Reducing the loss of vaccines from accidental freezing in the cold chain: the experience of continuous temperature monitoring in Tunisia

Advancements and Challenges in Peptide-Based Cancer Vaccination: A Multidisciplinary Perspective

With the continuous advancements in tumor immunotherapy, researchers are actively exploring new treatment methods. Peptide therapeutic cancer vaccines have garnered significant attention for their potential in improving patient outcomes. Despite its potential, only a single peptide-based cancer vaccine has been approved by the U.S. Food and Drug Administration (FDA). A comprehensive understanding of the underlying mechanisms and current development status is crucial for advancing these vaccines. This review provides an in-depth analysis of the production principles and therapeutic mechanisms of peptide-based cancer vaccines, highlights the commonly used peptide-based cancer vaccines, and examines the synergistic effects of combining these vaccines with immunotherapy, targeted therapy, radiotherapy, and chemotherapy. While some studies have yielded suboptimal results, the potential of combination therapies remains substantial. Additionally, we addressed the management and adverse events associated with peptide-based cancer vaccines, noting their relatively higher safety profile compared to traditional radiotherapy and chemotherapy. Lastly, we also discussed the roles of adjuvants and targeted delivery systems in enhancing vaccine efficacy. In conclusion, this review comprehensively outlines the current landscape of peptide-based cancer vaccination and underscores its potential as a pivotal immunotherapy approach.

Non-Invasive Vaccines: Challenges in Formulation and Vaccine Adjuvants

Given the limitations of conventional invasive vaccines, such as the requirement for a cold chain system and trained personnel, needle-based injuries, and limited immunogenicity, non-invasive vaccines have gained significant attention. Although numerous approaches for formulating and administrating non-invasive vaccines have emerged, each of them faces its own challenges associated with vaccine bioavailability, toxicity, and other issues. To overcome such limitations, researchers have created novel supplementary materials and delivery systems. The goal of this review article is to provide vaccine formulation researchers with the most up-to-date information on vaccine formulation and the immunological mechanisms available, to identify the technical challenges associated with the commercialization of non-invasive vaccines, and to guide future research and development efforts.

Evaluation of the immune response of dogs after a mass vaccination campaign against rabies in Tunisia

BACKGROUND

Rabies (RABV) is an enzootic disease in Tunisia, with dogs being the primary reservoir. Vaccinating dogs is the key to eradicate rabies. Regional Veterinary Services conduct nationwide immunisation campaigns on an annual basis. Evaluation of the immune response is still important to make sure that the vaccination is effective in the conditions of the Tunisian field. In this paper, the FAVN technique was used to test rabies antibody dynamics in dogs from three distinct Tunisian areas observed for one year following a mass vaccination campaign.

RESULTS

On day 30 after vaccination, 75% of all dogs vaccinated during the campaign were sero-positive (titres greater than or equal to 0.5 transformed IU/ml). On day 180, 48% of all dogs were sero-positive. Only 25.6% of primary-vaccinated dogs remained sero-positive on day 180 and 7% on day 365, whereas 91% of previously sero-positive dogs remained sero-positive on day 365.

CONCLUSIONS

Although a single rabies vaccine is successful at stimulating an immunological response, it is recommended that primary-vaccinated dogs have a second booster between one and three months after the initial vaccination to maintain seropositivity. To achieve the rabies eradication objective, all dogs should receive an annual booster to maintain effective immunological protection.

Leveraging Lessons Learned from Yellow Fever and Polio Immunization Campaigns during COVID-19 Pandemic, Ghana, 2021

Ghana is a yellow fever-endemic country and experienced a vaccine-derived polio outbreak in July 2019. A reactive polio vaccination campaign was conducted in September 2019 and preventive yellow fever campaign in November 2020. On March 12, 2020, Ghana confirmed its first COVID-19 cases. During February-August 2021, Ghana received 1,515,450 COVID-19 vaccines through the COVID-19 Vaccines Global Access initiative and other donor agencies. We describe how systems and infrastructure used for polio and yellow fever vaccine deployment and the lessons learned in those campaigns were used to deploy COVID-19 vaccines. During March-August 2021, a total of 1,424,008 vaccine doses were administered in Ghana. By using existing vaccination and health systems, officials in Ghana were able to deploy COVID-19 vaccines within a few months with <5% vaccine wastage and minimal additional resources despite the short shelf-life of vaccines received. These strategies were essential in saving lives in a resource-limited country.

