POST 00609E : DESTRUCTION OF VACCINES Follow-up on Posts 00603E and 00606E 5 October 2003 ____________________________________________ This posting contains three contributions. The first is from StÃ©phane Guichard (mailto:[log in to unmask]) from WHO. The second is from James Patterson (mailto:[log in to unmask]) and finally, the last is from Jeanne Mondo (mailto:[log in to unmask]) from DR Congo. _______________ Both StÃ©phane and James contributions point to risks of releasing live attenuated vaccines in the environment. I do not feel that I am in any position to assess such risk but I question it as maybe others do. Consequently I would like to ask if any member has precise scientific information to share on this topic. The Moderator ____________________________________________ I think before crushing the vial or burying it, vaccine must be decontaminated especially live attenuated virus vaccine. A simple method would be to boil the vial for 20 to 30 minutes. StÃ©phane Guichard Technical Officer VSQ WHO SEARO _____________________________________________ Having started and benefited from the East Timor discussion on vaccine disposal some two years back, perhaps it would be useful to share the results of our thinking/learning at that time. In short, following the circumstances of an emergency deployment of EPI activities in 1999/2000, there was inadvertently a massive residual of expired and destroyed vaccines. I suspect this is important, as practically speaking many options appeared ominous when the quantities are large. We also directed all EPI clinics to send expired vaccines to the capital for destruction. In such a small country this was straightforward and we avoided designing/implementing solutions at a local level. Indeed there was (and still is) a shortage of elegant solutions. Nevertheless, we found the "Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and after Emergencies", provided the greatest level of technical detail. (http://www.who.int/medicines/library/pa ... r-99-2.htm) Options considered. 1. Returning to vendor. This was felt to be too complicated with multiple vaccine suppliers and too expensive with high shipping costs from a remote island. 2. Incineration. There was no incinerator with sufficient capacity to cope reliably with the volume of metal and glass. Further, there was fear that a very specialised system was needed to ensure that noxious vapours would be safely filtered. The risk of damaging the main/only incinerator with exploding vials was also raised. 3. Breaking the vials. There are some suggestions in the guide (above) for breaking vials and neutralising the liquid, etc. However the task still appeared to pose some risk to both the worker and the environment especially for such a large stock of vaccines. The consequences of releasing quantities of live vaccines was particularly problematic. 4. Encapsulation. This was the option settled on. Under direct supervision of health staff, the vials were layered with concrete into a 200 liter fuel drum and welded shut. The drum was delivered to the landfill. If faced with a similar situation, I still think encapsulation is the most expedient solution. Further, centralising (whether regional or national) the collection of destroyed vaccines highlighted clinics with weak cold chain management for follow-up support and supervision. Best regards James Patterson __________________________________________ The problem of destruction of vaccines and other medicines will remain with us so long as the management of our programmes remains weak. Some four years ago, EPI-DRCongo has experienced the deterioration of a large quantity of vaccines, which had to be destroyed, following the country guidelines valid at the time. The adopted destruction procedure was as follows: 1. Inform the Department of Drugs and Medicines on the deterioration, with the maximum details possible regarding its causes. 2. Draw up an account of stocks and its disposal, with the help of inspectors from that same Department, 3. Incinerate and bury the debris. 4. Write a circumstantial report for the attention of the authorities. We would like to highlight the fact that the destruction of vaccine at the time did not follow the established standard. 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