title: Provider adoption of pneumococcal conjugate vaccine and the impact of vaccine shortages.
abstract: OBJECTIVE
  To 1) determine the factors associated with provider acceptance of pneumococcal conjugate vaccine and 2) describe how providers prioritize pneumococcal conjugate vaccine during shortages.
  
  
  METHODS
  During April-November 2002, we conducted a mailed survey of rural and urban Colorado practitioners who provided routine pediatric immunizations. Three groups were surveyed: 1) all immunization providers (n = 51) in 2 geographically large rural areas, identified through a regional immunization registry; 2) all providers (n = 61) from private pediatric practices in metropolitan Denver that were actively participating in the same registry; and 3) all family physicians (n = 244) from the same urban areas as the pediatric practices.
  
  
  RESULTS
  Response rate was 60%. Provider adoption of pneumococcal conjugate vaccine was strong: 66% of urban family physicians, 84% of rural providers, and 98% of urban pediatric providers always recommended pneumococcal conjugate vaccine to healthy children < or = 23 months old when vaccine supplies were adequate. In multivariate analysis, vaccine nonadopters were significantly more likely than adopters to report financial barriers to vaccination (odds ratio [OR] 3.17, 95% confidence interval [CI] 1.58, 6.35) and concerns about vaccine safety (OR 3.37, 95% CI 1.37, 8.26). Eighty-nine percent of respondents had encountered pneumococcal conjugate vaccine shortages. During shortages, children <5 years old with a chronic medical condition were considered the highest priority for vaccination.
  
  
  CONCLUSIONS
  While provider acceptance of pneumococcal conjugate vaccine appears high, concerns about vaccine safety, cost, and availability exist, and these concerns will need to be addressed to maximize prevention of invasive pneumococcal disease in children.
authors.affiliation: Department of Pediatrics, University of Colorado Health Sciences Center, Denver, Colorado 80218, USA. daley.matthew@tchden.org
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Daley
authors.forename: Lori A
authors.initials: LA
authors.lastname: Crane
authors.forename: Brenda L
authors.initials: BL
authors.lastname: Beaty
authors.forename: Jennifer
authors.initials: J
authors.lastname: Barrow
authors.forename: Kellyn
authors.initials: K
authors.lastname: Pearson
authors.forename: John M
authors.initials: JM
authors.lastname: Stevenson
authors.forename: Stephen
authors.initials: S
authors.lastname: Berman
authors.forename: Allison
authors.initials: A
authors.lastname: Kempe
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D003120:Colorado; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D008297:Male; D015999:Multivariate Analysis; D010372:Pediatrics / Q000592:standards / Q000639:trends; D011008:Pneumococcal Infections / Q000517:prevention & control*; D022242:Pneumococcal Vaccines / Q000008:administration & dosage / Q000600:supply & distribution*; D010818:Practice Patterns, Physicians'; D011336:Probability; D012423:Rural Health; D011795:Surveys and Questionnaires; D014504:Urban Health; D014611:Vaccination / Q000592:standards* / Q000639:trends; D018074:Vaccines, Conjugate / Q000008:administration & dosage
chemical_list: D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate