:+2(3,75$05HY

2ULJLQDO(QJOLVK
'LVWULEXWLRQ*HQHUDO

0RGXOH

7KHFROGFKDLQ

5HYLVLRQ  LQFRUSRUDWHV QHZ WH[W LQ VHFWLRQ  SDJH  WR UHIOHFW
FKDQJHV LQ SROLF\ UHJDUGLQJ WKH KDQGOLQJ RI PXOWLGRVH YLDOV RI
YDFFLQH 7KHVH FKDQJHV DUH LVVXHG DV :+2(3,75$0
&RUUGDWHG$SULO

*/2%$/352*5$00()259$&&,1(6$1',0081,=$7,21

(;3$1'('352*5$00(21,0081,=$7,21

:RUOG+HDOWK2UJDQL]DWLRQ*HQHYD
 :+2(3,75$0&RUU
25,*,1$/(1*/,6+
',675*(1(5$/

Immunization in practice
Module 3: The cold chain
(WHO/EPI/TRAM/98.03)

Corrigendum 1
Module 3 is affected by recent changes in policy regarding the handling of multi-dose vials of
vaccine, as described below.
4. How to load cold-chain equipment

4.1 Vaccine refrigerators - on page 12:

 After the fifth bulleted sentence: “Arrange the boxes of vaccines in stacks between which
the air can move.”, insert the following new paragraphs:

• Multi-dose vial policy. Opened multi-dose vials of liquid vaccines from which
one or more doses have been removed, following standard sterile procedures, may
be used in the next immunization session, if all of the following conditions are met:
a) The expiry date has not passed; and
b) The vaccine has not been contaminated; and
c) The vials have been stored under appropriate cold chain conditions; and
d) The VVM on the vial, if attached, has not reached the discard point.

• Liquid vaccines to which the statement above applies include OPV, DPT, TT, DT,
Td, hepatitis B, and liquid formulations of Hib.

• Freeze-dried vaccines, which include BCG, measles, yellow fever, and freeze-
dried formulations of Hib, must be discarded six hours after reconstitution or the
end of the immunization session, whichever comes sooner.

• Keep opened multi-dose vials of OPV, DPT, TT, DT, Td, hepatitis B, and liquid
formulations of Hib that meet the conditions above in a special box in the main
section of the refrigerator, so that you remember to use them first in the next
session.

• Discard opened vials of all reconstituted vaccines, including BCG, measles, and
yellow fever vaccines.

 Delete all of the text under the two bullets that begin as follows:
• Keep unopened vials that have been taken out…
• Discard opened vials of OPV, measles vaccine…
 7DEOHRIFRQWHQWV

/LVWRIILJXUHV  LLL

$ERXWWKLVPRGXOH  LY

:KDWLVWKHFROGFKDLQ"  

:KDWFROGFKDLQHTXLSPHQWLVXVHGLQKHDOWKFHQWUHV" 

:KDWFROGFKDLQPRQLWRULQJHTXLSPHQWLVXVHGLQKHDOWKFHQWUHV" 

+RZWRORDGFROGFKDLQHTXLSPHQW 

0DNLQJLFHSDFNV 

+RZWRPRQLWRUDQGDGMXVWWKHWHPSHUDWXUH 

+RZWRPDLQWDLQFROGFKDLQHTXLSPHQW 

7KHVKDNHWHVWWRGHWHUPLQHZKHWKHUYDFFLQHKDVEHHQIUR]HQ 

6XPPDU\  

LL ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 /LVWRIILJXUHV

)LJXUH$7KHFROGFKDLQ

)LJXUH%7ZRRIWKHPRVWFRPPRQUHIULJHUDWRUV

)LJXUH&6PDOOYDFFLQHFROGER[

)LJXUH'/DUJHYDFFLQHFDUULHUV

)LJXUH()RDPSDGLQXVH

)LJXUH),FHSDFNV

)LJXUH*¥7KHUPRPHWHUV

)LJXUH+&ROGFKDLQPRQLWRU

)LJXUH,¥)UHH]HZDWFKLQGLFDWRU

)LJXUH-¥6723:DWFKPRQLWRUFDUG

)LJXUH.9DFFLQHYLDOPRQLWRUV 

)LJXUH/9DFFLQHUHIULJHUDWRU

)LJXUH0$UUDQJLQJLFHSDFNVLQDYDFFLQHFDUULHU

)LJXUH1:UDSSLQJQHZVSDSHUDURXQGWKH'37DQG77YDFFLQHV

)LJXUH2&ORVLQJWKHYDFFLQHFDUULHU

)LJXUH39DFFLQHFDUULHUZLWKLFHFXEHV 

)LJXUH45HIULJHUDWRUWHPSHUDWXUHFKDUW 

)LJXUH5)RDPSDGLQXVH 

)LJXUH6&KHFNLQJWRVHWKDWWKHUHLVVWLOOVRPHLFHLQDQLFHSDFN

)LJXUH76KDNHWHVWWRFKHFNLI'37RU77YDFFLQHKDVEHHQGDPDJHG

:+2(3,75$05HY LLL
 $ERXWWKLVPRGXOH

7KLVPRGXOHGHVFULEHVZKDWWKHFROGFKDLQLVZKDWYDFFLQHVWRUDJH
HTXLSPHQWLVQHHGHGLQKHDOWKFHQWUHVDQGKRZWRXVHDQGPDLQWDLQWKLV
HTXLSPHQW

LY ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 :KDWLVWKHFROGFKDLQ"

9DFFLQHV DUH VHQVLWLYH WR KHDW DQG PXVW EH NHSW FROG IURP WKH WLPH WKH\ DUH
PDQXIDFWXUHGXQWLOWKH\DUHXVHG7KHHTXLSPHQWDQGSHRSOHWKDWNHHSYDFFLQHV
FROGGXULQJWKHLUMRXUQH\DUHWRJHWKHUFDOOHGWKH FROGFKDLQ

