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

• Main Authors: Nelson Carib M. (Author), Wibisono Hariadi (Author), Purwanto Hary (Author), Mansyur Isa (Author), Moniaga Vanda (Author), Widjaya Anton (Author)
• Format: Book
• Published: The World Health Organization, 2004-01-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 0042-9686
• Keywords: Hepatitis B vaccines; Freezing; Refrigeration; Drug storage/methods; Transportation; Drug stability; Child health services; Indonesia; Public aspects of medicine; RA1-1270
• Source: Bulletin of the World Health Organization, Vol 82, Iss 2, Pp 99-105 (2004)

OBJECTIVES: 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. METHODS: 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 °C cold chain. FINDINGS: 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. CONCLUSIONS: 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 °C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity.