Temperature integrity and exposure of vaccines to suboptimal temperatures in cold chain devices at different levels in three states of India

Manoja Kumar Das,Thomas Mathew,Salam Kabita Devi,Bhadresh Vyas,Narendra Kumar Arora,Abhishek Yadav

doi:10.1186/s40794-020-00109-z

Abstract

ObjectiveTo document the temperature integrity at the vaccine storage devices at various levels in three states of India.MethodsA total of 213 health facilities including 196 facilities (district and sub-district levels) from 27 select districts and 17 division or state level vaccine stores in three states were included. At these facilities, temperature in 223 vaccine storage devices was recorded for at least 7 consecutive days using electronic temperature datalogger.ResultsDuring the observation period, overall the vaccines were exposed to temperature < 0 °C for 14.8% of the storage time with 8.6, 6.7 and 18% at state/division, district and sub-district vaccine stores, respectively. The vaccines were also exposed to temperature > 8 °C for 6.6% of the storage time including 1.3, 13 and 5.1% at state/division, district and sub-district vaccine stores, respectively. Continuous episodes of temperature deviation for 45 min or longer to < 0 °C and > 8 °C was observed in 7.2 and 6.4% of the observation period, respectively. These temperature deviations were not captured by the routine temperature monitoring practice.ConclusionThe vaccines were exposed to freezing temperature for a considerable period at all level stores, which was more than the exposure to higher temperature. To ensure vaccine potency and immunogenicity, stringent temperature integrity maintenance is needed at all levels.

Highlights

Vaccination is one of the most cost-effective public health interventions in twenty-first century [1]
The temperature dipped to sub-zero range for 8.5%, 7.4% and 17.7% of the observation period at the state/division, district and sub-district vaccine stores (VSs) respectively
The temperature crossed above 8 °C in 5.2%, 10.1% and 5.4%

Summary

Introduction

Vaccination is one of the most cost-effective public health interventions in twenty-first century [1]. The cold chain in India is a fivetier storage system with about 26,388 cold chain points or vaccine stores (VSs), including the government medical supply depots (GMSDs) (n = 4), state VSs (n = 53), divisional VSs (n = 110), district VSs (n = 666) and the subdistrict VSs (n = 25,555) at community health centers (CHCs) and primary health centers (PHCs) [9]. At state and division VSs, the vaccines are usually stores in WICs, icelined refrigerators (ILRs) and WIFs. At district and subdistrict (CHCs and PHCs) VSs, the vaccines are stored in ILRs. The cold rooms, WICs and ILRs are expected to maintain the optimum temperature (+ 2 to + 8 °C) for vaccine storage. The WIFs and deep freezers (DFs) are expected to maintain the optimum temperature (− 15 to -25 °C) for long-term vaccine storage.

Methods

Results

Discussion

Conclusion