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Canadian Immunization Guide

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Part 1
Key Immunization Information 2013

Storage and Handling of Immunizing Agents

General considerations

Immunizing agents are biologic materials that are subject to gradual loss of potency from deterioration and denaturation. Loss of potency can be accelerated under certain conditions of transport, storage and handling and may result in failure to stimulate an adequate immunologic response, leading to lower levels of protection against disease. Conditions that result in loss of potency vary among products.

Maintaining the potency of vaccines is important for several reasons:

  • There is a need to ensure that an effective product is being used. Vaccine failures caused by administration of compromised vaccine may result in the occurrence and possible transmission of a vaccine preventable disease.
  • Vaccine losses are expensive and may exacerbate existing supply problems. Loss of vaccines may result in the cancellation of immunization clinics, resulting in lost opportunities to immunize.
  • The recommendation for revaccination of people who have received a potentially ineffective vaccine may cause a loss of public confidence in vaccines and the health care system, as well as inconvenience for the vaccine recipient and the provider.

A detailed discussion of storage and handling recommendations for immunizing agents is beyond the scope of the Canadian Immunization Guide. Detailed information for vaccine providers regarding vaccine storage and handling is available in the Public Health Agency of Canada’s (PHAC) National Vaccine Storage and Handling Guidelines for Immunization Providers (2007). Recommendations for vaccine storage and handling procedures may vary across jurisdictions.

Handling of vaccines

Vaccines are biological products which may become less effective, or even be destroyed, if exposed to light or temperatures outside the recommended range.

Vaccine “Cold Chain”
“Cold chain” refers to the process used to maintain optimal conditions, particularly temperature, during the transport, storage and handling of vaccines, beginning at the manufacturer and ending with administration of the vaccine to the vaccine recipient. Monitoring of vaccines’ cold chain is required to ensure that these products have been stored and transported at recommended temperatures. Exposure of a vaccine to environmental conditions outside those recommended for the product is called a cold chain break, breach or failure, or temperature excursion. Refer to the list of steps in handling vaccines exposed to inappropriate vaccine storage conditions for product specific storage recommendations.

There are several negative consequences of breaks in the cold chain. Vaccines exposed to temperatures above the recommended temperature range may experience some loss of potency with each episode of exposure. Repetitive exposure to increased temperature can result in protein denaturation and a cumulative loss of potency that is not reversible. Some vaccines, such as those containing an aluminum adjuvant, experience a permanent loss of potency due to adjuvant clustering when subjected to freezing and thawing. Freezing of a vaccine or diluent may cause cracks in the container which may lead to contamination of the contents.

It can be difficult to assess the potency of a mishandled vaccine because there is little information about vaccine degradation; multipoint stability studies on vaccines are challenging to perform and information from manufacturers is not always available. Data are available to indicate that some products remain stable at temperatures outside of the recommended range for specified periods of time, but mechanisms rarely exist for monitoring the effect of cumulative exposures. Products that have been exposed to adverse environmental conditions should be managed in accordance with specific instructions from public health officials or the vaccine supplier.

Ongoing cold chain monitoring is an integral part of immunization practices. PHAC’s National Vaccine Storage and Handling Guidelines for Immunization Providers (2007) provides detailed information on establishing standards for cold chain monitoring (i.e., temperature monitors in packages or on vaccine vials, freeze indicators) and evaluating awareness, equipment, practices and potential administrative errors during vaccine transportation and storage.

Single-dose vials
Single-dose vaccines should be reconstituted or drawn up immediately before administration. They should be discarded if the vaccine has been drawn up or reconstituted and subsequently not used within the time frame specified by the manufacturer or jurisdictional guidelines. If the protective cap on a single-dose vial is removed, or if a manufacturer’s pre-filled syringe is opened (e.g., syringe cap removed), the vaccine should be used on that clinic day or discarded.

Multi-dose vials
Once punctured, multi-dose vials should be marked with the date of initial entry into the vial and, if reconstituted, marked with the date and time of reconstitution. Some vaccines provided in multi-dose vials must be used within a specified time after initial puncturing of the vial or after reconstitution. This date will be different than the expiration date printed on the vial by the manufacturer. The new “use by” date should be written on the vial once it has been punctured.

