VACCINE STORAGE

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 Introduction
• Failure to adhere to recommended specifications for storage
and handling of immunobiologics can reduce or destroy their
potency, resulting in inadequate or no immune response in the
recipient.

• Maintenance of vaccine quality is the shared responsibility of

all handlers of vaccines from the time a vaccine is
manufactured until administration.

• It is estimated that $20 million is wasted annually from poor

refrigeration , and up to 35% of vaccines are affected by
improper storage.
Vaccine Storage
Storing vaccines in ILR
• 2 cm. space between boxes of vaccines for
circulation of air
• Thermometer/ sensor to ascertain
temperature
• Use basket provided in the ILR.
• As per the Early expiry first out (EEFO) /
FIFO
• As per heat and cold sensitivity
Periodic checking of vaccines while in store
• For the VVM
• Expiry date
• Vaccine freezing
• Cleaning of the vaccine store
• Putting labels & batch cards
 Vaccine Storage

• BCG (after
Most reconstitution) Most
sensitive • OPV, RVV sensitive
• IPV • Hep. B
• Measles / MR (both
• Pentavalent
before and after
reconstitution) • IPV
• JE (both before and
• DPT
after reconstitution)
• DPT • TT
Least • BCG (before Least
sensitive reconstitution) sensitive
• TT
• Pentavalent, Hep. B
Temperature monitoring
Monitoring the temperature in vaccine refrigerators

• continuous process and not a spot check.

• Introduction of new time-temperature devices
Freeze tag ILR Solar Direct Drive (SDD)
In the absence of new time-temperature device , to
monitor the temperature of the main section of a
refrigerator you need:
• thermometer
• temperature chart that you tape to the outside of
the refrigerator door
Vaccine carrier
 Vaccine vial monitor(VVM)
• Thermochromic label placed on vaccine vial
which registers the cumulative effect of heat
exposure over time
• Will always indicate whether or not the
vaccine in the vial is safe to use
• Useful indicator when conducting outreach
activities.
• VVM will not indicate whether a freeze-
sensitive vaccine has been frozen.
Vaccine vial monitor(VVM)
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Safe Injection and waste disposal
 Selecting safe injection
• use auto-disable (AD) syringes for immunization and
mass campaigns.
• Standard disposable equipment should be used for
reconstitution of vaccines .
 Safe injection practices
• Use a new sterile AD syringe and needle for
every injection.
• Use a new sterile syringe and needle each
time a lyophilized vaccine is reconstituted.
• Discard an AD syringe that has touched any
non-sterile surface before injection.
• Prepare the injection on clean surface
 Safe injection practices
• Protect fingers with a small gauge pad before
opening glass ampules
• For multi-dose vials, always pierce the septum with a
sterile needle and never leave a needle in the
stopper.
• If disinfection are practiced do not use cotton balls
stored wet in a multi-use container.
• Never re-cap the AD syringe , dispose it immediately
within reach into the safety box .
 Estimating of safe injection and waste-
disposal equipment
• Managers should plan the correct ordering
and distribution of safe injection and waste-
disposal equipment on a timely basis to all
immunization centres and mobile team.
• Keep extra, empty safety box nearby at all
times.
• Revise the requirement when new vaccine is
introduced
Positioning ?
Positioning
 Making an immunization waste-disposal plan

• Local solution
• Estimate quantities to be disposed
• Disposal options

- On site and Off site disposal

- Disposal options when syringes and needles are
not separated
Disposal options
 AEFI: DEFINITION
An adverse event following immunization (AEFI) is any
untoward medical occurrence which
 follows immunization, and
 does not necessarily have a causal relationship with the usage
of the vaccine
The adverse event may be
 any unfavorable or unintended disease, symptom, which a
vaccine recipient complaints
 and may abnormal laboratory finding, sign or disease found
by medical staff
What can be the cause of an AEFI?
 Examples

1 2 3 4 5
Vaccine product- Vaccine quality Immunization Immunization Coincidental
related reaction defect-related error-related anxiety-related event
reaction reaction reaction
EXAMPLE EXAMPLE EXAMPLE EXAMPLE
EXAMPLE
Extensive Transmissi Vasovagal A fever
limb Failure by the on of syncope in occurs at
swelling manufacturer infection an the time of
following to by adolescent the
DTP completely contamina following vaccination
vaccination. inactivate a ted multi vaccination. (temporal
lot of dose vial. association)
inactivated but is in fact
polio vaccine caused by
leads to cases malaria.
of paralytic
polio.
 Other important terms and definitions
• AEFI can be classified by • Cluster – two or more cases
seriousness as: of the same or similar
– Serious AEFI – results in events related in time,
death, is life-threatening,
place/geography, and/or
requires hospitalization or
prolongation of existing vaccine administered.
hospitalization, results in • Coincidental events can
persistent or significant
occur as clusters.
disability, or is a congenital
anomaly/birth defect • Immunization stress-related
– Non-serious AEFI (minor) – responses (ISRR) can occur
does not pose a potential risk in clusters.
to the health of the recipient.
– Both serious and non-serious
• Clusters should be reported
events should be carefully
monitored.
 Reaction Sign and Symptoms Management

Skin and mucosal symptoms such as

generalized hives, itching, or flushing;
swelling of lips, face, throat, or eyes.
Respiratory symptoms such as nasal
Anaphylaxis congestion, change in voice, sensation of Injection adrenaline I.M
throat closing, stridor, shortness of breath,
wheeze, or cough. Gastrointestinal
symptoms such as nausea, vomiting,
diarrhea, cramping abdominal pain.
Cardiovascular symptoms such as collapse,
dizziness, tachycardia, hypotension
Treatment of anaphylaxis
 Which of the reported AEFI should be
investigated in more detail
 Serious AEFIs:
 Death, Hospitalization, Significant disability, Life threatening, or Congenital
anomaly/ Birth defect
 Part of a cluster:
 A cluster occurs when two or more AEFIs related in time, place and/or vaccine*
occur together
 Part of a suspected signal

 Suspected immunization error

 Appears on the list of events defined for AEFI investigation: Bacterial abscess,
severe local reaction, high fever, sepsis, Toxic shock syndrome, lymphadenopathy
or lymphadenitis
 Causes significant parental or public concern
AEFI monitoring cycle, key players and roles