Vaccine Wastage Rates Research Articles

Minimizing Vaccine Wastage in Nigeria: A National Assessment of Vaccine Wastage Rates and Potential Determinants.

High vaccine wastage can serve as a critical barrier to achieving the gains of vaccination, especially in a country like Nigeria, where data on vaccine wastage are sparsely available. We determined the country-wide vaccine wastage rates and their determinants through a mixed-methods study conducted across 576 health facilities (primary and secondary) in 24 states in Nigeria. We collected facility-based immunization records from June 2018 to May 2019, in addition to healthcare workers' interviews and observations of fixed and outreach sessions. The results show that open-vial wastage ranged from 21.2% (95% CI: 20.2%, 22.2%) for the pentavalent vaccine to 72.6% (95% CI: 71.5%, 73.6%) for BCG. Open-vial wastage rates for BCG, measles, and yellow fever vaccines were higher during outreach sessions, with rates of 76.2%, 64.3%, and 65.2%, respectively. For the outreach and fixed sessions, PCV and Penta had the least wastages of 22.0% for fixed sessions and 20.4% for outreach sessions. This study identified vaccine presentation (liquid vs. lyophilized vaccines), vial size (4 dose vs. 5 dose vs. 10 dose vs. 20 dose), RI service delivery strategies (fixed vs. outreach sessions), number of children vaccinated, and human resources (healthcare workers position/cadre) as key determinants of vaccine wastages in Nigeria.

Coronavirus Disease 2019 Vaccination Status at a Tertiary Care Hospital of Uttarakhand: A Retrospective Record-Based Study

Abstract Background: Coronavirus disease 2019 (COVID-19) vaccination has proved its importance and effectiveness in the fight against COVID-19. India began the world’s largest vaccination campaign against COVID-19 on 16th January 2021 with two vaccines, namely, Covishield and Covaxin. Aims: The present study was conducted to understand the trend of COVID-19 vaccination during the 1st year of the vaccination drive at a COVID Vaccination Centre in a tertiary care hospital of Uttarakhand. Patients and Methods: It was a retrospective record-based study conducted at a COVID-19 Vaccination Centre in a tertiary care hospital of Uttarakhand. Vaccination-related data of 1-year period (16th January 2021–16th January 2022) had been collected from the CoWIN app and COVID-19 vaccination register and analysed. Results: The total dose administered was 63,015 over a time period of 1 year during 299 vaccination sessions that were conducted. Analysis of total doses administered in relation to vaccination sessions held during different months of 1-year study period shows that on average, 199 individuals per session were vaccinated. There was an overall declining trend in the COVID-19 vaccine wastage rate for 1-year period of COVID-19 vaccination. Conclusion: This study will help us to understand how this experience of the past 1 year can be utilised for further planning and policy making.

Overcoming barriers to COVID‐19 herd immunity in Afghanistan

AbstractAfghanistan faces numerous obstacles in its endeavor to achieve herd immunity against COVID‐19. Inadequate resources, vaccine hesitancy, and the new government's lack of international recognition have impeded the country and harmed vaccine procurement and distribution. Although the recent power shift has led to a more secure situation, the country's vaccination coverage remains at 44.05% as of November 26, 2023. The main hurdles to herd immunity include limited vaccine accessibility, extensive vaccine hesitancy, an inefficient cold chain system causing high vaccine wastage rates, substandard service delivery, recent restrictions on women's healthcare access, low health literacy, and a weakened economy owing to decades of conflict and international sanctions. This article assesses vaccination progress, and herd immunity barriers, and provides solutions to overcome them in Afghanistan. A comprehensive approach is required, which involves enhancing public awareness of the benefits of vaccination, debunking vaccine‐related misconceptions through the media, expanding vaccine accessibility especially in remote areas, increasing vaccination personnel, promoting the cold chain and delivery system, reversing the ban on women's education and employment, boosting the economy, and increasing the inflow of humanitarian aid by lifting international sanctions. Successfully implementing these measures can help Afghanistan overcome obstacles to herd immunity, leading the country toward a safer and healthier future.

