Managing Vaccine
How to keep vaccines viable and patients protected
Only viable vaccine will protect your patients. You can’t tell by looking at vaccine
whether it has lost potency through mishandling or improper storage. Everyone
who works with vaccines must to be familiar with best practices for minimizing the
risk of vaccine becoming nonviable.
Overview of this section
"It is better to NOT
vaccinate than
to administer a
mishandled
Best Practices Checklist: Managing Vaccine
Managing Your Vaccine
vaccine!"
Donna Weaver, CDC
Ordering Vaccine and Managing Inventory
Receiving Vaccine
Storing and Handling Vaccine
Who to Call
Disposing of Vaccine
Planning for Vaccine Storage Emergencies
Packing and Transporting Vaccine
Minnesota Vaccines for
Children
651-201-5522
Key Resources for Managing Vaccine
Minnesota Immunization
Program
800-657-3970
651-201-5503
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
1
Best Practices Checklist: Managing Vaccine
The information in this checklist will be covered in more detail throughout this section.
Ordering vaccine and managing inventory
Disposing of vaccine
ˆˆ We keep an up-to-date list of the vaccines our
clinic uses and where/how to order them.
ˆˆ We dispose of spoiled or expired vaccine and
diluents properly.
ˆˆ We check our vaccine inventory at least monthly
and with each vaccine order.
Planning for vaccine storage emergencies
ˆˆ We rotate vaccines at least monthly by placing
lots with the earliest expiration dates in front so
they will be used first.
Receiving vaccine
ˆˆ We make sure all staff know what to do with
vaccine when it arrives.
ˆˆ We train our staff on the appropriate arrival
condition of each vaccine.
ˆˆ We keep a log of all vaccines received.
Storing and handling vaccine
ˆˆ We train our staff to be familiar with proper
vaccine storage and handling (e.g., protecting
MMR from light, refrigerated vs. frozen
vaccines).
ˆˆ We have a plan for storing and transporting
vaccine in an emergency and staff are trained
accordingly.
ˆˆ We have identified an alternate site to store
vaccine in case of a lengthy power outage.
Packing and transporting vaccine
ˆˆ We keep a list of clinics and contact names in
case we need to transfer or transport vaccine.
ˆˆ We use coolers and thermometers that meet all
the specifications for transferring or transporting
vaccine.
ˆˆ Our staff is familiar with how to pack vaccine
according to established standards.
ˆˆ We keep a list of packing suppliers.
ˆˆ We use refrigerator(s) and freezer(s) that meet
all the specifications for proper vaccine storage.
ˆˆ We store vaccine in the recommended
compartments - frozen vaccine in the freezer
and refrigerated vaccine in the refrigerator.
ˆˆ We use our refrigerators and freezer only for
vaccine storage (i.e., no food or beverages).
ˆˆ We only use calibrated thermometers.
ˆˆ We check and record temperatures on a log
twice a day and post it on the refrigerator/freezer
door.
ˆˆ We train our staff to take immediate action when
temperatures are out of range.
ˆˆ We perform routine maintenance on our vaccine
storage units.
ˆˆ We safeguard the power supply of our vaccine
storage units by posting Do Not Unplug and
Warning stickers.
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www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Managing Your Vaccine
“Vaccine quality is the
shared responsibility of
all handlers of vaccines
from the time a vaccine
is manufactured until
administration.”
Vaccines are expensive — one of the most valuable assets a clinic has — so
it is important to keep them safe. Taking care that all staff adhere to vaccine
management policies will best protect this costly asset.
ACIP General
Recommendations on
Immunizations, 2011
The cost of vaccine adds up quickly — even for a small immunization clinic. Take
a moment to think about what your clinic's refrigerator and freezer are worth and
make a commitment to adopt solid storage and handling policies.
What’s your refrigerator and freezer worth? Over $38,000.00!*
Refrigerator-only unit
$5567.20
$910.80
DTaP
20 doses
PedvaxHib
Freezer-only unit
20 doses
20 doses
Rotateq
PedvaxHib
$5437.50
$2415.50
20 doses
Rotateq
20 doses
MMR
$3536.00
20 doses
10 doses
MMR
MMR
Frzn Pack Frzn Pack
$4029.00
old
Cold C ack
P
Pack
30 doses
20 doses
PCV
PCV
$2605.40
$2068.20
20 doses
Gardasil
20 doses
30 doses
Pediarix
40º
0º
Pediarix
$1497.20
20 doses
20 doses
Varicella
20 doses
20 doses
20 doses
Menveo
Adacel
Adacel
10 doses
Varicella Varicella
Frzn Pack Frzn
Pack
$807.50
$247.10 $209.60 $547.80 $213.70 $758.60
10 doses
10 doses
20 doses
10 doses
20 doses
5 doses
IPOL
Infanrix
Havrix
Engerix-B
PPSV
Zoster
$525.00
10 doses
Cold
Cold Pack
Pack
HepB Adult
H2O
$394.00
$5246.40
$1025.00
40 doses
100 multi-dose
vials
20 doses
Afluria
Flumist
Fluzone Peds
H2O
H2O
H2O
Frozen
Pack
Frozen
Pack
Frzn Pack
Frozen
Pack
Frzn Pack
Frzn Pack
H2O
Value of vaccine in freezer = $7252.00
Value of vaccine in refrigerator not including flu = $24,151.10
Value of vaccine in refrigerator including flu = $30,816.50
*Based on 2010 vaccine prices and inventory of a small clinic. Brand name identification is for sample purposes and is not
an endorsement of one product brand over another.
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
3
Ordering
Vaccine and
Managing
Inventory
General instructions for ordering vaccine
yy Write a procedure for the primary and backup vaccine coordinators to follow
for ordering vaccine from both the MnVFC program and from manufacturers/
distributors.
yy Keep an up-to-date list of the vaccines your clinic uses and where to order them.
Managing vaccine inventory
yy Review your vaccine inventory each month and with each vaccine order to
avoid over-ordering. Make sure you:
○○ Check vaccine expiration dates.
○○ Rotate your supply by placing vaccines with the earliest expiration dates in
front of others and always using them first. Mark the packages "use first"
to alert staff. If the expiration date is listed by month and year, the vaccine
expires the last day of the month (for example, "06/2011" means the
vaccine will expire on June 30, 2011).
yy Keep a log of all vaccines in inventory; see Monthly Vaccine Inventory Log on
page 39. At the very least, make sure you record the:
○○ Vaccine name
○○ Manufacturer
○○ Lot number
○○ Number of doses
○○ Expiration date
○○ Date of receipt
○○ National Drug Code (NDC) number
yy Use the log as a tool to provide information on how much of each vaccine
your clinic uses. You may need to refer to it if you have a storage and handling
mishap or if you need to find a recalled vaccine.
Implementing a new combination vaccine
yy Work with the physician(s) on staff to use up current stock of vaccine while
transitioning to the new combination vaccine (i.e., completing a series with
the current brand and starting the new vaccine only in children beginning a
series).
yy If you have excess vaccine you won't use after transitioning to the new
combination vaccine try to transfer it to another clinic where it can be used
before it expires.
TAKE ACTION
If you have excess vaccine or vaccine that will expire within three
months:
1. Don't wait until the last minute. Determine which vaccines can be used
before they expire.
2. Transfer vaccines you won't use to another clinic where they can be used
before they expire.
3. If it is MnVFC vaccine, call the MnVFC program at 651-201-5522 for
guidance. For private purchase vaccine, check your purchase agreement
for guidance.
4
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
General instructions for receiving vaccine
yy Write a procedure for receiving vaccine.
yy Make sure all staff know what to do with vaccine when it arrives.
yy Be familiar with the appropriate arrival condition of each vaccine; see Guide to
Receiving, Storing, and Handling Vaccines on page 19.
yy Open containers immediately upon receipt, inspect vaccine for damage,
and check the warm- or cold-mark temperature indicators (if included in the
package). If you have questions about the condition or viability of the vaccine
at the time of delivery, see the TAKE ACTION box on page 6.
yy Check quantities ordered, lot numbers, and expiration dates against the
invoice or packing slip. For MnVFC vaccine, report any discrepancies or
concerns within two hours of receiving the vaccine. For private purchase
vaccine, check your purchase agreement for guidance.
yy Keep invoices and/or packing slips and record the date the vaccine was
received on them.
Receiving MMRV, varicella, and zoster vaccine
yy Regardless of whether these vaccines are ordered privately or come from the
MnVFC program, they are shipped directly to the clinic from the manufacturer/
distributor.
yy MMRV, varicella, and zoster vaccines should arrive frozen.
yy Based on manufacturer recommendations, redistribution of MMRV, varicella,
and zoster vaccines to other clinic sites is not allowed. Redistribution of
these vaccines is not allowed by the MnVFC program.
yy If you receive MnVFC MMRV, varicella, or zoster vaccine from somewhere
other than the manufacturer (i.e., your parent clinic or central pharmacy)
please call the MnVFC program for guidance.
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
Receiving
Vaccine
Did you know that MIIC
can help you manage
vaccine inventory? Here's
how:
yy When you receive
vaccine, record it in
MIIC.
yy Each time a vaccine is
given MIIC tracks the
amount of vaccine left
in inventory.
yy MIIC automatically
inserts the lot number,
expiration date, and
manufacturer when you
enter each vaccination.
yy Using MIIC takes a little
time up front but will
save many steps in the
long run.
www.health.state.mn.us/immunize
5
Receiving Vaccine
TAKE ACTION
If you have questions about the condition or viability of the vaccine at
the time of delivery, for example:
yy Refrigerated vaccines arrive warm or frozen.
yy MMRV, varicella, or zoster vaccine arrives thawed.
yy The color of the cold- or warm-mark temperature indicator (if included in
the package) has changed or the thermometer indicates an out-of-range
temperature.
yy Vaccine vials or syringes are damaged.
1. Mark the vaccine “DO NOT USE” so staff won't inadvertently administer it.
2. Store the vaccine at the correct temperature – apart from other vaccines
– until you can determine if it is viable. Do not throw it away!
3. Call the MnVFC program within two hours of receipt if the vaccine
in question is from MnVFC. For private purchase vaccine, check your
purchase agreement for guidance.
○○ Be ready to provide temperature details, lot numbers, and expiration
dates.
○○ If you are instructed to contact the manufacturer, make sure to ask to
speak to the medical consultant or quality assurance staff.
3. Document your actions; see Vaccine Troubleshooting Log on page 51.
6
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
M
DH does not endorse or recommend a particular brand of refrigerator/freezer
or thermometer, but we do recommend certain features.
Have the right refrigerators/freezers
Use the Volume Based Refrigerator and Freezer Recommendations table on page
9 to help you choose the right refrigerator and/or freezer for your facility based on
the volume of vaccine you need to store.
Essential refrigerator/freezer features
yy Ability to maintain uniform temperatures, preferably with a preset temperature
of 40°F (4°C) in a refrigerator and 0°F (-18°C) or colder in a freezer
yy Enough usable space to hold the year’s largest inventory, such as the back-toschool rush or flu season, and still have room for air circulation
yy Automatic defrost cycle
yy Separate exterior doors and separate controls in each compartment if using a
combination refrigerator/freezer
Storing and
Handling
Vaccine
Don't use a combination
refrigerator/freezer with
one exterior door because
they are unable to
maintain the temperatures
needed for storing
vaccines.
