Post00339 : VACCINE FREEZING: WHY IS THE COLD CHAIN TOO COLD?

1. WHY IS THE COLD CHAIN TOO COLD? Soren Spanner, WHO/SEARO, kindly posts the file of his recent presentation at the Asia-Pacific Regional Working Group Briefing, March 2001. The findings of a multi year-multi site study, including a clear description of the failure modes leading to frequent long duration freezing events in refrigerators used for vaccine storage, are reported The evidence is unequivocal in demonstrating that all freeze sensitive vaccine stored in the cold chain is at risk of damage. We now have data from all climates and temperature zones that demonstrates that frequent long duration freezing events in vaccine storage equipment are the rule. The implications of all this data - in terms of the reduced effectiveness of the current investment in new vaccine introduction - is of concern. "The big investment and little effectiveness is exactly my point" to quote from Soren's email of April 13, 2001. Clearly without operational and vaccine management changes - a long term developmental process, this damage to vaccines will continue. Technet has discussed the problem of vaccine freezing in the cold chain since the first global Technet meeting in Nicosia in 1990. At the Casablanca meeting Artur Galazka presented the Hepatitis B vaccine stability data showing great heat stability and but subject to damage by freezing. It was at the same meeting that the technology of the current VVMs was adopted by the Technet. * Now we have Hepatitis B vaccine presentations with Vaccine Vial Monitors coming into the vaccine distribution system - and this offers some real possibilities for improving the quality and effectiveness of vaccine supply chain. * It would be good if the Technet meeting can decide on the issue of moving HepB with VVMs out of the cold chain along with improving the low temperature protection for the central level HepB vaccine storage and distribution. The moderator proposes that Technet consider these recommendations 1. Make countries' central level storage and distribution freeze sensitive vaccine SAFE by - equipment modification - Change operator behavior through training and supervision 2. Implement VVMs on HepB vaccine and use VVMs to manage the vaccine out of the cold chain from district level down to point of use. We have been discussing this since Technet Casablanca! Time to do something! Opinion, comments and additions please: [[email protected]][email protected][/email] or use your reply button ___________________________________________________________________________ Get the file on the web at: ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/VAX-Freeze/ Click on the file: WHY IS THE COLD CHAIN TOO COLD.pdf This file is large at 1.8 Mb. It is too large to make available for email download - as most email systems will bounce the file. If you are unable to download the file on the web but still would like it please let us know - we will see if there is another way to get you the file. ___________________________________________________________________________ From: "Spanner, Mr. Soren" To: "'Technet Moderator'" Subject: TECHNET Date: Fri, 13 Apr 2001 Dear Allan, I have just gone through the meeting points for the TechNet/GAVI meeting. As far as I can see, there is no separate point on discussion of freezing risk, especially I'm thinking of Hep. B. Could that be added? best regards soren Soren Spanner Cold Chain Engineer WHO/SEARO New Delhi, India +91 11 331 7804 ext. 26503 +91 11 335 2106 fax Mobile +91 98104 01227 NEW --- From: "'Technet Moderator'" Sent: Friday, April 13, 2001 To: "Spanner, Mr. Soren" Cc: [[email protected]][email protected][/email] Subject: Re: TECHNET Dear Soren, Umit is organizing the agenda for the Technet-SIGN meeting - I'll copy your question to Umit. I think Hep B freezing risk should be on the agenda. For years no action was taken to address the problem - and skeptics asked for data - certainly you do - and it now calls for action by Technet and WHO - or the big investment on HepB (and HIB & Pneumococcal vaccines as well) will be less effective than we all hope. regards and best wishes, allan --- From: "Spanner, Mr. Soren" Sent: Friday, April 13, 2001 To: "'Technet Moderator'" Cc: [[email protected]][email protected][/email] Subject: Re: TECHNET Dear Allan, The big investment and little effectiveness is exactly my point. best regards soren --- From: [[email protected]][email protected][/email] To: [[email protected]][email protected][/email], [[email protected]][email protected][/email] Subject: TECHNET Date: Mon, 16 Apr 2001 Thanks for this Soren and Allan, I am in Abidjan and could not download the big attachment Soren sent (it will take ages). I'll see it when I'm back this weekend. There is no problem in adding this issue to the Technet agenda, which is a good idea indeed. Any suggestions who could cover this issue as a short presentation to stimulate discussion? Thanks and cheers, Umit --- Dear Soren and Umit, It would be good if the Technet meeting can move the issue of moving HepB with VVMs out of the cold chain along with improving the low temperature protection for the central level HepB vaccine storage and distribution. We have been discussing it since Technet Casablanca! Time to do something! regards, allan PS: Soren: Thanks for the copy of your RWG presentation. I'll make available on Technet forum - if that is OK with you. ___________________________________________________________________________ These files on vaccine freezing are available for download: FreezePreventionFeasibility-4-1996.PDF FreezePrevention-References-1.PDF ILR-Temperature-annex1.pdf ILR-Temperature-annex2.pdf Vaccine Storage in cold climates-1998.zip VaccineStorageInColdClimatesTechnet98.PDF Warmchain.zip Go to the Technet FTP site on the web: ftp://ftp.acithn.uq.edu.au/Technet/1-ClickHereForTECHNETfiles/VAX-Freeze/ Click on the filenames in your browser to download These files are also available for download by email. Send a message to: [[email protected]][email protected][/email] ____________________________________*______________________________________ 2. NEWS Selected news items reprinted under the fair use doctrine of international copyright law: http://www4.law.cornell.edu/uscode/17/107.html ___________________________________________________________________________ "Vaccine Shipment Feared Ruined on Way to Abbotsford: The Vaccine Was to be Used for Thousands of Young People in the Area" Vancouver Sun (www.southam.com/vancouversun) (05/01/01) P. B4; Galashan, Sarah Teenagers in Abbotsford, Canada, will have to wait until a new batch of meningitis vaccines are shipped from Italy before getting their shots. The 20,000-dose shipment that arrived this week may have ruined by poor shipping conditions while traveling from Europe; officials will know by Wednesday whether the vaccine is still effective. A second shipment of the conjugate C meningococcal vaccine, which is not yet licensed in Canada, has been ordered and is due next week. Health officials are urging high school students and adults up to 29 years of age who are either residing or employed in the region to get vaccinated. An outbreak of the disease occurred in April, infecting seven people between the ages of 18 and 27 years old and killing two. ____________________________________*______________________________________ ____________________________________*______________________________________ All members of the TECHNET Forum are invited to send messages to all subscribers or to comment on any posting or to use the forum to request technical information in relation to EPI and logistics for health. The forum invites all French speakers to send their comments either in French - and we will translate and post bilingually - or in hesitant English and we will correct before posting. 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