Unit 4 : Cold chain and logistics management

Cold Chain and

logistics
management
Cold chain

Cold chain is a system of storing and transporting vaccines at recommended temperatures

from the point of manufacture to the point of use. The cold-chain system is depicted at Fig
4.1.
Fig Cold chain system

Vaccine Air Transport Primary Store Refrigerated State Store Insulated Van
Manufacturer ( 2 to 8 C (GMSD & State) Insulated Van WIC ( 2 to 8 C) & ( 2 to 8 C &
& -15 to WIC ( 2 to 8 C) ( 2 to 8 C & WIF (-15 to -25 C) -15 to -25 C)
-25 C) & WIF (-15 to -15 to -25 C)
-25 C)

Mother & Sub-Centre Vaccine Primary Health Insulated Van District Vaccine
Child Session Sites Carrier ( 2 Centre ( 2 to 8 C) Store
to 8 C) ILR 2 to 8 C & ILR ( 2 to 8 C) &
All Vaccines in ILR DF (-15 to -25 C)

Cold Chain - ey elements

The key elements of the cold chain are

• Personnel to manage vaccine storage and distribution (vaccine and cold-chain handler
at each cold-chain point)
• Equipment: to store and transport vaccine and monitor temperature
• Procedures to ensure correct utilization of equipment and ensure vaccines are stored
and transported safely.

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As MO, you need to ensure that cold-chain equipment is functional, storage temperatures
are correctly maintained and recorded and that adequate stock of vaccines and logistics are
available and issued. A vaccine and cold-chain handler (VCCH) is trained and designated to
maintain the cold chain. It is also necessary to look into the dry storage areas, i.e. storage of
syringes and diluents, and ensure that they are safely stored and accessible.

Personnel

In case more than one MO is posted in the centre, designate one MO for RI, who can also
be the focal point for the cold chain.
Vaccine and cold-chain handler At every ILR point, designate a senior male or female HW
(pharmacist staff nurse ANM LHV MPW health supervisor) as the VCCH. He she should
be responsible for forecasting, indenting, receiving, storing and distributing vaccines and
logistics, maintaining cold-chain equipment and related records. They will require training
or update of knowledge and skills in order to perform their roles effectively. (refer Handbook
for Vaccine Cold Chain Handlers)

Equipment and procedures

Cold chain equipment Cold chain equipment, both electrical and non-electrical, is used
for storing vaccines and or transporting them at appropriate temperatures. Figure .2
summarizes the cold chain equipment supplied under the UIP. The NCCMIS (National Cold
Chain Management Information System) website is the platform where all information on
the cold chain equipment and management is being collated.
Fig Overview of cold-chain equipment

COLD CHAIN EQUIPMENT

TEMPERATURE
ASSOCIATED
STORAGE TRANSPORTATION MONITORING
EQUIPMENT
DEVICES

• REFRIGERATED VAN • THERMOMETER

• INSULATED VAN • STABILIZER • ELECTRONIC
ELECTRICAL SOLAR NON-
• COLD BOX • GENERATOR DATA LOGGER
ELECTRICAL • VACCINE CARRIER • INVERTER • FREEZE
• ICE-PACKS INDICATOR
• REALTIME
TEMP
• WIC SOLAR • COLD BOX MONITORING
• WIF REFRIGE • VACCINE DEVICE
• ILR RATOR CARRIER
• DF

WIC – walk-in cooler; WIF – walk-in freezer; ILR – ice-lined refrigerator; DF – deep freezer

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Table Technical speci cations of cold chain equipment

Equipment Temperature Storage Capacity Holdover time

Electrical
Deep Freezer -15 C to Ice packs or OPV stock for 3 months At 3 C for 2 hrs 30
(Large) -25 C (275 to 300 Litres) mins (minimum)
BCG, OPV, IPV, RVV, DPT, TT, Measles
At 3 C for 20 hrs
ILR (Large) 2 C to 8 C MR, Hep-B , Penta, IPV, Vaccine stock
(minimum)
for 3 months (135 to 160 litres)
Deep Freezer -15 C to At 3 C for 2 hrs 30
Ice packs (105 to 125 litres)
(Small) -25 C mins (minimum)
BCG, OPV, IPV,RVV, DPT, TT, Measles
At 3 C for 20 hrs
ILR (Small) 2 C to 8 C MR, Hep-B vaccine stocks for one
(minimum)
month (90-105 litres)
Non-electrical
Cold Box All vaccines stored for transport or in At 3 C for 96 hrs
2 C to 8 C
(Large) case of power failure (20 to 25 litres) (minimum)
Cold Box All vaccines stored for transport or in At 3 C for 8 hrs
2 C to 8 C
(Small) case of power failure. (5 to 8 litres) (minimum)
Vaccine
All vaccines carried for 12 hours At 3 C for 36 Hrs
carrier 2 C to 8 C
( conditioned Ice packs & 16-20 vials) (minimum)
( litres)

