Docstoc

Cold Chain _ Logistics for New Vaccines

Document Sample
Cold Chain _ Logistics for New Vaccines Powered By Docstoc
					   Cold Chain & Logistics for New
             Vaccines

A presentation on the logistics and cold
    chain issues for the new vaccines




               WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines

   Cold Chain issues
       What is the capacity of existing cold chain?
       Does it need to be expanded to
        accommodate the new vaccines?
       What plans do you have for expansion/
        improvement in your cold chain system?
       What training needs are there for cold
        chain?
       A national cold chain assessment, if
        conducted, would highlight the above needs
                      WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Cold Chain Assessment
     Many  countries have ageing cold chain
      equipment
     No major reviews of cold chain carried out in
      the past
     New vaccines require additional
      consideration in the cold chain
       increased  space requirement
       special technical consideration (e.g. freezing)

       new equipment (e.g. new freeze watch)



                     WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Cold Chain Consideration (for HepB)




    * Monovalent HepB (liquid) in pre-filled single-dose injection device



                                             WHO/V&B/AVI
Comparison of storage volumes of
    different formulations




          WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Cold Chain Consideration (for HepB)
     If it is DTP-HepB combined, there is a slight
      increase in cold chain space requirement
      than for DTP alone
     A DTP-HepB combined has the same
      volume as that of HepB monovalent.
      Therefore, if you choose HepB monovalent,
      your cold chain space requirement doubles
     Your cold chain space requirement triples or
      quadruples if you choose single dose
      monovalent preparations of HepB
                     WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines

   Cold Chain Consideration (for HepB),
    contd..
      And your cold chain requirement
       approximately triples if you choose DTP-
       HepB (liquid) combined in single pre-filled
       injectable device
      The pentavalent also increases your cold
       chain space requirement roughly by three
       times than of what you would need for DTP
       alone
                     WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Cold Chain Consideration (for Hib)




                    WHO/V&B/AVI
      Cold Chain & Logistics for New Vaccines
   Cold Chain Consideration (for Hib)
     A 10 dose DTP/Hib requires a slightly more
      cold chain space than DTP/HepB, but this
      requirement more than triples if you choose
      liquid, single dose Hib
     A lyophilized 10 dose vial needs just slightly
      more space than a 10 dose DTP/HepB, but
      increases tremendously if you choose
      lyophilized, single dose with AD’s packed
      together
     A lyophilized two dose vial will need double
      the space than a lyophilized 10 dose vial
                       WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Logistics for the new vaccines
     Once  you have established your cold chain
      needs, you have to plan for the ordering, receipt
      & distribution of vaccines
     Ensure that your vaccine requirement forecast
      is correct
     Establish your quantity required and the
      frequency with which supplies will be delivered
     By carefully adjusting your vaccine orders, even
      without increase in your cold chain capacity,
      you can manage greater amount of vaccine with
      shorter supply periods.
                      WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines

   Logistics for the new vaccines, contd..
      Know the dates of delivery of your vaccines
       so that you have in place storage and
       transport ready
      Make sure that your distribution to the
       regional, provincial and district levels is
       planned and that all key people are aware of
       the shipment of the vaccine



                     WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Logistics for the new vaccines, contd..
      Ensure that your transport system is in
       place and functioning prior to your actual
       receipt of the vaccine
      Receive the vaccine, check to ensure that
       the cold chain was maintained
       throughout the transport period from the
       manufacturer to your cold store at
       national national; reject shipment if
       evidence of breakdown of cold chain-
       document everything for future reference
                    WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Distribution from the central to regional/
    provincial & district stores
      The faster you can ship vaccines from
       central to regional and provincial stores,
       the easier it will be for you to lessen
       pressure on cold chain space at the
       national level
      But the regional and provincial level cold
       stores must be in a position to take care
       of the vaccine

                     WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines

   Distribution from the central to regional/
    provincial & district stores, contd...
      Over-stocking at the district & peripheral
       health facility should be avoided to
       lessen potential for loss of vaccine due
       to expiry or failure of cold chain




                     WHO/V&B/AVI
     Cold Chain & Logistics for New Vaccines

   Issue of Freezing
     DTP  freezes at about -5o C, but HepB and
      its combinations freeze at -0.5o C
     Therefore, monovalent HepB vaccine or
      any of its combination formulation cannot
      be allowed to reach 00 C or lower at any
      point of time



