Notice to Readers: Update: Supply of Diphtheria and Tetanus Toxoids
and Acellular Pertussis Vaccine
Diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) remains
in short supply, and the shortage will continue into mid-2002
(1). Shortages are greatest in the public sector. Despite high vaccination rates, pertussis continues to
cause serious illness and death, particularly among infants aged <6 months who are
too young to have completed the 3-dose primary series of DTaP. In 2000, a total of
1,873 pertussis cases (rate: 99 per 100,000 infants aged <6 months) and 16 deaths
were reported among infants aged <6 months. Vaccinating infants on time with the
3-dose primary series of DTaP to protect them from serious disease remains a priority
during this vaccine shortage.
The shortage began in 2000 when two manufacturers (Wyeth Lederle, Pearl
River, New York, and Baxter Hyland Immuno Vaccines, Baltimore, Maryland)
stopped production of DTaP (1). Aventis Pasteur (Swiftwater, Pennsylvania)
and GlaxoSmithKline (Philadelphia, Pennsylvania), producers of
Tripedia® and
Infanrix™, respectively, are the only two U.S. suppliers.
DTaP is recommended as a 5-dose series: 3 doses administered to infants at
ages 2, 4, and 6 months, followed by 2 additional doses at age 15--18 months and at age
4--6 years (2). During the shortage of DTaP, the Advisory Committee on
Immunization Practices recommends that providers who do not have enough DTaP to vaccinate
all children with 5 doses give priority to vaccinating infants with the first 3 doses.
To ensure an adequate supply of DTaP to vaccinate infants, providers should first
defer vaccination of children aged 15--18 months with the fourth DTaP dose. If deferring
the fourth dose does not leave enough DTaP to vaccinate infants, then the fifth DTaP
dose (given to children aged 4--6 years) also should be deferred*. In areas with
severe DTaP shortages, local public health officials might elect to recommend
communitywide deferral of the fourth DTaP dose, and, if necessary, the fifth DTaP dose.
When the DTaP shortage ends, providers should recall and administer DTaP to
all children who missed a dose. Vaccination of children aged 4--6 years is needed
to ensure immunity to pertussis, diphtheria, and tetanus during the elementary
school years (2).
*Children traveling to countries where the risk for diphtheria is high should be
vaccinated according to the Recommended Childhood Immunization Schedule
(3). Travelers might be at increased risk for exposure to toxigenic strains of
Corynebacterium diphtheriae, especially with prolonged travel, extensive contact with children, or exposure to
poor hygiene. High-risk countries include
Africa---Algeria, Egypt, and sub-Saharan
Africa; Americas---Brazil, Dominican Republic, Ecuador, and Haiti;
Asia/Oceania---Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Iran, Iraq, Laos, Mongolia,
Myanmar, Nepal, Pakistan, Philippines, Syria, Thailand, Turkey, Vietnam, and Yemen; and
Europe---Albania and all countries of the former Soviet Union.
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