Communicating updates essential during vaccine shortages

Issue: August 2008

ATLANTA — Communication between government health agencies and practicing physicians must be improved during vaccine shortage periods because frequent changes in vaccine type and dosing schedules may confuse physicians.

“At the physician level, these are significant changes. These have a real impact on your day-to-day work in practice,” said Gregory S. Wallace, MD, chief of the vaccine supply and assurance branch, immunization services division. All pediatricians and 99% of family medicine physicians were aware and understood the CDC’s recent interim Haemophilus influenza type b recommendations to defer the 12 to 15 month dose in healthy children according to preliminary data from a national survey of attitudes and practices among physicians concerning the shortages.

However, about 20% of those physicians were not deferring administration of routine Hib vaccine booster doses to healthy children aged 12 to 15 months, as the recommendation states.

The survey involved 373 pediatricians and family medicine physicians in a sentinel physician network, developed as part of the Vaccine Policy Collaborative Initiative. The researchers recruited participants from a random sample of AAP and AAFP members.

“Initially, when we supplied these interim recommendations, we thought we were doing a pretty good job. Until we started getting some feedback about providers who were continuing to give the 12- to 15-month dose to healthy individuals, as well as some who didn’t have enough vaccine to reach the full recommendation for healthy children aged 2, 4, and 6 months old,” Wallace said.

Physician responses to open-ended questions included in the survey indicate that this lack of compliance may be a result of a misunderstanding that the interim recommendations are based on the Hib vaccine supply at individual practices. “There was some misunderstanding that these recommendations only applied at the practice level, so if you had enough vaccine, you didn’t have to defer those doses,” Wallace said at the CDC’s National Center for Immunization and Respiratory Diseases said at the Advisory Committee on Immunization Practices meeting in June. .

Previous recommendations from the first seven-valent pneumococcal conjugate vaccine (Prevnar, Wyeth) shortage in which the CDC based recommendations on manufacturer specific vaccine supply levels may be the root of the confusion, Wallace said. In addition to simplifying national recommendations, additional methods for reaching out to physicians to reemphasize these recommendations are needed, according to Wallace. “If you’re ignoring the interim recommendations, you may actually be impacting your colleagues and the kids that they serve,” Wallace said. “There is a lot of work that needs to be done as far as how to best communicate and provide updates.” – by Nicole Blazek

For more information:

Wallace GS. Vaccine supply. Presented at: Presented at: ACIP meeting; June 25-26, 2008; Atlanta.