Storage and Handling

53

5

This chapter provides an overview of best practice guidance 

for storage and handling. CDC’s Vaccine Storage and Handling 

Toolkit contains detailed information on best practices and 

recommendations. Participants in the Vaccines for Children 

(VFC) program or providers with vaccines purchased with public 

funds should consult their state or local immunization program 

to ensure all state storage and handling requirements are met, 

since there may be requirements that are specific to or tailored 

to the jurisdiction. 

Vaccine Cold Chain

A cold chain is a temperature-controlled supply chain that 

includes all vaccine-related equipment and procedures. The cold 

chain begins with the cold storage unit at the manufacturing 

plant, extends to the transport and delivery of the vaccine 

and proper storage at the provider facility, and ends with 

administration of the vaccine to the patient. 

Manufacturers, distributors, public health staff, and health care 

providers share responsibility to ensure the vaccine cold chain is 

maintained from the time vaccines are manufactured until they 

are administered.

Vaccine Storage and Handling Standard 

Operating Procedures (SOPs)

Facilities should develop and maintain clearly written, detailed, 

and up-to-date storage and handling standard operating 

procedures (SOPs). SOPs should be reviewed by all staff and 

updated by the vaccine coordinator annually.

SOPs should contain plans and information for three 

major areas:

• General information – include contact information for

vaccine manufacturers, equipment service providers, and

important facility staff, as well as job descriptions, regularly

used forms, and staff training requirements.

• Routine storage and handling – include information for all

aspects of vaccine inventory management, from ordering to

monitoring storage conditions.

• Emergency vaccine storage, handling, and transport

– outline steps to be taken in the event of equipment

malfunctions, power failures, natural disasters, or

other emergencies that might compromise vaccine

storage conditions.

VFC providers or those who have vaccines purchased with 

public funds should contact their immunization program for 

guidance regarding routine and emergency SOPs.

NOTES

Tina Objio, RN, MSN; Valerie Morelli, BA; and Sean Trimble, BS, MPH

https://www.cdc.gov/vaccines/pubs/pinkbook/vac-storage.html Aug 2021
54

Storage and Handling

 5

Staff Training 

All staff members who receive deliveries or handle vaccines 

should be trained in proper storage and handling as described 

in the facility’s SOPs. SOPs should be kept near vaccine storage 

units and staff should know where to find them.

Storage and handling training should be done:

• As part of new employee orientation

• Annually as a refresher for all staff involved in 

immunization activities

• When new vaccines are added to inventory

• When vaccine recommendations are updated

Vaccine Coordinator

A primary vaccine coordinator should be responsible for 

ensuring all vaccines are stored and handled correctly, with 

an alternate coordinator appointed who can serve in the 

absence of the primary coordinator. These individuals should 

be fully trained in routine and emergency policies and 

procedures. Coordinator responsibilities may be completed 

by the coordinator or delegated to appropriate staff. The 

coordinator must ensure the delegate has documented training 

demonstrating competency for the specific tasks assigned and 

must confirm that tasks are completed.

Some coordinator responsibilities include:

• Ordering vaccines

• Overseeing proper receipt and storage of vaccine deliveries

• Documenting vaccine inventory information

• Organizing and monitoring vaccines within storage units, 

including rotating stock and removing expired vaccines

• Setting up temperature monitoring devices (TMDs) and 

recording daily temperatures

• Responding to temperature excursions (out-of-range 

temperatures) and equipment failures

• Overseeing vaccine transport (when necessary)

• Overseeing emergency preparations

• Creating and updating storage and handling SOPs

NOTES
Storage and Handling

55

5

Vaccine Storage and Temperature 

Monitoring Equipment

It is important for a facility to have proper storage and 

monitoring equipment that is set up correctly, maintained 

appropriately, and repaired as needed. This equipment protects 

patients from inadvertently receiving compromised vaccine 

and protects facilities against costs of revaccinating patients, 

replacing expensive vaccines, and losing patient confidence. 

