step T Vaccine Storage and Handling

1 VaccinatingAdults:A Step-by-Step GuideImmunization action coalition chapter will help youprepare for yourfirst Vaccine shipment. Vaccines only work when they are viable, that is, when they are intact undamaged and uncontaminated. To ensure vac-cines are viable or potent or good, you must main-tain them between the manufacturer-recommendedtemperature ranges that are not too cold or toowarm. This information is available in the packageinsert. Although most vaccines should not be frozen,certain vaccines containing varicella Vaccine virus(VAR, MMRV, and Zostavax) require frozen addition, several vaccines including MMR, MMRV,VAR, Zostavax, IPV, HPV (Gardasil 9), meningo -coccal ACWY (Menveo), meningococcal B (Bexsero),and certain formulations of influenza Vaccine (Aflu -ria,Fluad,Fluarix,Flublok, FluLaval, FluMist, Flu virin,andFlucelvax) should be protected from light.

2 Before we get started on this important topic, besure to review the three resources shown first two provide some basic information to helpas you are setting up your Vaccine operations, whilethe third is a guide that offers a wealth of infor -mation to help with almost any Vaccine Storage andhandling issue you are likely to encounter. Checklist for Safe Vaccine Storage and Don't Be Guilty of These PreventableErrors in Vaccine Storage and Handling ! Vaccine Storage and Handling : Vaccine Storage and HandlingTStep-by-Step: Vaccine Storageand Handling Tasks Receive Vaccine shipments Open package immediately Assess for proper Storage conditions of the Vaccine shipment upon arrival Store vaccines immediately at the recom-mended Storage temperature Know where to place vaccines within therefrigerator or freezer Monitor and record temperatures at leasttwice each day Choosing thermometers If there s a problem, take appropriate actionright away; report power failures or other Storage issues immediately!

3 Transport vaccines properly (and only whenabsolutely necessary) Transporting frozen varicella-containing vaccines to an offsite clinic locationTo ensure vaccines are viable or potent or good, you must maintain them between themanufacturer-recommended temperature ranges that are not too cold or too :A Step-by-Step GuideImmunization action coalition Vaccine shipmentsOpen package immediatelyVaccine deliveries should be made only when yourvaccine coordinator or backup person is it is important for everyone in your clinic especially your front desk staff or any individualswho receive deliveries to know how important itis to store these fragilevaccines promptly whenthey arrive.

4 Don t let a Vaccine package sit at thefront desk or outside your front or back door! Assess for proper Storage conditions of the Vaccine shipment upon arrivalPackages should be opened and inspected imme-diately for any damage and to determine if thepackages seem too warm or too cold to the temperature indicators if they are includedin the box. Check the Vaccine quantities, lot num-bers, and expiration dates against the packing there are discrepancies, contact the source of the shipment ( , manufacturer, distributor, statehealth department) your shipments arrive, check to see that theinactivated vaccinesare cold but not frozen, andthat the varicella andZostavaxvaccines are Vaccine may be refrigerated or frozen.

5 Nasalspray influenza Vaccine is refrigerated. If a tempera-ture indicator (often, this is a temperature-sensitivestrip that changes colors) is included in the ship-ment, check it to see if appropriate temperatureshave been maintained. Not all shipments will con-tain a temperature indicator. That s acceptable ifthe shipments have been packed according to cer-tain FDA-approved packing standards. But make30step3: Vaccine Storage and HandlingA Little Background: Types of Vaccines and DiluentsInactivated vaccinescan be composed of eitherkilled whole viruses, or fractions of either viruses orbacteria. Inactivated vaccines are damaged by freez-ing.

6 The inactivated vaccines needed by manyadults include: tetanus, diphtheria, and pertussis (Tdap/Td); injectable influenza; pneumococcal polysaccharide and conjugate; human papillomavirus; hepatitis A and B; meningococcal ACWY and B vaccines; and zoster (shingles; Shingrix).Live attenuated vaccinesconsist of a weakenedform of the live virus. They are easily damaged ordestroyed by heat and light. This makes it even moreimportant that they be stored and handled withextreme care. Live attenuated vaccines available formany adults include: measles, mumps and rubella (MMR); varicella (chickenpox); zoster (shingles; Zostavax); and nasal spray influenza Vaccine (when recommended).

7 Diluentsare liquids used with some vaccines are provided as a liquid that is alreadypackaged in a syringe, or in a vial, ready to bedrawn into a syringe and injected. However, somevaccines are provided as a lyophilized (freeze-dried)powder. A separate liquid (the diluent) is providedfor lyophilized vaccines. The diluent must be added to the lyophilized powder before injection, aprocess called reconstitution. A lyophilized vaccinemust only be reconstituted with the specific diluentprovided for that Vaccine ; diluents are not inter-changeable. Most Vaccine diluents may be storedeither in the refrigerator or maintained at roomtemperature.

8 Check the package insert to determineappropriate Storage guidance for the specific dilu-ent you are using. Summary information may befound in the immunization action coalition s (IAC)Vaccines with Diluents: How to Use Them, availableat is important for everyonein know how important it is tostore these fragilevaccines promptlywhen they arrive. VaccinatingAdults:A Step-by-Step GuideImmunization action coalition 3: Vaccine Storage and Handling31sure the container included appropriate insulationand gel packs or ice packs and that any ice packshave not completely thawed. If the product seemsto have been exposed to too-high or too-low ( ,frozen) temperatures or something seems amiss,put the Vaccine in a specially marked, segregatedarea or tray in the refrigerator or freezer (whicheveris indicated according to the type of Vaccine deliv-ered).

9 Call the source of your shipment ( , man-ufacturer, distributor, state health department) foradvice about what to do vaccines immediately at the recommended Storage temperatureMost vaccines (all inactivated vaccines and live nasalspray influenza Vaccine ) must be stored between2 to 8 C (36 to 46 F), which is the recommendedrefrigerator temperature. Live varicella (chickenpox)and Zostavax(shingles) vaccines must be storedfrozen between -50 to -15 C (-58 to +5 F). Thesevaccines may be temporarilystored in a refrigerator(between 2 to 8 C [36 to 46 F]) for up to 72 hoursbefore use, if theyhave not beenrecon stituted andwill be used withinthat time period.

10 If they are not used within 72 hours, they must bediscarded. Once these vaccines have been storedin the refrigerator, they must not be refrozen; oncethey have been reconstituted, you have only 30minutes in which to administer these sensitive vac-cines before they lose potency and cannot be line don t remove these vaccines fromthe freezer or reconstitute them until you have yourpatient sitting in front of you! (More informationon this subject is located in Step 5: AdministeringVaccines.) The live MMR Vaccine can be stored in eitherthefreezer or the refrigerator. However, once the vac-cine has been drawn into the syringe, it must beused within 8 hours or discarded.