Dual-chamber injection device for measles-rubella vaccine: The potential impact of introducing varying sizes of the devices in 3 countries.
Dual-chamber injection device for measles-rubella vaccine: The potential impact of introducing varying sizes of the devices in 3 countries.
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DOI：
10.1016/j.vaccine.2018.08.026
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发表时间：
2018-09-18
期刊：
影响因子：
5.5
通讯作者：
Lee BY
中科院分区：
文献类型：
--
作者：
Wedlock PT;Mitgang EA;Siegmund SS;DePasse J;Bakal J;Leonard J;Welling J;Brown ST;Lee BY
通过将稀释剂与疫苗配对，双腔室疫苗注射装置简化了在施用前重构疫苗的过程，从而减少了相关的开瓶浪费和不良事件。然而，由于这些装置比目前用于冻干疫苗的疫苗瓶大，制造商需要关于这些装置的尺寸如何影响疫苗分配和交付的指导。使用HERMES生成的贝宁，比哈尔邦（印度）和莫桑比克的免疫供应链模型，我们用单剂量MR双室注射装置取代常规的10剂量麻疹-风疹（MR）冻干疫苗，每剂量体积（5.2 - 26立方厘米）和每剂量价格（0.70美元，1.40美元）。在5.2 cm3的每剂量体积下，与中度受限供应链中的基线相比，双腔注射装置导致相似的疫苗可用性、减少的开瓶浪费（OVW）和相似的每剂量总成本。在7.5 cm3和26 cm3的体积之间，这些设备导致疫苗可用性降低1%至14%，因为冷链储存利用率增加了1%至7%，平均峰值运输利用率增加了2%至44%。在每剂最高体积26立方厘米时，疫苗的可用性下降9%至14%。每剂疫苗的总费用在每种情况下都有所不同，因为疫苗采购费用的减少与接种剂量的减少相结合。然而，在贝宁和莫桑比克，双腔注射装置的引入仅在给药总次数相对于基线变化<1%时才导致每次给药的总成本改善（5.2 cm3，每次给药0.70美元）。在3个不同国家的供应链中，单剂量MR双腔注射装置需要不大于5.2 cm3，才不会显著影响其他疫苗的流动。
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. 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). 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. 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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