Module 2

Vaccine and Cold Chain

Management in the RHUs and
Barangay
 Objectives
At the end of 4 hours, participants should be able to:
1. Appreciate the cold chain at the level of health facilities
2. Understand the use and maintenance of cold chain
equipment in health facilities
3. Know how to monitor temperature of cold chain
equipment in order to protect viability of vaccines
4. Be able to calculate/ quantify needs for vaccines,
capacity of equipment and needles and syringes

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 The Cold Chain
• The Cold Chain is a system for ensuring the potency of
a vaccine from the time of manufacture to the time it
is given to an eligible child or person.
• It is sometimes referred to as the vaccine supply chain,
or the immunization supply chain.
• The cold chain consists of a series of links that are
designed to keep vaccines within WHO recommended
temperature ranges, from the point of manufacture to
the point of administration.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 2.1 The Cold Chain

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 2.1 The Cold Chain
Allowable stock/Minimum stock at different levels
• National level: 6 months
• Regional level: 3 months
• Provincial level: 3 months
• City/ District level: 3 months
• RHUs: 1 month
• Barangay Health Stations
• Some BHSs have domestic refrigerators and can keep vaccines up
to 1 month.
• Otherwise, vaccines are only brought for use within the day.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 The Cold Chain
Activity 1: Group Work for Proper Storage and Temperature
Requirements for Vaccines
Objectives: To familiar with essential cold chain management
information on Proper Storage and Temperature Requirements
for Vaccines

Time allotted: 30 minutes

Materials needed:
1. Worksheet 2A (fill in the blanks) on Proper Storage of
Vaccines
2. Worksheet 2B (fill in the blanks) Sensitivity to heat, freezing
and light

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Vaccines According to Heat Sensitivity
More sensitive OPV
MCV
DTP
BCG
Hib DT
TT Hep B

Less sensitive
Vaccines According to Freezing Sensitivity

More sensitive

HepB
Hib (liquid)
DTP
Td
TT

Less sensitive
Vaccines’ Sensitivity to Lightto Light
More sensitive
BCG

MCV

Rubella

Less sensitive
 The Cold Chain
Activity 1: Group Work for Proper Storage and
Temperature Requirements for Vaccines

Instructions
1. Divide the participants into four groups
2. Provide them the tarpaulin and other materials
for Proper Storage and Temperature
Requirements for Vaccines
3. Fill up the blanks.
4. Check the manual for the right answers.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Water Packs

OPV and
MCV

BCG, Penta, Hepa B,Hib

DPT, TT, Diluents

Water packs

Open vials should be put in

a box labelled "use first."
Penta TT Penta Penta Penta
TT BCG BCG TT
Water
Accumu
OPV MCV MCV OPV lateurs
Packs
OPV MCV MCV OPV For
à
congeler
Freezing
Water Packs Water Packs
Specific rules for using top-opening refrigerators
with baskets


In baskets with thermometer No baskets, no thermometer
- vaccine safe  - vaccine at risk
 Health Facility Cold Chain Equipment
Refrigerators
Categories of vaccine refrigerators
• Electric
• Preferred when there is reliable supply of electricity
• Can preserve the +2’C to +8’C holdover time with
periodic breaks in electricity
• Ice-lined refrigerators can expose vaccines to freezing
temperatures if vaccines are not properly loaded
• Solar
• More expensive than electric but no running costs

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Health Facility Cold Chain Equipment
Starting to use any type of refrigerator:
• Set the thermostat so that the refrigerator compartment stays
between +2°C and +5 °C during the coldest part of the day (typically
the morning).
• Avoid freezing temperatures and the freezing risk is greatest when the
ambient room temperature is low.
• Once the daily temperature range remains consistent between +2 °C
and +8 °C, the thermostat is correctly adjusted. Setting should not be
changed, even if electrical power is lost.
• Do not adjust the thermostat if the temperature occasionally rises a
degree or so above +8 °C after a power cut, or in very hot weather.
• Follow the correct vaccine arrangement and packing in a refrigerator.
Always leave plenty of space around the vaccines and diluents to allow
air to circulate freely, and to make vaccine handling easier.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Health Facility Cold Chain Equipment
A health facility refrigerator must be able to hold:
• At least one month’s supply of vaccines and
diluents in the refrigerator compartment
• A minimum of four ice packs in the
freezer/cooling compartment.
• Note: Some solar direct-drive refrigerators
cannot freeze ice packs.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Types of Refrigerators

