Pertussis

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, NewYork, and Baxter Hyland Immuno Vaccines, Baltimore, Maryland) stopped production of DTaP (1). Aventis Pasteur (Swiftwater, Pennsylvania) and GlaxoSmithKline (Philadelphia, Pennsylvania), producers of Tripedia[R] and Infanrix[TM], 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.

References

(1.) CDC. Update on the supply of tetanus and diphtheria toxoids and of tetanus and diphtheria toxoids and acellular pertussis vaccine. MMWR 2001;50:189-90.

(2.) CDC. Pertussis vaccination: use of acellular pertussis vaccine among infants and young children--recommendations of the Advisory Committee on Immunization Practices. MMWR 1997;46(no. RR-7).

(3.) CDC. Recommended childhood immunization schedule--United States, 2001. MMWR 2001;50:7-10, 19.

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