Strategic Planning of a Joint SARS-CoV-2 and Influenza Vaccination Campaign in the UK.

The simultaneous administration of SARS-CoV-2 and influenza vaccines is being carried out for the first time in the UK and around the globe in order to mitigate the health, economic, and societal impacts of these respiratory tract diseases. However, a systematic approach for planning the vaccine distribution and administration aspects of the vaccination campaigns would be beneficial. This work develops a novel multi-product mixed-integer linear programming (MILP) vaccine supply chain model that can be used to plan and optimise the simultaneous distribution and administration of SARS-CoV-2 and influenza vaccines. The outcomes from this study reveal that the total budget required to successfully accomplish the SARS-CoV-2 and influenza vaccination campaigns is equivalent to USD 7.29 billion, of which the procurement costs of SARS-CoV-2 and influenza vaccines correspond to USD 2.1 billion and USD 0.83 billion, respectively. The logistics cost is equivalent to USD 3.45 billion, and the costs of vaccinating individuals, quality control checks, and vaccine shipper and dry ice correspond to USD 1.66, 0.066, and 0.014, respectively. The analysis of the results shows that the choice of rolling out the SARS-CoV-2 vaccine during the vaccination campaign can have a significant impact not only on the total vaccination cost but also on vaccine wastage rate.

Vaccine wastage in Ghana, Mozambique, and Pakistan: An assessment of wastage rates for four vaccines and the context, causes, drivers, and knowledge, attitudes and practices for vaccine wastage

Vaccine procurement costs comprise a significant share of immunization program costs in low- and middle-income countries, yet not all procured vaccines are administered. Vaccine wastage occurs due to vial breakage, excessive heat or freezing, expiration, or when not all doses in a multidose vial are used. Better estimates of vaccine wastage rates and their causes could support improved management of vaccine stocks and reduce procurement costs. This study examined aspects of wastage for four vaccines at service delivery points in Ghana (n = 48), Mozambique (n = 36), and Pakistan (n = 46). We used prospective data from daily and monthly vaccine usage data entry forms, along with cross-sectional surveys, and in-depth interviews. The analysis found that estimated monthly proportional open-vial wastage rates for vaccines in single-dose vials (SDV) or in multi-dose vials (MDV) that can be kept refrigerated up to four weeks after opening ranged from 0.08 % to 3 %. For MDV where remaining doses are discarded within six hours after opening, the mean wastage rates ranged from 5 % to 33 %, with rates being highest for measles containing vaccine. Despite national-level guidance to open a vaccine vial even when only one child is present, vaccines in MDV that are discarded within six hours of opening are sometimes offered less frequently than vaccines in SDV or in MDV where remaining doses can be used for up to 4 weeks. This practice can lead to missed opportunities for vaccination. While closed-vial wastage at service delivery points (SDPs) was relatively rare, individual instances can result in large losses, suggesting that monitoring closed-vial wastage should not be neglected. Health workers reported insufficient knowledge of vaccine wastage tracking and reporting methods. Improving reporting forms would facilitate more accurate reporting of all causes of wastage, as would additional training and supportive supervision. Globally, decreasing doses per vial could reduce open-vial wastage.

