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An audit of pandemic (H1N1) 2009 influenza vaccine wastage in general practice
Author(s) -
Turnour Caroline E,
Conaty Stephen J,
Cretikos Michelle A
Publication year - 2010
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/j.1326-5377.2010.tb03624.x
Subject(s) - officer , public health , audit , unit (ring theory) , west yorkshire , management , library science , medicine , history , nursing , psychology , archaeology , mathematics education , metropolitan area , computer science , economics
TO THE EDITOR: From 30 September 2009, the Australian Government began offering free pandemic (H1N1) 2009 influenza vaccine (Panvax, CSL Limited, Melbourne, VIC), using either 10-dose (5 mL) or 20-dose (10 mL) vials. Multidose vials are not used routinely in Australia, and are designed for high-volume vaccination clinics. Once pierced, a Panvax vial must be used within 24 hours or discarded. We investigated vaccine wastage in general practice during the first month of the vaccine’s availability. We randomly selected 300 of 697 known general practices within the Sydney South West Area Health Service. A one-page audit of vaccine vials received and consumed, and of patients vaccinated to 31 October 2009 was faxed to practices. One reminder fax was sent. Faxes were successfully delivered to 271 practices and 146 (54%) responded. Twelve responses (4%) were substantially incomplete, leaving 134 (49%) for analysis. Practices reported vaccinating 28 445 people. A median of 70% (interquartile range, 50%–90%) of people immunised belonged to a priority group. An estimated 49 130 doses were consumed, indicating that 20 685 doses (42%) were wasted. A median of 40% of doses were wasted per practice. Three practices (2%) had administered only one dose per multidose vial. There was significantly less wastage in practices with access to 5 mL vials (median wastage, 30%) than practices that had only 10 mL vials (median wastage, 50%) (P < 0.001; Wilcoxon rank-sum test). There was no significant difference in the proportion of doses wasted between the 70 practices that organised vaccination clinics and the 63 practices that did not (median wastage, 43% v 40%; P = 0.9; Wilcoxon ranksum test). There was also no statistically significant difference in the proportion wasted between solo and multidoctor practices (median wastage, 43% v 34%; P = 0.2; Wilcoxon rank-sum test) although the absolute wastage level was lower for multidoctor practices. These results provide evidence that multidose vials (discarded within 24 hours of first use) are an inefficient method of presenting pandemic influenza vaccines for general practice use. Wastage was substantial. This study is limited to the program’s first month, so initial results may not reflect results over the whole program. However, if similar wastage occurred nationally, over 7.5 million of the 19 million doses available to Australians could be wasted. Nevertheless, the low unit cost and rapid production advantages of multidose vials may justify their use when faced with an urgent threat, and if used in mass vaccination clinics. Wastage could be reduced by increasing the availability of 5 mL multidose vials, but not (according to our data) by organising general practice vaccination clinics. Extending the vaccine shelf-life from 24 hours to 28 days, to align with licence conditions in the United States, could decrease wastage, as it may be that the short shelf-life results in more wastage than does supplying the vaccine in multidose vials. No rationale for the shorter shelf-life in Australia has been found, but we surmise it was set as a precaution to reduce the risk of contamination. Doses saved through reduced wastage could be used to increase Australia’s donation of vaccine to developing countries.