Should countries switch to using five- or ten-dose rotavirus vaccines now that they are available?

Single-dose rotavirus vaccines, which are used by a majority of countries, are some of the largest-sized vaccines in immunization programs, and have been shown to constrain supply chains and cause bottlenecks. Efforts have been made to reduce the size of the single-dose vaccines; however, with two-d...

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Bibliographic Details
Published in:Vaccine 2021-07, Vol.39 (31), p.4335-4342
Main Authors: Wedlock, Patrick T., Cox, Sarah N., Bartsch, Sarah M., Randall, Samuel L., O'Shea, Kelly J., Ferguson, Marie C., Siegmund, Sheryl S., Lee, Bruce Y.
Format: Article
Language:English
Subjects:
Availability
Benin
Costs
Dosage
Economic impact
Humans
Immunization
Immunization Programs
Impact analysis
India
Infant
Modeling
Mozambique
Multi-dose vials
Population
Refrigerators
Rotavirus
Rotavirus Infections - prevention & control
Rotavirus Vaccines
Simulation
Supply chains
Vaccine
Vaccines
Vaccines, Attenuated
Viruses
Waste disposal
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Summary:Single-dose rotavirus vaccines, which are used by a majority of countries, are some of the largest-sized vaccines in immunization programs, and have been shown to constrain supply chains and cause bottlenecks. Efforts have been made to reduce the size of the single-dose vaccines; however, with two-dose, five-dose and ten-dose options available, the question then is whether using multi-dose instead of single-dose rotavirus vaccines will improve vaccine availability. We used HERMES-generated simulation models of the vaccine supply chains of the Republic of Benin, Mozambique, and Bihar, a state in India, to evaluate the operational and economic impact of implementing each of the nine different rotavirus vaccine presentations. Among single-dose rotavirus vaccines, using Rotarix RV1 MMP (multi-monodose presentation) led to the highest rotavirus vaccine availability (49–80%) and total vaccine availability (56–79%), and decreased total costs per dose administered ($0.02-$0.10) compared to using any other single-dose rotavirus vaccine. Using two-dose ROTASIIL decreased rotavirus vaccine availability by 3–6% across each supply chain compared to Rotarix RV1 MMP, the smallest single-dose vaccine. Using a five-dose rotavirus vaccine improved rotavirus vaccine availability (52–92%) and total vaccine availability (60–85%) compared to single-dose and two-dose vaccines. Further, using the ten-dose vaccine led to the highest rotavirus vaccine availability compared to all other rotavirus vaccines in both Benin and Bihar. Our results show that countries that implement five-dose or ten-dose rotavirus vaccines consistently reduce cold chain constraints and achieve higher rotavirus and total vaccine availability compared to using either single-dose or two-dose rotavirus vaccines.
ISSN:0264-410X
1873-2518
DOI:10.1016/j.vaccine.2021.06.021