1. Waste Management of Excess tOPV Selecting Methods for the Destruction of Trivalent Oral Polio Vaccine (tOPV) during the switch February 2016 1

2. What is covered in this presentation? At the end of this presentation, decision makers will be able to select the most appropriate methods to safely destroy tOPV after reviewing: Inactivation of tOPV 3 Disposal of inactivated tOPV 4 Volume of tOPV to be destroyed 1 Material of vials to be destroyed 2 2

3. tOPV destruction involves inactivation and disposal Disposal of tOPV after the switch should follow national legislation. If national legislation does not exist, then this presentation provides guidance on how to safely dispose of tOPV tOPV MUST be inactivated* prior to disposal Inactivate by: autoclaving, boiling, chemical inactivation, encapsulation or incineration Dispose by: transporting to waste facility or burying * Inactivation of tOPV is defined as eliminating the infectious nature of poliovirus in tOPV or otherwise rendering the tOPV vials unusable and inaccessible (encapsulation) 3

4. tOPV Inactivation Decision Tree Small Volume Local inactivation Plastic or glass vials Autoclaving, Boiling, Chemical inactivation Encapsulation Large Volume Central or off- site inactivation Plastic vials Autoclaving, Boiling, Chemical inactivation Encapsulation Glass vials Autoclaving, Boiling, Chemical inactivation Encapsulation High temperature (>1100 °C) incineration 4

5. STEP 1: Evaluate volumes of tOPV vials to be destroyed Volume of tOPV to be destroyed Small volume (<20 vials) Allows for local level disposal at facility level Large volume (>20 vials) May require additional capacity for disposal of tOPV 5

6. STEP 2: Determine materials of tOPV vials to be destroyed tOPV Vial Glass May shatter and harm incinerator operator or may melt and cause damage Plastic Incineration or burning of plastics is prohibited in some countries 1 Sealed Not permeable for inactivation and may explode under pressure 2 Opened Open vials will allow for safe inactivation of tOPV by any method 6

7. STEP 3: Choose appropriate method to inactivate tOPV a) Autoclaving b) Boiling c) Chemical inactivation (e.g. with bleach) d) Encapsulation e) Incineration 7

8. Ideal use and drawbacks of tOPV inactivation methods AutoclavingBoiling Chemical Inactivation EncapsulationIncineration Ideal use Autoclaving should be done in a large autoclave with integrated shredder. Alternatively, vials can be opened and treated in any autoclave. Boil unopened vials Chemically inactivate opened vials using bleach or other chlorine solution at the recommended concentrations (0.5%). Encapsulate unopened vials in containers filled with concrete. Incinerate in a high- temperature incinerator capable of safely handling glass (such as a rotary kiln incinerator). Drawback Unopened/unshredded vials may not be fully inactivated in an autoclave, especially if the autoclave has been densely packed with other waste that could act as an insulator. Closed glass vials may explode under pressure if unopened. Boiling may be impractical for treating large quantities of vials. Operators must be careful to avoid scalding Expensive for processing large quantities of vials and requires operators to be trained in using chlorine solution. Chlorine solution must be safely disposed of Concrete-filled containers must still be securely buried. Melted glass can damage incinerators at temperatures < 1100°. Closed glass vials can explode under pressure if unopened Plastic vial incineration is prohibited in many countries due to toxic emissions. Please note: Staff should handle open vials as hazardous infectious waste and take precautions (e.g. wearing personal protective equipment) 8

9. Autoclaving High-temperature steam Most environmentally friendly method Glass vials full of liquid (i.e. not opened) should be “loosened” to avoid rupture, unless the autoclave has an integrated shredder Plastic vials or glass vials that contain little liquid do not need to be open or punctured After autoclaving, vials will be sterile but must still be disposed of following national or local waste management guidelines for municipal waste 9

10. Boiling Immersing vials in boiling water for approximately 30 minutes destroys pathogenic micro-organisms* Both glass and plastic vials can be safely boiled Glass vials can be boiled without opening After boiling, the inactivated vials should be disposed of following national or local waste management guidelines *http://www.cdc.gov/hicpac/pdf/guidelines/disinfection_nov_2008.pdf 10

11. Chemical Inactivation Inactivate tOPV using 0.5% chlorine solution tOPV vials should be opened and immersed in the solution for at least 30 minutes 9 parts clear water to 1 part household bleach 20 vials can be safely sterilized in 4 liters of solution After treatment, vials and leftover chlorine solution must both be disposed of following national or local waste management guidelines Koshmanova T: Stomatologia (Mosk) 1998;77(1): 48-0 http://www.biosafety.be/Polio/www729.pdf http://www.cdc.gov/hicpac/pdf/guidelines/disinfection_nov_2008.pdf 11

12. Incineration Open pit burning of plastics can have a severe negative environmental impact should not be used as an inactivation method Incinerators vary in temperatures reached in primary waste chamber Low temperature burning (<800°C) is not recommended because it is environmentally hazardous (e.g. single chamber cement or brick covered incinerators) Medium temperature burning (800-1100°C) using dual- chamber incinerators may cause glass vials to explode or partially melt, and it is not recommended Plastic vial incineration may be prohibited in some countries due to toxic emissions but is possible at medium and higher temperatures (>800°C) if permitted by national emissions guidelines 12

13. 13 Incineration, cont. >1100°C is needed for safe destruction of glass vials with tOPV (e.g. rotary-kiln incinerators and industrial furnaces) Co-incineration in industrial furnaces (e.g. cement kilns) will both inactivate and destroy tOPV vials and can be done in partnership with an industrial facility Ash and any other post-incineration residue must be treated as toxic waste and disposed of according to national or local waste management guidelines

14. Encapsulation Disposes of tOPV without immediate inactivation (and without opening the vials) but makes it inaccessible and puts it beyond use Involves filling containers ¾ full with tOPV vials, adding an immobilizing material (e.g. sand, cement, or clay) and sealing and burying the containers Encapsulated waste must be disposed of following National or local waste management guidelines for municipal waste 14

15. STEP 4: Dispose of the inactivated tOPV vials Transport the waste materials to a waste facility (e.g. sanitary land fill, municipal dump, industrial waste site, or other facility meeting national and local waste guidelines) Bury the waste materials on-site in a secured and fenced-off burial site 15

16. Thank you! 16