Current vaccines volumes per child (cm3)
450
400
350 Volumes,cm3
300
236.8 328.4 250
200
150 39
100 39 82.4 82.4 39 50 40.6 10.4 10.4 43.1 31.1 31.1 31.1 31.1 31.1 0 Tradi Vax TV+Penta_10d TV+Penta_1d TV+Penta 10d+PCV-10 TV+Penta_1d+PCV- TV+Penta_liq + PCV-10 10+Rota_liq + Rota_lyo
Traditional Vax dtp/hepB/Hib combo PCV Rota_liq Rota_liq BCG vaccines
• No. of manufacturers: 4 • Formulation: Lyophilized vaccine • Route of administration: ID injection • Schedule: 1 doses • Dosage: 0.05ml • Storage: +2° to +8°C, protect from light! • Type of VVM: VVM30 • MDVP: Keep cool reconstituted vial & Discard after six hours • Presentation: – 20-dose vials in boxes of 50: 1.3cm3/dose – 20-dose vials in boxes of 50: 1.6cm3/dose Tetanus Toxoid vaccines • No. of manufacturers: 6 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 2 doses • Dosage: 0.5ml • Storage: +2° to +8°C, Do not freeze! • Type of VVM: VVM30, 14, none • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose Uniject in boxes of 100: 12.0cm3/dose – 1-dose ampoule in boxes of 50: 15.7cm3/dose – 2-dose vial in boxes of 50: 13.1cm3/dose – 10-dose vial in boxes of 10: 2.46cm3/dose – 10-dose vial in boxes of 10: 4.12cm3/dose – 10-dose vial in boxes of 30: 4.36cm3/dose – 10-dose vial in boxes of 50: 2.6cm3/dose – 20-dose vial in boxes of 10: 0.75cm3/dose – 20-dose vial in boxes of 10: 2.05cm3/dose – 20-dose vial in boxes of 20: 2.9cm3/dose – 20-dose vial in boxes of 25: 2.4cm3/dose – 20-dose vial in boxes of 30: 2.57cm3/dose Tetanus – Diphtheria Toxoid (Td) Vaccines • No. of manufacturers: 4 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 1 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • VVM type: VVM 14, 30 • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose ampoule in boxes of 50: 15.715cm3/dose (none) – 10-dose vial in boxes of 10: 2.23cm3/dose (vvm30) – 10-dose vial in boxes of 10: 2.611cm3/dose (vvm30) – 20-dose vial in boxes of 25: 2.433cm3/dose (vvm30) – 10-dose vial in boxes of 50: 2.46cm3/dose (none) – 10-dose vial in boxes of 10: 4.125cm3/dose (vvm14) temp suspension – 20-dose vial in boxes of 10: 2.05cm3/dose (vvm14) temp suspension Diphtheria-Tetanus (DT) Vaccines • No. of manufacturers: 4 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • VVM type: VVM 14, 30 • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose ampoule in boxes of 50: 15.715cm3/dose (none) – 10-dose vial in boxes of 10: 2.1Cm3/dose (vvm30) – 10-dose vial in boxes of 50: 2.611cm3/dose (vvm30) – 20-dose vial in boxes of 25: 2.433cm3/dose (vvm30) – 10-dose vial in boxes of 10: 2.46cm3/dose (none) – 10-dose vial in boxes of 10: 4.11cm3/dose (vvm14) – 20-dose vial in boxes of 10: 2.05cm3/dose (vvm14) temp suspension Measles vaccines
• No. of manufacturers: 3 • Formulation: Lyophilized vaccine • Route of administration: SC injection • Schedule: 2 doses • Dosage: 0.5ml • Storage: +2° to +8°C, protect from light! • Type of VVM: VVM14 • MDVP: Keep cool reconstituted vial & Discard after six hours! • Presentation: – 1-dose vial in boxes of 50: 26.1cm3/dose – 2-dose vial in boxes of 50: 13.1cm3/dose – 5-dose vial in boxes of 50: 5.2cm3/dose – 10-dose vial in boxes of 50: 2.6cm3/dose – 20-dose vial in boxes of 50: 0.8cm3/dose Measles Rubella vaccines
• No. of manufacturers: 2 • Formulation: Lyophilized vaccine • Route of administration: SC injection • Schedule: 2 doses • Dosage: 0.5ml • Storage: +2° to +8°C, protect from light! • Type of VVM: VVM14 • MDVP: Keep cool reconstituted vial & Discard after six hours! • Presentations: – 1-dose vial in boxes of 50: 26.1cm3/dose – 2-dose vial in boxes of 50: 13.1cm3/dose – 5-dose vial in boxes of 50: 5.2cm3/dose – 10-dose vial in boxes of 50: 2.6cm3/dose Measles, Mumps and Rubella vaccines