Multi-dose vials must be maintained under appropriate storage conditions (+2°C to +8°C in a secure site to prevent tampering) and removed from the refrigerator (or cooler in community immunization clinics) only to withdraw the required dose from the vial. Vaccine providers should observe strict aseptic technique when using multi-dose vials.

In immunization clinic sessions in which only a single vaccine is being administered, the contents of more than one multi-dose vial may be combined to prevent wastage if the vials have the same lot number.

Manufacturer’s recommendations or jurisdictional guidelines for use of multi-dose vials should be followed. Available information from the product monographs has been summarized in Annex 1.

Reconstitution of lyophilized vaccines
For optimal potency, lyophilized (freeze-dried) vaccines (refer to Appendix 1) should be reconstituted immediately before use with the diluent provided by the manufacturer for that purpose. Refer to the product leaflet, product monograph, or jurisdictional guidelines for vaccine-specific recommendations regarding storage requirements for lyophilized vaccines and diluents, and the time frame for use following reconstitution. If not otherwise instructed by the manufacturer or jurisdictional guidelines, diluents that do not contain vaccine components and that are packaged separately from the vaccine may be stored at room temperature to conserve refrigerator space. The vaccine for which the diluent should be used must be marked clearly to avoid using the wrong diluent.

Reconstituted vaccines should be discarded if not used within the time frame specified for use by the manufacturer or jurisdictional guidelines.

Pre-loading vaccines in syringes
Many vaccines are now provided by manufacturers in pre-loaded syringes. If a vaccine is not provided in a pre-loaded syringe, it should ideally be drawn into the syringe immediately before use. If pre-loading vaccines in syringes is undertaken in an office setting, vaccine providers should prepare only the number of vaccine doses that are expected to be administered during the consultation. If pre-loading vaccines in syringes is undertaken in an immunization clinic setting, vaccine providers should prepare only the number of doses required to keep the clinic running efficiently and doses should be used as soon as possible. If syringes are pre-loaded by a hospital pharmacy, labels should indicate the time by which the vaccine should be used. Vaccine administrators need to consider: the length of time the vaccine will be stored in the pre-loaded syringe; the type of vaccine (i.e., live vs. inactivated vaccine); the potential of exposure to light; the potential for interaction between the vaccine and the material used in the syringe; and the manufacturers’ specifications for vaccine storage. Refer to Vaccine Administration Practices in Part 1 for additional information.

Vaccine-specific storage and handling information
Appendix 1 provides vaccine-specific storage and handling information. For additional storage and handling information consult the product leaflet or information contained within the product monograph available through Health Canada’s Drug Product DatabaseExternal Link.

Storage of Vaccines

Packaging
Store vaccines in their original packaging; the packaging provides protection from light and physical damage.

Refrigerated vaccines
The storage temperature for refrigerated vaccines is between +2°C and +8°C.

Frozen vaccines
Store frozen vaccines at a temperature between -15°C to -50°C or as specified by the product monograph. It should be noted that the use of dry ice may subject vaccines to temperatures colder than -50°C. In general vaccines that have thawed should not be refrozen.

Exposure to freezing
Vaccines that should be stored at +2°C to +8°C should not be used if they have been frozen. Diluent that has been frozen should not be used. Before use, vaccines should be inspected and not used if the usual appearance is altered or a temperature recording device shows that the vaccine was exposed to temperatures below 0ºC. If a vaccine has been exposed to freezing, refer to The list of steps in handling vaccines exposed to inappropriate vaccine storage conditions. and Appendix 1 and consult public health officials for advice. Additional information regarding stability of vaccines is available from the World Health OrganizationExternal Link.

Exposure to heat
Refer to the section on cold chain break management below.

Exposure to light
Vaccines should be stored in their original packaging and protected from light, as exposure to light may cause loss of potency in some vaccines. Some vaccines (such as measles-mumps-rubella (MMR), varicella, and Bacille Calmette-Guérin [BCG] vaccines) should be protected from light exposure at all times. Exposure to light should be limited when pre-loading syringes.