Refrigerators and Freezers

CDC recommends the following types of refrigerators 

and freezers: • Purpose-built or pharmaceutical-grade units designed to 

either refrigerate or freeze biologics, including vaccines, are 

preferred. These units can be compact, under-the-counter 

style or large units. 

• If a purpose-built or pharmaceutical-grade unit is not 

available, a stand-alone, household-grade unit may be 

an acceptable option in some practice settings. Only 

the refrigerator compartment of a household-grade 

combination refrigerator/freezer unit should be used. 

The freezer compartment of this type of unit is not 

recommended for storing vaccines and there may be 

areas of the refrigerated compartment that should not be 

used as well. These units have cold spots and temperature 

fluctuations, and air circulating from the freezer could 

expose refrigerated vaccines to freezing temperatures. 

A separate freezer unit is necessary for storage for facilities 

that stock frozen vaccines.

All units should have enough space to store the largest 

inventory expected at the busiest point in the year (e.g., flu 

season) without crowding.

Never store any vaccine in a dormitory-style or bar-style 

combined unit. These units often have a single exterior door 

and an evaporator plate/cooling coil, usually located in an 

icemaker/freezer compartment. These units pose a significant 

risk of freezing vaccines, even when used for temporary storage.

Temperature Monitoring Devices (TMDs) 

Every vaccine storage unit must have a reliable TMD. CDC 

recommends (and VFC requires) the use of a continuous 

monitoring and recording device called a “digital data logger” 

(DDL), set at recording intervals of at least every 30 minutes. 

Many DDLs use a buffered temperature probe. Temperatures 

measured by a buffered probe match vaccine temperature more 

closely than those measured by standard thermometers, which 

NOTES
56

Storage and Handling

 5

tend instead to reflect air temperature. DDLs provide details on 

how long a unit has been operating outside the recommended 

temperature range (a temperature excursion). Each DDL should 

have a current and valid Certificate of Calibration Testing (also 

known as a “Report of Calibration”) to ensure device accuracy.

DDLs should have the following characteristics:

• Detachable probe that best reflects vaccine temperatures 

(e.g., a probe buffered with glycol, glass beads, sand, 

or Teflon®)

• Alarm for out-of-range temperatures

• Low-battery indicator

• Current, minimum, and maximum temperature display

• Recommended uncertainty of +/-0.5°C (+/-1°F)

• Logging interval (or reading rate) that can be programmed 

by the user to measure and record temperatures at least 

every 30 minutes

Temperature data from a DDL can be downloaded to a 

computer using special software or retrieved from a website 

for user review, which is critical to ensuring vaccine safety. The 

software or website may also allow the user to set the frequency 

of temperature readings. 

Each facility should have a recommended TMD for:

• Each vaccine storage unit

• Each emergency transport unit

• Backup (with a different calibration testing schedule) 

in case a primary device malfunctions or is out for 

calibration testing

Calibration testing should be done every one to two years 

or according to the manufacturer’s suggested timeline. CDC 

recommends that a DDL’s current and valid Certificate of 

Calibration Testing include:

• Model/device name or number

• Serial number

• Date of calibration (report or issue date)

• Confirmation that the instrument passed testing (or 

instrument in tolerance)

• Recommended uncertainty of +/-0.5°C (+/-1°F) or less

NOTES
Storage and Handling

57

5

Storage Unit Setup

Storage units should be placed in a well-ventilated room, 

leaving space between the unit, ceiling, and any wall. Nothing 

should block the cover of the motor compartment. The unit 

should be firm and level, with the bottom of the unit above 

the floor. The unit door should open and close smoothly and 

fit squarely against the body of the unit. Studies find that most 

units work best when placed in an area with standard indoor 

room temperatures, usually considered to be between 20°C and 

25°C (68°F and 77°F). Check the manufacturer-supplied owner’s 

manual for additional guidance on placement and spacing.

Stabilizing Temperatures

It may take two to seven days to stabilize the temperature in a 

newly installed or repaired refrigerator and two to three days to 

stabilize the temperature for a freezer. 

