APHA Cold Chain Management 3 — Questions and Answers
Question 1: A shipment of inactivated influenza vaccine arrives and the cold pack in the shipping box feels warm. The temperature indicator card shows a color change indicating excursion. What should the provider do?
- Accept and refrigerate the vaccines since they are inactivated and heat-stable
- Refuse the shipment and return it to the distributor immediately
- Accept the shipment under quarantine, document the condition, and contact the distributor (Correct answer)
- Administer the vaccines that day since the excursion was brief
Correct answer: Accept the shipment under quarantine, document the condition, and contact the distributor
Providers should accept the shipment under quarantine, document the findings, and contact the distributor or manufacturer to evaluate whether vaccines are still viable.
Question 2: The Vaccine Vial Monitor (VVM) on an oral polio vaccine vial shows the inner square is darker than the outer circle. What does this indicate?
- The vaccine has been exposed to excessive cold and may be frozen
- The vaccine has passed its expiration date
- The vaccine has been exposed to excessive heat and should NOT be used (Correct answer)
- The vaccine requires shaking before administration
Correct answer: The vaccine has been exposed to excessive heat and should NOT be used
When the VVM inner square is darker than the outer circle, it indicates the vaccine has been heat-exposed beyond acceptable limits and must not be used.
Question 3: Which of the following vaccines is most sensitive to freezing and will lose potency if inadvertently frozen even briefly?
- Varicella (live attenuated)
- MMR (measles, mumps, rubella)
- Hepatitis B (Correct answer)
- Yellow fever
Correct answer: Hepatitis B
Hepatitis B vaccine contains an adjuvant that precipitates and loses potency upon freezing, making it one of the most freeze-sensitive refrigerated vaccines.
Question 4: What is the maximum amount of time refrigerated vaccines should be out of the cold chain during a routine patient visit preparation?
- No more than 15 minutes (Correct answer)
- No more than 30 minutes
- No more than 1 hour
- No more than 2 hours
Correct answer: No more than 15 minutes
Refrigerated vaccines should be removed from storage no more than 15 minutes before administration to minimize time out of the cold chain.
Question 5: A clinic loses power due to a storm. What is the recommended action for vaccines stored in the refrigerator if power will likely be restored within 4 hours?
- Immediately transfer all vaccines to a qualified off-site storage location
- Keep the unit closed and monitor temperature with a calibrated thermometer (Correct answer)
- Open the unit periodically to add dry ice
- Administer all refrigerated vaccines to patients immediately
Correct answer: Keep the unit closed and monitor temperature with a calibrated thermometer
If power will likely return within a few hours, keeping the unit closed conserves cold; continuous temperature monitoring will determine if an excursion occurs.
Question 6: According to CDC's Vaccine Storage & Handling Toolkit, what type of refrigeration unit is preferred for vaccine storage?
- A combined refrigerator-freezer household unit with vaccines in the lower compartment
- A purpose-built pharmaceutical-grade or commercial-grade stand-alone refrigerator (Correct answer)
- A dormitory-style (bar) mini-fridge with a separate freezer compartment
- Any frost-free household refrigerator under 5 years old
Correct answer: A purpose-built pharmaceutical-grade or commercial-grade stand-alone refrigerator
CDC recommends purpose-built pharmaceutical-grade or commercial-grade stand-alone refrigerators because they maintain stable temperatures better than household units.
Question 7: Which of the following actions is part of a proper emergency vaccine transport plan?
- Using a styrofoam cooler with loose ice cubes and no data logger
- Pre-qualifying a backup facility and having an insulated transport container with conditioned water packs ready (Correct answer)
- Keeping vaccines at room temperature in opaque bags during transport
- Contacting the health department only after vaccines have been transported
Correct answer: Pre-qualifying a backup facility and having an insulated transport container with conditioned water packs ready
An effective emergency plan pre-identifies a qualified backup storage facility and has calibrated transport containers with conditioned ice packs ready before an emergency occurs.
APHA Cold Chain Management 3
A shipment of inactivated influenza vaccine arrives and the cold pack in the shipping box feels warm.
The temperature indicator card shows a color change indicating excursion.
What should the provider do?