Vaccine cold chain management and cold storage technology to address the challenges of vaccination programs

The outbreaks of infectious diseases that spread across countries have generally existed for centuries. An example is the occurrence of the COVID-19 pandemic in 2020, which led to the loss of lives and economic depreciation. One of the essential ways of handling the spread of viruses is the discovery and administration of vaccines. However, the major challenges of vaccination programs are associated with the vaccine cold chain management and cold storage facilities. This paper discusses how vaccine cold chain management and cold storage technology can address the challenges of vaccination programs. Specifically, it examines different systems for preserving vaccines in either liquid or frozen form to help ensure that they are not damaged during distribution from manufacturing facilities. Furthermore, A vaccine is likely to provide very low efficacy when it is not properly stored. According to preliminary studies, the inability to store vaccine properly is partly due to the incompetency of many stakeholders, especially in technical matters. The novelty of this study is to thoroughly explore cold storage technology for a faster and more comprehensive vaccine distribution hence it is expected to be one of the reference and inspiration for stakeholders.

Thermostable vaccines: an innovative concept in vaccine development

INTRODUCTION

Vaccines represent one of the most common and safer ways of combating infectious diseases. Loss of potency owing to thermal denaturation or degradation of almost all the commercially available vaccines necessitates their storage, transportation, and final dissemination under refrigerated or deep-freeze conditions. However, maintenance of a continuous cold chain at every step raises the cost of vaccines significantly. A large number of life-saving vaccines are discarded before their application owing to exposure to sub-optimum temperatures. Therefore, there is a pressing need for the development of a thermostable vaccine with a long shelf life at ambient temperature.

AREAS COVERED

A literature search was performed to compile a list of different vaccines, along with their storage and handling conditions. Similarly, a separate list was prepared for different coronavirus vaccines which are in use against coronavirus disease 2019. A literature survey was also performed to look at different approaches undertaken globally to address the issue of the cold-chain problem. We emphasised the importance of yeast cells in the development of thermostable vaccines. In the end, we discussed why thermostable vaccines are required, not only in resource-poor settings in Asian and African countries but also for resource-rich settings in Europe and North America.

EXPERT OPINION

: Temperature change can severely impact the stability of various life-saving vaccines. Therefore, there is a pressing need for the development of thermostable vaccines with a long shelf life at ambient temperature.

Thermostable Vaccines in Veterinary Medicine: State of the Art and Opportunities to Be Seized

The COVID-19 pandemic has highlighted the weakness of the vaccine supply chain, and the lack of thermostable formulations is one of its major limitations. This study presents evidence from peer-reviewed literature on the development of thermostable vaccines for veterinary use. A systematic review and meta-analysis were performed to evaluate the immunogenicity and/or the efficacy/effectiveness of thermostable vaccines against infectious diseases. The selected studies (n = 78) assessed the vaccine’s heat stability under different temperature conditions and over different periods. Only one study assessed the exposure of the vaccine to freezing temperatures. Two field studies provided robust evidence on the immunogenicity of commercial vaccines stored at temperatures far in excess of the manufacturer’s recommended cold-chain conditions. The drying process was the most-used method to improve the vaccine’s thermostability, along with the use of different stabilizers. The pooled vaccine efficacy was estimated to be high (VE = 69%), highlighting the importance of vaccination in reducing the economic losses due to the disease impact. These findings provide evidence on the needs and benefits of developing a portfolio of heat- and freeze-stable veterinary vaccines to unleash the true potential of immunization as an essential component of improved animal health and welfare, reduce the burden of certain zoonotic events and thus contribute to economic resilience worldwide.

