#4. An example of a good temperature monitoring device in action (NAGLAA)

Temperature monitoring devices used in primary TTSPs storage facility. The cold room temperature is displayed on the panel, drawn temperature chart recorder with digital display. Temperature is also recorded twice daily by designated staff.  Data of Labguard temperature monitoring system is monitored from the control room.

#2 An example of a Good Warehouse keeping (SHALINIE)

This was taken this September 2016 at Cebu City Health Department Cold Room Facility. It shows a well spaced placement of the vaccines. It is arranged according to type of vaccines. The cold room staff also maintains cleanliness in the facility.

Hepatitis B vaccines are arranged in groups with label, Lot # and Expiration Date.

There are space in between PCV 13 vaccine supply to allow air circulation.

Cool water packs are laced on vacant spaces for packing of vaccines for delivery.

Although the cold room facility has its own temperature monitoring system with alarms, a Fridge Tag is placed on the vaccines to back up temperature monitoring.

#15 - A temperature violation (KWAME)

Number 15:  A temperature violation

This picture was taken in September 2016 at an outreach clinic during measles second dose post-introduction evaluation. At an outreach clinic, vaccines are put directly on top of a frozen ice pack. No condition of the ice packs  was done and no foam pad was used. Take note of the vial of tetanus toxoid vaccine,  a freeze sensitive vaccine.  At another clinic, the practice was different. Foam pad was in use.

#10 - A health worker in immunization outreach (KWAME)

Number 10: A health worker in immunization outreach 

This picture below  was taken in September 2016 during measles second dose post-introduction evaluation.  It shows a Health Surveillance assistant (HSA) at an outreach clinic in rural central Malawi giving a health talk to mothers before vaccination started. During immunisation clinics, other activities conducted include health talks, nutritional assessment, growth monitoring. In Malawi HSAs are the vaccinators and run the immunisation clinics. Some outreach clinics take place in  simple mud huts that are built by the communities especially in places where school classroom or churches are not available as alternative venues.

 

#6 A temperature sensitive product being administered to a child (SHALINIE)

#6 A temperature sensitive product being administered to a child

This picture is taken at Labangon Elementary school, Cebu City during the school based immunization for Grade 1 pupils. The nurse is giving MR vaccine to the child. Since this is a temperature sensitive product, vaccine carrier is brought to maintain the temperature requirement of the product.

#15 Temperature violation (HOA)

Every year, my institute have to order some reference agents from NIBSC for purpose establishment secondary standards and control quality vaccines.
This shipment was dispatched from NIBSC, England to Hanoi, Vietnam. They dispatched the parcel though DHL on Mon, Mar 7th. DHL sent the parcel pass though Germany, Thailand then Vietnam.
I received the parcel on Mar 18th (at 18.00). At that time, It had no dry ice and not in freezer. (Please see the photo).
I worried  about  condition during transportation of all the sample. I feedback to Dispatch Team Leader of NIBSC. He said that he need to consult with scientists about condition of products. Some of them could be shipped at room-temperature and so should be OK to use still. However some of them such as most of polio and influenza products must be -70degC all the time so they would have to be replaced.

After that he feedback to me that:

NIBSC would be replacing all the polio materials as they would not be fit for use.
Scientist has advised that the influenza antigens and antiserum reagents would be OK to use as long as they were not exposed to high temperatures.
However, if I feel quality was in doubt NIBSC could replace the influenza products as well. 

I were not sure about the quality of the influenza products so I required NIBSC replaced all polio and influenza products.

#11. A scanned image of a local temperature recording form (ARNULFO)

This is a scanned image ( as requested by Sir Umit) of a temperature monitoring chart (August 2016) of  10 cubic meter Cold Room No. 1, an intermediate vaccine store of the Department of Health-Regional Office VII, Cebu City, Philippines. The temperature limits of 2 degrees to 8 degrees Centigrade shaded in yellow is where the dots are mark corresponding to the reading of Fridge Tag 2. Twice a day recording of temperature and each dot is connected to plot a line graph, am - blue color / pm - red color. Exceeding this upper and lower boundary, corrective measures are done right away to prevent any negative effect to the vaccine stored.

The temperature monitoring tool calibration certificate date / due is indicated in the upper right hand corner. No break in  temperature monitoring even during Saturday, Sunday, and holiday.

The plotted line graph is the average temperature while the minimum / maximum temperature is in numerical. Alarm indication is also reflected and duly signed. Important notes is written in the  remarks portion for additional information.