Thousands of vaccinations given last year by the Multnomah County Health Department might have been completely worthless.
WW has learned that seven of the county's clinics flunked a routine state inspection in December. Inspectors found the clinics failed to maintain proper temperatures in the refrigerators and freezers where the inoculations were stored.
Four of the county's nine health clinics failed, as did three of the 12 offices in the county's public schools.
The result: An unknown number of adults and children may be unprotected from diseases like hepatitis, whooping cough and chickenpox because the shots were allowed to get too cold or too warm, possibly rendering them ineffective, according to an inspection report obtained by WW last week. Six vaccines, each with different storage requirements, may have been affected.
Between July and November 2005, 7,681 immunizations were given at the seven sites, during the questionable time periods, county health officials say. The county is also looking into how the temperature problems occurred. "We know the population as a whole is well immunized," said Dave Houghton, the county's director of community health services. "So we don't foresee an undue disease risk. It's not an emergency, just an urgency."
Revaccination is not the only option. For example, it could be determined that some of the vaccines simply need to be used more quickly, Houghton says.
At their lowest cost through federal contracts, vaccines range from $9 to $54 per dose. Doses obtained through other channels can cost twice as much. So even a modest-sized revaccination effort could cost county taxpayers tens of thousands of dollars that could have gone to other uses during a tight budget year.
State officials hope to have a handle on the scope of the problem in the coming weeks. They have not ruled out the possibility of revaccinations.
"We've got one person dedicated to looking at all the vaccines right now from those seven sites and making manufacturer calls and determining which of the vaccines are OK and which aren't," says Mimi Luther, the state's Vaccines for Children (VFC) program coordinator. "From that point we'll go look who got served with what kinds of vaccines."
VFC, which conducts the inspections, is a federal program administered by states that provides free vaccines for poor and uninsured children.
State health officials urged the public to await a fuller analysis before worrying.
"It's better to wait until we knew whether it's an issue or not," says immunization program manager Lorraine Duncan.
The three school sites with too-warm freezers—Madison and Roosevelt High Schools and Portsmouth Middle School—were told to be on the lookout for chickenpox. There has not been a spike in chickenpox reports from those schools.
The Multnomah County Health Department, the umbrella agency over the seven failed facilities, is one of 10 organizations in Oregon to have failed its inspections between 2003 and 2005, according to state records.
The largest revaccination effort during that time period involved a Portland-area clinic, Metropolitan Pediatrics (see "Shooting Blanks?" Jan. 25, 2005), where roughly 3,000 children were asked to get new shots for diphtheria, tetanus and whooping cough.
Here's a list of the Multnomah County clinics that failed the December inspection, and how many vaccinations were given during the period in question:
|HIV Health Services clinic, 426 SW Stark St.||"Appears vaccine frozen during August."||19|
|La Clínica de Buena Salud, 6736 NE Killingsworth St.||"Refrigerator either too cold, too warm or both 40% of the time July through November."||759|
|Northeast Health Center, 5329 NE Martin Luther King Jr. Blvd.||"Freezer too warm 88% of the time from July through November... Refrigerator either too cold, too warm or both 32% of the time."||2,368|
|Mid-County Health Center, 12710 SE Division St.||"Is vaccine stored in 'Supply Room' refrigerator? If yes, vaccine appears to have frozen in July-November."||4,408|
|Madison High School.||"Freezer too warm ~50% of the time in September.... Refrigerator too warm 40% of the days in October and November."||59|
|Portsmouth Middle School.||"Freezer too warm 50% of the time from August to October."||26|
|Roosevelt High School.||"Freezer too warm ~50% of the time in September... Refrigerator too warm 40% of the days in October and November."||42|
|Source: Oregon Department of Human Services|
Emails reveal how state health officials handled the flow of information during a 2004 revaccination effort involving 3,000 kids.
In November 2003, state inspectors found a vaccine refrigerator at Metropolitan Pediatrics in Beaverton was too cold. But the email traffic that followed that inspection was plenty hot.
After working with state and federal officials to determine which vaccines might no longer be effective because of the storage temperature, the clinic recommended revaccinating 3,000 kids for a single vaccine that had been stored in the coldest part of the fridge over the prior two years.
But one of the doctors from the clinic later said he had been fired after he raised a stink about Metropolitan's handling of the problem ["Shooting Blanks," WW, Jan. 25, 2006].
Before filing a lawsuit in January 2006, Dr. Joseph Livingston filed a complaint with the state Bureau of Labor and Industries. His attorney closed that complaint in 2005 to pursue the $7 million civil suit, but the state's investigation made public for the first time emails between state health officials and Metropolitan from the days just before, and just after, the story broke.
Here are a few excerpts:
On Feb. 10, 2004, Department of Human Services spokeswoman Bonnie Widerburg shared with her colleagues a draft letter giving Oregonian reporter Patrick O'Neill a "first shot at the story." Spokesman Jim Sellers replied: "You've told him much of the story, or so Patrick will think. Therefore, to try to avoid him trying to do a 'phoner' as soon as he receives your message, you might want to send this to him early afternoon.... I'd advise slightly changing the first sentence so he doesn't infer that we decided to alert him only after looking at the odds that he'd find out anyway." DHS did not issue a press release alerting other media outlets of the situation.
The Oregonian published a story on the revaccination effort on Feb. 18, 2004.
The next day, Widerburg wrote Sellers that other media outlets were upset about the story being leaked to The Oregonian:
"Several media outlets, including Ch 2 and Ch 8, did follow-up stories. [KGW's] Stephanie Stricklen really took me to task because we did not issue a news release on this. She felt this was a 'huge' story and we really should have let all the media know at once, etc. etc. (Of course she was basically upset because Oregonian had the story first.) Anyway, I did not get into it with her, listened and thanked her for her input. Just wanted you to know—in retrospect, IF the clinic had been more comfortable with being upfront with media, we could have done a collaborative news release. But the fact of the matter was, we had a hard time even convincing them that an alert to The Oregonian was a way to go."
State health officials also offered their support to Metropolitan staffers after the story broke.
Vaccine manager Mimi Luther wrote to clinic office manager Nichole Huyck on Feb. 18: "i heard that you were just hammered with press today ... i'm sure everyone over there is just doing a great job handling all of this." And the following day: "You did such a fantastic job on the TV interviews. I caught three on last night's news—you were just great: calm, focused, real, reassuring. Dr. M, too, was just wonderful. You folks have to come out on top with this."
An email exchange Feb. 19 also reveals that the public hasn't always found out about bad vaccines.
According to the exchange (and supported by other state records), Dr. Gerald Miller of Washington County failed a November 2003 inspection but refused to do a revaccination. "Fortunately for all, there are very few kiddos involved...less than 10 we believe," wrote Luther, noting providers have the discretion of whether or not to revaccinate.