Optimization methods for large-scale vaccine supply chains: a rapid review

Global vaccine revenues are projected at $59.2 billion, yet large-scale vaccine distribution remains challenging for many diseases in countries around the world. Poor management of the vaccine supply chain can lead to a disease outbreak, or at worst, a pandemic. Fortunately, a large number of those challenges, such as decision-making for optimal allocation of resources, vaccination strategy, inventory management, among others, can be improved through optimization approaches. This work aims to understand how optimization has been applied to vaccine supply chain and logistics. To achieve this, we conducted a rapid review and searched for peer-reviewed journal articles, published between 2009 and March 2020, in four scientific databases. The search resulted in 345 articles, of which 25 unique studies met our inclusion criteria. Our analysis focused on the identification of article characteristics such as research objectives, vaccine supply chain stage addressed, the optimization method used, whether outbreak scenarios were considered, among others. Approximately 64% of the studies dealt with vaccination strategy, and the remainder dealt with logistics and inventory management. Only one addressed market competition (4%). There were 14 different types of optimization methods used, but control theory, linear programming, mathematical model and mixed integer programming were the most common (12% each). Uncertainties were considered in the models of 44% of the studies. One resulting observation was the lack of studies using optimization for vaccine inventory management and logistics. The results provide an understanding of how optimization models have been used to address challenges in large-scale vaccine supply chains.

Evaluation of precipitation time of the aluminum salts adsorbed potentially frozen vaccines used in the Polish National Immunization Schedule for their pre-qualification before the administration

Purpose

Vaccines adsorbed on aluminum adjuvants irreversibly lose potency after freezing and their safety is affected. To prevent the administration of such vaccines, the World Health Organization developed the Shake Test designed to determine whether adsorbed vaccines have been frozen or not. However, the Shake Test is difficult and time-consuming when routinely conducted at the place of vaccination. In this study, a modified shake test for prequalification of potentially frozen vaccines was elaborated.

Materials and Methods

Vaccines used in the Polish Immunization Schedule were investigated and the analysis includes an assessment of precipitation time and the influence of the container type, amount and type of aluminum compound, and a volume of vaccine dose on the precipitation time.

Results

Significant differences between the precipitation time of frozen and non-frozen vaccines routinely used in the Polish Immunization Schedule were observed. The precipitation time of all non-frozen vaccines was above 30 minutes. The longest precipitation time of frozen vaccines was 10 minutes.

Conclusion

The finding of the study can be used in practice by the personnel administering vaccines to patients. Step-by-step recommendations for the preparation of the test have been proposed in the article.

A fuzzy multi-criteria framework to identify barriers and enablers of the next-generation vaccine supply chain

Purpose

Due to the introduction of new vaccines in the child immunization program and inefficient vaccine supply chain (VSC), the universal immunization program (UIP), India is struggling to provide a full schedule of vaccination to the targeted children. In this paper, the authors investigate the critical factors for improving the performance of the existing VSC system by implementing the next-generation vaccine supply chain (NGVSC) in India.

Design/methodology/approach

The authors design a fuzzy multi-criteria framework using a fuzzy analytical hierarchical process (FAHP) and fuzzy multi-objective optimization on the basis of ratio analysis (FMOORA) to identify and analyze the critical barriers and enablers for the implementation of NGVSC. Further, the authors carry out a numerical simulation to validate the model.

Findings

The outcome of the analysis contends that demand forecasting is the topmost supply chain barrier and sustainable financing is the most important/critical enabler to facilitate the implementation of the NGVSC. In addition, the simulation reveals that the results of the study are reliable.

Social implications

The findings of the study can be useful for the child immunization policymakers of India and other developing countries to design appropriate strategies for improving existing VSC performance by implementing the NGVSC.

Originality/value

To the best of the authors’ knowledge, the study is the first empirical study to propose the improvement of VSC performance by designing the NGVSC.

Application and research progress of phase change materials in biomedical field

Phase change materials (PCMs) are widely used in solar energy utilization, industrial waste heat recovery and building temperature regulation. However, there have been few studies on the application of PCMs in the field of biomedicine. In recent years, some scholars have carried out research in the biomedicine field using the characteristics of PCMs. It was observed that the excellent properties of PCMs enhance the quality of a variety of biomedical applications with many advantages over existing applications, which provide new methods for the treatment of disease. PCMs have broad application prospects in the field of biomedicine. Therefore, a timely review of relevant research progress is of great significance for the continuous development of new methods. Innovatively, from the unique perspective of the biomedical field, this paper systematically reviews the application and related research progress of PCMs from four aspects: cold chains for vaccines and medicines, drug delivery systems, thermotherapy/cold compress therapy and medical dressings. In addition, we summarize and discuss the general principles of the design and construction of PCMs in the biomedical field. Finally, existing problems, solutions and future research directions are also put forward in order to provide a basis for guidance and promote the future applications of phase change materials in the biomedicine field.

