Survey on 5-dose measles vaccine presentation

Questionnaire Regarding Measles Vaccine Vial Presentation Would a 5-dose vial of measles vaccine for routine immunization programs improve programme performance? We have received some reports that not all vaccination sessions include measles vaccination. Because the health workers are reluctant to open a measles 10-dose vial for just one or two children, caregivers are requested to return on another day when measles vaccinations are scheduled to be provided. The reason for the reluctance lies in the fact that opening a vial for just one or two children results in high wastage of the vaccine, as the reconstituted vaccine must be discarded after six hours or at the end of the session, whichever comes first. This may imply that the health centre will run out of vaccines early in the re-supply cycle and health workers might be blamed for a high wastage rate. These concerns and practices may result in delayed protection against measles and increased drop-out rates. A five dose measles vaccine vial is WHO pre-qualified and available on the market. The price for a 5-dose vial is approximately $0.36 per dose as opposed to a 10-dose vial that costs approximately $0.244 per dose. Steinglass states: “Making measles vaccine available in 5-dose vials would help to overcome the psychological barrier that health workers face when considering whether or not to open a vial for just one or a few children.” India uses a 5-dose vial in their routine programme. The price of a 5-dose vial is lower than the 10-dose vial, but the price of two 5-dose vials is higher than one 10-dose vial. UNICEF India stated that overall, as wastage comes down, the total expenditure for measles vaccines did not increase. Anecdotal information reveals that the coverage has increased as it has reduced the apprehensions of more wastage. Health workers bring at least one measles vaccine vial to each immunization session. Closer analysis of the cost of a 5-dose and 10-dose measles vial reveals that for small sessions (under 5 - 6 children per session) cost per administered dose is less for the 5-dose vial than for the 10-dose vial. The difference in price between the 5-dose and 10-dose vial is rather small in larger sessions (see graph in attached document). The volume of one 5-dose vial is the same volume as one 10-dose vial. Hence, the per-dose volume in a 5-dose vial is twice the volume in a 10-dose vial. However, a 5-dose vial could reduce wastage and therefore increase efficiency of cold chain use. Risk of programmatic errors would be present in settings where two presentations are available. Health workers could use the wrong size diluent for reconstitution. In light of the above, we are asking workers with field experience to answer a few questions on measles vaccine presentation: Please see the attached questionnaire and tick the appropriate box or provide the answer in the space provided as appropriate. Measles-vaccine-vial-presentation-survey-final2.docx Please send your responses to: [email protected]