title: Frequent exposure to suboptimal temperatures in vaccine cold-chain system in India: results of temperature monitoring in 10 states.
abstract: OBJECTIVE
  To estimate the proportion of time the vaccines in the cold-chain system in India are exposed to temperatures of < 0 or > 8 °C.
  
  
  METHODS
  In each of 10 states, the largest district and the one most distant from the state capital were selected for study. Four boxes, each containing an electronic temperature recorder and two vials of diphtheria, pertussis and tetanus vaccine, were placed in the state or regional vaccine store for each study state. Two of these boxes were then shipped - one per facility - towards the two most peripheral health facilities where vaccine was stored in each study district. The boxes were shipped, handled and stored as if they were routine vaccine supplies.
  
  
  RESULTS
  In state, regional and district vaccine stores and peripheral health facilities, respectively, the temperatures in the boxes exceeded 8 °C for 14.3%, 13.2%, 8.3% and 14.7% of their combined storage times and fell below 0 °C for 1.5%, 0.2%, 0.6% and 10.5% of these times. The boxes also spent about 18% and 7% of their combined times in transit at < 0 and > 8 °C, respectively. In shake tests conducted at the end of the study, two thirds of the vaccine vials in the boxes showed evidence of freezing.
  
  
  CONCLUSIONS
  While exposure to temperatures above 8 °C occurred at every level of vaccine storage, exposure to subzero temperatures was only frequent during vaccine storage at peripheral facilities and vaccine transportation. Systematic efforts are needed to improve temperature monitoring in the cold-chain system in India.
authors.affiliation: National Institute of Epidemiology, Indian Council of Medical Research, R127, Tamil Nadu Housing Board, Ayapakkam, Ambattur, Chennai 600 077, India .
authors.forename: Manoj V
authors.initials: MV
authors.lastname: Murhekar
authors.affiliation: United Nations Children's Fund, New Delhi, India .
authors.forename: Srihari
authors.initials: S
authors.lastname: Dutta
authors.affiliation: Indian Council of Medical Research, New Delhi, India .
authors.forename: Ambujam Nair
authors.initials: AN
authors.lastname: Kapoor
authors.affiliation: Directorate of Health, Medical and Familty Welfare, Government of Andhra Pradesh, Hyderabad, India .
authors.forename: Sailaja
authors.initials: S
authors.lastname: Bitragunta
authors.affiliation: Department of Health and Family Welfare, Government of Arunachal Pradesh, Papum Pare, India .
authors.forename: Raja
authors.initials: R
authors.lastname: Dodum
authors.affiliation: Department of Community Medicine, Medical College, Kolkata, India .
authors.forename: Pramit
authors.initials: P
authors.lastname: Ghosh
authors.affiliation: Directorate of Public Health, Government of Tamil Nadu, Chennai, India .
authors.forename: Karumanagounder Kolanda
authors.initials: KK
authors.lastname: Swamy
authors.affiliation: Directorate of Health and Family Welfare, Government of West Bengal, Kolkata, India .
authors.forename: Kalyanranjan
authors.initials: K
authors.lastname: Mukhopadhyay
authors.affiliation: Directorate of Health Services, Government of Manipur, Imphal, India .
authors.forename: Somorjit
authors.initials: S
authors.lastname: Ningombam
authors.affiliation: Department of Health and Family Welfare, Government of Gujarat, Gandhinagar, India .
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Parmar
authors.affiliation: Department of Health and Family Welfare, Government of Karnataka, Bengaluru, India .
authors.forename: Devegowda
authors.initials: D
authors.lastname: Ravishankar
authors.affiliation: Department of Community Medicine and Epidemiology, Indira Gandhi Medical College, Shimla, India .
authors.forename: Balraj
authors.initials: B
authors.lastname: Singh
authors.affiliation: State Institute of Health and Family Welfare, Government of Bihar, Patna, India .
authors.forename: Varsha
authors.initials: V
authors.lastname: Singh
authors.affiliation: Directorate of Health Services, Government of Madhya Pradesh, Bhopal, India .
authors.forename: Rajesh
authors.initials: R
authors.lastname: Sisodiya
authors.affiliation: Directorate of Public Health, Government of Tamil Nadu, Chennai, India .
authors.forename: Ramaratnam
authors.initials: R
authors.lastname: Subramanian
authors.affiliation: Department of Health and Family Welfare, Government of Arunachal Pradesh, Papum Pare, India .
authors.forename: Tana
authors.initials: T
authors.lastname: Takum
mesh_terms: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D004356:Drug Storage; D006801:Humans; D007194:India; D012034:Refrigeration / Q000706:statistics & numerical data*; D013696:Temperature; D014186:Transportation / Q000706:statistics & numerical data; D014612:Vaccines
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D014612:Vaccines