Research Article

Is the cold chain for vaccines maintained in general practice?

BMJ 1993; 307 doi: (Published 24 July 1993) Cite this as: BMJ 1993;307:242
  1. E A Haworth,
  2. R Booy,
  3. L Stirzaker,
  4. S Wilkes,
  5. A Battersby
  1. West Berkshire Health Authority, Prospect Park Hospital, Reading.


    OBJECTIVE--To investigate the cold chain for vaccines and compliance with the local code of practice for storage. DESIGN--In a random sample of general practices orders for live vaccines (oral polio and measles, mumps, and rubella) were accompanied by a cold chain monitor which was activated on leaving the supplying pharmacy. The monitors were read at specified intervals and when all vaccines in the order had been used. Structured interview was used to check compliance with the local code of practice on storage. SETTING--West Berkshire and Aylesbury Vale district health authorities. SUBJECTS--16 (25%) general practices in West Berkshire, and 13 (50%) in Aylesbury Vale. MAIN OUTCOME MEASURES--Compliance with code of practice. Changes in the cold chain monitor. RESULTS--For six key requirements within the code of practice compliance varied from 70% to 0%. Only 16 of 29 practices had a named person responsible for vaccine storage and only four were aware of the local code of practice. Vaccine was stored for longer and more breaks in the cold chain occurred in West Berkshire than in Aylesbury Vale. The potency of some vaccines in 10 of 26 orders became suspect before use. CONCLUSIONS--Knowledge of appropriate management of the cold chain in two districts was poor. Breaks in the chain were more frequent and compromised potency more likely when vaccine had been stored for more than eight weeks. Problems in maintaining the cold chain indicate the need for continuing audit, which should become a prerequisite for payments to general practitioners for immunisation.