CDC Vaccine Storage and Handling Guide

Home , Hib vaccine, Influenza vaccine, Vaccine storage

acn trg n adigGie ——————————————— Page 2 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Selected Biologicals General Information Human PapillomavirusVaccines Hepatitis-Containing Vaccines Haemophilus influenzae Vaccines Toxoid-,Diphtheria Tetanus Toxoid-Pertussis-Containing acellular and Vaccine StorageandHandlingBestPractices HPV4: Gardasil HPV2: Cervarix Hib-HepB: Comvax DTaP-HepB-IPV: Pediarix TwinrixHepA-HepB: HepB: Engerix-B,RecombivaxHB HepA: Havrix,VAQTA DTaP-IPV/Hib: Pentacel Hib-HepB: Comvax Hib: ActHIB, Hiberix,PedvaxHIB DTaP-IPV/Hib: Pentacel DTaP-HepB-IPV: Pediarix DTaP-IPV: KINRIX DTaP: DAPTACEL, Infanrix, Tripedia

typeb-ContainingVaccines

Table ofContents

23 23 15 11 19 19 19 11 15 15 11 11 11 11 5 acn trg n adigGie ——————————————— Page 3 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Tetanus Toxoid Vaccine Rotavirus Vaccines Poliovirus-Containing Vaccine Pneumococcal Vaccines Meningococcal Vaccines Measles-, Mumps-andRubella-ContainingVaccine Influenza Vaccines TT: Tetanus Toxoid RV5: RotaTeq RV1: ROTARIX DTaP-IPV/Hib: Pentacel DTaP-IPV: KINRIX DTaP-HepB-IPV: Pediarix IPV: IPOL PPSV23: Pneumovax23 PCV13: Prevnar13 MPSV4: Menomune MCV4: Menactra,Menveo MMRV: ProQuad MMR: M-M-RII Fluzone, FluzoneHigh-Dose,Intradermal TIV: Afluria, Fluarix,FluLaval,Fluvirin, LAIV: FluMist

Table ofContents 57 53 53 11 11 11 49 45 45 41 37 69 33 29 27 acn trg n adigGie ——————————————— Page 4 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease indicates thattheproducts mustbemixedorreconstitutedbytheuser. manufacturer anddonot requiremixingorreconstitutionbytheuser. A slash (/) vaccine productsindicates thatproductsaresuppliedintheirfinal formbythe divided equallyintoindependentlyavailable routine vaccines. A dash(-)between A combinationvaccineisdefined asaprod¬uctcontainingcomponentsthatcanbe product information. Advisory CommitteeonImmunizationPractices (ACIP)andthemanufacturer Information containedinthisdocumentisbased ontherecommendationsof Resources Varicella-Containing Vaccines Vaccines Tetanus Toxoid-, diphtheriatoxoid-,andacellularpertussis-Containing Tetanus Toxoid- anddiphtheriatoxoid-ContainingVaccines Manufacturer/Distributor ContactInformation State ImmunizationProgramInformation Other Resources CDC Resources MMRV: ProQuad ZOS: Zostavax(herpeszoster/shingles) VAR: Varivax (chickenpox) Boostrix Tdap: Adacel, DT: Diphtheriaand Tetanus Toxoid Td: DECAVAC

Table ofContents ’s 76 75 74 73 69 69 69 65 61 61 acn trg n adigGie ——————————————— Page 5 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease the followingfourelements. Routine Vaccine StorageandHandlingPlan VFC policyandworkwiththeirimmunizationprogram. staff orientation.Inaddition,Vaccines forChildren(VFC)providersshouldfollow Handling Toolkit annually. Educateallstaff, includingtemporarystaff, aspartofnew Immunization providersandstaff arestronglyencouragedtoreviewtheStorageand and Handling Toolkit containsdetailedinformationonvaccinemanagement. Below isanoutlineofvaccinestorageandhandlingbestpractices.CDC’ handling fromthetimevaccinearrivesatfacilityuntilisgiven. are administered.Immunizationprovidersresponsibleforproperstorageand Vaccines mustbestoredproperlyfromthetimetheyaremanufactureduntil Vaccine StorageandHandlingBestPractices 1. ●

● ● ● Ordering and Accepting Vaccine Deliveries 3. 2. 1. components. Vaccine Managementincludes,butisnotlimitedto,thesethree

immediately upondelivery. guidelines vaccine needstobestored accordingtothemanufacturer’s are oftenacceptedby nonmedical staff. They shouldbeawarethat Educate allfacilitystaff aboutvaccinestorage.Vaccine shipments operation, andstaff scheduleswhenorderingvaccines. immunization program.Considerholidays,vacations, changesinhoursof shipments canbedelivered.VFCproviders should alsonotifythe store thevaccineproperly. Informmanufacturer/distributor when vaccine shipments shouldbedeliveredwhenstaff isavailabletounpackand Ensure vaccinesaredeliveredwhenthefacility isopen.Vaccine arrival. Store vaccinesattherecommendedtemperaturesIMMEDIATELY upon Written storageandhandlingplansareupdatedatleastannuallyfor: At least2staff membersshouldberesponsibleforvaccinemanagement. Staff isknowledgeable reliable andappropriate. The equipmentusedforvaccinestorageandtemperaturemonitoringis – – – –

emergency vaccineretrievalandstorage Store frozenvaccinesbetween-58°Fand+5°F (-50°Cand-15°C). Store refrigeratedvaccinesbetween35°Fand 46°F(2°Cand8°C). routine storageandhandling

regardingpropervaccinestorageandhandling.

General Information ofvaccines;and . shouldinclude s Storage acn trg n adigGie ——————————————— Page 6 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Institute ofStandardsand Technology, ortoanotherinternationallyrecognizedstandards agency laboratory accreditedbytheInternational organizationofStandardization,tothestandards theNational *Certificate of Traceability andCalibrationthermometerwithcalibration measurementstraceabletoatesting 2.

● ● ● ● ● Storing andHandlingVaccines ● ● ●

temperature logsforatleast3years. each workday-inthemorningandbefore endoftheworkday. Keep Read anddocumentrefrigeratorfreezer temperaturesatleasttwice Power” signsnearcircuitbreakerstomaintain aconsistentpowersource. Post “DoNotUnplug”signsnextelectricaloutlets and“DoNotStop recalibrated asrecommendedbythemanufacturer. Calibration* intherefrigeratorandfreezer. These thermometers shouldbe Keep acalibratedthermometerwithCertificateof Traceability and never bestoredinthesameunitwithvaccines. stored onalowershelftopreventcontamination.Foodanddrinksshould biologic specimensmustbestoredinthesameunit,theseshould Store vaccineinstorageunitsdesignatedspecificallyforbiologics.If compartment (freezer)withintherefrigerator. evaporator plate(coolingcoil),whichisusuallylocatedinsideanicemaker freezer/refrigerator unitthatisoutfittedwithoneexteriordooran A dormitory-stylerefrigerator isdefinedasasmallcombination be used. and thermostatscanbeused.Dormitory-stylerefrigeratorsshouldnot preferred buthouseholdcombinationunitswithseparateexteriordoors largestinventorywithoutcrowding.Standaloneunits are the year’s the appropriatetemperaturerangeandarelargeenoughtomaintain Store vaccinesinrefrigeratorandfreezerunitswhichcanmaintain 5. 4. 3. 2. 1. Maintain avaccineinventorylogincluding: available frommanymanufacturerswithdiffering indications. and typesofpatientsthefacilityserves.Influenzavaccine,forexample,is Order thevaccinesandpresentationsthatareappropriateforages influenza seasonandorderaccordingly. the year. Anticipate peakperiodssuchasback-to-schoolappointmentsor the facility’s patients. The amountofvaccineneededcanvarythroughout Order vaccinestomaintainanadequateamountmeettheneedsof

vaccine expirationdate. vaccine manufacturerandlotnumber; condition ofvaccineonarrival; date vaccinereceived; vaccine nameandnumberofdosesreceived;

General Information acn trg n adigGie ——————————————— Page 7 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease 3.

● ● Managing Inventory ● ● ● ● ● ●

placed tohelpstaff choosetheappropriatevaccine. storage unit.Inaddition, clearlylabelthespacewherevaccine is identify VFCandother vaccinespurchasedwithpublicfundswithin the Keep vaccinestockwellorganized.VFCproviders shouldseparateand from usablestock. vaccine thatwillexpirethesoonest.Remove expiredvaccineanddiluent is usedfirst.Placevaccinewiththelongest expiration datebehindthe Rotate stocksovaccineanddiluentwiththe shortestexpirationdate instructions. manufacturer’s supplied bythevaccinemanufacturer. Storediluentaccordingtothe reconstituting or“mixing”vaccine,ifindicated.Useonlythediluent Prepare vaccinesatthetimevaccineisadministered. This includes appropriate temperature. shown storingvaccinesintheboxhelpstomaintainvaccineat administration errors. And intheeventofapowerfailure,studieshave together inthesamebinsorcontainerswhichcanleadtovaccine light. This practicealsohelpstoensuredifferent vaccinesarenotstored in placeuntiladministration.Severalvaccinesmustbeprotectedfrom Store unopenedandopenedvaccinesintheiroriginalboxwiththelid seal iscompromisedwhenthedoorclosed. caution mustbetakentoavoidweighingdownthedoorsomuchthat so theydonotdislodgeandpreventthedoorfromclosing.Inaddition, temperature. Frozenpacksorwaterbottleshouldbeplacedsecurely door oftherefrigeratortohelpstorageunitmaintainaconstant Place frozenpacksinthedooroffreezerandwaterbottles temperature hereisnotstable. should neverbestoredinthedooroffreezerorrefrigerator part oftheunitbestabletomaintainrequiredtemperature.Vaccines Store vaccinesontheshelvesawayfromwalls,andventsin space betweenthecontainerstopromoteairflow. sides oropeningsshouldbeusedtostorethevaccines. There shouldbe Bins, baskets,orsomeothertypeofuncoveredcontainerswithslotted air circulationisessentialtomaintainingthecorrectstoragetemperatures. Ensure goodaircirculationaroundthevaccineinstorageunit.Proper unacceptable temperatures. that canoccurinrefrigeratorsandfreezerswithoutexposingvaccinesto temperature range. This allowsforthesmalltemperaturefluctuations maintain storageunittemperatureswithinthemiddleofacceptable instructions. Store vaccineaccordingtothemanufacturer’s Aim to

General Information . The acn trg n adigGie ——————————————— Page 8 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease include thefollowingcomponents. Emergency Vaccine RetrievalandStoragePlanshould 3. 2. 1. 4.

vaccine orrefrigerated diluent. calibrated thermometer shouldbeplacedineachpackingcontainer nearthe Include writtendirectionsforpackingvaccines anddiluentsfortransport. A plan. Communicatetostaff whereeverythingiskept. these supplieswithacopyoftheemergency vaccineretrievalandstorage Toolkit largestinventorywhenstockingsupplies.Store . Considertheyear’s Acceptable packingcontainersaredescribed inthe wrap) inthefacilitythatwillbeneededtopack vaccinesforsafetransport. containers andmaterials(e.g.,frozenrefrigerated gelpacks,bubble Obtain andstoreanadequatenumber/amount ofappropriatepacking procedures thatallow24-houraccesstoalternate facilities. retail orclinicpharmacies,long-termcarefacilities,theRedCross.Identify Potential back-uplocationsincludelocalhospitals,anotherprovider available, temperaturemonitoringcapabilities,andback-upgenerator. stored. Considerationswhenchoosingasiteincludetypesofstorageunit(s) Designate analternatesitewherevaccinesanddiluentscanbesafely ● ● ● Managing PotentiallyCompromisedVaccines ● ●

prior toadministration. being compromised.Forexample,eachvaccineshouldbepreparedjust procedures todecreasethelikelihoodofvaccineordiluentinadvertently Educate staff administeringvaccinesoncorrecthandlingandpreparation vaccines anddiluents. appropriate actionsthatshouldbefollowedforallpotentiallycompromised Contact vaccinemanufacturersand/orstateimmunizationprogramfor discard thevaccineordiluent. labeled paperbagcanbeusedforthispurpose.Donotautomatically vaccines anddiluentsintherecommendedtemperaturerange. A clearly Label these“DONOT USE”.Storeseparatelyfromuncompromised Identify andisolateallpotentiallycompromisedvaccinesdiluents. Contact theimmunizationprogramfordetailsandstatespecificguidance. Dispose ofallvaccinematerialsusingmedicalwastedisposalprocedures. or displacedtoanareainappropriateforvaccinestorage. During abusyworkday, vaccinesandthermometerscanbeeasilymoved vaccines andthermometersareplacedappropriatelywithintheunit. Inspect thestorageunitdaily. A physicalinspectionhelpstoensure