Holdover time

In the event of power failure, “holdover time” for any functional healthy cold-chain
equipment is defined as “the time taken by the equipment to raise the inside cabinet
temperature from its cut-off temperature to the maximum temperature limit of its
recommended range”, e.g. in the case of ILR, if the temperature is C, then the time taken
to reach 8 C from C will be the holdover time for that ILR.
Holdover time of ILR depends on the following factors
• Ambient temperature more the ambient temperature, less will be the holdover time
• Frequency of opening of lid and use of basket
• uantity of vaccines kept inside with adequate space between the containers
(equipment empty loaded)
• Condition of the ice pack lining (frozen partially frozen melted) inside electrical non-
electrical cold-chain equipment.
Note: DF does not have holdover time like ILR as it does not have an ice lining inside its wall.
It is dependent on the number of frozen ice packs kept inside it.

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ILR point or Cold Chain point

An ILR point or cold chain point (CCP) is located at a health centre (usually PHC UHC CHC)
with an Ice Lined Refrigerator for storage of vaccines and a deep freezer for preparation of
frozen ice packs. The cold chain point must have a generator as power back up.
The function of the CCP point is to receive, store and further distribute vaccines, diluents
and other logistics to another ILR point or directly to the session sites.
Cold-chain room
Keep all electrical cold-chain equipment in a separate room (Fig. .3) with restricted entry
to keep the vaccines and cold-chain equipment safe and secure. During visits to the cold-
chain room and the weekly meetings, review the cold chain and vaccine distribution system
of your centre. Ensure proper display of all the cold chain related job aids and use them to
refresh knowledge and skills.
Fig. 4.3. Cold chain room
Fig Cold chain room

Fig. 4.4
4.4. Storing vaccines in ILR

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Ice-lined refrigerator (ILR)

A diagrammatic representation of an ILR is given in Fig. . . An ILR maintains a cabinet
temperature between 2 C and 8 C. It is used to store UIP vaccines at the PHC and district
levels. An ILR with a top-opening lid prevents loss of cold air during door opening and can
keep vaccines safe with as little as 8 hours electricity supply in a 2 -hour period. ILRs are
available in two sizes large (for districts) and small (for PHCs).
In case baskets are not available, two layers of empty ice packs can be laid flat on the
bottom of the ILR to avoid contact with the inside floor of the cabinet. Vaccines should
never be kept on the floor of the ILR Other dos and dont’s for ILR use are given in Table .2.
Fig Storing vaccines in ILR

NEVER keep any vials that are expired, frozen or with VVMs beyond the
end point in the cold chain, as they may be confused with those contain-
ing potent vaccines eep them in the red bag for disinfection and dispos-
al
IDENTIF A DR SPACE FOR STORING
E PIRED UNUSABLE VACCINES BEFORE FINAL DISPOSAL

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Table Dos and dont s for ILR use

Dos Dont s
9 Keep all vaccines including those ¾ Do not store any other drugs non-UIP
returned under open vial policy in the vaccines in the ILR.
basket supplied along with the ILR. ¾ Do not open the ILR frequently.
9 Store diluents at 2 C to 8 C at least ¾ Do not keep food or drinking water in
24 hours before use. the ILR.
9 Leave space in between the vaccine ¾ Do not keep vaccines which have
boxes. expired and have crossed the discard
9 Place a thermometer in the basket in point of VVM.
between the vaccines. ¾ Do not disturb the thermostat se ng
9 Keep freeze-sensitive vaccines at the frequently.
top of the basket. ¾ Do not place heavy weight on the ILR.
9 Keep heat-sensitive vaccines in the ¾ Do not store excess stock of vaccines,
bottom of the basket. i.e. more than the maximum stock.
9 Arrange vaccines as per their expiry
dates. (Early expiry should be kept
above the later expiry ones).

