As the CoolerMed family, which constantly develops technology for the application of the cold chain in vaccines, we believe in the importance of effective vaccination for a healthy society. The problems of breaking the cold chain are of great importance both in terms of the loss of national wealth and in terms of our responsibility towards the people who cannot reach the vaccine in the world. From this point of view, we work with the responsibility of presenting the best technology in the most accessible way so that there is no break in the vaccine cold chain. So, why do the cold chains of vaccines break and how is it prevented? Read on to learn about cold chain break…
A Barrier to Effective Vaccination: The Cold Chain Break
There is a supply chain to follow in the immunization process. The logistics activities during the transportation of the vaccine, that is, its arrival at the needed points, consists of 3 stages. Cold chain management is the most important step of these stages. Especially in the Covid 19 period, the importance of the cold chain has become one of the topics of interest. The obligation to store coronavirus vaccines at -70 degrees caused concern about distribution and storage. In this period, the question of how the cold chain was provided was among the first questions that came to mind.
Thanks to the Coolermed vaccine cabinet, it has become possible to store Covid 19 vaccines. Eco vaccine refrigerator were distributed to many health institutions.
We have researched the supply chain of the immunization vaccines sent to all over Turkey and the Covid 19 vaccines distributed to the world from several facilities. In addition, we have comprehensively discussed the answer to the question of what is a cold chain break, which is among the greatest dangers for vaccines, in all details.
Vaccine Logistics and The Importance of Cold Chain
The cold chain application in Turkey is maintained under the control of the Ministry of Health. During the implementation, support is received from AFAD and 122 emergency services. In the system, which includes more than 70,000 healthcare professionals, an average of 45 million doses of vaccines and antiserums are consumed annually. In the immunization system, which requires serious logistics support, this logistics has 3 main branches. This process, which starts with planning and supply, proceeds in the form of storage, distribution, cold chain management, and monitoring. The cold chain is one of the most important steps of this process. In this context, let’s first explain the meaning of cold chain.
Cold chain: It is defined as the system consisting of people and materials from the production of the vaccine until it reaches the people who need it. As a result of planning, vaccines are directed to desired places according to needs. In order for the targeted number of people to be immunized, the effects of the vaccines should not decrease during this referral. Because otherwise, without the use of ineffective vaccines, the desired immunity cannot be fully achieved with vaccines that are damaged or have a reduced effect. In both cases, the immunization system is disrupted.
Components of the Cold Chain in Vaccination
The vaccine cold chain components include the people who manage the storage and distribution of the vaccine and the materials to be used during these processes. The people component stands out when it comes to what is needed for an effective cold chain. No matter how suitable the materials are, it is not possible for the chain to progress effectively without the correct use. The interventions of the health personnel at the right time with the right materials protect the system from undesirable situations. In Turkey, since 1985, trainings have been given to health personnel about the cold chain. The materials used by health personnel are divided into two:
- Vaccine Coolers
- Vaccine Ice Boxes
Ice boxes, where coolers are the fixtures of the established chain, also meet the requirement of the moving chain. Vaccines that are extremely sensitive to heat; should be kept between certain temperature values during receiving, transport, and storage stages. Whether the vaccine is dead or alive, it must be protected from heat and light. Bacterial vaccines should be stored between +2 and +8 degrees, while viral vaccines should be stored between -15 and -20 degrees. Vaccines should be placed in the refrigerator immediately upon receipt. At this point, it is important that the vaccine cabinets have suitable conditions and that the vaccine cabinet temperature is monitored. There are a few titles that should be considered in the vaccine cabinets.
- No frost refrigerator should be preferred otherwise, the freezer part should be thawed at regular intervals.
- A thermometer should be kept in the refrigerator, and temperature monitoring should be provided twice a day.
- The refrigerator should be kept in an area that does not receive sunlight, and a distance should be left between it and the wall.
- Food and beverage-like products should not be placed in refrigerators.
Vaccines are kept in vaccine cabinets in hospitals, Family Health Centers, and health centers, but sometimes it is taken to the field. Among the rules to be considered during cold chain applications in the field are the following:
- Vaccines should be brought to the area where they will be used in a thermos or ice box.
- Vaccine vials should be packed with ice.
- Vaccines must be protected from impacts in the field area and stored securely.
- Vaccines should be kept in shaded areas, not be left under the sun. It should also be checked for possible changes in these areas.
- After use, the lid of the vaccine boxes should be left open and dried. Otherwise, the vaccine boxes may become moldy.
Vaccine Cold Chain Breakage
The vaccine gets damaged if exposed to temperatures outside of +2ºC to 8ºC. The exposure of the vaccine to a different temperature directly affects the effectiveness of the vaccine. The longer the vaccine is exposed to low or high temperatures, the more it is damaged. Some vaccines are more affected by a rise in temperature, while others are more affected by a drop. This situation differs according to the type of vaccine.
Live vaccines lose their effectiveness quickly when exposed to high temperatures. Dead vaccines, on the other hand, are sensitive to freezing and lose their effectiveness when the temperature drops. Vaccines; If they are stored in the right conditions before the temperature differs, this delays the time to lose their effectiveness. Another factor that affects the loss of effectiveness of vaccines is their expiration date. Vaccines that are close to their expiration date lose their effectiveness more quickly.
What To Do In Case Of A Cold Chain Break?
During carefully maintained cold chain applications, it is possible to break the cold chain. If the cold chain is broken after any mishap, the things to do are listed as follows;
- Even if there is a suspicion of a cold chain break, the vaccine must be marked and taken to a special area.
- A report should be prepared for the vaccine with a cold chain break. In this report; the heat exposure, the duration of the exposure, the storage conditions before the breach, and the expiry dates of the vaccine should be written. After the report is prepared, it can be decided whether the vaccine will be used or not. As a result of this decision, it should be evaluated urgently if the vaccine is to be used. If the vaccine has lost its effectiveness, it must be destroyed. Vaccine exposed to cold chain breakage is taken out of the cold chain and packaged separately with a label written on it.
The Rules of Maintaining the Cold Chain of Vaccines
There are rules determined for the protection of the cold chain, which needs great care and follow-up. Things to consider in the cold chain;
- Ice packs and molds should be available for transport situations.
- A distance should be left between the vaccines placed in the vaccine cabinet.
- Vaccine refrigerators shouldn’t be put too many vaccines.
- The door of the vaccine cabinet should be opened to a minimum.
- A thermometer should be kept in the vaccine cabinet.
- Doors of refrigerators should not be used to store vaccines.
- Iceboxes should be checked against the possibility of frost, and frost thickness should not exceed 0.5 cm.
- In the event of a power cut, the refrigerator door should not be opened.
During the transportation of the vaccine, planning should be done according to the distance and packaging rules should be followed.
All opened vaccines should be administered as soon as possible.Safely storing, transporting, and administering vaccines is essential for immunization and prevention measures of Covid 19. No step can be successful without another. Health workers have a great role to play in all processes. At this point, healthcare professionals are supported with materials they can use safely. CoolerMed, which was established in 2016 and is a local company, offers many alternatives for the health sector with its medical freezer and cooler systems in which it integrates new generation technology.
In this article, we have talked about the cold chain break. You can read our previous article on https://coolermed.com/en/cooler-med-medica-2021/