Barriers to Compliance with ACIP Recommendations during a Vaccine Shortage

Background:
In December 2007, a recall of approximately 1 million doses of Haemophilus influenzae tybe b (Hib) vaccine resulted in a nation-wide shortage. The Advisory Committee on Immunization Practice (ACIP) issued interim recommendations to defer the 4th (booster) dose of Hib vaccine for healthy children and increased the supply of Pentacel® available to Vaccines for Children (VFC) Program participants.

Objectives:
To assess the ability of King County VFC-enrolled providers to give Hib vaccine to their patients in accordance with current ACIP recommendations.

Methods:
A 7-question survey was faxed and emailed to all King County VFC provider sites (n=349) in October 2008. Twenty-nine provider sites were not eligible to respond because Hib vaccine is not routinely recommended for their patient population. Of the remaining sites, 179 returned surveys (56%) accounting for 35,695 (65%) of total Hib-containing vaccine distributed in 2008.

Results:
Seventy-nine respondents (44%) reported insufficient Hib vaccine to complete the recommended primary series. Of these, 42 (53%) maintained a recall list. Fifty-four respondents (30%) kept a recall list for the 4th dose and reported 4,042 total doses would be needed to finish the Hib series. The majority of providers (61%) will not use Pentacel® for children who require the Hib component only but not DTaP or IPV. Primary reasons for not using Pentacel® include parental hesitancy (20%) and provider concerns (58%).

Conclusions:
VFC providers encountered numerous challenges following interim recommendations during the shortage. The use of multiple combination vaccine formulations complicates the response to shortages. Public health authorities must establish clear, consistent communication with providers to address shortage-specific recommendations and the safety, efficacy, and true contraindications for new vaccines. Additional strategies are needed to help health care providers optimize use of limited vaccine supplies during shortages.