Influenza vaccine shortage during 2004-2005 season highlights fragility of supply

Substantial influenza vaccine shortages during the 2004-2005 season demonstrate how pediatricians need to think creatively about vaccine distribution in the present season and going forward.

“Given the volume of children for whom immunization is now recommended and the problems that primary care providers experience with supplies and financial risk, it is no longer realistic for influenza immunization to occur only at the doctor’s office,” said Allison Kempe, MD, MPH, of the department of pediatrics at the Children’s Hospital in Denver.

In a nationwide survey of 352 pediatricians during the 2004-2005 season, researchers determined 39% of pediatricians used computerized methods to identify patients at high risk who were in need of the influenza vaccine.

Ninety-four percent of pediatricians reported giving high priority of the vaccine to high-risk children aged 24 months and older, and 79% of pediatricians reported giving high priority to high-risk children aged 6 to 23 months. However, 41% reported giving high priority to household contacts and caregivers of children aged younger than 6 months.

Vaccine shortages for patients at high risk were reported by 43% of pediatricians; only 14% reported ordering the vaccine manufactured by Chiron, which was deemed unusable during the 2004-2005 influenza season.

Forty-eight percent of pediatricians reported receiving additional vaccine from another source and 47% referred high-risk patients elsewhere for vaccination. Thirty-seven percent stated they sold or gave away the vaccine and 49% had unused vaccine at the end of the season. – by Jennifer Southall

Pediatrics. 2009;doi:10.1542/peds.2008-1035.

This study illustrates the many pitfalls that pediatricians encounter when trying to institute an influenza vaccine program in their own offices. The 2008-2009 season was no better and was likely worse due to the expanded age range for the influenza vaccine recommendations. As practitioners, we seldom know how much flu vaccine to pre-order with the markedly expanding moving age target, plus we have two choices — the LAIV intranasally for our healthy children and thimerosal-free and thimerosal containing injectable vaccine. We do not want to get stuck with hundreds of extra unused doses in our offices either, which could be a fiscal disaster. As with the season reported in this article, influenza vaccine supply was occasionally spotty and ordered additional doses were quite limited, meaning many children missed their golden opportunity of efficient vaccination for influenza. Parents often forget to return and call backs are expensive and extremely difficult in a busy office. To do it correctly, we need the bulk of our vaccine order in the office as soon as it is available in August (LAIV) and September (injectable).

– Stan L. Block, MD

Infectious Diseases in Children Editorial Board member