Avian influenza vaccine supply chain in Quang Ninh province, Vietnam, 2021

Highly pathogenic avian influenza (HPAI) is a zoonotic disease that can affect both poultry and humans. Since 2005, the Vietnam government has implemented a national vaccination campaign to prevent the spread of avian influenza (AI). In 2021, the first outbreak of HPAI H5N8 was reported in a chicken farm in Quang Ninh province. To understand the stakeholders linked to the AI campaign, and their roles within the vaccine supply chain, we conducted a cross-sectional study from November 2021–January 2022. We purposively selected 114 participants, including 71 poultry farmers using HPAI vaccines, 16 veterinary drug store owners, 18 commune animal health workers (CAHWs), 8 staff from the Centers for Agricultural Services (ATSCs), and one vaccine distributor who were interviewed face-to-face using a structured questionnaire. Three HPAI vaccines (H5N1 clade 1 & 2.3.2.1, H5N1 clade 2.3.4 and H5N1 clade 2.3.2.1b) were used, and they were effective against the locally circulating virus strains. Distributors stored vaccines at the required temperature and transported them in appropriate vehicles. Vaccines remained in the supply chain for 3–5 months within their 12-month shelf-life period. The free government vaccination campaign, implemented by CAHWs, and administered by the ATSCs, reached 61% of small-scale poultry farms with a 1.21% vaccine wastage rate. Large-scale poultry farms followed the national campaign but paid a fee for the vaccines. We recommend expanding the support for AI vaccination to increase the vaccination rate among large-scale poultry farms, selecting higher efficacy seed vaccines, and that smaller dose vaccine vials are available for cost-effective vaccination.

COVID‐19 vaccine wastage in Thailand amidst vaccine inequity and pandemic‐to‐endemic transition

AbstractCOVID‐19 vaccine wastage is an emerging issue globally. In Thailand, which has declared COVID‐19 to be an endemic disease, the risk of vaccine wastage lingers despite the remaining vaccine inequity. Although the country does not publicly report its vaccine wastage rate, a wastage incident has been reported. With the remaining secured vaccine doses that have yet to be delivered and Thailand's pandemic‐to‐endemic transition, Thailand should strategize to avoid vaccine wastage. This commentary highlights several factors that can potentially lead to vaccine wastage in Thailand: cold chain logistics issues, vaccine hesitancy, and unequal vaccine accessibility. The Thai government should continue its efforts in mitigating these issues to maximize its vaccination program.

Vaccine management practices among healthcare workers in Morogoro, Tanzania: a cross-sectional study

BackgroundEffective vaccine management is essential to maintain the quality of vaccines, minimise wastages, and prevent missed opportunities for vaccination at service delivery points.ObjectivesThis study aims to assess vaccine management practices among vaccinators at health facilities in the Morogoro region, Tanzania.MethodologyA descriptive cross-sectional study design involved health workers from 77 health facilities offering vaccination services. The study population consisted of vaccine handlers and vaccinators working in public health facilities in the Morogoro region. The vaccine management practices were assessed using data collected from ledgers and the Vaccine Information Management System (VIMS). The temperature records were downloaded from the Fridge-tag® 2 and Coldtrace5 devices.ResultsThe findings indicated that 65 (84%) health facilities had functional refrigerators and are using power from 26 (34%), 28 (36%), and 23 (30%) of grid electricity, solar, and Liquefied Petroleum Gas (LPG), respectively. Besides, 27 (35%) health facilities have an alternative energy source as a backup. In general, healthcare workers had a good knowledge of cold chain management, including the World Health Organization recommended storage temperatures for vaccines. Furthermore, vaccine stockout was found in 12 (15.6%) health facilities for at least one antigen and 4 (5.1%) health facilities for all five antigens under observation. This current study also revealed that the average calculated vaccine wastage rates for DTP, Measles–Rubella and Rotavirus vaccines were 7%, 19%, and 15%, respectively. More than half of health workers did not perform monthly temperature data reviews. In addition, poor performance led to high wastage rates, including the Rotavirus vaccines, and a change in VVM to discard points. Finally, a small number of 5 (6.5%) health facilities consecutively reported temperature exposure beyond + 8 Celsius (between 5.9 and 281 h).ConclusionsHealthcare workers’ vaccine and cold chain management knowledge were good for temperature data reading and documentation. However, the practices were poor for some health facilities. The gaps observed in this study inform health managers and policymakers toward establishing interventions to improve health workers' knowledge and practice, including mentorships, supervision, and training to guarantee that each child in all communities reaps the benefits of immunisation services.

