Table 5.

Technical feasibility characteristics of Hepatitis B vaccination for aflatoxin risk reduction in Africa.

Category	Criteria	Intervention
Intervention Characteristics
Basic product design	Stability	Vaccine should be stored between 2°C to 8°C (refrigerated, not frozen) (Drugs.com 2009)
	Standardization	Necessary to ensure that all vaccine doses are the same for a given target group, and safe for that group
	Safety profile	This vaccine is very safe. The most common side effect is pain at the site of injection. There is no clear association to other serious side effects (NFID 2009).
		However, it is crucial that needles be kept sterilized and that vaccines be kept refrigerated.
	Ease of storage and transport	Vaccines require cold storage (See above; applies to transportation conditions as well)
Supplies	Need for regular supplies	To reduce HBV prevalence, multi-generation vaccination is needed. Therefore regular supply of vaccine is required
Equipment	High-technology equipment and infrastructure needed	Cold storage is necessary to preserve the vaccines, which can be a challenge in areas without electricity.
		Existing infrastructures in hospitals and other health centers can facilitate vaccination.
	Number of different types of equipments	Temperature controlled chambers/containers
		Needle syringe
		Antigen-antibody titer check
Delivery characteristics
Facilities	Retail sector	Vaccines must be provided by a reliable source to ensure efficacy, cleanliness, and proper dosage
	Outreach services	Mobile vaccination services (door-to-door) may be possible and desirable in certain communities
	First level care	Community education on HBV's health effects and how to prevent infection is desirable
	Hospital care	Clinics can provide vaccination to infants and previously unvaccinated, uninfected people
Human resources	Skill level required for service provision	Nurses, medical assistants or other trained personnel to administer vaccines
	Skill level required for staff supervision	Medical staff required
	Intensity of professional services (frequency/duration)	Regular service is required to supply vaccines to health care facilities
	Management and planning requirements	Because this vaccine is not locally manufactured in most of the high-HBV-prevalent countries, planning and management of vaccine inventories and funding are two requirements. Planning should also cover how the vaccine reaches the target population, evaluation, and up-scaling of the program.
Communication and transport	Delivery dependence on communication and transport infrastructure	Cold storage needed. To reach large proportions of the target population, it is important to distribute this vaccine to every part of the country: all local clinics and health centers, if possible.
Government capacity requirements
Regulation/ legislation	Need for regulation	No special regulation is required, but government must see HBV vaccination as priority to mobilize resources
Management systems	Need for sophisticated management systems	Clinics and other health care centers must be connected with vaccine supply outlets, and staff should be trained to administer vaccines.
Collaborative action	Collaborative efforts within government sectors and between government and other groups	Health departments within each nation should coordinate with each other and international health organizations to provide vaccines regularly where needed. External funding is necessary, because in order to achieve widespread vaccination, continuity of the program is a vital part. Without external funding or support from external agencies, it can be difficult for poorer nations to maintain this program.
Usage characteristics
Ease of usage	Need for information / education	Individuals must understand need for vaccine as well as where and how often to obtain it, for themselves and their children.
Pre-existing demand	Need for promotion	Vaccination has already been promoted in many African nations, but especially in rural areas, greater effort is needed to educate the public on benefits of vaccines.
Black-market risk	Need to prevent resale/counterfeiting	Low risk of resale or counterfeiting