What to know
Emergencies such as equipment failures, power outages, severe weather conditions, or natural disasters sometimes happen without warning and might compromise vaccine storage conditions. Providers should make plans for vaccine storage or transportation during emergencies. The Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration (FDA) offers information concerning the storage and use of temperature-sensitive biological products affected by flooding or a temporary power outage.
Important Note
Emergency vaccine storage and transport guidance may differ from non-emergency situations. To ensure proper cold chain maintenance during emergencies, carefully review both transport sections in this toolkit, along with the manufacturer's guidance for impacted vaccines.
The Center for Biologics Evaluation and Research (CBER) at the Food and Drug Administration (FDA) offers information concerning the storage and use of temperature-sensitive biological products that have been involved in a temporary electrical power failure or flood conditions.
Power Outages
Vaccine Storage During Emergencies
During an emergency, vaccines may remain inside a nonfunctioning unit if appropriate temperatures are maintained. With the unit door closed, monitor the DDL to determine when additional action should be taken.
During a power outage, only open the storage unit door if,
- Power is restored.
- Or it is determined that the vaccines need to be packed in separate storage containers and/or transported to an alternative storage facility.
Temperature Monitoring During a Power Outage
If the storage unit has an external temperature monitoring display that can be checked without opening the unit door, take the following steps:
- Record room temperature (if possible) and the temperature inside the unit as soon as the power goes out.
- Record minimum and maximum temperatures reached inside the unit during the outage.
- Temperature excursions should be avoided, if possible, by using emergency plans and SOPs for transport and alternative storage. However, if temperatures fall outside of the recommended range, providers should follow procedures for temperature excursions.
If it is not possible to monitor the temperature inside the unit without opening the door, and there is no access to an alternative facility with power for vaccine storage or established emergency vaccine storage procedures, wait until power is restored before taking the following steps:
- Record the room temperature (if possible) and the temperature inside the unit.
- If using a DDL, document the length of time the power was off and the minimum and maximum temperatures during that period.
- If temperatures inside the unit have already fallen outside of the recommended range, follow procedures for temperature excursions. If possible, move the vaccines to an alternative storage unit or location where they can be stored at appropriate temperatures. Make sure to separate and mark these vaccines "DO NOT USE—TEMPERATURE EXCURSION" until a decision can be made about whether the vaccines can still be used.
Generators and Backup Battery Power Sources
Having an on-site generator prevents the need to transport vaccines to an alternative storage facility during a power outage.
- Keep sufficient fuel on hand to continuously run the generator for at least 72 hours.
- 🖍 Test the generator quarterly and have it serviced annually.
A backup battery power source can be used in lieu of a generator.
- 🖍 Test backup battery power sources quarterly and have them serviced annually.
- Check the manufacturer's guide for testing.
Accessing Your Facility After-Hours
Emergency situations can arise outside of normal business hours, so providers should maintain a relationship with the facility's building manager or security staff. Ensure all staff members are familiar with emergency SOPs, including after-hours roles and responsibilities. The facility's storage and handling SOPs should include instructions for accessing the vaccine storage units when the building is closed, with a building map/diagram and locations of
- Spare batteries
- Flashlights
- Keys
- Locks
- Circuit breakers
- Emergency transport equipment and materials
Copies of the emergency SOPs should be stored with the emergency supplies, kept with vaccine coordinator staff at their homes, and shared with others as needed, such as security officers or building managers.
Vaccine Transport During Emergencies
Emergency transport usually involves relocating vaccines to protect them when a facility's ability to store vaccines is compromised because of a power outage, weather event, or other mishap.
During emergencies, two provisional vaccine transport options can be used:
- A transport system that uses conditioned water bottles1 and hard-sided insulated containers or Styrofoam™, in conjunction with the Packing Vaccines for Transport During Emergencies tool
- Manufacturers' original shipping containers (only as a last resort)
Portable Vaccine Refrigerator or Freezer
Qualified Container and Packout
Conditioned Water Bottle
Transport System1
Manufacturer’s Original Shipping Container
Yes (last resort only)
Food/Beverage Coolers
Alternative Storage Facility
No piece of vaccine storage equipment is infallible. At some point, equipment will fail because of a power outage, breakdown, or normal wear and tear.
☑ Establish a working agreement with at least one alternative storage facility, even if providers have a generator as backup equipment.
- Ensure 24-hour access to this facility. Hospitals, long-term care facilities, state depots, the Red Cross, fire stations, packing plants, grocery stores, funeral homes, and commercial pharmacies are some of the facilities that might be able to assist.
- Ensure the alternative storage facility has a dedicated unit or shared space that can maintain temperatures at the appropriate range. Please note that shared spaces may not be able to maintain temperatures within the recommended ranges for the vaccine supply.
- Before packing any vaccines, confirm with the alternative vaccine storage facility that they can accept them for storage.
Providers may also choose to have a backup storage unit so that vaccine might not have to be packed or moved to an alternative storage facility if the primary storage unit fails.
Temperature Monitoring at Alternative Storage Sites
Vaccine temperature should be maintained when stored at an alternative facility during an emergency. Temperatures should be monitored and documented in temperature logs when storing vaccines during an emergency. Sometimes getting temperature logs before an emergency is not feasible. However, the provider should confirm that the emergency unit can maintain the required temperature range. To confirm, locate online the specifications for the make and model of the storage unit.
If an Alternative Vaccine Storage Facility Is Not Available
If providers cannot find an alternative vaccine storage facility within a reasonable distance, or cannot reach the alternative facility, they can use portable vaccine refrigerator/freezer units (if power source is available), qualified containers and packouts2, or a hard-sided insulated container or Styrofoam™ using the Packing Vaccines for Transport during Emergencies tool. Always place a TMD with the vaccines and carefully monitor the TMD to ensure vaccines remain within the appropriate temperature range. Temporary storage containers should remain closed, and vaccines can only be stored safely for as long as the containers are validated to maintain proper storage temperatures.
VFC Reminder
VFC providers and others who administer vaccines purchased with public funds should contact their immunization program for state-specific requirements related to vaccine transport.
- Conditioned Water Bottles:Frozen water bottles that have been submerged under lukewarm water until the ice block inside can spin freely.
- Qualified Container and Packout:A type of container and supplies specifically designed for use when packing vaccines for transport. These containers are “qualified” through laboratory testing under controlled conditions to ensure they achieve and maintain desired temperatures for a set amount of time.