Desirable refrigerator/freezer features
yy Negative-pressure doors that close automatically
yy Built-in thermometers that come with a certificate stating they have been
calibrated according to standards set by the National Institute of Standards
and Technology
yy Security locks
yy Wire racks (as opposed to glass)
yy Visible temperature displays
Unacceptable refrigerator/freezer features
yy Visible cooling plates or open coils on the back wall of the unit
yy Combination refrigerator/freezer with one exterior door, including lab- or
pharmacy-grade units, because they are unable to maintain the temperatures
needed for storing vaccines
yy A manual defrost freezer combined with a cyclic defrost refrigerator
compartment
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
7
Refrigerator / Freezer Advantages and Disadvantages
Storage unit type
Advantages
Disadvantages
yy Able to maintain stable temperatures
Lab- or pharmacygrade purpose-built: yy Temperatures can be pre-set
yy Refrigerator-only yy Good temperature recovery after the
unit has been opened to get vaccines
yy Freezer-only
yy All internal space in the unit can be
used to store vaccines
yy Under-counter
y
y
Most provide an internal thermometer
refrigerator-only
with an external display
yy Under-counter
yy Offers the option of alarm and safety
freezer-only
features to alert you to and/or minimize
temperature fluctuations
Cost: $900 to
yy Includes key locks so only authorized
$10,000
staff can lock and unlock the doors
yy Variety of sizes are available
yy May be the most expensive option
yy Sold by specialty distributors so may be
less convenient to buy
yy Having the built-in thermometer
calibrated maybe an additional cost
yy Should be plugged into a back-up
emergency power supply (additional
cost)
yy Able to maintain stable temperatures
yy Some units allow enough usable space
for the year’s largest inventory, (e.g.,
back-to-school rush or flu season) and
still have room for air circulation
yy Available through major appliance
retailers
yy Variety of sizes are available
yy More usable space than a householdstyle combination
yy No cold air vent from freezer which
provides more stable temperatures
(refrigerator-only units)
yy Temperature control dial has arbitrary
scale; difficult to accurately set desired
temperature
yy Changes in the room temperature affect
the temperature inside the unit
yy Defrost function can cause temperature
fluctuations (freezer-only units)
yy Slow temperature recovery
yy Must also purchase a calibrated
thermometer
yy Able to maintain stable temperatures
yy Separate exterior doors and separate
controls in each compartment
yy Variety of sizes are available
yy Available through major appliance
retailers
yy Usable space is limited in refrigerator
compartment where only the middle
shelves can be used
yy Temperature control dial has arbitrary
scale which makes it difficult to set
temperature for each compartment;
setting freezer at 0°F/-18°C or colder
can make the temperature in the
refrigerator too cold for refrigerated
vaccines
yy Changes in the room temperature affect
the temperature inside the unit
yy Defrost function can cause temperature
fluctuations
yy Slow temperature recovery
yy Must also purchase a calibrated
thermometer
yy Smaller units (18 cubic feet or
less) aren't able to maintain stable
temperatures and may contain hot or
cold spots that put vaccines at risk
Household:
yy Refrigerator-only
yy Freezer-only
Cost: $400 to $4,000
Household-style
combination (dual
zone unit):
yy Refrigeratorfreezer with
separate
exterior doors
and separate
controls in each
compartment
Cost: $400 to $4,000
8
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Storing and Handling
Vaccine
Volume-Based Refrigerator and Freezer Recommendations
Volume
High
Approximate
doses/year
Recommended refrigerators/freezers
10,000 or more • Large capacity purpose-built (lab or pharmacy grade)
refrigerator-only or freezer-only unit designed for
optimum cooling capacity and stable temperature control
Medium
2,000-10,000
Low
2,000 or less
July 2011, Minnesota Department of Health In order of preference, with the first being the best:
yy Purpose-built (lab or pharmacy grade) refrigerator-only or
freezer-only unit designed for optimum cooling capacity and
stable temperature control
yy Household refrigerator-only or freezer-only unit (can be an
under-counter model)
In order of preference, with the first being the best:
yy Smaller under-counter version of a purpose-built (lab or
pharmacy grade) refrigerator-only or freezer-only unit
yy Household refrigerator-only or freezer-only unit
yy Household-style combination refrigerator/freezer with
separate exterior doors and separate controls in each
compartment
Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
9
Storing and Handling
Vaccine
Safeguard the power supply
In-use outlet covers
yy Place Do Not Unplug stickers on the:
○○ Refrigerator/freezer
Stickers are available
○○ Power cord
at no cost from MDH.
○○ Wall outlet
○○ and Warning stickers on the circuit breaker/fuse box
yy Plug refrigerators/freezers into backed-up (emergency power supply) power
outlets, where available.
yy Don't plug refrigerators/freezers into ground fault circuit interrupter (GFI or
GFCI) outlets or extension cords.
Safety-lock plugs
yy Use "in-use outlet covers" or "safety-lock plugs" to avoid accidentally
unplugging the unit. Some outlet covers also come with a locking mechanism.
yy Plan in advance for needed maintenance/electrical work. Make sure you
have a policy/plan in place for scheduled maintenance/electrical work that
may interrupt the power. Communication with building maintenance staff is
essential.
How to check the
refrigerator or freezer
door seal
Place a piece of paper
between the door and the
unit and shut the door. If
the paper stays in place,
the seal is good. If the
paper slides, the seal is
bad.
10
www.health.state.mn.us/immunize Perform routine maintenance
Keeping your refrigerators and freezers running properly requires some routine
maintenance. Add these tasks to your storage and handling policy.
yy For household-style refrigerators and freezers, each month:
○○ Clean the inside when you do inventory.
○○ Vacuum behind refrigerators/freezers and their coils.
○○ Check and clean the door seals to make sure they are sealing completely.
yy For purpose-built (lab or pharmacy grade) refrigerator-only or freezer-only:
○○ Follow the manufacturer’s maintenance schedule.
Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Storing and Handling
Vaccine
Have the right thermometers
Essential thermometer features
yy A certificate stating the thermometer has been calibrated according to national
standards (Without this certificate, thermometers are not acceptable because
their accuracy cannot be guaranteed.)
yy A battery backup, if the thermometer uses an electrical power source
Desirable thermometer features
yy A probe inserted into a biosafe liquid (This more accurately reflects the actual
temperature of the packaged vaccine inside the unit.)
yy An internal probe and an external read (This allows you to read the
temperature without opening the refrigerator/freezer.)
yy An alarm for out-of-range temperatures
yy Easy-to-read digital readout (So you don't have to interpret a scale.)
yy Provides a paper or electronic history of past temperatures
yy Minimum/maximum display of the highest and lowest temperatures
Unacceptable thermometer features
yy Doesn't use a probe inserted into a biosafe liquid (So it only reads the air
temperature inside the unit - not the temperature of the vaccine.)
yy Doesn't have external-read capability (You need to open the door to read the
temperature.)
yy Can't be calibrated
Other considerations when purchasing a thermometer
yy If your clinic maintains vaccine valued at $15,000 or more per year, consider
purchasing a temperature alarm system that will notify staff after hours if
temperatures are out of range; see Electronic temperature monitoring systems
below.
Acceptable
thermometers
Chart recorder
Minimum / maximum
digital with biosafe
liquid probe
Data logger
Data logger with
biosafe liquid probe
Unacceptable
thermometers
yy Make sure you have a backup thermometer to use for transport and in case
your current thermometer stops functioning.
yy If your thermometer uses batteries, replace them every six months.
Electronic temperature monitoring systems
If your clinic maintains vaccine valued at $15,000 or more per year, consider
purchasing an electronic temperature monitoring system that will notify staff after
hours if temperatures are out of range.
yy Make sure you have a written policy for handling out-of-range temperatures
that includes emergency 24-hour contacts and their backups.
yy Set time and temperature alarm parameters to allow for changes in
temperatures due to frequent opening of the unit during the day and for nonuse during the night (e.g., set the alarm to go off if the refrigerator temperature
is above 47°F or below 33.5°F for 30 minutes).
yy Temperatures should still be checked and recorded manually twice a day.
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
Dial
Non-digital fluid-filled
biosafe liquid probe
Minimum / maximum
digital with standard
probe
www.health.state.mn.us/immunize
11
Storing and Handling
Vaccine
Did you know the
accuracy of a calibrated
thermometer is only
guaranteed for a
specific period of time?
yy Look for the
recalibration due date
on the thermometer
and on the certificate
that comes with it.
yy Write the recalibration
due date on the front
of the thermometer as
a reminder.
yy Replace or recalibrate
thermometers that
have reached their
recalibration due date.
yy All thermometers,
even fluid-filled, need
to be recalibrated.
Monitor temperatures twice a day
yy Check and record temperatures of refrigerator(s) and freezer(s) twice a day –
even if you have an electronic temperature monitoring system.
yy If you use a minimum/maximum-type thermometer, make sure you reset the
memory each time you check and record the temperatures (twice a day) and
after an out-of-range temperature reading.
yy Record temperature readings on a temperature log posted in a visible location
on or near the refrigerator and freezer; see Vaccine Storage Temperature
Logs on pages 47-50.
yy Record temperature readings consistently in one scale, either Fahrenheit or
Celsius.
yy Keep temperature logs for three years. You may need to refer to them for
temperature trends or if you have a storage and handling mishap.
yy Take immediate action on all out-of-range temperatures! See the TAKE
ACTION box on page 14.
Store vaccine and diluents correctly
yy Place a thermometer in the center of the refrigerator and freezer near the
vaccines.
yy Use open trays, wire baskets, or other uncovered containers to help organize
vaccines. Containers should have openings on all sides to allow air circulation
around the vaccine.
yy Clearly label each container with the vaccine type. Avoid storing "look-alike"
and "sound-alike" vaccines next to each other (e.g., Tdap and DTaP, HepA
and HepB and Hib).
Check out CDC's Vaccine
Storage and Handling
Toolkit:
www2a.cdc.gov/vaccines/
ed/shtoolkit/default.htm
yy Keep vaccines in their original packaging to protect them from light.
yy Store diluents packaged together with their corresponding vaccines (e.g.,
Pentacel, Menveo).
yy Store diluents packaged separately from their corresponding vaccines in the
refrigerator or at room temperature and clearly label them (e.g., MMR diluent,
ActHIB diluent, Hiberix diluent).
yy Open only one multi-dose vial of a specific vaccine at a time.
yy Post a list on every refrigerator and freezer showing which vaccines are stored
there.
yy For storage of vaccines during off-site vaccination clinics, see Acceptable
Coolers for Vaccine Transfer or Transport on page 35.
yy For specific storage requirements for each vaccine, see Guide to Receiving,
Storing, and Handling Vaccines on page 19.
12
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Storing and Handling
Vaccine
Additional guidelines for storing vaccine in a household-style refrigerator or
freezer
For an illustration of how to properly store vaccine in this type of unit, see the
Vaccine Storage Guide on page 15.
yy It is difficult to set the temperature for the freezer compartment of a householdstyle combination refrigerator/freezer at 0°F/-18°C or colder without making
the temperature in the refrigerator too cold for refrigerated vaccines. If you use
the freezer compartment of a household-style combination refrigerator/freezer
to store frozen vaccine, consider purchasing a separate household freezer.
