Hepatitis B vaccine freezing in the Indonesian cold chain: evidence and solutions

Bull World Health Organ. 2004 Feb;82(2):99-105. Epub 2004 Mar 16.


Objectives: To document and characterize freezing temperatures in the Indonesian vaccine cold chain and to evaluate the feasibility of changes designed to reduce the occurrence of freezing.

Methods: Data loggers were used to measure temperatures of shipments of hepatitis B vaccine from manufacturer to point of use. Baseline conditions and three intervention phases were monitored. During each of the intervention phases, vaccines were removed progressively from the standard 2-8 degrees C cold chain.

Findings: Freezing temperatures were recorded in 75% of baseline shipments. The highest rates of freezing occurred during transport from province to district, storage in district-level ice-lined refrigerators, and storage in refrigerators in health centres. Interventions reduced freezing, without excessive heat exposure.

Conclusions: Inadvertent freezing of freeze-sensitive vaccines is widespread in Indonesia. Simple strategies exist to reduce freezing - for example, selective transport and storage of vaccines at ambient temperatures. The use of vaccine vial monitors reduces the risk associated with heat-damaged vaccines in these scenarios. Policy changes that allow limited storage of freeze-sensitive vaccines at temperatures >2-8 degrees C would enable flexible vaccine distribution strategies that could reduce vaccine freezing, reduce costs, and increase capacity.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cold Temperature*
  • Drug Stability*
  • Drug Storage / methods*
  • Feasibility Studies
  • Hepatitis B Vaccines / standards*
  • Hepatitis B Vaccines / supply & distribution*
  • Humans
  • Indonesia
  • Organizational Innovation
  • Transportation / methods*
  • Vaccines / standards
  • Vaccines / supply & distribution


  • Hepatitis B Vaccines
  • Vaccines