Vaccine wastage in Bangladesh

Guichard, Stephane; Hymbaugh, Karen; Burkholder, Brent; Diorditsa, Serguei; Navarro, Christine; Ahmed, Selina; Rahman, Mohd. Mahbubur

doi:10.1016/j.vaccine.2009.08.035

Cited by 52 publications

(55 citation statements)

References 2 publications

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“…This may partly explain why liquid and lyophilized vaccine wastage rates are similar despite country and global guidelines stating that acceptable wastage rates are higher for MCV (up to wastage of 50%) and BCG compared to other vaccines [10,20]. In other countries where implementation of policies around when to open a vial may differ from that in Nigeria, substantial differences between lyophilized and liquid vaccine wastage rates have been observed [16]. In Nigeria, the number of MCV and DTP3 doses provided in the analyzed sessions were similar, which may indicate that even if infants are turned away for MCV, eventually they receive MCV at similar levels as DTP3.…”

Section: Discussionmentioning

confidence: 99%

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices

Wallace

Willis²,

Nwaze

et al. 2017

Vaccine

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Introduction The introduction of new vaccines highlights concerns about high vaccine wastage, knowledge of wastage policies and quality of stock management. However, an emphasis on minimizing wastage rates may cause confusion when recommendations are also being made to reduce missed opportunities to routinely vaccinate children. This concern is most relevant for lyophilized vaccines without preservatives [e.g. measles-containing vaccine (MCV)], which can be used for a limited time once reconstituted. Methods We sampled 54 health facilities within 11 local government areas (LGAs) in Nigeria and surveyed health sector personnel regarding routine vaccine usage and wastage-related knowledge and practices, conducted facility exit interviews with caregivers of children about missed opportunities for routine vaccination, and abstracted vaccine stock records and vaccination session data over a 6-month period to calculate wastage rates and vaccine vial usage patterns. Results Nearly half of facilities had incomplete vaccine stock data for calculating wastage rates. Among facilities with sufficient data, mean monthly facility-level wastage rates were between 18 and 35% across all reviewed vaccines, with little difference between lyophilized and liquid vaccines. Most (98%) vaccinators believed high wastage led to recent vaccine stockouts, yet only 55% were familiar with the multi-dose vial policy for minimizing wastage. On average, vaccinators reported that a minimum of six children must be present prior to opening a 10-dose MCV vial. Third dose of diphtheria-tetanus-pertussis vaccine (DTP3) was administered in 84% of sessions and MCV in 63%; however, the number of MCV and DTP3 doses administered were similar indicating the number of children vaccinated with DTP3 and MCV were similar despite less frequent MCV vaccination opportunities. Among caregivers, 30% reported being turned away for vaccination at least once; 53% of these children had not yet received the missed dose. Discussion Our findings show inadequate implementation of vaccine management guidelines, missed opportunities to vaccinate, and lyophilized vaccine wastage rates below expected rates. Missed opportunities for vaccination may occur due to how the health system’s contradicting policies may force health workers to prioritize reduced wastage rates over vaccine administration, particularly for multi-dose vials.

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Section: Discussionmentioning

confidence: 99%

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices

Wallace

Willis²,

Nwaze

et al. 2017

Vaccine

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“…Microneedle patches do not need to be reconstituted which could significantly reduce the number of unsafe injections due to handling errors. Finally, current measles vaccine formulations must be discarded if not used within six hours after reconstitution of multi-dose vials, which can lead to wastage of up to 70% of vaccine doses [36]. Microneedle patches contain a single dose and could minimize vaccine wastage.…”

Section: Discussionmentioning

confidence: 99%

A microneedle patch containing measles vaccine is immunogenic in non-human primates

Edens¹,

Collins²,

Goodson³

et al. 2015

Vaccine

150

107

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Very high vaccination coverage is required to eliminate measles, but achieving high coverage can be constrained by the logistical challenges associated with subcutaneous injection. To simplify logistics of vaccine delivery, a patch containing micron-scale polymeric needles was formulated to encapsulate the standard dose of measles vaccine (1000 TCID50) and the immunogenicity of the microneedle patch was compared with subcutaneous injection in rhesus macaques. The microneedle patch was administered without reconstitution with diluent, dissolved in skin within 10 minutes, and caused only mild, transient skin erythema. Both groups of rhesus macaques generated neutralizing antibody responses to measles that were consistent with protection and the neutralizing antibody titers were equivalent. In addition, the microneedle patches maintained an acceptable level of potency after storage at elevated temperature suggesting improved thermostability compared to standard lyophilized vaccine. In conclusion, a measles microneedle patch vaccine was immunogenic in non-human primates, and this approach offers a promising delivery method that could help increase vaccination coverage.

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“…The new presentation, cPAD, might help to increase vaccine coverage, especially in hard-to-reach situations, 15,42 because it simplifies transport and logistics by being lightweight, 43 with a small volume, 43,44 safe disposal, 29,42 easy to use presentation simplifying vaccine administration, 15,20,21,42 and reducing handling errors. 15,19,45,46 It also offers several other benefits including reduced missed vaccination opportunities due to mismatch between vaccine doses and consumables (needles and syringes) as all required components are present at the same place and time, 29,42,43 increased vaccine coverage by reducing vaccination time (six times quicker administration versus a single-dose lyophilized vial), 21 and less vaccine wastage 45,[47][48][49] as the singledose presentation ensures opened multi-dose vials are not discarded.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the immunogenicity and safety of pentavalent vaccine Quinvaxem in a compact prefilled auto-disabled (cPAD) injection system versus single-dose vials in healthy infants: a phase 3, open-label, randomized, parallel-group, non-inferiority study

Capeding

Alberto

Versteilen

et al. 2016

International Journal of Infectious Diseases

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Vaccine wastage in Bangladesh

Cited by 52 publications

References 2 publications

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices

Vaccine wastage in Nigeria: An assessment of wastage rates and related vaccinator knowledge, attitudes and practices

A microneedle patch containing measles vaccine is immunogenic in non-human primates

Comparison of the immunogenicity and safety of pentavalent vaccine Quinvaxem in a compact prefilled auto-disabled (cPAD) injection system versus single-dose vials in healthy infants: a phase 3, open-label, randomized, parallel-group, non-inferiority study

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