Saar Kuzi
Alessandra Coutinho Fernandes
William Cope
Richard Tapping
Kashif Ahmad
Reda Sadki
Shubhra Kanti Karmaker Santu
Adam P Rusch
Elle Meisner
Nereyda Ochoa
Landon J. Kunzelman
James DotimasFA16 Immunization Module’s Updates
Vaccine Storage and Handling
Excessive heat or cold exposure can damage vaccines. What healthcare professionals and scientists call the “cold chain” refers to the process of maintaining optimal conditions for vaccines during its storage, transport, and handling. Vaccines can be sensitive to temperature – for example some vaccines have an aluminum adjuvant that will precipitate when frozen, resulting in a loss of vaccine potency and the adjuvant effect. Other vaccines like the varicella vaccine and LAIV need to be continuously frozen otherwise they lose potency. Vaccines themselves can either be refrigerated or frozen. Refrigerated vaccines should be stored at an ideal temperature of about 40 degrees Fahrenheit, with an ideal range of 36-46 degrees Fahrenheit. If the temperature goes above or below that range, the efficacy of the vaccine will be affected.
The CDC recommends that temperatures of the refrigerated vaccines should be checked two times a day, and records of temperatures kept for at least three years. Older vaccines should be used first, and refrigerators or freezers must be stocked in a certain manner to ensure optimal temperatures. If the vaccine ever exceeds the optimal temperature, the health department or manufacturer of the vaccine should be contacted. Frozen vaccines should be stored within the range of -58 degrees Fahrenheit to 5 degrees Fahrenheit. Dormitory style refrigerator or freezers should not be used to store vaccines, and food should not be placed in these compartments either. It is also extremely important to have a proper thermometer inside each storage compartment, and to evaluate cold chain procedures to ensure guidelines are followed. These vaccine handling and storage requirements pose serious challenges, especially for vaccines that travel to developing countries with hot and humid climates.
Providers also need to play a role in ensuring the safety and efficacy of vaccines thru proper administration, timing and spacing of vaccine doses, properly observing precautions and contraindications.
Video from CDC about vaccine storage and handling:
https://www.youtube.com/watch?v=0atwOngjVQY
Sources:
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5242a6.htm
https://www.cdc.gov/mmwr/preview/mmwrhtml/figures/m242a6t1.gif
http://cdn.msf.org/sites/msf.org/files/cold-chain_infographic_feb_2014.png
Before reading this post I never thought about special storage for vaccines and how sensitive they were to varying temperatures. I thought @ Amanda Johnson made a good point about if the vaccines were not kept in their correct storage conditions that patients could have been vaccinated by an inadequate vaccine. My question is that due to the fact that these vaccines are very sensitive and must be kept in an optimal range, if a malfunction occurs during the storage or travel process, how long are the vaccines allowed to be outside of their optimal range before effectiveness is no longer present?
I think your point is very interesting @Amanda Johnson. Maybe we should start requiring titers after performing vaccination to ensure immunity? I was in a similar situation where I had received the Hepatitis B vaccine during childhood but recent titers confirmed I did not have immunity. The only reason I even received the tier was for medical school. I could have gone years without knowing I did not have sufficient immunity for HBV.
I don't believe inactivated vaccines require specialized storage conditions because they are not replicating whereas live vaccines do. This is why inactivated vaccines typically require multiple doses.
Do different types of vaccines (live vs inactivated vs subunit, etc.) require drastically different storage conditions? It seems odd that a live vaccine would require strict temperature control.
This update made me interested in handling/storage of vaccines in tropical climates. I found the following abstract regarding the use of computerized/electronic temperature monitoring in tropical climates. It highlights the difficulties posed by reliance upon non-computerized methods which seem to be prevelant. https://www.ncbi.nlm.nih.gov/pubmed/21870554
I never realized how careful healthcare providers had to be when storing vaccinations, nor how often they are required to check the vaccine temperatures and keep records for 3 years. It makes me wonder how often those temperatures are perhaps not always where they should be, and in turn, how often that results in an ineffective vaccination being administered. It is not as if most people verify that the vaccination took by having titers drawn, so many people could possibly be walking around without the immunizations they think they have due to have received a dud vaccine.