Notice to Readers: Resumption of Routine Schedule for Tetanus
and Diphtheria Toxoids
The supply of adult tetanus and diphtheria toxoids (Td) in the United States has become sufficient to permit
the resumption of the routine schedule for Td use as recommended by the Advisory Committee on Immunization Practices
(1,2). Adolescents and adults for whom routine Td booster doses were deferred should be recalled by their health-care
providers to receive the delayed dose. School attendance provisions requiring students to have received a Td booster at age
>11 years can be reinstituted.
The Td shortage began in the last quarter of 2000 and resulted from 1) decreased production in 2000 by both
U.S. manufacturers (Wyeth Lederle [Pearl River, New York] and Aventis Pasteur [Swiftwater, Pennsylvania]), 2) the decision
by Wyeth Lederle to cease Td production in 2001, and 3) the 11-month period required for vaccine production, which led to
a lag before increased Td supplies were available from the remaining manufacturer distributing vaccine nationally
(Aventis Pasteur) (3--5). The amount of Td distributed nationally decreased 40% during 2001--2002, compared with
preshortage distribution levels (Biological Surveillance System, unpublished data, 2002). To ensure vaccine availability for
priority indications (3), CDC recommended in May 2001 that all routine Td boosters in adolescents and adults be deferred and
that health-care providers record the names of patients whose booster doses were delayed for call-back once Td supplies
are restored (5). Health-care providers should review the vaccination status of their patients and administer Td and
other indicated vaccines as appropriate.
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