• Rule 1 Keep Your Refrigerator Cold -- 36° - 40° F
• Rule 2 Keep Your Freezer Cold -- +5°F or lower
• Rule 3 Keep MMR Cold and Protected From Light  
• Rule 4 Keep Varicella Frozen and Protected From Light
• Rule 5 Blanket Freezer Vaccines with Ice Packs 
• Rule 6 Rotate Stock

Rule 1 and 2: Keep Your Refrigerator and Freezer Cold 

• Use a plug guard to prevent accidental unplugging.
• Place "Do Not Unplug!" warning signs on plugs and circuit breakers.
• Place thermometers in both refrigerator and freezer (thermometers should be kitchen-ware type).
• Check the temperature of refrigerator and freezer each morning and afternoon and record on a log sheet.
• Don't store food in refrigerator or freezer - they should be opened only for temperature checks and vaccines.
• Possible problems in refrigerator and freezer temperature control:
  - Thermometer is inaccurate or too close to front or back of unit.
  - Refrigerator/freezer needs repair.
  - Power is being interrupted.
  - Refrigerator and/or freezer are not cold enough.
  - Refrigerator is too cold.
• Refrigerator must be kept at 36° - 46° F (2° - 8° C) not colder, not warmer!
• Freezer must be kept at 5° F (-15° C) or below if storing Varicella.
• Ice cubes that remain consistently frozen are a good indicator that the freezer is maintaining a temperature below 32° F (O° C).
• To protect your vaccine in the refrigerator and freezer:
  - Never store vaccine in the refrigerator or freezer doors (temperature is too unstable).
  - Don't let refrigerator and freezer doors stand open.
  - Check refrigerator and freezer doors each night.
  - Keep bulk liquid water bottles in the refrigerator and freezer packs in the freezer -
  this maintains the temperature when doors are opened and in case of power interruption.

• Receiving Vaccine Shipments
  -VFC Vaccine Shipments: All VFC (excluding varicella) vaccine is shipped from GIV, and should have a temperature indicator in the pack. Be sure to check the indicator to make sure the vaccine is neither too warm nor too cold. The temperature should be 36° - 46° F (2° - 8° C).
  -Other shipments: ice can be melted but package should be cold. Check temperature and contact VFC if there is any question about the condition of the vaccine.
  -As soon as you receive the shipment, immediately put the vaccine in the refrigerator or freezer.

Vaccines that must be frozen: Varicella

Vaccines that must be refrigerated and will be inactivated by freezing (temperatures below 36° F (2° C).
DTP, DTaP, DTP/Hib, Td, DT
Hib, IPV, Hep B, Hep A
Pneumococcal (PPV23 and PCV7) and Influenza Vaccine

-If vaccines are left out, mark them so they are not used and then store properly. If the vaccine is VFC vaccine, contact the VFC Program at (602) 364-3276. If it is privately purchased vaccine, call the Quality Control Office of the vaccine manufacturer.
 
MMR is the only refrigerated vaccine that can be frozen.

• Keep a "Handle With Care" sign on your refrigerator door.

Rule 3: Keep MMR Cold and Protected From Light

• This rule applies to any single antigen or combination of Measles, Mumps, and Rubella.
• MMR is easily inactivated by light, so it is very important to keep this vaccine in the dark!
• Store in box with ends and lids in place and closed.
• Keep MMR in the refrigerator until ready to reconstitute and administer.
• If you are doing a mass immunization, you can reconstitute more than 1 dose of MMR if you do the following:
  - Use cold diluent.
  - Keep syringes cold.
  - Protect the syringes from light.
  - Discard reconstituted vaccine after 8 hours, even if the vaccine has been kept cold and protected from light at all times. 

Rule 4: Keep Varicella Frozen and Protected From Light

Varicella vaccine must be kept frozen at 5° F  (-15° C) or less.
Varicella should be blanketed with ice packs.
Varicella is the most fragile of the vaccines!

• If this vaccine shipment arrives without dry ice, or if there is any question about the condition of the vaccine, call VFC for advice.
• This is a powdered vaccine, so it won't look different when thawed.
• Diluent should be stored at room temperature.
• Use only the diluent supplied with the vaccine.
• Leave in the freezer until needed.
• Protect from light.
• Administer immediately after reconstituting.
• Discard reconstituted vaccine if it isn't used within 30 minutes - do not refreeze!
• Secondary shipping (from one site to be stored at another site) is NOT permitted.
• Only with prior approval from the VFC Program may VFC varicella vaccine be transported to be used at another site. Any unused vaccine must be discarded.
• Before transporting privately purchased varicella vaccine to another site you must contact the manufacturer for details on how to protect this vaccine.

Rule 5: Blanket Freezer Vaccines with Ice Packs

• Freeze ice packs to keep the cold chain and protect the varicella vaccine.  
• Make an igloo with the ice packs and place the varicella vaccine inside.

Rule 6: Rotate Stock

• Expiration dates vary by type of vaccine, lot number.
• Put new vaccine in the back, so you automatically use old vaccine first.
• Check expiration dates.
• Use short-dated vaccine first.
• Never use expired vaccine.
• Refer to vaccine package inserts.
• Like vaccines should be stored together to avoid possible mix-up, for example:
  - Keep all vaccines containing any combination of DTP on the same refrigerator shelf, arranged so that DTP is grouped together, DT grouped together, and so on.
• Order sensibly.

Wasted or spoiled VFC vaccine MUST be returned to the VFC Program! 

Vaccine quality controls ensure that your agency saves money and that
your patients get potent vaccines which protect them against disease.