Physician compliance with pneumococcal conjugate vaccine shortage recommendations in 2004.

OBJECTIVE: To assess pattern of pneumococcal conjugate vaccine (PCV) administration during periods of vaccine shortage and changing recommendations. METHODS: During 2004 PCV shortages, the Advisory Committee for Immunization Practices recommended delay of doses 3 and 4 (PCV3 and PCV4) to healthy children. A managed care health plan evaluated PCV doses administered to all enrolled children at ages 3, 5, 7, and 16 months in 2004; ICD9 codes were used to identify high-risk children. RESULTS: Immunization coverage for the first two PCV doses remained relatively stable throughout 2004 for both high-risk and healthy children. PCV3 coverage for healthy children dropped significantly from 63 percent preshortage (February 2004) to a low of 7 percent (June 2004), then rose to preshortage levels of 2 months after recommendations were made to resume PCV3 administration. Coverage of high-risk children followed a similar pattern as that for healthy children. PCV4 coverage showed similar declines and increases following shortage-related recommendations as PCV3. Most children whose PCV3 dose may have been delayed during the shortage did receive PCV3 after the shortage. CONCLUSIONS: Providers demonstrated rapid change in PCV administration in response to shortage-related recommendations. Little coverage difference was seen between healthy and high-risk children, possibly due to inadequate ability to determine which children truly are at high risk identified on the basis of ICD9 codes.