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 Siegmund, Jay DePasse, Jennifer Bakal, Jim Leonard, Joel Welling, Shawn T. Brown, Bruce Lee

Research output: Contribution to journalArticle

Abstract

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 cm3) and price-per-dose ($0.70, $1.40). Results: At a volume-per-dose of 5.2 cm3, 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 cm3 and 26 cm3, 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 cm3, 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 cm3 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 cm3 to not significantly impair the flow of other vaccines.

Original languageEnglish (US)
JournalVaccine
DOIs
StateAccepted/In press - Jan 1 2018

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Rubella Vaccine
Measles Vaccine
Vaccines
vaccines
injection
Equipment and Supplies
Injections
administered dose
dosage
Measles
supply chain
Mozambique
Benin
Costs and Cost Analysis
Rubella
Refrigeration
India
Immunization

Keywords

  • 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

Cite this

Dual-chamber injection device for measles-rubella vaccine : The potential impact of introducing varying sizes of the devices in 3 countries. / Wedlock, Patrick T; Mitgang, Elizabeth A.; Siegmund, Sheryl; DePasse, Jay; Bakal, Jennifer; Leonard, Jim; Welling, Joel; Brown, Shawn T.; Lee, Bruce.

In: Vaccine, 01.01.2018.

Research output: Contribution to journalArticle

Wedlock, Patrick T ; Mitgang, Elizabeth A. ; Siegmund, Sheryl ; DePasse, Jay ; Bakal, Jennifer ; Leonard, Jim ; Welling, Joel ; Brown, Shawn T. ; Lee, Bruce. / Dual-chamber injection device for measles-rubella vaccine : The potential impact of introducing varying sizes of the devices in 3 countries. In: Vaccine. 2018.
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abstract = "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 cm3) and price-per-dose ($0.70, $1.40). Results: At a volume-per-dose of 5.2 cm3, 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 cm3 and 26 cm3, 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 cm3, 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 cm3 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 cm3 to not significantly impair the flow of other vaccines.",
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T2 - The potential impact of introducing varying sizes of the devices in 3 countries

AU - Wedlock, Patrick T

AU - Mitgang, Elizabeth A.

AU - Siegmund, Sheryl

AU - DePasse, Jay

AU - Bakal, Jennifer

AU - Leonard, Jim

AU - Welling, Joel

AU - Brown, Shawn T.

AU - Lee, Bruce

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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 cm3) and price-per-dose ($0.70, $1.40). Results: At a volume-per-dose of 5.2 cm3, 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 cm3 and 26 cm3, 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 cm3, 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 cm3 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 cm3 to not significantly impair the flow of other vaccines.

AB - 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 cm3) and price-per-dose ($0.70, $1.40). Results: At a volume-per-dose of 5.2 cm3, 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 cm3 and 26 cm3, 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 cm3, 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 cm3 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 cm3 to not significantly impair the flow of other vaccines.

KW - Dual-chamber injection device

KW - Measles

KW - Supply chain

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