0DLQWHQDQFHRIWKHFROGFKDLQUHTXLUHVYDFFLQHDQGGLOXHQWWREH

• FROOHFWHGIURPDQDLUSRUWDVVRRQDVLWDUULYHV
• WUDQVSRUWHGDWWKHFRUUHFWWHPSHUDWXUHIURPWKHDLUSRUWDQGIURPRQHVWRUHWR
DQRWKHU
• VWRUHG DW WKH FRUUHFW WHPSHUDWXUH LQ FHQWUDO UHJLRQDO DQG GLVWULFW VWRUHV DQG
LQKHDOWKFHQWUHV
• WUDQVSRUWHGDWWKHFRUUHFWWHPSHUDWXUHWRRXWUHDFKVLWHV
• NHSWFROGGXULQJLPPXQL]DWLRQVHVVLRQV

<RX DUH UHVSRQVLEOH IRU PDLQWDLQLQJ WKH FROG FKDLQ ZKLOH YDFFLQH LV VWRUHG LQ
\RXU KHDOWK FHQWUH ZKLOH LW LV EHLQJ WUDQVSRUWHG WR RXWUHDFK VLWHV DQG GXULQJ
LPPXQL]DWLRQVHVVLRQV7KHFROGFKDLQPXVW QHYHUEHEURNHQ

7KHILJXUHEHORZLOOXVWUDWHVWKHFROGFKDLQ

:+2(3,75$05HY 
 )LJXUH$7KHFROGFKDLQ

0DQXIDFWXUHU

5HTXHVWIRUVXSSO\

$LUSRUW
$QQXDOVWDWLVWLFV HVWLPDWHV

$QDO\VLV
&HQWUDOVWRUH
0RQWKO\
UHSRUW
FKHFNLQJ

'LVWULFWUHJLRQDOVWRUH

'DLO\UHFRUG
+HDOWKFHQWUH

9DFFLQDWLRQ0RWKHUDQGFKLOG

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
:KDWFROGFKDLQHTXLSPHQW
LVXVHGLQKHDOWKFHQWUHV"

'LIIHUHQW OHYHOV RI WKH KHDOWK FDUH V\VWHP QHHG GLIIHUHQW HTXLSPHQW IRU
WUDQVSRUWLQJDQGVWRULQJYDFFLQHDQGGLOXHQWDWWKHFRUUHFWWHPSHUDWXUH

• &HQWUDODQGUHJLRQDOVWRUHVQHHGFROGURRPVIUHH]HUVUHIULJHUDWRUVDQGFROG
ER[HVIRUWUDQVSRUWDWLRQ
• 'LVWULFWVWRUHVQHHGIUHH]HUVUHIULJHUDWRUVDQGFROGER[HV
• +HDOWKFHQWUHVQHHGUHIULJHUDWRUVFROGER[HVDQGYDFFLQHFDUULHUV

7KHFROGFKDLQHTXLSPHQWXVHGLQKHDOWKFHQWUHVLQFOXGHVWKHIROORZLQJ

 5HIULJHUDWRUV
+HDOWKFHQWUHUHIULJHUDWRUVPD\EHSRZHUHGE\HOHFWULFLW\JDVNHURVHQHRUVRODU
HQHUJ\(OHFWULFUHIULJHUDWRUVDUHXVXDOO\WKHOHDVWFRVWO\WRUXQDQGWKHHDVLHVWWR
PDLQWDLQEXWPXVWKDYHDUHOLDEOHHOHFWULFLW\VXSSO\

:KHUH WKH HOHFWULFLW\ RU IXHO VXSSO\ LV QRW UHOLDEOH LFHOLQHG UHIULJHUDWRUV FDQ
PDLQWDLQWKHDSSURSULDWHWHPSHUDWXUHIRUKRXUVZLWKRXWSRZHULIWKH\RSHUDWH
ZLWKLWIRUDWOHDVWKRXUVDGD\

5HIULJHUDWRUV KDYH GLIIHUHQW FDSDFLWLHV IRU VWRULQJ YDFFLQH DQG IRU IUHH]LQJ DQG
VWRULQJLFHSDFNV$UHIULJHUDWRULQDKHDOWKFHQWUHVKRXOGEHDEOHWRKROG

• DRQHPRQWKVXSSO\RIYDFFLQHVDQGGLOXHQW DQG
• D RQH WR WZRZHHN UHVHUYH VWRFN RI YDFFLQHV DQG GLOXHQW DQ DGGLWLRQDO 
RIWKHRQHPRQWKVXSSO\ DQG
• IUR]HQLFHSDFNVRUERWWOHVRIZDWHULQWKHERWWRPRIWKHUHIULJHUDWRUWRNHHSLW
FRROLIWKHSRZHUIDLOV DQG
• QRWKLQJ LQ KDOI WKH WRWDO VSDFH DYDLODEOH WR DOORZ DLU WR FLUFXODWH DURXQG WKH
YDFFLQHVDQGGLOXHQWVRDVWRNHHSWKHPFRRO

:+2(3,75$05HY 
 )LJXUH%7ZRRIWKHPRVWFRPPRQUHIULJHUDWRUV

$EVRUSWLRQW\SHUHIULJHUDWRUDQGIUHH]HU3,60

&RPSUHVVLRQUHIULJHUDWRUDQGLFHSDFNIUHH]HU3,6(

 &ROGER[HV
$ FROG ER[ LV DQ LQVXODWHG FRQWDLQHU WKDW FDQ EH OLQHG ZLWK IUR]HQ LFH SDFNV WR
NHHSYDFFLQHVDQGGLOXHQWFROG

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
&ROG ER[HV DUH XVHG E\ KHDOWK FHQWUH VWDII WR FROOHFW DQG WUDQVSRUW PRQWKO\
YDFFLQHVXSSOLHVIURPGLVWULFWVWRUHV7KH\DUHDOVR XVHG WR VWRUH YDFFLQHV ZKHQ
WKHUHIULJHUDWRULVRXWRIRUGHURUEHLQJGHIURVWHG

