الفهرس 
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Abstract
The use of vaccination to prevent disease is the greatest public health success. Because of increasing Expanded Program of Immunization (EPI) vaccine costs during the last years, the WHO recommended a maximum limit for vaccine wastage rate for 10-20 dose vials to not exceed 50% for lyophilized vaccines vials and to not exceed 25% for liquid vaccine vials.
The Previous EPI policy stated that all vaccine vials that had been opened for an immunization session had to be discarded at the end of that session, regardless of the type of the vaccine or the number of doses remaining in the vial. But with introduction of the Open Vial Policy (OVP), a change has occurred, multi-dose vials of OPV, DTP, TT, DT, hepatitis B, and liquid formulations of Hib vaccines from which one or more doses of vaccine have been removed during an immunization session may be used in subsequent immunization sessions for up to a maximum of four weeks provided that certain conditions must be fulfilled.
The EPI in Egypt implemented OVP in February 1st 2016 to decrease any avoidable vaccine wastage rate.
Aim of the work:
The present work aims to study the impact of open vial management policy on vaccine wastage in Alexandria, by comparing vaccine waste rate and waste factor before and after introducing of open vial management policy and to estimate the cost reduction after implementation of that policy.
Material and Methods:
Interrupted time series (ITS) design with control was conducted using segmented fractional logistic regression models in the analysis.
We collected 33 data points after the policy, each point representing a month, and we compared to 25 data points, which were all data available, before.
Thus, we covered the period from January 1st 2014 till October 31st 2018. The sample was divided into pre-intervention and post intervention periods.
The monthly number of vaccinated children and the number of vaccine vials dispensed in the primary health care units vaccination sessions were retrieved from the medical records of the medical districts and healthcare units during the study period for the included vaccines.
Summary, Conclusion and Recommendations
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Results:
In our study, the Pentavalent vaccine achieved the highest reduction 84% (95%CI 82. 92%, 87%) followed by DPT vaccine with 82.5% (95%CI 59.4%, 89.4%) level reduction, then OPV with 32% (95%CI 16.14%, 45.33%).
The estimated annual cost reduction in Alexandria after implementation of OVP would be EGP 266,364(95%CI 698,88 to 4,354,968) and in all Egypt would be which represent about 0.01% (95%CI 0.003% to 0.017%) of the average annual budget for health in Egypt (2016-18).
As vaccination itself saved millions of lives and prevented a lot of epidemic diseases, thus saving money on the long term; the impact of implementation of the OVP in Egypt saved additional money on the short term and without any additional cost needed even for training.
Conclusion:
from the results and discussion of the study we could conclude that:
The introduction of the OVP was associated with significant level reduction in the wastage rates for all policy vaccines (OPV, DPT and Pentavalent). The highest reduction was in the Pentavalent vaccine (84%), followed by DPT (82.5%) then OPV (32%). The change in the levels of wastage came soon after the implementation of the policy as there was no need for training phase. The occurred reductions were stable without trend changes. The achieved cost savings with extrapolation of the results to the whole country represented 0.01% of the Egyptian health care budget which could be considered as accepted return for an intervention with no expenses. Adopting the OVP in our setting has proven to be a prudent investment especially in a country with limited resources.
Recommendations:
Recommendations for healthcare administrator and providers:
Electronic registries are required in order to facilitate data collection and decision making.
Health care administrators have not to overlook cost-saving interventions because they may have cost-reduction opportunities. As example, vaccination which is a cost saving intervention has shown a cost reduction opportunity through the OVP.
Recommendations for further researches:
Researches are recommended to assess the wastage rate for all vaccines supplied by the Egyptian Ministry of Health and Population.
Comprehensive information about the wastage rate of different vial sizes, different modes of administration and different vaccine types is needed.
Conducting researches to compare the wastage rate between fixed sites of immunization, outreach areas, and vaccination campaigns is also recommended.
Researches are recommended to evaluate policy performance in settings with different rates of vaccinated children.