Deep freezer (DF)

Freezing ice packs in the DF maintains the cabinet temperature between -15 C and -25 C.
Unlike the ILR, the DF has little or limited holdover time, which is dependent on the number
of frozen ice packs in it (See Fig. .5 and .6 for correct placement of ice-packs in the DF)
and the frequency of opening (See Table .3 for Dos and dont’s on use of DFs).
• At the PHC level, DF is used only for preparation of ice packs.
• At the district headquarters, DFs have been supplied for storage of recommended
vaccines such as OPV and preparation of ice packs.
Table Dos and dont s for DF use
Dos Dont s
9 Use DF only for preparation of ice ¾ Do not keep any vaccine in the DF at
packs at the sub-district level cold- sub-district level
chain points(PHC CHC SC) ¾ Never keep diluents in the deep
9 Use DF to store OPV at district level freezer
9 Keep frozen ice packs in the vaccine ¾ At district level do not use the same
storing DF to increase the holdover DF for simultaneously storing vaccines
time and preparing ice packs

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Fig Freezing ice packs in the deep freezer

Freezing Ice-packs in the Deep Freezer

Small
compartment
Arrange and
store frozen
icepacks
horizontally, in
Un-frozen layers.
icepacks
Also store in
for
cold boxes
freezing

Large compartment
Store frozen
Wipe dry and
icepacks only
arrange 20-25
up to half the
unfrozen icepacks
height of the
horizontally (never
large
flat) in a crisscross
compartment
pattern with space
for air circulation

Dos
Fig and don’ts for use ice
Brick layered of DFs is given
packs infreezer
in deep Table 4.3.Brick-layered ice packs in a DF is

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Domestic refrigerators

Domestic refrigerators also maintain a cabinet temperature between 2 C and 8 C with a

holdover time of only hours. Therefore, they are not recommended for common use in
the UIP. However, they are used in urban dispensaries and by private practitioners in urban
areas due to more assured power supply and non-availability of ILRs and DFs.
The refrigerator if used must be
• Used exclusively for vaccines
• No vaccine should be kept in the compartments of the freezer, chiller, door or basket
of the refrigerator
• Follow the guidelines to store vaccines on the shelves of the refrigerator in the same
order as used for ILR.

Voltage stabilizer

A voltage stabilizer is electronic equipment that ensures a constant output voltage of 220
volts whatever be the variation in input voltage, and thus safeguards equipment from
excessive voltage variation. This is suitable for the working of the ILR and DF. Each ILR or
DF should be connected to the mains through its own independent voltage stabilizer with
proper earthing.

ILR DF Control panel Remember

• Glowing of green light
A control panel monitors the temperature supply voltage and does not ensure that the
operates the cold-chain equipment. It is placed at the front equipment is in running
right bottom side of the ILR and DF. The control panel may condition. Always keep a
close watch on the inside
differ as per the make model of the cold-chain equipment.
temperature of the vac-
The functions of various components of the control panel are cines stored in the equip-
as follows: ment.
• The temperature indicat-
• Green light This is an indicator lamp, which shows that ed by the panel thermom-
electric power is available up to the equipment from the eter is not the tempera-
stabilizer. ture of the vaccine.
• Record the temperature
• Red light (in DF control panel only) It indicates that the of alcohol stem thermom-
temperature inside the equipment is not in safe range. eter kept inside the basket
of the ILR.

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• ellow switch (In ILR control panel only) It is a thermostat bypass switch used when
the ambient temperature is more than 5 C or when it requires lowering down inside
temperature quickly.
• Thermometer Shows the inside temperature of the equipment.
• Thermostat A thermostat is a component which senses the temperature of inside the
cabinet of the cold-chain equipment so that the system’s temperature is maintained
near a desired set point. The thermostat does this by switching the compressor on or
off to maintain the correct temperature.

Vaccine van

A vaccine van is an insulated van used for transporting of vaccines in bulk. Vaccines should
be transported only in cold boxes with the desired number of conditioned ice packs. These
cold boxes should be loaded in the vaccine van immediately a er packing with vaccines and
unloaded at the destination as soon it is reached. Vaccines should be removed from the
cold boxes and placed in the ILR immediately a er reaching the destination.