Biomineralization improves the stability of a Streptococcus pneumoniae protein vaccine at high temperatures

Aim: Protein vaccines have been the focus of research for vaccine development due to their safety record and facile production. Improving the stability of proteins is of great significance to the application of protein vaccines. Materials & methods: Based on the proteins pneumolysin and DnaJ of Streptococcus pneumoniae, biomineralization was carried out to prepare protein nanoparticles, and their thermal stability was tested both in vivo and in vitro. Results: Mineralized nanoparticles were formed successfully and these calcium phosphate-encapsulated proteins were resistant to proteinase K degradation and were thermally stable at high temperatures. The mineralized proteins retained the immunoreactivity of the original proteins. Conclusion: Mineralization technology is an effective means to stabilize protein vaccines, presenting a safe and economical method for vaccine administration.

Depiction of possible solutions to improve the cold supply chain performance system

Purpose

A poor performance of the cold supply chain (CSC) may increase the loss of quality and potency of perishables and temperature-sensitive products that deteriorate the financial and environmental aspects of the same. The purpose of the current research work is to identify the critical performance factors (criteria) and their co-factors (sub-criteria) that are responsible for the performance measurement of CSC and suggest the best possible solutions (alternatives) to improve the same.

Design/methodology/approach

To achieve the objective of the research, a hierarchical model has been developed and analyzed using Analytic Hierarchy Process (AHP)-Fuzzy TOPSIS as a hybrid approach to obtain the severity weights of the identified criteria and prioritization toward their relative importance for the best possible alternatives.

Findings

Analysis reveals that the criteria “energy consumption” comes out to be the most critical criteria, and alternative “application of passive cold devices” is the most effective solution for improving the performance of CSC. Higher energy consumption leads to a higher rate of greenhouse gas (GHG) emissions increasing the global warming phenomenon, high operational cost and degradation of natural energy resources. The Application of Passive Cold Devices (PCDs) utilizes solar energy to operate the refrigeration units reducing the energy consumption, environmental and operating cost of CSC.

Research limitations/implications

The research work provides several insights into the critical issues related to the CSC and suggests significant findings that enable the management and decision-makers to adopt these practices for performance evaluation and improvement of the same. The key findings of the work, such as “application of passive cold devices” and “application of IoT in cold chain logistics”, facilitate an improved platform to improve the CSC performance and proposed several directions that will enhance the merit of future research.

Originality/value

The presented study consolidates the various perspectives associated with CSC performance, explores the most critical criteria and proposes the best suitable cold chain practices for organizational growth. The work also provides an analytical analysis with the essence of practicalities and sensitivity analysis to support the robustness of the results. By enriching the literature and quantitative analysis of the new proposed model, this paper forms vast managerial and research implications in the field of CSC.

Lyophilized yeast powder for adjuvant free thermostable vaccine delivery

Thermolabile nature of commercially available vaccines necessitates their storage, transportation, and dissemination under refrigerated condition. Maintenance of continuous cold chain at every step increases the final cost of vaccines. Any breach in the cold chain even for a short duration results in the need to discard the vaccines. As a result, there is a pressing need for the development of thermostable vaccines. In this proof-of-concept study, we showed that E. coli curli-green fluorescent fusion protein remains stable in freeze-dried yeast powder for more than 18 and 12 months when stored at 30 °C and 37 °C respectively. Stability of the heterologous protein remains unaffected during the process of heat-inactivation and lyophilization. The mass of lyophilized yeast powder remains almost unchanged during the entire period of storage and expressed protein remains intact even after two cycles of freeze and thaws. The protease-deficient strain appears ideal for the development of whole recombinant yeast-based vaccines. The cellular abundance of expressed antigen in dry powder after a year was comparable to freshly lyophilized cells. Scanning electron microscopy showed the intact nature of cells in powdered form even after a year of storage at 30 °C. Observation made in this study showed that freeze-dry yeast powder can play a vital role in the development of thermostable vaccines.