'LIIHUHQWPRGHOVRIFROGER[HVKDYHGLIIHUHQWYDFFLQHVWRUDJH FDSDFLWLHV  +HDOWK

FHQWUHVXVXDOO\QHHGRQHRUPRUHFROGER[HVWKDWFDQKROG

• DRQHPRQWKVXSSO\RIYDFFLQHVDQGGLOXHQW DQG
• DRQHWRWZRZHHNUHVHUYHVWRFNRIYDFFLQHVDQGGLOXHQW

,QDGGLWLRQWRWKHLUYDFFLQHVWRUDJHFDSDFLW\FROGER[HVDUHVHOHFWHGDFFRUGLQJWR
WKHLU FROG OLIH WKH WLPH WDNHQ IRU WKH WHPSHUDWXUH LQVLGH D FROG ER[ RU YDFFLQH
FDUULHU WR ULVH IURP ƒ & WR ƒ & ZLWKRXW WKH OLG EHLQJ RSHQHG  'LIIHUHQW
PRGHOVKDYHDFROGOLIHRIWZRWRHLJKWGD\V

7KHPRVWVXLWDEOHFROGER[IRUDSDUWLFXODUKHDOWKFHQWUHLVGHWHUPLQHGE\

• WKHYDFFLQHVWRUDJHFDSDFLW\QHHGHG
• WKHFROGOLIHQHHGHGWKLVGHSHQGLQJ RQ WKH ORQJHVW WLPH WKDW YDFFLQH ZLOO EH
VWRUHGLQWKHER[
• LWVZHLJKWWKLVGHSHQGLQJRQKRZWKHER[ZLOOEHWUDQVSRUWHGHJE\PRWRU
YHKLFOHRUELF\FOH

)LJXUH&6PDOOYDFFLQHFROGER[

 9DFFLQHFDUULHUV
/LNHFROGER[HV YDFFLQH FDUULHUV DUH LQVXODWHG FRQWDLQHUV WKDW FDQ EH OLQHG ZLWK
IUR]HQLFHSDFNVWRNHHSYDFFLQHVDQGGLOXHQWVFROG 7KH\ DUH VPDOOHU WKDQ FROG
ER[HVDQGHDVLHUWRFDUU\LI\RXDUHZDONLQJEXWWKH\GRQRW VWD\ FROG DV ORQJ ¥
RQO\IRUKRXUV

:+2(3,75$05HY 
9DFFLQHFDUULHUVDUH XVHG WR WUDQVSRUW YDFFLQH DQG GLOXHQW WR RXWUHDFK VLWHV DQG
IRU WHPSRUDU\ VWRUDJH GXULQJ KHDOWK FHQWUH LPPXQL]DWLRQ VHVVLRQV  ,Q VPDOO
KHDOWK FHQWUHV WKH\ DUH XVHG WR WUDQVSRUW PRQWKO\ YDFFLQH VXSSOLHV IURP WKH
GLVWULFWVWRUH,QDGGLWLRQWKH\DUHXVHGWRVWRUHYDFFLQHVZKHQWKHUHIULJHUDWRULV
RXWRIRUGHURUEHLQJGHIURVWHG

'LIIHUHQWPRGHOVRIYDFFLQHFDUULHUVKDYHGLIIHUHQWVWRUDJHFDSDFLWLHV

7KHW\SHRIYDFFLQHFDUULHUQHHGHG LQ D SDUWLFXODU KHDOWK FHQWUH GHSHQGV RQ WKH

QXPEHU RI YDFFLQH YLDOV GLOXHQWV DQG LFH SDFNV WR EH WUDQVSRUWHG WKH FROG OLIH
QHHGHGDQGWKHPHDQVRIWUDQVSRUW

)LJXUH'/DUJHYDFFLQHFDUULHUV

$ IRDPSDGLV D SLHFH RI VRIW IRDP WKDW ILWV RQ WRS RI WKH LFH SDFNV LQ D YDFFLQH
FDUULHU  :KHQ WKH FDUULHU OLG LV RSHQ WKH IRDP SDG NHHSV WKH YDFFLQHV
XQGHUQHDWK LQ D FRRO VWDWH  ,W DOVR KROGV DQG SURWHFWV YDFFLQH YLDOV GXULQJ
LPPXQL]DWLRQVHVVLRQV

1RWH &XSV ZLWK LFH DQG LFH SDFNV DUH QR ORQJHU UHFRPPHQGHG IRU KROGLQJ
YDFFLQHDQGGLOXHQWGXULQJVHVVLRQV

)LJXUH()RDPSDGLQXVH

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 'RQRWSXWRSHQHGYLDOVLQWKHKROHVWKDWDUHPDGHLQVRPHLFHSDFNV8VHD
IRDPSDG

 ,FHSDFNV
,FHSDFNVDUHIODWVTXDUHSODVWLFERWWOHVWKDWFDQEHILOOHG ZLWK ZDWHU DQG IUR]HQ
7KHUHTXLUHGQXPEHULQDSDUWLFXODUFROGER[RUYDFFLQHFDUULHUYDULHV

,FHSDFNVDUHDYDLODEOHLQWZRVL]HV

• OLWUHIRUFROGER[HV
• OLWUHIRUYDFFLQHFDUULHUV

(YHU\KHDOWKFHQWUHVKRXOGKDYHWZRVHWVRILFHSDFNVRQHEHLQJIUR]HQZKLOHWKH
RWKHULVLQXVH

)LJXUH),FHSDFNV

:+2(3,75$05HY 
:KDWFROGFKDLQPRQLWRULQJ
HTXLSPHQWLVXVHGLQKHDOWK
FHQWUHV"
7KH SXUSRVH RI FROGFKDLQ PRQLWRULQJ HTXLSPHQW LV WR NHHS WUDFN RI WKH
WHPSHUDWXUHWRZKLFKYDFFLQHDQGGLOXHQWDUHH[SRVHGGXULQJWUDQVSRUWDWLRQDQG
VWRUDJH

