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COLD CHAIN AND

IMMUNIZATION SCHEDULE
Lavinia
Lee Jessie
Lew Ya En
Kabilen

Cold Chain
Definition:
The vaccine cold chain is a
temperature-controlled environment
used to maintain and distribute
vaccines in optimal condition

Place of
manufacture

Administrat
ion

The cold chain is a system of


transporting and storing vaccines within
the safe temperature of 2C -8 C from
the place of manufacture to the point of
administration.

Elements of Cold Chain


Reliable
transportati
on and
storage
equipment

Well-trained
personnel

Efficient
manageme
nt
procedures

Functioning vaccine
administered to people

Why do we have to maintain the


cold chain?
Excessive heat, cold
and light exposure

Damage vaccines

Decreased potency of
vaccines (irreversible
process)
Useless vaccine (offers
no benefit to
consumers)

Storage of vaccine

GENERAL GUIDANCE
CDC recommends
transport with a
portable refrigerator
unit
If not available, use
a hard-sided
insulated cooler with
at least 2-inch walls
Coolant packs that are frozen
have to be conditioned first by
leaving them at room
temperature for 1-2 hours until
edges have defrosted and pack
looks like its sweating (frozen

Transporting Varicella-containing
Vaccines
Varicella is a live vaccine- sensitive to heat
CDC does not recommend transporting
them
If have to be transported, CDC
recommends transport in a portable freezer
unit that maintains the temperature
between -50C and -15C
If cant use portable freezer, use same
packing layers as mentioned above but do
not defrost coolant packs

DISTRIBUTION ASPECT IN COLD


CHAIN
1.Custom Clearance:
. National Regulatory Authorities (NRA) or head of customs in
the destination country:
. To be cleared, the vaccines must have received marketing
authorisation and a release certificate from the national
regulatory authority.
. WHO office:
. Vaccines must meet WHO recommended norms and
standards (pre-qualification process).
. Local Ministry of Health (MOH):
. Depending on country specific requirements, the MOH may
issue a letter approving the shipment.

2.Shipping
In order for shipping to proceed smoothly. There
are few things to be looked into.

. Cool Box & Vaccine Carrier


. Documents
. Monitoring Means

Cool box
Temperature: 2-8C
Transport vaccine supplies from one fixed vaccine
store to another and from vaccine stores to health
facilities
Temporarily store vaccines when the refrigerator is
out of order or being defrosted

Vaccine Carrier
Temperature:
2-8C
Used for transporting
vaccines from health
facilities with refrigeration to outreach
sessions where refrigeration and ice are not
available.

DOCUMENTS

The following original documents must


accompany the consignment when it is
shipped, and a copy of these must also be
placed in the box.
Airway bill
Suppliers invoice
Packing list
Lot release certificate issued by the National Regulatory
Authority of the country of manufacture for each lot of
vaccine supplied
Any other documents, certificates or instructions
specified in the individual contract.

MONITORING MEANS
Twice daily temperature
sheet:
Refers to the sheet on
which the temperature is
indicated morning and
evening, everyday of the
month. Any maintenance
work done is also
indicated.

Monitoring card:

Referred to as the 3M card,


it is used to monitor temperature
variations during storage and
shipping from the manufacturer
to the user.
Irreversible freezing indicator
(at 0C):

This indicator is placed near


products that should not be
frozen.

Stop Watch card:


A 3M card with freezing indicator.
Placed in the refrigerator and
is used to monitor temperature
variations and determine if the
equipment is functioning properly.
Temperature Data Logger:
A portable measurement
instrument which
autonomously records temperature
over a period of time.

CONTROL MONITOR
Vaccine Vial Monitor
(VVM)
VVM is a label containing
heat sensitive material
that is placed on a
vaccine vial to register
heat exposure

1. Walk In Cold Room

(WIC)
at regional level
Storage up to 3 months

2. Deep Freezers
at district & PHC levels
temp: -15oc to -25oc
at PHC, used only for
the preparation of ice
packs

3. Ice Lined
Refrigerators (ILR)
Both at distict and PHC
levels
Temp: +2oc to +8oc
ILR's are top opening,
can hold cold air inside
better than front
opening refrigerators

Placing Vaccines in
Refrigerator

Diluent Storage
Store diluent as directed in manufacturers
product information
Store refrigerated diluent with
corresponding vaccine (these diluents may
contain vaccine antigen)
Never store diluents in the freezer
Label diluent to avoid inadvertent use of
the wrong diluent when reconstituting a
vaccine

Correct Storage Methods


Criteria for Selecting a Cold Box
It needs to be large enough to store
vaccines and icepacks during transport
External surface material needs to be
durable and robust
Lid needs to be tight fitting
Strong handles for carrying the cold box

IMPORTANCE OF MAINTAINING
VACCINE POTENCY

Vaccine heat liable


Success of any vaccination program
depends on the potency of vaccine
Vaccine loses activity and irreversible
Not functional
Maintaining clinical efficacy
Reduce protection from vaccinepreventable disease

WHAT IS
IMMUNIZATION

-Process by which an individuals immune


system become fortified against an
agent/immunogen.
-Mostly done by vaccination.

