1. Authorized Age group: COVID-19 vaccination is indicated only for 18 years and above
2. Co-administration of vaccines: If required COVID-19 vaccine and other vaccine should be separated by an interval of at least 14 days
3. Interchangeability of COVID-19 vaccines is not permitted: Second dose should be the same COVID-19 vaccine which was administered as the first dose.

Persons with history of anaphylactic or allergic reaction to a previous dose of COVID-19 vaccine and immediate or delayed onset anaphylaxis or allergic reaction to vaccines or injectable therapies, pharmaceutical products, food items etc.

In these conditions COVID-19 vaccination is to be deferred for 3 months after recovery:
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1. Persons having active symptoms of SARS CoV2 infection
2. SARS CoV2 patients who have been given anti SARS CoV 2 monoclonal antibodies or convalescent plasma
3. Unwell and hospitalized patients due to any illness.

Vaccine should be administered with caution with history of any bleeding or coagulation disorder (clotting factor deficiency, coagulopathy or platelet disorder)
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Following conditions are not contraindicated for COVID-19 vaccines
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1. Persons with a past history of COVID-19 infection
2. History of chronic diseases and morbidities (cardiac, neurological, pulmonary, metabolic, renal, and malignancies)
3. Immunodeficiency, HIV, patients on immunosuppression due to any condition

1. Always keep the power supply switch on.
2. Do NOT lift the trays inside the ILR, only slide them to move them around. Trays should never be taken out of ILR while keeping or removing vaccine doses.
3. Temperature should be between 2°C to 8°C. Temperature log should be maintained before taking out vaccine vials before use & putting back the excess vials at the end of day.
4. Do NOT keep vaccines directly on the floor of the ILR Refrigerator. In case the trays are not sufficient, use the thermoplastic trays to be placed on the floor of the ILR.
5. In case the temperature is above 8°C or below 2°C, an alarm will go off. If temperature is more, vaccines should immediately be shifted to another functional ILR using vaccine carriers.
6. Normally with 8 hours of power the ILR can give a minimum 24 hour backup.
7. The space where the ILR is placed should be properly ventilated.
8. It is recommended to keep power backup for the ILR using UPS or power generators.
9. The ILR should be properly locked and the key should be with an authorised personnel.
10. It is recommended that the ILR remains under CCTV coverage 24x7 to avoid any unwanted practices.
11. The serial numbers of the vaccine vials should be properly tracked and documented before taking it out for vaccination.

Cold chain maintenance is extremely important to maintain the potency of the vaccine. A Vaccine Vial Monitor (VVM) is not present on the vaccine vial. The following points need to be ensured at the campsite:
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1. It is necessary to carry extra conditioned ice-packs in a spare vaccine carrier or to be stored in a refrigerator for immediate replenishment of ice packs in the vaccine carrier with vaccine vials.

What is a conditioned ice-pack?
Ice-packs that have first been fully frozen, then removed from the freezer and left at room temperature for a short time (it may take over 30 minutes if the room is cold). Allow the frozen ice-packs to sit at room temperature until the ice begins to melt and water starts to form. Check to see if each ice-pack has been conditioned properly by shaking it and listening for the sound of water moving inside. This prevents the ice-packs from freezing the vaccines inside a cold box or vaccine carrier, and damaging the freeze-sensitive vaccines.
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2. All the open vaccine vials are required to be discarded after 4 hours of opening. It is recommended that the on-site doctor should meticulously record the date and time of opening the vial to keep a track of the same.
3. Never expose the vaccine carrier, the vaccine vial or the ice pack to direct sunlight.
4. All vaccine vials, except those being used for vaccination, should be kept inside the vaccine carrier with the lid closed at all times.

1. It is recommended to have one authorized person to take the appropriate number of vials as per the approved number of doses of vaccines for a session from the ILR.
2. Before taking the vaccine out from ILR, vaccine carriers need to be prepared with frozen/conditioned ice-packs. Vaccine carriers are the insulated boxes which should be lined by frozen ice packs. All walls of the carrier should be packed with these.
3. The authorised person should record each vaccine box’s batch number & vial number with their and the recipient’s signature in the Vaccine Movement Register.
4. Vaccines are required to be transported in a well packed vaccine carrier to the camp location. Boxes should not be opened during transit unnecessarily.
5. The vaccine carrier should be responsibly handed over to the On-site Doctor or the site manager, who will cross check the vials & countersign giving an acknowledgement of the receipt of the vials.
6. On-site Doctor & the Site Manager should ensure that all the vaccine carriers are well conditioned with ice packs & remember that the ice packs are required to be replaced as the day progresses.
7. Nursing staff should be issued a vial with the permission of the Site Manager or the On-site Doctor and should record the same using the Vaccine Issuance Register along with the signature of the Nurse & On-site Doctor. The Nurse will then make the same entry in their Vaccine Administration Register for the batch no., vial no., & time of opening the vial. Once opened, a vaccine vial should be utilized within 4 hours. This opened vial can be kept outside or they can also be kept over an ice pack depending on the flow of people for vaccinations.
8. Every vaccine vial normally has 10 doses, the nursing staff should load exactly 0.5ml of vaccine in the syringe carefully. In the last 2 hours of the camp session when the in-flow of the beneficiaries slow down, wait for at least 10 eligible & medically fit people to assemble for vaccination before opening a new vial, after the old vial is emptied. If less than 10 people are remaining at the end of the camp session, they should be requested to come back for the next camp session. This will ensure that there is no wastage of doses. The Site Manager and the On-site Doctor should work together to ensure zero-wastage by managing the in-flow of the beneficiaries and opening the vials at the right time. They should also meticulously train the entire staff to develop sensitivity towards this.
9. At the end of the day, all remaining unopened vaccines need to be recorded in the Vaccine Movement Register along with the signatures of the Site Manager or the On-site Doctor & the Vaccine Transporter responsible for movement of vaccine back to storage facility. The Site Manager or the On-site Doctor should then handover the vaccine to Authorised Personnel to transport it to the storage facility. All the Vaccine Carriers along with Ice Packs need to be moved back to the storage facility after the camp session.
10. Once the vaccine reaches the storage facility, the Vaccine Transporter will handover the vaccine vials to the Storage Custodian and the same must be recorded in the Vaccine Movement Register along with their signatures. 
11. The Storage Custodian will then keep the Vaccine Vials carefully back in the Ice lined Refrigerator (ILR) followed by a complete stock count and an entry in the Vaccine Stock Register with their signature. The Ice Packs should be stored in the freezer so it can be used for the next session.

Every vaccine vial normally has 10 doses, the nursing staff should load exactly 0.5ml of vaccine in the syringe carefully. In the last 2 hours of the camp session when the in-flow of the beneficiaries slow down, wait for at least 10 eligible & medically fit people to assemble for vaccination before opening a new vial, after the old vial is emptied. If less than 10 people are remaining at the end of the camp session, they should be requested to come back for the next camp session. This will ensure that there is no wastage of doses. The Site Manager and the On-site Doctor should work together to ensure zero-wastage and should meticulously train the entire staff to develop sensitivity towards this.