Cold box

A cold box is an insulated box used for transportation and emergency storage of vaccines
and ice packs. It is available in two sizes, large and small. It is used to
• collect and transport large quantities of vaccines
• store vaccines for transfer up to 5 days, if necessary for outreach sessions or when
there is a power cut
• store vaccines in case of breakdown of ILR, as a contingency measure
• also used for storing frozen ice packs, e.g. during emergencies and before campaigns.
Packing a cold box (See Fig )
• Place conditioned ice packs at the bottom and sides of the cold box.
• Load the vaccines in cardboard cartons or polythene bags.
• Never place freeze-sensitive vaccines in direct contact with the ice packs. Surround
them with OPV BCG JE vaccines.
• Keep a thermometer in the cold box.
• Place two rows of conditioned ice packs above the vaccine vials.
• Place a plastic sheet to cover the ice packs kept on top to ensure full holdover time.
• Securely close the lid of the cold box.

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Fig Packing a cold box

acking a c

Ice packs
Ice packs are plastic containers filled with water. These are hard frozen in the deep freezer.
They are placed inside a vaccine carrier and cold box to improve and maintain the holdover
time. They are also used in ILRs as inside lining to improve and maintain holdover time
during electricity failure. Dos and dont’s for use of ice packs is given in Table .7.
About 20 25 ice packs (8 10 kg of ice) and 35 0 ice packs (12 1 kg of ice) can be frozen
in one day in small and large deep freezers, respectively. Standard ice packs used in UIP for
cold box and vaccine carrier are of 0.4 litre capacity.

Note The personnel involved in preparing the vaccine carriers and conditioned ice
packs may include other staff of the health centre
It is essential to train these staff as well on the importance and method of condi-
tioning ice packs

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Table Dos and dont s in using ice packs

Dos Dont s
9 Fill water only up to the level mark ¾ Do not use ice packs that are cracked
on the side to leave 10 mm room for and or are without cap or cork.
expansion as water freezes. ¾ Do not use ice packs with leakage
9 While filling, keep the ice pack vertically discard them.
upwards under the tap so that it will ¾ Never add salt to the water as it
overflow a er reaching the desired lowers the temperature to sub-zero
level. level, which is not recommended.
9 Fit the stopper and screw on the cap ¾ Do not refill an ice pack every time
tight. before use the same water can be
9 Check and ensure that ice pack does not used repeatedly. Space for air
Max water level
leak. Cap Cork
9 Clean the outer surface of ice packs
with dry cloth before pu ng into the
deep freezer.
9 Keep ice packs horizontally (not flat)
in a criss-cross manner in the DF (brick
layered pattern see Fig .7).
9 Keep a gap breathing space between
ice packs for freezing to be faster and
uniform.
9 Ensure use of conditioned ice packs
Reconstituted BCG and
when storing transporting RI vaccines. Measles vial

Conditioning of ice packs

Ice packs come out of the freezer at a temperature of about -20 C. They need to be kept at
room temperature for a period of time to allow the ice at the core of the ice pack to rise to
0 C. This takes up to one hour at 20 C and rather less at higher temperatures. This process
is called “conditioning” (Fig. .8).
• Conditioning of ice packs prevents freezing of vaccines (freeze-sensitive vaccines such
as Hep B and T series) during transportation.
• Freeze-sensitive vaccines can be damaged if they come in direct contact with the frozen
ice packs.
• At the start of session day, take all the frozen ice packs that you need from the freezer
and close the door. Lay these out on a table leaving a 5 cm space all round each ice
pack.

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• Lay out ice packs preferably in single rows but never in more than two rows.
• Wait until there is a small amount of liquid water inside the ice packs.
• Shake one of the ice packs every few minutes. The ice is conditioned as soon as it
begins to move about slightly inside its container.
Fig Conditioning of ice packs

Vaccine sensitivities

Vaccines lose their potency due to exposure to heat (temperatures above 8 C) ,cold
(temperatures below 2 C) and light .
Reconstituted BCG, measles MR and JE vaccines are the most heat and light sensitive.
Since these live vaccines do not contain preservatives, there is risk of contamination with
Staphylococcus aureus leading to toxic shock syndrome and, therefore, they should be
used within hours of reconstitution. These light-sensitive vaccines are supplied in amber-
coloured vials.
Under the open vial policy (OVP), any open vaccine vial returned from the field has to be
used within weeks (28 days) from the date of opening, provided the vaccine vial monitor
(VVM) is in usable condition, vaccine has not been frozen and is within expiry date. The

