Mass Immunization Cold Chain Project A Public Private

Mass Immunization Cold Chain Project A Public – Private Partnership BC Centre for Disease Control Provincial Health Authorities sanofi pasteur Cryopak Industries Inc.

Goal n To enhance best practices for cold chain maintenance during school & community-based immunization clinics in British Columbia

5 Project Phases 1. 2. 3. 4. 5. Field Survey Site Visits Determination of Test Profiles & Selection of Vaccine Coolers Testing Presentations of testing results

Phase 1 – Cold Chain Needs Assessment Survey Web survey: Ø Current equipment Ø Packing and monitoring Ø Temperatures and time n

Survey Results: Coolers in Field Use n n n > 80 different containers described 83% used smaller coolers at immunization stations to minimize open/close times 16, 32 or 64 qt used for transporting vaccines to clinic setting

Survey Results: Cooler Packing Protocols n n 56% transport > 50 units of vaccine to clinics 28% pack coolers differently for summer & winter

Survey Results: Temperature Monitoring n n n 50% never monitor cooler temps during transport & handling & 10% always do so Chemical indicators & digital thermometers were equally used for monitoring Monitor placement varied – at top of cooler, near vaccine, next to ice packs

Phase 2 - Site Visits n n Purpose: n To validate survey data and elicit further comments/questions from field staff Sites visited: - community and school-based clinics

Site Visit Observation Summary n n n 50% monitor temperature in main vaccine cooler 5 sec open/close time of coolers Multitude of vaccine packing configurations: frozen ice packs always on bottom and seldom on top in the cooler

Phase 3: Testing of large (34 & 38 quart) and small (16 quart) hard-sided coolers n Two commonly used brands n Testing under summer and winter simulated conditions n

Summer/Winter Extreme Profiles Scenario Time: 19. 75 hr Summer Apr 2 -Nov 14 Winter Nov 15 -Apr 1 Car travel time & temp 3 hr @ 38 C 3 hr @ 28 C 6 hr @ 25 C 12 hr @ 22 C Ambient temp 38 C -15 C Site 22 C 6 hr

Thermocouple Probe Placement

Phase 5: Results n n First impact: time at which first probe at ≥ 8. 1 o C Core impact: time at which 50 % of probes at ≥ 8. 1 o C

Small Cooler : Winter

Small cooler travel to site clinic travel to HU Bio unpack Bio pack vehicle 1 st impact-18. 5 hr Core impact-20. 2 hr

Large Cooler: Summer

Large Cooler 1 st impact-2. 3 hr Core impact-7. 8 hr

Considerations: Different packing for seasonal conditions n Maintain the packing configuration n n Extremes of temperature n Ice on top

acknowledgements n n n Public health staff – provincial partners sanofi pasteur: Joan Rousseau Don Easterbrook, Thermal & Protective Packaging Linda A Walker Consulting, LLC Bruce Pettigrew BCCDC: Dr. Eleni Galanis

Thank you n cheryl. mcintyre@bccdc. ca