Cold Chain System
Cold Chain System
Cold Chain System
The cold chain is a system that ensures that vaccines are kept in a potent state during
transportation from the manufacturer to the people to be immunized or recipients. It consists of
transportation links during which adequate refrigeration is ensured.
A break at any level of the cold chain would destroy the potency of the vaccines. Once vaccines
lose their potency they cannot be rejuvenated through refrigeration or any other means.
Manufacturer
Airport (Ghana)
Central store
Regional store
District store
Sub-district store
Recipient (Clinic)
Manufacturer
The manufacturer produces the vaccine and sends telex to the airport of the receiving country.
The telex contains the quantity of vaccines that are coming to the country, the type, the date and
time the vaccines will reach the airport.
Airport
Vaccines are carried in special planes with refrigerators. The national cold chain staff is supposed
to be at the airport before the plane arrives with cold vans.
Recipient
Vaccines are carried in vaccine carriers from the health centre store to the recipient on the field.
Vaccines when reconstituted or removed from the carrier are placed in ice cubes to maintain the
potency before it is given to the recipient.
Adopted from the Field Guide for the Ghana Immunization Programme
The killed or dead organisms and toxoid, that is, DPT/HibHepB and tetanus vaccines should be
kept above freezing point (2 – 8 degrees).
The other live vaccines should be kept below 8 degrees but they are not damaged by freezing.
NB: all live vaccines are sensitive to heat and light.
Defrost your refrigerator when the ice on the walls of the freezing compartment becomes more
than 5mm thick. As ice builds up, the refrigerator gets rather warmer, but not colder.
Note: if you have to defrost your refrigerator more than once a month, the door is probably open
too often. If this is not the case, contact your supervisor for technical check-up by a cold chain
technician.
Check the power supply, the door, hinges and seals, for any defect.
Be sure that the door is opened as few times as possible.
Chart: 5.1
Table: 5.3
Jan Feb Mar Apr May Jun Cumulative
total for the
year
BCG 25 20 32 30 30 25 162
Measles 10 15 10 20 15 10 80
Yellow Fever 15 10 20 10 10 15 80
Total immunized 50 45 62 60 55 50 322
this month
From chart: 5.1 connect the new dot to the previous month’s dot with a straight line.
After you have completed the EPI monthly routine report, fill in the number of doses given in
that month for each monitored antigen into the “total immunized this month” space in table: 5.2.
Add the present month’s total to the previous month’s cumulative total to calculate the current
cumulative total (that is the total number of vaccinations given so far this year).
Calculate the annual target population that is to receive immunization. For infants less than 1
year of age and pregnant women, multiply the estimated total population in the catchment area
by 0.04 (=4%).
If you have more accurate figures for these target populations use them. (for example a health
centre with a catchment population of 15,000 will have a target population of 600 children < 1
year of age and 600 expected pregnant women).
Complete the information at the top of the chart (name of health facility, year, annual target
population, minimum target coverage (or the vaccine being monitored).
Label the intervals on the left side of the chart with the monthly target population figures (that is
the annual target population divided by 12, (for example 600 divided by 12 =50; look at the chart
example).
Label the boxes at the bottom of the chart with the name and doses of the vaccine (for example
BCG, DPT3 OPV3, and measles on chart1, and TT2+ for pregnant women on chart 2).
Compare the current month’s number of immunization with that of the previous month: were
there any changes? Has the number increased or decreased? Why? And what can be done in the
subsequent month?
If there is a problem with dropouts or left outs in your clinic, look at the chart if the distance
between BCG and DPT/HibHepB3/OPV3 or measles is growing wider. If there is more than
10% difference between the numbers for the two doses being compared, there is a problem with
dropouts. For example, there is a big problem with dropouts if 65 BCG immunizations have been
given and only 30 DPT/HibHepB3.
Stage 3 Stage 4
Stage 1 Stage 2
use this
vaccine Do Not Use This Vaccine
Inform Your Supervisor
Before putting the ice packs inside the cold box or the vaccine carriers, place them on a table for
20 to 30 minutes until the outside frost has melted. Place a thermometer and which indicates a 3
M cold chain monitor card in the center of the cold box or the vaccine carrier. Make sure the
temperature in the vaccine carrier or cold box is in the range of +2 to +8 degree Celsius.
Place measles and polio vaccines at the bottom, then BCG. Above them, place DPT-HibHepB
and Tetanol Toxoid vaccines and diluents.
Close the lid tightly and keep it closed as much as possible.
Ice Packs
They are used to pack vaccines in cold boxes and carrier to keep and maintain the vaccines’
potency.
1. Always use ice packs filled with water.
2. Do not use ice packs which have gel in them because they melt quickly.
What to Evaluate
According to the field guide for The Ghana immunization Programme, one should ask these
questions:
1. Did you hold all immunization sessions as planned?
2. Did you have enough vaccines to reach at your target?
3. Did you check your refrigerator everyday to record the temperature?
4. Were your temperatures recorded in safe ranges?
5. Did you check the immunization status of all children and women in child bearing age?
6. Did you inform them about the immunizations that they will need and when to have
them?
7. Did you have enough needles and syringes as well as other equipment?