General Information Storage andHandling ’s facility, acn trg n adigGie ——————————————— Page 9 —————————————————————————————— Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease to CDC’s Vaccine StorageandHandlingToolkit. For moredetailedinformationonpropervaccinestorageandhandlingpleaserefer 6. 5. 4.

immunization program. Include contactinformationforvaccinemanufacturersand/orthe vaccines. Incorporate writtenproceduresformanagingpotentiallycompromised where thevaccinesarestored. outages atthefacility. Includeinstructionsforgaining24-houraccessto Develop aplaninwhichvaccinecoordinatorswillbenotifiedofpower

General Information This page was left intentionally blank for printing purposes

Vaccine Storage and Handling Guide —————————————————————————————— Page 10 acn trg n adigGie —————————————————————————————— Page 11 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease freeze orexposetofreezing temperatures. Refrigerate vaccineanddiluent,ifapplicable, immediatelyuponarrival.Donot Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or the vaccineattimeofdelivery, youshouldtakethreesteps. facility hasbeenmorethan48hoursoryouhavequestionsabouttheconditionof between shipmentfromthedistributor/manufacturerandarrivalofvaccineat should nothavebeenfrozenorexposedtofreezingtemperatures.Iftheinterval temperature monitorispresent,checkandfollowtheinstructions. The vaccine during transport.Somevaccinesareshippedwithatemperaturemonitor. Ifa insulated container. Examinetheshippingcontainerandcontentsfordamage (DTaP, DTaP-HepB-IPV, DTaP-IPV, DTaP-IPV/Hib) shouldarrivepackedinan Diphtheria toxoid-,tetanustoxoid-andacellularpertussis-containingvaccines upon Arrival Condition DTaP-IPV/Hib: DTaP-IPV: KINRIX DTaP-HepB-IPV: Pediarix DTaP: DAPTACEL,Infanrix, Tripedia Pertussis-Containing Vaccines Toxoid-,Diphtheria Tetanus Toxoid-acellular and ● ● 3. 2. 1.

between 35°F*and46°F (2°Cand8°C). DTaP, DTaP-HepB-IPV (Pediarix),DTaP-IPV (KINRIX):Refrigerate same shippingcontainer. (ActHIB) andDTaP-IPV diluent vialsshouldarrivepackagedtogetherinthe DTaP-IPV/Hib (Pentacel)has2components. manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F

Pentacel Selected Biologicals

The lyophilizedHibvaccine , acn trg n adigGie —————————————————————————————— Page 12 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease end ofthisdocumentforinformationonvaccineadministration. combined ormixedwithanyothervaccines.RefertotheResourcessectionat (Pediarix), DTaP-IPV (KINRIX),DTaP-IPV/Hib (Pentacel) vaccinesshouldnotbe If theseconditionsexist,thevaccineshouldnotbeused.DTaP, DTaP-HepB-IPV Inspect thevaccinevisuallyforextraneousparticulatematterand/ordiscoloration. Preparation label. vaccine AND diluent,ifapplicable.Donotuseaftertheexpirationdateshown onthe Check expirationdateonthecontainer, vialormanufacturer-filledsyringe of the Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C)arespecifiedinthelabellicenseforthese ● ● ●

3. 2. 1. handout “Vaccines withDiluents:HowtoUse Them”. at theendofthisdocumentforanexample alabelandtheeducational manufacturer toreconstitutethevaccine. RefertotheResourcessection prior toadministeringit. labeling thevaccinetoremindstaff toreconstituteDTaP-IPV/Hib (Pentacel) be mixedtogetherbeforeadministration.Considerpostingremindersor DTaP-IPV/Hib (Pentacel): resuspended withthoroughagitation. should beacloudy, whitecoloredliquid.Donotusevaccineifitcannotbe shake vialormanufacturer-filledsyringewell. Aftershaking,thevaccine DTaP, DTaP-HepB-IPV (Pediarix),DTaP-IPV (KINRIX): Justbeforeuse, 46°F (2°Cand8°C).Donotstorethemseparately. (ActHIB) andthevaccinediluent(DTaP-IPV) togetherbetween35°F*and DTaP-IPV/Hib (Pentacel):RefrigeratethelyophilizedHibvaccine

thorough agitation. mix thoroughly. Donotusethevaccine ifitcannotberesuspendedwith Shake thevialcontaininglyophilizedvaccine anddiluentwellto capped vial). inject itintothevialcontaininglyophilized vaccinecomponent(green Withdraw theentirecontentsofdiluentvial (bluecappedvial)and Just beforeuse,shakethevialofDTaP/IPV diluent.

Only usethediluentsuppliedbyvaccine

This vaccineissuppliedin2vialsthatmust Selected Biologicals acn trg n adigGie —————————————————————————————— Page 13 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease exposed totemperaturesoutside therecommendedrange. NOTE: Contacttheimmunization programwheneverVFCorothervaccinespurchasedwithpublic funds are limited to,thesefouractions. a currentemergencyvaccineretrievalandstorage planthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromtheexpirationdate. *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrommanufacturer- reconstituted vaccinepriortoadministration. freeze orexposereconstitutedvaccinetofreezingtemperatures. the refrigeratorbetween35°Fand46°F(2°C8°C)forupto30minutes.Donot Administer immediately. Unused,reconstitutedDTaP-IPV/Hib maybestoredin a sterilesyringeusingneedleatthetimevaccineisadministered. DTaP-IPV/Hib (Pentacel):Allofthereconstitutedvaccineshouldbedrawninto administered. (i.e., syringetipremovedand/orneedleattached)atthetimevaccineis Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimevaccineisadministered. Single-Dose Vials: Beyond UseDate*:ShelfLifeafterOpening

4. 3. 2. 1. ●

or themanufacturer. Do notdiscardvaccine unlessdirectedtobytheimmunizationprogram and/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyand contactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthis purpose. Mark vaccine“DoNotUse”andseparatefrom uncompromisedvaccines. A and 8°C). Place thevaccineinrecommendedstorage between35°Fand46°F(2°C before discardingVFCorothervaccinespurchasedwithpublicfunds. is notusedwithin30minutes. Do notadministerreconstitutedDTaP-IPV/Hib (Pentacel)vaccineifit 4.

tinged) liquid. The reconstitutedvaccineisacloudy, uniform,whitetooff-white (yellow requires immediatecorrectiveaction!

All ofthevaccineshouldbedrawnintoasterilesyringeusing Follow theimmunizationprogramguidance Vaccine providers shouldhave Selected Biologicals Agitate stored,

acn trg n adigGie —————————————————————————————— Page 14 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Refer totheResourcessectionatendofthisdocumentforexampleslabels. information uniquetothevaccinecanhelppreventadministrationerrors. Labeling thespacewherevaccineisstoredwithname,ageindicationsorother each other. Donotstoresound-alikeorlook-alikevaccinesnexttoeachother. storage unitbyagegroupand/orcolorcodinglabelstodistinguishvaccinesfrom easily confusedincreasingtheriskforerror. Considerorganizingvaccines inthe Diphtheria toxoid-,tetanustoxoid-andacellularpertussis-containingvaccinesare Special Instructions

Selected Biologicals acn trg n adigGie —————————————————————————————— Page 15 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease temperatures. guidelines immediatelyuponarrival.Donot freeze orexposetofreezing Store thevaccineanddiluent,ifapplicable,according tothemanufacturer Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or the vaccineattimeofdelivery, youshouldtakethreesteps. facility hasbeenmorethan48hoursoryouhavequestionsabouttheconditionof between shipmentfromthedistributor/manufacturerandarrivalofvaccineat should nothavebeenfrozenorexposedtofreezingtemperatures.Iftheinterval If atemperaturemonitorispresent,checkandfollowtheinstructions. The vaccine damage duringtransport.Somevaccinesareshippedwithatemperaturemonitor. packed inaninsulatedcontainer. Examinetheshippingcontainerandcontentsfor Haemophilus influenzae upon Arrival Condition Note: InformationpertainingtoDTaP/IPV-Hib (Pentacel)canbefoundonpage11 Hib-HepB: Comvax Hib: ActHIB,Hiberix,PedvaxHIB Vaccines Haemophilus influenzae ● 3. 2. 1. ●

and 46°F(2°C8°C). PedvaxHIB andComvax vaccines:Refrigeratevaccinebetween 35°F* manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F shipping container. Hib vaccineanddiluentvialsshouldarrivepackaged togetherinthesame ActHIB andHiberixvaccineseachhave2components.Thelyophilized

typeb-containingvaccines(Hib,Hib-HepB)shouldarrive typeb-Containing Selected Biologicals ’s , acn trg n adigGie —————————————————————————————— Page 16 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease end ofthisdocumentforinformationonvaccineadministration. be combinedormixedwithanyothervaccines.RefertotheResourcessectionat these conditionsexist,thevaccineshouldnotbeused. These vaccinesshouldnot Inspect thevaccinevisuallyforextraneousparticulatematterand/ordiscoloration.If Preparation date shownonthelabel. vaccine AND diluent,ifapplicable.Donotusevaccineordiluentaftertheexpiration Check expirationdateonthecontainer, vialormanufacturer-filledsyringeofthe Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C)arespecifiedinthelabellicenseforthese ● ● ● ●

1. Diluents: HowtoUse Them”. document forexamplesoflabelsandtheeducational handout“Vaccines with reconstitute thevaccine.RefertoResourcessectionatendof this diluent. Onlyusethediluentsuppliedbyvaccine manufacturerto sodium chloridediluent.Hiberixisreconstituted with0.9%sodiumchloride same andtheyareNOT interchangeable. ActHIB isreconstituted with0.4% staff toreconstitutethesevaccines. ActHIB andHiberixdiluents arenotthe administration. Considerpostingremindersor labelingthevaccinetoremind ActHIB andHiberixvaccines:Thesevaccinesmustbereconstitutedbefore cannot beresuspendedwiththoroughagitation. vaccine shouldbeaslightlyopaque,whiteliquid.Donotuseifit PedvaxHIB andComvaxvaccines: or atroomtemperaturebetween68°Fand77°F(20°C25°C). Diluent: Storeintherefrigeratorbetween35°F*and46°F(2°C8°C) box. (2°C and8°C).Protectvaccinefromlightatalltimesbystoringintheoriginal Vaccine: Refrigeratethelyophilizedvaccinebetween35°F*and46°F together intherefrigerator. Hiberix vaccine:Ifspaceallows,storethelyophilizedvaccineanddiluent 35°F and46°F(2°C8°C). ActHIB vaccine:Refrigeratelyophilizedvaccineanddiluentbetween

it intothevialcontaining thelyophilizedHibvaccine. Just beforeuse,withdraw theentirecontentsofdiluentvialand inject

Donotstorethemseparately. Justbeforeuse,shakethevial. The Selected Biologicals acn trg n adigGie —————————————————————————————— Page 17 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease exposed totemperaturesoutside therecommendedrange. NOTE: Contacttheimmunization programwheneverVFCorothervaccinespurchasedwithpublic funds are limited to,thesefouractions. a currentemergencyvaccineretrievalandstorage planthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromtheexpirationdate. *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrommanufacturer- administration. reconstituted Hiberixfromlight. Agitate stored,reconstitutedvaccinepriorto not freezeorexposereconstitutedvaccinestofreezingtemperatures.Protect in therefrigeratorbetween35°Fand46°F(2°C8°C)forupto24hours.Do Administer immediately. Unused,reconstituted ActHIB orHiberixmaybestored into asterilesyringeusingneedleatthetimevaccineisadministered. ActHIB andHiberixvaccines: syringe usingasterileneedleatthetimevaccineisadministered. PedvaxHIB and Comvax vaccines: Beyond UseDate*:ShelfLifeafterOpening 4. 3. 2. 1. ●

or themanufacturer. Do notdiscardvaccineunlessdirectedtoby theimmunizationprogramand/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyand contactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthis purpose. Mark vaccine“DoNotUse”andseparatefrom uncompromisedvaccines. A and 8°C). Place thevaccineinrecommendedstorage between35°Fand46°F(2°C discarding VFCorothervaccinespurchasedwithpublicfunds. used within24hours. Do notadministerreconstituted ActHIB orHiberixvaccineifitisnot 3. 2.