Before using a unit for vaccine storage, the minimum and 

maximum temperatures each workday for two to seven days 

should be checked and recorded. If temperatures cannot be 

recorded digitally, they should be checked and recorded a 

minimum of two times each workday. Once two consecutive 

days of temperatures have been recorded within the 

recommended range, the unit is stable and ready for use. 

Power Supply

To protect the storage unit’s power supply:

• Plug in only one storage unit per electrical outlet. 

• Use a safety-lock plug or an outlet cover to prevent the unit 

from being unplugged.

• Post “DO NOT UNPLUG” warning signs at outlets and on 

storage units to alert staff, custodians, electricians, and 

other workers not to unplug units.

• Label fuses and circuit breakers to alert people not to turn 

off power to storage units. 

• Use caution when using power outlets that can be tripped 

or switched off and avoid using built-in circuit switches 

(that may have reset buttons), outlets activated by a wall 

switch, and multioutlet power strips.

NOTES
58

Storage and Handling

 5

Equipment Maintenance

Storage units and temperature monitoring devices need regular 

maintenance to ensure proper operation, maintain required 

temperatures, and extend the useful life of the equipment.

• Check storage unit door seals regularly for signs of wear 

and tear. 

• Check door hinges and adjust so that the door opens and 

closes smoothly and fits squarely against the body of the 

unit. Leaving the door open can cause the thermostat to 

respond to warmer room temperatures, and the unit will 

work harder to maintain the correct temperature inside. 

The temperature may become very cold in some parts of 

the unit. Using an open-door alarm and a self-closing door 

may be helpful.

• Clean unit coils and motor per manufacturer instructions.

• Clean inside of units to discourage bacterial and fungal 

growth. Cleaning must be done quickly to minimize the risk 

of the temperature going out of range.

• Defrost manual-defrost freezers when the frost exceeds 

either 1 cm or per the manufacturer’s suggested limit. 

Follow the manufacturer’s instructions. While defrosting, 

store vaccines temporarily in another unit with appropriate 

freezer temperatures.

• Temperature monitoring devices experience “drift” over 

time that affects accuracy. If calibration testing indicates 

the device is no longer accurate within +/-0.5°C (+/-1°F), it 

should be replaced. Adjustments to correct accuracy are 

not recommended.

• Storage unit temperatures may need to be adjusted over 

time. Temperature adjustments should only be made by 

a vaccine coordinator and not during a busy part of the 

workday when the door is being frequently opened. The 

coordinator should confirm there is not another issue (e.g., 

unit unplugged, door left open, broken TMD, etc.) before 

making any adjustment to the temperature.

• If you believe there could be an issue with the TMD, use 

the backup TMD to confirm the temperature before making 

any adjustments.

If a backup generator is used, it should be tested 

quarterly and serviced annually, and according to the 

manufacturer’s guidance.

NOTES
Storage and Handling

59

5

Organizing and Storing Vaccine in Storage Unit

Manufacturers’ package inserts should be referred to for the 

most up-to-date storage and handling recommendations for 

specific vaccines and diluents. 

Storing Vaccine

To confirm vaccines are stored correctly and to minimize the risk 

of administration errors: 

• Store vaccines in their original packaging with lids closed in 

separate containers until ready for administration to protect 

them from light and provide additional thermal stability/

protection. Never store loose vials or manufacturer-filled 

syringes outside of their packaging. This increases the 

risk of administration errors, exposes vaccine to light, 

and makes it more difficult to track expiration dates and 

manage inventory. For certain purpose-built units, it 

is recommended that vaccine be stored outside of the 

packaging. If this is the case, follow the manufacturer’s 

guidance for vaccine storage.

• Place vaccines and diluents with the earliest expiration 

dates in front of those with later expiration dates. 

• Store vaccines and diluents with similar packaging 

or names or with pediatric and adult formulations on 

different shelves.

• Whenever possible, store diluent with the corresponding 

refrigerated vaccine. Never store diluent in a freezer. 

