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 Table of Contents  
Year : 2015  |  Volume : 2  |  Issue : 1  |  Page : 63-64

Strengthening cold chain mechanism to enhance the effectiveness of immunization program

Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, India

Date of Web Publication23-Jun-2015

Correspondence Address:
Dr. Saurabh RamBihariLal Shrivastava
Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai Village, Thiruporur - Guduvancherry Main Road, 3rd Floor, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2349-4220.159161

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Strengthening cold chain mechanism to enhance the effectiveness of immunization program. Int J Adv Med Health Res 2015;2:63-4

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Strengthening cold chain mechanism to enhance the effectiveness of immunization program. Int J Adv Med Health Res [serial online] 2015 [cited 2021 Jun 12];2:63-4. Available from: https://www.ijamhrjournal.org/text.asp?2015/2/1/63/159161

Globally, from a public health point of view, bringing about a reduction in child mortality has received key attention, as witnessed in the millennium development goal - 4 and even in the primary health care approach. [1] Ensuring immunization of children against vaccine-preventable diseases has delivered promising results and is being considered as one of the most cost-effective public health interventions available to minimize child deaths worldwide. [1],[2] However, to achieve the desired targets, two parameters, namely delivery of potent vaccines to children through a properly maintained cold chain systems and achieving high vaccine coverage, needs to be monitored. [3]

The "cold chain" is an integrated system of storage and transport of vaccines at recommended temperature from the manufacturer to the actual vaccine administration location in order to maintain the quality/potency of the vaccines. [3],[4] The cold chain generally encompasses of walk-in-cold rooms (regional level), deep freezers and ice lined refrigerators (district level, primary health centers, etc.), cold boxes (all peripheral centers), vaccine carriers and day carriers (for outreach sessions), ice packs, and health personnel involved in immunization work. [1] Among the vaccines, polio (storage at minus 20°C) and measles must be stored in the freezer compartment while typhoid, diphtheria pertussis tetanus, tetanus toxoid, bacillus Calmette-Guerin and diluents must be stored in the cold part. [1] However, in the health centers, most vaccines (except polio) can be stored for almost 5 weeks if the refrigerator (4-8°C). [1],[2] Maintenance of cold chain system is of vital importance as any error during the storage/transportation results in vaccine failure, which in turn has negative effect on vaccine potency, immunization coverage rate, reporting of disease despites the availability and administration of vaccines, rise in adverse events following immunization among vaccinated children, loss of faith of general population on public health system, and significant burden on the existing health infrastructure. [5],[6] In-fact, definitive evidences are available to suggest the noncompliance of national immunization programs to the different components of the cold chain. [1],[2],[4],[5],[7],[8],[9],[10]

A wide range of avoidable parameters viz., absence of cold chain equipment in health facilities; poor condition of the cold chain equipment; limited access of cold chain equipment to power supply; absence of standardized protocols across different nations; untrained status of health personnel involved in the vaccination program; no sensitization of the general practitioner about the do's and don'ts of vaccine storage; incomplete or absence of temperature recording; wrong packing of vaccines and ice packs; poor awareness among the general population; use of domestic refrigerators in clinical settings for storage of vaccines; limited support from the policy makers; and absence of a streamlined mechanism to monitor the different stages of cold chain at different levels; [1],[5],[7],[8],[9],[10] and unavoidable parameters (like thermo-labile nature of vaccines, nonexistence of vaccine-vial monitor on all vaccines to suggest its potency); [2],[5] have been identified which seriously hampered the effectiveness of immunization and organization of outreach/mobile immunization sessions.

In order to ensure significant improvement in the cold chain, implementation of some key interventions to target the identified factors like devising regulatory pathways for both vaccine development and the supply chain; [2] promoting access to existing standardized guidelines and making available cold chain tools and equipment in health facilities; [5],[7] encouraging sponsors and researchers to manufacture thermo-stable vaccines; [2],[5] introducing quality standards like providing vaccine-vial monitor to all vaccines; [5] organizing training of health professionals; [5],[7] sensitizing general physicians regarding importance of maintenance of cold chain; [8] creating awareness among the masses about cold chain; [7] ensuring continuous power supply to maintain the potency of vaccines; [5] adopting innovative strategies like computerizing temperature monitoring of the vaccine; [11] and ensuring constant supervision to identify and address factors leading to failure of cold chain. [1],[5] Furthermore, studies have shown a significant improvement in different vaccine/cold-chain related parameters (viz., heat failure, potency of vaccines, overall wastage) on adhering to the cold chain guidelines. [5],[6]

To conclude, maintenance of the cold chain is the backbone for success of an immunization program, and thus there is a crucial need to preserve the potency and safety of the vaccine to ensure reduction in childhood deaths on the global level.

  References Top

Park K. Principles of epidemiology and epidemiologic methods. In: Park K, editor. Textbook of Preventive and Social Medicine. 20 th ed. Jabalpur: Banarsidas Bhanot Publishers; 2009. p. 101-3, 792-6.  Back to cited text no. 1
Harshakumar HN, Aggarwal A. Cold chain maintenance and vaccine administration practices in hospitals & clinics of Mangalore city - A health system's research. Natl J Community Med 2013;4:231-5.  Back to cited text no. 2
Krishnappa L, Anniappan AB, Voderhobli NH, Krishna SK, Yathiraj S, Sreekantaiah P. Evaluation of cold chain practices in urban health centers of a metro city in India. Natl J Community Med 2014;5:288-92.  Back to cited text no. 3
Naik AK, Rupani MP, Bansal RK. Evaluation of vaccine cold chain in urban health centers of municipal corporation of Surat city, Western India. Int J Prev Med 2013;4:1395-401.  Back to cited text no. 4
[PUBMED]  Medknow Journal  
Mallik S, Mandal PK, Chatterjee C, Ghosh P, Manna N, Chakrabarty D, et al. Assessing cold chain status in a Metro city of India: An intervention study. Afr Health Sci 2011;11:128-33.  Back to cited text no. 5
Goel NK, Swami HM, Bhatia SP. Evaluation of cold chain system in Chandigarh during PPI campaign 2001-2002. Indian J Public Health 2004;48:200-4.  Back to cited text no. 6
[PUBMED]  Medknow Journal  
Tuells J. Visibility of the vaccine cold chain in Spain. An Sist Sanit Navar 2013;36:309-20.  Back to cited text no. 7
Rao S, Naftar S, Baliga S, Unnikrishnana B. Evaluation, awareness, practice and management of cold chain at the primary health care centers in coastal South India. J Nepal Paediatr Soc 2012;32:19-22.  Back to cited text no. 8
Samant Y, Lanjewar H, Parker L, Block D, Stein B, Tomar G. Relationship between vaccine vial monitors and cold chain infrastructure in a rural district of India. Rural Remote Health 2007;7:617.  Back to cited text no. 9
Uçar A, Ozçelik AÖ. Individuals' knowledge and practices of the cold chain. Ecol Food Nutr 2013;52:116-29.  Back to cited text no. 10
Schlumberger M, Mireux F, Tchang SG, Mboutbogol D, Cheikh DO, Hissein AA, et al. Computerized temperature monitoring of the vaccine cold chain in a tropical climate, Chad. Med Trop (Mars) 2011;71:264-6.  Back to cited text no. 11


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