Published online July 23, 2007
PEDIATRICS Vol. 120 No. 2 August 2007, pp. e401-e409 (doi:10.1542/peds.2007-0359)
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ARTICLE

Pediatricians' Adherence to Pneumococcal Conjugate Vaccine Shortage Recommendations in 2 National Shortages

Gerry Fairbrother, PhDa, Karen Broder, MDb, Mary Allen Staat, MD, MPHc, Benjamin Schwartz, MDd, Christine Heubi, BSa, Shannon Hiratzka, MPHa, Frances J. Walker, MSPHe and Ardythe L. Morrow, PhDa

a Center for Epidemiology and Biostatistics
c Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio
b National Center for Immunization and Respiratory Diseases
e Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
d National Vaccine Program Office, Washington, DC

OBJECTIVES. The goals were (1) to compare pediatricians' heptavalent pneumococcal conjugate vaccine shortage experience and adherence to shortage recommendations during 2 heptavalent pneumococcal conjugate vaccine shortages, (2) to assess factors associated with nonadherence to second shortage recommendations, and (3) to assess opinions about national immunization policy during vaccine shortages.

METHODS. We mailed surveys to all pediatrician immunization providers in the greater Cincinnati, Ohio, metropolitan area. We assessed heptavalent pneumococcal conjugate vaccine supply and immunization practices during the shortages and provider attitudes regarding immunization shortage policy.

RESULTS. The response rate was 61% (171 of 282 providers). Most pediatricians experienced heptavalent pneumococcal conjugate vaccine shortages (first shortage: 86%; second shortage: 84%). The rate of adherence to recommendations to defer the fourth heptavalent pneumococcal conjugate vaccine dose for healthy children was significantly higher during the second shortage, compared with the first shortage (first shortage: 62%; second shortage: 89%). Adherence to recommendations to administer the fourth dose to high-risk children remained unchanged (first shortage: 43%; second shortage: 45%). Controlling for other factors, pediatricians who reported a severe second shortage had greater odds of not fully vaccinating high-risk children, compared with those who reported no shortage. Contrary to recommendations, many pediatricians did not maintain tracking systems during the heptavalent pneumococcal conjugate vaccine shortages (first shortage: 37%; second shortage: 46%). Most pediatricians (91%) thought that national vaccine shortage recommendations were needed to protect them from liability.

CONCLUSIONS. The rate of adherence to recommendations to defer heptavalent pneumococcal conjugate vaccine doses for healthy children increased significantly from the first shortage to the second shortage. The nonadherent practice of deferring the fourth dose for high-risk children was associated with more severe shortages and, potentially, an inability to vaccinate.

Key Words: immunization • vaccine shortage • heptavalent pneumococcal conjugate vaccine

Abbreviations: PCV7—heptavalent pneumococcal conjugate vaccine • CDC—Centers for Disease Control and Prevention • ACIP—Advisory Committee on Immunization Practices • AAP—American Academy of Pediatrics • OR—odds ratio • CI—confidence interval

Accepted Apr 3, 2007.