1. Vaccine Shortage 2002: National Problem . . . Local Proaction
National Immunization Conference 2003
Melanie Benge Koch, BSN, RN
Public Health Nurse, Allen County Department of Health
Kelly Zachrich
Executive Director, Super Shot, Inc.

2. Agenda  Background  Objectives  Process Protocol Development
Protocol Implementation
 Communication
 Deferment
 Recall
 Conclusions and Future Directions

3. Background  Allen County has a population of 331,849 (2000 census)
In 2002, 6,745 babies were born in Allen County
 40% of Allen County children seek free immunizations
through public sector

4. Background
 In 1999, a unique collaboration was begun. + =
SUCCESS!

5. Total Doses Administered
Background
Total Doses Administered
Collaboratively
By DOH and Super Shot

6. The Problem:
DTaP, April 2002-January 2003

7. Objective To ensure that vaccines were available to those Allen
County children most vulnerable to disease.
 To  morbidity and mortality of infections by
immunizing those at greatest risk for
complications.
 To provide some immunity to a greater # of
children rather than greater immunity to a
lesser # of children.

8. Protocol Development 1. Called together a collaborative group of
community immunization stakeholders.

9. Protocol Development 2. Reviewed CDC and ISDH recommendations.
(continued)
2. Reviewed CDC and ISDH recommendations.
3. Researched vaccine efficacy considering a sub-optimal
number of doses.
4. Collaboratively authored the “Protocol for Vaccine
Administration During Vaccine Shortage”.
Group periodically revised protocols and
implementation process as needed.

10. The Protocol: DTaP  Trigger (%) = doses available/ doses needed
Level
Action
Trigger
Percent of Needed
Doses Available
Baseline
Defer Dose #4 and #5 for all ages
86-100%
Level One
Children < 12 months
Provide only 1st three doses
75-85%
Level Two
Provide only the 1st two doses
50-74%
Level Three
Children < 6 months*
Provide only the 1st two doses for children with at least one of the following considerations :
Chronic medical condition with physician’s prescription
Childcare attendee with proof of attendance (cancelled check, receipt of payment, or note from daycare provider documenting attendance)
Children living at the poverty level (documented by possession of a Hoosier Healthwise Package A card or food stamps)
Refugee child with I-94 card
25-49%
Level Four
Children < 6 months
Provide only the 1st two doses only for children with a chronic medical condition documented by a physician’s prescription
<24%
 Trigger (%) =
doses available/
doses needed
 Baseline based on CDC
and ISDH
recommendations
 As vaccine available ↓’s,
the level ↑’s, and the
vulnerability of the
vaccinated child ↑’s
 Vulnerability based on
scientific research and
consultation with
a field expert
* A child who started the vaccine before 6 months of age and meets this criteria, may receive dose #2 even if they are beyond 6 months of age.

11. Implementation  Initially, inventory was counted and
levels were determined on a weekly
basis.
 In November, change was made to
determine levels as shipments of
vaccine arrived.
 This prevented levels from always
being high or low for specific clinics.

12. Communication: Professional  Mass fax to area physicians of initial
and revised protocols.
Fax of weekly levels sent to physicians upon
request.
Weekly levels published in evening
newspaper.
 Presentation about protocol offered to
physician offices.

13. Communication: General Public
Op-ed piece published in 5 different newspapers
requesting that parents:
Be proactive
Be prepared
Be flexible
Be understanding
Be trusting
Weekly levels published in evening
newspaper.
 Providing information per phone as requested.

14. Vs. Actual Doses Received of DTaP,
Minimum Doses Needed
Vs. Actual Doses Received of DTaP,
April 2002-January 2003
(based on 2001 usage)
*June (100), July (50), October (100), and December (70) figures include Trihibit received.

15. Deferment From April 2002 to January 2003, 8,568 doses
were deferred for all vaccines.
From April 2002 to January 2003, ~3000 DTaP
doses were deferred.
The process for deferment included several
steps:
Parental completion of postcards at intake to be
sent at a later date for recall.
ACCESS database used to:
* Sort names as needed for recall.
* Create ASCII files to implement autodialer use.
 Creation of deferment list has ceased.

16. Vaccinated and Deferred for DTaP,
Children < 12 months
Vaccinated and Deferred for DTaP,
April 2002-January 2003

17. Vaccinated and Deferred for DTaP,
Children > 12 months
Vaccinated and Deferred for DTaP,
April 2002-January 2003

18. Recall
How and when?
 When the # of doses in current inventory exceed estimated
immunization usage (based on previous years), that # of
recalls are made.
 Most vulnerable children recalled first.
 Recall occurs in the order (by date) that the deferment list
was created.
 As of today, only 698 recalls have been completed.

19. Recall Why has the recall process halted?
(continued)
Why has the recall process halted?
• Sufficient vaccine rarely became available through the
VFC program to implement recalls.
• Tobacco settlement monies were allocated to purchase vaccine
for the over 3000 children on the deferral list.
This vaccine was ordered in December 2002, and
we still await arrival of the complete order.
 Insufficient Vaccine Supply
• The Department of Health Immunization Clinic has
temporarily closed due to Small Pox-Phase I
implementation.
• Due to the closure, Super Shot is serving an increased number
of children with limited resources.
 Impact of Small Pox Program

20. Conclusions  The protocol worked well by allowing
us to cover those children most vulnerable
to disease.
 The deferral list and recall
process have become a
bureaucratic nightmare!

21. Future Directions The original collaborative group
will reconvene to revise the recall process.
Super Shot will increase vaccine
availability to families in our community
by becoming a VFC provider.
The DOH will research the impact of the
vaccine shortage on disease incidence in
Allen County (ie. Pertussis and Measles).