• No. of manufacturers: 3 • Formulation: Lyophilized vaccine • Route of administration: SC injection • Schedule: 2 doses • Dosage: 0.5ml • Storage: +2° to +8°C, protect from light! • Type of VVM: VVM7 & 14 • MDVP: Keep cool reconstituted vial & Discard after six hours! • Presentations: – 1-dose vial in boxes of 10: 15.0cm3/dose – 1-dose vial in boxes of 50: 26.1cm3/dose – 2-dose vial in boxes of 50: 13.1cm3/dose – 5-dose vial in boxes of 50: 5.2cm3/dose – 10-dose vial in boxes of 50: 2.6cm3/dose Yellow fever vaccines
• No. of manufacturers: 4 • Formulation: Lyophilized vaccine • Route of administration: SC injection • Schedule: 1 doses • Dosage: 0.5ml • Storage: +2° to +8°C, protect from direct light! • Type of VVM: VVM14 • MDVP: Keep cool reconstituted vial & Discard after six hours! • Presentations: – 2-dose vial in boxes of 10: 7.2cm3/dose – 5-dose vial in boxes of 10: 6.0cm3/dose – 5-dose vial in boxes of 50: 6.3cm3/dose – 10-dose vial in boxes of 50: 3.6cm3/dose – 10-dose vial in boxes of 10: 3.0cm3/dose – 20-dose vial in boxes of 10: 0.7cm3/dose – 50-dose vial in boxes of 50: 0.6cm3/dose Meningococcal A conjugate
• No. of manufacturers: 1 • Formulation: Lyophilized vaccine • Route of administration: IM injection • Schedule: 1 doses • Dosage: 0.5ml • Storage: +2° to +8°C, protect from light! • Type of VVM: VVM30 • MDVP: Keep cool reconstituted vial & Discard after six hours! • Presentation: – 10-dose vials in boxes of 50: 2.6cm3/dose Hepatitis B vaccines • No. of manufacturers: 8 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • Type of VVM: VVM30 • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose Uniject in boxes of 100: 12.0cm3/dose – 1-dose vial in boxes of 35: 16.8cm3/dose – 2-dose vial in boxes of 36: 7.2cm3/dose – 6-dose vial in boxes of 30: 5.3cm3/dose – 10-dose vial in boxes of 30: 4.4cm3/dose – 20-dose vial in boxes of 30: 2.6cm3/dose DTP-HepB-Hib vaccines - liquid
• No. of manufacturers: 3 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • Type of VVM: VVM14 & 7 • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose vial in boxes of 50: 13.1cm3/dose (vvm14) – 1-dose vial in boxes of 50: 10.3cm3/dose (vvm14) – 1-dose vial in boxes of 50: 26.1cm3/dose (vvm7) – 2-dose vial in boxes of 50: 13.1cm3/dose (vvm7) – 10-dose vial in boxes of 50: 2.6cm3/dose (vvm7) DTP-HepB+Hib vaccines – liquid+lyop.
• No. of manufacturers: 3 • Formulation: Liquid+lyophilized vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • Type of VVM: VVM14 & 7 • MDVP: Keep cool reconstituted vial & Discard after six hours • Presentations: – 1-dose vial in boxes of 200: 39.2cm3/dose (vvm7) – 1-dose vial in boxes of 216: 58.7cm3/dose (vvm14) – 2-dose vial in boxes of 200: 19.6cm3/dose (vvm7) – 10-dose vial in boxes of 144: 7.5cm3/dose (vvm14) – 10-dose vial in boxes of 150: 5.1cm3/dose (vvm7) Haemophilus influenzae type b vaccines
• No. of manufacturers: 3 • Formulation: Lyophilized vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C • Type of VVM: VVM14, 7 • Presentations: – 1-dose vial in boxes of 10: 39.2cm3/dose (vvm7) – 10-dose vial in boxes of 10: 7.5cm3/dose (vvm14) DTP-HepB vaccines
• No. of manufacturers: 3 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • Type of VVM: VVM14 & 7. • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose vial in boxes of 50: 15.7cm3/dose (vvm7) – 1-dose vial in boxes of 50: 26.1cm3/dose (vvm7) – 2-dose vial in boxes of 50: xxcm3/dose (vvm14) – 5-dose vial in boxes of 10: 4.2cm3/dose (vvm14) – 10-dose vial in boxes of 10: 2.1cm3/dose (vvm14) – 10-dose vial in boxes of 50: 2.6cm3/dose (vvm7) – 20-dose vial in boxes of 25: 2.4cm3/dose (vvm7) DTP-Hib vaccines - liquid
• No. of manufacturers: 2 • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • Type of VVM: VVM14, 7, • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose vial in boxes of 50: 19.2cm3/dose (vvm7) – 10-dose vial in boxes of 10: 2.4cm3/dose (vvm14) DTP+Hib vaccines – liquid+lyop.
