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Childhood Vaccines in Short Supply

Experts recommend delay in some booster shots

MONDAY, Jan. 7, 2002 (HealthDayNews) -- It looks like 2002 will go down as the year of shortages -- at least as far as childhood vaccines are concerned.

First, there are shortages of the pneumococcal vaccine, or PCV, which helps guard against diseases caused by various strains of Streptococcus pneumoniae. Also in short supply is the DtaP vaccine, which protects against tetanus, diphtheria and whooping cough. And the varicella, measles-mumps-rubella (MMR) and hepatitis B vaccines are on back-order for some clinics and doctors in private practice.

In the annual childhood immunization schedule, which appears in the January issue of Pediatrics, medical experts are recommending that healthy infants receive only the first three doses of the pneumococcal vaccine -- at 2, 4 and 6 months of age. The fourth dose, or "booster shot," should be deferred until supplies have returned to normal, hopefully by spring, according to the Centers for Disease Control and Prevention (CDC). The fourth shot is usually given when a child turns 1.

Experts are also suggesting that healthy, and not just sickly, children get the influenza vaccine. And they are urging that all newborns get the hepatitis B vaccine before they are discharged from the hospital.

The immunization schedule is drawn up by the American Academy of Pediatrics (AAP), the CDC's Advisory Committee on Immunization Practices Prevention, and the American Academy of Family Physicians.

Although the pneumococcal vaccine is only 1½ years old, physicians have high hopes it can help combat bacterial meningitis, blood stream infections and pneumonia in children younger than 5.

"That vaccine actually has the potential to save a couple of hundred lives of children every year," says Dr. Julia A. McMillan, professor of pediatrics at Johns Hopkins School of Medicine and a member of the AAP Committee on Infectious Diseases.

Right now, priority for the pneumococcal vaccine is being given to high-risk children, such as those with sickle-cell anemia or HIV. All other children will have to wait for their fourth shot, McMillan says.

The vaccine shortages are due primarily to manufacturing problems. Those, in turn, are due to more stringent quality control and production issues. Physicians aren't sure what impact the delay will have on childrens' immunity.

"If you get at least two doses as an infant, the protection is very good for six of the seven strains included in the vaccine," says McMillan. "How long those [initial doses] would last without a booster isn't known."

The shortage of the DtaP vaccine occurred when two manufacturers stopped producing it, leaving the remaining two companies struggling to make up the shortfall. So far, the shortages have varied from region to region, and are being felt more acutely in public clinics.

"It's basically get them while you can," says McMillan.

The consortium is asking doctors to give priority to children who need the first three doses of the DtaP vaccine. Children who have to go without the fourth and fifth doses are not likely to experience immediate threat from diphtheria or tetanus.

Pertussis [whooping cough], on the other hand, "is with us all the time," says McMillan, but some doses of the vaccine should give your child some immunity. Vaccine supplies are expected to return to normal by the end of March. The three vaccines on back-order are not in short supply yet.

Supplies of all other vaccines, including the influenza vaccine, are plentiful.

"The most important thing parents need to do is to fight for their children to be immunized," says McMillan. "These vaccines save lives every single day, and I think the government often takes them for granted."

"What are we doing that allows manufacturers without warning to stop producing, leaving children unprotected?" she adds. "I'm not sure what the right solution is, but it's important we understand it's a big problem."

What to Do: Updated information on vaccine release and supply, as well as statements on specific vaccines, can be found at the AAP, and at the CDC's National Immunization Program.

SOURCES: Interview with Julia A. McMillan, M.D., FAAP, professor, pediatrics, Johns Hopkins School of Medicine, Baltimore, and member, American Academy of Pediatrics Committee on Infectious Diseases; January 2002 Pediatrics; January 2002 AAP News
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