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vaccines that come under this policy are Hep B, OPV, DPT, pentavalent, TT and IPV.
Only those diluents that are provided with the vaccine by the manufacturer should be
used. Keep diluents in an ILR at between 2 C and 8 C at least 2 hours before use to
ensure that the vaccine and diluent are at the same temperature when being reconstituted.
Keep diluents with the vaccines in a plastic zipper bag inside the vaccine carrier during
transportation.
Sensitivity of various vaccines to heat, light and freezing is given in Table .5.
Table Sensitivity of vaccines to heat, light and freezing
Vaccine Exposure to heat light Exposure to cold
Heat and light sensitive vaccines
OPV Sensitive to heat Not damaged by freezing
Measles MR Sensitive to heat and light Not damaged by freezing
BCG, RVV and JE Relatively heat stable, but Not damaged by freezing.
sensitive to light
Freeze sensitive vaccines
HepB Penta PCV Relatively heat stable Freezes at -0.5 C
(Should not be frozen)
IPV, DPT and TT Relatively heat stable Freezes at -3 C
(Should not be frozen)
At the PHC level, all vaccines are kept in the ILR for a period of one month at tempera-
ture of C to C
Vaccines sensitive to heat
accines sensitive to heat
Vaccines sensitive to freezing
accines sensitive to ree ing
„accines
BCG sensitive to heat
(a er reconstitution) Most accines sensitive to ree Most
ing
C a ter reconstit tion ost ost
„ COPV,a Rota
ter reconstit tion sensitive
ost ost sensitive
accines sensitive to heat accines
e sensitive to ree ing
„ IPV I e „ HepB
I enta
„ easles
MR Ceasles R
a ter reconstit tion ost enta ost
R
Rotavir s I
„ PCV
„ Rotavir s
Rotavirus I e
I „ Penta
easles R enta
„ JE
C
Rotavir e ore
s reconstit tion „ IPV
I
„ CDPT e ore reconstit tion
„ east
DPT
„ BCG (before enta reconstitution)
e east „ TT
enta east
eC e ore reconstit Least
tion
„
east TT,
Least
sensitive east
„ Penta, HepB, enta PCV e sensitive
o to chec vaccines or correct maintenance o cold chain
o to chec east vaccines or correct maintenance o cold chain
Do not keep any vials that are expired, frozen or with VVM beyond the
end
o point in thevaccines
to chec cold chain,orascorrect
they may be confused with
maintenance those
o cold contain-
chain
ing potent vaccines

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 Unit 4 : Cold chain and logistics management

How to check vaccines for correct maintenance of cold chain

Vaccines need to be checked both for damage from excessive heat as well as from freezing.
However, the physical appearance of a vaccine may remain unchanged even a er it is
damaged.

Checking vaccines for heat damage

VVM is a label containing a heat-sensitive material to record cumulative heat exposure over
time. The combined effect of time and temperature causes the inner square of the VVM
to darken gradually and irreversibly. Before opening a vial, check the status of the VVM
(Fig. .9). If the VVM shows change in colour to the end point, then discard the vaccines.
Fig Different stages of vaccine vial monitor

Checking vaccines for cold damage (freezing)

DPT, TT, IPV, HepB and penta vaccines lose their potency if frozen. Moreover, the
risk of adverse events following immunization (AEFIs) such as sterile abscesses may
increase. Freezing can occur at any level in the cold chain. Discard the vial if it is
frozen or it contains floccules a er shaking. Conduct the shake test (as given below)
if you suspect that a large number of vials at the cold-chain point could have been frozen.
Information on vaccine sensitivities is given in Table .5, Dos and dont’s in cold chain are
given in Table .6. (Shake test NOT applicable for IPV)

