EPI COLD CHAIN AND

LOGISTICS

PEDRO M. MAGADAN RM, RN, MAN, BSM

Assistant Professor 5
 Introduction
Vaccines, syringes, needles, and
cold chain equipment are
essential components in our
immunization program.
Vaccines, Dose, Schedule, & Temperature Storage

 There are 6 vaccines used to combat 7 immunizable

diseases
• OPV must be kept frozen at -15 to -25degrees Celsius
• Measles vaccines can be stored at either -15 to
-25 or 2 and 8 degree Celsius
• BCG, DPT, TT, & Hepa B should be stored at +2 to
+8 degrees Celsius

 All vaccines should be stored at +2 to +8 degree

Celsius(presence of solid ice) during supplemental
immunization activities
 Dose Schedule & Recommended Storage Temperature of each Antigen
ANTIGEN SCHEDULE OF HOW IS IT REMARKS
VACCINATION STORED?
BCG Anytime after birth 2-8 degrees Celsius Freezing does not
Given at the earliest damage it but ampules
possible age protects may break.
the possibility of Diluents should also
infection from other be kept cold before
family members using.
OPV 1st dose-6 weeks 15-25 degrees Celsius It is easily damaged
The extent of 2nd dose-10 weeks by heat but is not
protection against 3rd dose-14 weeks harmed by freezing
polio is increased the
earlier the OPV is
given.
DPT 1st dose-6 weeks 2-8 degrees Celsius The “DT” component
An early start with 2nd dose-10 weeks is damaged by
DPT reduces the 3rd dose-14 weeks freezing and “P”
chance of severe component is
pertussis damaged by heat
 Hepatitis B 1st dose-6 weeks 2-8 degrees Both heat freezing
An early start of 2nd dose-10 weeks Celsius damages the
Hepatitis B 3rd dose-14 weeks vaccine
reduces the chance
of being infected
and becoming a
carrier
Measles 9 months 15-25 degrees Diluents should also
At least 85% of Celsius but can also be kept cold before
measles can be be safely stored using
prevented by between 0-8
immunization at degrees Celsius
this stage until its expiry date
Tetanus Toxoid 1st dose-as early as 2-8 degrees Celsius it should never be
Prevents tetanus in possible during 1st frozen
both the mother and pregnancy
the newborn 2nd dose-4weeks
after dose within
the same pregnancy
3rd dose-6mos after
TT2
4th dose-1yr after
TT3
5th dose-1 year after
TT4
 B. CAUSES OF VACCINE LOSS OF POTENCY
1. Sensitivity to heat 2. sensitivity to cold
most sensitive *OPV most sensitive
*Measles *Hep B
*DPT, yellow fever *Hib (liquid)
*BCG *DTP
less sensitive *Hib, DT least sensitive *DT
*Td, TT, Hepatitis B *Td
*TT
3.Sensitivity to light
BCG and measles vaccines are sensitive to sunlight and fluorescent light.
 Heat damages vaccine and losses its potency. Loss of potency accumulates with
repeated exposures. With long, high or frequent enough exposures, the vaccine
becomes ineffective.

4. Expiry Date
 C. Diluents
Diluents contain chemicals and additives to
stabilize a specific vaccine after reconstitution.
Each vaccine requires a specific diluents.
For example:
o Diluents made for measles vaccine, must not be
used for reconstituting BCG or any other type of
vaccine.Also,diluents made by one manufacturer
for use with a certain vaccine cannot be used for
reconstituting the same vaccine produced by
another manufacturer.
 Correct Condition for Storing
Diluents for EPI Vaccines
 Sufficient diluents for daily needs should be kept
in the cold chain at the point of vaccine used. At
a central, regional, provincial or district cold
chain stores, if it is unnecessary to keep diluents
at +2C to +8C unless needed within the next 24
hours.
 Diluents vials/ampules must never be frozen or
allowed to be in contact with any frozen surface
to avoid breakage and contamination.
 D. Vaccine Supply and Quality
 Estimating Annual Vaccine Requirements
-The vaccine required is often based on eligible
population, wastage factor and increased
annually to allow population growth. It can be
also estimated using numbers of registered
neonates and eligible women per immunization
setting (an immunization setting can be a
maternity ward, a fixed clinic or an outreach or
mobilize team session).
 A reserve or buffer stock must be added to
account for operational vaccine losses due to
cold chain failure during transit and storage . In
institutions where opened vials are disposed at
the end of each session, the session size
determines administrative wastage. If ,for
example ,a 20-dose vial of DPT is opened,9
doses are administered and the vial is then
discarded,11 doses are wasted .
However, if opened
Forecasting Vaccine Supply
The vaccine need to be forecast. This involves determining the target
population, knowing the amount of stock on hand, setting supply
intervals, and calculating reserve requirements including vaccine wastage.

