Gross Violation of Cold Chain Maintenance Norms.

Dear All

We are working in Nainwa block of Bundi district in Rajasthan on women
and adolescent health issues in 3 village panchayats. As part of our
work, we attend MCHN sessions each week regularly in different

We have some observations about cold chain maintenance of vaccines by the ANMs.

1. The used and unused vials of TT, DPT, Hb are carried in ordinary
plastic packets from session sites instead of vaccine carriers by ANM
and kept them in domestic refrigerators for use in subsequent
sessions. It is happening regularly. This problem is beside the issue
of vaccines not reaching the session sites quite often. So unused
returned vaccines may remain unused for months.

The Immunization Handbook for Medical Officers by GOI 2008 mentions that

• Vaccines like TT, DPT, Hb lose their potency if they are frozen.
They are to be stored always between 2 degree to 8 degree Celsius
• The unused vaccine vials from session sites are to be returned to
the PHC on the same day in the cold chain.
• Vaccines that have been returned unopened more than thrice have to
be discarded.
• No used vial is to be kept in the cold chain.

We think gross violation of norms is taking place at the grass root
level. The ANMs are unwilling to carry the vaccine carrier as they
perceive it to be beyond their dignity. The small revenue villages are
not included in micro plan of immunzn. So separate stock of vaccines
is not received by the ANMs. They use the used vials in these small
villages besides their planned villages.

The current practice raises doubts on efficacy of immunization and
ethical issue of playing with the lives of infants as well. There is a
need to look at the spread of this practice in other areas and to
question how much realistic is our present immunization implementation
plan keeping in mind the difficult geographical terrains and locations
of our country.