Dear Colleagues!
Wastage of vaccine by freezing is horrible in my country (Russia). It's much more important than heating. First of all, a huge part of Russia has winter (air temperatures below 0 C) for 7-8 months. And, as the result, most of the shipments come to clinics already frozen. As the rule it happens on the ramp (in airport). Second problem - old fridges and errors of storage practices (no water bottles in fridges, not properly installed thermo regulator, no well qualified personnel). And the third - "amber light - stop" it means that the vaccine can be discarded if the temperature is below +2C (not 0 C) in accordance with Russian sanitarian rules. Does anybody know what happens with the vaccine if the temperature of transportation was +1,5 deg C? In Russia nobody knows, but everybody is afraid to use the vaccine - because in sanitarian rules of transportation and storage we have a string - "+2 ...+8 deg C, otherwise - discard!"
In my experience up to 70% of the clinics (3-4 level) have these problems. It become better when personnel start to use fridge-tags, and after explanation of storage practices (WHO how to). Shake-test is still unknown in Russia and there are no approved methodis in Russian.
I don't know about official statistics of vaccine wastage in Russia, but according to IMHO it's about 75%! 35-40% happens on 2-3 level. 35% on 3-4 level.
What we do:
1. Study, Study and one more time Study! Personnel is the first.
2. Test fridge before use. We recommend to test fridge with data logger before we use it.
3. Use
Matryoshka" (nested doll) method when preparing winter shipment ( it means vaccine -> package -> cardbox-> coldpack->cardbox ->warmpack->PU or EPS container) for long distances.
4. Use insulated pouches or cardbox for 2-5 hour shipments on 3-4 level ( it means vaccine -> package ->pouche (cardbox)-> coldpack -> container)
There are still many functional vaccine coolers/refrigerators in the field that are equipped with adjustable thermostat. Is it possible to change these thermostats to a non-adjustable type so that users could not change its settings?
Absolutely agree. Automatic thermostats are much more useful then manual! I know a lot of cases when a big quantity of vaccine was delivered to the clinic, and the personnel change by themselves the settings of thermostat (because they are afraid of heating) and then forgot about it. So the vaccine become frozen in the night.
P.S. Sorry for my English.