HOW TO CALCULATE VACCINE NEEDS?

Vaccine required equals to the eligible population within a certain area times
the number of doses per antigen times a wastage factor.

VACCINE REQUIREMENT=TARGET POPULATION x THE

NUMBER OF DOSES OF THE PARTICULA R VACCINE REQUIRED
X WASTAGE FACTOR
 Essential information in calculating vaccine needs

ANTIGEN No. of doses to WASTAGE WASTAGE No. of doses per vial /

complete the ALLOWANC FACTOR ampoule
Immunization E

DPT 3 40% 1.67 20 OR 10

OPV 3 40% 1.67 20

MEASLES 3 50% 2.00 10

BCG 1 60% 2.50 10

HEPATITIS B 3 10% 1.10 1 OR 10

TETANUS 2 40% 1.67 10 OR 20
TOXOID
 STEPS IN CALCULATING THE ANNUAL VACCINE REQUIREMENT

1. TOTAL POPULATION
2.DETERMINE THE ELIGIBLE POPULATION
Formula: Eligible population=x 3%(children)
3.Total number of doses to immunize a child
Formula: TP x number of doses to immunize child /mother
4.Determine the vaccine required
Formula: Total number of vaccine required = EP x number of doses
5.Wastage factor (given wastage factor)
6.Calculate the Annual Vaccine Doses required
Formula: Annual Vaccine Requirements =Vaccine Required x Wastage Factor
7.Determine the monthly vaccine doses required
Formula: Monthly Vaccine Requirements = Annual Vaccine doses required
divided by 12 months
 Target population size
Accurate target population estimate is essential in
forecasting vaccine forecasting vaccine requirements. The
total no. of children below 1 yr. old and pregnant woman
should be estimated for each health facility catchment s
area and cumulatively at the national and regional levels.
Sources of information on population size include census
data, birth registration and head counts at the local level.
 RESERVE STOCK
 Quantity of vaccine that can be used for delayed supplies or
sudden increased demand.
STOCK ON HAND
 Should be determine before ordering.
 Ensures that:
 Adequate amount are available
 Space is available to store the stock
 Vaccine is used before the expiry date.
 The storage duration is consistent with recommendations.
 Supply
Intervals
Typical supply period which should be based on transportation
availability. Cold chain storage capacity and continuity of
energy supply, are:

HEALTH FACILITY MINIMUM DELIVERY

LEVEL PERIOD
National store 6 mos.
Regional 3 mos.
Provincial/ city 3 mos.
Municipal/ City Health Center 1 month
Vaccination Post Per session
STORAGE CAPACITY
It estimates the net storage requirements per fully immunized
child and pregnant women using selected immunization
schedule.
It also estimate the storage volume required for introducing a
new vaccine
For example ,if only few children attend sessions, use of
single dose vials may mean less vaccine is discarded. However,
single-dose presentation( available for measles and hepatitis B
vaccines)cost more per dose than multi-dose presentation.
 Multi-Dose Vial Policy(MDVP)

