Cold-Chain Adaptability During Introduction of Inactivated Polio Vaccine in Bangladesh, 2015.

Mallick M Billah,Tajul I A Bari,K Zaman,Cynthia J Snider,Shua J Chai,Lee M Hampton,Concepcion F Estivariz,Abhijeet Anand,Kevin L Russell

doi:10.1093/infdis/jiw591

Abstract

Background.Introduction of inactivated polio vaccine creates challenges in maintaining the cold chain for vaccine storage and distribution.Methods.We evaluated the cold chain in 23 health facilities and 36 outreach vaccination sessions in 8 districts and cities of Bangladesh, using purposive sampling during August–October 2015. We interviewed immunization and cold-chain staff, assessed equipment, and recorded temperatures during vaccine storage and transportation.Results.All health facilities had functioning refrigerators, and 96% had freezers. Temperature monitors were observed in all refrigerators and freezers but in only 14 of 66 vaccine transporters (21%). Recorders detected temperatures >8°C for >60 minutes in 5 of 23 refrigerators (22%), 3 of 6 cold boxes (50%) transporting vaccines from national to subnational depots, and 8 of 48 vaccine carriers (17%) used in outreach vaccination sites. Temperatures <2°C were detected in 4 of 19 cold boxes (21%) transporting vaccine from subnational depots to health facilities and 14 of 48 vaccine carriers (29%).Conclusions.Bangladesh has substantial cold-chain storage and transportation capacity after inactivated polio vaccine introduction, but temperature fluctuations during vaccine transport could cause vaccine potency loss that could go undetected. Bangladesh and other countries should strive to ensure consistent and sufficient cold-chain storage and monitor the cold chain during vaccine transportation at all levels.

Highlights

Introduction of inactivated polio vaccine creates challenges in maintaining the cold chain for vaccine storage and distribution
Following the polio endgame strategy suggested by the Global Polio Eradication Initiative [1, 2], Bangladesh introduced 1 dose of inactivated poliovirus vaccine (IPV) in the routine immunization schedule [3] in March 2015 and concurrently switched routine immunization with trivalent to bivalent oral poliovirus vaccine (OPV) in April 2016
A freezer to store ice packs and vaccines that required freezing was available in most (≥88%) of the district and city corporation depots and health facilities (Table 1)

Summary

Methods

We evaluated the cold chain in 23 health facilities and 36 outreach vaccination sessions in 8 districts and cities of Bangladesh, using purposive sampling during August–October 2015. We selected 5 districts and 3 city corporations from each of 8 administrative divisions across Bangladesh by convenience to include sites with different routine immunization program management, pentavalent vaccination coverage (because IPV was scheduled with the third dose of pentavalent vaccine), and levels of access to immunization [10]. Among the 24 selected wards, we collected data on cold-chain capacity and management in 23 health facilities (14 district and 9 city corporation health facilities) that stored and supplied vaccines for vaccination sites (1 facility supplied vaccines for 2 wards), and in 1 or National depot National level. Transport: every three months by cold boxes District depots.

Results

Discussion

Conclusion