• Position vaccines and diluents two to three inches from the 

unit walls, ceiling, floor, and door.

• Arrange vaccines and diluents in rows and allow space 

between them to promote air circulation.

• If using a household-grade unit, avoid storing vaccines and 

diluents in any part of the unit that may not provide stable 

temperatures or sufficient air flow, such as directly under 

cooling vents; in deli, fruit, or vegetable drawers; or on 

refrigerator door shelves. 

• Place water bottles on the top shelf, the floor, and 

in the door racks of a household-grade unit. Putting 

water bottles in the unit can help maintain stable 

temperatures. (Water bottles are not recommended 

for use with certain pharmaceutical-grade units, follow 

manufacturer’s directions.)

NOTES
60

Storage and Handling

 5

• Avoid placing or storing any items other than vaccines, 

diluents, and water bottles inside storage units. If other 

medications and biological products must be stored in 

the same unit as vaccines, they must be clearly marked 

and stored in separate containers or bins from vaccines. 

Potentially contaminated items (e.g., blood, urine, stool) 

should be properly contained and stored below vaccines 

to avoid contamination from drips or leaks. 

• Place the TMD in the center of the unit with the vaccines 

surrounding it. A DDL should be set to measure 

temperature no less frequently than every 30 minutes.

Temperature Ranges

Refrigerators should maintain temperatures between 2°C and 

8°C (36°F and 46°F). Freezers should maintain temperatures 

between -50°C and -15°C (-58°F and +5°F). Refrigerator 

or freezer thermostats should be set at the factory-set or 

midpoint temperature, which will decrease the likelihood of 

temperature excursions. 

Thermostats are marked in various ways and, in general, show 

levels of coldness rather than temperatures. The only way to 

know the temperature where vaccines are stored is to measure 

and monitor it with a TMD.

Monitoring Vaccine Temperatures

To ensure the safety of vaccines, the storage unit minimum 

and maximum temperatures should be checked and recorded 

at the start of each workday. If using a TMD that does not 

display minimum and maximum temperatures, then the current 

temperature should be checked and recorded a minimum of 

two times (at the start and end of the workday). 

A temperature monitoring log sheet should be placed on each 

storage unit door (or nearby), and the following information 

should be recorded: 

• Minimum/maximum temperature (or current temperature 

if using a device that does not record minimum/maximum 

temperatures) 

• Date 

• Time 

• Name of person who checked and recorded the 

temperature

• Any actions taken if a temperature excursion occurred 

NOTES
Storage and Handling

61

5

If a reading is missed, leave a blank entry in the log. Such entries 

should be distinguished from entries in which the TMD failed to 

display a reading. 

Check unit doors throughout the day and always at the end of 

the day to ensure they are tightly closed. 

On a weekly basis, review storage unit temperature readings 

for changes in temperature trends that might require action 

(adjusting unit temperature or repairing/replacing storage or 

temperature monitoring equipment). Temperature data should 

be kept for three years (unless state statutes or rules require a 

longer period).

Temperature Excursions (Out-of-Range 

Temperatures)

Any temperature reading outside ranges recommended in 

the vaccine manufacturers’ package inserts is considered a 

temperature excursion and requires immediate action: 

1. Notify the primary or alternate vaccine coordinator 

immediately or report the problem to a supervisor. 

2. Label exposed vaccines “DO NOT USE,” and place them 

in a separate container apart from other vaccines in the 

storage unit (do not discard these vaccines). 

3. The vaccine coordinator or supervisor should begin to 

document details of the event.

4. Implement your facility’s SOPs for temperature excursions, 

being sure to check temperature monitoring device 

placement or adjusting unit temperature as needed. 

5. Contact your immunization program and/or the vaccine 

manufacturer(s) per your SOPs for guidance.

6. Complete documentation of the event, including actions 

taken and results.

Vaccines should never remain in a nonfunctioning unit 

for an extended period. If it is believed a unit has failed, 

implementation of emergency SOPs should begin.

