HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
HERMES Logistics Modeling Team, Baltimore, MD and Pittsburgh, PA, USA; Pittsburgh Supercomputing Center, Carnegie Mellon University, Pittsburgh, PA, USA.
Vaccine. 2018 Sep 18;36(39):5879-5885. doi: 10.1016/j.vaccine.2018.08.026. Epub 2018 Aug 23.
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 cm) and price-per-dose ($0.70, $1.40).
At a volume-per-dose of 5.2 cm, 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 and 26 cm, 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, 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 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 cm to not significantly impair the flow of other vaccines.
通过将稀释剂与疫苗搭配使用，双室疫苗注射装置简化了疫苗在使用前的配制过程，从而减少了相关的安瓿瓶开启浪费和不良事件。然而，由于这些装置比目前用于冻干疫苗的疫苗小瓶大，制造商需要了解这些装置的大小如何影响疫苗的分配和接种。
我们使用 HERMES 生成的贝宁、印度比哈尔邦和莫桑比克的免疫供应链模型，用单剂量麻疹-风疹（MR）双室注射装置替代常规的 10 剂量麻疹-风疹冻干疫苗，剂量范围为每剂量体积（5.2-26 厘米）和每剂量价格（0.70 美元、1.40 美元）。
在每剂量 5.2 厘米的体积下，与基线相比，双室注射装置在供应适度受限的情况下，可实现相似的疫苗供应、减少开启瓶浪费（OVW），且每剂量接种的总成本相似。在 7.5 厘米至 26 厘米之间的体积下，由于冷链储存利用率增加 1%至 7%，以及平均峰值运输利用率增加 2%至 44%，这些装置导致疫苗供应减少 1%至 14%。在最高的每剂量体积 26 厘米时，疫苗供应减少 9%至 14%。每次接种的总成本因疫苗采购成本的降低而与接种剂量的减少而有所不同。然而，只有当接种的总剂量比基线变化<1%时，贝宁和莫桑比克（5.2 厘米和 0.70 美元/剂量）引入双室注射装置才能使每次接种的总成本降低。
在 3 种不同国家的供应链中，单剂量 MR 双室注射装置的体积不得超过 5.2 厘米，以避免对其他疫苗的流动产生重大影响。
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