Lessons Learned from Hurricane Katrina: Ensuring Proper Vaccine Management,

Handling, and Administration During a Disaster

What Can Happen?What Can Happen?

Natural Disasters - Ice/Snow Storms, Natural Disasters - Ice/Snow Storms, Hurricanes, etcHurricanes, etc

BlackoutsBlackoutsDelivery StrikesDelivery Strikes

Actions Steps for all Pediatric Practices: Actions Steps for all Pediatric Practices: Before Disaster Hits!Before Disaster Hits!

Promote good storage and handling at every Promote good storage and handling at every opportunityopportunity

• Regularly Regularly monitormonitor refrigerator temperatures refrigerator temperatures • Follow vaccine handling & storage Follow vaccine handling & storage

requirementsrequirements• Check equipment function when placing Check equipment function when placing

vaccine orders (door seals, etc)vaccine orders (door seals, etc)

Develop vaccine management Develop vaccine management protocolsprotocols Display Display Disaster Recovery PlanDisaster Recovery Plan

Contact Contact distributorsdistributors to stop all bulk vaccine to stop all bulk vaccine order deliveriesorder deliveries

Contact local public health agency to confirm Contact local public health agency to confirm suspension of VFC vaccine deliveriessuspension of VFC vaccine deliveries

If available, ensure power source backup for If available, ensure power source backup for vaccine refrigerators vaccine refrigerators

Document vaccine determined not viable for Document vaccine determined not viable for later returnlater return

Action Steps for Pediatric Practices Action Steps for Pediatric Practices Located within Disaster AreasLocated within Disaster Areas

Protecting the VaccineProtecting the VaccineBe proactive

•Ensure backup energy source – if possible•Develop emergency protocols for disaster scenarios

–Example: Loss of PowerClose the vaccine refrigerator door tightly Do not discard the affected vaccines. Mark the vaccines so that the potentially compromised vaccines can be easily identified Call the manufacturer(s) and notify the local or state health departmentRecord action taken

Protecting the VaccineProtecting the VaccineBe prepared

• Remind practice staff of vaccine protocols and procedures

Protect the vaccine and maintain the cold chain by following recommended vaccine temperatures, vaccine storage requirements, and temperature monitoring

If transporting vaccine to another location, maintain the cold chain during transport

• CDC Guidelines: www.cdc.gov/mmwr/preview/mmwrhtml/mm5242a6.htm

Protecting the VaccineProtecting the Vaccine

The following guidance developed for providers during the 2003 Northeast Power Outage may be helpful in the event of a temporary power outage. The Immunization Action Coalition has developed a worksheet to record this process.Do not open freezers and refrigerators until power is restored

•Most refrigerated vaccines are relatively stable at room temperature for limited periods of time •The vaccines of most concern are MMR and Varivax, which are sensitive to elevated temperatures

Protecting the VaccineProtecting the Vaccine

Monitor temperatures; don't discard; don't administer affected vaccines until you have discussed with public health authorities

If the power outage is on-going: 1. Keep all refrigerators and freezers closed to help to

conserve the cold mass of the vaccines.2. Continue to monitor temperatures if possible - Do

not open units to check temperatures during the power outage. Instead, record the temperature as soon as possible after the power is restored, and the duration of the outage. This will provide data on the maximum temperature and maximum duration of exposures to elevated temperatures

Protecting the VaccineProtecting the Vaccine

Continued:3. If alternative storage with reliable power sources

are available (i.e., hospital with generator power), transfer to that facility can be considered. If transporting vaccine, measure the temperature of the refrigerator(s) and freezer(s) when the vaccines are removed

4. If possible transport the vaccine following proper cold chain procedures for storage and handling or try to the record the temperature the vaccine is exposed to during transport

Protecting the VaccineProtecting the Vaccine

Continued: When power has been restored:

1. Record the temperature in the unit as soon as possible after power has been restored. Continue to monitor the temperatures until they reach the normal 2–8 degrees Celsius range in the refrigerator, or -15 degrees C or less in the freezer

2. Be sure to record the duration of increased temperature exposure and the maximum temperature observed

Protecting the VaccineProtecting the VaccineContinued:

3. If you receive vaccine from your state or local health department, they may be contacting you with guidance on collecting information on vaccine exposed to extreme temperatures

4. If you are concerned about the exposure or efficacy of any of your vaccine stock, do not administer the vaccine until you have consulted your state or local health department

Protecting the VaccineProtecting the Vaccine

Continued:5. Keep exposed vaccine separated from any new product you receive and continue to store at the proper temperature if possible

6. Do not discard any potentially exposed vaccine. We will be working with the vaccine manufacturers to determine which vaccines may be viable

Action Steps for Practice Staff After Action Steps for Practice Staff After Disaster Hits: Be Informed!Disaster Hits: Be Informed!

