2774. Impact of Yellow Fever Vaccine and Recombinant Zoster Vaccine Shortages on Patients Presenting to a Travel Clinic

Abstract

BackgroundIn 2017, the United States experienced a national shortage of the yellow fever vaccine (YF-Vax). In response to this, the US Food and Drug Administration (FDA) approved the use of Stamaril in a limited number of clinics across the country. This was soon followed by a shortage of the recently approved recombinant zoster vaccine (RZV) in 2018. This project describes the impact of both vaccine shortages on patients presenting to the Travel Health Clinic at Froedtert and the Medical College of Wisconsin.MethodsA retrospective review of Travel Health Clinic medical records between January and December of 2018 was performed. Information regarding patient demographics, travel destination, vaccination rates, reasons for not vaccinating, and referral information was obtained.ResultsOf the 306 patients seen in 2018, 98 were traveling to countries with active yellow fever transmission. Due to the YF-Vax shortage, 59.2% of these patients were referred to another clinic for Stamaril and 7.1% were unable to get the vaccine before departure. The remaining patients qualified for a medical exemption, had an itinerary that was lower risk for yellow fever, or their subsequent vaccine history was unknown. Additional cost for Stamaril at referral locations ranged from $169.50-$315.00 per person with a travel distance of 15–272 miles to the referred clinic. Regarding RZV, 134 clinic patients were qualified to receive the vaccine. 57.5% did not receive RZV due to vaccine shortage, 15.7% were referred to another clinic for RZV, while 15.7% were able to receive the vaccine during their appointment. Of these patients, 31.3% were covered under Medicare, thus necessitating referral to a pharmacy for vaccine coverage.ConclusionWe encountered high rates of unvaccinated travelers who would have qualified for and benefitted from YF-Vax and RZV in 2018. Even among those who could receive the recommended vaccines, there was substantial additional cost and inconvenience. This illustrates the considerable negative impact of the YF-Vax and RZV vaccine shortages. Further efforts are necessary to make these vaccines more accessible to the community.Disclosures All authors: No reported disclosures.