Immunization: Schedules, Reporting, and Resources
Adverse Event Reporting
All health care professionals in Ontario who administer vaccines and/or care for patients following immunization are required by law to report adverse events to their local Health Unit within 7 days of diagnosis. Adverse events may be reported using the Report of Adverse Event Following Immunization (AEFI) form (Public Health Ontario).
Questions about reporting an AEFI and the reporting form? See Adverse Event Following Immunization Reporting for Health Care Providers in Ontario.
Not sure if something is classified as a true AEFI? Learn more about AEFI case definitions.
- A Practical Guide for Safe and Effective Office-Based Practices
- Canadian Immunization Guide
- Epidemiology and Prevention of Vaccine-Preventable Diseases, 13th Edition
- Immunization Communication Tool for Immunizers
- Immunization Well-Child Toolkit: Helping your patients learn about childhood diseases.
- Infection Prevention and Control for Clinical Office Practice
- The Red Book, 2015 Report of the Committee on Infectious Diseases, 30th Edition
- Your Child’s Best Shot, 4th Edition
- National Advisory Committee on Immunization (NACI) Recommendations
Vaccines: Ordering, Storage, and Handling
To order publicly-funded vaccines from Elgin St. Thomas Public Health:
- Telephone: 519-631-9900
- Fax the Vaccine Order Form: 519-633-0468
**Only order enough vaccine for one month. Over stocking can result in high vaccine wastage**
Learn more about the MOHLTC requirements for Vaccine and Storage Handling.
Public Health Nurses also respond to all cold chain incidents reported to Elgin St. Thomas Public Health within 24 hours.
Definition of Cold Chain Incident
A cold chain incident occurs when the vaccine is exposed to temperatures outside the +2.0ºC and +8.0ºC range. This can happen in your refrigerator or during transport from Elgin St. Thomas Public Health to your facility.
Mandatory Requirements for Cold Chain
In order to be compliant with the mandatory requirements for vaccine storage and handling, facilities must:
- Maintain vaccine fridge temperatures between +2.0ºC and +8.0ºC
- Keep an minimum/maximum thermometer in the fridge to monitor temperatures
- Check fridge temperatures twice daily and record in a log book
- Keep Vaccine Storage and Handling Guidelines and materials on-site and easily accessible so that staff can consult them.
Responding to Out of Range Temperatures
When you notice refrigerator temperatures out of range:
- Place all exposed vaccines in a bag and mark “DO NOT USE”
- If your fridge has returned to a temperature between +2.0ºC and +8.0ºC, keep the vaccine in your fridge. If your fridge is still out of range and if you have access to another stable, monitored, and inspected fridge (ie another fridge inspected by Elgin St. Thomas Public Health in your building), store the vaccine in that fridge until your fridge is stable. You may also keep vaccine in a monitored hard sided cooler for a short period of time until your fridge returns to appropriate temperatures.
- Call Elgin St. Thomas Public Health immediately at 519-631-9900 to report the vaccine exposure.
Based on the temperature logs, the Public Health Nurse will determine the length of exposure and which vaccines are still okay to use.
- Vaccines which may still be used (exposed vaccine) are marked with a red-dot and stored in the vaccine refrigerator under cold chain.
- Vaccines which cannot be used (wasted vaccine) are placed in a bag marked with the name of the institution or office that is returning them and “DO NOT USE”. The bag should be sent back to Elgin St. Thomas Public Health with the Vaccine Wastage Form as soon as possible as this lessens the chance of someone using it by mistake.
- After a cold chain incident, you will be asked to fax copies of the refrigerator temperature logs to Public Health. You may have to submit your temperature logs for a few days to show that the fridge has stable temperatures before you can order vaccine again.
- A Public Health Nurse may choose to visit you after a cold chain incident if it’s serious (lots of vaccines are wasted) or if a face to face conversation would be helpful. A data logger may be placed in your refrigerator to gather additional information. Data loggers provide continuous temperature recording (at pre-determined intervals) that can be downloaded onto a computer and a report printed. Data logger readings and reports can be very useful in determining refrigerator functioning.
Using Digital Min/Max Thermometers
A digital min/max thermometer is a thermometer that accurately records the highest and lowest temperatures reached inside the refrigerator since the thermometer was last reset.
- If the thermometer has an IN-OUT switch, make sure it is always in the OUT position.
- The temperature probe should be placed in an empty vaccine box that is positioned in the middle of the refrigerator. This location provides the most accurate temperature readings.
- The batteries in the thermometer should be changed twice annually.
- Temperatures on the min/max thermometer should be read twice daily and the thermometer reset or cleared after each reading.
There are many effective practices that can be adopted to achieve the best possible Vaccine Storage and Handling:
- Order smaller amounts of vaccine more often to decrease vaccine wastage in case of a cold chain failure.
- Ensure the vaccine refrigerator is large enough to accommodate the required stock of vaccine.
- Store vaccines on the middle shelves. Never store vaccines in the door shelves, bottom drawer or close to the freezer section, as they could be exposed to significantly warmer or colder temperatures in these locations.
- Storing filled water bottles on the lower shelf and door of the refrigerator may help to maintain an even, stable temperature inside the refrigerator.
- With the exception of these water bottles, do not store anything else in the refrigerator except for vaccines (no food, drinks or lab specimens.)
- Ensure that the electrical outlet and refrigerator plug is secured to prevent the refrigerator from accidentally being unplugged or turned off.
- Always ensure that the refrigerator door is closed tightly – a velcro lock will ensure that the door is not accidentally left ajar. Making sure the refrigerator is level will also help keep the door closed.
- Defrost the refrigerator when there is more than 1 cm (¼”) of ice in the freezer compartment.
- Train all members of your office in proper vaccine storage and handling. Staff should be familiar with the Vaccine Storage and Handling Guidelines.
- Organize vaccines by type with shorter expiry dates at the front of the refrigerator so that they may be used first.
- Check vaccine expiry dates regularly and return expired vaccines with the Vaccine Wastage Form to Elgin St. Thomas Public Health.
Resources from the Immunization Workshop for Health Care Providers
These welcome signs can be hung on hospital or home doors asking guests to make sure immunizations are up-to-date before visiting the new baby. If you would like digital copies of these signs with placeholders to add your facility logo, contact a member of the Vaccine Preventable Diseases team at the health unit.
Our Kahoot game is just what you need.
These vaccine fridge labels can be printed out on card stock to make locating your vaccines quick and easy.
Visit the Infection Control page of our website.