The reconstitutedvaccineshouldbeaclearandcolorlessliquid. thorough agitation. mix thoroughly. Donotusethevaccineifitcannotberesuspendedwith Shake thevialcontaininglyophilizedvaccineanddiluentwellto requires immediatecorrectiveaction!

Followtheimmunizationprogramguidancebefore

All ofthereconstitutedvaccineshouldbedrawn

All of the vaccineshouldbedrawnintoasterile Vaccine providers shouldhave Selected Biologicals

acn trg n adigGie —————————————————————————————— Page 18 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease end ofthisdocumentforexampleslabels. help preventvaccineadministrationerrors.RefertotheResourcessectionat Labeling thespacewherevaccineisstoredwithnameandageindicationscan each other. Donotstoresound-alikeorlook-alikevaccinesnexttoeachother. storage unitbyagegroupand/orcolorcodinglabelstodistinguishvaccinesfrom the riskforvaccineadministrationerrors.Considerorganizingvaccinesin Storing multipleproductsandpresentationscanbeconfusingtostaff andincreases products andpresentationsoftenhavedifferent approvedindications(e.g.,ages). in thestorageunit.Forexample,singleantigenandcombinationvaccines.Vaccine Providers canhavedifferent productsorpresentationscontainingthesamevaccine Special Instructions

Selected Biologicals acn trg n adigGie —————————————————————————————— Page 19 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease

use aftertheexpiration dateshownonthelabel. Check expirationdate onthecontainer, vialormanufacturer-filled syringe.Donot Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C) arespecifiedinthelabelandlicenseforthese 8°C). Donotfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or time ofdelivery, you shouldtakethreesteps. more than48hoursoryouhavequestionsabouttheconditionofvaccineat from thedistributor/manufacturerandarrivalofvaccineatfacilityhasbeen been frozenorexposedtofreezingtemperatures.Iftheintervalbetweenshipment monitor ispresent,checkandfollowtheinstructions. The vaccineshouldnothave transport. Somevaccinesareshippedwithatemperaturemonitor. Ifatemperature insulated container. Examinetheshippingcontainerandcontentsfordamageduring Hepatitis-containing vaccines(HepA,HepB,HepA-HepB)shouldarrivepackedinan upon Arrival Condition InformationpertainingtoDTaP-IPV-HepB (Pediarix)canbefoundonpage11 Note: HepA-HepB: Twinrix HepB: Engerix-B,RecombivaxHB HepA: Havrix,VAQTA Hepatitis-Containing Vaccines 3. 2. 1.

manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F Information pertainingtoHib-HepB(Comvax)canbefoundonpage15

Storebetween35°F*and46°F(2°C Selected Biologicals , acn trg n adigGie —————————————————————————————— Page 20 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease exposed totemperaturesoutside therecommendedrange. NOTE: Contacttheimmunization programwheneverVFCorothervaccinespurchasedwithpublic funds are limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom administered. (i.e., syringetipremovedand/orneedleattached)atthetimevaccineis Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimevaccineisadministered. Single-Dose Vials: Allofthevaccineshouldbedrawnintoasterilesyringeusing Beyond UseDate*:ShelfLifeafterOpening vaccine administration. Refer totheResourcessectionatendofthisdocumentforinformationon in color. These vaccinesshouldnotbecombinedormixedwithanyothervaccines. with thoroughagitation. After shaking,thevaccineshouldbewhite,slightlycloudy or manufacturer-filledsyringewell.Donotusevaccineifitcannotberesuspended these conditionsexist,thevaccineshouldnotbeused.Justbeforeuse,shakevial Inspect thevaccinevisuallyforextraneousparticulatematterand/ordiscoloration.If Preparation 4. 3. 2. 1.

Vaccine providers shouldhave Selected Biologicals acn trg n adigGie —————————————————————————————— Page 21 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease for examplesoflabels. RefertotheResourcessection attheendofthisdocument administration errors. where thevaccineisstoredwithnameandageindicationscanhelpprevent not storesound-alikeorlook-alikevaccinesnexttoeachother. Labelingthespace age groupand/orcolorcodinglabelstodistinguishvaccinesfromeachother. Do vaccine administrationerrors.Considerorganizingvaccinesinthestorageunitby products andpresentationscanbeconfusingtostaff andincreasestheriskfor and HepBvaccineshavedifferent formulationsbasedonage.Storingmultiple approved indicationsanduses(e.g.,ages).Forexample,singleantigenHepA vaccine inthestorageunit.Vaccine productsandpresentationsoftenhavedifferent Providers canhavedifferent productsorpresentationscontainingthesame Special Instructions

Selected Biologicals

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Vaccine Storage and Handling Guide —————————————————————————————— Page 22 acn trg n adigGie —————————————————————————————— Page 23 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease use aftertheexpiration dateshownonthelabel. Check expirationdate onthecontainer, vialormanufacturer-filled syringe.Donot Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C) arespecifiedinthelabelandlicenseforthese 8°C). Donotfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or time ofdelivery, you shouldtakethreesteps. more than48hoursoryouhavequestionsabouttheconditionofvaccineat from thedistributor/manufacturerandarrivalofvaccineatfacilityhasbeen been frozenorexposedtofreezingtemperatures.Iftheintervalbetweenshipment monitor ispresent,checkandfollowtheinstructions. The vaccineshouldnothave transport. Somevaccinesareshippedwithatemperaturemonitor. Ifatemperature container. Examinetheshippingcontainerandcontentsfordamageduring Human papillomavirusvaccine(HPV)shouldarrivepackedinaninsulated upon Arrival Condition HPV4: Gardasil HPV2: Cervarix Human PapillomavirusVaccines ● 3. 2. 1.

original box. HPV4 (Gardasil):Protectvaccinefromlightatalltimesbystoring inthe manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F

Store between35°F*and46°F(2°C Selected Biologicals , acn trg n adigGie —————————————————————————————— Page 24 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease limited to,thesefouractions. a currentemergencyvaccineretrievalandstorage planthatincludes,butisnot or toocold- Vaccine exposedtotemperaturesoutsidetherecommended range-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom administered. (i.e., syringetipremovedand/orneedleattached)atthetimevaccineis Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimevaccineisadministered. Single-Dose Vials: Beyond UseDate*:ShelfLifeafterOpening administration. to theResourcessectionatendofthisdocumentforinformationonvaccine These vaccinesshouldnotbecombinedormixedwithanyothervaccines.Refer suspension. Donotusevaccineifitcannotberesuspendedwiththoroughagitation. liquid. Through agitation immediatelybeforeadministrationisneededtomaintain manufacturer-filled syringewell. Aftershaking,HPVvaccineisawhite,cloudy conditions exist,thevaccineshouldnotbeused.Justbeforeuse,shakevialor Inspect visuallyforextraneousparticulatematterand/ordiscoloration.Ifthese Preparation 3. 2. 1. ●

or theimmunizationprogram forfurtherguidance. Follow yourimmunization programpolicyandcontactthemanufacturer and/ clearly labeledpaperbag canbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefrom uncompromisedvaccines. A and 8°C). Place thevaccineinrecommendedstorage between35°Fand46°F(2°C deterioration. vial withaclear, colorlessliquidaboveduringstorage. This doesnotindicate HPV2 (Cervarix): requires immediatecorrectiveaction!

All ofthevaccineshouldbedrawnintoasterilesyringeusing Mayseparatetoafine,whitedepositonthebottomof Vaccine providersshouldhave Selected Biologicals acn trg n adigGie —————————————————————————————— Page 25 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease the Resourcessectionatendofthisdocumentforexampleslabels. indications tohelpdecreasethelikelihoodofavaccineadministrationerror. Referto to eachother. LabelthespacewhereHPVisstoredwithname,genderandage vaccines fromeachother. Donotstoresound-alikeorlook-alikevaccinesnext vaccines inthestorageunitbyagegroupand/orcolorcodinglabelstodistinguish vaccines areoftenconfused,increasingtheriskforanerror. Considerorganizing Vaccines thatsound alikeareoftenconfused.Forexample,HPV, HepBandHib and thefacility’s patientpopulationwhenorderingHPVvaccine. HPV2isapprovedforuseinfemales only. Considerindications males andfemales. from different manufacturerswithdifferent indications. HPV4canbeadministeredto the riskforvaccineadministrationerrors. There aretwoHPVproductsavailable Storing multipleproductsandpresentationscanbeconfusingtostaff andincrease Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare 4.

or themanufacturer. Do notdiscardvaccineunlessdirectedtobytheimmunizationprogramand/

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Vaccine Storage and Handling Guide —————————————————————————————— Page 26 acn trg n adigGie —————————————————————————————— Page 27 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease this documentforinformation onvaccineadministration. sprayer containsasingle doseofLAIV. RefertotheResources sectionattheendof This vaccineshouldnotbecombinedormixed withanyothervaccines.Eachnasal Preparation the label. expiration dateonthenasalsprayer. Donotuseaftertheexpirationdateshownon Influenza vaccineisformulatedforuseduring thecurrentinfluenzaseason.Check Shelf Life Do notfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or time ofdelivery, you shouldtakethreesteps. more than48hoursoryouhavequestionsabouttheconditionofvaccineat from thedistributor/manufacturerandarrivalofvaccineatfacilityhasbeen been frozenorexposedtofreezingtemperatures.Iftheintervalbetweenshipment monitor ispresent,checkandfollowtheinstructions. The vaccineshouldnothave transport. Somevaccinesareshippedwithatemperaturemonitor. Ifatemperature container. Examinetheshippingcontainerandcontentsfordamageduring Live, attenuatedinfluenzavaccine(LAIV)shouldarrivepackedinaninsulated upon Arrival Condition LAIV: FluMist Influenza Vaccines 3. 2. 1.