• No. of manufacturers: 2 • Formulation: Lyophilized vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • Type of VVM: VVM7 & none • MDVP: Keep cool reconstituted vial & Discard after six hours • Presentations: – 1-dose vial in boxes of 10: 44.72cm3/dose (none) – 1-dose vial & ampoule in boxes of 1: 39.2cm3/dose (VVM-7) – 10-dose vial in boxes of 1: 12.4cm3/dose (none) Human Papilloma Virus vaccines
HPV Gardasil: • Vaccine type: Quadravalent HPV (types 6, 11, 16 and 18) • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, Do not freeze. Protect from light. • VVM type: VVM30 • MDVP: N/A • Presentations: – 1-dose vial in boxes of 1: 75.0cm3/dose – 1-dose vial in boxes of 10: 15.0cm3/dose Human Papilloma Virus vaccines
HPV Cervarix: • Vaccine type: Bivalent (types 16 and 18) • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, Do not freeze. Protect from light • VVM type: VVM14 • MDVP: Keep cool opened & Discard after six hours • Presentations: – 1-dose vial in boxes of 1: 57.7cm3/dose – 1-dose vial in boxes of 10: 11.5cm3/dose – 1-dose vial in boxes of 100: 9.7cm3/dose – 2-dose vial in boxes of 1: 28.8cm3/dose – 2-dose vial in boxes of 10: 5.7cm3/dose – 2-dose vial in boxes of 100: 4.8cm3/dose Inactivated Polio Vaccines
• No. of manufacturers: 4 • Vaccine type: Inactivated polio • Formulation: Liquid vaccine • Route of administration: IM/SC injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C, Do not freeze. Protect from light! • VVM type: none, VVM7, VVM14 • MDVP: Keep & use for subsequent sessions! • Presentations: – 1-dose vial in akylux tray of 360: 15.7cm3/dose (none) – 1-dose vial in carton of 1: 101.4cm3/dose (vvm7) – 1-dose vial in carton of 10: 26.8cm3/dose (vvm7) – 1-dose vial in carton of 50: 12.9cm3/dose (vvm7) – 2-dose vial in carton of 100: xx.cm3/dose (vvm14) – 10-dose vial in boxes of 10: 2.46cm3/dose (none) Polio Oral bivalent vaccines
Polio Oral bivalent vaccines: • Formulation: Liquid vaccine • Route of administration: oral • Schedule: 3 doses • Dosage: 2ml • Storage: -15° to -20°C • VVM type: VVM2 • Presentations: – 10-dose vial in boxes of 100: 1.0cm3/dose – 20-dose vial in boxes of 25: 1.1cm3/dose – 20-dose vial in boxes of 50: 1.0cm3/dose – 20-dose vial in boxes of 100: 0.5cm3/dose Pneumococcal Conjugate Vaccines
Pneumococcal conjugate (PCV-7): • Vaccine type: serotypes 4, 6B, 9V, 14, 18C, 19F and 23F • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses Syringe with • Dosage: 2ml vaccine • Storage: +2° to +8°C. Discard if frozen! • VVM type: VVM30 • MDVP: NA • Presentations: – 1-dose prefilled syr.: in boxes of 10: 55.9cm3/dose – 1-dose vial: in boxes of 5: 21.0cm3/dose Pneumococcal Conjugate Vaccines
Pneumococcal conjugate (PCV-10) • Vaccine type: serotypes 1, 4, 5, 6B, 7F, 9V, 14, 18C, 19F and 23F • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C. Discard if frozen! • VVM type: VVM30 • MDVP: Use immediately opened vial & Discard after six hours • Presentations: – 1-dose vial in boxes of 1: 58.0cm3/dose – 1-dose vial in boxes of 10: 11.5cm3/dose – 1-dose vial in boxes of 100: 10.0cm3/dose – 2-dose vial in boxes of 100: 4.8cm3/dose Pneumococcal Conjugate Vaccines
Pneumococcal conjugate (PCV-13) • Vaccine type: serotypes 1, 3, 4, 5, 6A, 6B, 7F, 9V, 14, 18C, 19A, 19F and 23F • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 3 doses • Dosage: 0.5ml • Storage: +2° to +8°C. Discard if frozen! • VVM type: VVM30 • MDVP: NA • Presentations: – 1-dose vial in boxes of 25: 15.7cm3/dose – 1-dose vial in boxes of 50: 12.0cm3/dose Rotavirus vaccines