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Types of Cold Chain Equipment

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 The Domestic Refrigerator
• Many BHS commonly use domestic
refrigerators to hold vaccines for about a week.
• DOH is undergoing a gradual process towards
use of iced-line vaccine refrigerators in RHUs
and barangays.
• Basic Immunization Manual contains
information on the Domestic Refrigerator

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
General Protocols Maintaining Cold Chain Equipment
• If there is more than one refrigerator or freezer, put them all
in one room.
• Ensure good ventilation and protection from outside light
and heat.
• Place the refrigerators/ freezers about 12 inches or 1 foot
away from the wall to allow good air circulation and
minimize overworking of the motor.
• Ensure that each refrigerator/ freezer is properly plugged to
the electrical supply. If power goes out, unplug the socket if
voltage regulator is not used.
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
General Protocols Maintaining Cold Chain Equipment
• Use voltage regulator for three or more refrigerators/ freezers in an
area with power fluctuation.
• Keep doors and lids firmly shut. Paper test: Slip a piece of paper in a
closed door. If it can be easily pulled out, it means that doors/ lids are
not well-sealed. It is time to change the seal.
• Water packs should be placed inside the refrigerator to help maintain
storage temperature.
• Do not place other items inside and on the top the refrigerator
• Defrost and clean refrigerators/ freezers regularly when ice is thicker
than ¼ inch (0.5 cm), or once a month, whichever comes first.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
Regular daily tasks:
• Check the temperature inside the refrigerator and/or
freezer two times day (Record the reading in the
Temp. Monitoring Chart)

Regular weekly tasks:

• Check the ice formation on the freezer.
• If the ice is thicker than ¼ inch, defrost.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
Regular monthly task:
1. Check that the condenser and compressor are clean. Remove
any dirt or dust with a soft brush.
2. Check the outside of the refrigerator for damaged part which
may need repainting.
3. When necessary, clean the refrigerator in and outside with a
damp cloth using mild detergent.
4. Defrost and clean refrigerators/ freezers regularly when ice is
thicker than ¼ inch (0.5 cm), or once a month, whichever
comes first.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
Steps to follow in defrosting and cleaning a refrigerator.
1. Take out all the most heat-sensitive vaccines (OPV,
MCV, BCG, and JE) and transfer them to a cold box
lined with frozen ice-packs
2. Take out all the freeze-sensitive vaccines (Td, TT,
Hepatitis B, PCV, IPV, Rotavirus, HPV, Flu and
Pentavalent) and diluents, and transfer them to a cold
box lined with conditioned ice-packs
3. Turn off the power supply to the refrigerator;

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
Steps to follow in defrosting and cleaning a refrigerator.
4. Leave the door open and wait for the ice to melt. Do not try to
remove the ice with a knife or ice pick. Doing so can permanently
damage the refrigerator. You can place a pan of boiling water
inside and close the door;
5. Clean the inside of the refrigerator and door seal with a clean
wet cloth;
6. Turn the refrigerator on again; and
7. When the temperature in the main section falls to +8°C or lower
(but not less than +2°C), return the vaccines, diluents, and ice-
packs to their appropriate places.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
If a refrigerator needs to be defrosted more than once a
month, check for these common problems:
• Staff are opening the door too often (more than three
times daily)
• The door is not closing properly.
• The door seal needs to be replaced. Paper test: Slip a
piece of paper in a closed door. If it can be easily pulled
out, it means that doors/ lids are not well-sealed. It is
time to change the seal.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
How to manage vaccine refrigerator breakdowns or power
disruptions