Contact local public health department or CDC for information and guidance:

CDC Hotline: 800/232-4636

CDC Web site: http://www.cdc.gov/vaccines

Follow interim immunization recommendations (i.e., Interim Immunization Recommendations for Individuals Displaced by Hurricane Katrina and Interim Immunization Recommendations for Emergency Responders: Hurricane Katrina)

Continued…Continued…

Communicate interim immunization recommendations and requirements to practice staff. Examples:

• Select states waived school immunization requirements post-Hurricane Katrina

• VFC program was expanded to cover Hurricane Katrina evacuees

Displaced Persons Living Displaced Persons Living in Crowded Settingsin Crowded Settings

In addition to recommended vaccines, persons in crowded In addition to recommended vaccines, persons in crowded settings should receive the following vaccines:settings should receive the following vaccines:

Influenza - Everyone ≥6 months of age should receive Influenza - Everyone ≥6 months of age should receive influenza vaccine. Children 8 years old or younger influenza vaccine. Children 8 years old or younger should receive 2 doses, at least one month apartshould receive 2 doses, at least one month apart

  Varicella - Everyone >12 months of age and born in Varicella - Everyone >12 months of age and born in the United States after 1965 should receive one done of the United States after 1965 should receive one done of this vaccine unless they have a history of chickenpoxthis vaccine unless they have a history of chickenpox

  MMR - Everyone >12 months of age and born after MMR - Everyone >12 months of age and born after 1957 should receive one dose of this vaccine 1957 should receive one dose of this vaccine

Hepatitis A - Everyone >2 years of age should receive Hepatitis A - Everyone >2 years of age should receive one dose of hepatitis A vaccine unless they have a clear one dose of hepatitis A vaccine unless they have a clear history of hepatitis A history of hepatitis A

Immunization Record Keeping and Documentation During a Disaster

At all times - all vaccines administered be properly documented Immunization records should be provided in accordance with the practice of the state in which the vaccine is administeredImmunization cards should be provided to individuals at the time of vaccinationStandard immunization practices should be followed for delivery of all vaccines, including provision of Vaccine Information Statements (VIS)

Paying for Vaccines

In September, the U.S. Department of Health and Human Services announced that all children from birth -18 years old displaced by Hurricane Katrina are eligible to receive free vaccines through the federally-run Vaccines for Children program (VFC), regardless of whether they are staying at shelters, hotels, or with family and friends and regardless of previous health insurance coverage status

If you are not a VFC provider, contact your state VFC coordinator to find out how to enroll

Notify distributors to resume vaccine deliveriesNotify distributors to resume vaccine deliveriesNotify vaccine representatives to resume bulk order Notify vaccine representatives to resume bulk order

shipmentsshipmentsContact local public health department to determine Contact local public health department to determine

if VFC vaccine delivery has resumedif VFC vaccine delivery has resumedIn the event of vaccine shortage, work with local In the event of vaccine shortage, work with local

public health to identify/distribute needed vaccinepublic health to identify/distribute needed vaccine

Actions Steps for all Pediatric Practices: Actions Steps for all Pediatric Practices: AfterAfter the Disaster the Disaster

Comprehensive vaccine management protocols will help practice staff address future vaccine supply challenges (i.e., vaccine shortages or supply allocations) and help ensure appropriate vaccine handling procedures throughout the year!

Remember! Remember!

Communicate emergency to provider sites in Communicate emergency to provider sites in advance (mass fax, etc)advance (mass fax, etc)

Send additional information (if available) to Send additional information (if available) to those practices in the path of dangerthose practices in the path of danger

Communicate with local health departments Communicate with local health departments and local health officials (stay on message, and local health officials (stay on message, coordinate activities when possible)coordinate activities when possible)

Role of Public Health Role of Public Health and Medical Societiesand Medical Societies

Additional ResourcesAdditional Resources

How to Protect Your Vaccine Supply, 2004How to Protect Your Vaccine Supply, 2004. CDC video (25 . CDC video (25 min.). To order 1 free copy from the CDC call 800/232-min.). To order 1 free copy from the CDC call 800/232-4636.4636.

CDC’s Web-based Toolkit for Vaccine Storage and CDC’s Web-based Toolkit for Vaccine Storage and Handling. Available at: Handling. Available at: http://www2a.cdc.gov/nip/isd/shtoolkit/splash.htmlhttp://www2a.cdc.gov/nip/isd/shtoolkit/splash.html

Fact Sheet: Don’t be Guilty of These Storage & Handling Errors! Available at: http://www.immunize.org/catg.d/p3036.pdf