A retrospective review of vaccine wastage and associated risk factors in the Littoral region of Cameroon during 2016–2017

BackgroundImmunization is an effective preventive health intervention. In Cameroon, the Expanded Program on Immunization (EPI) aims to vaccinate children under 5 years of age for free, but vaccination coverage has consistently remained below the national target. Vaccines are distributed based on the target population size, factoring in wastage norms. However, the vaccine wastage rate (VWR) may differ among various settings. Our study aimed to assess vaccine wastage for different site settings, seasonality, and vaccine types in comparison to vaccination coverage in order to provide comprehensive insights on vaccine wastage.MethodsA retrospective data collection and analysis were conducted on immunization and vaccine wastage data in the Littoral Region of Cameroon during 2016 and 2017. Health districts were classified as urban or rural, seasonality was categorized as rainy or dry season, and vaccine types were grouped into liquid, lyophilized, oral, and injectable vaccines. VWRs and vaccination coverage rates (VCRs) were calculated, and the vaccine waste factor was investigated.ResultsThe VWR of Bacillus Calmette-Guérin (BCG; 32.19%) was the highest, followed by measles and rubella (MR; 19.05%) and yellow fever (YF; 18.34%) among all EPI vaccines in the Littoral Region of Cameroon during 2016 and 2017. Single-dose vaccine vials exhibited lower VWRs than multi-dose vials. Dry season was associated with higher VWRs for most vaccines, although more lyophilized vaccines (BCG, MR, YF vaccines) were wasted in rainy season in 2016. The VWR was persistently higher in rural than urban health districts. The months of February and November saw a decrease in VCRs. The study found an overall negative correlation between VCR and VWR.ConclusionsMultiple factors may cause wastage of EPI vaccines in Cameroon. Vaccination area characteristics, seasonality, types of vaccines such as multi- or single-dose, lyophilized or injectable vaccines are related to VWRs in Littoral Region. Further research on vaccine wastage and vaccination coverage across Cameroon is needed to better understand the socio-behavioral aspect of vaccine in-take that may affect the level of vaccination and vaccine wastage. Public health system strengthening is warranted to adapt more real-time monitoring of the VWR and VCR for each vaccine in the government’s immunization programs.

Vaccine Wastage and its Contributing Factors in Public Health Facilities of Oromia Special Zone, Ethiopia: Explanatory Sequential Mixed Method Design

Background: Although the availability of vaccines is crucial to achieve comprehensive and equitable immunization coverage. This study assessed vaccine wastage and its contributing factors in public health facilities in Ethiopia. Methods: A facility-based explanatory sequential mixed method was used. An institutional-based cross-sectional study design used to assess the vaccine wastage and vaccine cold chain management in all (27) health facilities offering consistence vaccination service and assessed the knowledge and attitude of 127 vaccinators and handlers. Finally, a phenomenological study design was employed among key informants and content analysis was performed using NVivo 11 plus. Results: The overall vaccine wastage rate was 22.9% while the wastage factor was 1.4. The vaccine wastage rate was found highest for Bacillus-Calmette-Guerin (55.2%), 20 dose vials (55.2%), lyophilized (44.7%) and injectable vaccine (26.0%). Only 13 (48.1%) facilities were having satisfactory cold chain infrastructure while 17 (63%) had good cold chain practices.. Distance from Woreda health office (p=0.03) and Ethiopian pharmaceutical supply agency (p=0.02), work experience (p=0.04), level of education (p=<0.001), profession (p=0.001), and attitude (p=0.04) of vaccinators and vaccine handlers were determinants of vaccine wastage. Key informants stated that factors related to logistics, immunization practices, health professional and vaccines were contributing to wastage. Conclusion: Vaccine wastage in health care facilities was above the standard. Large dose vials and opened vial policy were resulted higher wastage and hence, recommended to reduce vial size. Improving the availability of cold chain logistics, supportive supervisions and training were recommended to reduce wastage.

An assessment of vaccine wastage in the Solomon Islands.

