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Response to the 2004-2005 influenza vaccine shortage in veterans with spinal cord injury & disorder and their providers

Evans CT, LaVela SL, Smith BM, Weaver FM, Goldstein B, Wallace C. Response to the 2004-2005 influenza vaccine shortage in veterans with spinal cord injury & disorder and their providers. Poster session presented at: Society for Healthcare Epidemiology of America Scientific Annual Meeting; 2006 Mar 1; Chicago, IL.


BackgroundThe influenza vaccine shortage in the United States during the 2004-2005 season received considerable national and local media coverage. To assist clinicians' management of immunizations, interim recommendations were issued by the CDC. The Department of Veterans Affairs (VA) has promoted ongoing education of patients and providers for the past five years regarding the risks of influenza in persons with spinal cord injury and disorder (SCIandD), the need to be vaccinated and diagnostic and treatment options. The vaccine shortage provided an opportunity to assess its effect on patient behavior in getting the vaccine, provider behavior in providing the vaccine, and provider strategies of diagnostic testing and treatment of influenza.ObjectivesTo assess the effects of the 2004-2005 influenza vaccine shortage in veterans with SCIandD, including veterans' receipt of vaccine, provider provision of the vaccine, and diagnostic and treatment strategies. MethodsAnonymous surveys were distributed to veterans with SCIandD and SCIandD healthcare providers at VA facilities in 2005. Interviews with key staff at VA SCI Centers yielded further details. Analyses were descriptive.Results:Patients: The overall vaccination rate for veterans with SCIandD was 72.5% (n = 966); most veterans received the vaccine early (October-November) and at the VA. Vaccinations increased with age: < 50 years (56.9%), 50-64 years (74.2%), and > = 65 years (77.4%). Most respondents (95.9%) reported awareness of a vaccine shortage. When asked whether the shortage affected their ability to get the vaccine, 64.2% said they had no problem, 16.5% said they chose not to get it, 12.3% said they had to get the vaccine later in the year, 3.6% said they did not get the vaccine so that others could get it, and 3.4% reported inability to get the vaccine.Providers: 47.5% of survey respondents reported a vaccine shortage (n = 177), 41.2% reported no shortage, and 11.3% were unsure if they had a shortage. Most reported that the vaccine shortage did not affect availability of vaccine for patients with SCIandD. A few clinicians reported that the vaccine was not offered due to lack of vaccine or that patients with SCIandD declined so that others could receive it. Few clinicians conducted diagnostic test for influenza more often than in past years (4.9%). Interviews showed shortages at 12 centers (n = 23). Patients with SCIandD had priority at 11 of 12 centers. At one center, veterans with tetraplegia had priority October-November; by December, all veterans with SCIandD had priority. ConclusionsMost patients were aware of the vaccine shortage and though the vaccination rate decreased from the previous year (79%), it was still considered high. Providers and facilities targeted SCIandD as a high risk group and prioritized use of the limited vaccine supply for them. Continued educational efforts by the VA may have contributed to these positive findings.

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