Lessons Learned from Hurricane Katrina:
Ensuring Proper Vaccine Management,
Handling, and Administration
During a Disaster
What Can Happen?
Natural Disasters - Ice/Snow Storms,
Hurricanes, etc
Blackouts (August 2003, September 2005)
Delivery Strikes
Actions Steps for all Pediatric Practices:
Before Disaster Hits!
Promote good storage and handling at every
opportunity
• Regular monitor refrigerator temperatures
• Follow vaccine handling & storage
requirements
• Check equipment function when placing
vaccine orders (door seals, etc)
Develop vaccine management protocols
Display Disaster Recovery Plan
Action Steps for Pediatric
Practices Located within
Disaster Areas
Contact distributors to stop all bulk vaccine
order deliveries
Contact local public health agency to confirm
suspension of VFC vaccine deliveries
If available, ensure power source backup for
vaccine refrigerators
Document vaccine determined not viable for
later return
Protecting the Vaccine
Be proactive
•Ensure backup energy source – if possible
•Develop emergency protocols for disaster
scenarios (see Additional Resources)
–Example: Loss of Power
Close the vaccine refrigerator door tightly
Do not discard the affected vaccines. Mark the
vaccines so that the potentially compromised vaccines
can be easily identified
Call the manufacturer(s) and notify the local or state
health department
Record action taken
Protecting the Vaccine
Be prepared
• Remind practice staff of vaccine protocols
and procedures (see Additional Resources)
Protect the vaccine and maintain the cold chain by
following recommended vaccine temperatures,
vaccine storage requirements, and temperature
monitoring (see Additional Resources)
If transporting vaccine to another location,
maintain the cold chain during transport
Protecting the Vaccine
The following guidance developed for providers
during the 2003 Northeast Power Outage may be
helpful in the event of a temporary power outage:
Do not open freezers and refrigerators until power
is restored
•Most refrigerated vaccines are relatively stable at
room temperature for limited periods of time
•The vaccines of most concern are MMR and
Varivax, which are sensitive to elevated
temperatures
Protecting the Vaccine
Monitor temperatures; don't discard; don't
administer affected vaccines until you have discussed
with public health authorities
If the power outage is on-going:
•Keep all refrigerators and freezers closed to help to
conserve the cold mass of the vaccines
•Continue to monitor temperatures if possible - Do not
open units to check temperatures during the power
outage. Instead, record the temperature as soon as
possible after the power is restored, and the duration
of the outage. This will provide data on the maximum
temperature and maximum duration of exposures to
elevated temperatures
Protecting the Vaccine
Continued:
If alternative storage with reliable power sources
are available (i.e., hospital with generator power),
transfer to that facility can be considered. If
transporting vaccine, measure the temperature of
the refrigerator(s) and freezer(s) when the vaccines
are removed
If possible transport the vaccine following proper
cold chain procedures for storage and handling or
try to the record the temperature the vaccine is
exposed to during transport
Protecting the Vaccine
Continued:
When power has been restored:
1. Record the temperature in the unit as soon
as possible after power has been restored.
Continue to monitor the temperatures until
they reach the normal 2–8 degrees Celsius
range in the refrigerator, or -15 degrees C or
less in the freezer
2. Be sure to record the duration of increased
temperature exposure and the maximum
temperature observed
Protecting the Vaccine
Continued:
3. If you receive vaccine from your state or
local health department, they may be
contacting you with guidance on collecting
information on vaccine exposed to extreme
temperatures
4. If you are concerned about the exposure or
efficacy of any of your vaccine stock, do not
administer the vaccine until you have consulted
your state or local health department
Protecting the Vaccine
Continued:
5. Keep exposed vaccine separated from any
new product you receive and continue to store
at the proper temperature if possible
6. Do not discard any potentially exposed
vaccine. We will be working with the vaccine
manufacturers to determine which vaccines may
be viable
Action Steps for Practice Staff After
Disaster Hits: Be Informed!
