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The effect of cool water pack preparation on vaccine vial temperatures in refrigerators.

ABSTRACT: Cool water packs are a useful alternative to ice packs for preventing unintentional freezing of vaccines during outreach in some situations. Current guidelines recommend the use of a separate refrigerator for cooling water packs from ambient temperatures to prevent possible heat degradation of adjacent vaccine vials. To investigate whether this additional equipment is necessary, we measured the temperatures that vaccine vials were exposed to when warm water packs were placed next to vials in a refrigerator. We then calculated the effect of repeated vial exposure to those temperatures on vaccine vial monitor status to estimate the impact to the vaccine. Vials were tested in a variety of configurations, varying the number and locations of vials and water packs in the refrigerator. The calculated average percentage life lost during a month of repeated warming ranged from 20.0% to 30.3% for a category 2 (least stable) vaccine vial monitor and from 3.8% to 6.0% for a category 7 (moderate stability) vaccine vial monitor, compared to 17.0% for category 2 vaccine vial monitors and 3.1% for category 7 vaccine vial monitors at a constant 5 °C. The number of vials, number of water packs, and locations of each impacted vial warming and therefore percentage life lost, but the vaccine vial monitor category had a higher impact on the average percentage life lost than any of the other parameters. The results suggest that damage to vaccines from repeated warming over the course of a month is not certain and that cooling water packs in a refrigerator where vaccines are being stored may be a useful practice if safe procedures are established.

SUBMITTER: Goldwood G

PROVIDER: S-EPMC5736983 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:INTRODUCTION:Protecting vaccines from freeze damage is considered one of the most poorly addressed problems in vaccine management. Freezing may impair the potency especially of adsorbed vaccines. The Keep Cool study aims at ensuring optimal vaccine storage conditions in general practices. This publication analyses the baseline data using standardised temperature recordings. METHODS:This prospective study in German general practices analysed 7-day temperature recordings of refrigerators used for vaccine storage. Temperatures were recorded continuously using a standardised data logger with an accuracy of ±0.4 °C. The prevalence rates of refrigerators within the target range (2 to 8 °C) and of those reaching critically low temperatures (?0 °C) were calculated. In addition, the cumulative time and the duration of single episodes beyond the target range were computed. To assess for structural deficits, the prevalence of refrigerators with a cycling of >5 °C was determined. Generalised linear mixed models were applied to analyse correlating factors between the dependent variables 'within temperature range' and 'reaching critically low temperatures' with practice characteristics. RESULTS:The study included 64 of 168 practices (38.1% response rate) with 75 refrigerators. The prevalence of refrigerators with temperatures within the target range was 32.0% (n = 24), and 14.7% (n = 11) reached critically low temperatures <0 °C. 44.0% of refrigerators (n = 33) showed temperatures >8 °C and 28.0% (n = 21) <2 °C. Of the 168 hours recorded per refrigerator, the average cumulative time >8 °C was 49 hours, <2 °C 75 hours and ?0 °C 74 hours. The longest consecutive period of critically low temperatures was 168 hours (mean: 39±53). The prevalence of refrigerators with a cycling range of >5 °C was 29.3%. CONCLUSION:Given the importance of immunisation, the results of our study call for action, as two-thirds of the refrigerators exhibited cold chain breaches and 15% reached critically low temperatures threatening vaccine potency.

Project description:Cold chain maintaining is least stable at its end, where domestic storage often represents one of the most critical links because of storage time and inappropriate temperatures, increasing the risk of food-borne outbreaks in domestic households. Considering the time-temperature profile of refrigerators as a food safety indicator, the purpose of this study is to gain insight into refrigeration temperatures in parallel with refrigerator and household characteristics that could potentially influence the refrigeration temperatures. During a 24 h period in 15-min intervals, internal temperature of the test product, refrigerator air and ambient air temperatures were measured with one penetration and two air probes coupled with a data logger. The internal temperature of the test product was measured with pre-prepared "Karlsruhe Test Material", which had thermal properties similar to those of lean beef. Refrigerator and household characteristics were collected with a predefined observational sheet and short, structured questionnaire. In total, 50 households and their refrigerators were included. Gaps related to the cold storage and cross-contamination were observed. Temperature displays were present in 16% while control thermometers were not observed at all; 20% of the refrigerators enabled 24 h average internal temperature lower than 4 °C, 30% between 4 and 6 °C and 50% over 6 °C. Refrigerator age, type and load were observed but had no significant impact, which suggests thermostat setting as a key factor influencing refrigerator temperatures. Food distribution inside refrigerators was related to the refrigerator load with significant risk for cross-contamination in overpacked refrigerators. High temperatures combined with a non-systematic distribution of food in the refrigerator, expired dates of durability, and non-systematic cleaning strategies allow favourable preconditions for food infections occurring at the end of the food supply chain. Tailored acceleration of existing food safety messages could and should help consumers to minimise food safety risks, improve food quality, and reduce food wastage.

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The effect of cool water pack preparation on vaccine vial temperatures in refrigerators.

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