Primary Vaccine Container Selection

Bangladesh Perspectives Dr Tajul Islam A. Bari

Programme Manager, EPI and Surveillance Venue: PATH HQ, Washington DC

Vaccines & Target Population •  Children (0-1 Years)

– Childhood Tuberculosis- BCG – Poliomyelitis- OPV – Diphtheria, Whooping Cough and Tetanus -

DPT – Hepatitis B- Hepatitis B Vaccine – Measles- Measles Vaccine

•  Child Bearing Age Women (15-49 Years) –  Maternal Neonatal Tetenus– TT Vaccine

q  Pentavelent Vaccine Containing Hib, Hepatitis B and DPT

EPI Vaccines

Cold Chain Place Pentavalent, BCG,

MCV & TT Polio Duration

Central Store +20C to +80C -150C to -250C 6 months

District Store +20C to +80C -150C to -250C 3 months

Upazilla Store +20C to +80C +20C to +80C 1 months

Transportation •  Cold box •  Vaccine Carrier

+20C to +80C +20C to +80C

+20C to +80C +20C to +80C

Up to 04 days 01 day

Fixed & Outreach sites

•  140,000 EPI outreach sites

•  45,000 regular field workers and 21,000 first line supervisors

•  PLUS NGO, community workers and volunteers

National EPI Schedule

Vaccine Age at Vaccination

BCG At Birth

DPT-HepB-Hib W6, W10, and W14

Polio W6, W10, W14, W38

Measles W38

TT (PW & CBAW) Y15, +M1, +M6, +Y1 and Y1

Multidose Vial policy of Bangladesh •  Vaccines may be preserved and used for immunization

up to 4 weeks if the following conditions are fulfilled: –  The expiry date has not passed. –  The vaccines are stored under appropriate cold chain

conditions (+2 to +8 C) –  The vaccine vial septum has not been submerged in

water –  Aseptic technique has been used to withdraw all

doses –  The VVM, if attached, has not reached discard point. The Multi dose Vial Policy is application only for the

fixed sites which have vaccine storage facilities.

Current and Planned Cold Storage Space

Vaccines

Stock volume per

year (m3)

Reserve stock

volume (m3)

Space Requirem

ent

Space Requirement (Cumulative)

Existing Space (m3)

Planned improvement in CC space

Space Excess / Gap (m 3)

National LevelCurrent Vaccines 274 68 137 1 37 1 10 27 0MCV2 26 6 13 1 50 1 10 13 0PCV 10 (2 dose) 56 14 28 1 7 8 1 10 28 0Rota (1 dose liquid) 672 168 336 514 1 10 22 -382HepB Birth dose (1 dose) 70.9 18 35 550 1 10 -41 7District LevelCurrent Vaccines 274 23 91 91 1 18 27MCV2 26 2 9 100 1 18 18PCV 10 (2 dose) 56 5 19 1 1 9 1 18 -1Rota (1 dose liquid) 672 56 224 343 1 18 -225HepB Birth dose (1 dose) 7 1 6 24 366 1 18 -248Upazila LevelCurrent Vaccines 274 1 1 34 34 177 142MCV2 26 1 3 37 177 139PCV 10 (2 dose) 56 2 7 44 177 132Rota (1 dose liquid) 672 28 84 129 177 48HepB Birth dose (1 dose) 7 1 3 9 137 177 39

Cold chain requirement by vaccine at national,district and upazila

Vaccine National District Upazila

BCG (20 dose) 15 m3 10 m3 4 m3

Penta (1 dose) 72 m3 48 m3 18 m3

OPV (10 dose) 21 m3 14 m3 5 m3

Measles (10 dose) 21 m3 14 m3 5 m3

TT (10 dose) 29 m3 19 m3 7 m3

Total 158 m3 105 m3 39 m3

Vaccine wastage and cost for EPI vaccines 2011

Vaccine (doses per vial)

Doses per child

# of children vaccinated

# of doses used

% Vaccine wastage

Cost of vaccines ($)

Source of funding

BCG (20) 1 3,715,359 25,341,100 85.3 2,077,970 GoB

Penta (1) 3 10,881,811 11,015,974 1.2 27,980,574 GAVI+GoB

OPV (10) 3 14,807,455 21,925,270 32.5 3,902,698 GoB

Measles(10) 1 3,590,240 12,638,450 71.6 2,767,821 GoB

TT (10) 5 12,225,284 18,998,650 35.7 1,329,906 GoB

Vaccine wastage and cost for EPI vaccines if vial size of BCG, and measles changed

Vaccine (doses per vial)

Doses per child

# of children vaccinated

# of doses used

Vaccine wastage

Cost of vaccines

Source of funding

BCG (10) 1 3,715,359 12,384,530 70 - GoB

Penta (1) 3 10,881,811 11,015,974 1.2 27,980,574 GAVI+GoB

OPV (10) 3 14,807,455 21,925,270 32.5 3,902,698 GoB

Measles (5) 1 3,590,240 5,983,733 40 2,154,144 GoB

TT (10) 12,225,284 18,998,650 35.7 1,329,906 GoB

Cold chain requirement by vaccine at national, district and upazila if BCG and Measles

preparations changed Vaccine National District Upazila BCG(10 dose) 7 m3 5 m3 2 m3

Penta (10 dose) 25 m3 16 m3 6 m3

OPV (10 dose) 21 m3 14 m3 5 m3

Measles (5 dose) 10 m3 7 m3 3 m3

TT (10 dose) 29 m3 19 m3 7 m3

Total 92 m3 61 m3 33 m3

Introduction of MR vaccines and MCV 2

•  Current vaccine wastage of measles vaccine is 70.1%

•  However when MR is introduced it would be given to children at 9 months and girls at 15 years

•  Likely to be low vaccine wastage for MR •  Need to evaluate the situation after 1-2 years,

specially coverage of girls at 15 years •  Initiate MCV2 with 10 dose vials due to supply

constraints; GAVI / UNICEF to supply 5 dose vials from 2013

Can Bangladesh go to penta 10 dose vials ?

•  Vaccine wastage of DPT was 43% •  Compare cold storage needed for single and 10

dose vials

•  Unit cost of pentavalent vaccine is same in single dose or 10 dose vial

Level 1 dose vial 10 dose vialNational 72 m3 25 m3District 48 m3 16 m3Upazila 18 m3 6 m3

Conclusions

•  In Bangladesh there is no major injection safety issues when single or multi dose vials are used

•  Cost, vaccine wastage factor and cold storage spaces are major factors contributing to the decision

Thank You