Acceptability and Feasibility of Delivering Pentavalent Vaccines in a Compact, Prefilled, Autodisable Device in Vietnam and Senegal

Abstract

BackgroundPrefilled syringes are the standard in developed countries but logistic and financial barriers prevent their widespread use in developing countries. The current study evaluated use of a compact, prefilled, autodisable device (CPAD) to deliver pentavalent vaccine by field actors in Senegal and Vietnam.MethodsWe conducted a logistic, programmatic, and anthropological study that included a) interviews of immunization staff at different health system levels and parents attending immunization sessions; b) observation of immunization sessions including CPAD use on oranges; and c) document review.ResultsRespondents perceived that the CPAD would improve safety by being non-reusable and preventing needle and vaccine exposure during preparation. Preparation was considered simple and may reduce immunization time for staff and caretakers. CPAD impact on cold storage requirements depended on the current pentavalent vaccine being used; in both countries, CPAD would reduce the weight and volume of materials and safety boxes thereby potentially improving outreach strategies and waste disposal. CPAD also would reduce stock outages by bundling vaccine and syringes and reduce wastage by using a non-breakable plastic presentation. Respondents also cited potential challenges including ability to distinguish between CPAD and other pharmaceuticals delivered via a similar mechanism (such as contraceptives), safety, and concerns related to design and ease of administration (such as activation, ease of delivery, and needle diameter and length).ConclusionsCompared to current pentavalent vaccine presentations in Vietnam and Senegal, CPAD technology will address some of the main barriers to vaccination, such as supply chain issues and safety concerns among health workers and families. Most of the challenges we identified can be addressed with health worker training, minor design modifications, and health messaging targeting parents and communities. Potentially the largest remaining barrier is the marginal increase in pentavalent cost – if any – from CPAD use, which we did not assess in our study.

Assessment of temperatures in the vaccine cold chain in two provinces in Lao People’s Democratic Republic: a cross-sectional pilot study

“…To avoid freezing of vaccines, Kolwaite et al conducted a pilot study to assess the effect of “out-of-the-cold-chain” storage in Lao PDR and discovered improved Hepatitis B dose coverage without an increase in adverse reactions [ 25 ]. Some innovative solutions should be considered in the context of developing countries, such as a computerizing temperature monitoring system, development of thermostable vaccines, development of a compact prefilled vaccination device, or the use of a cold box that can manage temperature control on its own for a long duration [ 10 , 14 , 24 , 26 ].…”

Cost of goods sold and total cost of delivery for oral and parenteral vaccine packaging formats

“…Usability factors such as intuitiveness of use and the ability to easily squeeze and deliver vaccines from both oral and parenteral polymer packaging formats are dependent on the geometry and thickness of the container and viscosity of the vaccine [34] . Stakeholder input on the currently available Uniject™ CPAD has highlighted the simplicity, safety, and cold chain benefits of this preformed polymer container for vaccines [30] , [37] . PATH has conducted formative usability and acceptability studies of novel oral and parenteral polymer containers among health care workers and immunization program managers in low-resource settings.…”

Mother‐to‐child transmission of hepatitis B: What more needs to be done to eliminate it around the world?

“…Moreover, the use of such a device for BDV delivery has never been assessed in the African region. Nevertheless, numerous African studies evaluated the use of Uniject to deliver other products like oxytocin or pentavalent vaccines by minimally trained community workers, with encouraging results …”