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Shake test - Test vial

• Take a vaccine vial you suspect that may have been frozen This is “TEST” vial.
Shake test - Control vial
• Take a vaccine vial of the same antigen, same manufacturer, and same batch number
as the suspect vaccine vial you want to test.
• Freeze solid this vial at -20 C overnight in the DF, and this is the CONTROL’ vial and
label accordingly to avoid its usage.
• Let it thaw. Do NOT heat it.
• Hold the Control and the Test vials together between thumb and forefinger, and
vigorously shake the vials for 10-15 seconds.
• Place both vials to rest on a flat surface, side-by-side and observe them for 30 minutes.
• Compare for rate of sedimentation.
• If the sedimentation rate in the Test vial” is slower than in the “Frozen vial”, the
vaccine has not been damaged, it has passed the shake test. Use the vaccine batch it
is not damaged.
• If the sedimentation rate is similar in both vials or if sedimentation is faster in the
“Test” vial than in the “Frozen” vial, the vaccine is damaged, it failed in shake test. Do
NOT use. Notify your supervisor.
Fig Shake Test Passed - Fig Shake Test Failed -
Vaccine usable Do not use Vaccine
Control Vial Test Vial Control Vial Test Vial

Sedimentation

nformation ypes of
VVMs are unique to each vaccine.
There are four types of VVM - VVM 30, VVM 1 , VVM 7 and VVM 2. The
number corresponds to the number of days the vaccine remains potent with
exposure at 37 C. In combined vaccines the VVM corresponds to the most
heat sensitive component of the vaccines, e.g. in DPT vaccine the VVM
corresponds to the Pertussis component of the vaccine.

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Preventing freezing of vaccines in extreme cold climates

• Keep cold chain equipment in heated rooms.

• Do not leave cold boxes outdoors or in unheated rooms.
• Use room temperature water packs for vaccine transport. Fill ice-packs with ordinary
tap water do not freeze or chill them. In extremely cold conditions, use ice packs filled
with warm water at 20 C.
• Use freeze indicators in all refrigerators and cold boxes, if possible.
• Use a heated vehicle. Never leave cold boxes in an unheated vehicle, especially
overnight.

Storage and Use of Diluents

Only use the diluents supplied packaged by the manufacturer with the vaccine, since the
diluents are specifically designed for the needs of that vaccine, with respect to volume, pH
level and chemical properties.

The diluents should be stored in the ILR at the last cold chain point. If the ILR has space
constraints then the diluents may be stored outside the cold chain. However diluents must
be kept in ILR at least hours before use or issuing to sessions to ensure that vaccines
and diluents are at same temperature (i.e. 2 C to 8 C) during reconstitution. Otherwise,
it can lead to thermal shock that is, the death of some or all the essential live organisms in
the vaccine. Store the diluents and droppers with the vaccines in the vaccine carrier during
transportation.

Table Dos and dont s in cold chain and vaccine sensitivities

Do s Dont s
9 Keep all vaccines in ILR at 2 C to 8 C ¾ Do not keep in the cold chain
at PHC o Expired vials,
9 Use diluent provided by the manufac- o Frozen vials or
turer with the vaccine o Vials with VVM beyond the end
9 Keep diluents in ILR at 2 C to 8 C point
atleast 24 hours before use ¾ Do not use Rotavirus vaccines or re-
9 Use Rotavirus vaccine, reconstituted constituted BCG, JE and Measles MR
BCG, JE and measles MR within vaccines a er hours
hours
9 Discard all damaged vials for disinfec-
tion and disposal

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Vaccine carrier

It is an insulated box used for carrying vaccines (16 20 vials) and diluents from the PHC
cold-chain point to session sites and to bring back the open vials (under the open vial policy)
from the session sites to the cold-chain point on the same day a er the session for storage
and subsequent use. Vaccine carrier (with conditioned ice packs) maintains the inside
temperature between 2 C and 8 C for 12 hours, if not opened frequently.

Packing a vaccine carrier

9 Confirm that there are no cracks in the walls of the vaccine carrier.
9 Take out the required number of ice packs from the deep freezer and wipe them dry.
9 Keep them outside for conditioning before placing into the carrier.
9 Place four conditioned ice packs into the vaccine carrier along the sides.
9 Wrap vaccine vials and ampoules in thick paper, e.g. plain white paper before pu ng
in a polythene bag so as to prevent them from touching the ice packs. Place some
packing material between “T” series vaccine and the ice packs to prevent them from
touching the ice packs.
9 Place the plastic bag in the centre, away from the ice packs. This will prevent labels
from peeling off from the vials.
9 Place foam pad on top of the ice packs.
9 If more than one vaccine carrier is being carried, keep the whole range of vaccines
required for the day’s use in each carrier so that only one carrier is opened at a time.
Fig rrect ofacking
Correct packing the
a vaccine carrier accine arrier
1 repare Ice- acks r Freezing 2 n i n Fr zen Ice- acks
• Fill the Ice-Pack with water to mark. Check
water level before every use. Do NOT add salt • Place frozen Ice-Packs in the open till there is
to this water. liquid water inside the ice packs

