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Mandy A. Allison, MD, MSPH; Matthew F. Daley, MD; Jennifer Barrow, MSPH; Lori A. Crane, PhD, MPH; Brenda L. Beaty, MSPH; Norma Allred, MSN, PhD; Allison Kempe, MD, MPH

Arch Pediatr Adolesc Med. 2009;163(5):426-431.

Objective  To assess whether pediatric practices with a system to identify and recall children with high-risk conditions (HRCs) could maintain high influenza vaccination coverage levels among these children during a vaccine shortage year.

Design  Observational study using data from a computerized billing database and an electronic immunization information system.

Setting  Four Denver pediatric practices during the 2003-2004 and 2004-2005 influenza seasons.

Participants  Children aged 24 to 72 months with and without HRCs.

Main Exposure  The vaccine shortage of the 2004-2005 influenza season.

Main Outcome Measures  Proportion of children with and without HRCs who were immunized and the timing of influenza immunization in nonshortage (2003-2004) and shortage (2004-2005) seasons.

Results  In the 2003-2004 season, 770 of 1166 children with HRCs (66.0%) were immunized and, in the 2004-2005 season, 656 of 1053 (62.3%) were immunized. Although vaccination coverage did not significantly decrease for children with HRCs during the 2004-2005 season (P = .07), coverage for healthy children decreased from 43.8% (4435/10 117) to 29.5% (3066/10 387) (P < .001). After the priority group recommendation in October 2004, the practices provided few vaccines to healthy children, whereas children with HRCs continued to receive the vaccine.

Conclusion  Pediatric practices with a system to identify and recall children with HRCs can target these children for receipt of the influenza vaccine and maintain high vaccination coverage, despite a vaccine shortage that may result in decreased vaccine coverage in healthy children.

Author Affiliations: Departments of Pediatrics (Drs Allison, Daley, and Kempe) and Preventive Medicine and Biometrics (Dr Crane), and the Colorado Health Outcomes Program (Drs Daley and Kempe and Mss Barrow and Beaty), University of Colorado, Denver; the Children's Outcomes Research Program, The Children's Hospital, Aurora, Colorado (Drs Allison, Daley, Crane, and Kempe and Ms Barrow); and the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Dr Allred). Dr Allison is now with the Division of General Pediatrics, University of Utah, Salt Lake City.

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