Published online January 26, 2009
PEDIATRICS Vol. 123 No. 2 February 2009, pp. e186-e192 (doi:10.1542/peds.2008-1035)
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ARTICLE

Impact of the 2004–2005 Influenza Vaccine Shortage on Pediatric Practice: A National Survey

Lon McQuillan, MD, MSPHa,b, Matthew F. Daley, MDa,b,c, Shannon Stokley, MPHd, Lori A. Crane, PhD, MPHc,e, Brenda L. Beaty, MSPHc, Jennifer Barrow, MSPHb,c, Christine Babbel, MSPHb,c, L. Miriam Dickinson, PhDf and Allison Kempe, MD, MPHa,b,c

a Departments of Pediatrics
e Preventive Medicine and Biometrics
f Family Medicine
c Colorado Health Outcomes Program, University of Colorado Denver, Aurora, Colorado
b Children's Outcomes Research Program, Children's Hospital, Aurora, Colorado
d National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia

BACKGROUND. A severe influenza vaccine shortage occurred during the 2004–2005 influenza season because of the loss of all vaccine made by Chiron (Emeryville, CA) for US distribution.

OBJECTIVES. The objectives of this study were to assess among pediatricians nationally: (1) influenza vaccine-delivery strategies; (2) reported vaccine shortages and factors associated with experiencing shortages; and (3) the impact of shortages on vaccine redistribution, patient referral, and clinical practice, including patient prioritization.

METHODS. A survey was administered in March 2005 through June 2005 to 427 pediatricians who participated in a national network representative of the American Academy of Pediatrics membership.

RESULTS. Our response rate was 82%. Thirty-nine percent of the pediatricians had a computerized method for identifying patients at high risk needing vaccination. Ninety-four percent and 79% reported giving high-priority to children ≥24 months old with high-risk conditions and children 6 to 23 months old, respectively, whereas 41% gave high-priority to household contacts and caregivers of children <6 months old. Forty-three percent reported experiencing shortages of vaccine for patients at high risk, whereas only 14% ordered Chiron vaccine. In multivariate analyses, ordering vaccine from Chiron and ordering Aventis Pasteur (Lyon, France) vaccine solely from a vaccine distributor were associated with experiencing a shortage. Forty-eight percent of respondents obtained additional vaccine from another source, most frequently the public health sector, whereas 37% reported selling or giving away vaccine. In addition, 47% referred patients at high risk elsewhere for vaccination, primarily to public health clinics. Forty-nine percent reported having unused vaccine remaining at the end of the season.

CONCLUSIONS. Although few pediatricians ordered Chiron vaccine, substantial influenza vaccine shortages were reported, highlighting the tenuousness of injectable influenza vaccine supplies for children. The extensive redistribution of vaccine suggests that cooperative efforts between the private and public sectors were widespread. Efforts to vaccinate patients at high risk during shortages would be aided by better systems to identify and recall these patients.

Key Words: immunization • influenza vaccine • vaccine shortages • physician attitudes

Abbreviations: CDC—Centers for Disease Control and Prevention • TIV—trivalent inactivated influenza vaccine • VFC—Vaccines for Children • MCO—managed care organization • LAIV—live attenuated influenza vaccine

Accepted Oct 10, 2008.


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