Don’ts
yy Never store food
or beverages with
vaccine.
yy Never store vaccines
in the door or drawers
of the refrigerator/
freezer.
yy Store vaccines only on the middle shelves and two to three inches from the
walls of the refrigerator/freezer.
yy Remove vegetable bins and crisper drawers or use the bins and drawers to
store water bottles or jugs or other medical supplies (e.g., diabetic and lab
supplies or allergy serum). This will help avoid storing vaccine in the wrong
place.
yy Keep vaccine away from the cold air vent in the refrigerator compartment.
yy Keep water bottles, jugs, or cold packs in the refrigerator and frozen packs or
other ice-filled containers in the freezer to help maintain temperatures. Water
bottles can be stored in the door and water jugs in the bottom of the unit. Don't
store gallon water jugs in the door because the door may not close properly.
It's important to label any substance stored in the refrigerator, so make sure to
label water bottles and water jugs.
yy Consider locking the refrigerator or freezer at the end of the day to prevent
accidently leaving the door ajar overnight.
yy Make sure there is enough usable space to hold the year’s largest inventory,
such as the back-to-school rush or flu season, and still have room for air
circulation. If your refrigerator or freezer is packed full, consider purchasing a
larger unit.
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
13
Storing and Handling
Vaccine
TAKE ACTION
On out-of-range temperatures:
Refrigerator:
○○ Below 35°F (2°C)
○○ Above 46°F (8°C)
(Aim for 40°F / 4°C)
Freezer:
○○ Above 5°F
(Aim for 0°F / -18°C)
1. Determine the problem; it might be easily corrected (e.g., door not closed
tightly, unit malfunction, power outage).
2. Adjust the thermostat, if necessary.
3. Keep refrigerator/freezer door closed.
4. Monitor the temperature every 30 minutes until it stabilizes in the correct
range. If the temperature doesn’t stabilize in the correct range within 30
minutes go to step 5.
5. Immediately contact your primary and backup vaccine coordinator and:
○○ Emergency staff and others, as necessary
○○ Alternate vaccine storage facility(s) if you are moving the vaccine to
them
6. If the temperature remains out of range after checking every 30 minutes
for two hours:
○○ Stop using the vaccine, but do not throw it away!
○○ Mark the vaccine “DO NOT USE” so staff won’t inadvertently administer
it.
○○ Move the vaccine to a refrigerator/freezer that’s maintaining the correct
temperature – apart from other vaccines – until you can determine if it is
viable.
7. Call for guidance right away. If the vaccine in question is from MnVFC,
call the MnVFC program. For private purchase vaccine, check your purchase agreement for guidance.
○○ Be ready to provide the temperature details, lot numbers, and expiration
dates.
○○ If you are instructed to contact the manufacturer, make sure to ask to
speak to the medical consultant or quality assurance staff.
8. Document your actions; see Vaccine Troubleshooting Log on page 51.
14
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Available on the web at www.health.state.mn.us/divs/idepc/immunize/hcp/vaxhandling.html
July 2011, Minnesota Department of Health
Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
15
H2O
Flu
Tdap
Hib
40º
Hep B
H2O
H2O
HPV
Flu
MCV
Hep A
Flu
Rota
PCV
For all units:
0º
Frozen
Pack
Varicella
Zoster
MMR
Fill space with frozen packs.
Frozen
Pack
Frozen
Pack
Varicella
Varicella
MMRV
DTaP
MMR
DTaP
No food in
freezer!
Place thermometer probe in the center of the unit.
Post a temperature log on the door.
Post Do Not Unplug stickers on electrical outlets. Plug in only one unit
per outlet.
Keep vaccine 2-3 inches away from walls and other boxes.
Frzn Pack
Frzn Pack
Frzn Pack
Frzn Pack
Frzn Pack Fr
zn Pack
Too warm
Varicella
H2O
Flu
Hep A
Hib
Hep B
Tdap
Zoster
HPV
DTaP
No vaccine on
top shelf!
MMRV
Frozen Pack
CCold Pack
CColold Pack Cold Pack
Page 1 of 2 (5/12) IC# 141-0110
Adapted with permission from the California Department of Public Health
Cold Pack
No vaccine in doors!
Fill space with cold packs
and water bottles.
Cold Pack Cold Pack Cold Pack
Frzn Packk
No food or beverage
in refrigerator or
freezer!
zn Pack
Frzn Pack Fr
No vaccine in doors!
Fill space with frozen packs.
No vaccine in drawers or on floor
H2O
H2O
of refrigerator!
Fill space with cold packs or water jugs.
40º
PCV
0º
Frozen Pack
Dashed lines show usable space.
X’s and lines show areas to avoid.
H2O
MPV/MCV
IPV
DTaP
Rota
DTaP
No vaccine near
cold air vent!
MMR
Frozen Pack
Combination refrigerator/freezer unit
58ºF ( 50°C) to 5ºF ( 15°C)
No vaccine in doors!
Fill space with frozen packs.
Frzn Pack Frzn Pack
Too cold
Aim for 0ºF ( 18ºC)
Don’t freeze liquid vaccines!
Freeze MMR, MMRV, varicella, and zoster.
Proper FREEZER Temperatures
Freezer-only unit
Too warm
Group vaccines by type.
Clearly label the designated space for each vaccine.
No vaccine in drawers or
on floor of refrigerator!
Fill space with cold packs or
water jugs.
H2O
PPSV
MPV
IPV
DTaP
DTaP
DTaP
No food or
beverages in
refrigerator!
Minnesota Dept. of Health, Immunization Program
Cold
Cold Pack
k
Pac
olldd
Cold Coacckk
Pack Pa
No vaccine in
doors! Fill space
with cold packs
and water bottles.
35°F (2°C) to 46°F (8°C)
Refrigerator-only unit
Proper Set-Up
Too cold
Aim for 40ºF (4ºC)
influenza, IPV, Japanese encephalitis, meningococcal, pneumococcal, rabies,
rotavirus, typhoid, and yellow fever.
Proper REFRIGERATOR Temperatures
1A.Refrigerate
Proper Freezer
Temperatures
anthrax, DTaP, DT, Td, Tdap, hepatitis A and B, Hib, HPV,
Vaccine Storage Guide
Available on the web at www.health.state.mn.us/divs/idepc/immunize/hcp/vaxhandling.html
16
www.health.state.mn.us/immunize
Got Your Shots? Providers Guide - MANAGING VACCINE
Minnesota Department of Health, July 2011
Adapted with permission from the California Department of Public Health
Immunization Program
0/æ"OXæ
3Tæ0AULæ-.æ
æ
www.health.state.mn.us/immunize
s If you have stock of both private and
MnVFC vaccine, mark them clearly.
s Call the MnVFC program if you have
MnVFC vaccine that will expire within
æMONTHSæTHATæYOUæCANNOTæUSEæ
s Identify vaccine that will expire and
determine if it should be transferred.
sæ2OTATEæYOURæVACCINEæSUPPLYæBYæPLACINGæ
vaccines with the earliest expiration
dates in front of other vaccines and
always use them first.
sæ#HECKæVACCINEæEXPIRATIONæDATES
monthly basis and with each vaccine
order to avoid over-ordering.
the refrigerator or freezer near the
vaccines.
certificate stating they have been
calibrated according to national
standards. Thermometers without this
certificate are not acceptable.
sæ-AKEæSUREæYOUæHAVEæENOUGHæSPACEæTOæ
store vaccine for the back-to-school
rush and flu season.
sæ+EEPæWATERæBOTTLESæJUGSæORæCOLDæPACKSæ
in the refrigerator and frozen packs or
other ice-filled containers in the
freezer. Mark water bottles “DO NOT
$2).+v
sæ3TOREæVACCINESæONæTHEæMIDDLEæSHELVESæ
ANDææTOææINCHESæFROMæTHEæWALLSæOFæTHEæ
combination refrigerator/freezer, not in
the door or bins.
sæKeep vaccines in their original
packaging.
sæClearly label each container with the
vaccine type. Avoid storing look-alike,
sound-alike vaccines next to each
other (e.g., Tdap and DTaP, HepA and
(EP"
sæ5SEæOPENæTRAYSæWIREæBASKETSæORæOTHERæ
uncovered containers to help organize
vaccines.
sæTake immediate action on all
out-of-range temperatures!
sæ-AKEæSUREæTHEæDOORæISæSHUT
sæ"EæSUREæTOæKEEPæTEMPERATUREæLOGSæFORææ
years.
sæ2ECORDæTEMPERATUREæREADINGSæONæAæ
temperature log and post it in a visible
location on or near the refrigerator or
freezer.
sæ#HECKæANDæRECORDæREFRIGERATORæANDæ
freezer temperatures twice a day, first
thing in the morning and last thing at
the close of business.
Page 2 of 2 (5/12) IC# 141-0110
sæDocument your actions.
sæ#ALLæFORæGUIDANCEæRIGHTæAWAYæ
For MnVFC vaccine call
æORæ
For private purchase vaccine, check
your purchase agreement for
guidance.
sæMove the vaccine to a
refrigerator/freezer that’s maintaining
the correct temperature.
sæ-ARKæTHEæVACCINEæh$/æ./4æ53%v
sæStop using the vaccine.
If the temperature doesn’t stabilize in the
correct range within 2 hours:
sæContact the vaccine coordinator.
sææMonitor the temperature.
sææAdjust the thermostat, if necessary.
sææDetermine the cause.
Designate one fully trained staff member to be the primary vaccine coordinator and at least one person to be backup. Ensure ongoing training for all immunization staff.
Manage vaccine inventory
Store vaccine correctly
Monitor temperatures
Take action on out-of-range
temperatures
s 2EVIEWæYOURæVACCINEæINVENTORYæONæAæ
sæ0LACEæAæTHERMOMETERæINæTHEæCENTERæOFæ
sæ5SEæTHERMOMETERSæTHATæCOMEæWITHæAæ
Proper Management
Vaccine Storage Guide
Items to Post on or Near
Refrigerators and Freezers
The illustration below shows essential tools that should be posted on refrigerators/freezers used to store
vaccine. All are available from MDH.
Tip: Use these helpful magnets
Who to Call About
Vaccine Storage Mishaps
Keep Vaccines Safe
Keep Vaccines Safe!
Make sure your vaccines are stored at the
right temperature
Refrigerator
35˚ — 46˚F
2˚ — 8˚C
Aim for 40˚F (5˚C)
Freezer
5˚F or colder
-15˚C or colder
Aim for 0˚F (-18˚C)
If your refrigerator or freezer temperatures fall
outside this range, follow these three easy steps:
1.
Stop using the vaccine.
2.
Call MDH for guidance.
 Adjust thermostat.
 1-800-657-3970
 Be ready to give: current temperature and
temperature log details.
3.
Document your actions.
MDH Immunization Program: 1-800-657-3970
IC#399-1744
10/09
Vaccine Storage
Temperature
Log for recording
temperature
readings
Keep Vaccines Safe!
Make sure your vaccines are stored at the
right temperature
July 2011, Minnesota Department of Health Refrigerator
35˚ — 46˚F
2˚ — 8˚C
Aim for 40˚F (5˚C)
Freezer
5˚F or colder
-15˚C or colder
Aim for 0˚F (-18˚C)
If your refrigerator or freezer temperatures fall
outside this range, follow these three easy steps:
1.
Stop using the vaccine.
 Adjust thermostat.
2.
Call MDH for guidance.
 1-800-657-3970
 Be ready to give: current temperature and
temperature log details.
3.Vaccine
Document
your actions.