Expiration dates

All vaccines and diluents have expiration dates beyond which the product must not be used. Expiration dates are labelled on product containers (e.g., vials, syringes) and package boxes. When the expiration date is marked with only a month and year, the vaccine or diluent may be used up to and including the last day of the month indicated on the vial. If vaccine has been inappropriately exposed to excessive heat, cold, or light, its potency may be reduced before the expiration date is reached. If an expired vaccine has been inadvertently administered, it should not be counted as a valid dose and should be repeated, respecting the appropriate interval between live parenteral vaccines.

Vaccine disposal

Vaccines that cannot be used because of expiry or breach of the cold chain should either be returned to the supplier for disposal or appropriately disposed of according to jurisdictional standards. Live vaccines and their containers must be disposed of according to standards for biologic products.

Refrigerators and freezers for vaccine storage

General requirements
Any refrigerator or freezer used for vaccine storage must:

  • maintain required vaccine storage temperatures; under-counter bar or dormitory refrigerators should not be used because they do not reliably maintain temperature.
  • hold sufficient inventory, including vaccine for the influenza season, and should not be an under-counter bar or dormitory type refrigerator
  • have a minimum/maximum thermometer or calibrated temperature data logger inside each storage compartment
  • be dedicated to the storage of vaccines only
  • be placed in a secure location away from unauthorized and public access

Central vaccine depots should be equipped with auxiliary generators for refrigerators in case of power failures.

Refer to Section 3 of PHAC’s National Vaccine Storage and Handling Guidelines for Immunization Providers (2007) for detailed information on vaccine storage equipment, including guidelines for purchase of vaccine refrigerators.

Temperature monitoring
The temperature in frost-free refrigerators may vary widely; temperature should be monitored to ensure that temperature cycling is within the acceptable range of +2ºC to +8ºC. Maximum/minimum thermometers are commercially available and are useful for refrigerators used to store vaccines in offices. Constant chart-recording thermometers with alarms are appropriate for larger vaccine storage depots.

Current, maximum and minimum refrigerator temperatures should be recorded twice daily and local public health officials or the vaccine supplier should be contacted if vaccines are exposed to temperatures outside the recommended range. Refer to Cold chain break management for additional information.

Domestic refrigerators
Domestic refrigerators are not designed to meet the requirements for vaccine storage; therefore, precautions and modifications are needed if vaccines are stored in such refrigerators. Refrigerators older than 10 years are more likely to malfunction and to have breaks in the seal around the door, leading to temperature instability. The use of such refrigerators for vaccine storage is a leading cause of cold chain breaks.

Purpose-built vaccine refrigerators
A purpose-built vaccine refrigerator (pharmacy, lab-style or laboratory grade refrigerator) is the standard for storing large inventories of vaccines. Under-counter purpose-built vaccine refrigerators are acceptable for vaccine storage.

Recommended office procedures

Refer to PHAC’s National Vaccine Storage and Handling Guidelines for Immunization Providers (2007) for detailed information on vaccine inventory management and storage practices. The following procedures are recommended to ensure that storage of vaccines in vaccine provider offices is optimized.

Inventory management
An adequate supply of vaccines should be maintained to meet the monthly needs of the served population. Do not over order vaccines since this increases the risk of wastage (e.g. cold chain break as a result of power failure, or expiry of unused vaccines). To ensure good management of inventory:

  • Designate and train one staff member to be responsible for managing vaccines and another staff member as a backup.
  • Limit access to the vaccine supply to authorized personnel only. This will help to protect the vaccine supply by avoiding inappropriate removal of vaccine or inappropriate handling of vaccine and vaccine storage units by untrained personnel. All staff handling vaccines should be familiar with policies and procedures for vaccine storage and handling.
  • Place vaccines into the designated refrigerator immediately upon delivery to the office.
  • Rotate stock so that vaccines with the earliest expiration date are at the front of the shelf.
  • Check inventory and expiry dates monthly.
  • Store vaccine products that have similar packaging in different locations that are clearly marked in order to avoid confusion and administration errors.
  • Place expired vaccine into a marked box and remove from the refrigerator for appropriate disposal.
  • Establish at least one alternate storage facility where vaccine can be appropriately stored and monitored in case of failure of the designated refrigerator.