Contact local public health department or CDC for
information and guidance:
CDC Hotline: 800/232-2522 (English)
CDC Hotline: 800/232-0233 (Spanish)
CDC Web site: http://www.cdc.gov/
AAP Web site: http://www.aap.org/
Follow interim immunization recommendations
(i.e., Interim Immunization Recommendations for Individuals
Displaced by Hurricane Katrina and Interim Immunization
Recommendations for Emergency Responders: Hurricane
Katrina)
Continued…
Communicate interim immunization
recommendations and requirements to practice
staff. Examples:
• Select states waived school immunization
requirements post-Hurricane Katrina
• VFC program was expanded to cover
Hurricane Katrina evacuees
Interim Immunization Recommendations
for Persons Displaced by Hurricane Katrina
If immunization records are available –
ensure persons are immunized in accordance
with the 2005 Recommended Immunization
Schedule for Children and Adolescents and
Adult Immunization Schedule
Interim Immunization Recommendations for
Children Displaced by Hurricane Katrina
If immunization records are not available - children 12 months of age and born in
the United States after 1965 should receive one done of
this vaccine unless they have a history of chickenpox
MMR - Everyone >12 months of age and born after
1957 should receive one dose of this vaccine
Hepatitis A - Everyone >2 years of age should receive
one dose of hepatitis A vaccine unless they have a clear
history of hepatitis A
Interim Immunization Recommendations
for Persons Displaced by Hurricane Katrina
Immunocompromised individuals, such
as HIV-infected persons, pregnant women,
and those on systemic steroids, should not
receive the live viral vaccines, varicella and
MMR.
Screening should be performed by self-
report.
Immunization Record Keeping
and Documentation During a Disaster
At all times - all vaccines administered be properly
documented
Immunization records should be provided in
accordance with the practice of the state in which the
vaccine is administered
Immunization cards should be provided to
individuals at the time of vaccination
Standard immunization practices should be
followed for delivery of all vaccines, including
provision of Vaccine Information Statements (VIS)
Paying for Vaccines
In September, the U.S. Department of Health and
Human Services announced that all children from
birth -18 years old displaced by Hurricane Katrina are
eligible to receive free vaccines through the federally-
run Vaccines for Children program (VFC), regardless
of whether they are staying at shelters, hotels, or with
family and friends and regardless of previous health
insurance coverage status
If you are not a VFC provider, contact your state
VFC coordinator to find out how to enroll
Actions Steps for all Pediatric Practices:
After the Disaster
Notify distributors to resume vaccine deliveries
Notify vaccine representatives to resume bulk order
shipments
Contact local public health department to determine
if VFC vaccine delivery has resumed
In the event of vaccine shortage, work with local
public health to identify/distribute needed vaccine
Remember!
Comprehensive vaccine management protocols will
help practice staff address future vaccine supply
challenges (i.e., vaccine shortages or supply
allocations) and help ensure appropriate vaccine
handling procedures throughout the year!
Role of Public Health
and Medical Societies
Communicate emergency to provider sites in
advance (mass fax, etc)
Send additional information (if available) to
those practices in the path of danger
Communicate with local health departments
and local health officials (stay on message,
coordinate activities when possible)
Practice Resources
Notice to Readers: Guidelines for Maintaining and
Managing the Vaccine Cold Chain, MMWR, October 2003.
Available at:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5242a6.htm
Maintaining Cold Chain During Transport. Available at:
http://www.immunize.org/catg.d/p3049.pdf
How to Protect Your Vaccine Supply, 2004. CDC video
(25 min.). To order 1 free copy from the NIP/CDC call
800/232-2522.
Practice Resources
CDC’s Web-based Toolkit for Vaccine Storage and
Handling. Available at:
http://www2a.cdc.gov/nip/isd/shtoolkit/splash.html
Vaccine Management: Recommendations for Handling
and Storage of Selected Biologicals. Available at:
http://www.cdc.gov/nip/publications/vac_mgt_book.htm
For additional information about vaccine storage during
a power outage, see the guidance provided by the CDC
National Immunization Program or contact your state or
local health department.
Practice Resources
IAC Express Checklist for Safe Vaccine Storage &
Handling. Available at:
http://www.cdc.gov/nip/publications/pink/Appendices/D/chk
list_handling.pdf
Fact Sheet: Don’t be Guilty of These Storage &
Handling Errors! Available at:
http://www.immunize.org/catg.d/p3036.pdf
Vaccine Temperature Logs. Available at:
http://www.immunize.org/catg.d/p3039.pdf (Fahrenheit)
http://www.immunize.org/news.d/celsius.pdf (Celsius)
Practice Resources
Contact Information for Vaccine Manufacturers and
Distributors. Available at:
http://cispimmunize.org/pro/Manufacturers.html
IAC Express Emergency Response Worksheet.
Available at: http://www.immunize.org/catg.d/p3051.pdf
AAP Resources to Help Cope with Natural and Other
Disasters. Available at:
http://www.aap.org/new/disasterresources.htm