WHO –first to introduced the multi-dose vial policy

(MDPV) previously called “open vial policy” in 1995
and revised in 2000 based on vaccine safely and potency.
 Absorbed vaccines such as DPT,TT, and Hepatitis B
contain preservatives that prevent growth of bacterial
contamination.
 MDVP does not apply to handling BCG, and Measles
vaccines.
 Most freeze-dried(lyophilized vaccines ) do not contain
preservatives.
Multi-dose vials of OPV, DPT,TT and Hepatitis B vaccine
from which 1 or more doses have been removed during
an immunization session may be used in subsequent
sessions for four weeks provided the following
conditions are met:
 Expiry date has not passed.
 Vaccines are stored under appropriate cold chain
conditions
 Vaccines vial septum has not been submerged in water .
 Aseptic technique has been used to withdraw all doses.
 The VVM, if attached, has not reach its discard point
 Vaccine Wastage
Wastage
 Defined as loss by use, decay, erosion or leakages or through
wastefulness.
 Vaccines usage can be defined as the proportion of vaccine
issued w/c is administered.

Number of doses administered

Vaccine Usage rate= X100
Number of doses supplied
 CALCULATING VACCINE WASTAGE
Formula:
Wastage rate= doses supplied-doses administered
doses supplied x 100
Ex:
Given: Dose supplied: 200
Dose administered : 150
Calculate for wastage rate:
200-150
Wastage rate= X100= 25%
200
Doses supplied is calculated from stock record for given time
period by adding the starting balance of usable vaccines doses to
new doses received during the period and subtracting the ending
balance.
 2. Types of Vaccine Wastage
VACCINE WASTAGE IN UNOPENED VACCINE WASTAGE IN OPENED
VIALS VIALS
•Expiry •Discarding remaining doses at end of
•VVM indication session.
•Heat exposure •Not being able to draw the no. of doses
•Freezing indicated on the label of vial.
•Breakage •Poor reconstitution practices
•Missing invention •Submergence of open vials in water
•Theft •Suspected contamination
•Discarding unused vials returned from an •Patient reaction requiring more than one
outreach session dose
 3. WAYS TO REDUCE VACCINE WASTAGE
 Ensure compliance on MDVP.
 Use VVM
 Ensure vital information is recorded when vaccines are
received, stored and distributed.
 Monitor temperature of stored vaccines.
 Ensure the EEFO( Earliest Expiry First Out) is maintained.
 Ensure vaccines are transported following the standard
operating procedures.
 Ensure a functional contingency plan on cold chain failure
exist.
 Monitor ,maintain and routinely repair cold chain equipment.
 Perform Shake Test
 F. “SHAKE TEST”
 Determine whether DPT,TT or Hepatitis B has been frozen.
Test Procedure
Step 1: Prepare a Frozen control sample
Step 2: Choose a test sample.
Step 3: Shake the control and test sample.
Step 4: Allow to rest
Step 5: Compare the Vials
SUBSEQUENT ACTION
* If the test indicates freezing has damaged the sample, notify
your supervisor.
 G. PHYSICAL INVENTORY
 To ensure stock records and running balances are accurate
and complete.
 Spot check VVM, CCM and freeze indicator status. If
damaged are found set a side and deal with them as
described:
 Expired ,heat damaged vials or vials w/ VVMs beyond the
discard point should not be kept in the cold store , refrigerator
or freezer as they may confused with good quality vaccines.
 If unusable vaccines have to be kept for a period before
disposal.
 Should be disposed properly if disposal has been authorized.
 H. INJECTION SAFELY
VACCINATION
 One of the most cost-effective and safe health intervention
provided when good quality, appropriately stored and handled
and when injection are given safely.
SAFE INJECTION(WHO)
 Does not harm the recipient
 Does not expose the health staff to any avoidable risk
 Does not result in the waste in that is dangerous to the
community.
INJECTION EQUIPMENT
1.Auto-disable syringe
 Disposable injection devices that are esp. made to prevent reuse
to avoid person to person transmission of blood borne disease.
2.Conventional Syringe
 Plastic syringes w/ steel needles.
 May either be fixed to the syringe when it is produced or
attached by the health staff just before use.
Thank you…………………………..
And

God bless!!!!