Journal Article

Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions

WIDJAYA, Anton, MONIAGA, Vanda, NELSON, Carib M, WIBISONO, Hariadi, MANSYUR, Isa, PURWANTO, Hary

2004

Overview

To document and characterize freezing temperatures in the Indonesian vaccine cold chain and to evaluate the feasibility of changes designed to reduce the occurrence of freezing. Data loggers were used to measure temperatures of shipments of hepatitis B vaccine from manufacturer to point of use. Baseline conditions and three intervention phases were monitored. During each of the intervention phases, vaccines were removed progressively from the standard 2-8 degrees C cold chain. Freezing temperatures were recorded in 75% of baseline shipments. The highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centres. Interventions reduced freezing, without excessive heat exposure. Inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia. Simple strategies exist to reduce freezing - for example, selective transport and storage of vaccines at ambient temperatures. The use of vaccine vial monitors reduces the risk associated with heat-damaged vaccines in these scenarios. Policy changes that allow limited storage of freeze-sensitive vaccines at temperatures >2-8 degrees C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity.

• Publisher: Organisation mondiale de la santé,World Health Organization,The World Health Organization
• Subject: Ambient temperature / Biological and medical sciences / Blood diseases / Child health services / Cold / Cold Temperature / Drug Stability / Drug Storage - methods / East Java (province), Indonesia / Feasibility / Feasibility Studies / Freezing / Health conditions / Health facilities / Health policy / Health Policy & Services / Hepatitis / Hepatitis B / Hepatitis B vaccines / Hepatitis B Vaccines - standards / Hepatitis B Vaccines - supply & distribution / Hepatitis B virus / Human viral diseases / Humans / Immunization / Indonesia / Infectious diseases / Intervention / Medical sciences / Midwifery / Nusa Tenggara Barat (province), Indonesia / Organizational Innovation / Policy making / Prevention / Provinces / Public health / Refrigeration / Research Article / Risk reduction / Shipments / Storage / Temperature / Tetanus / Transportation / Transportation - methods / Vaccination and vaccines / Vaccines / Vaccines - standards / Vaccines - supply & distribution / Viral diseases / Viral hepatitis / Viruses / Whooping cough