U.S. COVID-19 vaccine distribution strategies, systems, performance, and lessons learned, December 2020 - May 2023.

During December 2020 through May 2023, the Centers for Disease Control and Prevention's (CDC) Immunization Services Division supported and executed the largest vaccine distribution effort in U.S. history, delivering nearly one billion doses of COVID-19 vaccine to vaccine providers in all 50 states, District of Columbia, Puerto Rico, Virgin Islands, Guam, Federated States of Micronesia, American Samoa, Marshall Islands, Northern Mariana Islands, and Palau.

Metformin-Associated Lactic Acidosis: A Case Report.

Introduction: Metformin is considered a first-line therapy for patients with diabetes secondary to its cost efficiency, minimal side effects, and marked improvement in one's hemoglobin A1c; however, metformin is avoided in patients with renal insufficiency out of concern for drug accumulation and lactic acidosis. In fact, there is a black box warning for metformin, identifying lactic acidosis as the inciting trigger for fatal arrhythmias and death.

Case Presentation: A 62-year-old male presented with multiple episodes of nausea, vomiting, abdominal pain, and decreased urine output for 3 days after working on a roof, all day in the summer heat.

Effects of the COVID-19 Pandemic on Routine Pediatric Vaccine Ordering and Administration - United States, 2020.

On March 13, 2020, the president of the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic (1). With reports of laboratory-confirmed cases in all 50 states by that time (2), disruptions were anticipated in the U.S.

Temporary vaccine recommendations and provider compliance: a survey of pediatric practices during the 2003-2004 pneumococcal conjugate vaccine shortage.

Objective: Heptavalent pneumococcal conjugate vaccine was in short supply from December 2003 to August 2004. The Centers for Disease Control and Prevention with the American Academy of Pediatrics and the American Academy of Family Physicians made recommendations to providers to withhold third and fourth doses of heptavalent pneumococcal conjugate vaccine to ensure availability for those at highest risk. Previous studies of vaccine shortages have demonstrated that provider compliance with temporary recommendations is low.

Gaps in vaccine financing for underinsured children in the United States.

Context: The number of new vaccines recommended for children and adolescents has nearly doubled during the past 5 years, and the cost of fully vaccinating a child has increased dramatically in the past decade. Anecdotal reports from state policy makers and clinicians suggest that new gaps have arisen in financial coverage of vaccines for children who are underinsured (ie, have private insurance that does not cover all recommended vaccines). In 2000, approximately 14% of children were underinsured for vaccines in the United States.

Influenza vaccination coverage of children aged 6 to 23 months: the 2002-2003 and 2003-2004 influenza seasons.

Background: Beginning in 2002 the Advisory Committee on Immunization Practices encouraged, when feasible, annual influenza vaccination of all children aged 6 to 23 months and household contacts and out-of-home caregivers of children < 2 years of age.

Objective: We sought to report influenza vaccination coverage for the 2002-2003 and 2003-2004 influenza seasons among children aged 6 to 23 months according to demographic and immunization-provider characteristics.

Methods: Data from the 2003 and 2004 National Immunization Survey were analyzed.

Use of a new combined vaccine in pediatric practices.

Objective: On December 13, 2002, Pediarix, a combination vaccine that contains diphtheria, tetanus, acellular pertussis; hepatitis B; and inactivated polio vaccines, was licensed by the Food and Drug Administration for use in the primary immunization series. Use of this vaccine decreases the number of injections that children receive when completing their primary immunization series at the 2-, 4-, and 6-month well-child visits. The objective of this study was to determine the factors that influence the use of this combined vaccine in private pediatric practices, with particular attention to the perceived economic impact of Pediarix and actions taken to address this impact within the private pediatric setting.

Impact of state vaccine financing policy on uptake of heptavalent pneumococcal conjugate vaccine.

Objective: We examined heptavalent pneumococcal conjugate vaccine (PCV7) uptake among children aged 19 to 35 months in the United States and determined how uptake rates differed by state vaccine financing policy.

Methods: We analyzed data from the 2001-2003 National Immunization Survey. States that changed their vaccine financing policy between 2001 and 2003 (n=17) were excluded from analysis.

Disparities between white and African-American children in immunization coverage.

Introduction: A recent study has shown that the national-scale difference in immunization coverage between non-Hispanic white (abbreviated "white") and non-Hispanic African-American (abbreviated "African-American") children aged 19-35 months in the United States has increased by about 1 percentage point annually. We examined how this widening gap differs with geography and income.

Methods: We used data from the National Immunization Survey, 1998-2003, a national telephone survey.

Vaccine shortages: history, impact, and prospects for the future.

