Table 3 summarizes the responses received to both the vaccinator and the supervisor questionnaires. In Kangaré, three unfinished vials of OPV had to be disposed of during the Epacadostat order CC days, which used ice packs and traditional cold chain procedures. This was due to the humidity generated by the ice packs inhibitors inside the vaccine carrier, which caused the labels to get wet

and subsequently detach from the vials, rendering them unreadable and therefore the vials unusable. Two of these vials were full. Maintaining the standard cold chain during vaccination campaigns is a challenge, especially in areas where electricity, equipment and resources are scarce. This study provides evidence that flexible cold chain management procedures as outlined in the WHO document

on flexible cold chain management are possible to implement [6]. We found that OPV kept outside of the cold chain during NID activities remained sufficiently potent for use as per its VVM status. No VVM reached the endpoint despite exposure to external temperatures between 25 and 40 °C during vaccination activities that lasted nearly seven hours on average. There was no OPV wastage resulting from heat exposure. The OCC procedure was easily understood and feasible for all vaccination teams that participated in the NID. This approach provides a possible practice for overcoming the challenges of delivering vaccines in situations where the continuity of the cold chain cannot be assured. Selleckchem BYL719 Our study was conducted in a rural context in a country with limited resources and high temperatures. In Mali, it is almost impossible ever to continuously maintain the cold chain in all settings. This is made even more difficult during national immunization campaigns, which strain

the country’s already overloaded transportation systems and storage capacities. Some additional factors make maintaining the cold chain problematic, notably the access to an infrastructure capable of freezing ice packs, as well as the need to carry these ice packs along with the OPV to maintain the recommended 2–8 °C temperature range. This is especially true during immunization activities outside the health care posts where it results in additional weight to be carried during the outreach vaccination activities. Moreover, the moisture generated by the ice packs inside the vaccine carriers soaks the OPV labels. After a few hours, the labels often either peel off and/or become destroyed, and the vial details as well as the VVM become unreadable. If a vial has not yet been opened or finished at this point, it must be disposed of. Vaccine wastage was higher on days with CC procedures, whereas on OCC days it was zero. The temperature data collected by the LogTag® recorders will inform programmatic guidance for controlled temperature chains.