A cold chain break occurs when an interruption in the temperature-controlled supply chain keeps sensitive goods, like vaccines, food, and certain pharmaceuticals, at the correct temperature during transportation and storage. This disruption can result in the degradation of product quality, loss of effectiveness, and increased risk of spoilage. Ensuring the integrity of the cold chain is crucial for maintaining the safety and efficacy of temperature-sensitive products from manufacture to final use. Let’s delve into why cold chain break happens to have a better understanding of the topic.
A Barrier to Effective Vaccination: The Cold Chain Break
In the journey of vaccines from production to administration, a crucial supply chain needs to be meticulously followed. The logistics of getting vaccines to their required destinations involve three main stages, among which cold chain management is the most critical. This process ensures that vaccines are kept at their necessary temperatures throughout transportation and storage to maintain their potency and effectiveness.
The significance of a robust cold chain was highlighted prominently during the COVID-19 pandemic. The unique requirement for coronavirus vaccines to be stored at extremely cold temperatures, such as -70 degrees Celsius, brought distribution and storage challenges to the forefront. Ensuring the integrity of the cold chain became a paramount concern, raising questions about how such stringent temperature requirements could be consistently met. A cold chain break at any point in this process can compromise vaccine efficacy, presenting a significant barrier to successful immunization efforts worldwide.
Vaccine Logistics and The Importance of Cold Chain
Cold chain is defined as the system consisting of people and materials from producing the vaccine to reaching the people who need it. As a result of planning, they are directed to the desired place according to their needs. Their effects should remain the same during this referral for the targeted number of people to be immunized. Because otherwise, a cold chain break happens, and without effective vaccines, the desired immunity cannot be fully achieved with damaged or reduced effects. 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 regarding what is needed for an effective cold chain. No matter the materials’ suitability, the chain can only progress effectively with 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, health personnel have been trained in the cold chain break. The materials used by health personnel are divided into two:
- Vaccine Coolers
- Vaccine Ice Boxes
1. Vaccine Coolers
Ice boxes, where coolers are the fixtures of the established chain, also meet the requirement of the moving chain. Vaccines are extremely sensitive to heat and should be kept between certain temperature values during the receiving, transport, and storage stages. Whether 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. They should be placed in the refrigerator immediately upon receipt. At this point, it is important that the vaccine cabinets have suitable conditions and that their temperature is monitored. A few titles should be considered in these cabinets to prevent cold chain break.
- 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 daily.
- 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.
2. Vaccine Cabinets
Vaccines are kept in cabinets in hospitals, family health centers, and health centers, but sometimes they are taken to the field. Among the rules to be considered in preventing cold chain breaks in the field are the following:
- They should be brought to the area where they will be used in a thermos or ice box.
- Vaccine vials should be packed with ice.
- They must be protected from impacts in the field area and stored securely.
- They should be kept in shaded areas and not left under the sun. They should also be checked for possible changes in these areas.
- After use, the vaccine boxes’ lids should be left open and dried. Otherwise, they may become moldy.
Vaccine Cold Chain Breakage
If exposed to temperatures outside of +2ºC to 8ºC, the vaccine gets damaged. Exposure to a different temperature directly affects its effectiveness. The longer the vaccine is exposed to low or high temperatures, the more it is damaged. Some 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, however, are sensitive to freezing and lose their effectiveness when the temperature drops due to the cold chain break. 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 their efficacy 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?
It is possible to break the cold chain during carefully maintained cold chain applications. 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 broken cold chain. In this report, the heat exposure, the duration of the exposure, the storage conditions before the breach, and the expiration dates of the vaccine should be written. After the report is prepared, it can or cannot be used. As a result of this decision, it should be urgently evaluated if it is to be used. If it has lost its effectiveness, it must be destroyed. Vaccines exposed to cold chain breaking are taken out of the cold chain and packaged separately with labels written on them.
The Rules of Maintaining the Cold Chain of Vaccines
There are rules for preventing cold chain break, 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 cabinet.
- Vaccine refrigerators shouldn’t be put in too many vaccines.
- The door of the vaccine cabinet should be opened to a minimum.
- A thermometer should be kept in the 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 vaccine’s transportation, planning should be done according to the distance, and packaging rules should be followed to prevent cold chain breaks. All opened vaccines should be administered as soon as possible. Safely storing, transporting, and administering is essential for immunization and prevention measures for COVID-19. Every step can only be successful with 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, established in 2016 as a local company, offers many alternatives for the health sector with its medical freezer and cooler systems, in which it integrates new-generation technology.
You can read our previous article at https://coolermed.com/cooler-med-medica-2021/