NOTES
62

Storage and Handling

 5

Vaccine Inventory Management

It is important to make sure vaccines are unpacked and 

stored correctly and to account for every dose received and 

used, whether administered, wasted, compromised, expired, 

or transferred.

Deliveries

Scheduling and Receiving Deliveries 

The vaccine coordinator or alternate should be notified 

immediately when vaccines arrive. Vaccines should be unpacked 

and stored immediately. Vaccine delivery should only be 

scheduled on dates and during times staff will be present. A 

vaccine delivery container should never be left unattended.

Unpacking Deliveries 

Vaccines and diluents should be unpacked and promptly stored 

at recommended temperatures. They should not be stored in an 

unopened shipment box. 

• Examine the shipping container and contents for signs 

of damage. 

• Compare contents against the packing list. For frozen 

vaccines, the packing list may show the maximum time 

vaccines can be in transit based on shipment date. 

• Ensure that lyophilized vaccines came with the correct type 

and quantity of diluents. 

• Check vaccine and diluent expiration dates to ensure there 

are no expired or soon-to-expire products.

• If included, check the cold chain monitor (CCM) for any 

temperature excursion during transit. Note: CCMs are for 

one-time use and should be discarded after being checked.

If there are discrepancies between the contents and the 

packing list or other concerns about the contents (including 

temperature excursion), the vaccine manufacturer should be 

immediately notified. If a temperature excursion is suspected, 

vaccines should be labeled “DO NOT USE” and stored in the 

appropriate vaccine storage unit, separated from other vaccines, 

until a vaccine viability determination is made. The state or local 

immunization program should be contacted regarding any VFC 

or other vaccines purchased with public funds.

NOTES
Storage and Handling

63

5

Inventory Accounting

Conduct a vaccine inventory assessment at least once a 

month and before placing vaccine orders to ensure adequate 

vaccines and diluents are on hand. Determining factors for 

ordering include projected demand, storage capacity, and 

current vaccine supplies. Many state and local immunization 

information systems (IISs) have vaccine inventory accounting 

functions and VFC providers may be required to use the IIS to 

track inventory. 

Stock Rotation and Removal 

Vaccine stock should be rotated and checked for expired doses 

regularly. Any expired vaccines and diluents should be removed 

immediately to avoid inadvertently administering them. 

Understanding Expiration Dates

Determining when a vaccine or diluent expires is an essential 

step in proper vaccine storage and handling. Administration 

of expired vaccine remains one of the top vaccine storage and 

handling errors, so it is crucial for staff to understand how to 

read expiration dates to prevent patients from receiving invalid 

vaccine doses.

When the expiration date has only a month and year, the 

product may be used up to and including the last day of 

that month. If a day is included with the month and year, the 

product may only be used through the end of that day. Products 

that have been contaminated or compromised should not be 

used, regardless of the expiration date.

In some instances, such as when a manufacturer indicates there 

is a beyond-use date (BUD), vaccines must be used before the 

expiration date on the label.

The BUD is calculated based on the date the vial is first 

punctured and the storage information in the package insert. 

If the vaccine has no BUD, the vaccine should be used by the 

expiration date indicated by the manufacturer.

The BUD replaces the expiration date and should be noted 

on the label, along with the initials of the person making the 

calculation. Examples include:

• Reconstituted vaccines have a limited time frame for use 

once the vaccine is mixed with a diluent. For example, if 

the package insert states that the reconstituted vaccine 

must be used within 30 minutes, it must be discarded if 

not used by that time. This time frame might only apply as 

long as the reconstituted vaccine is still in the vial, not after 

it is drawn into a syringe, so the package insert should be 

carefully checked. 

NOTES
64

Storage and Handling

 5

• Multidose vials (MDVs) might have a specified time frame 

for use once they have been entered with a needle. For 

example, the package insert may state that the vaccine 

must be discarded 28 days after it is entered. If the vial is 

entered on June 1, 2020, the BUD is June 29, 2020.

• Manufacturer-shortened expiration dates may apply when 

vaccine is exposed to inappropriate storage conditions. 