Store between35°Fand46°F(2°C8°C). Selected Biologicals ,

acn trg n adigGie —————————————————————————————— Page 28 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Resources sectionatthe endofthisdocumentforanexamplea label. Refertothe of administrationcanhelppreventvaccine errors. the spacewherevaccineisstoredwithname, ageindications,androute from eachother. Donotstoresound-alike vaccinesnexttoeachother. Labeling in thestorageunitbyagegroupand/orcolor codinglabelstodistinguishvaccines increase theriskforvaccineadministrationerrors. Considerorganizingvaccines ages). Storingmultipleproductsandpresentations canbeconfusingtostaff and Influenza productsandpresentationshave different approvedindications (e.g., Often providershavedifferent influenzapresentationsinthesame storage unit. Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom at thetimevaccineisadministered. Single-Dose Sprayer:Thenasalsprayershouldberemovedfromtherefrigerator Beyond UseDate*:ShelfLifeafterOpening 4. 3. 2. 1.

or themanufacturer Do notdiscardvaccineunlessdirectedtobytheimmunizationprogramand/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyandcontactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A and 8°C). Place thevaccineinrecommendedstoragebetween35°Fand46°F(2°C requires immediatecorrectiveaction!

Vaccine providers shouldhave Selected Biologicals acn trg n adigGie —————————————————————————————— Page 29 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease the expirationdateshown onthelabel. expiration dateonthe container, vialormanufacturer-filled syringe.Donotuseafter Influenza vaccineisformulated foruseduringthecurrentinfluenza season.Check Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C) arespecifiedinthelabelandlicenseforthese 8°C). Donotfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or delivery, youshould takethreesteps. 48 hoursoryouhavequestionsabouttheconditionofvaccineattime distributor/manufacturer andarrivalofthevaccineatfacilityhasbeenmorethan or exposedtofreezingtemperatures.Iftheintervalbetweenshipmentfrom present, checkandfollowtheinstructions. The vaccineshouldnothavebeenfrozen vaccines areshippedwithatemperaturemonitor. Ifatemperaturemonitor is Examine theshippingcontainerandcontentsfordamageduringtransport.Some Trivalent influenzavaccine(TIV)shouldarrivepacked inaninsulatedcontainer. upon Arrival Condition Dose, FluzoneIntradermal TIV: Afluria,Fluarix,FluLaval,Fluvirin,Fluzone,FluzoneHigh- Influenza Vaccines ● 3. 2. 1.

times bystoringintheoriginalbox. Afluria, Fluarix,FluLaval,andFluvirin: manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F

Store between35°F*and46°F(2°C Protect vaccinefromlightatall Selected Biologicals , acn trg n adigGie —————————————————————————————— Page 30 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease limited to,thesefouractions. a currentemergencyvaccine retrievalandstorageplanthatincludes, butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines Exposedto InappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvac cine isreconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused; determinedfromthedateortime product printed information. on the vial unless otherwise stated in the manufacturer’s in appearance,storedandhandledproperlycanbeusedthroughtheexpirationdate refrigerated between35°Fand46°F(2°C8°C). be usedforeachimmunization. time thevaccineisadministered. A separate,sterilesyringeand needle should age-appropriate doseofvaccineintosterilesyringeusinganeedleatthe Multidose Vials: Shakevialwellpriortowithdrawingeachdose.Withdrawasingle administered. should beactivated(i.e.,needlecapremoved)atthetimevaccineis Intradermal MicroinjectionSyringe: is administered. time thevaccine at the attached) orneedle tip removed (i.e., syringe Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimevaccineisadministered. Single-Dose Vials: Beyond UseDate*:ShelfLifeafterOpening . administration. to theResourcessectionatendofthisdocumentforinformationonvaccine Refer These vaccinesshouldnotbecombinedormixedwithanyothervaccines. a dose.Donotusevaccineifitcannotberesuspendedwiththoroughagitation. filled syringewellbeforeuse.Shakemultidosevialseachtimewithdrawing these conditionsexist,thevaccineshouldnotbeused.Shakevialormanufacturer- Inspect thevaccinevisuallyforextraneousparticulatematterand/ordiscoloration.If Preparation ●

discarded after28days. Once entered,amultidosevialof Afluria orFluLavalshouldbe requires immediatecorrective action!

All ofthevaccineshouldbedrawnintoasterilesyringeusing

Unused portionsofmultidosevialsshouldbe Manufacturer-filledmicroinjectionsyringe Vaccine providersshouldhave

A multidosevialthatisnormal Selected Biologicals acn trg n adigGie —————————————————————————————— Page 31 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease the Resourcessectionofthisdocumentforexamples oflabels. and routeofadministrationcanhelpprevent vaccineadministrationerrors.Referto Labeling thespacewherevaccineisstored withname,ageindications,dosage each other. Donotstoresound-alike orlook-alikevaccinesnexttoeachother. storage unitbyagegroupand/orcolorcoding labelstodistinguishvaccinesfrom the riskforvaccineadministrationerrors.Consider organizingvaccinesinthe Storing multipleproductsandpresentations can beconfusingtostaff andincrease products andpresentationshavedifferent approvedindications(e.g., ages,route). Often providershavedifferent TIV presentationsinthesamestorageunit.Influenza recommended temperaturerangeandusedordiscardedbytheendofworkday. activated (e.g.,syringecapremovedorneedleattached)itmustbestoredwithinthe as communityinfluenzavaccinationclinics.Onceamanufacturer-filledsyringeis CDC recommendsmanufacturer-filledsyringesforlargeimmunizationevents,such temperature rangeandusedordiscardedbytheendofworkday. Any syringesprefilledbytheprovidermustbestoredwithinrecommended Provider prefilledsyringesshouldbeadministeredbythepersonwhofilledthem. syringes (nomorethan10dosesorthecontentsofonemultidosevial). advance. Ifmorethanonedoseofvaccinemustbepredrawn,onlydrawupafew of administration.CDCstronglydiscouragesprovidersfromprefillingsyringesin Vaccines, including TIV, shouldbedrawnfromthevialintosyringeattime Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare 4. 3. 2. 1.

Selected Biologicals

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Vaccine Storage and Handling Guide —————————————————————————————— Page 32 acn trg n adigGie —————————————————————————————— Page 33 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease by themanufacturer. products. However, guidanceforFahrenheit isrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween 36°Fand46°F(2°C8°C)arespecifiedinthelabellicense forthese or exposetofreezingtemperatures. or atroomtemperaturebetween68°Fand 77°F(20°Cand25°C). Diluent: Storediluentintherefrigeratorbetween 35°F*and46°F(2°C8°C) times bystoringintheoriginalbox. freezer between-58°Fand+46°F(-50° +8°C). Lyophilized vaccine:StoreMMRlyophilizedvaccineintherefrigeratoror immediately uponarrival. Store lyophilizedvaccineanddiluentaccording tothemanufacturer Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or three steps. questions abouttheconditionofvaccineattimedelivery, youshouldtake and arrivalofthevaccineatfacilityhasbeenmorethan48hoursoryouhave temperatures. Iftheintervalbetweenshipmentfromdistributor/manufacturer the instructions. The vaccineshouldnothavebeenfrozenorexposedtofreezing with atemperaturemonitor. Ifatemperaturemonitorispresent,checkandfollow container andcontentsfordamageduringtransport.Somevaccinesareshipped The vaccineanddiluentshouldbeinseparatecompartments.Examinetheshipping and diluent.Bothcomponentsshouldarrivetogetherinthesameshippingcontainer. Measles, Mumps,Rubellavaccine(MMR)has2components:lyophilized upon Arrival Condition Note: InformationpertainingtoMMRV (ProQuad)canbefoundonpage69 MMR: M-M-RII Vaccine Measles-, Mumps-andRubella-Containing 3. 2. 1.

manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A and +46°F(-50°C+8°C). Immediately placethevaccineinrecommendedstoragebetween-58°F

Protect vaccinefromlightatall Selected Biologicals ’s guidelines Donotfreeze , acn trg n adigGie —————————————————————————————— Page 34 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease expiration date. manufacturer-filled syringeis activated,vialisenteredorvaccinereconstituted;maybe different fromthe *The dateortimeafterwhich the vaccineshouldnotbeused;determinedfromdate or timethe stored, reconstitutedvaccinepriortoadministration. freezing temperatures.Protectreconstituted vaccinefromlightatalltimes. Donotfreezeorexposereconstitutedvaccineto and 8°C)forupto8hours. reconstituted MMRmaybestoredintherefrigerator between35°Fand46°F(2°C needle atthetimevaccineisadministered. All ofthereconstitutedvaccineshouldbedrawnintoasterilesyringeusing Beyond UseDate*:ShelfLifeafterOpening information. Resources sectionattheendofthisdocumentalsoincludesvaccineadministration Them”. This vaccineshouldnotbecombinedormixedwithanyothervaccines. The example ofalabelandtheeducationalhandout“Vaccines withDiluents:HowtoUse the vaccine.RefertoResourcessectionatendofthisdocumentforan it. Onlyusethediluentsuppliedbyvaccinemanufacturertoreconstitute Consider postingremindersorlabelingthevaccinetoremindstaff toreconstitute MMR issuppliedin2vialsthatmustbemixedtogetherbeforeadministration. Preparation use aftertheexpirationdateshownonlabel. Check expirationdateonthecontainerorvialofvaccine AND diluent.Do not Shelf Life ● 3. 2. 1.

other vaccinespurchasedwithpublicfunds. hours. Followtheimmunizationprogramguidancebefore discardingVFCor Do notadministerreconstitutedMMRvaccine ifitisnotusedwithin8 the vaccineshouldnotbeused. extraneous particulatematterand/ordiscoloration.Iftheseconditionsexist, The reconstitutedvaccineshouldbeayellow, clearliquid.Inspectvisuallyfor agitation. thoroughly. Do notusethevaccineifitcannotberesuspendedwiththorough Shake thevialnowcontaininglyophilizedvaccineanddiluenttomix into thevialcontaininglyophilizedvaccinecomponent. Just beforeuse,withdrawtheentirecontentsofdiluentvialandinjectit

Administer immediately. Unused, Selected Biologicals Agitate acn trg n adigGie —————————————————————————————— Page 35 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease in thestorageunit,for example,MMRandMMRV (ProQuad)vaccines.Vaccine Providers canhavedifferent productsorpresentations containingthesamevaccine temperatures colderthan-58°F(-50°C). recommended, evenfortemporarystorage.Dryicemaysubject MMRvaccineto Monitorandrecordthetemperature. with thevaccine. 35°F and46°F(2°C8°C).Placeacalibrated thermometerinthecontainer MMR maybestoredand/ortransportedinan insulatedcontainerbetween the freezerbetween-58°Fand+5°F(-50°C-15°C). MMR vaccinecanbestoredintherefrigeratororfreezer. ConsiderstoringMMRin Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposedtotemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures

● ● 4. 3. 2. 1.

decreases thelikelihoodofthishappening. because staff confuseditwithMMR.StoringMMRandMMRV inthefreezer freezer. MMRV hasbeeninadvertentlymovedtotherefrigerator storage stocking bothMMRandMMRV (ProQuad).MMRV mustbestoredinthe In addition,storingMMRinthefreezercandecreaseconfusionwhen stored intherefrigerator. MMR inthefreezerincreasesspaceavailableforvaccinesthatshouldbe More vaccinesmustbestoredintherefrigeratorthanfreezer Storing MMRinthefreezercanfreeupstoragespacerefrigerator or themanufacturer. Do notdiscardvaccineunlessdirectedtobytheimmunizationprogramand/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyandcontactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (-50°C and+8°C). Place thevaccineinrecommendedstoragebetween-58°Fand+46°F requires immediatecorrectiveaction!Vaccine providersshouldhave

Use ofdryiceisnot Selected Biologicals . Storing . acn trg n adigGie —————————————————————————————— Page 36 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease end ofthisdocumentforanexamplealabel. RefertotheResourcessectionat help preventvaccineadministrationerrors. Labeling thespacewherevaccineisstoredwithnameandageindicationscan from eachother. Donotstoresound-alikeorlook-alikevaccinesnexttoeach other. in thestorageunitbyagegroupand/orcolorcodinglabelstodistinguishvaccines increase theriskforvaccineadministrationerrors.Considerorganizingvaccines ages). Storingmultipleproductsandpresentationscanbeconfusingtostaff and products andpresentationsoftenhavedifferent approvedindicationsanduses(e.g.,