Protect the vaccines

• Move the vaccines to other cold chain equipment until the
refrigerator is repaired.
• If the problem is temporary and can be solved quickly, a cold box or
vaccine carrier lined with conditioned ice packs can be used for
temporary storage.
• If it will take longer to solve, another refrigerator is needed.
• Always keep a freeze indicator (if available) with the freeze-sensitive
vaccines.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Using and Maintaining Cold Chain
Equipment
Restore the refrigerator to working order
• Check the electricity or solar power supply and make
arrangements to deal with any interruptions.
• If a lack of electricity or solar power is not the problem,
contact your supervisor and ask for a repair service visit.
Do not attempt to repair the refrigerator yourself unless
the problem is a simple one that you have been trained to
deal with.
• Record the breakdown on the daily temperature
monitoring chart.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Steps in Defrosting and Cleaning
1. Clean all parts inside and outside the cabinet, the lid and the gaskets with
lukewarm water and mild detergent.
2. Allow the cleaned parts to dry completely.
3. Put back carefully the inner liner into its position.
4. Reset the drainage plug at its position at the bottom.
5. Take the ice pack holder one by one, wipe their outside with a clean dry
cloth and put them back carefully into their positions.
6. Examine the icepacks for any leakage, before putting them back around the
evaporator.
7. Replace the white cabinet frame
8. Close the lid. Connect the power supply plug to the wall socket and switch
on the unit. Allow it to run and observe the cabinet temperature on the
front thermometer.
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Steps in Defrosting and Cleaning

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Multi-Dose Vial Policy
All opened WHO-prequalified multi-dose
vials of vaccines should be discarded at the
end of the immunization session, or within
six (6) hours of opening, whichever comes
first, unless the vaccine meets all four of
the criteria listed below. WHO Multidose
Vial Policy (MVDP), 2014

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Multi-Dose Vial Policy
• If the vaccine meets the following four criteria, the
opened vial can be kept and used for up to 28 days after
opening.
1. The vaccine is currently prequalified by WHO.
2. The vaccine is approved for use for up to 28 days after
opening the vial, as determined by WHO.
3. The expiry date of the vaccine has not passed.
4. The vaccine vial has been, and will continue to be, stored at
WHO- or manufacturer-recommended temperatures;
furthermore, the vaccine vial monitor, if one is attached, is
visible on the vaccine label and is not past its discard point,
and the vaccine has not been damaged by freezing.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Multi-Dose Vial Policy

• All vaccines follow MDVP except:

• Single dose (BCG), or
• Reconstituted hence can only be at max 6
hours, e.g. MCV (MR, Measles and MMR)

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Vaccine Vial Monitor
• Vaccine vial monitors (VVMs)
• A VVM indicates if the vaccines are exposed to
heat.
• A color change in the VVM indicates whether or
not vaccine may be used.
• Four types of VVMs – VVM2, VVM7, VVM14
and VVM30
• The number refers to the number of days it takes
for the inner square to reach the color indicating a
discard point if the vaccine is constantly exposed
to temperature of 37oC

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Four Types of VVM
Category Type of Days to end- Days to end- Time to end-
(Vaccine Vaccine point at +37 point at +25 point at +5
stability) °C °C °C
VVM30 BCG, Hep.B, 30 193 > 4 years
(High stability) TT, PCV, HPV
VVM14 DPT-HepB- 14 90 > 3 years
(Medium stability) HiB,
MMR, MR,
MCV
BCG
VVM7 IPV 7 45 > 2 years
(Moderate
stability)
VVM2 OPV 2 NA* 225 days
(Least stable)

No VVM PPV23, Rota,

Dengue
Note: Category of VVM of specific vaccine type may change depending on the manufacturers

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Type of Antigens
VVM

2 Oral Polio Vaccine

7 Inactivated Polio Vaccine
DTwP-HepB-Hib (Pentavalent)
Anti-Measles Vaccine (AMV)
14 Measles Mumps Rubella (MMR)
Measles Rubella (MR)
Tetanus diphtheria (Td)
BCG
Human Papillomavirus (HPV)
30 Hepatitis B (HepB)
Tetanus Toxoid (TT)
Pneumococcal Conjugate Vaccine (PCV)
No VVM PPV23, Influenza, Rotavirus, Dengue

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 The Vaccine Vial Monitor (VVM)

USE VIAL WHEN THE

SQUARE IS WHITE (stage 1) OR
LIGHTER THAN THE
CIRCLE (stage 2).

