title: Visual Indicators on Vaccine Boxes as Early Warning Tools to Identify Potential Freeze Damage.
abstract: BACKGROUND
  The aim of this study was to determine whether the use of visual freeze indicators on vaccines would assist health care providers in identifying vaccines that may have been exposed to potentially damaging temperatures.
  
  
  METHODS
  Twenty-seven sites in Connecticut involved in the Vaccine for Children Program participated. In addition to standard procedures, visual freeze indicators (FREEZEmarker®L; Temptime Corporation, Morris Plains, NJ) were affixed to each box of vaccine that required refrigeration but must not be frozen. Temperatures were monitored twice daily.
  
  
  RESULTS
  During the 24 weeks, all 27 sites experienced triggered visual freeze indicator events in 40 of the 45 refrigerators. A total of 66 triggered freeze indicator events occurred in all 4 types of refrigerators used. Only 1 of the freeze events was identified by a temperature-monitoring device. Temperatures recorded on vaccine data logs before freeze indicator events were within the 35°F to 46°F (2°C to 8°C) range in all but 1 instance. A total of 46,954 doses of freeze-sensitive vaccine were stored at the time of a visual freeze indicator event. Triggered visual freeze indicators were found on boxes containing 6566 doses (14.0% of total doses). Of all doses stored, 14,323 doses (30.5%) were of highly freeze-sensitive vaccine; 1789 of these doses (12.5%) had triggered indicators on the boxes.
  
  
  CONCLUSIONS
  Visual freeze indicators are useful in the early identification of freeze events involving vaccines. Consideration should be given to including these devices as a component of the temperature-monitoring system for vaccines.
authors.affiliation: Department of Pediatrics and the Child Study Center, Yale University School of Medicine, New Haven, CT; †Foundation for Children, Hezekiah Beardsley Connecticut Chapter, American Academy of Pediatrics; ‡Maria C. Chernock & Associates and §Tipping Consulting, LLC.
authors.forename: Ronald
authors.initials: R
authors.lastname: Angoff
authors.affiliation: Department of Pediatrics and the Child Study Center, Yale University School of Medicine, New Haven, CT; †Foundation for Children, Hezekiah Beardsley Connecticut Chapter, American Academy of Pediatrics; ‡Maria C. Chernock & Associates and §Tipping Consulting, LLC.
authors.forename: Jillian
authors.initials: J
authors.lastname: Wood
authors.affiliation: Department of Pediatrics and the Child Study Center, Yale University School of Medicine, New Haven, CT; †Foundation for Children, Hezekiah Beardsley Connecticut Chapter, American Academy of Pediatrics; ‡Maria C. Chernock & Associates and §Tipping Consulting, LLC.
authors.forename: Maria C
authors.initials: MC
authors.lastname: Chernock
authors.affiliation: Department of Pediatrics and the Child Study Center, Yale University School of Medicine, New Haven, CT; †Foundation for Children, Hezekiah Beardsley Connecticut Chapter, American Academy of Pediatrics; ‡Maria C. Chernock & Associates and §Tipping Consulting, LLC.
authors.forename: Diane
authors.initials: D
authors.lastname: Tipping
keywords: freeze indicator; vaccine; vaccine potency; vaccine storage; vaccine waste