 7KHUPRPHWHUV
+HDOWK FHQWUH VWDII XVH GLDO DQG OLTXLG FU\VWDO WKHUPRPHWHUV WR PRQLWRU WKH
WHPSHUDWXUHRIUHIULJHUDWRUVFROGER[HVDQGYDFFLQHFDUULHUV

/LTXLG FU\VWDO WKHUPRPHWHUV VKRXOG QRW EH XVHG DORQH LQ UHIULJHUDWRUV EHFDXVH
WKH\GRQRWRSHUDWHDWWHPSHUDWXUHVEHORZIUHH]LQJ

)LJXUH*7KHUPRPHWHUV

'LDOWKHUPRPHWHU

:DWHUSURRIOLTXLGFU\VWDOWKHUPRPHWHU

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 9DFFLQHFROGFKDLQPRQLWRUV
$ YDFFLQH FROGFKDLQ PRQLWRU LV D FDUG ZKLFK FKDQJHV FRORXU ZKHQ YDFFLQH LV
H[SRVHGWRWHPSHUDWXUHVWKDWDUHWRRKLJK+HDOWKZRUNHUVXVHWKHPWRHVWLPDWH
WKHOHQJWKRIWLPHWKDWYDFFLQHKDVEHHQH[SRVHGWRKLJKWHPSHUDWXUH

0DQXIDFWXUHUV SDFN WKHVH PRQLWRUV ZLWK WKH %&* '37 SROLR DQG PHDVOHV
YDFFLQHVVXSSOLHGE\:+281,&()

)LJXUH+&ROGFKDLQPRQLWRUFDUG

 )UHH]HZDWFKLQGLFDWRUV
$IUHH]HZDWFKLQGLFDWRUFRQVLVWVRIDVPDOOYLDORIUHGOLTXLGDWWDFKHGWRDZKLWH
FDUG DQG FRYHUHG LQ SODVWLF  7KH YLDO EUHDNV LI WKH WHPSHUDWXUH ZKHUH WKH
LQGLFDWRU LV ORFDWHG GURSV EHORZ ƒ & IRU PRUH WKDQ RQH KRXU DQG WKH YDFFLQH
PXVWWKHQEHGHVWUR\HG

0DQXIDFWXUHUVSDFNWHPSHUDWXUHLQGLFDWRUVZLWK'7DQG77YDFFLQHVWR PRQLWRU
WKHPGXULQJWUDQVSRUWDWLRQDQGVWRUDJH

:+2(3,75$05HY 
 )LJXUH,)UHH]HZDWFKLQGLFDWRU

 6723ZDWFKUHIULJHUDWRUPRQLWRUV
$ 6723 ZDWFK PRQLWRU FRPELQHV WZR LQGLFDWRUV  2QH LQGLFDWRU WHOOV \RX
ZKHWKHU YDFFLQH KDV EHHQ H[SRVHG WR WHPSHUDWXUHV DERYH ƒ &  7KH RWKHU
LQGLFDWHVZKHWKHUWKHWHPSHUDWXUHKDVGURSSHGEHORZ¥ƒ&

6723ZDWFKPRQLWRUVDUHXVHGLQYDFFLQHUHIULJHUDWRUV

)LJXUH-6723:DWFKPRQLWRUFDUG

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 9DFFLQHYLDOPRQLWRUV
$ YDFFLQH YLDO PRQLWRU 990 LV D ODEHO RQ D YDFFLQH YLDO WKDW FKDQJHV FRORXU
ZKHQ H[SRVHG WR KHDW RYHU D SHULRG RI WLPH  +HDOWK ZRUNHUV FKHFN WKH 990
EHIRUHWKH\RSHQDYLDOWRVHHZKHWKHUWKHYDFFLQHKDVEHHQGDPDJHGE\KHDW

0DQXIDFWXUHUVDWWDFK990VWRDOO239YLDOVEHFDXVHWKH\DUHWKHPRVWVHQVLWLYH
WRKHDW(YHQWXDOO\990VZLOOEHDWWDFKHGWRWKHYLDOVRIRWKHUYDFFLQHV

)LJXUH.9DFFLQHYLDOPRQLWRUV

(DFKPRQLWRUDERYHVKRZVDGLIIHUHQWVWDJHRIFRORXUFKDQJH

:+2(3,75$05HY 
 +RZWRORDGFROGFKDLQ
HTXLSPHQW

&ROGFKDLQ HTXLSPHQW LQFOXGLQJ UHIULJHUDWRUV FROG ER[HV DQG YDFFLQH FDUULHUV

PXVWEHORDGHGFRUUHFWO\WRPDLQWDLQWKHWHPSHUDWXUHRIWKHYDFFLQHDQG GLOXHQW
LQVLGH

1RWH 7KHUH VKRXOG EH RQH SHUVRQ LQ HDFK KHDOWK FHQWUH ZKR KDV WKH PDLQ
UHVSRQVLELOLW\ IRU WKH UHIULJHUDWRU  +HU RU KLV UHVSRQVLELOLWLHV VKRXOG LQFOXGH
VWRULQJYDFFLQHVGLOXHQWVDQGLFHSDFNVFKHFNLQJDQGUHFRUGLQJWKHWHPSHUDWXUH
GDLO\ DQG PDLQWDLQLQJ WKH FHQWUH
V FROGFKDLQ HTXLSPHQW  +RZHYHU DOO KHDOWK
ZRUNHUVLQDKHDOWKFHQWUHVKRXOGNQRZKRZWRPRQLWRUWKHFROGFKDLQDQGZKDW
DFWLRQWRWDNHLIWKHWHPSHUDWXUHLVWRRKLJKRUWRRORZ

