:[log in to unmask]
Michel
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This is a very interesting issue. It also shows that there is a lack of
information on that point and we have to work on it. If you come across any
option please share the information. This will be part of my work on Health
Care Waste Management.
We are talking about vaccines.
Incineration: Some vials may explode and most of them will melt under high
temperature (800°C to 1000°C). For that I suggest that prior to
incineration the vials are opened. They can also be simply crushed in a
metal container then incinerated with other medical wastes. After
incineration the reduced wastes will be then safely buried..
If you have a lot of vials and a way to recycle them, then they can be
opened, burned at a lower temperature (such as for an open fire) not to
melt, for a few minutes. Then they will be cleaned with chlorinated water
for safety and finally rinsed in clear water. Recycling if done in a safe
manner is an even better option. For instance some health care structures
reuse empty vials to put patient's medication in them.
Another option could be to contact the vaccine supplier and see with them
if the expired vaccines can be returned to them. In my point of view, all
vaccine suppliers should have, or at least be in contact with, someone able
to deal with such expired products. It might be an agreement to set up at
an early stage.
Encapsulation could be another option but so far I am a bit worried of
using that much the underground to hide what is unwanted at ground level.
If none of the options above are feasible, the vaccines can be burned in a
shallow pit then buried underground in a deep hole.
I hope this will be helpful. As mentioned above, if you come across with
any other options please share the information.
Best regards,
Yves Chartier
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This issue was also raised by several other people in the past and very
lately by UNICEF Bangladesh through Søren Spanner.
In 2001 UNICEF/East Timor also raised the same question. I quote from the
TechNet posting POST00338 dated 1 May 2001. The aide-mémoire I mentioned in
my message did not cover this issue. This means, we still have a gap
information in this field. I am sure, we need to come up with a clear
answer on this.
Cheers, ÃœMIT
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From POST 00338:
After a review of WHO guidelines for waste disposal, we remain confused as
to the best practice for disposal of UNUSED vaccine vials/ampoules. (To be
destroyed either because of expiry or cold chain failure.) The vaccines in
question are: freeze-dried BCG & Measles, OPV, DPT, DT, and TT.
Should such sealed vials be incinerated (>1400°C) or encapsulated?
best regards,
EPI East Timor
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Thank you for raising this issue. I am not aware of any specific WHO
recommendation regarding disposal of unused/used vaccine vials/ampoules. I
also cross-checked this with some colleagues in WHO Geneva and it seems
that there is not any.
The only document I found mentioning of disposal of used vaccine vials is
the "Immunization in Practice" Module 9 "After a session" page 5, reads as
follows: "Wrap empty vials, other vials and rubbish in newspaper or other
paper. Then either bury or burn them if the local government does not
collect them."
In East Timor situation (assuming that you do not have high temperature
incineration facility) the best way of disposal would be burying them. I
would also like to inform you that this issue would be addressed in a group
work to put together an aide-mémoire for planners and managers on
management of wastes from immunization activities. I will keep you posted
on developments.
Regards,
Umit
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Incineration at 800°C is the recommendation as I recall - but as you know -
the vials will explode and do present a hazard - either to the incinerator
or the operators. Lower temp burning - if it is complete and long enough
duration - is probably just as effective. Let us see what Ãœmit answers.
Immunization waste management is a real problem without really good
solutions at this point in time.
regards,
allan
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