Vaccine storage and handling

1. VACCINE STORAGE AND
HANDLING

8. Walk-in Coolers
Walk-in-coolers (WIC) are made up of modular and
prefabricated physical unclonable function (PUF) insulated
panels with floor of either stainless steel panels or modular
floor panels with an aluminum
chequered plates. These cold rooms are typically controlled
between 2°C and 8°C. It has digital light-emitting device/light
crystal device (LED/LCD), temperature display, and
temperature recorder. It is fitted with an audio-video alarm
system to warn of high or low temperature. These are used
for bulk storage of vaccines at state and regional stores.
Walk-in coolers/walk-in freezers stores 3 months of
requirement of vaccines and 25% buffer stock for the
districts they cater.

9. Deep Freezers

10. Ice-lined Refrigerator

11. Hence, it is suitable for use in the area with poor power
supply.
ILR has two sections—the top and the bottom. The bottom
of the refrigerator is the coldest place. OPV and measles
vaccine can be placed at the bottom of the ILR. The DPT
(diphtheria, pertussis, and tetanus), DT (diphtheria and
tetanus), TT (tetanus toxoid), and Hep B(hepatitis B)
vaccines should not be kept directly on the floor of the
refrigerator as they can freeze and get damaged, and they
should be stored in basket along with diluents (Figs. 1 to 3).

16. However, if domestic refrigerator is the only alternative to
store the vaccines in that it is acceptable to store vaccines
provided that the refrigerator and freezer compartments
have separate external doors. There are two types of
domestic refrigerators
(1) frost-free refrigerator
(2) manual and cyclic defrost refrigerator

17. The Frost-free refrigerators have no heating cycles but
have low-level warming cycles and hence it provides
more uniform temperatures than manual and cyclic
defrost models and may be more suitable for vaccine
storage.
The manual and cyclic defrost model refrigerator
and bar refrigerator (dormitory style) should not be used
to store the vaccine as they have wide fluctuations in the
temperature in the internal compartment.

26. 1)Dial thermometer
2)Stem (alcohol) thermometer
3)Digital thermometer-most accurate

27. VACCINE VIAL MONITOR
A vaccine vial monitor (VVM) is a label containing a heat-
sensitive
material, which is placed on a vaccine vial to register
cumulative heat exposure over time ... A VVM enables the
health worker to know whether vaccine has been damaged
by exposure to heat. The VVM is a circle with a small
square inside it, which is lighter in color than surroundings.
The inner square of VVM is made of heat-sensitive
material that is lighter in color at the starting point. The
combined effect of time and temperature causes the inner
square of the VVM to
darken gradually.

28. A direct relationship exists between rate of color change and
temperature. Thus, lower the temperature, slower the color
change; and higher the temperature,
faster the color change.
If the inner square is lighter than the outer ring
the vaccine can be used, whereas if inner-square matches
has darker color than outer ring, then the vaccine should be
discarded

33. ADVERSE EVENTS
FOLLOWING
IMMUNIZATION

34. ADVERSE EVENTS FOLLOWING IMMUNIZATION

35. CAUSE-SPECIFIC TYPES OF ADVERSE EVENTS FOLLOWING
IMMUNIZATION
Vaccine product-related reaction: An AEFI that is caused or
precipitated by a vaccine due to one or more of the
inherent properties of the vaccine product (or ingredients),
e.g. extensive limb swelling following DTP vaccination. In this
scenario, vaccine might have been used correctly without
compromising with manufacturing process, transport, or
storage. Thus, absolutely correct use of vaccine may also
cause this type of AEFI. In most
cases, such events are usually not serious in nature

37. malaise, etc.), which can be managed with
antipyretics and antiinflammatory and resolves within
2–3 days.

41. ADVERSE EVENTS FOLLOWING IMMUNIZATIONS
COMMITTEES
Adverse events following immunization committees have
been formed in all districts, states, and at the national level.
The responsibilities of the AEFI committees are to
strengthen AEFI reporting at all levels, ensure maintenance
of national policy and standards, ensure prompt and
thorough investigation of serious/
severe AEFI, carry out periodic review of AEFI for trends of
nonserious AEFIs

42. CAUSALITY ASSESSMENT
Causality assessment is the systematic evaluation of the
information obtained about an AEFI to determine the
likelihood of the event having been caused by the
vaccines received. The causality assessment is
conducted at state and national levels by trained experts
in the AEFI committees within a month of receipt of all
records and reports of the AEFI case

43. Eligibility for Causality Assessment

44. Causality
assessment
checklist

47. Steps after Causality Assessment

49. MANAGEMENT OF ANAPHYLAXIS
Although anaphylactic reactions are rare after vaccination,
their immediate onset and life-threatening nature require
anaphylaxis management.
If flushing, facial edema, urticaria, itching, swelling of the
mouth or throat, wheezing, dyspnea, or other signs or
symptoms of anaphylaxis occur, the patient should be
placed in a recumbent position with the legs elevated if
possible.administration of epinephrine is the
management of choice. Additional drugs also