Can thermostable vaccines help address cold-chain challenges? Results from stakeholder interviews in six low- and middle-income countries

Kristensen, Debra; Lorenson, Tina; Bartholomew, Kate; Villadiego, Shirley

doi:10.1016/j.vaccine.2016.01.001

Cited by 54 publications

(56 citation statements)

References 23 publications

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“…Emphasis has long been placed on avoiding high temperatures, but, as this study also showed, recent studies have reported exposure to freezing temperature at many stages during distribution [ 12 , 23 , 24 ]. The World Health Organization guidelines specify that the hepatitis B, diphtheria–tetanus–pertussis, diphtheria–tetanus, and tetanus toxoid vaccine must not be frozen [ 12 ].…”

Section: Discussionmentioning

confidence: 74%

“…To avoid freezing of vaccines, Kolwaite et al conducted a pilot study to assess the effect of “out-of-the-cold-chain” storage in Lao PDR and discovered improved Hepatitis B dose coverage without an increase in adverse reactions [ 25 ]. Some innovative solutions should be considered in the context of developing countries, such as a computerizing temperature monitoring system, development of thermostable vaccines, development of a compact prefilled vaccination device, or the use of a cold box that can manage temperature control on its own for a long duration [ 10 , 14 , 24 , 26 ].…”

Section: Discussionmentioning

confidence: 99%

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Assessment of temperatures in the vaccine cold chain in two provinces in Lao People’s Democratic Republic: a cross-sectional pilot study

Kitamura

Bouakhasith²,

Phounphenghack³

et al. 2018

BMC Res Notes

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ObjectiveAll childhood vaccines, except the oral polio vaccine, should be kept at 2–8 °C, since the vaccine potency can be damaged by heat or freezing temperature. A temperature monitoring study conducted in 2008–2009 reported challenges in cold chain management from the provincial level downwards. The present cross-sectional pilot study aimed to assess the current status of the cold chain in two provinces (Saravan and Xayabouly) of Lao People’s Democratic Republic between March–April 2016. Two types of temperature data loggers recorded the temperatures and the proportions of time exposed to < 0 or > 8 °C were calculated.ResultsThe temperature remained within the appropriate range in the central and provincial storages. However, the vaccines were frequently exposed to > 8 °C in Saravan and < 0 °C in Xayabouly in the district storage. Vaccines were exposed to > 8 °C during the transportation in Saravan and to both > 8 and < 0 °C in Xayabouly. Thus, challenges in managing the cold chain in the district storage and during transportation remain, despite improvements at the provincial storage. A detailed up-to-date nationwide analysis of the current situation of the cold chain is warranted to identify the most appropriate intervention to tackle the remaining challenges.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Assessment of temperatures in the vaccine cold chain in two provinces in Lao People’s Democratic Republic: a cross-sectional pilot study

Kitamura

Bouakhasith²,

Phounphenghack³

et al. 2018

BMC Res Notes

View full text Add to dashboard Cite

show abstract

“…Use of vaccine vial monitors that measure cumulative heat exposure and development of pre-filled injection devices further facilitate ease and safety of vaccination by community health workers and could also help address cold-chain challenges in remote areas [24]. In 2017, MenAfriVac Ò conjugate meningococcal meningitis A vaccine was the first vaccine prequalified by WHO for use outside the cold chain in controlled temperature chain (CTC); use of CTC for a mass vaccination campaign in Chad would have reduced logistics costs by an estimated 50% [25].…”

Section: Discussionmentioning

confidence: 99%

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

Wang

Lee²,

Liu

et al. 2018

Vaccine

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“…Another potential solution for improved vaccine efficacy under difficult storage conditions could be the development of more thermostable vaccines by the pharmaceutical industry [ 28 , 29 ]. However, this possibility is not yet available, and therefore, until then, compliance with the recommended vaccine storage temperatures throughout the entire cold chain remains key to maximize the efficacy of all vaccines used to prevent infectious diseases.…”

Section: Discussionmentioning

confidence: 99%

Good vaccination practice: it all starts with a good vaccine storage temperature

Vangroenweghe¹

2017

Porc Health Manag

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BackgroundRecent introduction of strategies to reduce antibiotic use in food animal production implies an increased use of vaccines in order to prevent the economic impact of several important diseases in swine. Good Vaccination Practice (GVP) is an overall approach on the swine farm aiming to obtain maximal efficacy of vaccination through good storage, preparation and finally correct application to the target animals. In order to have a better insight into GVP on swine farms and the vaccine storage conditions, a survey on vaccination practices was performed on a farmers’ fair and temperatures in the vaccine storage refrigerators were measured during farm visits over a period of 1 year.ResultsThe survey revealed that knowledge on GVP, such as vaccine storage and handling, needle management and injection location could be improved. Less than 10% had a thermometer in their vaccine storage refrigerator on the moment of the visit. Temperature measurement revealed that only 71% of the measured refrigerators were in line with the recommended temperature range of +2 °C to +8 °C. Both below +2 °C and above +8 °C temperatures were registered during all seasons of the year. Compliance was lower during summer with an average temperature of 9.2 °C while only 43% of the measured temperatures were within the recommended range.ConclusionsThe present study clearly showed the need for continuous education on GVP for swine veterinarians, swine farmers and their farm personnel in general and vaccine storage management in particular. In veterinary medicine, the correct storage of vaccines is crucial since both too low and too high temperatures can provoke damage to specific vaccine types. Adjuvanted killed or subunit vaccines can be damaged (e.g. structure of aluminiumhydroxide in adjuvans) by too low temperatures (below 0 °C), whereas lyophilized live vaccines are susceptible (e.g. loss of vaccine potency) to heat damage by temperatures above +8 °C. In conclusion, knowledge and awareness of GVP and vaccine storage conditions are crucial under practical field conditions in swine herds. Focus on a correct on-farm vaccine storage is part of the responsible veterinarians’ guidance in order to obtain the required vaccine efficacy.

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Can thermostable vaccines help address cold-chain challenges? Results from stakeholder interviews in six low- and middle-income countries

Cited by 54 publications

References 23 publications

Assessment of temperatures in the vaccine cold chain in two provinces in Lao People’s Democratic Republic: a cross-sectional pilot study

Assessment of temperatures in the vaccine cold chain in two provinces in Lao People’s Democratic Republic: a cross-sectional pilot study

Vaccine-preventable disease control in the People’s Republic of China: 1949–2016

Good vaccination practice: it all starts with a good vaccine storage temperature

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