The recommendations further specified priority groups in the event of a vaccine shortage, giving priority to the first three of the previous groups, and in addition children aged 6 months to 4 years, and children and adolescents aged 5–18 years who have a medical condition that could cause them influenza-related complications. Finally, the ACIP recommendations stated that decisions
about opening vaccination up beyond the target groups should be made at the local level. GSK2118436 order Despite the pro-rata allocation of vaccine to the states, by the end of January 2010 [2] state-level vaccination coverage varied markedly across states, with rates for children aged 6 months to 17 years ranging from 21.3% to 84.7%, and for high-risk adults from 10.4% to 47.2%. This variation suggests that implementation strategies (e.g. location of vaccination or types of providers receiving vaccine) may have affected state-level MLN2238 purchase vaccination rates achieved and that specific distribution strategies may be associated with reaching specific groups. Fig. 1 summarizes coverage outcomes [2] for children and high-risk adults compared to overall adults (18 and up, including those with high-risk conditions). Coverage rates were higher for more than one group in some states,
pointing to the potential contribution of state systems, processes, or underlying characteristics to coverage achieved. In a previous study, we found that certain supply chain and system factors were associated with state-level coverage of overall adults [12].
The purpose of this study was to extend that analysis and focus on factors associated with coverage of children and high-risk adults, two of the initial target groups for vaccination. Some of the characteristics of the state’s health supply chain Phosphatidylinositol diacylglycerol-lyase that we expected to relate with coverage of children and high-risk adults were the number of locations where vaccine was available, type of providers that received doses, focus on school vaccination, timing of opening of vaccine distribution to non-priority groups, use of third parties for transfer and redistribution of vaccine, and use of retail and pharmacy for vaccination. Fig. 2 presents an example of the supply chain of vaccine. We considered health infrastructure characteristics for the states, and data about vaccine shipments and distribution strategies during the primary shortage period. To account for other factors that may affect vaccination coverage [13], [14], [15], [16], [17] and [18], we included factors pertaining to the underlying characteristics of the state’s population such as demographics and utilization of preventive health services.