Troubleshooting
Log
Date
&
Time
Storage Unit
Problem
Action Taken
MDH Immunization Program: 1-800-657-3970
Outcome
Location Temp
Is Vaccine Supervisor
Viable?
Notified
No
IC#399-1744
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0975
1-800-657-3970 or 651-201-5522
www.health.state.mn.us/immunize
Yes
No
Yes
Initials
Do Not Unplug
stickers should be
attached to:
○○ Power cord
○○ Storage unit
○○ Outlets
Warning stickers
should be attached
to:
○○ Circuit breaker/
fuse box
10/09
Vaccine
Troubleshooting
Log to document
actions taken if you
have a storage and
handling mishap
See any patterns of problems with temperatures? Take action to keep vaccines safe!
(3/11)
Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
17
18
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
19
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
DTaP–HepB–IPV
DTaP–IPV–Hib
Pentacel
Pediarix
DT generic, Td generic,
Decavac
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0975
651-201-5503, 1-800-657-3970
www.health.state.mn.us/immunize
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Tetanus, diphtheria
(DT, Td, )
Daptacel, Infanrix
Preparing/reconstituting
Shelf life after opening/reconstituting
Handling
• Administer immediately after
drawing up in syringe or after
placing needle on pre-filled
syringe.
• Multi-dose vials: refrigerate
unused portions. May be
used until expired, unless
contaminated.
Page 1 of 7 (10/13)
• Refrigerate immediately at
• Reconstitute just before using. • Administer immediately after
• Gently shake vial of liquid
35º to 46ºF (2º to 8ºC).
withdrawal from the vial.
DTaP-IPV and withdraw entire • Discard if not used within 30
• Don’t expose to temperatures
contents.
32°F or below.
minutes of reconstitution.
• Inject DTaP-IPV into the vial
• Protect both diluent and
of ActHIB powder and shake
powder from exposure to light
well.
(i.e., store in original box).
• Withdraw entire contents,
about 0.5 mL.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don’t expose to temperatures
don't use if they don't dissolve.
syringe.
32°F or below.
• Use until expiration date noted
on vial, unless contaminated.
• Refrigerate immediately at
• Shake vial well before use.
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
• Don’t expose to temperatures
don't use if they don't dissolve
32°F or below.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
35º to 46ºF (2º to 8ºC).
drawing up in syringe or after
• Look for floating particles;
• Don't expose to temperatures
don't use if they don't dissolve.
placing needle on pre-filled
32°F or below.
syringe.
Storage requirements
Arrival condition
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Storing
Receiving
Diphtheria, tetanus,
pertussis (DTaP)
Vaccine
 Open multi-dose vials can be used until the expiration date on the vial, unless contaminated.
 Keep vaccines in their original boxes to protect them from exposure to light (which can affect potency) and to help keep them organized.
 Visually inspect vaccines for floating particles and/or discoloration before administration.
 This guide is not a substitute for the package insert included with each vaccine.
Guide to Receiving, Storing, and Handling Vaccines
20
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Hepatitis B
(HepB)
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Hib–HepB
MDH, Immunization Program
Comvax
Twinrix
HepA–HepB
Engerix-B, Recombivax HB
Havrix, Vaqta
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Hepatitis A
(Hep A)
ActHIB
Hiberix
PedvaxHIB
Haemophilus influenzae
type b (Hib)
Adacel, Boostrix
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Tetanus, diphtheria,
pertussis (Tdap)
Kinrix
Preparing/reconstituting
Shelf life after opening/reconstituting
Handling
Page 2 of 7 (10/13)
• Use until expiration date
• Refrigerate immediately at
• Shake vial well before use.
• Look for floating particles;
noted on vial, unless
35º to 46ºF (2º to 8ºC).
• Don't expose to temperatures
don't use if they don't dissolve.
contaminated.
32°or below.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don't expose to temperatures
don't use if they don't dissolve.
32°or below.
syringe.
• Use until expiration date
noted on vial, unless
contaminated.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don't expose to temperatures
don't use if they don't dissolve.
syringe.
32°or below.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don't expose to temperatures
don't use if they don't dissolve.
syringe.
32°or below.
• Refrigerate immediately at
• Use only diluent supplied with • Administer immediately after
drawing up in syringe.
35º to 46ºF (2º to 8ºC).
ActHIB or Hiberix.
• Don't expose to temperatures • Reconstitute ActHIB or
• Use ActHIB and Hiberix
32°or below.
within 24 hours of
Hiberix just before using.
• Protect from exposure to light • Inject the entire volume of the
reconstitution when stored in
(i.e., store in original box).
refrigerator.
diluent into the vial of vaccine.
• Diluent: may be refrigerated or
• Shake well.
stored at room temperature 68º
• Withdraw entire volume of
to 77ºF (20º to 25ºC).
reconstituted ActHIB or
0.5 mL Hiberix.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don't expose to temperatures
don't use if they don't dissolve.
syringe.
32°or below.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don't expose to temperatures
don't use if they don't dissolve.
32°or below.
syringe.
• Use until expiration date
noted on vial, unless
contaminated.
Storage requirements
Arrival condition
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Storing
Receiving
DTaP–IPV
Vaccine
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
21
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Japanese Encephalitis
(JE)
MDH, Immunization Program
Ixiaro
Flumist
• May arrive frozen or partially
frozen
• Packed with refrigerator
packs
Influenza, live
attenuated (LAIV)
Afluria, Agriflu, Fluarix,
Flublok, Flucelvax, Flulaval,
Fluvirin, Fluzone
Influenza, inactivated
(IIV)
Ipol
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Polio, inactivated
vaccine (IPV)
Cervarix, Gardasil
Preparing/reconstituting
Shelf life after opening/reconstituting
Handling
• Administer immediately after
reconstitution.
• Use within 8 hours after
reconstitution.
• Refrigerate immediately at
• Shake vial well before use.
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
• Don’t expose to temperatures
don’t use if they don’t dissolve
32°F or below.
• Protect from exposure to light
(i.e., store in original box).
Page 3 of 7 (10/13)
• Administer immediately
after removing from the
refrigerator.
• For use during current flu
season; check expiration dates.
• Note: shelf life is 18 weeks
(4½ months).
• Refrigerate immediately at
• Remove the rubber tip
35º to 46ºF (2º to 8ºC).
protector from the sprayer.
• Don't store in the freezer.
• Deliver ½ dose into one
• Don’t expose to temperatures
nostril.
32°F or below.
• Remove the dose-divider clip
and deliver the remaining ½
dose into the other nostril.
• Administer immediately after
• Refrigerate immediately at
• Shake vial well before use.
withdrawing from the vial or
• Look for floating particles;
35º to 46ºF (2º to 8ºC).
after placing needle on pre• Don’t expose to temperatures
don't use if they don't dissolve.
filled syringe.
32°F or below.
•
Multi-dose vials: refrigerate
• Protect Fluarix,Flulaval,
unused portions. May be
Flucelvax, and Flublok from
used until expired, unless
exposure to light (i.e., store in
contaminated.
original box).
• For use during current flu
season; check expiration dates.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
drawing up in syringe or after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
placing needle on pre-filled
• Don’t expose to temperatures
don't use if they don't dissolve.
32°F or below.
syringe.
• Multi-dose vials: refrigerate
unused portions. May be
used until expired, unless
contaminated.
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
35º to 46ºF (2º to 8ºC).
drawing up in syringe.
• Look for floating particles;
• Don’t expose to temperatures
don't use if they don't dissolve. • Discard if not used by end of
32°F or below.
workday.
• Protect from exposure to light
(i.e., store in original box).
Storage requirements
Arrival condition
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Storing
Receiving
Human papillomavirus
(HPV)
Vaccine
22
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
• Administer immediately after
withdrawal from the vial.
• Mark the date and time the vial
was removed from the freezer.
• Use within 30 minutes of
reconstitution when protected
from light.
• Don't freeze reconstituted
vaccine.
MDH, Immunization Program
Menactra
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Page 4 of 7 (10/13)
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
35º to 46ºF (2º to 8ºC).
withdrawal from the vial.
• Look for floating particles;
• Don't expose to temperatures
don't use if they don't dissolve.
32°or below.
• Reconstitute just before using.
• Use only the diluent supplied
with the vaccine.
• Inject 0.7 mL of diluent into
the vial of vaccine and shake
well.
• Withdraw entire contents,
about 0.5 mL.
Meningococcal
conjugate (MCV)
• Diluent: may be refrigerated or
stored at room temperature, 68º
- 77ºF (20º - 25ºC). Don't expose
to temperatures 32°or below
• Keep frozen below 5ºF (-15ºC).
• Once vaccine has been
removed from the freezer
it can be stored in the
refrigerator and administered
up to 72 hours, but can’t be
re-frozen.
• Protect from exposure to light
(i.e., store in original box).
Shelf life after opening/reconstituting
• Reconstitute just before using. • Administer immediately after
• Use only the diluent supplied
withdrawal from the vial.
with the vaccine.
• Use within 8 hours of
• Inject the entire volume of the
reconstitution when stored
diluent into the vial of vaccine
in refrigerator and protected
and shake well.
from light. Discard unused
• Withdraw entire contents,
portions after 8 hours.
• Don't freeze reconstituted
about 0.5 mL.
vaccine.
• Multi-dose vials: refrigerate
unused portions. May be
used until expired, unless
contaminated.
Preparing/reconstituting
Handling
• Refrigerate immediately at
• Reconstitute just before using. • Administer immediately after
reconstitution.
35º to 46ºF (2º to 8ºC).
• Use only the diluent supplied
• Discard if not used within 30
• Don’t expose to temperatures
with the vaccine.
minutes of reconstitution.
32°or below.
• Inject 0.6 mL of diluent into
•
Don’t freeze reconstituted
• Diluent: may be refrigerated
the vial of vaccine and gently
vaccine.
or stored at room temperature,
shake well.
68º to 77ºF (20º to 25ºC).Don’t
• Withdraw entire contents,
expose to temperatures 32°or
about 0.5 mL.
below.
• Should arrive frozen
• Diluent: may be refrigerated
or stored at room temperature,
68º to 77ºF (20º to 25ºC). Don't
expose to temperatures 32°or
below.
• Refrigerate immediately at
35º to 46ºF (2º to 8ºC) OR
freeze below 5ºF (-15ºC).
• MDH recommends storing
MMR in the freezer, not the
refrigerator.
• Protect from exposure to light
(i.e., store in original box).
Storage requirements
Arrival condition
• Packed with refrigerator
packs
Storing
Receiving
Meningococcal C/Y –Hib • Packed with refrigerator
Menhibrix
packs in winter OR frozen
packs in summer
• Never frozen
ProQuad
Measles, mumps,
rubella, varicella
(MMRV)
M-M-R II
Measles, mumps,
rubella (MMR)
Vaccine
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
23
Storage requirements
Arrival condition
Preparing/reconstituting
Shelf life after opening/reconstituting
Handling
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
35º to 46ºF (2º to 8ºC).
• Look for floating particles;
withdrawal from the vial.
• Don’t expose to temperatures
don't use if they don't dissolve. • Multi-dose vials: refrigerate
32°F or below.
unused portions. May be
used until expired, unless
contaminated.
• Refrigerate immediately at
• Reconstitute just before using. • Administer immediately after
35º to 46ºF (2º to 8ºC).
withdrawal from the vial.
