Manoj V Murhekar1, Srihari Dutta2, Ambujam Nair Kapoor3, Sailaja Bitragunta4, Raja Dodum5, Pramit Ghosh6, Karumanagounder Kolanda Swamy7, Kalyanranjan Mukhopadhyay8, Somorjit Ningombam9, Kamlesh Parmar10, Devegowda Ravishankar11, Balraj Singh12, Varsha Singh13, Rajesh Sisodiya14, Ramaratnam Subramanian7, Tana Takum5. 1. National Institute of Epidemiology, Indian Council of Medical Research, R127, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 077, India . 2. United Nations Children's Fund, New Delhi, India . 3. Indian Council of Medical Research, New Delhi, India . 4. Directorate of Health, Medical and Familty Welfare, Government of Andhra Pradesh, Hyderabad, India . 5. Department of Health and Family Welfare, Government of Arunachal Pradesh, Papum Pare, India . 6. Department of Community Medicine, Medical College, Kolkata, India . 7. Directorate of Public Health, Government of Tamil Nadu, Chennai, India . 8. Directorate of Health and Family Welfare, Government of West Bengal, Kolkata, India . 9. Directorate of Health Services, Government of Manipur, Imphal, India . 10. Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, India . 11. Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India . 12. Department of Community Medicine and Epidemiology, Indira Gandhi Medical College, Shimla, India . 13. State Institute of Health and Family Welfare, Government of Bihar, Patna, India . 14. Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India .
Abstract
OBJECTIVE: To estimate the proportion of time the vaccines in the cold-chain system in India are exposed to temperatures of < 0 or > 8 °C. METHODS: In each of 10 states, the largest district and the one most distant from the state capital were selected for study. Four boxes, each containing an electronic temperature recorder and two vials of diphtheria, pertussis and tetanus vaccine, were placed in the state or regional vaccine store for each study state. Two of these boxes were then shipped - one per facility - towards the two most peripheral health facilities where vaccine was stored in each study district. The boxes were shipped, handled and stored as if they were routine vaccine supplies. FINDINGS: In state, regional and district vaccine stores and peripheral health facilities, respectively, the temperatures in the boxes exceeded 8 °C for 14.3%, 13.2%, 8.3% and 14.7% of their combined storage times and fell below 0 °C for 1.5%, 0.2%, 0.6% and 10.5% of these times. The boxes also spent about 18% and 7% of their combined times in transit at < 0 and > 8 °C, respectively. In shake tests conducted at the end of the study, two thirds of the vaccine vials in the boxes showed evidence of freezing. CONCLUSION: While exposure to temperatures above 8 °C occurred at every level of vaccine storage, exposure to subzero temperatures was only frequent during vaccine storage at peripheral facilities and vaccine transportation. Systematic efforts are needed to improve temperature monitoring in the cold-chain system in India.
OBJECTIVE: To estimate the proportion of time the vaccines in the cold-chain system in India are exposed to temperatures of < 0 or > 8 °C. METHODS: In each of 10 states, the largest district and the one most distant from the state capital were selected for study. Four boxes, each containing an electronic temperature recorder and two vials of diphtheria, pertussis and tetanus vaccine, were placed in the state or regional vaccine store for each study state. Two of these boxes were then shipped - one per facility - towards the two most peripheral health facilities where vaccine was stored in each study district. The boxes were shipped, handled and stored as if they were routine vaccine supplies. FINDINGS: In state, regional and district vaccine stores and peripheral health facilities, respectively, the temperatures in the boxes exceeded 8 °C for 14.3%, 13.2%, 8.3% and 14.7% of their combined storage times and fell below 0 °C for 1.5%, 0.2%, 0.6% and 10.5% of these times. The boxes also spent about 18% and 7% of their combined times in transit at < 0 and > 8 °C, respectively. In shake tests conducted at the end of the study, two thirds of the vaccine vials in the boxes showed evidence of freezing. CONCLUSION: While exposure to temperatures above 8 °C occurred at every level of vaccine storage, exposure to subzero temperatures was only frequent during vaccine storage at peripheral facilities and vaccine transportation. Systematic efforts are needed to improve temperature monitoring in the cold-chain system in India.
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