DISCARD VIAL WHEN THE

SQUARE IS AS DARK AS
THE CIRCLE (stage 3), OR
DARKER THAN THE
CIRCLE (stage 4).

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Two Types of VVM
Two different locations for VVMs:
1. VVM on the label of the vaccine. Meaning: The vaccine vial,
once opened, can be kept for next immunization sessions up
to 28 days, regardless of the formulation of the product
(liquid or freeze-dried)
2. VVM attached in a location other than on the label e.g. cap
or neck of ampoule. Meaning: The vaccine must be
discarded at the end of the immunization session or within
six hours of opening, whichever comes first. This is
regardless of the formulation of the product (liquid or
freeze-dried).

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Vaccine Vial Monitor

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• Does VVM measure the potency of
vaccines?

• Can change of colour in one vial show the

situation in the other vials?

• I kept one vial of vaccine with VVM in my

pocket for 20 days and VVM was still intact
(colour did not change). Why?

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• Does VVM measure the potency of vaccines?
• No! VVM measures only the heat exposure with time.
• VVM does not give information on other factors.

• Can change of colour in one vial show the situation in

the other vials?
• No! The information may not be extended to the other vials
with or without VVM.

• I kept one vial of vaccine with VVM in my pocket for 20

days and VVM was still intact (colour did not change).
Why?
• Do not put vaccine in your pocket! They should be kept in
refrigerators!

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• Does VVM change colour as soon as
exposed to Temperature >8°C?

• If vaccine is back in fridge, does colour

reverse back?

• If vaccine is frozen, does VVM colour

change?

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• Does VVM change colour as soon as exposed
to t° >8°C?
• No, vaccine can be exposed to temp. > 8°C for
limited time.
• If vaccine is back in fridge, does colour reverse
back?
• No! VVM colour change is irreversible.
• If vaccine is frozen, does VVM colour change?
• No! VVM colour does not change if Temperature is
kept below 0°C.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• Are VVMs for OPV the same as for other
antigens?

• If VVM does not reach « Stage3 », can vaccine be

used after expiry date?

• If we have VVM on all vaccine vials, do we have to

keep other temperature monitoring devices in the
refrigerators?

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• Are VVMs for OPV the same as for other
antigens?
• No! VVM is usually specific for each vaccine.
• If VVM does not reach « Stage3 », can vaccine
be used after expiry date?
• No! Expired vaccine should NEVER been used !
• If we have VVM on all vaccine vials, do we have
to keep other temperature monitoring devices
in the refrigerators?
• Yes! VVM does not replace other temperature
monitoring devices (thermometers, freeze-
indicators, Fridge-tags, etc.
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 FAQs on Cold Chain
• If indications on temperature monitors are different
than VVM, which ones to consider?
• VVM! Since VVM has the historical exposure to heat from
the manufacturer to the point.
• Should we treat vials with VVMs at stage 2 differently?
• Yes! Use the vial before the other vials that VVM is intact!
• Does VVM has other functions?
• Yes, VVM shows status of each vial and allows health staff
to:
• Check which vial to use first (FEFO but also Stage 2 first)
• Identify cold chain problems
• Reduce wastage and using vaccine in case of cold chain failure as
long as VVM is OK.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Cold Chain Management Skills A
Activity 2.2. World Café
Objectives: To practice actual skills essential to vaccine and cold chain
management in RHUs and barangays – vaccine arrangement, preparing
ice packs and temperature monitoring
Time allotment: 2 hours
Materials needed:
1. Three stations: a) Vaccine arrangement, b) ice packs and vaccine
carriers and c) temperature monitoring
2. Tarpaulin “refrigerator” and “vaccines”
3. Ice packs, vaccine carrier and transport box
4. Temperature monitoring chart and case scenario

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Cold Chain Management Skills A
Instructions:
1. There are three stations for this activity
2. Divide the group into three
3. Each group will visit each station for 30 minutes and
follow the instructions provided
4. Refer to you Participant’s Kit for reminders and specific
instructions
5. For Station 3, you will use Worksheets 2.C.1 and 2.C.2
6. After 30 minutes, allow the groups to move to the next
station to do the activity provided
7. After 1.5 hours, gather the groups for synthesis