Refrigerator

  • Post storage and handling guidelines on the refrigerator.
  • Place full, plastic water bottles in the lower compartment and door shelves of the refrigerator and ice packs in the freezer compartment to help stabilize temperatures, especially in the event of a power failure.
  • Store vaccines in the middle of the refrigerator to avoid the coldest and warmest parts of the refrigerator; do not store vaccines on the door shelves or in the vegetable and fruit bins i.e. crispers of domestic refrigerators.
  • Ideally, store frozen vaccines in a separate designated freezer unit. However, for domestic refrigerators having a separate freezer compartment, frozen vaccine may be stored at -15° C or colder in the middle of the freezer compartment away from the walls and coils. Do not store vaccines in the freezer door.
  • Place a maximum/minimum thermometer on the middle shelf of the fridge and another in the freezer compartment.
  • Read, record and re-set the thermometer inside each compartment of the vaccine storage unit at least twice during each work day – once at the beginning of the day and once at the end of the day just before the door is closed for the last time.
  • Check the thermometer function annually (refer to PHAC’s National Vaccine Storage and Handling Guidelines for Immunization Providers (2007) for instructions).
  • Secure the electrical cord from the fridge to the wall outlet to prevent the plug from being removed from the electrical socket. Place a warning near the outlet stating that the plug must not be disconnected.
  • Ensure that the refrigerator door does not inadvertently open by installing a fail-safe closing mechanism (e.g., hook and ladder fastener). Keyed door locks to the room storing the refrigerator contribute to vaccine inventory security.
  • Do not store food or biologic specimens in the same refrigerator as vaccines.
  • If refrigerator malfunction is suspected on the basis of temperature readings, obtain servicing immediately, move the vaccine to an alternative refrigerator and refer to the section on cold chain break management below.
  • In the event of a power failure, move the vaccine to an alternative refrigerator and refer to the section on cold chain break management below.
  • Defrost non-frost-free refrigerators regularly; defrost when frost has accumulated to a thickness of more than 1 cm; move vaccines to a functioning refrigerator with the proper temperature during the defrosting process.
  • Avoid unnecessarily opening the refrigerator door.
  • Remove the vaccine from the refrigerator only immediately prior to administration.

Vaccine transportation

  • Use insulated storage containers with ice packs for transport of vaccines out of the office (e.g., to vaccinate people in their homes or in off-site clinics); to avoid freezing, do not place vaccine packages in direct contact with ice packs.
  • Maintain vaccine between +2°C and +8°C during off-site clinics; store in an insulated container with ice packs. Keep the container closed as much as possible. Keep a thermometer in the container with the vaccines, and check and record temperatures periodically to ensure that the cold chain is maintained.
  • When transporting vaccines, keep a log of pre- and post-transport vaccine temperatures and the vaccine lots transported.

Cold chain break management
If vaccines are exposed to temperatures outside the recommended range (refer to Appendix 1) or other inappropriate storage conditions, immediate action should be taken in order to avoid product loss (refer to The list of steps in handling vaccines exposed to inappropriate vaccine storage conditions). It should not be assumed that vaccine inappropriately exposed to light or to temperatures outside the recommended range cannot be salvaged.

List of Steps in handling vaccines exposed to inappropriate vaccine storage conditions.

  1. Separate the affected vaccine from other vaccine supplies and label it as “DO NOT USE” to ensure that the vaccine is not administered. Store the affected vaccine under appropriate cold chain conditions until its integrity is determined.
  2. Record the following information:
    1. Vaccine name, lot number, expiry date
    2. Date and time of incident
    3. The issue (e.g., exposure to inappropriate temperature or exposure to light)
    4. Length of time the vaccine may have been exposed to inappropriate conditions
    5. The room temperature where the vaccine storage unit is located
    6. Current temperature inside the vaccine storage unit (and freezer)
    7. Minimum and maximum temperature readings inside the vaccine storage unit (and freezer)
    8. Presence of water bottles in the refrigerator
    9. Presence of frozen packs in the freezer
  3. Contact local public health officials or the vaccine supplier to seek advice regarding use of the vaccine. Provide the information outlined in step 2.
  4. Follow directions provided by local public health officials or the vaccine supplier regarding use or disposal of affected vaccines. Adapted from PHAC’s National Vaccine Storage and Handling Guidelines for Immunization Providers (2007).

