Vaccines and Refrigeration: Beware of Thin Ice

[[{"type":"media","view_mode":"media_crop","fid":"42321","attributes":{"alt":"","class":"media-image media-image-right","height":"294","id":"media_crop_4832919601987","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4559","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"©JamesSteidl/Shutterstock.com ","typeof":"foaf:Image","width":"200"}}]]Most pediatric offices have at least two domestic refrigerators-one for vaccines and one for staff lunches and drinks. A two-provider office may be able to get by with just one vaccine refrigerator, but larger offices will usually need at least two. If you see patients eligible for the Vaccines for Children program (VCF) then you have to have duplicates of most of your vaccines. And VFC-supplied vaccine, unlike privately purchased vaccines, will not be replaced at no cost if your refrigerator temperature goes out of range and vaccines are damaged. If you still use a basic household refrigerator, you need to follow some important rules. Let's see how well you know them.

1. Where insdie a domestic (household) refrigerator is it safe to store vaccines?

A. On any shelf below the top shelf.

B.  On any shelf or in a storage bin, but not on the door.

C. On any shelf except the bottom shelf.

D. On any shelf or in a storage bin, but not on the top shelf.

For answer, discussion, and next question, please click here.

Answer:  A. On any shelf below the top shelf.

In addition, vaccines should be stored at least 2-3 inches from rear and side walls. All of a sudden, the refrigerator that looked like it had a lot of storage space when you bought it is having a hard time handling the multitude of vaccines you need. Domestic refrigerators are usually cooled with air below the freezing point blowing onto the top shelf. Not a problem for foods resistant to freezing, but a big problem for liquid vaccines whose potency can be destroyed by freezing.

The opposite problem occurs with vaccines stored in the door as the temperature goes above the recommend top temperature of 8°C as the door is opened. Biologic-grade and freezerless refrigerators have evaporator coils designed to not produce freezing conditions, making them much safer. Another advantage of biologic-grade refrigerators is the presence of internal circulation fans that keep the temperature more even throughout the refrigerator. In these fridges, all the shelves can be used and vaccines can be stored right next to walls.

2. Can you store frozen vaccines (MMR, Varivax, ProQuad, and Zostavax) in the freezer compartment of a domestic refrigerator?

A. Per recent CDC guidelines, this is now forbidden for VFC vaccines but OK for privately purchased vaccines.

B. Per recent CDC guidelines, it is forbidden for all stored vaccines.

C. Per recent CDC guidelines, it is allowed but “discouraged” for all vaccines.

D. The CDC actually does not have any recommendation on this issue.

For answer, discussion, and next question, please click here.

Answer: C. Per recent CDC guidelines, it is allowed but “discouraged” for all vaccines.

Freezer compartments in domestic units that combine a refrigerator/freezer have demonstrated that they are not capable of maintaining correct temperatures for frozen vaccines.  “If existing equipment is a household combination refrigerator/freezer CDC recommends using only the refrigerator compartment for refrigerated vaccines.” The freezer should be left on, however, to maintain proper temperature in the refrigerator.

[[{"type":"media","view_mode":"media_crop","fid":"42324","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_2684199270017","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4561","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 165px; width: 265px; float: right;","title":"©AfricaStudio/Shutterstock.com","typeof":"foaf:Image"}}]]During flu season, a lot of offices receive hundreds, even thousands of vaccine doses in September. Some offices will use a small “dormitory-style” (or bar-style) style refrigerator to store the “overflow.”

3. Does the CDC’s VFC program (supplies free vaccine for Medicaid, uninsured, and some other groups) have any regulations concerning use of these units?  

A. No, CDC does not have regulations.

B. Yes; CDC says dormitory-style units may not be used to store vaccines under any circumstances.

C. Yes; CDC says dormitory-style units can be used to store overflow inventory as long as the door is not opened more than twice a day.

D. No, CDC does not have regulations, but use of dormitory-style refrigerators is discouraged in written guidelines.

For answer and discussion, please click here.

[[{"type":"media","view_mode":"media_crop","fid":"42325","attributes":{"alt":"","class":"media-image media-image-right","height":"228","id":"media_crop_7181678094537","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4562","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"©KitchBain/Shutterstock.com","typeof":"foaf:Image","width":"171"}}]]Answer: A. No, CDC does not have regulations. 

Strictly speaking, each state has its own VFC regulations. But all 50 states forbid the use of dormitory- or bar-style refrigerators (defined as “a combination refrigerator/freezer unit that is outfitted with one exterior door and an evaporator plate (cooling coil), which is usually located inside an icemaker compartment (freezer) within the refrigerator.” They are more sensitive to room temperature changes and are prone to causing accidental freezing in the refrigerator compartment. They should not even be used for temporary storage.

If you are in the market for a vaccine refrigerator, I would urge you to look at the biologic-grade models. I would not be surprised to see them required for VFC vaccines within the next decade. The downside...the cost. Expect to pay about $1,800 to $8,000 for a model with an electronic thermostat.

On the bright side, you won't have to spend a lot on a stand-alone freezer (the biologic-grade refrigerators lack a freezer.) For $500-$600 you can buy two 1.5-cubic ft models, using the back-up when you need to defrost the first. Most offices will not need more freezer space.

What's in your wallet?  You'd better have some cold cash.

References:

http://www.cdc.gov/VACCINES/RECS/storage/default.htm

http://www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf