The document discusses India's vaccine cold chain system and its importance. It notes that vaccines must be transported and stored between 2-8°C from manufacture to point of use to maintain potency. Vaccines move from primary stores to state, regional, district and local levels. Equipment includes walk-in freezers, cold rooms, deep freezers, ice-lined refrigerators, cold boxes, carriers and monitors. Proper temperature maintenance and logistics are essential to ensure effective immunization programs.

1. COLD CHAIN
Dr. Preeti Tiwari

2.  The ‘cold chain’ is the system of transporting and
storing vaccines at recommended temperature from
the point of manufacture to the point of use.

4. Production and distribution of
vaccines in India
1. Primary stores(GMSDs/ government medical store
depots ) - 3 months
• 4 GMSDs (Karnal, chennai, Mumbai and kolkatta)
2. State vaccine stores
3. Divisional vaccine store
4. District vaccine store
5. CHC/PHC

5. Store level Number
GMSDs 4
State vaccine stores 35
Regional vaccine stores 20
Divisional vaccine stores 96
District vaccine stores 626
CHC/PHC 26439
Number of vaccine store in India

6. Why is the cold chain important ?
1. Vaccines are:
 Biological products
 lose potency with time
 Process irreversible and accelerated if proper
storage conditions are not adhered to.

7. 2. Assurance in potent product and vaccine
programmes
 Professional responsibility
 Confident the vaccines you give will be effective
 Public Health responsibility
 Public confidence in immunisation programmes

8. 3. Reduce wastage from errors.
4. Compliance with manufacturer
Any vaccine that has not been stored at a temperature
of 2-8ºC as per its licensing conditions is no longer a
licensed product

9. Cold chain equipments
 Walk in freezer
 Walk in cooler
 Deep freezer
 Ice lined refrigerators
 Domestic refrigerators
 Cold box
 Vaccine carriers
 Day carriers
Non electrical cold chain equipments

11. Walk in freezer
 State level
 Bulk storage of OPV
 Prepare frozen ice packs

12.  Maintain temperature : - 20 deg C
 Storage capacity: 15 – 20 Lakh doses.
 Stand by generator
 Alarm

13. Walk in cold rooms(WIC)
 At state/regional level
 4-5 districts
 Store for 3 month requirement / 25% buffer stock
 Temp : +2 to 8 degree C

14.  Storage capacity: 12 to 15 Lakh doses.
 Sizes – 16.5 cum and 32 cum
 Standby generator – auto start/stop
 Temperature recorder
 Alarm(+10 degree C)

15. Deep freezer
 Districts – 2-5 large deep freezers.
 PHCs – 1 small deep freezer.

16.  Temperature : -15 to -25 degree C.
 Maintain temperature for 18 to 26 hours (42 – 32
degree C).

18. Ice lined refrigerator(ILR)
 Both at district and PHC levels
 Temp :- +2oc to +8oc

19.  2 sections – A and B.
A- bottom – OPV and Measles.
B- upper – BCG, DPT, DT and TT.

20. Heat sensitive vaccines
BCG
(after reconstitution)
OPV
Measles
DPT
DT
Hep B

21. Freeze sensitivity
HepB
DPT
DT/TT

23. Shake test
Except???

24. Do’s for Use of ILR/Freezer
 Keep the equipment in a cool room
 Away from direct sunlight
 At least 10 cms away from the wall.
 Keep the equipment properly levelled.
 Fix the plug permanently to the socket.
 Use voltage stabilizer.

25.  Keep the vaccines neatly stacked with space for
circulation of air.
 Keep the equipment locked and open it only when
necessary.
 Defrost periodically.
 Check the temperature twice a day

26.  Maintain a record
Supervised and signed - supervisor/Medical Officer
regularly.
 Outside the equipment - notice of the
contingency plan
 Should know whom to contact
 Should arrange for alternate place for storing
vaccines.

28. Don’ts for Use of ILR/Freezer
• Do not keep other drugs and vaccines not used in
UIP.
• Do not open the top un-necessarily
• (Paste this message on the top of the ILR).
• Do not keep food or drinking water in the DFs/ILR.

29.  Do not keep –
 More than one month’s requirement at PHC
headquarters
 More than 3 months requirement at district level.
 Do not keep vaccines, which have expired.
 Do not disturb thermostat setting frequently.

30. Domestic refrigerators
• 2 to 8 degree C
• Not recommended for UIP

31. Ice
packs
Arrange vaccine in
order
Measles
BCG,TT
DPT, DT
Hep B
Diluents in
door
pocket
2 Thermometer

32. Vaccine storage
 No food or medical specimens
 Do not place fridge in direct sunlight or near heat
source
 Do not store vaccines for more than 1 month at
PHC.
 Do not store vaccines in fridge doors or in solid
plastic trays/containers within the fridge

33.  Safeguard electricity supply
 Not more than 50% full
 Place vaccines in clearly labelled plastic mesh
baskets
 Group vaccines by type (Paediatric, Adult,
Adolescent)
 Defrost/calibrate fridge regularly

34. Cold Box

35. • Collect and transport large quantities of vaccines.
• These are of different sizes
5, 8, 20 and 22 litres.
• Store vaccines for transfer up to five days

36. • The hold over time is-
 More than 90 hours for 5 Litre
 Six days for 20 Litre cold box
 Remember - ?
If not opened at
all

37. Vaccine carriers
• Carrying small quantities of vaccines
• 16-20 vials
• Sub-centers or session sites.

39. Day carriers
 Used to carry very small quantities of vaccines(6 to 8
vials)
 For a near by session
 Icepacks - 2
 For only 2 hours period

40. Cold chain monitoring
equipment:
 Thermometers.
 Cold Chain Monitor (CCM).
 VVM

41. Dial type Thermometer

42. Bar type Thermometer

43. Vaccine cold chain monitor

45. VVM

46. Thank you!