title: Effect of a national vaccine shortage on vaccine coverage for American Indian/Alaska Native children.
abstract: OBJECTIVE
  We determined the effect of national vaccine shortages on coverage with 4 doses of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine for American Indian/Alaska Native (AIAN) children.
  
  
  METHODS
  Data on DTaP coverage for children aged 19 to 27 months were abstracted from Indian Health Service (IHS) immunization reports. Coverage with the fourth DTaP dose (DTaP4) was compared for different periods to determine coverage levels before, during, and after the shortage. Data were stratified geographically to determine regional variation.
  
  
  RESULTS
  AIAN children experienced a significant decline (14.8%) in DTaP4 coverage during the shortage. Considerable variation was seen among IHS regions (declines ranged from 4.5% to 26.5%).
  
  
  CONCLUSIONS
  AIAN children included in IHS immunization reports experienced a greater decline in DTaP4 coverage during the shortage than the decline reported nationally for children receiving vaccine at public clinics (14.8% vs 6%). Variations in the decline in coverage highlight possible inequities in vaccine supply and distribution and in implementation of vaccine shortage recommendations. We must identify ways to ensure more equitable vaccine distribution and consistent implementation of vaccine recommendations to protect all children from vaccine-preventable diseases.
authors.affiliation: OMHD/OSI/OD, Centers for Disease Control and Prevention, c/o Indian Health Service, Division of Epidemiology and Disease Prevention, 5300 Homestead Rd NE, Albuquerque, NM 87110, USA. rrb2@cdc.gov
authors.forename: Amy V
authors.initials: AV
authors.lastname: Groom
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
authors.forename: Ralph T
authors.initials: RT
authors.lastname: Bryan
mesh_terms: D002675:Child, Preschool; D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines / Q000600:supply & distribution*; D006801:Humans; D007198:Indians, North American; D007223:Infant; D004930:Inuit; D011054:Poliovirus Vaccine, Inactivated / Q000600:supply & distribution; D014481:United States; D016549:United States Indian Health Service / Q000458:organization & administration; D014611:Vaccination
chemical_list: D022681:Diphtheria-Tetanus-acellular Pertussis Vaccines; D011054:Poliovirus Vaccine, Inactivated