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High priority vaccines in developing countries include diphtheria, tetanus and pertussis (DTP), hepatitis B (HepB), Haemophilus influenzae type B (Hib), rotavirus and pneumococcal conjugate vaccines. Key elements of the Global Vaccine Movement not only focus on introduction of such life saving vaccines, but also effective vaccine coverage, sustainability and trust. Innovative vaccine formulations, vaccine delivery and post-marketing surveillance are ways to meet these goals.
Combination vaccines, the current cornerstone of the EPI program, can facilitate immunization delivery and the introduction of new vaccines. Additional clinic visits or injections are reduced, as are the chances of missed or wrong dosages. Timeliness and parental compliance are increased, and thus vaccine effectiveness is improved. Combination vaccines also simplify logistics, reduce costs, and so diminish the burden on weaker health systems in resource-poor situations.
Trivalent DTP vaccine has been largely responsible for the rise in global DTP immunization (82% in 2009). However the coverage for HepB and Hib is lagging – in particular there is a need to increase Hib coverage in lower middle-income countries. Pentavalent vaccines, now available in 90% of WHO member states, offer a solution. Moreover, fully liquid pentavalent vaccines offer additional benefits: reduced vaccination time, reduced storage space, reduced medical waste, simplified handling, and, without a reconstitution step, a reduction in the complexity of the vaccination process.
Auto-disabled pre-filled syringes are another mean to improve vaccine delivery, with the advantages of an all-in-one injection system, a single-dose format, compact packaging and easy disposal. Such single- instead of multi-dose vial presentations can also help to reduce both wastage, and potential contamination.
Specific data are presented for Quinvaxem® (DTwP-HepB-Hib), an established fully liquid pentavalent combination vaccine, WHO prequalified since 2006. Vaccines safety aspects will be discussed with respect to recent data from post-marketing surveillance study in Guatemala.
Learning Objectives: Describe developments in combination vaccines and how their deployment has improved vaccine coverage and discuss new developments in combination vaccines that will further improve operational efficiences and injection safety.