                    WHO/V&B/AVI
Vaccines affected or not affected by
              freezing

affected by freezing                       not affected by freezing
DTPw                                       OPV
DTPw combos                                measles lyophilised
DTPa                                       mumps lyophilised
DTPa combos                                rubella lyophilised
Td/TT/dtpa                                 MR lyophilised
hepatitis B                                MMR lyophilised
hepatitis A                                varicella lyophilised
HA/HB; HA/S.typhi                          Hib lyophilised
 adapted from WHO EPI/LHI/98.02
                                  WHO/V&B/AVI
Stability of commonly used vaccines


vaccine                            +2°/8°C +22/25°C +35/37°C >+37°C

DT toxoids                         3-7 yrs                           mths                              wks              45°C wks
                                                                                                                        53°C days
                                                                                                                        >60°C hours
HB                                 2-4 yrs                           mths                              wks              45°C days
Me                                 2 yrs                             1 mth                             >1 wk            41°C 50% loss
                                                                     50% loss                          20% loss d1-4             in 2-3 d
                                                                                                       50% loss d2-6    54°C 80% loss
                                                                                                                                 in 1 day
Pw                                 1.5-2 yrs 2 wks                                                     1 wk             45°C
                                                                     some                              <50% loss        10%loss/day
OPV                                0.5-1 yr° 1-2 wks                                                   unstable             very unstable
                                                                    some                               potency loss 1-3 d
° MgCl2 OPV vaccine is more stable than the OPV sucrose vaccine; SBBio OPV can be frozen (2 year shelf-life in frozen form)

                                                                WHO/V&B/AVI
  adapted from WHO report 1998 Galazka A et al thermostability of vaccines WHO GPV 98/07 pp 63-63-64
    Cold Chain & Logistics for New Vaccines

   Issue of Freezing, contd..
     And  it is also known that, especially in those
      top opening refrigerators, there is a gradient
      or differential temperature from top to
      bottom- I,e, it is warmer at the top and cooler
      at the bottom
     Therefore, a temperature reading closer to
      the top may not necessarily indicate the
      right temperature at the bottom
     Anything in contact with the sides and
      bottom (in ILRs) is likely to freeze
                      WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines

   What can be done to prevent freezing-some
    practical tips?
     Reset   any refrigerators so that temperatures
      can be maintained between +20 C to +80 C
     If freezing is likely, set the thermostat of the
      refrigerator closer to the +80C. If temperature
      is set around 80C around noon, it is unlikely
      to reach zero at night.
     Stock DTP-HepB or DTP-HepB+Hib or HepB
      on the lower racks in a front opening
      refrigerators
                      WHO/V&B/AVI
Cold Chain & Logistics for New Vaccines-
practical tips---contd/
 Stock  DTP-HepB or DTP-HepB+Hib or HepB
  in the middle of the pile or closer to the lid in
  top opening refrigerators
 Do not stock anything that should not be
  frozen at the bottom or in contact with sides
  of ILRs- keep sufficient space on the sides,
  use a polystyrene board or wooden pelt at
  the bottom to prevent vaccines from coming
  in direct contact (of course, you lose space
  for this)


                  WHO/V&B/AVI
Cold Chain & Logistics for New Vaccines-
practical tips---contd/
 Even  if it is a holiday or weekend, make
  sure that you check your refrigerator
  temperature at least once a day
 Use freeze watch. The previous freeze
  watch is designed to pop at -40C and
  when it pops, it stains the absorbing
  paper red. But the current freeze watch
  for the new vaccines is designed to pop
  at 00C and when it pops, the paper is
  stained dark blue

                WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines-
    practical tips---contd/
   If freezing is suspected, try the shake test, always
    with a never frozen vial as control
   If freezing seen > DISCARD
   If freezing suspected > conduct shake test. If
    sedimentation rate <2 minutes > DISCARD
   If sedimentation rate >10 minutes, suspected
    samples will need to be tested for particle size
    distribution
   If in doubt (and if vaccine quantity is small)
    discard, but if quantity is large, then further testing
    may be necessary: contact your programme in-
    charge for further advice
                        WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines
   Monitoring vaccine wastage
     Because the new vaccines are expensive,
      it is essential to make every effort to
      reduce vaccine wastage
     Therefore, daily vaccine use and vaccine
      wasted must be recorded and reported
      periodically (ideally on a monthly basis)
      from the health facilities to the next
      higher level



                    WHO/V&B/AVI
    Cold Chain & Logistics for New Vaccines

   Monitoring vaccine wastage
     At the national level, at least a quarterly
      analysis of vaccine wastage should be
      possible
     Any large scale, sudden wastage of
      vaccine should be investigated




                     WHO/V&B/AVI

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:30
posted:11/29/2011
language:English
pages:24