1. Cold Chain – An Overview
1www.drjayeshpatidar.blogspot.in

2. Cold Chain is a system of
transporting and storing
vaccines at recommended
temperature from the point of
manufacture to the point of
use
Definition
2www.drjayeshpatidar.blogspot.in

3. Essential Elements of Cold Chain
 PERSONNEL to organize and
manage vaccine distribution
 EQUIPMENT for storage and
transport of vaccines.
 Transport facilities
 Maintenance of equipment
 Monitoring
3www.drjayeshpatidar.blogspot.in

4. In general
• All Vaccines tend to lose potency
on exposure to heat above +80 C
• Some Vaccines lose potency when
exposed to freezing temperatures
• The damage is irreversible
4www.drjayeshpatidar.blogspot.in

5. OPV
Measles
BCG
Vaccines sensitive to heat
5www.drjayeshpatidar.blogspot.in

6. Hep- B
DPT
DT
TT
Vaccines sensitive to freezing
6www.drjayeshpatidar.blogspot.in

7. Ice lined refridgerators (ILRs)
•Capacity: 140 litres at PHC level(1200 vials)
•Ideal Temperature: +2 C to 8 C
(Effective with electricity supply of 8/24 hrs)
•Safe Storage: Always in the basket section
(Always T series, Hepatitis-B and Diluents)
(OPV/Measles/BCG may be kept below basket in case
space is not available)
•Thermometer: Place in the ILR-basket
7www.drjayeshpatidar.blogspot.in

8. Right way of keeping vaccines
in ILR
• Keep all vaccines in baskets
• Place a thermometer in the
center of the ILR.
• Avoid placing vaccines at bottom
of ILR. (never diluents, freeze sensitive)
• Leave space between the
vaccine boxes
• Same vaccines in same area.
• Diluent / freeze sensitive/ Closer expiry date vaccines on top
• Heat sensitive / Further expiry date vaccines in the bottom of basket
8www.drjayeshpatidar.blogspot.in

9. Deep freezers (DF)
• Capacity: 140 litres at PHC level
• Ideal Temperature: -18 C to -20 C
(In case of power failure - maintain
temperature for 18-20 hrs)
• Ice Pack Freezing Capacity:
freezes 20 ice packs every 24 hours.
9www.drjayeshpatidar.blogspot.in

10. Cold Boxes
• Type: Insulated boxes of 5 litre capacity
• Usage: Stores & transports vaccine. Also stores
frozen Ice Packs
• Capacity: 1500 doses (mixed antigen) or 5000
doses (only OPV) with 24 ice packs.
• Holdover Time:3 days (Keep thermometer
inside)
• Vaccine Layout: Direct contact of frozen Ice
packs spoil the vaccine. Give carton
spacers/surround vaccine by OPV vials.
• Label Protection: Place vaccine in cartons or
polythene bags.
10www.drjayeshpatidar.blogspot.in

11. Vaccine Carrier
• Type: Insulated boxes used for carrying small
quantities of vaccine.
• Capacity: 16-20 vials
• Holdover Time: Maintain +2 to+80 C for about
24 hours (one day)
• Ice packs: A maximum of 4 frozen packs
• Vaccine Layout: Keep vaccines in a plastic bag
(not in direct touch with the Ice packs)
11www.drjayeshpatidar.blogspot.in

12. Ice Packs
Water Fill:
• Do not fill 100%.
• Leave 10 mm room for
expansion as water freezes.
• Close the cap tightly
• Clean the outer surface dry
before freezing
12www.drjayeshpatidar.blogspot.in

13. Ice Pack Freezing
• Ice Packs to be frozen ROCK Solid
• Freezing is faster & uniform if gap
/breathing space is left between ice packs
• Ice Packs are best frozen in Deep Freezers
• Condition before use
13www.drjayeshpatidar.blogspot.in

14. Preparing icepacks for use: Conditioning
A Conditioned ice-pack
•On the session day,
take the frozen ice-packs
you need from the
freezer and place on a
table
•Allow ice-packs to
sweat (droplets of water)
at room temperature
•Shake the ice pack to
listen to sound of water.
14www.drjayeshpatidar.blogspot.in

15. Maintenance of Equipment
• Defrosting/Cleaning: Ice deposit 5mm & over in
freezer or at the bottom of ILR results in rise in
temperature. Periodic defrosting & cleaning ensures
trouble free performance for a long period.
• Cold boxes/Vaccine Carriers: Cold box hinges, lid
knobs & chains are often damaged. Replace or repair
locally. Minor insulation casing cracks/gaps can also be
repaired with fresh PUF insulation
• Ice Packs: Fill clean water for freezing & leave 10mm
room for expansion as water freezes. Cap tightly to avoid
leakage. Keep pack clean & dry.
15www.drjayeshpatidar.blogspot.in

16. Vaccine Distribution
• Follow first-in-first - out rule (FIFO)
• Also: first to expire - first out. (FEFO)
• Vaccines are not stored at the sub-centre level
and must be supplied on the day of use
• Note manufacturer, batch no, VVM status
• Use VVM stage-II vaccine near the cold chain
point (do not distribute to remote areas) 16www.drjayeshpatidar.blogspot.in

17. Storage Temperature
• Monitor temperature twice daily.
• All vaccines at PHC are stored
between +2 to+8 C
17www.drjayeshpatidar.blogspot.in

18. Shake test
Shake the control and test samples
• Hold the Control and the
Test sample together in
hand and vigorously shake
the samples
• Place both vials to rest on
a flat surface, side-by-side
observe them for 30
minutes.
• Compare for rate of
sedimentation
USE
TestControl
Test Control
Discard
18www.drjayeshpatidar.blogspot.in

19. Shake Test: Summary
19www.drjayeshpatidar.blogspot.in

20. Vaccine Vial Monitor
3 = bad:
Don’t Utilize
4 = bad:
Don’t Utilize
The central square is equal to, or
darker than the surrounding circle
X
X
1 = good:
Utilize
2 = good:
Utilize
The central square is lighter
than the surrounding circle
20www.drjayeshpatidar.blogspot.in

21. Potency
• T series, Hep B and diluents should never be frozen.
• BCG, OPV & Measles are sensitive to heat and light & lose
potency fast.
• Potency lost due to heat exposure does not change the
appearance of the vaccine.
• VVM is an effective tool in monitoring OPV potency.
• Damage to vaccine cannot be reversed by re-freezing.
• Discard frozen vaccine.
21www.drjayeshpatidar.blogspot.in