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Cold Chain Management Skills A
Synthesis of Activity 2.2 (30 minutes)
1. What are the take home points for each of the
stations?
• Station 1: Vaccine arrangement
• Station 2: Ice packs and vaccine carriers
• Station 3: Temperature monitoring
2. What protocols are standard for all facilities?
3. What practices are unique depending on the
areas?
4. How can you teach your staff the same skills?
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Preparing ice packs and cool water packs
Filling and checking water packs
❑New water packs are supplied empty and must be filled before use. All water
pack should be checked for leaks. Proceed as follows:
1. New empty water packs: Fill each pack with clean water, up to the fill line.
Do not over-fill; leave a little air space at the top. Fix the cap on tightly.
2. Used water packs: It is not necessary to empty and refill water packs unless
they have leaked. If there is a leak, top up the water and make sure the cap is
fixed securely.
3. Before use: Hold each pack upside down and squeeze it to make sure it does
not leak. If the pack has been damaged, discard it.
 Freezing ice packs
❑Depending on a range of factors, it can take 24 hours or more to fully
freeze a batch of ice packs.
❑Always follow the manufacturer’s instructions and never overload the
freezing compartment. Put packs in the freezer, arranged upright or on
their sides so that the surface is touching the evaporator plate. If there is
a door or lid to the compartment, make sure it is properly closed.

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Conditioning frozen ice packs

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Conditioning frozen ice packs

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Packing vaccines in cold boxes and
vaccine carriers

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Packing vaccines in cold boxes and
vaccine carriers

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Packing vaccines in cold boxes and
vaccine carriers

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Temperature monitoring devices

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Electronic freeze indicators

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Integrated digital thermometers

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 Stem thermometers

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
Monitoring cold chain temperatures
 Packing vaccines in cold boxes and
vaccine carriers

Immunization in Practice: A practical guide for health staff- 2015 update (WHO)
 The Shake Test
Activity 3. The Shake Test (Demo-Return-Demo)

Objective: To practice the Shake Test and know why and

when it should be used.

Time allotment: 30 minutes

Materials needed:
1. The Shake Test video
2. Good/ viable vaccines
3. Vaccines exposed to heat

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 The Shake Test
Activity 3. The Shake Test (Demo-Return-Demo)

Instructions:
1. Show the Shake Test video
2. Gather the group
3. Demonstrate the Shake Test following the
instructions in Module 2
4. Allow participants to practice on their own

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Computations
Steps for calculation of vaccines and injection
supplies annual quantity requirements
• Step 1: List all vaccines in the immunization
schedule
• Step 2: List the total population
• Step 3: Determine the target population
• Step 4: Total number of doses to immunization
a child or mother

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Computations
• Step 5: Number of doses per vial
• Step 6: Wastage factor for vaccines
• Step 7: Calculate annual quantity of doses
required for each vaccine (F = B x C x E)
• Step 8: Wastage factor for safe injection supplies
(Use 1.11 for a wastage rate of 10%)
• Step 9: Calculate quantity of 0.05 mL syringes for
BCG (H = B x C x G)

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Computations
• Step 10: Calculate quantity of 0.5 mL syringes for all
vaccines except OPV (I = B x C x G)
• Step 11: Calculate quantity of 2 mL mixing syringe
for BCG (J = F / D)
• Step 12: Calculate quantity of 5 mL mixing syringe
for MCV (K = F / D)
• Step 13: Calculate quantity of diluent for BCG and
MCV (L = F / D)

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Computations
• Step 14: Calculate quantity of droppers for OPV
(M = F / D)
• Step 15: Calculate quantity of safety box (N =
(H+I+J+K)/ 10

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Cold Chain Management Skills B
Activity 2.4. Seatwork
Purpose: To practice actual skills essential to vaccine and cold chain
management in RHUs and barangays – Computations and Preparing a
Draft Contingency Plan
Time allotment: 1 hour
Materials needed:
1. Worksheet for Computations
2. Calculator device
3. Barangay or RHU data
4. Worksheet for Contingency Plan

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Cold Chain Management Skills B
Activity 2.4. Seatwork

Instructions
1. This activity will be done individually. Feel free to check with
other participants and other facilitators on how the
Worksheets should be filled up. It is OKAY to ask for help.
2. You will be given two Worksheets on Computations and
Contingency Plan.
3. Fill in the Computations Worksheet (Worksheets 2.D.1 and
2.D.2) using your own data. Use the formulas provided.
4. Fill in Contingency Plan (Worksheet 2.E, blank form) with
information (e.g. contact details from your area).