Vaccine shortages can result from higher-than-expected demand, interruptions in production/supply, or a lack of resources to purchase vaccines. Each of these factors has played a role in vaccine shortages in the United States during the past 20 years. Since 2000, the United States has experienced an unprecedented series of shortages of vaccines recommended for widespread use against 9 diseases, after more than 15 years without vaccine supply problems.

Differential effects of the DTaP and MMR vaccine shortages on timeliness of childhood vaccination coverage.

Objectives: We determined the effect of diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) and measles, mumps, rubella (MMR) vaccine shortages on timeliness of the third dose of DTaP (DTaP3), the fourth dose of DTaP (DTaP4), and the first dose of MMR (MMR1) among subgroups of preschool children.

Methods: Data from the 2001 and 2002 National Immunization Surveys were analyzed. Children age-eligible to receive DTaP3, DTaP4, or MMR1 during the shortages were considered subject to the shortage, and those not age-eligible were not subject to the shortage; timeliness of vaccinations was compared.

Influenza vaccination of high-risk children: what the providers say.

Background: Despite a longstanding national recommendation to administer influenza vaccine to children at high risk for disease complications, physicians' adherence remains low. This study evaluated physicians' perspectives on previously documented and persistent under-utilization of influenza vaccine for high-risk children.

Methods: A cross-sectional survey mailed in 2001-2002 to a nationally representative sample of 1460 U.

The United States pediatric vaccine stockpile program.

The initial goal of the national vaccine stockpile program was to establish a 6-month supply of all recommended childhood vaccines, to meet national demands if a manufacturing process was interrupted. When the first vaccine stockpiles were created in 1983, the childhood immunization schedule was much less complicated than it is today, and the first stockpiles included only measles-mumps-rubella, poliovirus, and pertussis vaccines, as well as diphtheria and tetanus toxoids. However, today's vaccine needs are much greater, and current stockpiles do not include all recommended childhood vaccines, partially because inclusion of vaccines that are universally recommended, fully implemented, and produced by a single manufacturer has been made a priority.

Status of quality improvement activities to improve immunization practices and delivery: findings from the immunization quality improvement symposium, October 2003.

The Centers for Disease Control and Prevention convened a symposium on 22-23 October 2003 to bring together investigators and stakeholders working to apply the quality improvement (QI) approaches to immunization delivery in individual medical practices. The goal was to identify effective program components and further development of model programs. A call for projects was widely disseminated; of 61 submissions received, eight projects were selected.

Economic evaluation of the 7-vaccine routine childhood immunization schedule in the United States, 2001.

Objective: To evaluate the economic impact of the routine US childhood immunization schedule: diphtheria and tetanus toxoids and acellular pertussis; tetanus and diphtheria toxoids; Haemophilus influenzae type b conjugate; inactivated poliovirus; measles, mumps, and rubella; hepatitis B; and varicella vaccines.

Design: Decision tree-based analysis was conducted using population-based vaccination coverage, published vaccine efficacies, historical data on disease incidence before vaccination, and disease incidence reported for 1995-2001. Costs were estimated using the direct cost and societal (direct and indirect costs) perspectives.

Impact of the introduction of pneumococcal conjugate vaccine on immunization coverage among infants.

Background: The introduction of pneumococcal conjugate vaccine (PCV) to the U.S. recommended childhood immunization schedule in the year 2000 added three injections to the number of vaccinations a child is expected to receive during the first year of life.

The association between having a medical home and vaccination coverage among children eligible for the vaccines for children program.

Background: The Vaccines for Children (VFC) program is designed to reduce the cost of vaccines for vulnerable children, including Medicaid-eligible children, American Indian/Alaska Native children, uninsured children, and underinsured children whose health insurance does not cover the cost of vaccinations. A desired consequence of the program is to promote comprehensive continuous medical care within a medical home for these children.

Objectives: To explore how having a medical home is associated with vaccination coverage among children eligible for the program.

Parental vaccine safety concerns: results from the National Immunization Survey, 2001-2002.

Background: According to the 2002 National Immunization Survey (NIS), vaccination coverage with recommended vaccines among U.S. children aged 19 to 35 months remained near all-time highs.

The feasibility of universal influenza vaccination for infants and toddlers.

Background: Physicians' opinions on the feasibility of routine influenza vaccination of infants and toddlers are unknown.

Objective: To assess the opinions of primary care providers regarding (1) the feasibility of an expanded influenza vaccination recommendation, (2) potential barriers, and (3) current and projected use of immunization reminder systems for influenza vaccination.

Methods: In February 2001, we mailed a 20-item, self-administered survey to a national random sample of pediatricians and family physicians (FPs).