{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,9]],"date-time":"2026-05-09T06:29:47Z","timestamp":1778308187908,"version":"3.51.4"},"reference-count":13,"publisher":"BMJ","issue":"6898","license":[{"start":{"date-parts":[[1993,7,24]],"date-time":"1993-07-24T00:00:00Z","timestamp":743472000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1993,7,24]]},"abstract":"<jats:p>OBJECTIVE--To investigate the cold chain for vaccines and compliance with the local code of practice for storage. DESIGN--In a random sample of general practices orders for live vaccines (oral polio and measles, mumps, and rubella) were accompanied by a cold chain monitor which was activated on leaving the supplying pharmacy. The monitors were read at specified intervals and when all vaccines in the order had been used. Structured interview was used to check compliance with the local code of practice on storage. SETTING--West Berkshire and Aylesbury Vale district health authorities. SUBJECTS--16 (25%) general practices in West Berkshire, and 13 (50%) in Aylesbury Vale. MAIN OUTCOME MEASURES--Compliance with code of practice. Changes in the cold chain monitor. RESULTS--For six key requirements within the code of practice compliance varied from 70% to 0%. Only 16 of 29 practices had a named person responsible for vaccine storage and only four were aware of the local code of practice. Vaccine was stored for longer and more breaks in the cold chain occurred in West Berkshire than in Aylesbury Vale. The potency of some vaccines in 10 of 26 orders became suspect before use. CONCLUSIONS--Knowledge of appropriate management of the cold chain in two districts was poor. Breaks in the chain were more frequent and compromised potency more likely when vaccine had been stored for more than eight weeks. Problems in maintaining the cold chain indicate the need for continuing audit, which should become a prerequisite for payments to general practitioners for immunisation.<\/jats:p>","DOI":"10.1136\/bmj.307.6898.242","type":"journal-article","created":{"date-parts":[[2009,3,30]],"date-time":"2009-03-30T08:16:37Z","timestamp":1238400997000},"page":"242-244","source":"Crossref","is-referenced-by-count":28,"title":["Is the cold chain for vaccines maintained in general practice?"],"prefix":"10.1136","volume":"307","author":[{"given":"E A","family":"Haworth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R","family":"Booy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"L","family":"Stirzaker","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"S","family":"Wilkes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"A","family":"Battersby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1993,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1136\/bmj.304.6829.756","article-title":"Storage of vaccines in the community: weak link in the cold chain?","volume":"304","author":"Thakker, Y.; Woods, S.","year":"1992","unstructured":"Thakker Y, Woods S. Storage of vaccines in the community: weak link in the cold chain? BMJ 1992;304:756-8.","journal-title":"BMJ"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"661","DOI":"10.1136\/bmj.299.6700.661","article-title":"Storage ofvaccines in general practice","volume":"299","author":"Hunter, S.","year":"1989","unstructured":"Hunter S. Storage ofvaccines in general practice. BMJ 1989;299:661-2.","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1542\/peds.89.2.193","article-title":"Vaccine storage practices in pediatric offices","volume":"89","author":"Bishai, D.M.; Bhatt, S.; Lee, T.; Miller, M.D.; Hayden, G.F.","year":"1992","unstructured":"Bishai DM, Bhatt S, Lee T, Miller MD, Hayden GF. Vaccine storage practices in pediatric offices. Pediatrics 1992;89:193-6.","journal-title":"Pediatrics"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1001\/jama.1971.03180340031007","article-title":"Measles in children previously vaccinated against measles","volume":"216","author":"Lerman, S.J.; Gold, E.","year":"1971","unstructured":"Lerman SJ, Gold E. Measles in children previously vaccinated against measles. JAMA 1971;216:1311-4.","journal-title":"JAMA"},{"key":"ref_5","first-page":"512","article-title":"Impotency of live virus vaccines as a result of improper handling in clinical practice. YPediatr","volume":"85","author":"Krugman, R.D.; Meyer, B.C.; Enterline, J.C.; Parkman, P.D.; Witte, J.J.; Meyer, H.M.","year":"1974","unstructured":"Krugman RD, Meyer BC, Enterline JC, Parkman PD, Witte JJ, Meyer HM. Impotency of live virus vaccines as a result of improper handling in clinical practice. YPediatr 1974;85:512-4."},{"key":"ref_6","first-page":"863","volume":"38","author":"Centres for Disease Control and Prevention","year":"1989","unstructured":"Centres for Disease Control and Prevention. Measles-United States, first 26 weeks 1989. MMWR 1989;38:863-72.","journal-title":"MMWR"},{"key":"ref_7","article-title":"WHO Expanded Programme on Immunisation. Vaccine cold chain monitor EPI\/CCIS\/85. 1","year":"1985","unstructured":"WHO Expanded Programme on Immunisation. Vaccine cold chain monitor EPI\/CCIS\/85. 1. Geneva: World Health Organisation, 1985."},{"key":"ref_8","first-page":"431","article-title":"Transport and storage of vaccines in Hungary","volume":"68","author":"Lugosi, L.; Battersby, A.","year":"1990","unstructured":"Lugosi L, Battersby A. Transport and storage of vaccines in Hungary. BuUl World Health Organ 1990;68:431-9.","journal-title":"BuUl World Health Organ"},{"key":"ref_9","article-title":"WHO Expanded Programme on Immunisation. Chemical indicators for monitoring the cold chain EPl\/CCIS\/83\/Rev. 1","year":"1987","unstructured":"WHO Expanded Programme on Immunisation. Chemical indicators for monitoring the cold chain EPl\/CCIS\/83\/Rev. 1. Geneva: World Health Organisation, 1987."},{"key":"ref_10","article-title":"Guidelines on the storage of vaccines","author":"Authority, West Berkshire Health","year":"1989","unstructured":"West Berkshire Health Authority. Guidelines on the storage of vaccines. Reading: West Berkshire Health Authority, 1989.","journal-title":"Reading: West Berkshire Health Authority"},{"key":"ref_11","article-title":"Oxford Regional Health Authority. Guiddines on the storage of vaccines","year":"1990","unstructured":"Oxford Regional Health Authority. Guiddines on the storage of vaccines. Oxford: Oxford Regional Health Authority, 1990."},{"key":"ref_12","article-title":"Immunisation against infectious disease","author":"on Vaccination, Joint Committee; Immunisation","year":"1990","unstructured":"Joint Committee on Vaccination and Immunisation. Immunisation against infectious disease. London: Department ofHealth, HMSO, 1990."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1309","DOI":"10.1016\/0140-6736(91)92601-W","article-title":"Vaccine safety versus vaccine efficacy in mass immunisation programmes","volume":"ii:","author":"Nokes, D.J.; Anderson, R.M.","year":"1991","unstructured":"Nokes DJ, Anderson RM. Vaccine safety versus vaccine efficacy in mass immunisation programmes. Lancet 1991;ii:1309-12.","journal-title":"Lancet"}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.307.6898.242","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.307.6898.242","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T18:42:40Z","timestamp":1766428960000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.307.6898.242"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,7,24]]},"references-count":13,"journal-issue":{"issue":"6898","published-online":{"date-parts":[[1993,7,24]]},"published-print":{"date-parts":[[1993,7,24]]}},"alternative-id":["10.1136\/bmj.307.6898.242"],"URL":"https:\/\/doi.org\/10.1136\/bmj.307.6898.242","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"value":"0959-8138","type":"print"},{"value":"1468-5833","type":"electronic"}],"subject":[],"published":{"date-parts":[[1993,7,24]]}}}