In general, live attenuated vaccines, even in their lyophilised form, are more sensitive to heat exposure than inactivated vaccines. High ambient temperatures (up to +37°C) may not cause an immediate loss of potency but can shorten the shelf life of a vaccine. Evidence on the thermostability of vaccines suggests that an increase in temperature to above +8°C for a short period of time is unlikely to affect the potency of most vaccines significantly, particularly if the vaccines are used relatively quickly.

When a cold chain break is identified after an affected vaccine has been administered, consult local public health officials or the vaccine supplier for advice. The type of vaccine, as well as the duration and temperature of the exposure, need to be taken into account when assessing the situation. Serological testing or revaccination may be suggested.

Refer to Section 6 of PHAC’s National Vaccine Storage and Handling Guidelines for Immunization Providers (2007) for detailed information on handling vaccines that have been exposed to inappropriate storage conditions.

Selected references

  • Carrasco P, Herrera C, Rancruel D et al. Protecting vaccines from freezing in extremely cold environments. Can Commun Dis Rep 1995;21(11):97-101.
  • Centers for Disease Control and Prevention. General Recommendations on Immunization Recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Morb Mortal Wkly Rep 2011;60(RR-02):1-61.
  • Centers for Disease Control and Prevention. Vaccine administration guidelines. Accessed July 2012 at: http://www.cdc.gov/vaccines/recs/vac-admin/default.htm
  • Centers for Disease Control and Prevention. The Vaccine Storage and Handling Toolkit. Accessed March 2013 at: http://www.cdc.gov/vaccines/recs/storage/toolkit/storage-handling-toolkit.pdf
  • Gold MS, Martin L, Nayda CL et al. Electronic temperature monitoring and feedback to correct adverse vaccine storage in general practice. Med J Aust 1999;171(2):83-4.
  • Guthridge SL, Miller NC. Cold chain in a hot climate. Aust N Z J Public Health 1996;20(6):657-60.
  • Health Canada. Guidelines for temperature control of drug products during storage and transportation. 2011. Accessed July 2012 at: http://www.hc-sc.gc.ca/dhp-mps/compli-conform/gmp-bpf/docs/gui-0069-eng.php
  • Kendal AP, Snyder R, Garrison PJ. Validation of cold chain procedures suitable for distribution of vaccines by public health programs in the USA. Vaccine 1997;15(12-13):1459-65.
  • Milhomme P. Cold chain study: danger of freezing vaccines. Can Commun Dis Rep 1993;19(5):33-8.
  • Public Health Agency of Canada. National Vaccine Storage and Handling Guidelines for Immunization Providers (2007). Accessed July 2012 at: http://www.phac-aspc.gc.ca/publicat/2007/nvshglp-ldemv/index-eng.php
  • United Kingdom, Department of Health. Immunisation Against Infectious Disease. The Green Book. 2012. Accessed July 2012 at: http://immunisation.dh.gov.uk/category/the-green-book/
  • World Health Organization. Report of the Technical Review Group Meeting, 7-8 June 1998: Achievements and plan of activities, July 1998-June 1999. Geneva: World Health Organization, 1998 (Technical Report Series, No. 98.02).

Appendix 1: vaccine storage recommendations

Cold chain should always be maintained.
Vaccine
(Brand name)
Vaccine form Vaccine presentation Storage temperatureFootnote 1 (°C)
(* = +2° to +8°C)
Handling recommendations (°C)
(* = +2° to +8°C)
Other
y = yes
Time frame for use Additional recommendations and information
L = Lyophilized powder

LS = Liquid or solution

S = Suspension
Single-dose Multi-dose vial Vaccine Diluent

NI = no information
Reconstituted vaccineFootnote 2 Multi-dose vial after entryFootnote 3 Protect from light Do not freeze NI = no information
V = vial

S = pre-filled syringe

Y = with preservative

N = no preservative

Table developed from information contained in manufacturer’s product monographs accessed April 2013 at Health Canada’s Drug Product DatabaseExternal Link. Product monographs are continually updated; it is a best practice to consult the current product monographs available at Health Canada’s Drug Product DatabaseExternal Link. Additional information regarding stability of vaccines is available from the World Health OrganizationExternal Link.

