Analysis of vaccine loss due to temperature change

retrospective cross-sectional study with secondary data obtained from Temperature Change Notification Forms used by the Epidemiological Surveillance Group XXIX of São José do Rio Preto between 2010 and 2017. Descriptive and inferential analysis were performed using multiple linear regression and significance level of 95%.

Results:

in total, 341 notifications of temperature changes were analyzed, of which 70.1% were caused by structural reasons, 57.8% in industrial refrigerators and 91.2% in primary care services. Of the doses that suffered a change in temperature, 41.4% were lost and 58.6% were administered to the population. The highest percentage of lost doses compared to those applied occurred in smaller municipalities, although they reported less.

Conclusions:

nursing workers who work in vaccination rooms should make efforts to prevent temperature changes and avoid losses and higher public expenses.

Descriptors:
Refrigeration; Vaccines; Immunization; Disease Prevention; Health Care

Variables	Year of notification
	2010			2011			2012			2013			2014			2015			2016			2017			Total
	n	%	p value	n	%	p value	N	%	p value	n	%	p value	n	%	p value	n	%	p value	n	%	p value	n	%	p value	n	%	p value
Notification Period			0.053			0.280			0.437			0.398			0.085			0.455			0.244			0.190			0.876
Jan - Mar	9	28.2		11	34.4		6	15.8		22	46.8		15	36.6		12	21.8		15	28.3		14	32.6		104	30.5
Apr - Jun	4	12.5		3	9.4		7	18.4		6	12.8		5	12.2		16	29.1		11	20.7		5	11.6		57	16.7
Jul - Sep	6	18.7		8	25.0		8	21.0		12	25.5		9	21.9		15	27.3		15	28.3		8	18.6		81	23.7
Oct - Dec	13	40.6		10	31.2		17	44.7		7	14.9		12	29.3		12	21.8		12	22.6		16	37.2		99	29.0
Reasons for Temperature Change			0.015			0.359			0.564			0.310			0.574			0.225			0.733			0.169			0.085
Structural	20	62.5		17	53.1		33	86.8		33	70.2		26	63.4		41	74.5		36	67.9		33	76.7		239	70.1
Professional	6	18.7		12	37.5		0	-		13	27.7		12	29.3		14	25.4		12	22.6		7	16.3		76	22.3
Uninformed	6	18.7		3	9.4		5	13.2		1	2.1		3	7.3		0	-		5	9.4		3	7.0		26	7.6
Type of Equipment			0.131			0.569			0.744			0.423			0.190			0.291			0.559			0.094			0.848
Industrial	14	43.7		12	37.5		13	34.2		31	66.0		26	63.4		39	70.9		36	67.9		26	60.5		197	57.8
Domestic	17	53.1		19	59.4		23	60.5		14	29.8		12	29.3		11	20.0		13	24.5		13	30.2		122	35.8
Others	1	3.1		1	3.1		2	5.3		2	4.3		3	7.3		5	9.1		4	7.5		4	9.3		22	6.4
Classification of Municipalities			0.068			0.505			0.060			0.472			0.840			0.415			0.453			0.652			0.020
Up to 10,000 inhab.	8	25.0		7	21.9		7	18.4		17	36.2		24	58.5		27	49.1		17	32.1		15	34.9		122	35.8
10,001 to 50,000 inhab.	7	21.9		7	21.9		11	28.9		12	25.5		3	7.3		8	14.5		13	24.5		12	27.9		73	21.4
50,001 to 500,000 inhab.	17	53.1		18	56.2		20	52.6		18	38.3		14	34.1		20	36.4		23	43.4		16	37.2		146	42.8
umber of Vaccination Rooms			0.029			0.652			0.011			0.649			0.591			0.942			0.333			0.749			0.039
1 Room	7	21.9		2	6.2		6	15.8		11	23.4		16	39.0		13	23.6		9	17.0		8	18.6		72	21.1
2 a 5 Rooms	6	18.7		10	31.2		10	26.3		17	36.2		12	29.3		21	38.2		22	41.5		20	46.5		118	34.6
> 5 Rooms	19	59.4		20	62.5		22	57.9		19	40.4		13	31.7		21	38.2		22	41.5		15	34.9		151	44.3
Type of Health Service			0.307			0.143			0.218			0.950			0.033			0.072			0.066			0.026			<0.001
Primary Care	31	96.9		28	87.5		34	89.5		46	97.9		32	78.0		52	94.5		48	90.6		40	93.0		311	91.2
Other Services^* * Specialized Care: outpatient clinic, hospital, specialty center; Urgency/Emergency Unit; Prison Unit.	1	3.1		4	12.5		4	10.5		1	2.1		9	21.9		3	5.4		5	9.4		3	7.0		30	8.8

	Notification year
	2010		2011		2012		2013		2014		2015		2016		2017
	n	%	n	%	n	%	n	%	n	%	n	%	n	%	n	%
Loss of Immunobiologicals
Yes	29	90.6	25	78.1	32	84.2	42	89.4	34	82.9	40	72.7	47	88.7	36	83.7
No	3	9.4	7	21.9	6	15.8	5	10.6	7	17.1	15	27.3	6	11.3	7	16.3
Total	32	100.0	32	100.0	38	100.0	47	100.0	41	100.0	55	100.0	53	100.0	43	100.0

Notification Year	Number of Notifications	Total Doses	Lost Doses		Doses Used
Notification Year	Number of Notifications	Total Doses	Nr.	%	Nr.	%
2010	32	52,245	18,701	35.8	33,544	64.2%
2011	32	29,773	13,204	44.3	16,569	55.6
2012	38	25,151	9,271	36.9	15,880	63.1
2013	47	48,784	19,230	39.4	29,554	60.6
2014	41	42,754	19,591	45.8	23,163	54.2
2015	55	84,707	20,104	23.7	64,603	76.3
2016	53	61,974	34,573	55.8	27,401	44.2
2017	43	52,948	30,188	57.0	22,760	43.0
Total	341	398,336	164,862	41.4	233,474	58.6
Mean	42.6	49,792	20,608	41.4	29,184	58.6

Classification of municipalities	Number of municipalities	Number of notifications	Total doses applied	Altered doses		Lost doses after alteration		Doses used after alteration
Classification of municipalities	Number of municipalities	Number of notifications	nº	nº	%	nº	%	nº	%
Up to 10,000 inhab.	40	122	1,207,708	119,795	9.9	60,605	5.0	79,194	6.6
10,001 to 50,000 inhab.	23	73	2,001,816	85,141	4.2	34,808	1.7	60,171	3.0
50,001 to 500,000 inhab.	4	146	4,526,554	193,400	4.3	69,449	1.5	94,109	2.1
Total	67	341	7,736,078	398,336	5.1	164,862	2.1	233,474	3.0
Mean		113.7	2,578,693	132,778.7	5,1	54,954	2.1	77,824.7	3.0

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Flavia dos Santos Patine E-mail: patineflavia@hotmail.com