Recommendations and Guidelines

Emergency Procedures for Protecting Vaccine Inventories

The Vaccines For Children (VFC) program maintains vaccine inventories in the field valued at over $1 billion. To protect this national vaccine inventory and minimize the potential monetary loss from natural disasters or other emergencies, immunization facilities should develop a Written Emergency Plan to safeguard their vaccine inventories.

Emergency procedures should address the protection and/or retrieval of vaccines at both the depot and provider level. Projects should have the ability to routinely communicate during normal operations and quickly communicate action plans during emergencies or anticipated emergencies with all providers receiving public purchased vaccines.

When states, local officials, or providers have reasonable cause to believe that emerging conditions will disrupt vaccine operations, emergency procedures should be implemented IN ADVANCE OF THE EVENT.

In advance of the emergency, all providers should:

1. Identify an alternative storage facility (hospital, packing plant, state depot, etc.) with back-up power (generator) where the vaccine can be properly stored and monitored for the interim, Insure the availability of staff to pack and move the vaccine, Maintain the appropriate packing materials (insulated containers, ice packs, dry ice for Varicella/MMR vaccine, etc.) and,

2. Insure a means of transport for the vaccine to the secure storage facility.

NOTE: Whenever possible, facilities should suspend vaccination activities BEFORE the onset of emergency conditions to allow sufficient time for packing and transporting vaccine. The information below is provided as a guideline for developing facility-specific Standard Operating Procedures for the protection of vaccine inventories before and during emergency conditions.

Emergency Procedures

1. List emergency phone numbers, companies, and points of contact for:

   1. Electrical power company
   2. Refrigeration repair company
   3. Temperature alarm monitoring company
   4. Perimeter alarm repair company
   5. Perimeter alarm monitoring company
   6. Backup storage facility
   7. Transportation to backup storage
   8. Dry ice vendor
   9. Emergency generator repair company
   10. National weather service
   11. Manufacturers
       1. Merck Sharpe & Dohme: 800-672-6372
       2. Aventis Pasteur: 800-VACCINE (800-822-2463)
       3. GlaxoSmith Kline: 888-825-5249
       4. Wyeth Lederle Labs: 800-666-7248

2. State/project assistance to providers in possession of vaccine:

   1. Establish working agreements with hospitals, health departments or other facilities to serve as emergency vaccine storage facilities and communicate these agreements with your providers. (This might also be done at the regional or county level and/or with the assistance of Bioterrorism or Emergency Preparedness Units.)
   2. Prioritize assistance and communication to those providers in areas at highest risk from the emergency.

3. Entering vaccine storage facilities:

Describe how to enter the building and vaccine storage spaces in an emergency if closed or after hours. Include a floor diagram and the locations of:

1. Doors
2. Flash lights
3. Spare batteries
4. Light switches
5. Keys
6. Locks
7. Alarms
8. Circuit breakers
9. Packing materials

4. Identify who to call for the following assistance:

1. Equipment problems
2. Packing containers, cold packs, (and dry ice, if necessary)
3. Backup storage
4. Backup transportation
5. Security

5. Identify what vaccines to pack first in an emergency and while the power is still working:

1. Pack the refrigerated vaccines first with an adequate supply of cold packs.
2. Remove and pack the Varicella vaccine, using dry ice, immediately before it is to be transported.

6. Pack and transport all vaccine or if that is not possible, determine the types and amounts to save:

e.g., save only the most expensive vaccines to minimize dollar loss or save some portion of all vaccines to ensure a short term, complete supply for resuming the vaccination schedule. We would suggest the first priority be given to those vaccines which would be the most expensive to replace.

7. Follow vaccine packing procedures for transport to backup storage facilities:

1. Have vaccine packing instructions readily available for staff unfamiliar with packing procedures.
2. Open refrigerated units only when absolutely necessary and only after you have made all preparations for packing and moving the vaccine to alternative storage sites.
3. Use properly insulated containers.
4. Use a properly placed temperature monitoring device in each container.
5. Record vaccine type(s), quantity, date, time, and originating facility on the container.
6. Document the storage container temperatures at the time the vaccine is removed for storage at the alternate site.

8. Move vaccine to backup storage according to pre-arranged plans.

   1. How to load transportation vehicle
   2. Routes to take (alternate routes if necessary)
   3. Time en route
   4. Ensure vaccine containers are stored properly in the emergency storage facility. (Varicella in freezer; refrigerated vaccines in refrigerator; adequate circulation; functioning temperature monitoring devices, etc.

NOTE: The Federal Emergency Management Agency (FEMA) offers a wide range of information on disaster preparedness: www.fema.gov/

Related MMWR article dated Oct. 24, 2003 / 52(42);1023-1025.
Notice to Readers: Guidelines for Maintaining and Managing the Vaccine Cold Chain

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