 9DFFLQHUHIULJHUDWRUV

9DFFLQHVGLOXHQWVDQGLFHSDFNVVKRXOGKDYHWKHLURZQUHIULJHUDWRU
6WRULQJRWKHUVXSSOLHVLQDYDFFLQHUHIULJHUDWRUUDLVHVLWVWHPSHUDWXUH

9DFFLQHUHIULJHUDWRUVKDYHWZRVHFWLRQV

• $ PDLQ VHFWLRQIRU VWRULQJ YDFFLQHV DQG GLOXHQWV LQ ZKLFK WKH WHPSHUDWXUH
VKRXOGEHNHSWEHWZHHQƒ&DQGƒ&7KHUPRVWDWVLQWKLVVHFWLRQDUHXVHG
WRDGMXVWWKHWHPSHUDWXUH
• $IUHH]HUIRUIUHH]LQJLFHSDFNV7KLVVHFWLRQVKRXOGEHNHSWEHORZƒ&

/RDGDYDFFLQHUHIULJHUDWRUDVIROORZV

• )UHH]HDQGVWRUHIUR]HQLFHSDFNVLQWKHIUHH]HU
• 3XWYDFFLQHVDQGGLOXHQWVRQWKHWRSDQGPLGGOHVKHOYHVRIWKHPDLQVHFWLRQ

− 239DQGPHDVOHVYDFFLQHRQWKHWRSVKHOI
− %&*'3777KHSDWLWLV%DQG\HOORZIHYHUYDFFLQHVRQWKHPLGGOH
VKHOYHV
− GLOXHQWVQH[WWRWKHYDFFLQHVZLWKZKLFKWKH\ZHUHVXSSOLHG

• $UUDQJHWKHER[HVRIYDFFLQHLQVWDFNVEHWZHHQZKLFKWKHDLUFDQPRYH

• 0XOWLGRVHYLDOSROLF\2SHQHGPXOWLGRVHYLDOVRIOLTXLGYDFFLQHVIURPZKLFK
RQHRUPRUHGRVHVKDYHEHHQUHPRYHGIROORZLQJVWDQGDUGVWHULOH procedures,

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 may be used in the next immunization session, if all of the following conditions
are met:
a) The expiry date has not passed; and
b) The vaccine has not been contaminated; and
c) The vials have been stored under appropriate cold chain conditions; and
d) The VVM on the vial, if attached, has not reached the discard point.
• /LTXLGYDFFLQHVWRZKLFKWKHVWDWHPHQWDERYHDSSOLHVLQFOXGH239'3777
'77GKHSDWLWLV%DQGOLTXLGIRUPXODWLRQVRI+LE
• )UHH]HGULHGYDFFLQHVZKLFKLQFOXGH%&*PHDVOHV\HOORZIHYHUDQGIUHH]H
GULHGIRUPXODWLRQVRI+LEPXVWEHGLVFDUGHGVL[KRXUVDIWHUUHFRQVWLWXWLRQRU
WKHHQGRIWKHLPPXQL]DWLRQVHVVLRQZKLFKHYHUFRPHVVRRQHU
• .HHS RSHQHG PXOWLGRVH YLDOV RI 239 '37 77 '7 7G KHSDWLWLV % DQG
OLTXLGIRUPXODWLRQVRI+LEWKDWPHHWWKHFRQGLWLRQV DERYH LQ D VSHFLDO ER[ LQ
WKHPDLQVHFWLRQRIWKHUHIULJHUDWRUVRWKDW\RXUHPHPEHUWRXVHWKHPILUVWLQ
WKHQH[WVHVVLRQ
• 'LVFDUG RSHQHG YLDOV RI DOO UHFRQVWLWXWHG YDFFLQHV LQFOXGLQJ %&* PHDVOHV
DQG\HOORZIHYHUYDFFLQHV
• .HHSSODVWLFERWWOHVRULFHSDFNVILOOHGZLWKZDWHURQ WKH ERWWRP VKHOI  7KH\
KHOSWRNHHSWKHWHPSHUDWXUHFRQVWDQW
)LJXUH/9DFFLQHUHIULJHUDWRU

'2127SXWYDFFLQHVRQWKHGRRUVKHOYHVWKHWHPSHUDWXUHLVQRWORZ
HQRXJK
'2127NHHSH[SLUHGYDFFLQHVLQWKHUHIULJHUDWRU7KURZWKHPDZD\RU
UHWXUQWKHPWRWKHGLVWULFWVWRUH
'2127NHHSDQ\IRRGGULQNRUGUXJVLQDYDFFLQHUHIULJHUDWRU

:+2(3,75$05HY 
 2SHQLQJWKHUHIULJHUDWRUGRRUUDLVHVWKHWHPSHUDWXUH
%HIRUH\RXRSHQWKHGRRUSODQZKDW\RXDUHJRLQJWRGR
:KHQ\RXRSHQWKHGRRUGRZKDW\RXKDYHWRGRTXLFNO\DQGFORVHWKHGRRU
DVVRRQDVSRVVLEOH
7U\QRWWRRSHQWKHUHIULJHUDWRUGRRUPRUHWKDQWKUHHWLPHVDGD\

 &ROGER[HVDQGYDFFLQHFDUULHUV
/RDGYDFFLQHLQWRFROGER[HVDQGYDFFLQHFDUULHUVDVIROORZV

 4XLFNO\ WDNH DOO WKH IUR]HQ LFH SDFNV VHH 6HFWLRQ  \RX QHHG IURP WKH
IUHH]HUDQGFORVHWKHGRRU
 3XWLFHSDFNVDJDLQVWHDFKRIWKHIRXUVLGHVRIWKHFROGER[RUYDFFLQHFDUULHU

