Vaccine
Volume 31, Issue 17, Pages 2109-2214 (19 April 2013)
Cincinnati pediatricians’ measured and reported immunizing behavior for children during the national shortages of pneumococcal conjugate vaccine

Original Research Article
Pages 2177-2183
Gerry Fairbrother, Stephanie Donauer, Mary Allen Staat, Karen Broder, Shelia Salisbury, Ardythe L. Morrow, Meredith E. Tabangin, Mekibib Altaye, Michol Holloway, Benjamin Schwartz

Abstract
Background
The United States has experienced two shortages of heptavalent pneumococcal conjugate vaccine (PCV7). National guidelines called for deferring the third and fourth PCV7 doses from healthy children during these shortages. However, recommendations were not the same during the first and second shortages, and recommendations changed over time during each of the shortages as shortages worsened.

Objectives
To measure PCV7 immunizing behavior for healthy children during shortage and non-shortage periods and assess the accuracy of the physicians’ reported immunizing behavior when compared to their actual immunizing behavior.

Methods
We reviewed medical records in 14 randomly selected practices to measure actual immunizing behavior during shortage and non-shortage periods. We surveyed pediatricians in the Greater Cincinnati area to ascertain reported immunizing behavior. Actual and reported immunizing behaviors were compared.

Results
2888 medical records were reviewed; surveys were obtained from 51 pediatricians (65% response rate). During periods of non-shortage, 74% of healthy children received their first two doses of PCV7 on time, whereas during periods of shortage, only 66% of healthy children received their first two doses of PCV7 on time. Compared with measured immunizing behavior from chart reviews, 54–76% of the pediatricians overestimated their compliance with guidelines to defer the fourth PCV7 dose while only 5–20% underestimated their compliance.

Conclusions
Physicians often overestimated the percentage of children whose vaccine doses they deferred during vaccine shortages. Despite these findings, physicians were able to maintain high coverage with the first two PCV7 doses among healthy children.