Key Points

• Yeast-based vaccines can overcome problem of cold chain associated with conventional vaccines

• Lyophilized yeast powder can be a simple way for long-term storage of immunogen(s)

• Protease deficient strain is important for whole recombinant yeast-based vaccines

Effect of thermal ballast loading on temperature stability of domestic refrigerators used for vaccine storage

Vaccine temperature control failures represent a significant public and private healthcare cost. Vaccines damaged by excessive heat or freezing lose their effectiveness, putting public health at risk. Some vaccine administration programs recommend placing water bottles inside domestic refrigerators used for vaccine storage as a thermal ballast, to mitigate temperature excursion risks. However, the effect of variable thermal ballast loading on refrigerator performance has not been thoroughly quantified or documented, and generalized programmatic recommendations are subject to end-user interpretation. Here we show that a thermal ballast load comprising ten to fifteen percent of the total refrigerator storage volume provides a measurable effect on domestic refrigerator temperature stability during power outage events, maintaining vaccine temperatures between 2 °C and 8 °C for 4 to 6 hours without power. Thermal ballast usage does not reliably reduce the frequency or severity of temperature excursions caused by repeated door opening, accidental "door left open" events, or refrigerator defrost cycle activation. Use of a moderate thermal ballast load is a practical strategy for mitigating temperature excursions risks in areas with frequent or protracted power outages, but the practice has limited benefit in other adverse scenarios. Empowering providers to make informed decisions about the use of thermal ballast materials supports better, safer vaccine management.

Effect of freezing on recombinant hepatitis E vaccine

Studies have revealed that vaccines are more often exposed to sub-zero temperatures during cold chain transportation than what was previously known. Such exposure might be detrimental to the potency of temperature-sensitive vaccines. The aim of this study was to evaluate the impact of exposure to freezing on the physicochemical properties and biological activities of recombinant hepatitis E (rHE) vaccine. Changes in rHE vaccine due to freezing temperatures were analyzed with regard to sedimentation rate, antigenicity, and antibody affinity and potency. The freezing temperature of rHE was measured, then rHE vaccine was exposed to freezing temperatures below -10°C.Significant increase of sedimentation rate was noted, according to shake test and massed precipitates. In addition, the binding affinity of rHE vaccine to six specific monoclonal antibodies was significantly reduced and the in vivo potency for eliciting a protective IgG response was also partially lost, especially for anti-HEV neutralizing antibodies. Altogether, our work indicates that exposure of rHE vaccine to a temperature below -10°C results in the loss of structural integrity and biological potency of rHE vaccine.

Evaluation of temperature stability among different types and grades of vaccine storage units: Data from continuous temperature monitoring devices

OBJECTIVE

To evaluate the ability of different types of vaccine storage units to maintain appropriate temperatures for the storage of vaccines and to characterize deviations from recommended temperatures.

DATA SOURCES

Continuous temperature monitoring devices, or digital data loggers, from vaccine providers who participated in a continuous temperature monitoring pilot project.

STUDY DESIGN

We computed descriptive statistics on the percentage of runtime with an out-of-range temperature, or excursion, for different storage unit types (freezers and refrigerators) and for different storage unit grades (household-grade combination, household-grade stand alone, and purpose-built or pharmaceutical grade). We developed frequency histograms for the percentage of storage unit runtime outside of the normal range. We plotted the duration and temperature extrema for identified excursions. Analyses were stratified by storage unit type and grade.

RESULTS

Household-grade combination units underperformed relative to household-grade stand-alone and purpose-built units. Among refrigerators, household-grade combination units operated in the normal temperature range an average of 98.9% of their observed runtime, which was lower than 99.4% (p value = 0.038) for household-grade stand-alone and 99.9% (p value < 0.001) for purpose-built units. Among freezers, household-grade combination units operated in the normal temperature range an average of 95.0% of their observed runtime, which was lower than 99.3% (p value < 0.001) for household-grade stand-alone units and 99.7% (p value < 0.001) for purpose-built units.

CONCLUSION

These findings, in particular the underperformance of household-grade combination units relative to household-grade stand-alone and purpose-built units, support current CDC recommendations to avoid the use of household-grade combination storage units when possible.