Calculating vaccine wastage rates supports vaccine forecasting and prevents stock outs/over-stock at central and immunisation delivery facilities. Ensuring there are sufficient vaccines on the several small islands of The Solomon Island while minimising waste is a challenge. Twenty-two health facilities were selected randomly from six purposefully identified provinces in the Solomon Islands and across the different levels of the health service. Additional data were obtained from the national medical stores and the Expanded Programme on Immunisation (EPI) monthly reports for 2017 and 2018. All the selected facilities were visited to observe stock management practices. We calculated wastage rates for each vaccine antigen in the EPI and described the type of wastage. We found a wide variation in the average wastage rates at the second level medical stores which may be attributed to the partial availability of wastage data. The overall wastage rate for 20-dose BCG was 38.9% (18.5-59.3), 10-dose OPV was 33.6% (8.1-59.1), and single dose PCV was 4.5% (-4.4-13.5). The data from the two smaller and farthest provinces were incomplete/not available and did not contribute to the overall wastage rates. About 50% of the reported wasted doses at the facility were reported as "damaged" vials. Wastage rates were high for the multidose vials and slightly lower for the single dose vials which were also higher than the indicative rates. There is a need to improve recording of vaccine wastage through continuous monitoring for better forecasting and program effectiveness.

ASSESSMENT OF VACCINE WASTAGE IN A TERTIARY CARE CENTRE OF DISTRICT CUTTACK, ODISHA

BACKGROUND: Vaccine wastage is dened as loss by use, decay, erosion or leakage or through wastefulness. Vaccine wastage is an important factor in forecasting vaccine needs. Despite the concerted efforts of the government and other health agencies, a large proportion of vulnerable infants and children remain unimmunized in India and one of the rationales behind it is mismanagement of vaccine logistics. OBJECTIVE: To monitor Vaccine Wastage at the Immunization Clinic in a Tertiary Care Hospital. 2.To assess Vaccine Wastage Rate (VWR) and Vaccine Wastage Factor (VWF)or wastage multiplication factor of different vaccines administered. 3.To compare the VWR and VWF of different vaccines. METHODS: Record based descriptive study carried out in an Immunization clinic of a tertiary center at SCB Medical College, Cuttack. All children who got vaccinated in the immunization clinic between 1st April 2018 and 31st July 2018 were included in the study. Number of vaccine vials issued and number of children vaccinated for was obtained from immunization register. Vaccine wastage rates and Wastage factor were calculated. RESULTS: Vaccine wastage rate (VWR) and Wastage multiplication factor (WMF) was highest for BCG and was lowest for Pentavalent vaccine. VWF or WMF for vaccines of 10 dose preparations (BCG, DPT, DT and TT) was 2.0, i.e highest for BCG (3.4) and lowest for vaccines of 5 dose preparations (Measles), i.e 1.8. Wastage factor and wastage rate were higher in lyophilized vaccines (2.86 and 64.86% respectively) compared to that of liquid vaccines i.e. (1.40 and 28.36% respectively). CONCLUSION: Monitoring vaccine wastage is useful as a programme monitoring tool to improve programme quality and increase the efciency of the programme. Such monitoring can provide good guidance on the introduction of corrective actions to reduce wastage whenever necessary.

Vaccine wastage and cost saving after multi-dose vial policy implementation in Egypt: A success story

