Distribution of Pandemic Influenza Vaccine and Reporting of Doses Administered, New York, New York, USA

Roopa Kalyanaraman Marcello1, Vikki Papadouka, Mark Misener, Edward Wake, Rebecca Mandell2, and Jane R. Zucker

Author affiliations: New York City Department of Health and Mental Hygiene, Queens, New York, USA (R.K. Marcello, V. Papadouka, M. Misener, E. Wake, R. Mandell, J.R. Zucker); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Wake, J.R. Zucker)

Abstract

In 2009, the New York City Department of Health and Mental Hygiene delivered influenza A(H1N1)pdm09 (pH1N1) vaccine to health care providers, who were required to report all administered doses to the Citywide Immunization Registry. Using data from this registry and a provider survey, we estimated the number of all pH1N1 vaccine doses administered. Of 2.8 million doses distributed during October 1, 2009–March 4, 2010, a total of 988,298 doses were administered and reported; another 172,289 doses were administered but not reported, for a total of 1,160,587 doses administered during this period. Reported doses represented an estimated 80%–85% of actual doses administered. Reporting by a wide range of provider types was feasible during a pandemic. Pediatric-care providers had the highest reporting rate (93%). Other private-care providers who routinely did not report vaccinations indicated that they had few, if any, problems, thereby suggesting that mandatory reporting of all vaccines would be feasible.

In April 2009, a novel swine-origin influenza A (H1N1) virus (now called influenza A(H1N1)pdm09 [pH1N1]) was detected in the United States (1). During the next 2 months, more than 1 in 10 New York City (NYC) residents reported influenza-like illness; cases occurred primarily among children and young adults (2). By June 2009, the World Health Organization had declared an influenza A(H1N1) pandemic (3). In July 2009, in anticipation of limited vaccine supply, the Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention prioritized groups for receipt of monovalent pH1N1 vaccine (4,5).

Building on previous pandemic influenza preparedness planning, in the summer of 2009, the NYC Department of Health and Mental Hygiene (DOHMH) began planning for pH1N1 vaccine allocation and distribution. To efficiently provide limited doses to a diverse population of providers in a large urban setting, DOHMH developed an allocation plan that included hospitals, private care providers (including adult, pediatric, and obstetric practices), and other outpatient facilities (including federally qualified health centers, pharmacies, DOHMH walk-in immunization clinics, and NYC agencies with a medical unit). In addition, DOHMH conducted a large-scale school-located vaccination program that offered pH1N1 vaccine to virtually all of the 1.4 million NYC schoolchildren in kindergarten through grade 12 (6). DOHMH also conducted 58 point-of-dispensing mass vaccination clinics over 5 weekends (7).

In NYC, all vaccine doses administered to persons < 19 years of age must be reported to the Citywide Immunization Registry (CIR), DOHMH Immunization Information System; this requirement includes influenza vaccine (8). Vaccine doses administered to patients >19 years of age can be reported to the CIR with the patient’s consent. Electronic files containing birth certificates are entered into the CIR on a weekly basis to establish a population base and to facilitate reporting among pediatric-care providers. Since 2008, the CIR has been one of the Immunization Information System sentinel sites in the United States and has met data-quality and population-capture requirements, including those of receiving complete and timely data from at least 85% of providers and participation of at least 85% of children <19 years of age (9).

On October 28, 2009, because of the pH1N1 pandemic, various provisions of New York State public health law were suspended, including the requirement to obtain consent to report vaccines given to adults. This change authorized the NYC Health Commissioner to issue a Declaration of a Public Health Emergency and to modify the NYC Health Code to require reporting to the CIR of all pH1N1 influenza vaccinations administered, including those administered to persons >19 years of age. This change was made to increase provider accountability, track vaccine uptake, and assist with estimating vaccine coverage.