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Section 1. Active and Passive Immunization
ACTIVE IMMUNIZATION
Vaccine Handling and Storage
Vaccines should be stored at recommended temperatures. Inattention to vaccine storage conditions can contribute to vaccine failure. Exposure of inactivated vaccines to freezing temperature (0.0°C [32.0°F] or colder) is the most common storage error. Live-virus vaccines, including MMR, MMRV, varicella, yellow fever, live-attenuated influenza, and OPV vaccines, are sensitive to increased temperature (heat sensitive). Inactivated vaccines may tolerate limited exposure to elevated temperatures but are damaged rapidly by freezing (cold sensitive). Examples of cold-sensitive vaccines include diphtheria and tetanus toxoids and acellular pertussis (DTaP and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis [Tdap]) vaccines, IPV vaccine, H influenzae type b (Hib) vaccine, pneumococcal polysaccharide and conjugate vaccines, hepatitis A and hepatitis B vaccines, inactivated influenza vaccine, and meningococcal polysaccharide and conjugate vaccines. Some products may show physical evidence of altered integrity, and others may retain their normal appearance despite a loss of potency. Physical appearance is not an appropriate basis for determining vaccine acceptability. Therefore, all personnel responsible for handling vaccines in an office or clinic setting should be familiar with standard procedures designed to minimize risk of vaccine failure. Recommended storage conditions for commonly used vaccines are listed in Table 1.4 (p 13); new vaccines and new formulations of currently available products may have storage requirements different from those listed. In addition, storage recommendations may be revised by the manufacturer. Revisions require approval by the FDA.
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Recommendations for handling and storage of selected biologicals are summarized in several areas, including the package insert for each product; in a publication titled Vaccine Management, available from the Centers for Disease Control and Prevention (CDC)
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