Graphic-output temperature data loggers for monitoring vaccine refrigeration: implications for pertussis.

We conducted the first US study using graphic-output temperature data loggers in quantifying cold chain failure. Fifty-four vaccine refrigerators of a county outpatient health system were studied. Forty-eight percent maintained temperatures of 2°C to 8°C and 24% had protracted periods of temperatures less than 0°C. The correlation between the percentage of refrigerators with freezing temperatures and the pertussis rate for each health region was r = 0.76. The findings suggest that improper vaccine storage may have contributed to recent increases in pertussis rates.

US vaccine refrigeration guidelines: loose links in the cold chain.

This commentary compares Centers for Disease Control (CDC) guidelines for vaccine storage with international cold chain standards. Problems related to the use of domestic refrigerators in clinical settings are discussed. Optimal vaccine refrigerator design characteristics are summarized. The adoption of World Health Organization storage recommendations is advised.

Vaccine refrigeration: thinking outside of the box.

This commentary reviews recent changes in Centers for Disease Control (CDC) vaccine storage guidelines that were developed in response to an investigative report by the Office of the Inspector General. The use of temperature data loggers with probes residing in glycol vials is advised along with storing vaccines in pharmaceutical refrigerators. These refrigerators provide good thermal distribution but can warm to 8 °C in less than one hour after the power is discontinued. Consequently, electric grid instability influences appropriate refrigerator selection and the need for power back-up. System Average Interruption Duration Index (SAIDI) values quantify this instability and can be used to formulate region-specific guidelines. A novel aftermarket refrigerator with a battery back-up power supply and microprocessor control system is also described.