)LJXUH0$UUDQJLQJLFHSDFNVLQDYDFFLQHFDUULHU

 4XLFNO\WDNHDOOWKHYDFFLQHV DQG GLOXHQW \RX QHHG IURP WKH PDLQ VHFWLRQ RI

WKHUHIULJHUDWRUDQGFORVHWKHGRRU

 )RU RXWUHDFK VHVVLRQV WDNH XQRSHQHG YLDOV RQO\ 3XW WKH YDFFLQHV DQG
GLOXHQW LQ WKH PLGGOH RI WKH FROG ER[ RU FDUULHU  9LDOV PD\ EH NHSW LQ WKHLU
ER[HVRUSDFNHGZLWKRXWWKHPGHSHQGLQJRQKRZPDQ\YLDOV\RXQHHG
'R QRW OHW '37 77 RU KHSDWLWLV % YDFFLQH YLDOV WRXFK WKH LFH SDFNV 3XW
QHZVSDSHURUFDUGERDUGDURXQGWKHPWRSURWHFWWKHPIURPIUHH]LQJ

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 )LJXUH1:UDSSLQJQHZVSDSHUDURXQGWKH'37DQG77YDFFLQHV

 3XW D WKHUPRPHWHU RQ WRS RI WKH YDFFLQHV XQOHVV YDFFLQH YLDO PRQLWRUV DUH
DWWDFKHGWRWKHYLDOV
 3XWLFHSDFNVRQWRSRIWKHYDFFLQHV
 )RUYDFFLQHFDUULHUVSODFHDIRDPSDGRQWRSRIWKHLFHSDFNV
 &ORVHWKHFDUULHUOLGWLJKWO\

)LJXUH2&ORVLQJWKHYDFFLQHFDUULHU

3XWDSODVWLFEDJRILFHFXEHVRQWRSRIWKH &ORVHWKHOLGOLJKWO\
YDFFLQH

1RWH,I\RXXVH LFHFXEHVSXWRQHSODVWLFEDJIXOORIFXEHV LQ WKH ERWWRP RI WKH

FDUULHUDQGRQHEDJIXOORIFXEHVRQWRSRIWKHYDFFLQHV

:+2(3,75$05HY 
 )LJXUH39DFFLQHFDUULHUZLWKLFHFXEHV

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 0DNLQJLFHSDFNV

,WWDNHVKRXUVWRIUHH]HDQLFHSDFN

0DNHLFHSDFNVDVIROORZV

• )LOOZLWKFOHDQFROGZDWHUDQGSXWWKHFDSRQWLJKWO\
• +ROGHDFKLFHSDFNXSVLGHGRZQDQGVTXHH]HLWWRPDNHVXUHWKDWWKHUHLVQR
OHDN
• 3XWWKHLFHSDFNVXSULJKWRURQWKHLUVLGHVLQWKHIUHH]HUDQGFORVHWKHGRRU
• /HDYHWKHPLQWKHIUHH]HUIRUDWOHDVWKRXUVWRIUHH]HVROLG

.HHS LFH SDFNV WKDW GR QRW ILW LQ WKH IUHH]HU RQ WKH ERWWRP VKHOI RI WKH PDLQ
VHFWLRQLQRUGHUWRNHHSWKLVVHFWLRQFROG:KHQ\RXSXWWKHVHLFHSDFNVLQWRWKH
IUHH]HU WKH\ ZLOO IUHH]H UHODWLYHO\ TXLFNO\ EHFDXVH WKH ZDWHU LQVLGH ZLOO DOUHDG\
EHFROG

5HPHPEHU
• <RXGRQRWKDYHWRUHILOOLFHSDFNVHYHU\WLPH\RXXVHWKHP8VHWKH
VDPHZDWHUUHSHDWHGO\
• $QLFHSDFNPHOWVTXLFNO\LIQRWFRPSOHWHO\IUR]HQ0DNHVXUHWKDWWKH
FHQWUHLVIUR]HQDVZHOODVWKHRXWVLGH

:+2(3,75$05HY 
 +RZWRPRQLWRUDQGDGMXVW
WKHWHPSHUDWXUH

 0RQLWRULQJWKHWHPSHUDWXUHLQYDFFLQHUHIULJHUDWRUV
7RPRQLWRUWKHWHPSHUDWXUHRIWKHPDLQVHFWLRQRIDUHIULJHUDWRU\RXQHHG

• DWKHUPRPHWHU
• DWHPSHUDWXUHFKDUWZKLFK\RXVKRXOGWDSHWRWKHRXWVLGHRIWKHGRRU

5HDG WKH WHPSHUDWXUH RQ WKH WKHUPRPHWHU LQ WKH PDLQ VHFWLRQ HYHU\ PRUQLQJ
DQG DIWHUQRRQ LQFOXGLQJ ZRUN GD\V ZHHNHQGV DQG KROLGD\V  2Q WKH FKDUW
UHFRUGWKHWHPSHUDWXUHIRUWKHGD\DQGWLPHDVVKRZQEHORZ

)LJXUH45HIULJHUDWRUWHPSHUDWXUHFKDUW

,I WKH WHPSHUDWXUH LV DERYH RU EHORZ WKH VDIH WHPSHUDWXUH UDQJH DGMXVW LW LI
SRVVLEOHVHH6HFWLRQ

:KHQ D FKDUW KDV EHHQ FRPSOHWHG UHSODFH LW ZLWK D QHZ RQH  .HHS WKH
FRPSOHWHGFKDUWVLQDUHFRUGERRNIRUIXWXUHUHIHUHQFH

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 +RZWRDGMXVWWKHWHPSHUDWXUHRIYDFFLQHUHIULJHUDWRUV
,IWKHWHPSHUDWXUHLVWRR+,*+DERYHƒ&SURFHHGDVIROORZV

• 0DNHVXUHWKDWWKHUHIULJHUDWRULVZRUNLQJFKHFNWKHIXHORUSRZHUVXSSO\
• ,I WKH UHIULJHUDWRU LV ZRUNLQJ WXUQ WKH WKHUPRVWDW NQRE VR WKDW WKH DUURZ
SRLQWVWRD+,*+(5QXPEHU7KLVZLOOPDNHWKHUHIULJHUDWRUFRROHU
• ,IWKHUHIULJHUDWRULVQRW ZRUNLQJ VWRUH YDFFLQHV LQ DQ DOWHUQDWLYH SODFH XQWLO
WKHUHIULJHUDWRULVUHSDLUHG

,IWKHWHPSHUDWXUHLVWRR/2:EHORZƒ&SURFHHGDVIROORZV

• 7XUQ WKH WKHUPRVWDW NQRE VR WKDW WKH DUURZ SRLQWV WR D /2:(5 QXPEHU
7KLVZLOOPDNHWKHUHIULJHUDWRUZDUPHU
• &KHFN ZKHWKHU WKH GRRU RI WKH IUHH]HU FORVHV SURSHUO\  7KH VHDO PD\ EH
EURNHQ
• &KHFN '37 DQG 77 YDFFLQHV IRU GDPDJH E\ XVLQJ WKH VKDNH WHVW VHH
6HFWLRQ

 0DLQWDLQLQJWKHFRUUHFWWHPSHUDWXUHLQFROGER[HVDQGYDFFLQH
FDUULHUV
7KH WHPSHUDWXUH LQ YDFFLQH FDUULHUV DQG FROG ER[HV FDQQRW EH DGMXVWHG EXW \RX
FDQPDLQWDLQWKHWHPSHUDWXUHEHORZƒ&LI\RXNHHSKHDWRXWDVIROORZV

• .HHSWKHOLGWLJKWO\RQWKHYDFFLQHFDUULHULQWUDQVLW
• 'XULQJ LPPXQL]DWLRQ VHVVLRQV NHHS RSHQHG YLDOV RQ WKH IRDP SDG RI \RXU
YDFFLQH FDUULHU  7KH IRDP SDG NHHSV YDFFLQHV LQVLGH WKH FDUULHU FRRO ZKLOH
SURYLGLQJDSODFHWRKROGDQGSURWHFWYDFFLQHYLDOVLQXVH

)LJXUH5)RDPSDGLQXVH

• 'RQRWSXWYLDOVEDFNLQVLGHWKHFDUULHUDIWHU HDFK XVH LI \RX NHHS OLIWLQJ XS

WKHIRDPSDGWKHLQVLGHRIWKHFDUULHUZLOOEHFRPHZDUP
• .HHSFROGER[HVDQGYDFFLQHFDUULHUV LQ WKH VKDGH  'R QRW OHDYH D FROG ER[
RUYDFFLQHFDUULHULQDYHKLFOHWKDW LV VWDQGLQJ LQ WKH VXQ  7DNH LW RXW RI WKH
YHKLFOHDQGSXWLWLQWKHVKDGH

:+2(3,75$05HY 
<RXFDQFKHFNZKHWKHU\RXFDQVWLOOXVHYDFFLQHE\VKDNLQJDQLFHSDFNIURPWKH
FROG ER[ RU FDUULHU  ,I \RX FDQQRW KHDU ZDWHU VSODVKLQJ WKH LFH SDFN KDV QRW
PHOWHGDQGWKHYDFFLQHVDUHQRWGDPDJHG,I \RX FDQ KHDU ZDWHU VSODVKLQJ WKH
LFHSDFNKDVPHOWHGDQGWKHYDFFLQHVDUHWRRZDUPDQGPXVWEHGLVFDUGHG

)LJXUH6&KHFNLQJDQLFHSDFN

5HPHPEHU
,QRUGHUWRPDLQWDLQWKHWHPSHUDWXUHLQFROGER[HVDQGYDFFLQHFDUULHUV

• .HHSWKHPLQWKHVKDGH
• .HHSWKHLUOLGVRQ

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 +RZWRPDLQWDLQ
FROGFKDLQHTXLSPHQW

 0DLQWHQDQFHRIYDFFLQHUHIULJHUDWRUV
$UHIULJHUDWRUZRUNVZHOORQO\LILWLVFOHDQHGDQGGHIURVWHGUHJXODUO\

7KLFN LFH GRHV 127 NHHS D UHIULJHUDWRU FRRO EXW PDNHV LW ZRUN KDUGHU DQG XVH
PRUH SRZHU RU IXHO  <RX VKRXOG WKHUHIRUH UHPRYH LFH ZKHQ LW EHFRPHV PRUH
WKDQFPWKLFNRURQFHDPRQWK

7RGHIURVWDQGFOHDQDUHIULJHUDWRUSURFHHGDVIROORZV

• 7DNHRXWDOOWKHYDFFLQHVGLOXHQWVDQGIUR]HQLFHSDFNVDQGWUDQVIHUWKHPWRD
FROGER[OLQHGZLWKIUR]HQLFHSDFNV
• 7XUQRIIWKHSRZHUVXSSO\WRWKHUHIULJHUDWRU
• /HDYHWKHGRRURSHQDQGZDLWIRUWKHLFH WR PHOW  'R QRW WU\ WR UHPRYH WKH
LFH ZLWK D NQLIH RU LFH SLFN VLQFH GRLQJ VR FDQ SHUPDQHQWO\ GDPDJH WKH
UHIULJHUDWRU
• &OHDQWKHLQVLGHRIWKHUHIULJHUDWRUZLWKDFORWK
• 7XUQWKHUHIULJHUDWRURQDJDLQ
• :KHQWKHWHPSHUDWXUHLQWKHPDLQVHFWLRQIDOOVWRƒ&RUORZHUUHWXUQWKH
YDFFLQHVGLOXHQWVDQGLFHSDFNVWRWKHLUDSSURSULDWHSODFHV

