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POST 00606E : DESTRUCTION OF VACCINES Follow-up on Post 00603E 24 September 2003 ____________________________________________ 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 Ümit 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, Ümit 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 ____________________________________________ 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 ______________________________________________________ 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 ______________________________________________________ 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 ______________________________________________________ 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, ÜMIT ______________________________________________________ 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 ******************** 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 ********************* 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 Ümit answers. Immunization waste management is a real problem without really good solutions at this point in time. regards, allan _____________________________________________________________________________ Visit the TECHNET21 Website at http://www.technet21.org You will find instructions to subscribe, a direct access to archives, links to reference documents and other features. ______________________________________________________________________________ To UNSUBSCRIBE, send a message to : mailto:[log in to unmask] Leave the subject area BLANK In the message body, write unsubscribe TECHNET21E ______________________________________________________________________________ The World Health Organization and UNICEF support TechNet21. The TechNet21 e-Forum is a communication/information tool for generation of ideas on how to improve immunization services. It is moderated by Claude Letarte and is hosted in cooperation with the Centre de coopération internationale en santé et développement, Québec, Canada (http://www.ccisd.org) ______________________________________________________________________________


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