Provider Adoption of Pneumococcal Conjugate Vaccine and the Impact of Vaccine Shortages

Daley, Matthew F.; Crane, Lori A.; Beaty, Brenda L.; Barrow, Jennifer; Pearson, Kellyn; Stevenson, John M.; Berman, Stephen; Kempe, Allison

doi:10.1367/A04-142R.1

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Volume 5, Issue 3 , Pages 157-164, May 2005

Provider Adoption of Pneumococcal Conjugate Vaccine and the Impact of Vaccine Shortages

Matthew F. Daley, MD
- Address correspondence to Matthew F. Daley, MD, 1056 E 19th Ave, B032, Denver, CO 80218
Lori A. Crane, PhD, MPH
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga
Brenda L. Beaty, MSPH
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga
Jennifer Barrow, MSPH
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga
Kellyn Pearson, MSN
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga
John M. Stevenson, MA
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga
Stephen Berman, MD
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga
Allison Kempe, MD, MPH
- From the Departments of Pediatrics (Drs Daley, Berman, and Kempe) and Preventive Medicine and Biometrics (Dr Crane) and the Colorado Health Outcomes Program (Ms Beaty), University of Colorado Health Sciences Center, Denver, Colo; the Children's Outcomes Research Program (Drs Daley, Crane, Berman, Kempe, Ms Barrow, and Ms Pearson), The Children's Hospital, Denver, Colo; and the National Immunization Program (Mr Stevenson), Centers for Disease Control and Prevention, Atlanta, Ga

Received 16 August 2004; accepted 28 November 2004.

Objectives.—To 1) determine the factors associated with provider acceptance of pneumococcal conjugate vaccine and 2) describe how providers prioritize pneumococcal conjugate vaccine during shortages.

Design/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 ≤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.

KEY WORDS: immunization , pneumococcal conjugate vaccine , provider attitudes , vaccine shortages