Evaluation of storing hepatitis B vaccine outside the cold chain in the Solomon Islands: Identifying opportunities and barriers to implementation

Abstract

Monovalent Hepatitis B vaccine (HepB) is heat stable, making it suitable for storage outside cold chain (OCC) at 37 °C for 1 month. We conducted an OCC project in the Solomon Islands to determine the feasibility of and barriers to national implementation and to evaluate impact on coverage. Healthcare workers at 13 facilities maintained monovalent HepB birth dose (HepB-BD) OCC for up to 28 days over 7 months. Vaccination data were recorded for children born during the project and those born during 7 months before the project. Timely HepB-BD coverage among facility and home births increased from 30% to 68% and from 4% to 24%, respectively. Temperature excursions above 37 °C were rare, but vaccine wastage was high and shortages common. Storing HepB OCC can increase HepB-BD coverage in countries with insufficient cold chain capacity or numerous home births. High vaccine wastage and unreliable vaccine supply must be addressed for successful implementation.

Progress Toward Hepatitis B Control and Elimination of Mother-to-Child Transmission of Hepatitis B Virus — Western Pacific Region, 2005–2017

“…This use of the HepB-BD outside the commonly recommended storage temperatures of 35°F–46°F (2°C–8°C) for limited periods under monitored and controlled conditions, has been demonstrated to be safe and effective, with WHO suggesting outside-the-cold-chain use in settings where HepB-BD administration is restricted by access to cold storage ( 1 ). HepB-BD use outside the cold chain has been used to increase timely HepB-BD administration by 27% in Laos, 70% in China, and 150% in the Solomon Islands ( 7 , 8 ). Cambodia and China have national policies that encourage pregnant women to deliver in health facilities to reduce maternal and neonatal mortality by ensuring that mothers and newborns are examined by health care professionals within 24 hours of delivery.…”

Prevalence of Chronic Hepatitis B Virus Infection among Children in Haiti, 2017

“…The use of pregnancy registers by community health workers has been successful in informing HCWs of infants needing vaccination following a home birth. [35][36][37] Because monovalent HepB is heat stable and able to withstand exposure to a temperature as high as 37°C for up to 1 month, 5 its use outside of the cold chain has increased timely HepB-BD coverage in countries with high rates of home births, 33,38,39 while maintaining vaccine immunogenicity. 40 In addition, the use of compact prefilled auto-disable injection devices, which can be administered with minimal training, might also be useful in remote areas that lack trained HCWs.…”

Aiming for the elimination of viral hepatitis in Australia, New Zealand, and the Pacific Islands and Territories: Where are we now and barriers to meeting World Health Organization targets by 2030

“…However, in some PICT—such as Samoa—50% of births are still home/village based where administration of the birth dose is challenging . To overcome barriers to delivery of birth dose vaccine, pilot projects delivering hepatitis B vaccine outside of the cold chain by volunteers have been successfully conducted in Kiribati and Solomon Islands, and the Solomon Islands Government has also recently approved use of hepatitis B vaccine outside of cold chain.…”