Selected Biologicals acn trg n adigGie —————————————————————————————— Page 37 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease by themanufacturer. products. However, guidanceforFahrenheit isrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween 36°Fand46°F(2°C8°C)arespecifiedinthelabellicense forthese freeze orexposetofreezingtemperatures. Refrigerate vaccineanddiluent,ifapplicable, immediatelyuponarrival.Donot Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or time ofdelivery, you shouldtakethreesteps. more than48hoursoryouhavequestionsabouttheconditionofvaccineat from thedistributor/manufacturerandarrivalofvaccineatfacilityhasbeen been frozenorexposedtofreezingtemperatures.Iftheintervalbetweenshipment monitor ispresent,checkandfollowtheinstructions. The vaccineshouldnothave transport. Somevaccinesareshippedwithatemperaturemonitor. Ifatemperature container. Examinetheshippingcontainerandcontentsfordamageduring Meningococcal conjugatevaccine(MCV4)shouldarrivepackedinaninsulated upon Arrival Condition MCV4: Menactra,Menveo Meningococcal Vaccines

● ● 3. 2. 1. ●

original box. store themseparately. ProtectMenveofromlightatalltimes by storinginthe (Men C, Y, W-135) togetherbetween35°F*and46°F(2°C8°C).Donot Menveo: RefrigeratethelyophilizedMen A vaccineand diluent Menactra: Refrigeratebetween35°Fand46°F (2°Cand8°C). manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor vaccines. A clearlylabeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromotheruncompromised (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F shipping container. (Men C, Y, W-135) vialsshouldarrivepackagedtogetherinthesame Menveo has2components.

The lyophilizedMen A vaccineandthediluent Selected Biologicals , acn trg n adigGie —————————————————————————————— Page 38 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease end ofthisdocumentforinformationonvaccineadministration. combined ormixedwithanyothervaccines.RefertotheResourcessectionat conditions exist,thevaccineshouldnotbeused. These vaccinesshouldnotbe Inspect visuallyforextraneousparticulatematterand/ordiscoloration.Ifthese Preparation date shownonthelabel. vaccine AND diluent,ifapplicable.Donotusevaccineordiluentaftertheexpiration Check expirationdateonthecontainer, vialormanufacturer-filledsyringe of the Shelf Life Protect fromlight. Agitate anystored, reconstitutedvaccinepriortoadministration. 8 hours.Donotfreezeorexposereconstituted vaccinetofreezingtemperatures. Unused, reconstitutedMenveomaybestored atorbelow77°F(25°C)forupto a sterileneedleatthetimevaccineisadministered. Menveo: All of the reconstitutedvaccineshouldbedrawn intoasterilesyringeusing needle atthetimevaccineisadministered. Menactra: Beyond UseDate*:ShelfLifeafterOpening ● ●

3. 2. 1. handout “Vaccines withDiluents:HowtoUse Them”. at theendofthisdocumentforanexamplealabelandeducational manufacturer toreconstitutethevaccine.ReferResourcessection remind staff toreconstituteit.Onlyusethediluentsuppliedbyvaccine before administration.Considerpostingremindersorlabelingthevaccineto Menveo: Thisvaccineissuppliedin2vialsthatmustbemixedtogether Menactra: Thisvaccineisacleartoslightlycloudyliquid.

The reconstitutedvaccineshouldbeaclear, colorlessliquid. thorough agitation thoroughly. Do notusethevaccineifitcannotberesuspendedwith Shake thevialcontaininglyophilizedvaccineanddiluentwelltomix it intothevialcontaininglyophilizedvaccinecomponent. Just beforeuse,withdrawtheentirecontentsofdiluentvialandinject

All ofthevaccineshouldbedrawnintoasterile syringeusingasterile

Administer immediately. Selected Biologicals acn trg n adigGie —————————————————————————————— Page 39 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Resources sectionsat theendofthisdocumentforexampleslabels. of administrationcanhelppreventvaccine errors.Refertothe the spacewherevaccineisstoredwithname, ageindications,and/orroute other. Donotstoresound-alikeor look-alikevaccinesnexttoeachother. Labeling unit byagegroupand/orcolorcodinglabels todistinguishvaccinesfromeach risk forvaccineadministrationerrors.Consider organizingvaccinesinthestorage multiple productsandpresentationscanbe confusing tostaff andincrease the (MCV4 andMPSV4)canbeconfusedwhen storedinthesamestorageunit.Storing approved indicationsanduses(e.g.,ages). For example,meningococcalvaccines vaccine inthestorageunit.Vaccine productsandpresentations oftenhavedifferent Providers canhavedifferent productsorpresentationscontainingthesame Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom 4. 3. 2. 1. ●

Vaccine providers shouldhave Selected Biologicals

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Vaccine Storage and Handling Guide —————————————————————————————— Page 40 acn trg n adigGie —————————————————————————————— Page 41 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Consider postingreminders orlabelingthevaccinetoremindstaff toreconstitute MPSV4 issuppliedin 2 vialsthatmustbemixedtogetherbeforeadministration. Preparation use vaccineordiluentaftertheexpirationdate shownonthelabel. Check expirationdateonthecontainerorvial ofthevaccine AND diluent.Donot Shelf Life freeze orexposetofreezingtemperatures. lyophilized vaccineanddiluentbetween35°F and46°F(2°C8°C). Refrigerate thelyophilizedvaccineanddiluentimmediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or delivery, youshould takethreesteps. 48 hoursoryouhavequestionsabouttheconditionofvaccineattime distributor/manufacturer andarrivalofthevaccineatfacilityhasbeenmorethan or exposedtofreezingtemperatures.Iftheintervalbetweenshipmentfrom present, checkandfollowtheinstructions. The vaccineshouldnothavebeenfrozen vaccines areshippedwithatemperaturemonitor. Ifatemperaturemonitor is Examine theshippingcontainerandcontentsfordamageduringtransport.Some components shouldarrivepackagedtogetherinthesameshippingcontainer. vaccine anddiluent.MPSV4shouldarrivepackedinaninsulatedcontainer. Both Meningococcal polysaccharidevaccine(MPSV4)has2components:lyophilized upon Arrival Condition MPSV4: Menomune Meningococcal Vaccines 3. 2. 1.

manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor vaccines. A clearlylabeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromotheruncompromised and 46°F(2°C8°C). Immediately placethevaccineanddiluentinrefrigeratorbetween35°F

Selected Biologicals Store the Donot , acn trg n adigGie —————————————————————————————— Page 42 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease expiration date. manufacturer-filled syringeisactivated,vialenteredorvac cine isreconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused; determinedfromthedateortime between 35°Fand46°F(2°C8°C). each immunization. vaccine isadministered. A separate,sterilesyringeandneedleshouldbeusedfor dose (0.5mL)ofvaccineintosterilesyringe using asterileneedleatthetime Multidose Vials: Shakewellpriortowithdrawingeachdose.Withdrawasingle stored, reconstitutedvaccinepriortoadministration. refrigerator between35°Fand46°F(2°C8°C)forupto30minutes. immediately. Unused,reconstitutedMPSV4vaccinemaybestoredinthe syringe usingasterileneedleatthetimevaccineisadministered. Single-Dose Vials: Allofthereconstitutedvaccineshouldbedrawnintoasterile Beyond UseDate*:ShelfLifeafterOpening information. Resources sectionattheendofthisdocumentalsoincludesvaccineadministration Them”. This vaccineshouldnotbecombinedormixedwithanyothervaccines. The example ofalabelandtheeducationalhandout“Vaccines withDiluents:HowtoUse the vaccine.RefertoResourcessectionatendofthisdocumentforan it. Onlyusethediluentsuppliedbyvaccinemanufacturertoreconstitute

● ● 3. 2. 1.

days. Once entered,themultidosevialofMPSV4 shouldbediscardedafter35 VFC orothervaccinespurchasedwithpublicfunds. 30 minutes.Followtheimmunizationprogramguidancebeforediscarding Do notadministerreconstitutedMPSV4vaccineifitisusedwithin exist, thevaccineshouldnotbeused. for extraneousparticulatematterand/ordiscoloration.Iftheseconditions The reconstitutedvaccineshouldbeaclear, colorlessliquid.Inspectvisually agitation. thoroughly. Donotusethevaccineifitcannotberesuspendedwiththorough Swirl thevialcontaininglyophilizedvaccineanddiluentwelltomix into thevialcontaininglyophilizedvaccinecomponent. Just beforeuse,withdrawtheentirecontentsofdiluentvialandinjectit

Unused portionsofmultidosevialsshould berefrigerated Selected Biologicals Administer Agitate any acn trg n adigGie —————————————————————————————— Page 43 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Resources sectionattheendofthisdocument foranexampleofalabel. route ofadministrationcanhelppreventvaccine administrationerrors.Refertothe Labeling thespacewherevaccineisstored withname,ageindicationsand from eachother. Donotstoresound-alikeorlook-alikevaccinesnexttoeachother. in thestorageunitbyagegroupand/orcolorcodinglabelstodistinguishvaccines increase theriskforvaccineadministrationerrors.Considerorganizingvaccines unit. Storingmultipleproductsandpresentationscanbeconfusingtostaff and vaccines (MCV4andMPSV4)canbeconfusedwhenstoredinthesamestorage approved indicationsanduses(e.g.,ages,route).Forexample,meningococcal vaccine inthestorageunit.Vaccine productsandpresentationsoftenhavedifferent Providers canhavedifferent productsorpresentationscontainingthesame Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposedtotemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures 4. 3. 2. 1.

Selected Biologicals

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Vaccine Storage and Handling Guide —————————————————————————————— Page 44 acn trg n adigGie —————————————————————————————— Page 45 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease use aftertheexpirationdateshownonlabel. Check expirationdateonthecontainer, vialormanufacturer-filledsyringe.Donot Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C) arespecifiedinthelabelandlicenseforthese 8°C). Donotfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or time ofdelivery, you shouldtakethreesteps. more than48hoursoryouhavequestionsabouttheconditionofvaccineat from thedistributor/manufacturerandarrivalofvaccineatfacilityhasbeen been frozenorexposedtofreezingtemperatures.Iftheintervalbetweenshipment monitor ispresent,checkandfollowtheinstructions. The vaccineshouldnothave transport. Somevaccinesareshippedwithatemperaturemonitor. Ifatemperature container. Examinetheshippingcontainerandcontentsfordamageduring Pneumococcal vaccines(PCV13,PPSV23)shouldarrivepackedinaninsulated upon Arrival Condition PPSV23: Pneumovax23 PCV13: Prevnar13 Pneumococcal Vaccines

3. 2. 1.