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Cold Chain Management Skills B
Activity 2.4. Seatwork

For the computations, you may use any of the

following:
• For a population of 50,000
• For your health center’s population
• Practice using the MS Excel file provided

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
72
Wastage
No. Required
Vaccine VVM rate
Vaccine composition doses routine Remarks
type Type (wastage
per vial doses
factor)
Negative Storage Temperature (-15°C to -25°C)
bOPV Polio (live attenuated) 20 2 3 doses 25% (1.33) Store at -15°C to -25°C at the national,
regional, provincial/city levels. For
RHU/HC/BHU store at +2°C to +8°C
temperature
Positive Storage Temperature (+2°C to +8°C)
MMR Measles, mumps and rubella 5 14 2 doses 25% (1.33) Can be safely stored at -15°C to -25°C
or +2°C to +8°C temperatures
MR Measles and rubella 10 14 2 doses 25% (1.33) Can be safely stored at -15°C to -25°C
or +2°C to +8°C temperatures
BCG Bacillus Calmette Guerin 20 30 1 dose 50% - 75% Not damaged by freezing but ampoules
(2.00 - 2.50) may break
HepB Hepatitis B 10 30 1 dose 15% (1.18) Damaged by freezing
Pentavalent Diphtheria, Pertussis, 1 14 3 doses 5% (1.05) Damaged by freezing
Tetanus-Hepatitis B-
Haemophilus influenzae type
b
Td Tetanus and diphtheria 10 14 2 doses per 15% (1.18) Damaged by freezing.
target ➢ 2 doses for pregnant woman
➢ 1 dose for Grade 1
➢ 1 dose for Grace 7
IPV Polio (inactivated) 10 7 1 dose 15% (1.18) Damaged by freezing
PCV13 Pneumococcal conjugate 1 30 3 doses 5% (1.05) Damaged by freezing
JE Japanese encephalitis 5 14 1 dose 25% (1.33)
Damaged by freezing
HPV Human papilloma 1 30 2 doses 5% (1.05)
 Reminders for Cold Chain Emergency
1. Ensure that you have enough transport boxes for all
your vaccines and that the required number of
icepacks is frozen at all times.
2. Always keep spare fuses or spare fuse wires in
stocks or learn where these are kept.
3. If you plan to be absent or go on leave, train your
replacement to follow these guidelines.
4. If possible locate another source of ice or frozen
icepacks to ensure availability during a mechanical
or electrical failure.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Reminders for Cold Chain Emergency
5. Locate and obtain permission to use another refrigerator in the
building for temporary storage of vaccines in case of a
mechanical failure.
6. During brownouts, do not open refrigerator. Domestic
refrigerators can maintain the correct temperature for 2 hours.
Especially designed vaccine refrigerators have 6-12 hours
holdover time.
7. Locate other refrigerators/ freezers in the area that would
probably not be affected by power failure and get permission to
use it e.g. cold storage merchants.
8. Ask BHS staff, barangay staff or nearby residents to inform you
after working hours if the electricity in the building or area stops
for more than two hours.

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Other Essential Parts of Module 2

For Self-Review
1. Other Health Facility Cold Chain Equipment
2. Temperature Monitoring Devices
3. Safe Storage and Use of Diluents

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Photos during the Effective Vaccine
Management Assessment in BARMM
(February 2020)

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Photos during the Effective Vaccine
Management Assessment in BARMM
(February 2020)

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
-Frozen Vials
-All vials with frost
-Unopened vials mixed
with partially used
-Damaged Labels
-mixed routine Vaccines
-frosted and frozen mOPV2
vials
-refrigerator frost is more
than 1 inch thick
-routine vaccines mixed with
insulin and PPD
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
 Hold your breath for the finale…

Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay
Module 2: Vaccine and Cold Chain Management in the RHUs and Barangay