The manufacturer might determine that the vaccine can 

still be used but will expire on an earlier date than the date 

on the label.

In addition to a BUD, some MDVs have a specific number of 

doses that can be withdrawn. Once the maximum number of 

doses has been removed, the vial should be discarded, even if 

there is residual vaccine in the vial.

Vaccine and Equipment Disposal

Sometimes unused vaccine and diluent doses, unopened vials, 

expired vials, and potentially compromised vaccine may be 

returned for credit, even if they must be discarded. The state or 

local immunization program or the vaccine manufacturer can 

provide vaccine-specific information.

Open and broken vials and syringes, manufacturer-filled 

syringes that have been activated, and vaccines predrawn 

by providers cannot be returned and should be discarded 

according to state requirements. 

Immediately after use, all syringe/needle devices should be 

placed in biohazard containers that are closable, punctureresistant, leakproof on sides and bottom, and labeled or colorcoded. This practice helps prevent accidental needlesticks and 

reuse. Used needles should not be recapped, cut, or detached 

from syringes before disposal. 

Empty, expired, or compromised vaccine vials are usually not 

considered hazardous or pharmaceutical waste and do not 

require disposal in a biomedical waste container. However, 

state requirements regarding disposal should be followed. 

Medical waste disposal requirements are set by state 

environmental agencies. 

Predrawing Vaccines 

Vaccines should be drawn up only at the time of administration. 

General-use syringes are designed for immediate 

administration, not for storage. Contamination and growth of 

microorganisms can occur in syringes with predrawn vaccine 

that does not contain a preservative. In addition, vaccine 

components may interact with polymers in a plastic syringe 

over time, potentially reducing vaccine potency. Predrawing 

vaccines can also result in vaccine waste.

NOTES
Storage and Handling

65

5

Even for off-site clinics, vaccine manufacturers do not 

recommend predrawing vaccines. As an alternative, CDC 

recommends using manufacturer-filled syringes (MFSs) for large 

vaccination clinics.

If vaccines must be predrawn: 

• Set up a separate administration station for each vaccine 

type to prevent medication errors. 

• Draw up vaccines only after arriving at the clinic site or mass 

vaccination event. 

• Each person administering vaccines should draw up no 

more than one MDV or 10 doses at one time. 

• Monitor patient flow to avoid drawing up 

unnecessary doses.

• Predraw reconstituted vaccine into a syringe only when 

ready for administration. 

• If a predrawn vaccine is not used within 30 minutes of being 

reconstituted, follow manufacturer guidance for storage 

conditions and time limits. 

Any remaining vaccine in predrawn syringes should be 

discarded at the end of the workday. Predrawn, reconstituted 

vaccine should never be transferred back into a vial for storage.

Vaccine Transport

To protect the vaccine supply, vaccine should be delivered 

directly to the facility where it will be used. However, 

sometimes, vaccine needs to be transported to an off-site or 

satellite facility for an event like an on-site vaccination clinic. 

Transport may also be required during emergencies such as 

long-term power outages or flooding or other natural disasters 

that can put the vaccine supply in jeopardy. In these instances, 

certain actions must be taken to protect the vaccine supply.

Vaccine transport to off-site or satellite facilities is different 

from both shipping and emergency transport. Shipping 

usually involves a professional carrier and a long distance 

and time frame for moving vaccines between locations. 

Transport involves the movement of vaccine over a short 

time frame and distance between providers. Depending on 

the situation, transport recommendations may vary. An organization’s SOPs should clearly define transport procedures for 

all possible scenarios and should be used by trained staff for 

any vaccine transport.

NOTES
66

Storage and Handling

 5

Preparing Vaccine for Transport 

A facility should have a supply of materials needed for 

transport of the largest annual vaccine inventory. 

Soft-sided containers specifically engineered for vaccine 

transport are acceptable (and may be part of a qualified 

container and packout system). Commercially available 

soft-sided food or beverage coolers should not be used 

because most are poorly insulated and likely to be affected 

by room or outdoor temperatures.

