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James ER, Church LWP, Hoffman SL, Richie TL, Robertson BD, Hickey PW, Schwartz DJ, Logan PT, Asare TD, Jones ML, Bay JL, Roschel AK, Pfeiffer JL, Acosta RW, Schiavi E, Acosta AM, Noble M, Henkel T, Young C. Piloting delivery of PfSPZ vaccines for malaria through a cryogenic vaccine cold chain to travel and military medicine clinics. J Travel Med 2024; 31:taae007. [PMID: 38206875 PMCID: PMC10998499 DOI: 10.1093/jtm/taae007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/13/2024]
Abstract
BACKGROUND PfSPZ vaccines comprising Plasmodium falciparum (Pf) sporozoites (SPZ) have demonstrated > 90% protection against variant Pf malaria infections for at least 12 weeks; they are the only vaccines with the level of efficacy necessary to protect travellers. PfSPZ are eukaryotic cells stabilized by cryopreservation and distributed using a cryogenic (below -150 °C) cold chain. The Ebola vaccine and mRNA vaccines against SARS-CoV-2 pioneered uptake of vaccines requiring non-standard ultra-low temperature cold chains. The cryogenic cold chain using liquid nitrogen (LN2) vapour phase (LNVP) cryoshippers, is simpler, more efficient than -80, -20 or 2-8 °C cold chains, and does not use electricity. This study was conducted to evaluate implementation and integration of a cryogenically distributed vaccine at travel and military immunization clinics. METHODS We conducted sequential 28-day studies evaluating vaccine shipping, storage, maintenance and accession at two US military and two civilian travel health/immunization clinics. In each clinic, personnel were trained in equipment use, procurement and handling of LN2, temperature monitoring and inventory record keeping by in-person or video instruction. RESULTS Sites required 2-4 h/person for two persons to assimilate and develop the expertise to manage vaccine storage and LNVP operations. LN2 for recharging cryoshippers was delivered every 1-2 weeks. Vaccine ordering, receipt, storage and inventory control was conducted effectively. Simulated single dose vaccine cryovial retrieval and thawing were performed successfully in different travel clinic settings. Continuous temperature monitoring at each site was maintained with only one short excursion above -150 °C (-145 °C) through shipping, use and reverse logistics. Staff, during and at study conclusion, provided feedback that has been incorporated into our models for cold chain logistics. CONCLUSIONS These studies demonstrated that the training in delivery, storage, administration and integration of PfSPZ vaccines can be successfully managed in different immunization clinic settings for travellers and military personnel.
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Affiliation(s)
| | | | | | | | - Brian D Robertson
- Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Patrick W Hickey
- Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - David J Schwartz
- Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Patrick T Logan
- Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Theresa D Asare
- Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Macie L Jones
- Walter Reed National Military Medical Center, Bethesda, MD 20889, USA
| | - Jeannie L Bay
- Joint Base Lewis-McChord/Madigan Army Medical Center, Lewis-McChord, WA 98431, USA
| | - Austin K Roschel
- Joint Base Lewis-McChord/Madigan Army Medical Center, Lewis-McChord, WA 98431, USA
| | | | | | | | | | - Mark Noble
- Passport Health Silver Spring Travel Clinic, Silver Spring, MD 20903, USA
| | - Thomas Henkel
- Passport Health Silver Spring Travel Clinic, Silver Spring, MD 20903, USA
| | - Cebrina Young
- Passport Health Silver Spring Travel Clinic, Silver Spring, MD 20903, USA
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