Dual mechanism of ionic liquid-induced protein unfolding

Ionic liquids (ILs) are gaining attention as protein stabilizers and refolding additives.

Prioritizing the vaccine supply chain issues of developing countries using an integrated ISM-fuzzy ANP framework

Purpose

Delivering vaccines to the children who need them requires a supply chain that is efficient and effective. In most of the developing countries, however, the unknown and unresolved supply chain issues are causing inefficiencies in distributing vaccines. There is, therefore, a great need in such countries to recognize the issues that cause delays in vaccine delivery. With this purpose, the present study aims to identify and analyze the key issues in the supply chain of basic vaccines required to immunize children in developing countries.

Design/methodology/approach

Based on a field survey of three states of India, in-depth review of relevant literature and experts’ opinions, 25 key issues were recognized as factors of the vaccine supply chain (VSC) and categorized into five main domains. Using integrated interpretive structural modeling and fuzzy analytic network process approaches, the issues have been prioritized to determine their relative importance in the VSC. In addition, a sensitivity analysis has been performed to investigate the priority stability of the issues.

Findings

The results of the analysis show that among the five domains of VSC issues, the economic domain with a weight of 0.4262 is the most important domain, followed by the management (0.2672), operational (0.2222), environmental (0.0532) and social (0.0312).

Research limitations/implications

This study focuses on the prioritization of VSC issues; therefore, the results of the present study can provide direction to the decision-makers of immunization programs of developing countries in driving their efforts and resources on eliminating the most important obstacles to design successful vaccination programs.

Originality/value

To the authors’ knowledge, this paper is first to provide a direction to the decision-makers in identifying and managing important issues through the use of an analytical approach.

Collective construction of bundle for immunobiological agents conservation best practices

OBJECTIVE

to construct collectively with nursing professionals bundle for best practices of cold chain maintenance of immunobiological agents conservation at the local level.

METHOD

a qualitative research of convergent care type. Bundle construction was guided by the Evidence-Based Practice criterion. Data collection was carried out from October to December 2016, through five workshops, with the participation of 21 professionals from 7 vaccination rooms of a municipality of Minas Gerais State. The framework developed by Morse and Field was adopted for data analysis.

RESULTS

through bundle, care is taken regarding refrigeration equipment temperature monitoring, contingency plan performance, recyclable ice coil setting and chamber use as refrigeration equipment.

FINAL CONSIDERATIONS

the chosen interventions began to guide the practice and promote a care based on safety and quality.

Storage Conditions of Insulin in Domestic Refrigerators and When Carried by Patients: Often Outside Recommended Temperature Range

Objective: Not much is known about how people with diabetes store their insulin. Objective of our evaluation was to analyze at which temperature insulin is stored in domestic refrigerators and when opened/carried as a spare, and if these temperatures meet the manufacturers' recommendations. Methods: People with diabetes (n = 338; 46% US, 41% EU) put Bluetooth-enabled temperature sensors (MedAngel ONE, Netherlands) next to the insulin into their refrigerator or diabetes bag. Measurement results were transferred to an app and stored in a protected online database. Results: Temperature logs from 400 sensors were analyzed (230 for refrigerated, 170 for carried insulin). Deviations outside the recommended range were found in 315 (78.8%) logs (230 [100%] refrigerated, 85 [50%] carried). For refrigerated insulin, temperature recorded was out of range 11.3% of the time, on average 2 h 43 min/day with an average deviation of 3.7 K. For carried insulin, temperatures were out of range 0.5% of the time (8 min/day) with an average deviation of 1.1 K. Seventeen percent of sensors measured temperatures <0°C (57 of sensors for refrigerated, 9 for carried insulin). Conclusions: Storage conditions of insulin are known to have an impact on its blood glucose-lowering effect. This is the first study investigating temperature conditions of insulin storage in industrialized countries. In a clinically relevant percentage of storage time, insulin was exposed to temperatures outside the recommended range, especially when refrigerated. Thus, domestic refrigerators may pose an underestimated risk for insulin quality.

Challenges of cold chain quality for routine EPI in south-west Burkina-Faso: An assessment using automated temperature recording devices

BACKGROUND

Abnormal temperatures are a major issue for vaccines within the Expanded Program of Immunization in tropical climates. Prolonged exposure to temperatures outside the standard +2 °C/+8 °C range can impact vaccine potency.