Store between35°F*and46°F(2°C Selected Biologicals , acn trg n adigGie —————————————————————————————— Page 46 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease limited to,thesefouractions. a currentemergencyvaccine retrievalandstorageplanthatincludes, butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines Exposedto InappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvac cine isreconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused; determinedfromthedateortime product printed information. on the vial unless otherwise stated in the manufacturer’s in appearance,storedandhandledproperlycanbeusedthroughtheexpirationdate refrigerated between35°Fand46°F(2°C8°C). be usedforeachimmunization. time thevaccineisadministered. A separate,sterilesyringeand needle should a singledose(0.5mL)vaccineintosterilesyringeusingneedleatthe PPSV23 MultidoseVials: Shakevialwellpriortowithdrawingeachdose.Withdraw administered. (i.e., syringetipremovedand/orneedleattached)atthetimevaccineis Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimeofadministration. Single-Dose Vials: Allofthevaccineshouldbedrawnintoasterilesyringeusing Beyond UseDate*:ShelfLifeafterOpening the endofthisdocumentforinformationonvaccineadministration. be combinedormixedwithanyothervaccines.RefertotheResourcessectionat these conditionsexist,thevaccineshouldnotbeused. These vaccinesshouldnot Inspect thevaccinevisuallyforextraneousparticulatematterand/ordiscoloration.If Preparation ● ●

thorough agitation. clear, colorlessliquid.Donotusethevaccineifitcannotberesuspendedwith PPSV23: Just before use, shake vialwell. After shaking, PPSV23shouldbea agitation. white liquid.Donotusethevaccineifitcannotberesuspendedwiththorough Justbeforeuse,shakeVIGOROUSLY. After shaking,PCV13isa particles. this canresultinaclearliquidsolutionabovethealuminumphosphate PCV13: Duringstorage,thealuminumphosphateparticlesmaysettle,and requires immediatecorrective action!

Unused portionsofmultidosevialsshouldbe Vaccine providersshouldhave

A multidosevialthatisnormal Selected Biologicals acn trg n adigGie —————————————————————————————— Page 47 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease document forexamplesoflabels. Refer totheResourcessectionofthis help preventvaccineadministrationerrors. Labeling thespacewherevaccineisstoredwithnameandageindicationscan each other. Donotstoresound-alikeorlook-alikevaccinesnexttoeachother. storage unitbyagegroupand/orcolorcodinglabelstodistinguishvaccinesfrom the riskforvaccineadministrationerrors.Considerorganizingvaccinesin Storing multipleproductsandpresentationscanbeconfusingtostaff andincrease (PCV13 andPPSV23)canbeconfusedwhenstoredinthesamestorageunit. approved indicationsanduses(e.g.,ages).Forexample,pneumococcalvaccines vaccine inthestorageunit.Vaccine productsandpresentationsoftenhavedifferent Providers canhavedifferent productsorpresentationscontainingthesame Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare 4. 3. 2. 1.

Selected Biologicals

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Vaccine Storage and Handling Guide —————————————————————————————— Page 48 acn trg n adigGie —————————————————————————————— Page 49 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease conditions exist,thevaccine shouldnotbeused. This vaccineshouldnotbe Inspect visuallyforextraneous particulatematterand/ordiscoloration. Ifthese Preparation use aftertheexpirationdateshownonlabel. Check expirationdateonthecontainer, vialormanufacturer-filledsyringe.Donot Shelf Life Do notfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or delivery, youshould takethreesteps. 48 hoursoryouhavequestionsabouttheconditionofvaccineattime distributor/manufacturer andarrivalofthevaccineatfacilityhasbeenmorethan or exposedtofreezingtemperatures.Iftheintervalbetweenshipmentfrom present, checkandfollowtheinstructions. The vaccineshouldnothavebeenfrozen vaccines areshippedwithatemperaturemonitor. Ifatemperaturemonitoris Examine theshippingcontainerandcontentsfordamageduringtransport.Some Inactivated poliovaccine(IPV)shouldarrivepackedinaninsulatedcontainer. upon Arrival Condition InformationpertainingtoDTaP-IPV (KINRIX)canbefoundonpage11 Note: IPV: IPOL Poliovirus-Containing Vaccine 3. 2. 1.

Store between35°Fand46°F(2°C8°C) Selected Biologicals ,

. acn trg n adigGie —————————————————————————————— Page 50 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease in thestorageunit.For example,singleantigenandcombinationvaccines. Vaccine Providers canhavedifferent productsorpresentations containingthesamevaccine Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCor othervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromtheexpirationdate. *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom(time)manufacturer- productinformation. manufacturer’s used throughtheexpirationdateprintedonvialunlessotherwisestatedin A multidosevialthatisnormalinappearance,storedandhandledproperlycanbe multidose vialsshouldberefrigeratedbetween35°Fand46°F(2°C8°C) syringe andneedleshouldbeusedforeachimmunization. using asterileneedleatthetimevaccineisadministered. A separate,sterile Multidose Vials: Withdrawasingledose(0.5mL)ofvaccineintosterilesyringe is administered. time thevaccine at the attached) orneedle tip removed (i.e., syringe Manufacturer-Filled Syringes: Beyond UseDate*:ShelfLifeafterOpening end ofthisdocumentforinformationonvaccineadministration. combined ormixedwithanyothervaccines.RefertotheResourcessectionat 4. 3. 2. 1.

Manufacturer-filled syringesshouldbeactivated Vaccine providers shouldhave Unusedportionsof Selected Biologicals . acn trg n adigGie —————————————————————————————— Page 51 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease this documentforanexampleofalabel. prevent vaccineadministrationerrors.RefertotheResourcessectionatendof Labeling thespacewherevaccineisstoredwithname,ageindicationscanhelp from eachother. Donotstoresound-alikeorlook-alikevaccinesnexttoeach other. in thestorageunitbyagegroupand/orcolorcodinglabelstodistinguishvaccines increase theriskforvaccineadministrationerrors.Considerorganizingvaccines ages). Storingmultipleproductsandpresentationscanbeconfusingtostaff and products andpresentationsoftenhavedifferent approvedindicationsanduses(e.g.

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Vaccine Storage and Handling Guide —————————————————————————————— Page 52 acn trg n adigGie —————————————————————————————— Page 53 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease by themanufacturer. products. However, guidanceforFahrenheit isrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween 36°Fand46°F(2°C8°C)arespecifiedinthelabellicense forthese temperatures. Protectvaccinefromlightatall timesbystoringintheoriginalbox. guidelines immediatelyuponarrival.Donot freeze orexposetofreezing Store thevaccineanddiluent,ifapplicable,according tothemanufacturer Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or delivery, youshould takethreesteps. 48 hoursoryouhavequestionsabouttheconditionofvaccineattime distributor/manufacturer andarrivalofthevaccineatfacilityhasbeenmorethan or exposedtofreezingtemperatures.Iftheintervalbetweenshipmentfrom present, checkandfollowtheinstructions. The vaccineshouldnothavebeenfrozen vaccines areshippedwithatemperaturemonitor. Ifatemperaturemonitor is Examine theshippingcontainerandcontentsfordamageduringtransport.Some Rotavirus vaccines(RV1, RV5) shouldarrivepacked inaninsulatedcontainer. upon Arrival Condition RV5: RotaTeq RV1: ROTARIX Rotavirus Vaccines ● ● 3. 2. 1. ●

RV5 (RotaTeq): Refrigeratebetween35°F*and46°F(2°C8°C). 68°F and77°F(20°C25°C). (2°C and8°C).Storediluentseparatelyat roomtemperaturebetween RV1 (ROTARIX): Refrigeratelyophilizedvaccinebetween35°Fand46°F manufacturer and/ortheimmunizationprogramforguidance. Follow yourimmunizationprogrampolicyandcontactthedistributor clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A (2°C and8°C). Immediately placethevaccineinrefrigeratorbetween35°Fand46°F should arrivepackagedtogetherinthesameshippingcontainer. RV1 (ROTARIX) has2components.

The lyophilizedvaccineanddiluent Selected Biologicals ’s , acn trg n adigGie —————————————————————————————— Page 54 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease expiration date. manufacturer-filled syringeis activated,vialisenteredorvaccinereconstituted;maybe different fromthe *The dateortimeafterwhich the vaccineshouldnotbeused;determinedfromdate or timethe immediately. removed, thedosingtubeshouldnotbereturned totherefrigerator. Administer cap removedatthetimevaccineisadministered. Oncethescrewcaphasbeen RV5 (RotaTeq): reconstituted vaccinepriortoadministration.Donotfreezevaccine. Agitateanystored, or atroomtemperatureupto77°F(25°C)for24hours. reconstituted RV1 intheoralapplicatorbetween35°Fand46°F(2°C8°C) RV1 (ROTARIX): Afterreconstitution,administerimmediately . Storeunused, Beyond UseDate*:ShelfLifeafterOpening administration. to theResourcessectionatendofthisdocumentforinformationonvaccine RV1 andRV5 shouldnotbecombinedormixedwithanyothervaccines.Refer Preparation vaccine ordiluent,ifapplicable,aftertheexpirationdateshownonlabel. Check expirationdateonthecontainerorvialofvaccine AND diluent.Donot use Shelf Life ● ● ●

before discardingVFCorothervaccinespurchased withpublicfunds. other publiclypurchasedvaccines.Followthe immunizationprogramguidance hours. Do notadministerreconstitutedRV1 vaccineifitisnotusedwithin 24 free dosingtubewithatwistoff cap. The dosingtubeiscontainedinapouch RV5 (RotaTeq): Thisvaccineissuppliedinasingledosesqueezableplastic,l atex- Use Them”. of thisdocumentforaneducationalhandout“Vaccines withDiluents:Howto vaccine isacloudy, whiteliquid.RefertotheResourcessectionatend by thevaccinemanufacturertoreconstitutevaccine.Reconstituted vaccine toremindstaff toreconstituteit.Onlyusethediluentsupplied together beforeadministration.Considerpostingremindersorlabelingthe RV1 (ROTARIX): Thisvaccineissuppliedin2vialsthatmustbemixed Follow theimmunizationprogramguidancebefore discardingVFCor

This vaccineshouldberemovedfromtherefrigerator andthescrew

Selected Biologicals

acn trg n adigGie —————————————————————————————— Page 55 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease this documentforexamplesoflabels. prevent vaccineadministrationerrors.Refer totheResourcessectionatendof vaccine isstoredwithname,ageindicationsandrouteofadministrationcanhelp sound-alike orlook-alikevaccinesnexttoeachother. Labelingthespacewhere and/or colorcodinglabelstodistinguishvaccinesfromeachother. Donotstore administration errors.Considerorganizingvaccinesinthestorageunitbyagegroup and presentationscanbeconfusingtostaff andincreasetheriskforvaccine different approvedindicationsanduses(e.g.,ages).Storingmultipleproducts vaccine inthestorageunit.Vaccine productsandpresentationsoftenhave Providers mayhavedifferent productsorpresentationscontainingthesame Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCorothervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposedtotemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures 4. 3. 2. 1.

Vaccine providersshouldhave Selected Biologicals

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Vaccine Storage and Handling Guide —————————————————————————————— Page 56 acn trg n adigGie —————————————————————————————— Page 57 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease section attheendofthis documentforinformationonvaccineadministration. should notbecombined ormixedwithanyothervaccines.Referto theResources Thisvaccine not usevaccineifitcannot beresuspendedwiththoroughagitation. conditions exist, the vaccine shouldnot be used. Just before use, shake vialwell.Do Inspect visuallyforextraneousparticulatematter and/ordiscoloration.Ifthese Preparation shown onthelabel. Check expirationdateonthecontainerorvial. Donotuseaftertheexpirationdate Shelf Life Do notfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or should takethreesteps. or youhavequestionsabouttheconditionofvaccineattimedelivery, you manufacturer andarrivalofthevaccineatfacilityhasbeenmorethan48hours to freezingtemperatures.Iftheintervalbetweenshipmentfromdistributor/ and followtheinstructions. The vaccineshouldnothavebeenfrozenorexposed are shippedwithatemperaturemonitor. Ifatemperaturemonitorispresent, check the shippingcontainerandcontentsfordamageduringtransport.Somevaccines Tetanus toxoidvaccine(TT)shouldarrivepackedinaninsulatedcontainer. Examine upon Arrival Condition TT: Tetanus Toxoid Tetanus ToxoidVaccine 3. 2. 1.

