Survey of state practices during the 2004-2005 influenza vaccine shortage

To describe state-level actions and policies during the 2004-2005 influenza vaccine shortage and determine whether these or other factors were related to vaccination coverage, we surveyed all state health departments (including the District of Columbia). We included 2004-2005 Behavioral Risk Factor Surveillance System data to examine whether state-level actions, policies, or other factors like vaccine supply were related to changes in vaccination coverage in adults aged >= 65 years from the previous non-shortage year. We found that 96% (n=49) of states reported adopting or recommending adherence to the initial national interim influenza vaccination recommendations. Of these, at some point during the season, 22% (n=11) reported local public health agencies issued prioritization recommendations that differed from the state health department's guidance. Eighty percent (n=41) initiated at least one emergency response activity and 43% (n=22) referred to or implemented components of their pandemic influenza plans. In 35% (n=18), emergency or executive orders were issued or legislative action occurred. In a multivariable linear regression model, the availability and use of practitioner contact lists and having a relatively high vaccine supply in early October 2004 were associated with smaller decreases in coverage for adults aged >= 65 years from the previous non-shortage season (p=0.003, r(2)=0.26). States overwhelmingly followed national vaccination prioritization guidelines and used a range of activities to manage the 2004-2005 vaccine shortage. The availability and use of practitioner contact lists and having a relatively high vaccine supply early in the season were associated with smaller decreases in coverage from the previous non-shortage season.