Vaccines are precarious and sensitive, and they perform vital functions in the medical and public health fields. Accordingly, the CDC opposes the handling of vaccines outside of their temperature regulated vaccine refrigerators. However, vaccination storage can be compromised for a variety of reasons, including natural disasters, power outages, and equipment failures. As such, measures must be taken to ensure the vaccines remain viable during a safe and effective vaccine transportation. If you understand protocol and prepare for these eventualities, your facility will gain confidence in handling vaccines while preserving vaccine potency.
An important note about the viability of vaccines: much of the concern surrounding vaccine transportation is to prevent them from warming. However, temperature fluctuations below the recommended temperature threshold can be just as damaging to vaccines and render them useless. Damage from a frozen vaccine is usually permanent, so take extra care in regulating temperatures to ensure the vaccines are neither too hot nor too cold. Furthermore, you should never use dry-ice to keep vaccinations cold, as this will likely ruin them.
Emergency Procedure Overview
The best way to remain calm during the unexpected is to plan for it. Design an emergency protocol before disaster strikes, and ensure all faculty are properly trained. It is critical for vaccines to be stored and transported in a cool space via a portable vaccine refrigerator. However, that is not always possible. If you are not able to hold your vaccines in a portable refrigerator, qualified containers with proper insulation and temperature monitoring devices can be used.
Routine transfer of vaccines is to be avoided at all costs. The CDC consistently upholds the importance of the “cold chain,” which must be sustained from the time of vaccine manufacture to transport and administration. This usually involves high grade temperature controlled medical refrigerators, hard-sided insulated containers, coolant materials, a digital data logger, and materials for added insulation such as bubble wrap and corrugated cardboard. Most of these supplies, though not all, should be purchased from reputable medical providers who avoid commercially produced products. For example, the CDC would not consider a food cooler to be a proper transport container for vaccines as they are usually poorly insulated.
If possible, you should arrange to have your vaccines received by a reputable medical facility with appropriate cooling storage devices. Note that the total transportation time should be a maximum of 8 hours.
The Tools You’ll Need
Safe and effective vaccine transportation is contingent upon your emergency toolkit. Here are the essential items your emergency transport protocol should include.
- Temperature monitoring devices.
Using a digital data logger with a buffered probe provides the greatest degree of accuracy in readings and ease of use. Temperature monitoring devices should be re-calibrated every year and can also be set to a minimum and maximum levels of a degree accuracy.
The acceptable range of temperatures vary between each vaccine. Follow the guidelines provided in this vaccine storage chart to keep your inoculations at the correct temperature throughout transportation.
Certain vaccinations need to be reconstituted before administration. This requires the additional transportation of diluents (liquids) that are mixed with the vaccines. Diluents have been engineered to correct the pH, volume, and sterility of certain vaccines, and thus must be considered in your overall transport plan.
Diluents should be labeled according to their corresponding vaccine. They should also be transported together to ensure there are enough diluents for vaccine reconstitution. Temperature requirements for diluents can be found within the manufacturer’s guidelines. Diluents should never be frozen, but they can be chilled prior to transportation and kept with the vaccines. Chilling diluents prevents them from raising the internal temperature of the refrigerators and ruining their efficiency.
Coolants provide an added layer of protection and can help maintain proper temperature controls. However, you may run the risk of potentially freezing your vaccines, so coolants must be used only when necessary and executed with care.
- Insulating material.
Bubble wrap, packing foam, and Styrofoam (at least one inch thick) can be used to cover corrugated cardboard if you plan on transporting the vaccines via the conditioned water bottle transport system—outlined briefly below.
Transportation With and Without A Portable Refrigerator
If you have a portable refrigerator, your job is going to be that much easier. It eliminates a lot of the hassle of creating insulation because the refrigerator itself already has all those necessary features. The most important thing to remember when transporting with a portable refrigerator is to bring along a transportable power source. This ensures the space is appropriately conditioned throughout transport and there is no risk of a power lapse. Otherwise, the vaccines should be properly sorted and labeled to eliminate confusion and risk of mix-up. Travel with one or two trusted employees; preferably, those who have prior experience with similar voyages.
There is another system favored among medical professionals that does not involve the very costly portable refrigerator. This system uses hard-sided coolers and frozen water bottles that act as a makeshift refrigerator. This method depends on ‘conditioning’ water bottles: this means warming the frozen water bottles so that a small amount of water is visible inside where ice has begun to melt. Water bottles that have not been conditioned may indeed be colder than 32°F which could freeze the vaccines. You’ll know that the water bottles have been conditioned properly if the ice moves freely in the bottle when you rotate it.
Use regular 16.9 oz water bottles, but do not use coolant for this process. It relies entirely on the conditioned water bottles. Only use coolant when transporting vaccines that need to be frozen like Varivax—and remember to transport your refrigerated vaccines in a separate container than frozen vaccines.
The first layer of your cooler should be the conditioned water bottles. Add a layer of insulating materials, such as the corrugated cardboard and bubble wrap (the more the better). Stack your vaccines and prepared diluents on top of the insulation with your temperature monitoring device. Cover your vaccines with another insulation layer of bubble wrap or Styrofoam and an additional piece of cardboard, and finish with conditioned water bottles on the very top. Your vaccines are ready for transport!