title: Pediatricians' adherence to pneumococcal conjugate vaccine shortage recommendations in 2 national shortages.
abstract: OBJECTIVE
  The goals were (1) to compare pediatricians' heptavalent pneumococcal conjugate vaccine shortage experience and adherence to shortage recommendations during 2 heptavalent pneumococcal conjugate vaccine shortages, (2) to assess factors associated with nonadherence to second shortage recommendations, and (3) to assess opinions about national immunization policy during vaccine shortages.
  
  
  METHODS
  We mailed surveys to all pediatrician immunization providers in the greater Cincinnati, Ohio, metropolitan area. We assessed heptavalent pneumococcal conjugate vaccine supply and immunization practices during the shortages and provider attitudes regarding immunization shortage policy.
  
  
  RESULTS
  The response rate was 61% (171 of 282 providers). Most pediatricians experienced heptavalent pneumococcal conjugate vaccine shortages (first shortage: 86%; second shortage: 84%). The rate of adherence to recommendations to defer the fourth heptavalent pneumococcal conjugate vaccine dose for healthy children was significantly higher during the second shortage, compared with the first shortage (first shortage: 62%; second shortage: 89%). Adherence to recommendations to administer the fourth dose to high-risk children remained unchanged (first shortage: 43%; second shortage: 45%). Controlling for other factors, pediatricians who reported a severe second shortage had greater odds of not fully vaccinating high-risk children, compared with those who reported no shortage. Contrary to recommendations, many pediatricians did not maintain tracking systems during the heptavalent pneumococcal conjugate vaccine shortages (first shortage: 37%; second shortage: 46%). Most pediatricians (91%) thought that national vaccine shortage recommendations were needed to protect them from liability.
  
  
  CONCLUSIONS
  The rate of adherence to recommendations to defer heptavalent pneumococcal conjugate vaccine doses for healthy children increased significantly from the first shortage to the second shortage. The nonadherent practice of deferring the fourth dose for high-risk children was associated with more severe shortages and, potentially, an inability to vaccinate.
authors.affiliation: Center for Epidemiology and Biostatistics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Ave, MLC 7014, Cincinnati, OH 45229-3039, USA. gerry.fairbrother@cchmc.org
authors.forename: Gerry
authors.initials: G
authors.lastname: Fairbrother
authors.forename: Karen
authors.initials: K
authors.lastname: Broder
authors.forename: Mary Allen
authors.initials: MA
authors.lastname: Staat
authors.forename: Benjamin
authors.initials: B
authors.lastname: Schwartz
authors.forename: Christine
authors.initials: C
authors.lastname: Heubi
authors.forename: Shannon
authors.initials: S
authors.lastname: Hiratzka
authors.forename: Frances J
authors.initials: FJ
authors.lastname: Walker
authors.forename: Ardythe L
authors.initials: AL
authors.lastname: Morrow
mesh_terms: D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D015276:Health Care Rationing / Q000379:methods / Q000592:standards*; D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D006801:Humans; D007115:Immunization Schedule; D008297:Male; D022401:Meningococcal Vaccines / Q000592:standards*; D010820:Physicians / Q000592:standards*; D022242:Pneumococcal Vaccines / Q000592:standards*; D014481:United States; D018074:Vaccines, Conjugate / Q000592:standards
chemical_list: D000069443:Heptavalent Pneumococcal Conjugate Vaccine; D022401:Meningococcal Vaccines; D022242:Pneumococcal Vaccines; D018074:Vaccines, Conjugate