TYPES OF VACCINE
Live, attenuated vaccines
Inactivated vaccines
Polysaccharide
vaccines(pure/conjugated)

VACCINE PREVENTABLE
DISEASES

Tuberculosis
Hepatitis A & B
Diphtheria
Tetanus
Whooping Cough
Rubella
Measles, Mumps
Haem Influenza type b

IMPORTANCE OF VACCINE

Prevent serious illness and complication


Prevent outbreaks
It is safe
It has no side effects except a swollen injection
site
Herd immunity

HERD IMMUNITY
Community Immunity
Achieved by vaccinating large number of people in a
population.
As not everyone is able to get vaccinated
(pregnant women, immunocompromised
individuals, infants) ,having the majority of
the population vaccinated against a disease
gives protection to the unvaccinated.
In order to prevent major disease outbreak,
it is thus vital for governments to ensure the
community is vaccinated against otherwise
fatal diseases.

IMMUNIZATION SCHEDULE IN
MALAYSIA

Age

Vaccine

New born

Bacillus CalmetteGurin (BCG)


1st dose: Hepatitis B (HepB)

1 month

2nd dose: Hepatitis B

2 month

1st dose:
Diptheria, Tetanus, accellular Pertussis (DTaP)
Haemophilus influenzae b (Hib)
Inactivated Poliovirus (IPV)

3 month

2nd dose:
DTaP
Hib
IPV

5 month

3rd dose:
DTP
Hib
IPV

6 month

3rd dose:Hepatitis B
Measles (Sabah only)

10month

1st Dose: Japanese Encephalitis (JE) (Sarawak only)

12month

1st dose: Mumps, Measles, Rubella (MMR)


2nd dose: Japanese Encephalitis (Sarawak only)

18month

4th dose:
DTP
Hib
IPV
3rd dose:JE (Sarawak only)

4 years

4th dose: JE (Sarawak only)

7years

BCG (option only if no scar found)


Diptheria, Tetanus (DT booster)
2nd dose of MMR

13years

Human papillomavirus (HPV) with3 doses within 6 months


(2nd dose 1 month after 1st dose, 3rd dose 6 months after
1st dose)

15years

Tetanus (TT)

Optional Vaccines in
Malaysia

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6 WEEKS :Rotavirus
2 MONTHS : Pneumococcal
6 MONTHS : Influenza
10 MONTHS : Hepatitis A
12 MONTHS :Chicken pox

YELLOW CARD(CARTE JAUNE)


International certificate of Vaccination or
Prophylaxis.
Issued by World Health Organisation(WHO)
To prevent the international spread of the disease
by protecting countries from the risk of importing or
spreading the disease.
Required for entry to certain countries where there
are increased health risks for travellers or locals.
(medical passport)
If you do not show a valid certificate when
requested at the border, you may NOT be allowed to
enter the country, or you may be QUARANTINED for
up to 6 days!!!
contact diplomatic or consular office of countries
you are planning to visit to know the vaccination

YELOW FEVER VACCINATION


The countries that require proof of vaccination are
those where the mosquito vector and potential
non-human primate hosts of yellow fever are
present.
Any importation of the virus into such countries by
infected travellers could result in its propagation
and establishment, leading to a permanent risk of
infection for the human population.
Proof of vaccination is often required for travellers
arriving from countries with risk of yellow
fever transmission and sometimes for travellers in
transit through such countries.
List of yellow fever vaccination country requirements
-> WHO website

Other vaccinations:
- Tetanus and diphtheria
- Pertussis
- MMR
- Polio
- Meningococcal meningitis
- JE
- Hep B
- Typhoid
- Cholera

Medications:
Travellers diarrhoea (protect against
water-borne pathogens)
* antibiotics(ciprofloxacin,levofloxacin)
* Bismuth subsalicylate( Pepto-Bismul)
Malaria chemoprophylaxis (endemic
areas)
*chloroquine, primaquine
YELLOW CARD.pdf
Country vaccinations list.pdf

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