VFC influenza vaccine delivery delayed compared with privately purchased vaccine

Bhatt P. Pediatr Infect Dis J . 2011;30:100-106.

Influenza vaccine delivered to providers through the Vaccines for Children program is delayed significantly compared with delivery of privately purchased vaccine, according to a new study.

Delivery of private-sector influenza vaccine generally occurs on or near the date the vaccine becomes available, according to the findings. However, provider procurement of influenza vaccine through the VFC program appears to arrive in providers’ offices much later than privately purchased vaccine. During the 2-year study, initial VFC vaccine shipment and administration were delayed by 4 to 5 weeks compared with non-VFC vaccine. The difference was seen consistently across all vaccine types, according to the researchers.

The investigators conducted a prospective, observational study in 126 pediatricians’ offices across the United States from 2007 to 2009. The study looked at children of different ages who were enrolled and not enrolled in the VFC program and their needs for influenza vaccine dosing.

The study was conducted by Praful Bhatt, MD, who is in private practice in Lock Haven, Pa., and colleagues.

This delay in influenza immunization, the researchers wrote, may result in lower two-dose compliance among children in the VFC program.

“Manufacturers, distributors and public health officials should take steps to ship VFC influenza vaccine to providers as quickly as possible, with the goal of delivering VFC vaccine on the same timeline as privately purchased vaccine,” the researchers wrote.

The VFC vaccine distribution system is more complex than private-purchase distribution and “has the additional burden of ensuring equity across jurisdictions and product types; as a result, simultaneous delivery of VFC and privately purchased vaccine may not be feasible,” they wrote.

However, the researchers said, “Pediatric health care providers should increase efforts to vaccinate all populations, especially the VFC population, in later months.”

The study results also indicated that the administration of influenza vaccines through the VFC program occurred predominately early in the influenza season, with a severe reduction after November.

“Pediatricians do not appear to be able or willing to sustain influenza vaccination activities past December,” Bhatt and colleagues wrote. “This pattern of vaccine delivery may be the result of reduced acceptance of vaccination by parents, physician concern over unused doses, the misperception that local influenza outbreaks negate the benefit of vaccination, or office fatigue resulting from 2 to 3 months of influenza vaccine administration.”

Bhatt and colleagues said about 50% of children received both doses of the two-dose vaccine, and that compliance with the two-dose regimen was lower among the VFC population. The researchers attributed this phenomenon to the VFC “population’s shorter time-interval for second-dose receipt.”

Disclosure: The study was supported by MedImmune.

This article, of which I am one of the co-authors, shows the significant delay that has occurred in a recent 2-year interval with flu vaccines supplied by Vaccines for Children program. This backlog essentially has created a two-tier system for the indigent child in our pediatric practices. The delay has frustrated and handcuffed practitioners attempting to comply with the new universal flu vaccine recommendation from the CDC. We are supposed to give the flu vaccine to all children. But then we receive no vaccine for a full month to give the child who has VFC, compared with those who have private insurance. Even large industries in our local area, such as Ford and GE, receive their flu vaccine stock for adults weeks ahead of all children.

Not only are many more children going unvaccinated when they should have the opportunity, but the data shows also, that under-vaccinated rates for flu are nearly 17% to 19% lower for VFC children. It becomes too short a season to catch up. And, unlike the intra-nasal vaccine, prior data clearly demonstrate that a single dose of injectable flu vaccine in vaccine-naive young children is minimally protective, if at all. (Block SL, Clin Ther. 2009 Oct; 31(10):2140-7). All of this backlogging likely increases tremendously the rates of hospitalizations and medical costs in one of our most vulnerable populations.

However, in fairness to the supply problem of flu vaccines, this year (2010) the injectable form did reach our own offices at the same time for both parties. However, the LAIV intranasal version was again delayed by 6 weeks for VFC. And we had many VFC supply shortages throughout the vaccination season again, often going without vaccine for as long as 3 weeks.

This flu vaccine supply problem needs to be addressed promptly by government distributors for next season.

– Stan L. Block, MD

Infectious Diseases in Children Editorial Board member

Disclosure: Dr. Block receives research support from Sanofi, MedImmune and Novartis, and serves as a speaker for MedImmune and Novartis.

Follow the PediatricSuperSite.com on Twitter.