title: Modular vaccine packaging increases packing efficiency.
abstract: BACKGROUND
  Within a typical vaccine supply chain, vaccines are packaged into individual cylindrical vials (each containing one or more doses) that are bundled together in rectangular "inner packs" for transport via even larger groupings such as cold boxes and vaccine carriers. The variability of vaccine inner pack and vial size may hinder efficient vaccine distribution because it constrains packing of cold boxes and vaccine carriers to quantities that are often inappropriate or suboptimal in the context of country-specific vaccination guidelines.
  
  
  METHODS
  We developed in Microsoft Excel (Microsoft Corp., Redmond, WA) a spreadsheet model that evaluated the impact of different packing schemes for the Benin routine regimen plus the introduction of the Rotarix vaccine. Specifically, we used the model to compare the current packing scheme to that of a proposed modular packing scheme.
  
  
  RESULTS
  Conventional packing of a Dometic RCW25 that aims to maximize fully-immunized children (FICs) results in 123 FICs and a packing efficiency of 81.93% compared to a maximum of 155 FICs and 94.1% efficiency for an alternative modular packaging system.
  
  
  CONCLUSIONS
  Our analysis suggests that modular packaging systems could offer significant advantages over conventional vaccine packaging systems with respect to space efficiency and potential FICs, when they are stored in standard vaccine carrying devices. This allows for more vaccines to be stored within the same volume while also simplifying the procedures used by field workers to pack storage devices. Ultimately, modular packaging systems could be a simple way to help increase vaccine coverage worldwide.
authors.affiliation: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Norman
authors.affiliation: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Jayant
authors.initials: J
authors.lastname: Rajgopal
authors.affiliation: Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, United States.
authors.forename: Jung
authors.initials: J
authors.lastname: Lim
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh, PA (formerly) and Baltimore, MD (currently), United States; International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
authors.forename: Katrin
authors.initials: K
authors.lastname: Gorham
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh, PA (formerly) and Baltimore, MD (currently), United States; Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States.
authors.forename: Leila
authors.initials: L
authors.lastname: Haidari
authors.affiliation: Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA, United States.
authors.forename: Shawn T
authors.initials: ST
authors.lastname: Brown
authors.affiliation: Public Health Computational and Operations Research (PHICOR), Pittsburgh, PA (formerly) and Baltimore, MD (currently), United States; International Vaccine Access Center (IVAC), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States. Electronic address: brucelee@jhu.edu.
authors.forename: Bruce Y
authors.initials: BY
authors.lastname: Lee
mesh_terms: D000293:Adolescent; D001541:Benin; D002648:Child; D002675:Child, Preschool; D004349:Drug Packaging / Q000379:methods*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D014612:Vaccines / Q000600:supply & distribution*
chemical_list: D014612:Vaccines
keywords: Modular packaging; Packaging; Primary container; Supply chain; Vaccine vial; Vaccines