BackgroundPrevention of disease through vaccination is one of the greatest public health successes. The Expanded Program of Immunization (EPI) previous policy stated that all vaccines had opened for immunization session had to be discarded at the end of the session, regardless to the type of the vaccine or the number of doses remaining in the vial. To bring wastage rate down, the WHO multi-dose vial policy (MDVP) was introduced. It stated that multi dose liquid vaccine vials, from which one or more doses have been administered, may be used for subsequent immunization session up to 28 days in the recommended manufacture storage conditions provided that certain condition must be met. The EPI in Egypt had adopted the MDVP in 2016. The current study aimed to evaluate the impact of implementation MDVP on vaccine wastage rate in Alexandria, and to estimate the cost reduction after that policy. MethodsInformation regarding to vaccine doses consumed and children vaccinated were retrieved from medical districts and primary health care units for the period from January 1st 2014 to October 31st 2018. Interrupted time series design with control was conducted to determine the level change and trend change for the policy vaccines and for estimating the average cost saved after the policy. ResultsThe adoption of MDVP led to a significant reduction in the wastage rates of Pentavalent vaccine by 84.7%, DPT vaccine by 82.5% and OPV by 32%. Thus, by implementation of MDVP the estimated annual cost saved for the policy vaccine in all Egypt could be USD2,449,07995%CI826,076to12,219,869. ConclusionThe implementation of MDVP in Alexandria made a significant reduction in the vaccine wastage rate which led to a saving in vaccine requirement and by consequence a cost saved.

The influence of linkages, feedback mechanisms, and caregiver mobility on immunization follow-up visits in Lideta sub-city of Addis Ababa, Ethiopia: a qualitative study

BackgroundLosing children to follow-up is one of the major barriers identified in Ethiopia’s immunization programme. In many urban slum areas like Lideta sub-city, Addis Ababa, several demand- and supply-side factors affect the follow-up visits for routine immunization services, so this study aimed to explore the influence of linkages, a feedback mechanism, and caregiver mobility on immunization follow-up visits.MethodsThe study team employed a qualitative method and conducted 30 in-depth interviews with caregivers, 26 interviews with key informants, and five focus group discussions with health officials and decision-makers. A deductive content and thematic analysis was carried out by importing the transcripts into OpenCodes, applying the a priori codes, and identifying new codes and themes.ResultsThe linkages among health facilities included those from hospitals to health centres, from hospitals to hospitals, and from health centres to health centres within and outside the sub-city. Using these linkages, most vaccinators transfer caregivers without providing multi-dose vial (MDV) vaccines, mainly bacille Calmette–Guérin (BCG) and measles-containing vaccines (MCV), “to minimize wastage” and thus successfully reduce vaccine wastage rates; yet most caregivers wasted their time, energy, and money travelling from one health facility to another. Despite some efforts to transfer caregivers using “transferal slips” and informal phone calls to vaccinators’ friends, unfortunately, there was no formally established system for obtaining feedback about the arrival of caregivers and continuation of the follow-up visits. Overall, the transfer process lacked uniformity, used various approaches, and was not systematic.ConclusionsTransferal of caregivers for the sake of minimizing wastage of MDV vaccines without checking the vaccination schedules of the receiving health facilities, using various informal types of tools and approaches, along with a poor follow-up and feedback system, were major identified challenges which cost caregivers extra money, energy, and time in getting timely immunization services. Therefore, the Federal Ministry of Health should strengthen the linkages among facilities, ensure the establishment of formal communications by developing guidelines and standardized tools – transferal slips and approaches – and initiate a fast feedback provision system using SMS text messages.

Development of a monitoring system and power management for an IoT based vaccine carrier

The development and implementation of automated system to monitor the temperature, humidity, and location of a vaccine carrier in real-time are presented in this paper. All the collected data are sent via SMS and also stored on an SD card to prevent the loss of any data. The weak power infrastructure is one of the challenges in the developing countries which brings into consideration the overall power management and power saving modes of the carrier. The monitoring system and vaccine carrier have been powered from the same source: by either using the vehicle battery or portable batteries. The current consumption of the individual components has been reduced up to 92% and the overall current consumption of the system has been reduced by 8%. Being able to monitor the vaccine storage conditions and the carrier location remotely in real-time, and maintaining low power consumption at the same time, would allow to reduce the vaccine wastage rates and can be very effective in increasing the vaccine outreach in developing and undeveloped countries.