Table 1 - Footnote 1
In general, do not use vaccines that should be stored at +2°C to +8°C if they have been frozen. Do not use diluent which has been frozen.
Table 1 - Footnote 2
Reconstitute or withdraw single-dose vaccines immediately before administration. Discard single-dose vaccines if the vaccine has been withdrawn or reconstituted and subsequently not used within the time frame specified by the manufacturer or jurisdictional guidelines.
Table 1 - Footnote 3
Maintain multi-dose vials under appropriate storage conditions and remove from the refrigerator only to withdraw the required dose. Observe strict aseptic technique when using multi-dose vials.
Table 1 - Footnote 4
In cases of temporary temperature excursions only; not a storage or shipping recommendation.

hr = hours

Act-HIB® L V   * * Use immediately     Y Use immediately after reconstitution Diluent: sterile saline in a vial
ADACEL® S V   *         Y NI Stable at above +8° and up to +25° for maximum of 72 hr, before openingFootnote 4
ADACEL® -POLIO S V or S   *         Y NI Stable at above +8° and up to +25° for maximum of 72 hr, before openingFootnote 4
AGRIFLU® S S   *       Y Y NI Can be used after 2 hr exposure at +8° to +25° before openingFootnote 4
AVAXIM® S S   *         Y NI  
BCG vaccine (live) L   N * * * * Y Y Discard if not used within 8 hr after first puncture
  • Diluent: sterile phosphate-buffered saline containing 0.025% polysorbate 80 in a vial
  • Store in the dark except when doses are being withdrawn from vial
BOOSTRIX® S S   *       Y Y NI Stable at 21° for 8 hr, before openingFootnote 4
BOOSTRIX® -POLIO S V or S   *       Y Y NI  
CERVARIX® S V or S   *       Y Y NI
  • Stable at +8° to +25° for maximum of 3 days, before openingFootnote 4
  • Stable at between +25° to +37° for up to 1 day, before openingFootnote 4
  • Discard is exposed to +37° or higher
DUKORAL® S V   * Room temp (up to 25°) Room temp     Y 2 hr after opening
  • Store buffer sachet at room temperature
  • Vaccine can be stored at room temperature (up to +25°) for up to 2 weeks on one occasion only, before opening
ENGERIX®-B (multi-dose) S   Y *     * Y Y 24 hr after first puncture  
ENGERIX®-B (single-dose) S V   *       Y Y Use immediately after withdrawl  
FLUAD® S S   *       Y Y NI Can be used after 2 hr exposure at temperatures between +8° to +25°, before openingFootnote 4
Flulaval™ Tetra S   Y *     * Y Y 28 days after first puncture  
FLUMIST® (live) Intranasal spray Nasal sprayer   *         Y NI  
FlulavalTM Tetra S   Y *     * Y Y 28 days after first puncture  
FLUVIRAL® (multi-dose) S   Y *     *   Y 28 days after first puncture  
FLUZONE® (multi-dose) S   Y *     * Y Y 28 days after first puncture  
FLUZONE® (single-dose) S V or S   *       Y Y NI  
FLUZONE® Quadrivalent (single-dose) S V or S   *       Y Y NI  
GARDASIL® S V or S   *       Y Y NI
  • Can be used if total cumulative time out of refrigeration (between +8° to +25°) does not exceed 72 hr, before openingFootnote 4
  • Can be used if total cumulative time between +0° to +2° does not exceed 72 hr, before openingFootnote 4
HAVRIX® S V or S   *
  • * or ambient temps (up to 25°)
  • Do not freeze
Use immediately     Y Use immediately after reconstitution Diluent: sterile water in syringe
HIBERIX® L V   *
  • * or ambient temps (up to 25°)
  • Do not freeze
Use immediately   Y Y Use immediately after reconstitution
  • Diluent: sterile saline in vial or pre-filled syringe
IMOVAX® Polio S S   *         Y NI  
IMOVAX® Rabies L V   * * Use immediately     Y Use immediately after reconstitution Diluent: sterile water in syringe
INFANRIX hexa® L & S V & S   * *
  • Use promptly
  • Stable for 8 hr at 21°
  Y Y
  • Use promptly
  • Stable for 8 hr at 21°
  • PEDIARIX™ suspension in pre-filled syringe
  • Lyophilized Haemophilus influenza type b vaccine in vial
INFANRIX®-IPV S S   * *     Y Y    
