Proper vaccine storage and handling are critical to ensuring vaccine potency and avoiding waste that can result from incorrectly stored products. Fortunately, a number of resources are available to assist health care providers in storing and handling vaccines appropriately. An often-overlooked aspect of vaccine management is compliant vaccine disposal.

Requirements for medical waste disposal are regulated by state environmental agencies; contact your immunization program or state environmental agency to ensure that your facility’s disposal procedures, and related documentation, are in compliance with state and federal regulations. Unused vaccine and diluent doses may be returnable in certain situations. Contact the vaccine supplier, which may be the immunization program or the vaccine manufacturer, for specific policies regarding the disposition of returnable vaccines, unopened vials, expired vials, unused doses, and potentially compromised vaccines that have been inappropriately stored.

• Expired or Compromised Vaccine Doses
  Contact your immunization program and/or the vaccine manufacturer. Sometimes unused vaccine and diluent doses, unopened vials, expired vials, and potentially compromised vaccine may be returned for credit, even if they must be discarded
• Open Vials, Broken Vials and Syringes, Manufacturer-Filled Syringes that Have Been Activated, and Vaccines Pre-Drawn by Providers
  These products cannot be returned and must be discarded according to state requirements
• Empty Vaccine Vials
  Most empty vaccine vials are not considered hazardous or pharmaceutical waste and do not require disposal in a biomedical waste container. Check state requirements before disposal
• Empty Rotavirus Vaccine Dispensing Tube or Oral Applicator
  While empty vaccine vials are not usually considered hazardous or pharmaceutical waste, an empty rotavirus dispensing tube or oral applicator is considered medical waste and should be disposed of in a medical waste container

State immunization program Web sites are listed at www.cdc.gov/vaccines/imz-managers/awardee-imz-websites.html. Contact information for vaccine manufacturers and distributors is available at https://www.cdc.gov/vaccines/hcp/admin/storage/downloads/manufact-dist-contact.pdf.

Disposal of 2016-2017 Flu Vaccines

Flu vaccine, including unused or partial vials, should be disposed of in accordance with applicable federal, state, and local regulations. Under 40 CFR Part 261.24 of the Resource Conservation and Recovery Act (RCRA), if the waste contains one or more constituents at concentrations greater than those specified in the maximum concentration of contaminants for the toxicity characteristic, the waste is considered hazardous. The D009 toxicity characteristic applies for mercury-containing waste when the concentration exceeds the 0.2 mg/L threshold. Thus, all full or partially used multi-dose vials of seasonal flu vaccine, which contain thimerosal preservative, should be disposed of as federally hazardous waste, waste code D009.

Proper disposal of flu vaccines requires determining if the flu vaccine used in the organization qualifies as hazardous or non-hazardous waste.

• Non-Hazardous
  Flu vaccine waste that does not meet the definition of hazardous waste under RCRA may be disposed of with other non-hazardous pharmaceutical waste, but consider all applicable state and local regulations. Flu vaccine that contains live, attenuated virus should be disposed of as biohazardous
• Hazardous
  Flu vaccine that is classified as hazardous must be appropriately segregated and managed as hazardous waste. It should not be placed in a red sharps container or regular trash container
• Both Hazardous and Biohazardous
  A full or partially used sharp syringe containing a vaccine with thimerosal should be disposed of as dual hazardous and biohazardous waste

See TABLE on page 8 for categorization of 2016-2017 flu vaccines.

Jennifer Karpinski is a senior editor for Pharmacy Purchasing & Products magazine, and can be reached at jkarpinski@ridgewoodmedia.com.