Dual-chamber injection device for measles-rubella vaccine: The potential impact of introducing varying sizes of the devices in 3 countries

Patrick T. Wedlock, Elizabeth A. Mitgang, Sheryl S. Siegmund, Jay DePasse, Jennifer Bakal, Jim Leonard, Joel Welling, Shawn T. Brown, Bruce Y. Lee

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Introduction: By pairing diluent with vaccines, dual-chamber vaccine injection devices simplify the process of reconstituting vaccines before administration and thus decrease associated open vial wastage and adverse events. However, since these devices are larger than current vaccine vials for lyophilized vaccines, manufacturers need guidance as to how the size of these devices may affect vaccine distribution and delivery. Methods: Using HERMES-generated immunization supply chain models of Benin, Bihar (India), and Mozambique, we replace the routine 10-dose measles-rubella (MR) lyophilized vaccine with single-dose MR dual-chamber injection devices, ranging the volume-per-dose (5.2–26 cm 3 ) and price-per-dose ($0.70, $1.40). Results: At a volume-per-dose of 5.2 cm 3 , a dual-chamber injection device results in similar vaccine availability, decreased open vial wastage (OVW), and similar total cost per dose administered as compared to baseline in moderately constrained supply chains. Between volumes of 7.5 cm 3 and 26 cm 3 , these devices lead to a reduction in vaccine availability between 1% and 14% due to increases in cold chain storage utilization between 1% and 7% and increases in average peak transport utilization between 2% and 44%. At the highest volume-per-dose, 26 cm 3 , vaccine availability decreases between 9% and 14%. The total costs per dose administered varied between each scenario, as decreases in vaccine procurement costs were coupled with decreases in doses administered. However, introduction of a dual-chamber injection device only resulted in improved total cost per dose administered for Benin and Mozambique (at 5.2 cm 3 and $0.70-per-dose) when the total number of doses administered changed <1% from baseline. Conclusion: In 3 different country supply chains, a single-dose MR dual-chamber injection device would need to be no larger than 5.2 cm 3 to not significantly impair the flow of other vaccines.

Original languageEnglish (US)
Pages (from-to)5879-5885
Number of pages7
Issue number39
StatePublished - Sep 18 2018


  • Dual-chamber injection device
  • Measles
  • Supply chain

ASJC Scopus subject areas

  • Molecular Medicine
  • Immunology and Microbiology(all)
  • veterinary(all)
  • Public Health, Environmental and Occupational Health
  • Infectious Diseases


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