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Availability And Storage Of Vaccines In Community Pharmacies
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Poverty
The poorer
parents are, the more likely they are to fail to immunise their children
(FBA, Systems Analyst, 2005), increasing morbidity and mortality and
further impoverishing the families and creating a vicious circle. Even
though immunization is free, in some areas people still pay for items
such as transportation for health workers attending to patients in hard
to reach areas. Such receipt is required to be shown before vaccination
takes place. Many are unable to pay these monies and therefore do not
present their children for immunization (Oluwadare, 2012). The failure
of governments to address issues relating to poverty and to undertake
effective poverty alleviation exercises therefore affects adversely the
rates of routine immunization in Nigeria.
1.3 The Pharmacist and Vaccination
One
important cause of vaccine failure may be the use of poor or impotent
vaccine mostly due to improper storage (Rathore, 1987). According to the
Canadian National Vaccine Storage and Handling Guidelines for
Immunization Providers, (2007), all vaccines must be maintained in a
cold chain network. The Cold Chain refers to maintaining potency and
integrity of a vaccine by ensuring optimal conditions during storage,
handling and transport. This process includes stakeholders, equipment,
and facilities from manufacture to administration and is designed to
ensure that proper storage temperatures and protection from light is
maintained at every step.
According to the American Pharmaceutical
Association 2013 report, it was revealed that all 50 states in the
United State have approved the involvement of pharmacists in routine
immunizations. Likewise, the involvement of pharmacists in Mannitoba
Canada as reported by Wei et al., (2016) revealed that pharmacists
contributed to the efficacy of routine immunization against influenza
virus.
In a country like Nigeria were electricity or power supply is
poor and vaccines are also handled by untrained personnel who do not
know the need for cold chain system in vaccine storage problems must
definitely abound (Okwor, et al., 2009). An exposure to excessive cold,
heat, or light will result in cumulative and irreversible loss of
potency. The Cold Chain mandates that the optimum temperature for
refrigerated vaccines remain between +2°C and +8°C, and that frozen
vaccines remain at a temperature of -15°C or lower. Protection from
light is necessary for light sensitive vaccines. The pharmacists’ role
in the Cold Chain is to maintain its integrity by properly receiving,
handling and transporting vaccines including the proper use and
management of equipment, refrigerators, thermometers, temperature
monitoring devices, transport coolers, insulation supplies and ice pack
(Public Health Agency of Canada [PHAC] , 2007).
1.4 General Recommendations for Safe Storage and Handling of Vaccines in a Pharmacy (PHAC, 2007)
Temperature
Thermostats
should never be relied upon to monitor temperature as they may not
measure the temperature where the vaccines are stored. It is recommended
that additional thermometers be placed inside the unit next to the
vaccines on the storage shelf and that these thermometers be used for
monitoring purposes. Room temperature should also be monitored at every
refrigerator reading. To provide the best safety margin for temperature
fluctuations within the +2°C to +8°C range, the refrigerator compartment
should be set at +5°C which is mid-range and allows for suitable
temperature fluctuations. The freezer should be set at -15°C or colder.
The temperature of each compartment must be checked at least once in the
morning when the door is opened for the first time and at the end of
the day just before the door is closed for the last time. The
thermometer should be positioned so that the fridge does not have to be
opened to read the temperature (CDC, 2015).
Refrigerated and Frozen Vaccines
Heat
sensitive vaccines experience an irreversible and cumulative loss of
potency following cold chain breaches whereas cold sensitive vaccines
experience an immediate loss of potency following freezing. Vaccines
should always be placed on the middle rack in the center of the
refrigerator or freezer and never on the side of the door or in the
vegetable crisper bins.
How to Adjust Temperature
The temperature
should be adjusted when it is outside the recommended range already or
if over time the temperature trends demonstrate it to be moving toward
the upper or lower temperature limit. Only the designated vaccine
coordinator should adjust the temperature and if any additional staff
notices the unit requires adjustment, they are to alert the vaccine
coordinator. When adjusting the freezer temperature, take into
consideration that this may potentially affect the temperature of the
air venting into the fridge compartment. A warning sign should be placed
on the unit saying “DO NOT adjust refrigerator or freezer temperature
controls.â€
When adjusting the temperature, determine if it is
necessary to remove all vaccines and store them appropriately. Check the
temperatures inside the refrigerator and freezer and adjust the
thermostat slightly. Adjustments should be done slowly; careful not to
exceed the recommended temperature range. The temperature inside the
unit may take about a half hour to stabilize at which time it should
then be rechecked. As needed, continue to adjust the thermostat every
half hour but be sure the temperature inside the unit has stabilized
before returning the removed vaccines
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