• Use only the diluent supplied
• Don't expose to temperatures
with the vaccine.
• Use within 30 minutes of
32°or below.
• Shake vial gently to suspend
reconstitution.
mixture.
• Refrigerate immediately at
• Reconstitute just before using. • Administer immediately after
35º to 46ºF (2º to 8ºC).
• Use only the diluent supplied
withdrawal from the vial.
• Don’t expose to temperatures
with the vaccine.
• Use within 24 hours of
32°F or below.
• Mix oral diluent into powder,
reconstitution when stored in
• Protect from exposure to light
shake, and return mixed
the refrigerator.
(i.e., store in original box).
liquid to oral applicator to
administer.
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Pneumococcal
polysaccharide (PPSV)
MDH, Immunization Program
Rotarix
Rotavirus (RV1)
Imovax, RabAvert
Rabies
Pneumovax
Prevnar 13
Page 5 of 7 (10/13)
• Refrigerate immediately at
• Shake vial well before use.
• Administer immediately after
35º to 46ºF (2º to 8ºC).
withdrawing from the vial or
• Look for floating particles;
• Don’t expose to temperatures
don't use if they don't dissolve.
after placing needle on pre32°F or below.
filled syringe.
• Administer immediately after
reconstitution.
• Discard if not used within 30
minutes of reconstitution.
• Don't freeze reconstituted
vaccine.
• Multi-dose vials: Mark with
date of use and refrigerate
unused portions. Use within
35 days of reconstitution.
Pneumococcal
conjugate (PCV)
Menomune
• Refrigerate immediately at
• Reconstitute just before using.
35º to 46ºF (2º to 8ºC).
• Use only the diluent supplied
• Don't expose to temperatures
with the vaccine.
32°or below.
• Inject 0.7 mL of diluent into
• Diluent: may be refrigerated
the vial of vaccine and gently
or stored at room temperature,
shake well.
68º to 77ºF (20º to 25ºC).Don't
• Withdraw entire contents,
expose to temperatures 32°or
about 0.5 mL.
below.
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Meningococcal
polysaccharide (MPSV)
Menveo
• Packed with refrigerator
packs
• Never frozen
• Refrigerate immediately at
• Reconstitute just before using. • Administer immediately after
• Gently shake vial of liquid
35º to 46ºF (2º to 8ºC).
reconstitution.
MenC,Y,W-135 and withdraw • Use within 8 hours of
• Protect both diluent and
entire contents.
powder from exposure to light
reconstitution.
• Inject MenC,Y,W-135 into
(i.e., store in original box).
the vial of MenA powder and
• Don’t expose to temperatures
shake well.
32°F or below.
• Withdraw entire contents,
about 0.5 mL.
Storing
Receiving
Meningococcal
conjugate (MCV)
Vaccine
24
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• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
MDH, Immunization Program
YF-Vax
Yellow fever
• Diluent: may be refrigerated
or stored at room temperature,
68º to 77ºF (20º to 25ºC).Don’t
expose to temperatures 32°or
below.
• Refrigerate immediately at
35º to 46ºF (2º to 8ºC).
• Diluent: may be refrigerated or
stored at room temperature, 68º
- 77ºF (20º - 25ºC). Don't expose
to temperatures 32°or below
Page 6 of 7 (10/13)
• Reconstitute just before using. • Administer immediately after
• Use only the diluent supplied
reconstitution.
with the vaccine.
• Use within 1 hour of
• Inject the entire volume of the
reconstitution.
diluent into the vial of vaccine
and allow to sit for 2 minutes;
then carefully swirl mixture.
• Do not shake vigorously.
• Withdraw entire contents,
about 0.5 mL.
• Administer immediately after
withdrawal from the vial.
• Mark the date and time the vial
was removed from the freezer.
• Use within 30 minutes of
reconstitution when protected
from light.
• Don't freeze reconstituted
vaccine.
• Keep frozen below 5ºF (-15ºC).
• Once vaccine has been
removed from the freezer
it can be stored in the
refrigerator and administered
up to 72 hours, but can’t be
re-frozen.
• Protect from exposure to light
(i.e., store in original box).
• Should arrive frozen
• Reconstitute just before
using.
• Use only the diluent supplied
with the vaccine.
• Inject 0.7 mL of diluent into
the vial of vaccine and shake
well.
• Withdraw entire contents,
about 0.5 mL.
• Oral capsule
• Refrigerate immediately at
• Oral capsule
35º to 46ºF (2º to 8ºC).
• Don’t expose to temperatures
32°or below.
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Varicella (VAR)
Varivax
Shelf life after opening/reconstituting
• Administer immediately after
withdrawal from the vial.
Typhoid, oral
Vivotif
Preparing/reconstituting
• Refrigerate immediately at
• Shake vial well before use.
• Look for floating particles;
35º to 46ºF (2º to 8ºC).
• Don’t expose to temperatures
don’t use if they don’t
32°or below.
dissolve.
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Typhim Vi
Rotateq
Typhoid, inactivated
Storage requirements
Handling
• Refrigerate immediately at
• Remove dosing tube from
• Administer immediately
35º to 46ºF (2º to 8ºC).
pouch, turn the cap clockwise
after removing from the
• Don’t expose to temperatures
to puncture the tube, and
refrigerator.
32°F or below.
unscrew the cap counter• Protect from exposure to light
clockwise so that the liquid
(i.e., store in original box).
can be squeezed from the
tube for oral administration.
Arrival condition
• Packed with refrigerator
packs in winter OR frozen
packs in summer
• Never frozen
Storing
Receiving
Rotavirus (RV5)
Vaccine
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
25
Storage requirements
Arrival condition
• Diluent: may be refrigerated or
stored at room temperature, 68º
- 77ºF (20º - 25ºC). Don’t expose
to temperatures 32°F or below.
• Keep frozen below 5ºF (-15ºC).
• Once vaccine has been
removed from the freezer
it can be stored in the
refrigerator and administered
up to 72 hours, but can’t be
re-frozen.
• Protect from exposure to light
(i.e., store in original box).
Storing
Receiving
• Should arrive frozen
MDH, Immunization Program
Zostavax
Zoster (ZOS)
Vaccine
• Reconstitute just before
using.
• Use only the diluent supplied
with the vaccine.
• Inject 0.7 mL of diluent into
the vial of vaccine and shake
well.
• Withdraw entire contents,
about 0.65 mL.
Preparing/reconstituting
Page 7 of 7 (10/13)
• Administer immediately after
withdrawal from the vial.
• Mark the date and time the vial
was removed from the freezer.
• Use within 30 minutes of
reconstitution when protected
from light.
• Don't freeze reconstituted
vaccine.
Shelf life after opening/reconstituting
Handling
26
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
V
accine may need to be disposed of because it spoils (e.g., storage and
handling mishap), expires, or is replaced by a newer product. Proper disposal
of vaccines is everyone’s responsibility to protect our environment. Before
disposing of vaccine, contact the MnVFC program (for MnVFC vaccine) or the
manufacturer/distributor (for privately purchased vaccine) to see if it can or should
be returned.
For MnVFC vaccine:
yy Call MnVFC for guidance and approval.
yy Once you have MnVFC approval, return all spoiled and expired MnVFC
vaccine to McKesson following the instructions on the Returning Nonviable
MnVFC Vaccine form. Never return empty vials or syringes, open multi-dose
vials, or syringes with needles.
yy See the MnVFC Policy and Procedure Manual for more information.
Disposing of
Vaccine
Be familiar with your
facility's disposal
procedures!
For privately purchased vaccine:
yy Check your purchase agreement for guidance. If there is none, call the
manufacturer for guidance and ask to speak to the medical consultant or
quality assurance staff. See Resources on page 217 for telephone numbers.
Disposing of vaccine in Minnesota
Sometimes vaccine cannot be returned to the distributor or manufacturer (for
example, partially used multi-dose vials or private-purchase vaccines). Instead,
providers are responsible for disposal. To dispose of vaccines appropriately, you
need to know if they are hazardous waste, infectious waste, both hazardous
and infectious waste, or neither. For more information, see Where to Dispose of
Vaccine, Vials, and Syringes on page 29.
Hazardous waste
According to Minnesota Hazardous Waste Rules (Minn. R. 7045.0127, subp. 2.),
vaccines containing any amount of the preservative thimerosal (which contains
ethylmercury) are considered hazardous waste. Most multi-dose vials contain
thimerosal and some pre-filled syringes contain trace amounts of thimerosal.
So these vaccines/presentations must be disposed of in a hazardous waste
container - not an infectious waste (sharps) container. However, empty thimerosalcontaining vaccine vials and syringes (see definition below) are considered
nonhazardous and noninfectious waste. For an up-to-date listing of vaccines that
contain thimerosal, see:
Wondering if a
vaccine contains
thimerosal? Check
the package insert.
Details on the use
of preservatives is
provided under the
"Description" heading.
yy www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/
UCM096228
yy www.vaccinesafety.edu/thi-table.htm
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
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27
Disposing of Vaccine
What does "empty" mean and why does it matter?
According to Minnesota Hazardous Waste Rules, a vial or syringe containing
any amount of thimerosal is only considered empty when 3% by weight or
less of the original vaccine liquid remains. Practically speaking, this means:
yy A vial or syringe is considered empty when there isn't any remaining liquid
that can be removed from it.
yy A vial or syringe that still has any liquid with any amount of thimerosal in it
must be disposed of as hazardous waste.
What is a trace amount of thimerosal?
• Vaccines labeled as "preservative-free" may contain trace amounts of
thimerosal that was used during manufacturing but later removed, leaving
only a trace amount (about 1/100th of the amount found in vaccines that
use thimerosal as a preservative). Vaccines with even trace amounts of
thimerosal need to be disposed of as hazardous waste according to state
rules.
• Vaccines labeled as "thimerosal-free" do not contain thimerosal and are not
considered hazardous waste.
For information
on hazardous waste
disposal in your area,
call your city or county
environmental health
office.
Disposing of hazardous waste
If you already work with a hazardous waste disposal company, you might want
to use them to dispose of vaccine that is considered hazardous. However, it is
generally less expensive to go through a Very Small Quantity Generators (VSQG)
site. If you have never generated or shipped hazardous waste before, the VSQG
site or hazardous waste disposal company will help with that.
For a fact sheet about VSQGs for disposal of hazardous waste, go to www.pca.
state.mn.us/index.php/waste/waste-permits-and-rules/waste-permits-and-forms/
hazardous-waste-publications.html and look for the article titled VSQG Collection
Program Requirements for Generators and List of Licensed Programs.
Infectious waste
Infectious waste has the potential to transmit disease to humans. It is also called
biohazardous, red bag, or regulated medical waste. Infectious waste disposal is
not the same as hazardous waste disposal.
yy All live virus vaccines (LAIV, MMR, MMRV, rotavirus, oral typhoid, varicella,
yellow fever, and zoster) must be managed as infectious waste according to
Minnesota Infectious Waste Rules.
yy In addition, empty syringes with a used needle attached are infectious waste
because they may contain infectious bodily fluids.
Nonhazardous and noninfectious (normal trash)
Nonhazardous and noninfectious waste is waste that can be disposed of in the
normal trash. It is also called solid waste or industrial solid waste.
