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Background: In Niger and other African countries, both rotavirus and pneumococcal disease cause high morbidity and mortality. Over 65% of deaths associated with rotavirus infection occurred in eleven Asian and African countries in 2004. Of these countries, Niger had the highest under-five mortality rate (392 per 100,000 population <5 years).
Objectives: Although there is great potential for the rotavirus vaccine (RV) and the seven-valent pneumococcal conjugate vaccine (PCV-7) to fill significant needs in West Africa, it is unclear whether the supply chains (i.e., the series of steps required to get a vaccine from the manufacturers to the arms and mouths of patients) of countries such as Niger can handle introductions of such vaccines.
Methods: We developed mathematical models of the entire Niger vaccine supply chain to determine the impact of introducing the rotavirus vaccine (RV), the pneumococcal vaccine (PCV-7) or both, to the Niger expanded programs on immunization (EPI).
Results: Our models suggest that introducing the three-dose (55.9 cm3/dose) PCV-7 vaccine or the following RVs; two-dose (17.1cm3/dose), three-dose (43.3cm3/dose), three-dose (79.8cm3/dose), two-dose (156.0cm3/dose), and two-dose (259.8cm3/dose), or any of their combinations may on average decrease the availability of all current and new vaccines to patients from 69% to 24.1% (10%-51%) in the baseline scenario containing only current EPI vaccines. would require An average of 6.6 or 41.6 liters, and 0.3 or 1.9 liters of additional storage space per month at the two lowest levels would be needed to maintain enough vaccine to immunize at least 90% of arriving patients when introducing even the smallest RV or the PCV-7 vaccine alone.
Conclusions: Transport and storage capacity appears to be a significant bottleneck throughout the supply chain. For the vaccine introduction scenarios to fit smoothly into the supply chain, significant increases in these capacities would need to occur.