METHODS

The current study used automatic temperature recording devices (Testostore 171-1©) to monitor cold chain in remote areas of Western Burkina Faso. A series of 25 randomly selected health centers representing 33% of the existing 176 EPI facilities in Western Burkina Faso were prospectively assessed for eight months in 2015. Automatic measurements were compared to routine temperature loggers and vaccine vial monitors (VVM).

RESULTS

The median age for all refrigerators was 9 years with 10/25 (42%) older than 10 years. Adverse temperatures were recorded in 20/24 (83%) refrigerators and ranged from -18.5 °C to +34.2 °C with 12,958/128,905 (10%) abnormal hourly records below +2 °C and 7357/128,905 (5.7%) above +8 °C. Time of day significantly affected the rate of temperature excursions, with higher rates from 00 am to 06 am (p < 0.001) for low temperatures and 10-12 am (p < 0.001) and 13-16 pm (p < 0.001) for high temperatures. Abnormal temperatures lasted from 1 h to 24 h below +2 °C and 13-24 h above +8 °C. Standard manual registers reported only 182/2761 (7%) inadequate temperatures and VVM color change detected only 133/2465 (5%) disruptions. Reliability of the refrigerators ranged from 48% to 98.7% with a median of 70%. Risk factors for excursions were old age of the refrigerators, the months of April and May, hours of high activity during the day, and health staff-associated factors such as inappropriate actions or insufficient knowledge.

CONCLUSION

Important cold chain reliability issues reported in the current study in Western Burkina Faso raise concern about vaccine potency. In the absence of systematic renewal of the cold chain infrastructure or improved staff training and monitoring, antibody response assessment is recommended to study levels of effective immunization coverage.

On-farm storage of livestock vaccines may be a risk to vaccine efficacy: a study of the performance of on-farm refrigerators to maintain the correct storage temperature

BACKGROUND

Livestock vaccines (LV) are often stored on-farm, in a refrigerator (fridge), prior to use and little is documented about the storage conditions during this period. As the quality of a vaccine can be impaired by storage at an incorrect temperature, the present study aimed to evaluate the on-farm performance of farm fridges to maintain the correct storage temperature. From January to August 2014, temperature data loggers were placed on selected farms fridges used to store LV (n = 20) in South-West England.

RESULTS

Temperature recording data was available from 17 of the 20 farms. Fifty-nine percent of farm fridges had at least one temperature recording above 8 °C, 53% had at least one recording below 2 °C and 41% at or below 0 °C. Internal fridge temperatures attained 24 °C and dropped to - 12 °C as an absolute maximum and minimum respectively. Fridges tested spent an average of 16% of the total time recorded above 8 °C. Time of the year significantly influenced the percentage of time above 8 °C. External and internal temperatures were found to be positively correlated (p < 0.001). Statistical significant differences in internal and external temperatures were found between March and August.

CONCLUSIONS

The majority of fridges in this study would have failed to keep any stored LV within the recommended storage temperature range. If LV are going to be stored on-farm prior to use, then urgent improvements in this part of the cold-chain are required in order to insure vaccine efficacy is not compromised.

Cold chains, interrupted

Purpose

The purpose of this paper is to analyze how far technology and information enable, facilitate or support the planning and implementation decisions in humanitarian vaccine cold chains for vaccination campaigns. The authors specifically focus on three emerging technologies that have the potential to create more flexible conditions in the field, and identify the need to further explore the link between uncertainty, information and irreversibility.

Design/methodology/approach

The authors present a basic structure for the analysis of cold chain disruptions in terms of three distinct yet connected layers of deficient infrastructure and capacity, information gaps and failures in decision making. The authors then review three humanitarian technologies and their impact on vaccine campaigns along these layers. From there, a research agenda is developed to address research gaps this review brought forward.

Findings

Three critical research gaps in the areas of technology innovation for humanitarian vaccine cold chain management are presented. The authors argue that technology to improve capacity, information and decisions need to be aligned, and that the areas of uncertainty, information and irreversibility require further investigation to achieve this alignment. In this way, the paper contributes to setting the research agenda on vaccine cold chains and connects humanitarian logistics to technology, information management and decision making.