Applicator Vaccine Rotavirus lyop. - Rotarix with diluent vial • Formulation: freeze-dried with diluents • Route of administration: Oral • Schedule: 2 doses Transfer adapter • Dosage: 2.0ml • Storage: +2° to +8°C, protect from light • VVM type: VVM14 • MDVP: NA • Presentations: – 1-dose vial in boxes of 1: 256.0cm3/dose – 1-dose vial in boxes of 10: 156.0cm3/dose Rotavirus vaccines
Rotavirus liquid - Rotarix Plastic tube • Formulation: liquid vaccine with vaccine • Route of administration: Oral • Schedule: 2 doses • Storage: +2°C to +8°C, protect from light • Type of VVM: VVM14 • MDVP: NA Applicator • Presentation single-dose vial: with vaccine – plastic single-dose tubes: • boxes of 1 tube: 115.3cm3/dose • boxes of 10 tubes: 43.3cm3/dose • boxes of 50 tubes: 17.1cm3/dose – single-dose applicators: • boxes of 1 applicator: 134.1cm3/dose • boxes of 10 applicators: 85.3cm3/dose Rotavirus vaccines
Rotavirus liquid - RotaTeq • Formulation: Liquid vaccine • Route of administration: Oral • Schedule: 3 doses • Storage: +2°C to +8°C, protect from light • Type of VVM: none • MDVP: NA • Presentation single-dose vial: – boxes of 1 vial: 146.0cm3/dose – boxes of 10 vials: 75.3cm3/dose – boxes of 25 vials: 46.3cm3/dose Rabies Vaccines
• No. of manufacturers: 4 • Formulation: Lyophilized vaccines • Route of administration: IM injection • Schedule: 3 to 5 doses • Dosage: 1.0ml • Storage: +2° to +8°C, NEVER FREEZE! • VVM type: VVM30 or none • MDVP: NA • Presentations: – 1-dose vial in boxes of 10: 20.1cm3/dose (vvm30) – 1-dose vial in boxes of 5: 53.6cm3/dose (none) – 1-dose vial in boxes of 1: 174.0cm3/dose, incl syr. Polio Oral bivalent vaccines
Polio Oral bivalent vaccines: • Formulation: Liquid vaccine • Route of administration: oral • Schedule: 3 doses • Dosage: 2ml • Storage: -15° to -20°C • VVM type: VVM2 • MDVP: keep and for subsequent sessions • Presentations: – 10-dose vial in boxes of 100: 1.0cm3/dose – 20-dose vial in boxes of 25: 1.1cm3/dose – 20-dose vial in boxes of 50: 1.0cm3/dose – 20-dose vial in boxes of 100: 0.5cm3/dose Typhoid Vaccines
• No. of manufacturers: 1 • Vaccine type: polysaccharide • Formulation: Liquid vaccine • Route of administration: IM injection • Schedule: 1 doses • Dosage: 0.5ml • Storage: +2° to +8°C, NEVER FREEZE! • VVM type: VVM30 • MDVP: Discard opened vial after six hours! • Presentations: – 20-dose vial in boxes of xx: 1.58cm3/dose Cholera vaccines
DUKORAL: • Vaccine type: Inactivated oral cholera • Formulation: Liquid + buffer • Route of administration: oral • Schedule: 3 doses (2 for adults) • Dosage: 3ml • Storage: +2° to +8°C. Do not freeze. • VVM type: none • MDVP: NA • Presentations: – 1-dose carton: xxx cm3/dose – 2-dose carton: 136.0cm3/dose – 20-dose carton: xxx cm3/dose Cholera vaccines
Shanchol: • Vaccine type: Inactivated oral cholera • Formulation: Liquid • Route of administration: oral • Schedule: 2 doses (@ 2 weeks interval) • Dosage: 1.5ml • Storage: +2° to +8°C. Discard if frozen • VVM type: VVM-14 • MDVP: NA • Presentations: – 1-dose carton of 35: 16.8 cm3/dose Monitoring vaccine utilization & wastage Two concepts (wastage vs sacrificed)
“wasted”, for nothing! “sacrificed” for good reasons: – Losses of inventory, in unopened vials, – Doses discarded from for different reasons: expiry, damage reconstituted vaccine vials at the from cold chain breakdowns, breaking, end of a vaccination session, in freezing & VVM beyond discard point line with the multi-dose vial – Losses of failure of multi-dose vial policy: BCG, Measles, YF, JE. policy, discarding opened vials of – Unplanned administration of vaccines eligible for reuse because of vaccine (non-target populations, misuse or ignorance of the multiple- booster doses, other population dose vial policy: TT, DTP, HepB, etc. groups). – Losses of misuse include administration of incorrect doses, invalid doses at wrong intervals and ages. Two types of wastage - unopened vial