28
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Disposing of Vaccine
Where to Dispose of Vaccine, Vials, and Syringes
Vaccine waste items
Hazardous
Infectious
Nonhazardous
& noninfectious
Thimerosal-free inactivated vaccines
yy Unused, spoiled, or expired
X
yy Empty used vial
X
yy Empty used syringe with needle attached
X
yy Empty used syringe without needle attached
X
Live virus vaccines (thimerosal-free)
yy Unused, spoiled, or expired
X
yy Empty used vial
X
yy Empty used syringe with needle attached
X
yy Empty used syringe without needle attached
X
yy Empty used oral applicator (rotavirus) or nasal
sprayer (LAIV)
X
Thimerosal-containing multi-dose vials or preservative-free single dose inactivated vaccines (which contain
trace amount of thimerosal)
yy Unused, spoiled, or expired
X
yy Empty* used vial
X
yy Empty* used syringe with needle attached
X
yy Empty* used syringe without needle attached
Where to dispose
*A practical definition of "empty" is
a vial or syringe with no remaining
liquid you can remove from it. (See
page 27 for a formal definition as
it applies to Minnesota Hazardous
Waste Rules.)
X
Hazardous
waste container
Sharps container

Normal trash
Sharps
Container
Make sure to follow
hazardous waste
management requirements.
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
29
Planning
for Vaccine
Storage
Emergencies
R
efer to the Worksheet for Developing an Emergency Plan for Managing
Vaccine on page 43 to develop your own site-specific plan for storing and
transporting vaccines in the event of a refrigerator or freezer malfunction, power
failure, natural disaster, or other emergency that might compromise appropriate
vaccine storage conditions.
yy Be sure your plan includes procedures for situations when you will have some
lead time (e.g., when you know your office is moving) as well as those when
you have no lead time (e.g., a sudden power outage).
yy Your plan should also identify an alternate site (e.g., a hospital or long-term
care facility) that has a backup generator to store your vaccine in case of a
lengthy power outage.
yy If there is no hospital or long-term care facility with a backup generator in your
area, contact a pharmacy or grocery store to pre-arrange vaccine storage in
the event of a lengthy power outage.
yy Larger clinics should consider purchasing their own backup generator.
yy Go over the plan with staff each year and update it as needed.
TAKE ACTION
If your refrigerator/freezer is not working:
1. Call for service immediately.
2. Refer to your emergency plan for managing vaccine for guidance on
storing and transporting vaccines in a power outage or other emergency.
3. Stop using the vaccine if temperatures are out of range.
○○ Mark the vaccine “DO NOT USE” so staff won’t inadvertently
administer it.
○○ Move the vaccine to a refrigerator/freezer that’s maintaining the
correct temperature – apart from other vaccines – until you can
determine if it is viable.
○○ Do not throw it away!
4. Call for guidance right away. If the vaccine in question is from MnVFC,
call the MnVFC program. For private purchase vaccine, check your purchase agreement for guidance.
○○ Be ready to provide the temperature details, lot numbers, and
expiration dates.
○○ If you are instructed to contact the manufacturer, make sure to ask to
speak to the medical consultant or quality assurance staff.
5. Document your actions; see Vaccine Troubleshooting Log on page 51.
30
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
General instructions for packing vaccine
1. Use hard-sided or Styrofoam coolers with at least two-inch thick walls; see
Acceptable Coolers for Vaccine Transfer or Transport on page 35.
○○ Don’t use thin-walled Styrofoam coolers, soft-sided coolers, or lunch bags
found at grocery stores or gas stations.
2. Depending on the type of vaccine, place cold/frozen packs on the bottom of
the cooler and at the sides to surround the vaccine.
○○ Don’t transport refrigerated vaccines in the same cooler with frozen
vaccines.
○○ Don’t place vaccines directly on or next to cold/frozen packs; see Packing
frozen vaccines on page 32.
3. Place a minimum of two inches of insulating barrier over the cold/frozen packs.
This will help keep the vaccine from touching the packs and prevent accidental freezing and shifting during transport. Some examples of insulating barrier
include:
○○ Bubble wrap
○○ Brown packing paper
○○ Newspaper
Packing and
Transporting
Vaccine
Packing Supplies
ˆˆ Calibrated
thermometer
ˆˆ Cooler
ˆˆ Cold or frozen packs
ˆˆ Plastic bags
ˆˆ Packing tape
ˆˆ Insulating barrier:
○○Bubble wrap
○○ Brown packing paper
○○ Newspaper
4. Place vaccines (in their original packaging) in a plastic bag on top of the
insulating barrier.
5. When transport will take more than one hour, place a calibrated thermometer
on top of the vaccine, preferably one with an internal probe and external read.
6. Add another two-inch layer of insulating barrier.
7. Add another layer of cold/frozen packs.
8. Secure lid; tape if necessary.
Packing refrigerated vaccines
2 inches
2 inches
Cold or Frozen Packs
Cold or Frozen Packs
Refrigerated vaccines include DTaP, DT, Td, Tdap, hepatitis A and B, Hib,
HPV, influenza (TIV, LAIV), IPV, meningococcal, pneumococcal, rotavirus, and
combinations of these vaccines. MMR can also be packed as a refrigerated
vaccine.
yy Keep cold at 35° to 46°F (2° to
8°C), but do not freeze.
yy Use cold or frozen packs
depending on the outdoor
temperature:
2 inches
Frozen
Cold
Packs
OR
○○ Frozen packs for
Insulating barrier
temperatures of 75°F or
Thermometer
more
Vaccine
○○ Cold packs for
Insulating barrier
temperatures of 74°F or
Frozen
Cold
Packs
OR
less
Walls must be at least 2 inches thick
Inside view of cooler for refrigerated vaccines
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
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31
Packing and Transporting
Vaccine
Transfer or transport of
frozen vaccines (MMRV
and varicella) is not
permitted by the MnVFC
program; call them for
guidance.
Packing frozen vaccines
Frozen vaccines include MMRV, varicella, and zoster. Even if you pack and
transport them with frozen packs, the viability of these vaccines may not be
preserved At best, their shelf life will be reduced. These vaccines are extremely
fragile and should only be packed and transported when:
yy You need to give one or two prescheduled doses at an off-site location.
yy There is an emergency such as a weather-related disaster.
yy There may be a long-term power outage (four hours or more).
Keeping vaccine frozen between -58°F and +5°F (-50°C and -15°C):
yy Use frozen packs to pack and transport frozen vaccine because it can
maintain the temperature between -58°F and +5°F.
yy Do not freeze diluent; the vials may break.
yy Do not use dry ice.
yy Pack frozen vaccines immediately before transporting them.
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE 2 inches
Frozen Pack
2 inches
32
Frozen Pack
Using frozen packs:
yy Use a minimum of 6 frozen
packs to surround the vaccine
on all sides.
yy Place vaccines (in their original
2 inches
packaging) in a plastic bag
Frozen Pack
Frozen Pack
Frozen Pack
Frozen Pack
directly on frozen packs; you
Thermometer
don't need an insulating barrier.
Vaccine
yy Place a calibrated thermometer
between the vaccine and frozen
Frozen Pack
Frozen Pack
Frozen Pack
Frozen Pack
packs, preferably between the
Walls must be at least 2 inches thick.
vaccine boxes.
Inside view of cooler using frozen packs
yy Tape the cooler shut until you
are ready to unpack the vaccine.
yy Check the temperature of the cooler immediately upon arrival and:
○○ If the temperature is between -58°F and +5°F (-50°C and -15°C), the
vaccine is still considered frozen and can be placed in the freezer.
○○ If the temperature is 5°F to 32°F (-15°C to 0°C), the vaccine is still
considered frozen and can be placed in the freezer. However, because
the temperature exceeded 5°F (-15°C) the expiration date may need to
be adjusted. Contact the manufacturer (ask for the medical consultant or
quality assurance staff) for guidance on adjusting the vaccine expiration
date. Be ready to provide temperature details, transport time, lot numbers,
and current expiration dates.
○○ If the temperature is 33°F to 46°F (1°C to 8°C), the vaccine is no longer
frozen and should be placed in the refrigerator and used within 72 hours.
○○ If the temperature is 47°F (9°C) or above, place it in the refrigerator
marked “DO NOT USE,” and call the MDH Immunization Program for
guidance right away (651-201-5522, 1-800-657-3970). Follow the steps in
the TAKE ACTION box on page 30.
○○ Document your actions; see Vaccine Troubleshooting Log on page 51.
Minnesota Department of Health, July 2011
Packing and Transporting
Vaccine
Transferring and transporting vaccine
Whether you are transferring vaccine to another provider or transporting vaccine
to an off-site clinic, follow these tips:
yy Pack the vaccine correctly in an appropriate cooler; see Acceptable Coolers
for Vaccine Transfer or Transport on page 35.
yy Pack refrigerated vaccines first and frozen vaccines immediately before
transporting them.
yy Keep the cooler in a temperature-controlled environment (e.g., don’t put it in
the trunk of a car or the back of a pick-up truck, and don’t leave it in a car on a
hot summer day or a cold winter day).
yy Attach labels to the outside of the cooler to clearly identify the contents as
valuable and fragile.
yy Clearly mark vaccine packages with the date and time they were removed
from the refrigerator/freezer.
yy Put a list of vaccine types, quantities, lot numbers, expiration dates, and the
originating facility in the cooler.
yy Open and close the cooler as little as possible.
Transferring vaccine to another clinic or provider:
yy Hand deliver the cooler with vaccine to the vaccine coordinator at the
accepting facility.
yy Ensure the vaccine is immediately stored correctly, i.e., placed in the
refrigerator or freezer.
Transporting vaccine to an off-site clinic:
yy Transport only the quantity of vaccine needed.
yy Don’t use home refrigerators/freezers for overnight storage of any vaccine;
see Acceptable Coolers for Vaccine Transfer or Transport on page 35.
yy Never pre-draw vaccine for transport.
yy Check and record vaccine temperatures hourly if transport time is longer than one
hour, preferably using a thermometer with an internal probe and external read.
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
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www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Acceptable Coolers for Vaccine Transfer or Transport
It is essential to maintain proper storage temperatures while transferring vaccine to another provider/clinic or
transporting vaccine to an off-site clinic. The table below may help you choose the type of cooler that fits your
needs. Make sure to follow the best practices for packing and transporting vaccine to keep your vaccine safe.
A thermometer with an internal probe and external read is preferred over one that is placed inside the cooler
and can only be read by opening the cooler.
The Minnesota Department of Health does not endorse or recommend any specific brand of cooler.
Cooler type
Description
When and how
to use
Compressor  Small portable
 For use off-site over
cooler that is cooled
several days
cooler
by a compressor.
 An option for staff
Can be plugged
into a vehicle’s
power source or
into an electrical
outlet
traveling to several
sites and staying
overnight
Examples:
 FridgeFreeze
 WAECO
Personal
cooler
 Hard-sided cooler
with a hard cover
Example:
 Igloo Playmate
Cooler
Industrial
Styrofoam
cooler
Must meet
industry
standard for
transport of
vaccine
Monitoring temperatures off-site
 It can be challenging to achieve and maintain the
correct temperature when this type of cooler is
plugged into a vehicle’s power outlet.
 Check and record temperatures several times:
o Hourly during transport in a vehicle
o On arrival at your home or hotel
o One hour later
o When you retire for the night
o First thing in the morning
o Hourly during clinics
 To maintain the temperature, open the cooler as little
as possible.