Store between35°Fand46°F(2°C8°C) Selected Biologicals ,

. acn trg n adigGie —————————————————————————————— Page 58 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease recommends thefollowing: toxoid-containing vaccine, the Advisory CommitteeonImmunizationPractices containing vaccines.Forpersons11 yearsofageandolder whoneedatetanus severe, life-threateningallergytothediphtheria componentinothertetanus- TT vaccineshouldonlybeusedfortetanusimmunizationiftheperson hasa Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCor othervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom product printed information. on the vial unless otherwise stated in the manufacturer’s in appearance,storedandhandledproperlycanbeusedthroughtheexpirationdate refrigerated between35°Fand46°F(2°C8°C). be usedforeachimmunization. time thevaccineisadministered. A separate,sterilesyringeandneedleshould single dose(0.5mL)ofvaccineintoasterilesyringeusingneedleatthe Multidose Vials: Shakevialwellpriortowithdrawingeachdose.Withdrawa Beyond UseDate*:ShelfLifeafterOpening ● 4. 3. 2. 1.

vaccinated with Tdap. Tdap vaccine,ifavailable, ispreferredto TT or Td for thosenotpreviously or themanufacturer. Do notdiscardvaccineunlessdirectedtobytheimmunizationprogramand/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyandcontactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A and 8°C). Place thevaccineinrecommendedstoragebetween35°Fand46°F(2°C requires immediatecorrectiveaction!

Unused portionsofmultidosevialsshouldbe Vaccine providers shouldhave

A multidosevialthatisnormal Selected Biologicals acn trg n adigGie —————————————————————————————— Page 59 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Resources sectionattheendofthisdocumentforanexamplealabel. Refertothe unique tothevaccinecanhelppreventadministrationerrors. space wherethevaccineisstoredwithname,ageindicationsorotherinformation Do notstoresound-alikeorlook-alikevaccinesnexttoeachother. Labelingthe by agegroupand/orcolorcodinglabelstodistinguishvaccinesfromeachother. vaccine administrationerror. Considerorganizingvaccinesinthestorageunit Tetanus toxoid-containingvaccinesareeasilyconfusedincreasingtheriskfora ● ●

Tdap or Td vaccines,ifneitheravailable, TT shouldbeadministered. with Tdap. Td vaccine,ifavailable,ispreferredto TT forthose previouslyvaccinated

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Vaccine Storage and Handling Guide —————————————————————————————— Page 60 acn trg n adigGie —————————————————————————————— Page 61 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease conditions exist,thevaccine shouldnotbeused.Justbeforeuse, shake vialor Inspect visuallyforextraneous particulatematterand/ordiscoloration. Ifthese Preparation use aftertheexpirationdateshownonlabel. Check expirationdateonthecontainer, vialormanufacturer-filledsyringe.Donot Shelf Life Do notfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or the vaccineattimeofdelivery, youshouldtakethreesteps. facility hasbeenmorethan48hoursoryouhavequestionsabouttheconditionof between shipmentfromthedistributor/manufacturerandarrivalofvaccineat should nothavebeenfrozenorexposedtofreezingtemperatures.Iftheinterval If atemperaturemonitorispresent,checkandfollowtheinstructions. The vaccine damage duringtransport.Somevaccinesareshippedwithatemperaturemonitor. packed inaninsulatedcontainer. Examinetheshippingcontainerandcontents for Tetanus toxoid-anddiphtheriatoxoid-containingvaccines(Td;DT)shouldarrive upon Arrival Condition DT:and Tetanus Diphtheria Toxoid Td: DECAVAC Vaccines Tetanus Toxoid- and diphtheriatoxoid-Containing 3. 2. 1.

Store between35°Fand46°F(2°C8°C)

Selected Biologicals ,

. acn trg n adigGie —————————————————————————————— Page 62 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease increasing theriskfor a vaccineadministrationerror. Considerorganizingvaccines Diphtheria toxoid-and tetanustoxoid-containingvaccinesareeasily confused Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCor othervaccinespurchasedwithpublicfundsare limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom administered. (i.e., syringetipremovedand/orneedleattached)atthetimevaccineis Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimevaccineisadministered. Single-Dose Vials: Beyond UseDate*:ShelfLifeafterOpening information onvaccineadministration. any othervaccines.RefertotheResourcessectionatendofthisdocumentfor after thoroughagitation. These vaccinesshouldnotbecombinedormixedwith manufacturer-filled syringewell.Donotusevaccineifitcannotberesuspended 4. 3. 2. 1. ●

or themanufacturer. Do notdiscardvaccineunlessdirectedtoby theimmunizationprogramand/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyand contactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthis purpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A and 8°C). Place thevaccineinrecommendedstoragebetween35°Fand46°F(2°C After shaking, Td vaccineisacloudy, whitish-graycoloredliquid. requires immediatecorrectiveaction!Vaccine providers shouldhave

All ofthevaccineshouldbedrawnintoasterilesyringeusing Selected Biologicals acn trg n adigGie —————————————————————————————— Page 63 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Refer totheResourcessectionatendofthisdocumentforexampleslabels. information uniquetothevaccinecanhelppreventadministrationerrors. Labeling thespacewherevaccineisstoredwithname,ageindicationsorother from eachother. Donotstoresound-alikeorlook-alikevaccinesnexttoeach other. in thestorageunitbyagegroupand/orcolorcodinglabelstodistinguishvaccines

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Vaccine Storage and Handling Guide —————————————————————————————— Page 64 acn trg n adigGie —————————————————————————————— Page 65 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease use aftertheexpiration dateshownonthelabel. Check expirationdateonthecontainer, vialormanufacturer-filledsyringe.Donot Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C) arespecifiedinthelabelandlicenseforthese 8°C). Donotfreezeorexposetofreezingtemperatures. Refrigerate immediatelyuponarrival. Storage Requirements other vaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthedistributorandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC)or three steps. questions abouttheconditionofvaccineattimedelivery, youshouldtake and arrivalofthevaccineatfacilityhasbeenmorethan48hoursoryouhave temperatures. Iftheintervalbetweenshipmentfromdistributor/manufacturer the instructions. The vaccineshouldnothavebeenfrozenorexposedtofreezing with atemperaturemonitor. Ifatemperaturemonitorispresent,checkandfollow container andcontentsfordamageduringtransport.Somevaccinesareshipped (Tdap) shouldarrivepackedinaninsulatedcontainer. Examinetheshipping Tetanus toxoid-,diphtheriatoxoid-andacellularpertussis-containingvaccine upon Arrival Condition Tdap: Adacel,Boostrix pertussis- ContainingVaccines Tetanus Toxoid-, diphtheria toxoid-,andacellular 3. 2. 1.

Store between35°F*and46°F(2°C Selected Biologicals , acn trg n adigGie —————————————————————————————— Page 66 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease exposed totemperaturesoutside therecommendedrange. NOTE: Contacttheimmunization programwheneverVFCorothervaccinespurchasedwithpublic funds are limited to,thesefouractions. a currentemergencyvaccineretrievalandstorageplanthatincludes,butisnot or toocold- Vaccine exposed totemperaturesoutsidetherecommendedrange-eithertoowarm (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom administered. (i.e., syringetipremovedand/orneedleattached)atthetimevaccineis Manufacturer-Filled Syringes:Manufacturer-filledsyringesshouldbeactivated sterile needleatthetimevaccineisadministered. Single-Dose Vials: Allofthevaccineshouldbedrawnintoasterilesyringeusing Beyond UseDate*:ShelfLifeafterOpening administration. to theResourcessectionatendofthisdocumentforinformationonvaccine These vaccinesshouldnotbecombinedormixedwithanyothervaccines.Refer after thoroughagitation. After shaking, Tdap shouldbeacloudy, whitecoloredliquid. manufacturer-filled syringewell.Donotusevaccineifitcannotberesuspended conditions exist,thevaccineshouldnotbeused.Justbeforeuse,shakevialor Inspect visuallyforextraneousparticulatematterand/ordiscoloration.Ifthese Preparation 4. 3. 2. 1.

Vaccine providers shouldhave Selected Biologicals acn trg n adigGie —————————————————————————————— Page 67 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease label. Refer totheResourcessectionatendofthisdocumentforanexamplea information uniquetothevaccinecanhelppreventadministrationerrors. Labeling thespacewherevaccineisstoredwithname,ageindicationsorother from eachother. Donotstoresound-alikeorlook-alikevaccinesnexttoeach other. in thestorageunitbyagegroupand/orcolorcodinglabelstodistinguishvaccines increasing theriskforavaccineadministrationerror. Considerorganizingvaccines Diphtheria toxoid-andtetanustoxoid-containingvaccinesareeasilyconfused Special Instructions

Selected Biologicals This page was left intentionally blank for printing purposes

Vaccine Storage and Handling Guide —————————————————————————————— Page 68 acn trg n adigGie —————————————————————————————— Page 69 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease with separatecompartmentsandexteriordoors. original box.Vaccine shouldonlybestoredinfreezersorrefrigerator/freezer units and +5°F(-50°C-15°C). Lyophilized vaccine:Storelyophilizedvaccineinthefreezerbetween-58°F immediately uponarrival.Donotstorelyophilized vaccineanddiluenttogether Store thelyophilizedvaccineanddiluentaccording tothemanufacturer Storage Requirements or othervaccinespurchasedwithpublicfundsthatmaynothavebeentransportedproperly. NOTE: ContactthemanufacturerandimmunizationprogramregardingshipmentsofVaccines forChildren(VFC) should takethreesteps. or youhavequestionsabouttheconditionofvaccineattimedelivery, you manufacturer andarrivalofthevaccineatfacilityhasbeenmorethan72hours or exposedtofreezingtemperatures.Iftheintervalbetweenshipmentfrom present, checkandfollowtheinstructions. The vaccineshouldnothavebeenfrozen vaccines areshippedwithatemperaturemonitor. Ifatemperaturemonitoris Examine theshippingcontainerandcontentsfordamageduringtransport.Some shipping container. The vaccineanddiluentshouldbeinseparatecompartments. lyophilized vaccineanddiluent.Bothcomponentsshouldarrivetogetherinthesame Varicella-containing vaccines(VAR, MMRV andZOS)have 2components: upon Arrival Condition MMRV: ProQuad ZOS: Zostavax(herpeszoster/shingles) VAR: Varivax (chickenpox) Varicella-Containing Vaccines 3. 2. 1.

Protectvaccinefromlightatalltimesbystoring inthe Selected Biologicals ’s guidelines , . acn trg n adigGie —————————————————————————————— Page 70 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease between 68°Fand77°F (20°Cand25°C)forupto30minutes.Protect fromlight.Do reconstituted varicella and MMRV vaccinesmay bestoredatroomtemperature needle atthetimevaccineisadministered. All ofthereconstitutedvaccineshouldbedrawn intoasterilesyringeusing Beyond UseDate*:ShelfLifeafter Opening section attheendofthisdocumentalsoincludesvaccineadministrationinformation. vaccines shouldnotbecombinedormixedwithanyothervaccines. The Resources and theeducationalhandout“Vaccines withDiluents:HowtoUse Them”. These Refer totheResourcessectionatendofthisdocumentforexampleslabels diluent suppliedbythevaccinemanufacturertoreconstitutevaccine. reminders orlabelingthevaccinetoremindstaff toreconstituteit.Onlyusethe These vaccinesmustbereconstitutedbeforeadministration.Considerposting Preparation use aftertheexpirationdateshownonlabels. Check expirationdateonthecontainerorvialofvaccine AND diluent.Do not Shelf Life by themanufacturer. products. However, guidanceforFahrenheitisrounded 2˚Cisexactlyconvertedto35.6˚Fsothemanufacturer’s *Storage temperaturesbetween36°Fand46°F(2°C8°C)arespecifiedinthelabellicenseforthese (20°C and25°C). 35°F* and46°F(2°Cto8°C)oratroomtemperaturebetween68°F77°F Diluent: Storeseparatelyfromlyophilizedvaccineintherefrigeratorbetween 3. 2. 1.