Originality/value

This paper presents the humanitarian vaccine cold chain problem from an original angle by illuminating the implications of technology and information on the decisions made during the planning and implementation phases of a vaccine campaign. The authors develop an agenda to provide researchers and humanitarians with a perspective to improve cold chain planning and implementation at the intersection of technology, information and decisions.

Demonstration of the Use of Remote Temperature Monitoring Devices in Vaccine Refrigerators in Haiti

After the 2010 earthquake, Haiti committed to introducing 4 new antigens into its routine immunization schedule, which required improving its cold chain (ie, temperature-controlled supply chain) and increasing vaccine storage capacity by installing new refrigerators. We tested the feasibility of using remote temperature monitoring devices (RTMDs) in Haiti in a sample of vaccine refrigerators fueled by solar panels, propane gas, or electricity. We analyzed data from 16 RTMDs monitoring 24 refrigerators in 15 sites from March through August 2014. Although 5 of the 16 RTMDs exhibited intermittent data gaps, we identified typical temperature patterns consistent with refrigerator door opening and closing, propane depletion, thermostat insufficiency, and overstocking. Actual start-up, annual maintenance, and annual electricity costs for using RTMDs were $686, $179, and $9 per refrigerator, respectively. In Haiti, RTMD use was feasible. RTMDs could be prioritized for use with existing refrigerators with high volumes of vaccines and new refrigerators to certify their functionality before use. Vaccine vial monitors could provide additional useful information about cumulative heat exposure and possible vaccine denaturation.

Is freezing in the vaccine cold chain an ongoing issue? A literature review

Vaccine exposure to temperatures below recommended ranges in the cold chain may decrease vaccine potency of freeze-sensitive vaccines leading to a loss of vaccine investments and potentially places children at risk of contracting vaccine preventable illnesses. This literature review is an update to one previously published in 2007 (Matthias et al., 2007), analyzing the prevalence of vaccine exposure to temperatures below recommendations throughout various segments of the cold chain. Overall, 45 studies included in this review assess temperature monitoring, of which 29 specifically assess 'too cold' temperatures. The storage segments alone were evaluated in 41 articles, 15 articles examined the transport segment and 4 studied outreach sessions. The sample size of the studies varied, ranging from one to 103 shipments and from three to 440 storage units. Among reviewed articles, the percentage of vaccine exposure to temperatures below recommended ranges during storage was 33% in wealthier countries and 37.1% in lower income countries. Vaccine exposure to temperatures below recommended ranges occurred during shipments in 38% of studies from higher income countries and 19.3% in lower income countries. This review highlights continuing issues of vaccine exposure to temperatures below recommended ranges during various segments of the cold chain. Studies monitoring the number of events vaccines are exposed to 'too cold' temperatures as well as the duration of these events are needed. Many reviewed studies emphasize the lack of knowledge of health workers regarding freeze damage of vaccines and how this has an effect on temperature monitoring. It is important to address this issue by educating vaccinators and cold chain staff to improve temperature maintenance and supply chain management, which will facilitate the distribution of potent vaccines to children.

A fuzzy MICMAC analysis for improving supply chain performance of basic vaccines in developing countries

INTRODUCTION

In recent years, demand to improve child immunization coverage globally, and the development of the latest vaccines and technology has made the vaccine market very complex. The rise in such complexities often gives birth to numerous issues in the vaccine supply chain, which are the primary cause of its poor performance. Figuring out the cause of the performance problem can help you decide how to address it. The goal of the present study is to identify and analyze important issues in the supply chain of basic vaccines required for child immunization in the developing countries.

RESEARCH DESIGN & METHODS

Twenty-five key issues as various factors of the vaccine supply chain have been presented in this paper. Fuzzy MICMAC analysis has been carried out to classify the factors based on their driving and dependence power and to develop a hierarchy based model. Further, the findings have been discussed with the field experts to identify the critical factors.

RESULTS & CONCLUSION

Three factors: better demand forecast, communication between the supply chain members, and proper planning and scheduling have been identified as the critical factors of vaccine supply chain. These factors should be given special care to improve vaccine supply chain performance.