 For transferring
 Check and record temperatures hourly when using
vaccine to another
clinic or provider
(e.g., 1 hour or less)
 For same-day clinic;
use within 6-8 hours
after packing the
vaccine
 Must be properly
packed and used for
no more than 6-8
hours
the cooler for more than one hour.
 To maintain the temperature, open the cooler as little
as possible.
 Styrofoam coolers
 For transferring
that vaccine is
vaccine to another
delivered in from the
clinic or provider
manufacturer or
(e.g., 1 hour or less)
distributor
 For same-day clinic;
 Styrofoam coolers
use within 6-8 hours
with walls at least 2
after packing the
inches thick
vaccine
 Check and record temperatures hourly when using
the cooler for more than 1 hour.
 To maintain the temperature, open the cooler as little
as possible.
Do Not Use!  Thermoelectric cooler that can be plugged into a vehicle’s power source or into an electrical outlet
 Thin-walled Styrofoam coolers purchased at grocery stores or gas stations to hold beverages
 Soft-sided coolers or lunch bags
These types of coolers are not adequate at any time for transporting or storing vaccines. They can’t
maintain the correct temperatures.
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0975
651-201-5503, 1-800-657-3970
www.health.state.mn.us/immunize
(03/11) Page 1 of 1
Available on the web at www.health.state.mn.us/divs/idepc/immunize/ipi/coolerrecs.pdf
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www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Key
Resources
for Managing
Vaccine
For Managing Vaccine
yy Monthly Vaccine Inventory Log (MDH)
Log for managing your vaccine inventory.
www.health.state.mn.us/divs/idepc/immunize/hcp/vaxinv.pdf
yy Guide to Managing Out-of-Range Temperatures (MDH)
An algorithm to help determine next steps when discovering out-of-range
temperatures, page 41
For copies of the
MDH materials
listed here use the
Immunization Materials
for Professional Use
order form at www.
health.state.mn.us/
divs/idepc/immunize/
ordermat.html or you
can download many of
them from the web.
yy Worksheet for Developing an Emergency Plan for Managing Vaccine (MDH)
A worksheet to help you plan for managing your vaccine in case of an
emergency.
www.health.state.mn.us/divs/idepc/immunize/hcp/worksheet.pdf
yy Do Not Unplug and Warning stickers (MDH)
Stickers (pictured below) to affix to refrigerator/freezers and circuit breakers to
prevent accidental unplugging.
(Actual size: 4¼ X 4¼)
(Actual size: 3½ X 8½)
yy Vaccine Storage Temperature Log (MDH)
Log to post on the refrigerator and freezer to record temperatures (Celsius or
Fahrenheit).
www.health.state.mn.us/divs/idepc/immunize/hcp/vaccine.html#storage
yy Vaccine Troubleshooting Log (MDH)
Log to record actions you take if a temperature is our of range or a vaccine
storage and handling mishap occurs.
www.health.state.mn.us/divs/idepc/immunize/hcp/vaxlog.pdf
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
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Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxinv.pdf
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
39
MDH, Immunization Program
Vaccine manufacturer
CSL Biotherapies
GlaxoSmithKline
ID Biomedical
Massachusetts Biologic Labs
MedImmune, Inc.
Merck & Co., Inc
Novartis
Pfizer
sanofi pasteur Inc
Wyeth Vaccines
Code
CSL
SKB
IDB
MBL
MED
MSD
NOV
PFR
PMC
WAL
Vaccine
manufacturer1
Lot
number
Packaging type
Single-dose vial
Multidose vial
Manufacturer-filled syringe
Tubes (Rotateq)
Nasal sprayer (LAIV)
2
Packaging
type2
Code
SD
MD
MF
T
NS
Vaccine expires in 3 months
Expiration
date
Vaccine
expires in
3 months3
MnVFC
vaccine
Private
purchase
vaccine
Staff
initials
(3/11) Page 1 of 2
If you have excess vaccine or vaccine that will expire within 3 months
1. Determine which vaccines can be used before they expire.
2. Transfer vaccines you won’t use to another clinic where they can be used before they expire.
3. If it’s MnVFC vaccine or vaccine that will expire within 3 months, call the MnVFC program at
651-201-5522 for guidance. For private purchase vaccine, check your purchase agreement for
guidance.
3
National
Number of
Drug Code
doses
(NDC)
Check vaccine expiration dates.
Rotate your vaccine supply, placing vaccines with the earliest expiration dates in front of other vaccines and always using them first. Mark these
packages “use first” to alert staff.
If the expiration date is listed by month and year, the vaccine expires the last day of the month (e.g., “06/2012” means the vaccine will expire on
June 30, 2012).
Vaccine or diluent
name
1
y
y
y
Use this log to record your vaccine inventory each month and with each vaccine order to avoid over-ordering. Make sure you:
Month and Year ________________________________________
Monthly Vaccine Inventory Log
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxinv.pdf
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
40
Vaccine
manufacturer1
Packaging
type2
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0974
651-201-5503, 1-800-657-3970
www.health.state.mn.us/immunize
Vaccine or diluent
name
Lot
number
National
Number of
Drug Code
doses
(NDC)
Expiration
date
Vaccine
expires in
3 months3
MnVFC
vaccine
Private
purchase
vaccine
(3/11) Page 1 of 2
Staff
initials
Guide to Managing Out-of-Range Temperatures
Out-of-range temperature discovered!
• Determine cause and follow algorithm below.
• Immediately adjust thermostat, if necessary.
• Keep refrigerator/freezer door closed as much as possible.
• Monitor temperature every 30 minutes.
If temperature has not started to correct within 30 minutes:
TAKE ACTION
99 Contact immediately:
• Primary and backup vaccine coordinator
• Emergency staff and others as necessary
• Alternate vaccine storage facility(s) if you need to move the vaccine
If temperature remains out of range after checking every 30 minutes for 2 hours:
99 Stop using the vaccine:
yy Mark the vaccine “DO NOT USE” so staff won’t inadvertently administer it.
yy Move the vaccine to a refrigerator/freezer that’s maintaining the correct temperature – apart from other vaccines
– until you can determine if it is viable. Do not throw it away!
99 Call for guidance right away: If the vaccine in question is from MnVFC, call the MnVFC program (651-201-5522).
For private purchase vaccine, check your purchase agreement.
yy Be ready to provide temperature details, lot numbers, and expiration dates.
yy If you are instructed to contact the manufacturer, make sure to ask to speak to the medical consultant or quality
assurance staff.
99 Document your actions; see Vaccine Troubleshooting Log on page 51.
Yes
Temperature
back in range
within 60 minutes?
Does your facility have a
backup generator?
Power failure?
(storm, flood, tornado, other)
No
Determine cause
• Start backup generator.
• Monitor temperature
every 30 minutes.
Yes!
Monitor temperature and
be ready to follow TAKE
ACTION steps above, if
necessary.
Prepare to move vaccine
according to your emergency
plan for managing vaccine.
Call for service
immediately.
Mechanical malfunction?
If it will be more than 2 hours before the
unit will be functioning, follow the TAKE
ACTION steps above, and be ready to
move vaccine, if necessary, according
to your emergency plan for managing
vaccine.
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0974
651-201-5503, 1-800-657-3970
www.health.state.mn.us/immunize
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
(03/11)
www.health.state.mn.us/immunize
41
42
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Worksheet for Developing an Emergency Plan
for Managing Vaccine
In advance of an emergency, complete this worksheet and store it in an easily accessible area near vaccine storage unit(s).
Emergency Plan for Managing Vaccine
Checklist of essential items:
 Designated primary and backup vaccine coordinators with emergency contact
information
 Emergency staff contact list in order of priority
 Vaccine storage unit specifications (type, brand, model number, serial number)
 Alternate vaccine storage facility(s)
 Written protocols and identified vehicles and drivers for transporting vaccine to
and from the alternate vaccine storage facility(s)
 Written instructions for how to enter your facility and access vaccine storage
units if the building is closed or it’s after hours. Include the building security afterhours access procedure, a floor diagram, and the locations of:
• Doors
• Flashlights
• Spare batteries
• Light switches
• Keys
• Locks
• Alarms (including instructions for use)
• Circuit breakers
• Packing materials
 Written protocol for vaccine packing
 Appropriate packing materials to safely transport and/or temporarily store
vaccine
 Written protocol for appropriately storing vaccine at the alternate storage
facility(s)
 Up-to-date list of manufacturer quality control office phone numbers
MnVFC Program: 651-201-5522
Page 1 of 4
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/worksheet.pdf
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
43
Worksheet for Developing an Emergency Plan for Managing Vaccine
Page 2 of 4
Vaccine Coordinators
Phone Numbers
(home, cell)
Name
Email
(work, home)
Primary
Backup
Emergency Staff Contact List
Name (list in order of priority)
Emergency Role
(driver, vaccine packer, etc.)
Phone Numbers
(home, cell)
1.
2.
3.
4.
5.
6.
Vaccine Storage Unit Specifications
Type of Unit
(refrigerator or freezer)
Brand
Model Number
MnVFC Program: 651-201-5522
Serial Number
www.health.state.mn.us/vfc
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/worksheet.pdf
44
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Worksheet for Developing an Emergency Plan for Managing Vaccine
Page 3 of 4
Emergency Resources Contact List
Emergency Resources
Company Name
Contact Person
Phone Numbers
Electric power company
Generator repair company
Generator fuel source
Refrigeration repair company
Local Health Department
State Health Department
Immunization Program
800-657-3970
651-201-5501
State Health Department
MnVFC Program
651-201-5522
Alternate Vaccine Storage Facility(s)
Facility Name
Contact Person
Phone Numbers
Storage Capacity
Transportation to Alternate Vaccine Storage Facility(s)
Company Name
Contact Person
Phone Numbers
Refrigerated vehicle company
Refrigerated vehicle company
(alternate)
Private vehicle
Private vehicle (alternate)
MnVFC Program: 651-201-5522
www.health.state.mn.us/vfc
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/worksheet.pdf
July 2011, Minnesota Department of Health Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
45
Worksheet for Developing an Emergency Plan for Managing Vaccine
Page 4 of 4
Packing Materials
Company Name
Contact Person
Phone Numbers
Insulated containers or
coolers
Insulated containers or
coolers (alternate)
Fillers (e.g., bubble wrap, brown
packing paper, newspaper)
Fillers (alternate)
Cold / frozen packs
Cold / frozen packs (alternate)
Dry ice vendor
(if inventory includes MMRV,
varicella, or zoster vaccine)
Dry ice vendor (alternate)
Certified, calibrated
thermometers
Certified, calibrated
thermometers (alternate)
Based on CDC’s Emergency Vaccine Retrieval and Storage Plan Worksheet from the Storage and Handling
Toolkit.
www2a.cdc.gov/vaccines/ed/shtoolkit/resources/Emerg_Vac_Rtrvl_Strg_Plan_Worksheet.htm
MnVFC Program: 651-201-5522
www.health.state.mn.us/vfc
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/worksheet.pdf
46
www.health.state.mn.us/immunize Got Your Shots? Providers Guide - MANAGING VACCINE Minnesota Department of Health, July 2011
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/provguide/mangvax.html#logs
Location of Unit:______________________________ Month/Year: _____
3
pm
pm
am
am
4
pm
pm
pm
am
6
pm
am
7
pm
am
8
pm
am
9
pm
am
10
pm
am
11
pm
am
12
pm
Adjust
j
thermostat
h
o
and call
c MDH
M
for
f guidance
gu n .
