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Abstract Excessive vaccine wastage and safety concerns have prompted the international health community to develop and supply vaccines in formats other than the standard multi-dose vial. This article presents a programmatic and economic comparison of the major differences between the multi-dose vials and single-dose formats used for immunization services in developing countries.
Multi-dose vials, in general, sell at a lower per-dose price and occupy less cold-chain capacity than single-dose formats. However, higher wastage rates may offset these benefits, especially for more expensive vaccines. Single-dose formats offer several important programmatic benefits, such as increased vaccination opportunities and improved vaccine safety. One single-dose format, the prefilled auto-disable (AD) device, provides additional injection safety and convenience features because it physically combines the vaccine and AD syringe.
Selecting the appropriate vaccine presentation will depend on many factors. However, multi-dose vials are likely to be most appropriate for cheaper vaccines and in settings where cold-chain storage capacity is restricted. Single-dose formats will be most appropriate for more expensive vaccines and where there are problems with unsafe injection practices. Prefilled AD injection devices will be particularly useful in expanding outreach services while eliminating the possibility of needle reuse.
Keywords Vaccines/administration and dosage/economics; Dosage forms; Injections/standards; Immunization programs; Comparative study; Developing countries (source: MeSH, NLM).
Introduction
Immunization programmes save millions of lives every year worldwide (1). Vaccination is heralded as one of the most costeffective medical interventions (2). However, nearly 25 years after WHO established the Expanded Programme on Immunization (EPI), it was estimated that in 2000, about 37 million children worldwide did not receive routine immunization during their first year of life (3). At the end of the 1990s, a decade that saw declining vaccination coverage rates (4), vaccinepreventable diseases killed nearly 3 million people, most of whom were children, every year (3, 5).
Fortunately, immunization services have entered a new era, with an expanding selection of vaccines, safer injection syringes, and increased support from international organizations and donor agencies. Auto-disable (AD) syringes are quickly replacing reusable sterilizable syringes for vaccinations (6, 7). With the founding of the Global Alliance for Vaccines and Immunization (GAVI) and the Vaccine Fund (8, 9), over US$ 1 billion have been committed to support immunization in 60 of the world's poorest countries over the...