● ● ● should havethefollowingappearance: these conditionsexist,thevaccineshouldnotbeused.Reconstituted Inspect visuallyforextraneousparticulatematterand/ordiscoloration.If with thoroughagitation. diluent tomixthoroughly. Donotusethevaccineifitcannotberesuspended Gently shakeoragitatethevialnowcontaininglyophilizedvaccineand slowly intothevialcontaininglyophilizedvaccinevial. Just beforeuse,withdrawtheentirecontentsofdiluentvialandinjectit

MMRV: Paleyellowtolightpink,clear liquid. ZOS: Semi-hazytotranslucent,off whitetopale,yellowliquid. VAR: Clear, colorlesstopaleyellowliquid. Donotfreezeorexposetofreezingtemperatures.

Administer immediately. Unused, Selected Biologicals acn trg n adigGie —————————————————————————————— Page 71 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease refrigerator. refrigerator temperature willbenecessarytoavoidfreezingvaccines storedinthe compartment temperaturebeingloweredas well.Carefulmonitoringofthe temperature dialdowntothecoldestsetting. This mayresultintherefrigerator it willbenecessaryinmostcombinationrefrigerator/freezer modelstoturnthe In ordertomaintaintemperaturesbetween-58°F and+5°F(-50°C-15°C), Special Instructions exposed totemperaturesoutsidetherecommendedrange. NOTE: ContacttheimmunizationprogramwheneverVFCor othervaccinespurchasedwithpublicfundsare to, thesefouractions. current emergencyvaccineretrievalandstorageplanthatincludes,butisnotlimited range requireimmediatecorrectiveaction! Varicella-containing vaccinesexposedtotemperaturesoutsidetherecommended (Temperature Excursions) Vaccines ExposedtoInappropriateTemperatures expiration date. manufacturer-filled syringeisactivated,vialenteredorvaccinereconstituted;maybedifferent fromthe *The dateortimeafterwhichthevaccineshouldnotbeused;determinedfrom stored, reconstitutedvaccinepriortoadministration. not freezeorexposedreconstitutedvaccinetofreezingtemperatures. 4. 3. 2. 1. ●

or themanufacturer. Do notdiscardvaccineunlessdirectedtobytheimmunizationprogramand/ or theimmunizationprogramforfurtherguidance. Follow yourimmunizationprogrampolicyandcontactthemanufacturerand/ clearly labeledpaperbagcanbeusedforthispurpose. Mark vaccine“DoNotUse”andseparatefromuncompromisedvaccines. A between -58°Fand+5°F(-50°C-15°C). Vaccine exposed totemperaturesbelow-58Fshouldbestoredinafreezer refrigerator between35°Fand46°F(2°C8°C). Vaccine exposed totemperatureabove+5°Fshouldbestoredinthe public funds. program guidancebeforediscardingVFCorothervaccinespurchasedwith ZOS, MMRV) ifitisnotused within30minutes. Do notadministerreconstitutedvaricella-containingvaccine(VAR,

Vaccine providers shouldhavea Followtheimmunization

Selected Biologicals Agitate any acn trg n adigGie —————————————————————————————— Page 72 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease name andageindicationscanhelpprevent vaccine administrationerrors. vaccines nexttoeachother. Labeling thespacewherevaccineisstoredwith labels todistinguishvaccinesfromeachother. Donotstoresound-alikeorlook-alike Consider organizingvaccinesinthestorage unitbyagegroupand/orcolorcoding can beconfusingtostaff andincreasetheriskforvaccineadministration errors. indications anduses(e.g.,ages,route).Storing multipleproductsandpresentations vaccines. Vaccine productsandpresentationsoftenhavedifferent approved combination and antigen unit. Forexample,single in thestorage vaccines containing Providers canhavedifferent productsorpresentationscontainingthevaricella- subject varicella-containingvaccinetotemperaturescolderthan-58°F(-50°C). Use ofdryiceisnotrecommended,evenfortemporarystorage.Drymay transported between35°Fand46°F(2°C8°C)completethefollowingactions: 72 continuoushourspriortoreconstitution.Ifvaricella-containingvaccinesmustbe containing vaccinesmaybestoredbetween35°Fand46°F(2°C8°C)forupto rent insomeplaces. productinformationvaricella- According tothemanufacturer’s between -58°Fand+5°F(-50°C-15°C).Portablefreezersmaybeavailablefor recommends transportwithaportablefreezerunitthatmaintainsthetemperature containing vaccines.Ifvaricella-containingvaccinesmustbetransported,CDC CDC andthevaccinemanufacturerdonotrecommendtransportingvaricella- (freezer) withintherefrigerator. plate (coolingcoil),whichisusuallylocatedinsideanicemakercompartment freezer/refrigerator unitthatisoutfittedwithoneexteriordoorandanevaporator A dormitory-stylerefrigeratorisdefinedasasmallcombination containing vaccines. “Dormitory-style” refrigerator/freezerisnotappropriateforthestorageofvaricella- 4. 3. 2. 1.

c. b. a. immunization programforguidance. Do notdiscardvaccinewithoutcontactingthemanufacturerand/or at thealternatestoragefacilityforfurtherguidance. Contact themanufacturer(1-800-9-VARIVAX) immediatelyuponarrival Record: vaccine. Place acalibratedthermometerinthecontainerasclosepossibleto

storage temperatureduringtransport the timerefrigeratorstorageended the timerefrigeratorstoragebegan

Selected Biologicals acn trg n adigGie —————————————————————————————— Page 73 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Vaccine Administration webpage V Storage andHandlingToolKit Storage andHandlingwebpage Advisory CommitteeonImmunizationPractices(ACIP) General RecommendationsonImmunization:ofthe Session 2includesvaccinestorageandhandlinginformation Epidemiology andPreventionofVaccine-Preventable DiseaseCourse VaccineD Administration Appendix Storage andHandlingResources Appendix C Storage andHandlingChapter5 Epidemiology andPreventionofVaccine-Preventable Diseases12thEdition ABBREVIATIONS Advisory CommitteeonImmunizationPracticesU.S.VACCINE CDC Resources accine LabelExamples http://www.cdc.gov/vaccines/recs/vac-admin/default.htm http://www2a.cdc.gov/vaccines/ed/shtoolkit/ http://www.cdc.gov/vaccines/recs/storage/default.htm http://www.cdc.gov/mmwr/pdf/rr/rr6002.pdf http://www.cdc.gov/vaccines/ed/epivac/default.htm full-d.pdf http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/appdx http://www.cdc.gov/vaccines/pubs/pinkbook/pink-appendx.htm#appc http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/vac-storage.pdf http://www.cdc.gov/vaccines/recs/acip/downloads/vac-abbrev.pdf http://www.cdc.gov/vaccines/recs/storage/guide/vaccine-storage-labels.pdf

Resources acn trg n adigGie —————————————————————————————— Page 74 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Immunization Action Coalition(IAC) EZIZ- CaliforniaVaccines forChildren(VFC)Program Alliance forImmunizationinMichigan(AIM)ProviderToolKit Other Resources http://www.immunize.org/catg.d/p3051.pdf Emergency Response Worksheet http://www.immunize.org/catg.d/p3036.pdf Don’t beGuiltyofTheseErrorsinVaccine StorageandHandling http://www.immunize.org/catg.d/p3035.pdf Checklist forSafeVaccine Storage andHandling http://www.immunize.org/askexperts/experts_general.asp Handling andStorageFAQ’s http://www.immunize.org/handouts/vaccine-storage-handling.asp Handling andStorageResources www.immunize.org http://eziz.org/resources/vaccine-admin-job-aids/ VaccineJob Aides Administration http://eziz.org/eziz-training/ Vaccine Administration EducationalVideo http://eziz.org/resources/materials_storageandhand.html Storage andHandlingJob Aides http://eziz.org/eziz-training/ Storage andHandlingEducationalVideo www.eziz.org http://www.aimtoolkit.org/adults.php Adults http://www.aimtoolkit.org/adolescents.php Adolescents http://www.aimtoolkit.org/children.php Children VaccineMaterials Administration http://www.aimtoolkit.org/vaccine.php Storage andHandlingMaterials www.aimtoolkit.org

Resources acn trg n adigGie —————————————————————————————— Page 75 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease State ImmunizationProgramWebsites State ImmunizationProgramInformation Thermal Analysis ofRefrigerationSystemsUsedforVaccine Storage http://www.cdc.gov/vaccines/spec-grps/prog-mgrs/grantee-imz-websites.htm http://www.nist.gov/customcf/get_pdf.cfm?pub_id=904574 http://www.immunize.org/packageinserts/ ProductInformation Manufacturer’s http://www.immunize.org/catg.d/p2020.pdf How to Administer IMandSCInjections http://www.immunize.org/catg.d/p3085.pdf Administering Vaccines: Dose,Route,Site,andNeedleSize http://www.immunize.org/askexperts/experts_general.asp#admin VaccineFAQ’s Administration http://www.immunize.org/clinic/administering-vaccines.asp VaccineResources Administration http://www.immunize.org/catg.d/p3048.pdf Vaccine HandlingTips http://www.immunize.org/catg.d/p3040.pdf Vaccines withDiluents:HowtoUseThem Fahrenheit http://www.immunize.org/catg.d/p3039.pdf Celsius http://www.immunize.org/catg.d/p3039a.pdf Temperature LogsforRefrigeratorandFreezer: http://www.immunize.org/catg.d/p7010.pdf Skills ChecklistforImmunization

Resources acn trg n adigGie —————————————————————————————— Page 76 Vaccine Storageand Handling Guide Vaccine Storage and Handling Guide National Center for Immunization and Respiratory Disease Resources: ManufacturerQualityControlOfficeTelephoneNumbers and Prevention Centers forDiseaseControl Novartis biotherapeutics-us-home.htm http://www.talecris.com/talecris https://www.vaccineshoppe.com/ http://pfizerpro.com/ us/index.shtml http://www.novartisvaccines.com/ products/nabiHB.html http://www.biotestpharma.com/ https://www.merckvaccines.com/ http://www.medimmune.com/ massbiolabs/index.aspx http://www.umassmed.edu/ http://www.gskvaccines.com drugservice/index.html http://www.cdc.gov/laboratory/ drug-service.html www.cdc.gov/ncidod/srp/drugs/ Merck &Co.,Inc Labs Massachusetts Biological Pfizer/Wyeth GlaxoSmithKline (GSK) Talecris Biotherapeutics Sanofi Pasteur Biotest Pharmaceuticals MedImmune Manufacturer /Distributor Websites

/ [email protected] [email protected] [email protected] [email protected] [email protected] Number/E-mail 404-639-3670/ 866-475-8222 800-520-2807 800-822-2463 800-438-1985 800-637-2590 617-474-3000 877 683-4732 800 458-4244 877-633-4411 Telephone diphtheria antitoxin,VIG, DTaP-IPV, HepA,HepB, DTaP, DTaP-HepB-IPV, HepA, HepB,Hib,Hib- HBIG, IGIM,RIG, TIG MPSV4, Rabies,RIG, DT, DTaP, DTaP-IPV/ MMRV,PPSV23, Td, Hib, IPV, MCV4, HepB, HPV4,MMR, HepA-HepB, HPV2, Td, Tdap,TIV, TT smallpox vaccine RV1, Tdap,TIV TIV, VAR, ZOS Distributor for IGIM, Td, TT Products PCV13 HBIG LAIV TIV