INFANRIX®-IPV/Hib L & S V & S   * *
  • Use promptly
  • Stable for 8 hr at 21°
  Y Y
  • Use promptly
  • Stable for 8 hr at 21°
  • INFANRIX®-IPV vaccine in pre-filled syringe
  • HIBERIX® vaccine in vial
INFLUVAC® S S   *       Y Y NI  
INTANZA S S   *         Y Microinjection system  
IXIARO® S S   *       Y Y NI  
Menactra® LS V   *         Y NI  
Meningitec® S S   *         Y NI  
Menjugate® L V   * * Use immediately   Y Y Use immediately after reconstitution
  • Diluent: aluminum hydroxide in vial or syringe
  • Alternatively, vaccine can be stored for up to 6 months at +8° to +25°, if unopened
MENOMUNE® (multi-dose) L   Y * * * *   Y 35 days after first puncture Diluent: sterile saline with lactose and thimerosal in vial
MENOMUNE® (single-dose) L V   * * *     Y 24 hr after reconstitution Diluent: sterile saline with lactose in vial
Menveo™ L & LS V   * *
  • Stable for up to 2 hr at or below 25°
  Y Y
  • Stable for up to 2 hr at or below 25° after reconstitution
  • Lyophilized Men A conjugate in 1 vial
  • Liquid MenCWY conjugate in 1 vial
M-M-R® II Live L V   * or frozen at temperature above –50°
  • *or room temp
  • Do not freeze
*   Y Y
  • Maximum 8 hr at +2° to +8° after reconstitution
  • Diluent: sterile water in vial
  • Maintain vaccine at 10° or colder during shipment.
  • Protect vaccine from light at all times
  • Prior to reconstitution, can be used if total cumulative time out of refrigeration, at +8°C to +25°C does not exceed 6 hours. These are not, however, recommendations for storage
NeisVac-C® S S   *         Y NI Alternatively, can be stored for a single period not exceeding 9 months at room temperature (up to +25°), if unopened
NIMENRIXTM L V   * Room temp (up to 25°)     Y Y    
PEDIACEL® S V   *         Y NI
  • Discard if exposed to 0° or lower
  • Stable at +8° to +25° for a maximum of 72 hr, if unopenedFootnote 4
PNEUMOVAX® 23 (multi-dose) LS   Y *     *     48 hr after first puncture  
PNEUMOVAX® 23 (single-dose) LS V   *           NI  
Prevnar® 13 S S   *         Y NI Prevnar 13 has been shown to be stable at temperatures of up to 25°C for 4 days. Cumulative multiple temperature excursions between 8°C and 25°C are permitted, as long as the total time does not exceed 4 days (96 hours). These data are not recommendations for shipping or storage, but may guide decisions for use in case of temporary temperature excursionsFootnote 4
PRIORIX® (live) L V   * Room temp (up to 25°) *   Y  
  • Use as soon as possible
  • Maximum 8 hr at +2° to +8° after reconstitution
Diluent: sterile water in ampoule
PRIORIX-TETRA® (live) L V   * * *   Y Y
  • Use as soon as possible
  • Maximum 8 hr at +2° to +8° after reconstitution
Diluent: sterile water in pre-filled syringe or ampoule
PROQUADTM L V   * * or room termperature (up to 25°) Room termperature (up to 25°)   Y  
  • Use as soon as possible
  • Discard if not used within 30 min after reconstitution
  • Vial should be stored at 2°C to 8°C or colder (above -50°C).
  • The diluent may be stored in the refrigerator with the lyophilized vaccine or separately at room temperature
QUADRACEL® S V   *         Y NI
  • Discard if exposed to 0°C or lower
  • Stable at above +8°C and up to +25°C for a maximum of 72 hr, if unopenedFootnote 4
RabAvert® L V   * * Use immediately   Y   Use immediately after reconstitution
  • Diluent: sterile water in vial
RECOMBIVAX HB® (single-dose) S V   *         Y NI
  • Can be used if total cumulative time out of refrigeration (between +8° to +25°) before opening does not exceed 72 hrFootnote 4
  • Can be used if total cumulative time between +0° to +2° before opening does not exceed 72 hrFootnote 4
ROTARIX™ (live) LS Oral applicator   *       Y Y NI  
RotaTeq® (live) LS Oral applicator   *       Y Y
  • Administer as soon as possible
  • Stable for up to 4 hr at +25° after opening
 
