EXPANDED PROGRAMME ON IMMUNIZATION. Dr.Qazi Afsar Anwar Assistant Director EPI (Logistics) Khyber Pakhtunkhwa. Provincial EPI Cell, KP. Cold Chain system of EPI. System that ensures 1.Potency 2.Quality 3.Safety of Vaccines by maintaining the correct temperature from Manufacturer to
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Dr.Qazi Afsar Anwar
Assistant Director EPI (Logistics) Khyber Pakhtunkhwa
System that ensures
of Vaccines by maintaining the correct temperature from Manufacturer to
♦ Vaccines are sensitive to heat and must be kept cold from the time they are manufactured until they are used.
♦ The equipment and people that keep vaccines cold during their journey are together called the cold chain.
♦ The cold chain is only as strong as its weakest link. We are all part of that chain.
♦ Manufacturer to airport; cold storage at airport
♦ Transport at the correct temperature from airport to storage in central, regional and district stores and in health centers
♦ Transported at the correct temperature to outreach sites
♦ Kept at correct temperature during immunization sessions
National Vaccine store,
Provincial Vaccine store
Punjab, Sindh, KPK, Balochistan, AJK and FANA
District Vaccine store
Tehsil, Bhu, Rhc, FC facilities
Vaccinators/EPI service providers
Children and Women
♦ Put vaccines and diluents on the top and middle shelves of the main section
♦ OPV and measles vaccine on the top shelf
♦ BCG, Pentavalent and TT vaccines on the middle shelves
♦ Diluents next to the vaccines with which they were supplied
♦ Arrange the boxes of vaccine in stacks between which the air can move.
If your vaccine refrigerator stops working, first protect the vaccines and then repair the refrigerator.
Protecting the vaccines
Move the vaccines to another place until the refrigerator is repaired. If you think that the problem will last only a short time, you may use a cold box or vaccine carrier lined with conditioned ice-packs for temporary storage. For a longer duration, use another refrigerator. Always keep a freezer indicator with the freeze-sensitive vaccines to monitor eventual freezing.
Check the power, gas or kerosene supply. If there is no power, make other arrangements (e.g. store the vaccine in a household refrigerator) until power is restored. If there is no gas or kerosene, get it as soon as possible.
If a lack of power, gas or kerosene is not the problem, repair the refrigerator or report to your repair technician or supervisor.
Record the breakdown on the daily temperature recording chart.
Note: Concerning the routine maintenance and the servicing of refrigerators, WHO technical manuals exist for each kind of refrigerator.
All the vaccines should be stored in the basket provided with the refrigerator1.Measles,BCG and OPV in the bottom only2.Freeze-sensitive vaccines (Penta, TT) in the top only.
Different Types of Refrigerators/Freezers
ILR Mk 074
♦ Opening the refrigerator door raises the temperature.
♦ Before you open the door, plan what you are going to do.
♦ When you open the door, do what you have to do quickly and close the door as soon as possible.
♦ Try not to open the refrigerator door more than three times a day.
♦ Vaccines must not be kept:
– In the door compartments of domestic refrigerators
– In the salad trays at the bottom of the refrigerator
– In contact with the evaporator plate
♦ Must not be confused with other heat sensitive
♦ Diluents must be stored at the same temperature
at the point of use. This prevents damage to the potency of the vaccine
♦ Each facility should have a contingency plan for power failures and these must be visible – placed on the fridge
♦ It must be include an alternative storage area/place and it must be adequate
♦ Health centre staff use dial thermometers, as recommended by WHO to monitor the temperature of
refrigerators, cold boxes and cooler boxes.
♦ Max-min thermometers are not recommended as training is required
Dial type Thermometer
Bar type Thermometer
(read safety zone as 20 to 80 C & not as 00 to 80)
Vaccine carriers and cold boxes must be well dried after their use. If they are left wet with their lids closed, they will become mouldy. Mould may affect the seal of the cold boxes and vaccine carriers. If possible, store cold boxes and vaccine carriers with the lid open, when not being used.
Knocks and sunlight can cause cracks in the walls and lids of cold boxes and vaccine carriers. If this happens the vaccines inside will be exposed to heat.
If a cold box or vaccine carrier wall has a small crack you may be able to repair it with adhesive tape until you can get an undamaged one.
1. Take all the frozen ice packs you need from the freezer and condition them.
2. Put ice packs against each of the four sides of the cold box or vaccine carrier.
3. Take all the vaccines and diluent you need from the main section of the refrigerator and close the door.
4. Put the vaccines and diluent in the middle of the cold box or carrier. Vials may be kept in their boxes or packed without them, depending on how many vials you need.
Cold box and Vaccine Carriers
Vaccine carrier with vaccine vials in foam pad
♦ Keep the lid tightly on the vaccine carrier in transit.
♦ Keep cold boxes and vaccine carriers in the shade. Do not leave a cold box or vaccine carrier in a vehicle that is standing in the sun. Take it out of the vehicle and put it in the shade.
♦ Ice packs are flat, square plastic bottles that can be filled with water and frozen. The required number in a particular cold box or vaccine carrier varies.
♦ Every health centre should have two sets of ice packs, one being frozen while the other is in use.
♦ Condition the ice packs before use
A vaccine vial monitor (VVM) is a label containing a heat-sensitive material which is placed on a vaccine vial to register cumulative heat
exposure over time.
Non-operational ILRs stockpiled
around the store
Refrigerated vans for collecting vaccines from NIH