• Fit the stopper and screw on the cap tightly • Check if an Ice-Pack has been conditioned by
shaking it and listening for movement of ice inside
• Make sure the Ice-Pack does not leak the ice pack
• Wipe the Ice-Pack dry and place in the Deep • Unconditioned Ice-Packs may damage freeze
Freezer sensitive vaccines (DPT, TT, IPV, Penta and HepB)

3
ack the accine arrier
•Place four conditioned Ice- packs against the
sides of the carrier

•Place the plastic bag containing all vaccines

and diluents in the centre of the carrier.

•Place foam pad at the top of ice packs

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Table Dos and dont s in using a vaccine carrier

Dos Dont s
9 Place vaccines and diluents in cartons ¾ Never use day carriers, which contain
or polythene bags to ensure labels are 2 ice packs or thermos flasks for
protected. routine immunization.
9 Use only conditioned ice packs in the ¾ Never use a screwdriver or any other
vaccine carrier. sharp sha to open the lid of vaccine
9 Ensure that some ice is present in carrier.
the ice packs while conducting the ¾ Do not drop, knock or sit on the
immunization session. vaccine carrier.
9 Ensure collection of vaccines in the ¾ Do not leave the vaccine carrier in the
vaccine carrier on the session day sunlight.
itself. ¾ Do not leave the lid open once
9 Close the lid tightly and securely. packed.
9 Keep the interior of the vaccine carrier
clean and dry a er every use.

Fig Placement of vaccines when at RI session site

PCV

Temperature monitoring

Temperature recording is done in order to ensure that the vaccines are kept at recommended
temperatures and the cold-chain equipment is working properly. A break in the cold chain
is indicated if the temperature rises above 8 C or falls below 2 C in the ILR and above
-15 C in the DF. Different type of thermometers and instruments are used to measure the
temperature during storage and transport of vaccines as given below.
Dos and dont’s in temperature monitoring of vaccines is given in Table .8.

100 Immunization handbook for Medical Officers

 Unit 4 : Cold chain and logistics management

Alcohol stem thermometer Fig Alcohol stem thermometer

Alcohol thermometers (Fig. .1 ) are very sensitive

and more accurate than dial thermometers. They C

can record temperatures from - 0 C to 50 C and

can be used for ILRs or DFs. Numbers Numbers
in RED are in BLUE are
for below for above
Temperature logbook zero (-) zero (+)
temperature temperature
Temperature logbook (Table .8) should be used
to take action to shi vaccines to cold boxes or
other ILRs when the situation requires.
ILR: +2°C to
+8°C
VVM
A VVM attached to vaccine vials is also a DF: -15°C to
temperature monitoring device which records -25°C

cumulative heat exposure over time.

- C
Electronic data logger ( DTR days
temperature recorder) Do not hold here

Electronic data loggers are being introduced to

monitor the temperature of ILR. An electronic logger is an electronic device placed with
the vaccines it records the vaccine temperature for 30 days. It has an alarm that alerts the
handlers as soon as the temperature of the equipment Fig Fridge indicator
storing the vaccines crosses the safe range.
Fridge indicator
The fridge indicator (Fig. .15) is placed in between
freeze sensitive vaccines (Hep B, DPT, TT, IPV, penta,
etc.)
Freeze indicator Fig Freeze indi-
cator
A Freeze indicator is an electronic device to monitor vaccines
exposed to temperatures less than 0 C. It contains an electronic
temperature measuring circuit with associated LCD display. If the
indicator is exposed to a temperature below 0 C for more than
60 minutes, the display will change from the “good” status “9” to
the “alarm” status “ ”. Once it changes to , it cannot be re-used
or reset and will need to be discarded. Its shelf life is five years.
Vaccines should never be used without conducting the shake test
when freeze tag shows the “ ” mark.

Immunization handbook for Medical Officers 101