Smallpox Vaccine (live) L   N Frozen at -15°C to -25°C Do not freeze+15° to+30° * Do not freeze * Do not freeze     Preferably use at once Stable for 6-8 hr at 20-25°C and 30 days at +2° to +8°C after reconstitutions Supplied with bifurcated needles for percutaneous scarification
Diluent: glycerol in McIlvaine buffer with 0.2% v/v phenol
SYNFLORIX® (multi-dose) S   N *     * Y Y
  • Use immediately
  • Discard if not used within 6 hr after first puncture
Can be administered when vaccine has been at +8°C to +25°C for up to 72 hours before opening. These data are not recommendations for storage.
SYNFLORIX® (single-dose) S V or S   *       Y Y NI  
Td ADSORBED S V   *         Y NI  
Td POLIO ADSORBED S V   *         Y NI  
TWINRIX® S V or S   *       Y Y NI  
TYPHERIX® LS S   *       Y Y NI  
TYPHIM Vi® (multi-dose)   Y *     * Do not freeze   Y 6h after first puncture    
TYPHIM Vi® (single-dose) LS S   *         Y NI  
VAQTA® S V   *         Y NI
  • Can be used if total cumulative time out of refrigeration (between +8° to +25°) before opening does not exceed 72 hrFootnote 4
  • Can be used if total cumulative time between +0° to +2° before opening does not exceed 72 hrFootnote 4
VARILRIX® (live) L V   * * or +8° to +25° *       Up to 8 hr at +2° to +8°C
or
Up to 90 min at +25°C after reconstitution
  • Lyophilized vaccine not affected by freezing
  • Diluent: sterile water in pre-filled syringe or ampoule
VARIVAX® III (live) L V   *or Frozen at above -50°
  • * or +8° to +25°
  • Do not freeze
Do not freeze   Y   Up to 90 min at +20° to +25°C after reconstitution
  • Prior to reconstitution, can be used if total cumulative time out of refrigeration, at +8° to +25°, does not exceed 6hrFootnote 14
VAXIGRIP® (multi-dose) S   Y *     * Y Y 7 days after first puncture  
VAXIGRIP® (single-dose) S Ampoule or S   *       Y Y NI  
ViVAXIM® S & LS S   *   Use immediately after mixing     Y Use immediately after mixing
  • Syringe contains 2 components in separate chambers: hepatitis A vaccine suspension and typhoid vaccine solution
  • Mix contents of double chamber syringe just before administration
Vivotif® (live) L Oral capsule   *       Y Y NI
  • May be out of refrigeration during a reasonable transit time from clinic to home
  • Can be used if out of refrigeration at 25° for up to 12 hr on one occasion only
  • Protect from moisture or high humidity
YF-VAX® (live, multi-dose) L   N * * Do not freeze * *   Y 60 min after reconstitution Diluent: sterile saline in vial
YF-VAX® (live, single-dose) L V   * * Do not freeze *     Y 60 min after reconstitution Diluent: sterile saline in vial
ZOSTAVAX® (live) L V   Frozen at -15° to -50°
  • * or +20° to +25°
  • Do not freeze
  • 30 min at room temp
  • Do not freeze
  Y   30 min after reconstitution Diluent: sterile water in vial

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