Elsevier

Vaccine

Volume 32, Issue 2, 3 January 2014, Pages 246-251
Vaccine

System factors to explain 2009 pandemic H1N1 state vaccination rates for children and high-risk adults in US emergency response to pandemic

https://doi.org/10.1016/j.vaccine.2013.11.018Get rights and content
Under a Creative Commons license
open access

Highlights

  • Analysis of the relevant system factors related to state level 2009 H1N1 vaccination coverage in priority groups.

  • The study covers factors related with planning and managing the vaccine supply chain for successful emergency vaccination.

  • We focus on children and high-risk adults in a campaign with vaccine shortage during the 2009–2010 pandemic.

  • We present a first analysis on logistical aspects of campaign and on state-based distribution decisions and processes.

  • Important research for the evaluation of past response as well as potential future responses in priority populations.

Abstract

Introduction

During the 2009–2010 H1N1 pandemic, children and high-risk adults had priority for vaccination. Vaccine in short supply was allocated to states pro-rata by population, but vaccination rates as of January 2010 varied among states from 21.3% to 84.7% for children and 10.4% to 47.2% for high-risk adults. States had different campaign processes and decisions.

Objective

To determine program and system factors associated with higher state pandemic vaccination coverage for children and high-risk adults during an emergency response with short supply of vaccine.

Methods

Regression analysis of factors predicting state-specific H1N1 vaccination coverage in children and high-risk adults, including state campaign information, demographics, preventive or health-seeking behavior, preparedness funding, providers, state characteristics, and surveillance data.

Results

Our modeling explained variation in state-specific vaccination coverage with an adjusted R-squared of 0.82 for children and 0.78 for high-risk adults. We found that coverage of children was positively associated with programs focusing on school clinics and with a larger proportion of doses administered in public sites; negatively with the proportion of children in the population, and the proportion not visiting a doctor because of cost. The coverage for high-risk adults was positively associated with shipments of vaccine to “general access” locations, including pharmacy and retail, with the percentage of women with a Pap smear within the past 3 years and with past seasonal influenza vaccination. It was negatively associated with the expansion of vaccination to the general public by December 4, 2009. For children and high-risk adults, coverage was positively associated with the maximum number of ship-to-sites and negatively associated with the proportion of medically underserved population.

Conclusion

Findings suggest that distribution and system decisions such as vaccination venues and providers targeted can positively impact vaccination rates for children and high-risk adults. Additionally, existing health infrastructure, health-seeking behaviors, and access affected coverage.

Keywords

Pandemic
Coverage
State-specific
Factors
Estimates
Children and high-risk adults

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