When Weather Disrupts the Vaccine Cold-Chain: Shipping Delays and Storage Risks in Illinois

Background: Severe weather, including heatwaves, winter storms, floods, and associated power outages, poses persistent risks to the vaccine cold chain across the United States, including Illinois by causing storage-unit failures and shipping delays that can lead to temperature excursions - instances when vaccines are exposed to conditions outside the recommended temperature range, compromise vaccine potency, with public-health and economic consequences. Methods: We conducted a scoping review (Arksey & O’Malley; PRISMA-ScR) of publicly accessible evidence (2000-2025) on weather-related disruptions to vaccine storage and shipping, with emphasis on Illinois. Sources included peer-reviewed studies, CDC/IDPH guidance, national datasets (e.g., EAGLE-I, OpenFEMA), and grey literature on monitoring technologies. Results: Laboratory studies show pharmaceutical-grade refrigerators can cross 8？C within ~45 - 140 minutes after power loss. Public datasets report exposure (outages, storm events), and Illinois experienced weather-related shipping delays during Winter Storm Uri; Illinois drew on strategic stock to buffer operations. However, Illinois-specific, publicly accessible, cause-coded statewide aggregated data linking weather/power exposure to dose-level outcomes (e.g., excursion counts, doses affected) were not identified. Standard incident protocols are clear, but statewide performance descriptions (coverage, timeliness, equity, especially in high-outage or rural areas) were not found in public sources. Emerging tools (AI-enabled monitoring, cloud connectivity, predictive alerts) are described, yet we did not identify peer-reviewed evaluations or publicly accessible Illinois program documentation showing provider deployment of pre-threshold, predictive alerts or weather-linked excursion prediction. Conclusions & Public Health Implications: Given short warming intervals and outages that often last hours, planning in Illinois may be better calibrated to plausible local outage windows, emphasizing continuous digital monitoring, connectivity-resilient reporting, and rapid procedures for moving vaccines to approved backup storage or redistribution. Contextual evaluation of AI-enabled, cloud-connected, predictive tools in Illinois settings, alongside publicly accessible, cause-coded statewide aggregates of excursions and doses affected, would clarify added value, support cross-jurisdiction learning and strengthen preparedness as climate risks evolve.