This article is more than 5 years old. Information may no longer be current.
Awareness of interim recommendations urged during vaccine shortages
White KE. Pediatrics. 2011;127:e707-e712.
Click Here to Manage Email Alerts
Pediatricians are being urged to pay close attention to updated vaccination guidelines in times of vaccine shortages, after a study showed significant reductions in Haemophilus influenzae type b vaccination coverage during the shortages in 2008 and 2009.
Karen E. White, MPH, and colleagues of the Minnesota Department of Health wrote that during the 2008–2009 Hib vaccine shortage, clinicians were asked to defer the booster dose only among children who were not at risk for disease.
Providers had been deferring the booster dose of Hib since December 2007, when Merck recalled several lots of its vaccine because of possible bacterial contamination. Sanofi-Pasteur stepped up production on its Hib products after the recall but could not produce enough to include the booster dose.
The primary series continued to be recommended, but when the researchers collected vaccination data on 122,956 children from eight Immunization Information System (IIS) sentinel sites, they found that Hib vaccination coverage for the primary series was 7.8 to 10.3 percentage points lower than the 7-valent pneumococcal conjugate and the diphtheria and tetanus toxoids and acellular pertussis vaccines.
The researchers said the data may have been limited “by a lack of vaccine-type specificity, which may have led to misclassification. When Hib vaccine type was not reported to the IIS, three doses were required to consider a child up-to-date. It is possible that some of these children received two appropriate doses of [polyribosylribitol phosphate polysaccharide conjugated to a meningococcal outer-membrane protein] vaccine and were thus misclassified.”
White and colleagues said despite notifications by the CDC in the Morbidity and Mortality Weekly Report and others, some physicians still expressed being unclear about the interim recommendations.
“Vaccine providers play an essential role in an effective response to vaccine shortages through awareness of interim recommendations, implementation of these recommendations in their practices, and communication with public health authorities when issues arise that challenge the implementation of recommendations,” they concluded.
Disclosure: The researchers reported no relevant financial disclosures.
This clearly demonstrates that during the Haemophilus influenzae type b conjugate vaccine shortage, a significant percentage of infants who received other recommended vaccines on time, did not complete the Hib vaccine primary series on schedule. The authors show that although it was estimated that an adequate number of doses of Hib vaccine was available to maintain the three-dose primary series, up to 10% fewer children received the third Hib vaccine dose when compared with the number who received three DTaP and PCV vaccine doses on time. Thus, the shortage had an even greater impact than anticipated on infant susceptibility to H. influenzae.
It is very likely that individual providers may not have been able to maintain a steady supply of vaccine during the shortage to give Hib vaccine to all of their patients during immunization visits and opted to give the earlier doses to children when possible. Switching vaccine supplies to introduce a Hib-containing combination vaccine when it became available may have been difficult for some providers. It is also possible, as the authors indicated, that the recommendations were not clear to some physicians. Although the efforts of public health officials, professional organizations, vaccine manufactures and providers and the use of the CDC’s Hib vaccine stockpile did help minimize the impact of this shortage, this is an important lesson on the difficulties practitioners face in implementing recommendations to adjust to the shortage.
– Joseph A. Bocchini, MD
Infectious
Diseases in Children Editorial Board member
Disclosure: Dr. Bocchini reported no relevant financial disclosures.
 |
Follow the PediatricSuperSite.com on Twitter. |