A reactive vaccination campaign with single dose oral cholera vaccine (OCV) during a cholera outbreak in Cameroon

BackgroundCameroon chose Oral Cholera Vaccine (OCV) mass vaccination campaign in addition to other interventions to respond to outbreaks since 2015. There is still a persistent controversy on the effectiveness of reactive OCV mass vaccination campaign. ObjectiveThis article aimed to share evidence-based observations on the effect of a reactive single-dose OCV mass vaccination campaign on cholera cases in Cameroon. MethodsHealth area centered risk analysis was used to identify nine high risk health areas among four health districts in the |North Region as hotspots. About 537,274 people at risk of cholera transmission one year of age and above including pregnant women were eligible to receive OCV. A total of 537,279 doses of OCV was deployed for vaccination from August 1–5, 2019 through door-to-door strategy for urban health districts, and fixed/ temporary fixed posts strategies for rural health districts. ResultsThe overall vaccination coverage was 99.9%. Vaccine wastage rate was less than 0.5% (0.0011%). Independent monitoring showed vaccination coverage at 97.2%. The 2019 epidemic curve went down after OCV intervention on the contrary to that in the year 2018 at the same period. After OCV intervention, cholera cases dropped from about 10.5 to 9.3 cases per week at the regional level while at the district level, they dropped from 5.3 to 2.1, 2.2 to 1.7, 0.6 to 0 and 1.7 to 1.5 cases per week respectively for Garoua, Garoua II, Tchollire and Pitoa. Though not statistically significant (p = 1.4, α = 0.05), cases per 1000 population seemed to remain unchanged among OCV zones (0.32/1000) and non-OCV zones (0.31/1000) in 2018 while they increased from 0.37 (OCV zones) to 0.53 (non-0CV zones) cases per 1000 population in 2019. ConclusionThere might have been a general trend in the reduction of the number of new cases after a reactive single-dose OCV campaign.

Vaccine usage and wastage in a designated Yellow Fever Vaccination Centre in North India.

PurposeYellow fever is a viral hemorrhagic fever transmitted through the bite of mosquitoes. World Health Organization guidelines advocate a single dose of vaccine for life-long protective immunity against yellow fever. Yellow fever vaccine is included in routine childhood immunization schedules in countries at medium or high risk of yellow fever. For some travelers, visiting endemic countries, yellow fever vaccination is recommended to protect the travelers. We calculated the yellow fever vaccine wastage rate at a designated center in North India.Materials and MethodsThis is a record-based study. The data for the study was obtained from the immunization center of Government Medical College, Srinagar, Jammu and Kashmir. The particulars for every vaccine recipient were present in the register. The vaccine wastage rate was calculated. The analysis was done in IBM SPSS ver. 20.0 (IBM Corp., Armonk, NY, USA) and results were presented as numbers and frequencies.ResultsA total of 136 doses were issued out of which 111 doses were administered from November 2017 till October 2020. The maximum number of travelers was young adults (26.1%). In 83.7% of cases, the area of the visit was Africa. The vaccine wastage rate was 18.4%.ConclusionThe vaccine wastage rate was not very high and was within that recommended for vaccines in routine immunization.

Assessment of vaccine wastage in South Sudan.

Introductionvaccine utilization monitoring provides valuable information for practical forecasting and formulation of strategies to reduce avoidable wastage. This monitoring is weak at county and health facility levels in South Sudan. Lack of national wastage rates could result in inaccurate forecasting, leading to vaccine shortages or overstocking and expiration of vaccines at the subnational and service delivery points. As the country gears to introduce relatively expensive vaccines such as rotavirus and pneumococcal vaccines, a robust vaccine utilization monitoring system must be rolled out. This study provides the best possible estimates of vaccine wastage rates and the possible causes of the wastage.Methodswe conducted the study in 45 conveniently sampled health facilities across 9 of the ten states in South Sudan. Vaccine consumption data was prospectively collected to estimate vaccine wastage and the reason for the wastage of each vaccine type.Resultswastage of lyophilized vaccines, measles, and Bacillus Calmette–Guérin (BCG) ranged between 39.0-66.7% and 52.1-74.3%, respectively, mainly due to doses that were discarded 6 hours after the opening of the vial or at the end of the immunization session. Wastage of liquid vaccines Oral poliovirus vaccines (OPV), Penta, Inactivated polio vaccine (IPV), and Tetanus- diphtheria (Td) ranged between 24.4-49%, 15.5-43.4%, 25.3-57.9%, and 3.8-57.2%, respectively, mainly due to unusable VVM, expiry, unused doses at the end of outreach sessions, and vials without labels.Conclusionwasted rates for all vaccines were higher than the indicative WHO wastage rates used in South Sudan to forecast national vaccine needs. Unopened vial wastage was high and needs immediate attention.