A TMD for each transport container should be used during 

transport, as well as appropriate coolants and transport 

materials according to the specific transport system(s) 

being used. 

The same shipping containers the vaccines were initially 

shipped in may be used for emergency transport as a last 

resort only.

Partially used vials cannot be transferred between providers 

or across state lines.

Transport of Refrigerated Vaccines to Off-Site or 

Satellite Facilities

Best practices for transport include:

• The total time for transport alone or transport plus clinic 

workday should be a maximum of 8 hours.

• Transport diluents with their corresponding vaccines to 

ensure there are always equal amounts of vaccines and 

diluents for reconstitution.

• Transport only the amount of vaccine needed for 

the workday.

• If a noncommercial vehicle must be used, place the 

transport containers in the passenger compartment, not 

the trunk.

Transport System Recommendations

Container Description Emergency 

Transport

Transport to Off-Site Clinic or Satellite 

Facility or for Relocation of Stock

Portable Vaccine Refrigerator or Freezer Yes Yes

Qualified Container and Packout Yes Yes

Conditioned Water Bottle Transport System* Yes No

Manufacturer’s Original Shipping Container Yes 

(last resort only)

No

Food/Beverage Coolers No No

*cdc.gov/vaccines/hcp/admin/storage/downloads/emergency-transport.pdf
Storage and Handling

67

5

Transport of Vaccines in Emergencies

In addition to the actions outlined above, in an 

emergency situation:

• Contact an alternative vaccine storage facility before 

packing any vaccine to confirm it can accept vaccines 

for storage.

• Note any protective measures in place at the time of the 

event (water bottles, battery-powered TMD, transport to 

alternative facility, etc.).

• Only open the vaccine storage unit door when ready to 

pack vaccine in transport containers or when power has 

been restored.

If an emergency can be anticipated (e.g., weather event), 

suspend immunization activities before the onset of emergency 

conditions to allow adequate time for packing and transport.

Storing Vaccines at the Destination

Immediately upon arrival at the off-site location, vaccines 

should be stored in an appropriate storage unit with a TMD. 

Follow recommended guidelines for monitoring and recording 

storage unit temperatures:

• If the device displays minimum/maximum temperatures, 

this information should be checked and recorded.

• If the device does not display minimum/maximum 

temperatures, then the current temperature should be 

checked and recorded a minimum of two times (at the start 

and end of the workday).

If vaccines cannot be stored in an on-site storage unit, they 

should be kept in the portable vaccine storage unit using the 

following guidance:

• Place a TMD (preferably with a probe in a thermal buffer) 

as close as possible to the vaccines and check and record 

temperatures hourly.

• Keep the container closed as much as possible.

NOTES
68

Storage and Handling

 5

Acknowledgements

The editors would like to acknowledge Jennifer Hamborsky, 

Beth Hibbs, Ginger Redmon, Donna Weaver, A. Patricia Wodi, 

and Skip Wolfe for their contributions to this chapter.

Selected References

CDC. General Best Practice Guidelines for Immunization: Best 

Practices Guidance of the Advisory Committee on Immunization 

Practices (ACIP). www.cdc.gov/vaccines/hcp/acip-recs/generalrecs/downloads/general-recs.pdf, Accessed December 27, 2019 

and August 12, 2020.

CDC. Recommendations and Guidelines: Storage and Handling. 

www.cdc.gov/vaccines/recs/storage/default.htm. 

CDC. Vaccine Storage and Handling Toolkit. 

www.cdc.gov/vaccines/hcp/admin/storage/toolkit/storagehandling-toolkit.pdf. 

Food and Drug Administration (FDA). Vaccines Licensed for Use 

in the United States. www.fda.gov/BiologicsBloodVaccines/

Vaccines/ApprovedProducts/ucm093833.htm. 

Immunization Action Coalition. Clinic Resources: Storage and 

Handling. www.immunize.org/clinic/storage-handling.asp.

NOTES