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

Thursday, 6th of September 2018 Print

Vaccine. 2018 Aug 23. pii: S0264-410X(18)31135-6. doi: 10.1016/j.vaccine.2018.08.026. [Epub ahead of print]

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

Wedlock PT1 Mitgang EA1 Siegmund S1 DePasse J2 Bakal J2 Leonard J2 Welling J2 Brown ST3 Lee BY4.

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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 cm3to not significantly impair the flow of other vaccines.

Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.


Dual-chamber injection device; Measles; Supply chain

PMID: 30146404 DOI: 10.1016/j.vaccine.2018.08.026


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