The Thai Red Cross protocol experience in Côte d'Ivoire

Rabies is a public health problem in the world especially in Côte d'Ivoire. The epidemiological surveillance of rabies revealed 10,197 exposures with 17 deaths in 2015 and 11,481 exposures with 18 deaths in 2016. The management of exposed people was based on WHO's intramuscular (IM) protocols (Essen and Zagreb). The usual results from these anti-rabies protocols showed low compliance corresponding to 45–50% exposed people who did not complete the Post Exposure Prophylaxis (PEP) schedule,mainly due to the cost of vaccines.The main objective of the project was to test the feasibility of a free rabies PEP based on the Thai Red Cross (TRC) protocol used by intradermal route.The study population was exposed people (patients) vaccinated in the anti-rabies center of Bouake and San Pédro which were two departments selected for this study. The TRC protocol was implemented in y ear 2017. Patients have been vaccinated according to IM post exposure protocols or by the TRC schedule.This new protocol was administered free of charge to exposed people with their consent. Patients who did not complete the PEP schedule were researched and interviewed for having the reasons related to this non-completion.In 2017, 1625 exposures were registered including 1121 in Bouaké and 504 in San Pedro.Overall immunization compliance was 63%. Patients who received the TRC schedule were 829 (52%)With 70% PEP complianceThe PEP compliance of Zagreb protocol was 67%%and the Essen protocol recorded 38% of PEP compliance. The research of exposed people who did not complete the PEP schedule has shown that cost effectively remains the major limiting factor among exposed people vaccinated by Essen or Zagreb protocols. But negligencewas main cause for the non-completion PEP among exposed people who accepted the TRC schedule. Introduction of free rabies PEP through the TRC protocol has found the population support. This experience has been successful with a better PEP compliance, which means safe protection of people from rabies.This study has demonstrate that free rabies vaccine used by ID route is one of the best solutions to improve the PEP compliance in Côte d'Ivoire.Nevertheless, alternatives ways should be provided in order to minimize vaccine wastage rates in anti-rabies center receiving very few exposed persons.Community engagementwould be necessary for more rabies awareness raising and improving bite victim's follow-up.

Effective vaccine management through social behavior change communication: Exploring solutions using a participatory action research approach in the Solomon Islands

Addressing vaccine management bottlenecks, including high vaccine wastage rates, has traditionally been addressed through health worker training and other didactic methods of technical assistance or support as required. It has been shown, though, that the high level of technical skills, expertise, and responsibility required in vaccine handling and management cannot be achieved by mere didactic learning. While gains have been made in vaccine management and handling with these approaches, there remain challenges of high vaccine wastage rates and poor vaccine management practices across the board. Interestingly, approaching vaccine management through social behavior change has not been documented. Through Participatory Action Research (PAR), which is increasingly being used in health sciences, we explore an attempt at strengthening vaccine management and thus reducing high vaccine wastage rates by working together with health workers to identify plausible, realistic solutions to vaccine management through social behavior change. Select health workers directly involved with the immunization program in the four major provinces of the Solomon Islands were identified purposively to use action media and come up with concepts and materials for social behavior change communication that will have an impact on effective vaccine management and reducing wastages. This is the first documented use of such methodology in addressing vaccine management issues.