Take
T
e immediate
m e
t action
a o iff temperature
mpe t
is in
i shaded
h e area
a a
am
5
-50° or
am
1
pm
am
2
pm
Immunization Program
800-657-3970, 651-201-5503
www.health.state.mn.us/immunize
OTHER
-17°
-16°
-15°
-14°
-13°
-12°
OTHER
min/max
DAY
TIME
Freezer - Aim for -18°C
5
pm
am
6
pm
am
7
pm
am
8
pm
am
9
pm
am
10
pm
am
11
pm
am
12
pm
Adjust thermostat
h
o
and call MDH
M
for guidance
u n .
Take
T
e immediate
m e
t action
a o iff temperature
m e t
is in
i shaded
h e area
a a
am
Adjust
u thermostat
h
o
and call
c MDH
M
for
f guidance
u n
am
am
4
Take
T
e immediate
m
d t action
c o iff temperature
mpe
u is in
n shaded
h e area
a a
pm
3
1°
am
2
OTHER
2°
3°
4°
5°
6°
7°
8°
9°
10°
11°
OTHER
DAY
1
TIME
am
pm
min/max
Refrigerator - Aim for 4°C
am
am
13
13
pm
pm
am
am
14
14
pm
pm
15
pm
pm
am
am
16
16
pm
pm
Page 1 of 2
IC# 141-2232 (9/11)
am
am
15
Days 1-16
• Twice a day place an “X” in the box that corresponds with the current temperature and time. If the temperature is not on the grid, write the actual temperature in the
“OTHER” box; do not use an X.
• Fill in the minimum and maximum temperatures at the same time (if you have that information).
• Take immediate action on any temperature you find in the shaded area!
• If the temperature in your refrigerator/freezer is not on the grid or is in a shaded area, mark the vaccine in question and do not use it until you’ve called the Minnesota
Immunization Program, 800-657-3970 or 651-201-5522.
• If the vaccine has gotten too warm or too cold, you will not be able to distinguish viable from nonviable vaccine by looking at it.
• Keep these monthly temperature logs for 3 years.
Vaccine Storage Temperature Log (Celsius)
Too warm
Too cold Store at 2°– 8°C. Aim for 4°C!
Too warm
Got Your Shots? Providers Guide - MANAGING VACCINE
Store at -15°C or
July 2011, Minnesota Department of Health
www.health.state.mn.us/immunize
47
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/provguide/mangvax.html#logs
Got Your Shots? Providers Guide - MANAGING VACCINE
Location of Unit:______________________________ Month/Year: _____
pm
am
am
19
pm
pm
am
am
20
20
pm
am
21
pm
am
22
pm
am
23
pm
am
24
pm
am
25
pm
am
26
pm
am
27
pm
am
-50° or
am
17
pm
am
18
pm
Immunization Program
800-657-3970, 651-201-5503
www.health.state.mn.us/immunize
OTHER
-17°
-16°
-15°
-14°
-13°
-12°
OTHER
min/max
DAY
TIME
Freezer - Aim for -18°C
OTHER
1°
2°
3°
4°
5°
6°
7°
8°
9°
am
21
pm
am
22
pm
am
23
pm
am
24
pm
am
25
pm
am
26
pm
am
27
pm
am
Adjust
d
thermostat
t
m
t and call
c MDH
M
for
fo guidance
c .
Take immediate
a action
a o iff temperature
m e
u is
i in
n shaded
a d area
r
pm
Adjust
d
thermostat
t
m
t and call MDH
M
for
f guidance
u
c
Take immediate
a action
a o iff temperature
mpe
u is
i in
n shaded
a d area
re
Adjust
d
thermostat
t
m
t and call
c MDH
M
for
f guidance
c .
am
19
Take
a
immediate
a action
a o iff temperature
m e
u is
i in
n shaded
a d area
r
pm
18
11°
am
17
10°
OTHER
DAY
TIME
min/max
Refrigerator - Aim for 4°C
28
28
pm
pm
am
am
29
29
pm
pm
am
am
pm
pm
am
am
31
31
pm
pm
Page 2 of 2
IC# 141-2232 (9/11)
30
30
Days 17-31
• Twice a day place an “X” in the box that corresponds with the current temperature and time. If the temperature is not on the grid, write the actual temperature in the
“OTHER” box; do not use an X.
• Fill in the minimum and maximum temperatures at the same time (if you have that information).
• Take immediate action on any temperature you find in the shaded area!
• If the temperature in your refrigerator/freezer is not on the grid or is in a shaded area, mark the vaccine in question and do not use it until you’ve called the Minnesota
Immunization Program, 800-657-3970 or 651-201-5522.
• If the vaccine has gotten too warm or too cold, you will not be able to distinguish viable from nonviable vaccine by looking at it.
• Keep these monthly temperature logs for 3 years.
Vaccine Storage Temperature Log (Celsius)
Too warm
Too cold Store at 2°– 8°C. Aim for 4°C!
Too warm
www.health.state.mn.us/immunize
Store at -15°C or
48
Minnesota Department of Health, July 2011
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/provguide/mangvax.html#logs
am
1
pm
am
2
pm
am
2
pm
am
3
pm
am
4
pm
pm
pm
am
pm
pm
a tio
am
7
am
pm
am
9
iff t m e
8
pm
t
am
pm
i i
10
am
pm
am
12
h ded a
11
pm
a
am
5
pm
am
6
pm
am
7
pm
am
8
pm
am
9
pm
am
10
pm
am
Adjust
Adj
just
st thermostat
th
hermo
ostat and call MDH
MDH for g
guidance
guidan
uidance
nce
11
pm
am
12
pm
Take
T
ake
e immediate
im
mmediat
e
te action
actio
on iff temperature
tem
mpe
erature is in shaded
sh
hade
ed area
area
a
Adjust
Adj
just thermostat
th
hermo
ostat and call MDH
MDH for guidance
g
guidan
u nce
T ke im edi t
am
6
-58° or
Immunization Program
800-657-3970, 651-201-5503
www.health.state.mn.us/immunize
OTHER
3°
4°
5°
6°
Adjust
j
thermostat
h
o t and call MDH
M
for guidance
n
pm
am
5
Take
T
e immediate
m e
t action
a o iff temperature
m e t
is in shaded
h e area
a a
1
pm
4
7°
am
am
3
8°
OTHER
min/max
DAY
TIME
Freezer - Aim for 0°F
OTHER
33°
34°
35°
36°
37°
38°
39°
40°
41°
42°
43°
44°
45°
46°
47°
48°
49°
OTHER
min/max
DAY
TIME
Refrigerator - Aim for 40°F
•
•
•
•
•
•
am
am
13
13
pm
pm
am
am
14
14
pm
pm
am
am
pm
pm
am
am
16
16
pm
pm
Page 1 of 2
IC# 141-2233 (9/11)
15
15
Days 1-16
Location of Unit:______________________________ Month/Year: _____
Twice a day place an “X” in the box that corresponds with the current temperature and time. If the temperature is not on the grid, write the actual temperature in the
“OTHER” box; do not use an X.
Fill in the minimum and maximum temperatures at the same time (if you have that information).
Take immediate action on any temperature you find in the shaded area!
If the temperature in your refrigerator/freezer is not on the grid or is in a shaded area, mark the vaccine in question and do not use it until you’ve called the Minnesota
Immunization Program, 800-657-3970 or 651-201-5522.
If the vaccine has gotten too warm or too cold, you will not be able to distinguish viable from nonviable vaccine by looking at it.
Keep these monthly temperature logs for 3 years.
Vaccine Storage Temperature Log (Fahrenheit)
Too warm
Store at 35°– 46°F. Aim for 40°F!
Too cold
Too warm
Got Your Shots? Providers Guide - MANAGING VACCINE
Store at 5°F or
July 2011, Minnesota Department of Health
www.health.state.mn.us/immunize
49
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/provguide/mangvax.html#logs
Got Your Shots? Providers Guide - MANAGING VACCINE
am
17
pm
am
18
pm
am
18
pm
am
19
pm
am
20
am
pm
am
pm
am
23
pm
am
24
pm
am
25
pm
am
26
pm
am
27
pm
am
pm
am
21
pm
am
22
pm
am
23
pm
am
24
pm
am
25
pm
am
26
Adjust
Adj
Ad
djust
st thermostat
therm
mostatt and call MDH
MDH for
for g
guidance
guidanc
idance
ce
pm
am
27
pm
am
Take
Tak
ke immediate
im
mme
edia
ate action
actio
on iff temperature
tem
mpe
eratu
ure is
is in
n shaded
sha
aded
d area
are
ea
Adjust
dj
thermostat
t
m
t and call MDH
M
for
f guidance
g
c
Take
k immediate
m e a action
a o iff temperature
mpe
u is
i in
n shaded
a d area
e
pm
22
-58° or
Immunization Program
800-657-3970, 651-201-5503
www.health.state.mn.us/immunize
OTHER
3°
4°
5°
6°
Adjust
d
thermostat
t
m
t and call MDH
M
for
f guidance
u
c
pm
am
21
Take immediate
a action
a o iff temperature
m e
u is
i in
n shaded
a d area
r
17
pm
20
7°
am
am
19
8°
OTHER
min/max
DAY
TIME
Freezer - Aim for 0°F
OTHER
33°
34°
35°
36°
37°
38°
39°
40°
41°
42°
43°
44°
45°
46°
47°
48°
49°
OTHER
min/max
DAY
TIME
Refrigerator - Aim for 40°F
28
28
pm
pm
am
am
29
29
pm
pm
am
am
pm
pm
am
am
31
31
pm
pm
Page 2 of 2
IC# 141-2233 (9/11)
30
30
Days 17-31
Location of Unit:______________________________ Month/Year: _____
• Twice a day place an “X” in the box that corresponds with the current temperature and time. If the temperature is not on the grid, write the actual temperature in the
“OTHER” box; do not use an X.
• Fill in the minimum and maximum temperatures at the same time (if you have that information).
• Take immediate action on any temperature you find in the shaded area!
• If the temperature in your refrigerator/freezer is not on the grid or is in a shaded area, mark the vaccine in question and do not use it until you’ve called the Minnesota
Immunization Program, 800-657-3970 or 651-201-5522.
• If the vaccine has gotten too warm or too cold, you will not be able to distinguish viable from nonviable vaccine by looking at it.
• Keep these monthly temperature logs for 3 years.
Vaccine Storage Temperature Log (Fahrenheit)
Too warm
Store at 35°– 46°F. Aim for 40°F!
Too cold
Too warm
www.health.state.mn.us/immunize
Store at 5°F or
50
Minnesota Department of Health, July 2011
Available on the web at: www.health.state.mn.us/divs/idepc/immunize/hcp/vaxlog.pdf
July 2011, Minnesota Department of Health
Got Your Shots? Providers Guide - MANAGING VACCINE
www.health.state.mn.us/immunize
51
Date
&
Time
Problem
Immunization Program
P.O. Box 64975
St. Paul, MN 55164-0975
1-800-657-3970 or 651-201-5522
www.health.state.mn.us/immunize
Location Temp
Storage Unit
Outcome
No
Yes
Vaccine
Affected
No
Yes
Supervisor
Notified
(7/12)
See any patterns of problems with temperatures? Take action to keep vaccines safe!
Action Taken
Vaccine Storage Unit Troubleshooting Log
Initials