Unopened vial wastage Key considerations: – EVM limits at maxi UV wastage wi = 1% per Doses wasted in unopened vials x 100 storage facility Doses supplied – For the entire supply n - Cold chain failure: chain: ∑ wi (n = No. of • VVM at discard point, supply chain levels) • freeze-sensitive vaccines frozen – Managers anticipate - Poor stock inventory control: reasons leading to • expiry from non compliance to EEFO, actions to avoid • VVM status, wastage • breakages, – Establish a system to • damaged labels, record and review • missing inventories. vaccines losses - Poor forecasting: • expiry from over-supply. Two types of wastage - opened vial Key considerations: Opened vial wastage – Only service delivery – Related to multi-dose Doses opened-- Doses administered x 100 presentations Doses opened – No limits set (context dependant) • Vaccine presentation: – – MDV are prone to higher opened vial wastage Monitor with coverage as remaining doses usually need to be & class of discarded at the end of any session. performance • Status of MDVP: – Managers analyse data – with preservative for re-use till finish & supportive supervision to reduce – w/o preservative & discard within 6hours wastage • Vaccination strategies & settings: – Formulate/adjust – fixed vs outreach/mobile procurement policies – session size (urban/rural, routine/campaign
Classes of performance - "Glèlè classification"
High performing Districts/HF Interpretations: A – class A: high coverage & low wastage B – class B: high coverage & high wastage C – class C: low coverage & low wastage – class D: low coverage & high D wastage
Poor performing Where wastage happened?
Primary store Sub-nat. Low Distrib. Service store1-n Store points
Expiry
Cold chain failure Unopened Missing inventory vial wastage breakages
Over-dosage Remaining doses Opened vials Non-eligible dose Rational for reducing vaccine wastage
• Increase access to vaccines: – Reach more children with less vaccines – Save more resource to introduce new vaccines. • Cost savings: – Minimize demand/consumption • Protect environment: – Use of less vaccine to achieve the same/more objective will reduce the pressure on natural resources – generate less waste to the environment. Avoid unopened vial wastage -1
• Accurate vaccine forecasting: – Control of estimation parameters (population, wastage) – Multi-year planning • Coordinate procurement and supply: – Consistent ordering (stock levels, stock balances) – Reach consensus with procuring agency for vaccine deliveries. • Improve stock management: – Control of storage temperature – Establish effective stock management & supervision (comprehensive recording & reporting tools). Avoid unopened vial wastage -2
• Adequate vaccine distribution: – Establish critical stocks levels for all vaccine stores – Set and follow vaccine distribution plan. • Adopt vaccine management report at all stores: – Help to detect & correct gaps in distribution process, and allow proper remote supervision. Minimize opened vial wastage
• Effective implementation of MDVP: – Adopt MDVP as national policy – Train staff & implement supportive supervision – Ensure safe administration of liquid vaccines • Strengthen monitoring: – Contribute to sensitization of health workers on better control of wastage & information sharing – implement comprehensive vaccination monitoring tools to monitor wastage rates • Optimal vial size: – Smaller size, higher cost, but lower wastages – Higher size, lower cost, but higher wastage – Assess the real benefice for your programme