by Olivier Ronveaux, WHO, and Mojtaba Haghgou, Vaccine Management Consultant Maintaining required temperatures in vaccine refrigerators and freezers is one of the more thankless tasks of a cold chain manager as it requires painstaking manual recording of the temperature of each piece of equipment twice daily. Despite the monotony, temperature monitoring is a crucial task, especially in central stores at the national level where millions of doses of costly vaccines are at stake. A 2004 study of vaccine freezing in Indonesia, for example, found that freezing temperatures were recorded in 74% of shipments. Without careful temperature monitoring, accidental freezing or overheating of certain vaccines can reduce their potency to levels that render them ineffective against disease. Several countries, among them Sudan and Iran, have found a way to automate the temperature monitoring system saving both time and money while increasing the accuracy and reliability of the monitoring system. While Sudan is a bit smaller in population than Iran, the two countries have a similarly sized number of surviving infants (1,086,000 in Sudan and 1,300,000 in Iran) and handled an almost identical number of doses of vaccines in 2007/2008 (about 108.8 million doses). Sudan automated its temperature recording system with financial and technical support from the World Health Organization (WHO) Regional Office for the Eastern Mediterranean (EMRO) in 2007. A United Kingdom-based company was contracted for the design, assembly, and installation of the system which cost about £52,000 at the time. The system includes a network of gas-type temperature sensors (Figure 1) in each cold and freezer room that measures the internal temperature and transmits it wirelessly via a transmitter installed on the roof of each cold and freezer room to a hub. The hub is connected to a computer for saving data. The store manager can also view the data on a monitor in his office (Figure 2). When temperatures exceed 10[sup]o[/sup]C or fall below 0[sup]o[/sup]C, an alarm system sounds a siren in the store and calls the mobile phones of the store staff and the Expanded Programme on Immunization (EPI) manager. The system also sends a short message service (SMS) text to the mobile phones providing information about the specific cold or freezer room and its internal temperature at the time of breach. The system has functioned continuously since February 2007 without interruption or malfunction. A manual system is maintained for backup purposes and is kept on file. Iran's system is older (2005) and perhaps more impressive because it was manufactured, designed, assembled, installed, and maintained entirely by local companies. Although the cost of the system is unknown, it is likely to be the less expensive of the two systems since it involved no international travel or foreign labor costs. The system is similar to the Sudanese system with the following differences: local products and labor, the connection between the temperature monitor and the modem is wired (not wireless), the connection between the modem and the computer is wireless, and the temperature sensors are digital, rather than gas type. EPI staff members from many other countries in the region have already toured Sudan to learn about its system, and there is great interest globally in replicating the concept. Since 2007, WHO has established specifications for performance, quality, and safety (PQS) for temperature monitoring systems and protocols for testing such systems. To support decision-making, Optimize is working to establish minimum criteria under which countries should consider installing automatic temperature recording systems. The type of recommended system will depend on the size of the stores, the number of vaccine doses handled per year, and the importance and location of the store. Download a copy of a recent Optimize report on temperature monitoring systems in Sudan and Iran.
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I congratulate for the nice gesture for sharing the valuable information which would be helpful to one and all. Thanks a lot. Regards, Nagaraj
The seven publications of OPTIMIZE.WHO that were made available, in a series to all of us, are very valuable in many ways. Vaccine manufacturers, Government agencies and End Users in the UIP will benefit from such published work not only in terms of logistics and other technical details but also due to the possibility of an attitudinal change to think optimally. Governments of the developing countries should be encouraged to allot funds to train and educate those responsible for UIP implementation and execution. Thanks. Dr.G.V.J.A.Harshavardhan Director - RVDP
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The third country will be Pakistan. We are in coordination with the same firm to install this system in Pakistan and very soon we will succeed. All the formalities have been done; only the contract remains to be awarded to the firm, which will be done shortly. Ghulam Taqi
For the smaller vaccine store, we, at Remonsys Ltd in the UK, can supply the MULTiLOG--a 8, 12 or 16-sensor temperature data logger that connects to a PC and will log the temperaures in the store at, say 60 minute intervals, to provide a continuous record of temperatures. The temperaures at each sensor location can be viewed on screen at any time and the data will download to a hard disc at regular intervals. It operates off a long-life battery (5 years) and the sensor lead length can be up to 200m. The MULTiLOG has an audible alarm built in and an telephone auto-dialler can be connected to warn of out-of-hours temperature problems. Find more details at http://www.remonsys.com. I hope this is helpful. Tom Lewis Remonsys Ltd +44 1993 886996 Please reply to [firstname.lastname@example.org]email@example.com[/email]
Thank you for this detailed information. It is an information all programme managers can take. Regards, Nagaraj
Here are some photos of a 16-channel MULTILOG that I installed with UNICEF/ WHO at Haiti's national Cold Store about 3 years ago - roughly the same system that Ranjit described in his post. Manuals available to learn more about functionality at http:// http://www.remonsys.com/multilog.htm Easy setup but there were issues with needing an actual landline at the site to get the Autodialler to work. Also, there was no access allowed to the site on weekends for security reasons (leased facility if I recall), so setting it up to dial key personnel up the chain of command until someone answers and enters the required code, wasn't an option. A UPS for the desktop computer used to gather and display data, and a generator with a fast automatic-startup time were also needed. In this scenario, lines were run all the way from the cold room into the control room (no remote transmitter as described by Olivier and Motaba). When someone comes out with a version with a cellular transmitter which will display the data on PDA screens, foregoing the need for a computer on site, the technology will be mature! Tory Hart Consultant - Technology for Health and Environment ##text## ##text##
Thank you very much Tory Hart. This information and specially link will be very helpfull for those who have this system but not functional due to some reasons, specially for me. We have two multilogs but not working since long and tried lot of times to install it but fails due to non availability of installation material. Regarding remote transmitters shared by Oliver and Mojtaba. These are also very essential because multilog needs cabling from control room to cold rooms and for wireless temperature monitoring system no need of cabling. As per our experience we were using multilogs since ago but the cables broke due to construction/renovation in the campus and we failed. I say both systems will be very good and helpful to get all time data according to scenario of the country cold rooms situation/locations. However, thank you very much, now we can again try to install multilog systems with the help of your information. With best regards Ghulam TaqiIslamabad-Pakistan
Dear TaqiMy humble submission is that as long as we do not have the automated systems lets ensure that the temperatures are religiously recorded on a piece of card twice a day every day for each cold/freezer room and signed by supervisors atleast once every week. and signed by the program manager once every month. This is then presented in the Steering committe meetings atleast once every month. I asure you this will make a difference.Best regards
Dear Dr. Faisal, Thank you for your comments, we were doing the same practice since long and i have maitained the folder of these documents from last one year. We are also going to install wireless temperature monitoring system for National EPI Vaccines stores soon. Thank you and best regards Ghulam Taqi
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