Learning Objectives for this Presentation:
By the end of the presentation participants will be able to:
Understand the limited evidence for formulating storage and handling recommendations
Apply industry technology to storage unit recommendations
Evaluate policy issues for storage unit recommendations and provider accountability for compromised vaccine

Background:
Published data on the thermal stability of vaccines are limited. Most available data evaluate heat effects, while the majority of vaccine temperature abuse is exposure to temperatures below 32F. Liquid adjuvant-containing vaccines are damaged when exposed to freezing temperatures; however, scant data demonstrate the actual impact of specific temperatures on vaccine potency. Despite huge vaccine expenditures, there is no U.S. strategic goal or plan to critically evaluate vaccine thermal stability to develop practical storage, vaccine viability, and revaccination recommendations. Currently, each immunization project is responsible for these decisions. Basic refrigeration science does not support ACIP recommendations that combination refrigerator/freezer units sold for home use are acceptable for storage of vaccines.

Setting:
State Public Health Department, local health department clinics, and VFC offices.

Population:
VFC providers

Project Description:
In a large State Immunization Program, we
• Tracked and analyzed a sample of temperature violations and vaccine losses.
• Applied refrigeration principles to determine optimal and appropriate storage units.
• Developed visual aids and justifications for recommendations of practical and safe storage.
• Formulated policies to support improved vaccine storage and provider accountability.

Results/Lessons Learned:
The combination of suboptimal refrigerators, more vaccines and larger packaging volume increases the likelihood of temperature problems. Informed providers will take responsibility for safe storage when properly presented. Program policies should be designed to support optimal storage and handling.