,I\RXQHHGWRGHIURVW\RXUUHIULJHUDWRUPRUHWKDQRQFHDPRQWK
• <RXPD\EHRSHQLQJLWWRRRIWHQPRUHWKDQWKUHHWLPHVGDLO\RU
• 7KHGRRUPD\QRWEHFORVLQJSURSHUO\

 :KDWWRGRZKHQDYDFFLQHUHIULJHUDWRULVQRWZRUNLQJ
,I \RXU YDFFLQH UHIULJHUDWRU VWRSV ZRUNLQJ ILUVW SURWHFW WKH YDFFLQHV DQG WKHQ
GHDOZLWKWKHUHIULJHUDWRU

3URWHFWLQJWKHYDFFLQHV
0RYHWKHPWRDQRWKHU SODFH XQWLO WKH UHIULJHUDWRU LV UHSDLUHG  ,I \RX WKLQN WKDW
WKHSUREOHPZLOOODVWRQO\DVKRUWWLPH\RXPD\XVHDFROGER[RUYDFFLQHFDUULHU
OLQHG ZLWK IUR]HQ LFH SDFNV IRU WHPSRUDU\ VWRUDJH  )RU D ORQJHU GXUDWLRQ XVH
DQRWKHUUHIULJHUDWRU

:+2(3,75$05HY 
5HVWRULQJWKHUHIULJHUDWRUWRZRUNLQJRUGHU
• &KHFN WKH SRZHU RU IXHO VXSSO\  ,I WKHUH LV QR SRZHU PDNH RWKHU
DUUDQJHPHQWV XQWLO SRZHU LV UHVWRUHG  ,I WKHUH LV QR IXHO JHW PRUH IXHO DV
VRRQDVSRVVLEOH
• ,IDODFNRISRZHURUIXHOLVQRWWKHSUREOHPUHSDLUWKHUHIULJHUDWRURUUHSRUW
WR\RXUUHSDLUWHFKQLFLDQRUVXSHUYLVRU

 0DLQWDLQLQJFROGER[HVDQGYDFFLQHFDUULHUV
.QRFNV DQG VXQOLJKW FDQ FDXVH FUDFNV LQ WKH ZDOOV DQG OLGV RI FROG ER[HV DQG
YDFFLQHFDUULHUV,IWKLVKDSSHQVWKHYDFFLQHVLQVLGHZLOOEHH[SRVHGWRKHDW

,IDFROG ER[ RU FDUULHU ZDOO KDV D VPDOO FUDFN \RX PD\ EH DEOH WR UHSDLU LW ZLWK
GXFWWDSH

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 7KHVKDNHWHVWWRGHWHUPLQH
ZKHWKHUYDFFLQHKDVEHHQ
IUR]HQ
'37KHSDWLWLV%DQG WHWDQXV WR[RLG YDFFLQHV FDQ EH GDPDJHG E\ IUHH]LQJ  <RX
FDQILQGRXWZKHWKHUWKLVKDVRFFXUUHGE\XVLQJWKHVKDNHWHVW

 7DNHWZR'37YLDOVRQHWKDW\RXWKLQNPLJKWKDYHEHHQIUR]HQDQG DQRWKHU
IURPWKHVDPHPDQXIDFWXUHUZKLFK\RX.12:KDVQHYHUEHHQIUR]HQ
 6KDNHERWKYLDOV
 /RRNDWWKHYDFFLQHLQVLGHWKHWZRYLDOVVHHILJXUH7
 /HWWKHVHGLPHQWVHWWOHIRUPLQXWHV
 $JDLQORRNDWWKHYDFFLQHLQVLGHWKHWZRYLDOVVHHILJXUH7

)LJXUH76KDNHWHVWWRFKHFNLI'37RU77
YDFFLQHKDVEHHQGDPDJHG

:+2(3,75$05HY 
 ,IDYLDOIDLOVWKHVKDNHWHVWGLVSRVHRILW

5HPHPEHU
• 9DFFLQHVDUHGDPDJHGE\KHDWZKHWKHUWKH\DUHH[SRVHGWRDORWRIKHDW
LQDVKRUWWLPHHJDVDUHVXOWRINHHSLQJYDFFLQHLQDFORVHGYHKLFOHLQ
WKHVXQRUDVPDOODPRXQWRIKHDWRYHUDORQJSHULRGHJDVDUHVXOWRI
WKHIUHTXHQWRSHQLQJRIDUHIULJHUDWRUGRRU
• 0DLQWDLQLQJWKHFROGFKDLQGHPDQGVFRQVWDQWYLJLODQFH

 ,PPXQL]DWLRQLQ3UDFWLFH0RGXOH
 6XPPDU\

7KHWDEOHVEHORZVKRZWKHVHQVLWLYLW\RIGLIIHUHQWYDFFLQHVWRKHDWDQGIUHH]LQJ

6HQVLWLYLW\WRKHDW

5DQJH 9DFFLQHEHIRUH 9DFFLQHDIWHU

UHFRQVWLWXWLRQ UHFRQVWLWXWLRQ
0RVWVHQVLWLYH 239 %&*
0HDVOHV 239
<HOORZIHYHU 0HDVOHV
+HSDWLWLV% <HOORZIHYHU
'37 +HSDWLWLV%
%&* '37
/HDVWVHQVLWLYH 77 77

6HQVLWLYLW\WRIUHH]LQJ

9DFFLQHVGDPDJHGE\IUHH]LQJ 9DFFLQHVWKDWFDQEHIUR]HQZLWKRXWKDUP
+HSDWLWLV% %&*
'37 239
77 0HDVOHV
<HOORZIHYHU

:+2(3,75$05HY