Issue Number
210 November
17,
2000
CONTENTS OF THIS ISSUE
- CDC publishes supplemental ACIP recommendations on use
of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine (DTaP)
- CDC publishes notice about the shortage of adult tetanus
and diphtheria toxoids (Td) vaccine
- New! CDC's "Best Practices for Mass Influenza
Vaccination Campaigns" on IAC's website
- CDC website offers clinical questions and answers on
influenza
- Merck's hepatitis A vaccine gets supplemental approval
for extended use
- CDC reports on progress toward polio eradication in the
Eastern Mediterranean Region
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(1)
November 17, 2000
CDC PUBLISHES SUPPLEMENTAL ACIP RECOMMENDATIONS ON USE OF DIPHTHERIA TOXOID-TETANUS TOXOID-ACELLULAR PERTUSSIS
VACCINE (DTaP)
The Centers for Disease Control and Prevention (CDC) published a statement titled "Use of Diphtheria
Toxoid-Tetanus Toxoid-Acellular Pertussis Vaccine as a Five-Dose Series: Supplemental Recommendations of the Advisory
Committee on Immunization Practices (ACIP)" in the November 17, 2000, issue of "MMWR Recommendations and Reports"
(vol. 49, no. RR-13).
This 16-page report contains information on adverse reactions after the fourth
and fifth doses of a series, including limb swelling after booster doses, as well
as the supplemental recommendations for using DTaP vaccines.
The MMWR summary of the ACIP statement follows. Use the links provided following the summary to obtain the full
statement.
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SUMMARY
Four vaccines containing diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) are currently licensed
in the United States for use among infants and young children. As of October 2000, two products,
ACEL-IMUNE (a product of Lederle Laboratories) and Tripedia (Aventis Pasteur, Inc.) were licensed for the five-dose DTaP
vaccination series. Two other vaccines, Infanrix (SmithKline Beecham Biologicals) and Certiva (North
American Vaccine, Inc.) are licensed for the first four doses of the vaccination series, beginning with the primary
series at ages 2, 4, and 6 months, and for completing the DTaP series among children who began the
series with diphtheria and tetanus toxoids and whole-cell pertussis vaccine.
This report supplements the statement from CDC's Advisory Committee on Immunization Practices regarding use
of acellular pertussis vaccines and summarizes data regarding reactogenicity of acellular pertussis vaccines
when administered as the fourth and fifth consecutive doses. Increases in the
frequency and magnitude of local reactions at the injection site with increasing dose number
have occurred for all currently licensed DTaP vaccines. Extensive swelling of the injected limb, sometimes
involving the entire thigh or upper arm, after receipt of the fourth and fifth doses of DTaP
vaccines has been demonstrated for multiple products from different manufacturers. Because data are insufficient regarding the
safety, immunogenicity, and efficacy of using DTaP vaccines from different manufacturers in a mixed sequence, ACIP
continues to recommend that, whenever feasible, the same brand of DTaP vaccine be used for all doses in
the vaccination series. When the vaccine provider does not know or does not have available the type of DTaP vaccine
previously administered, any of the licensed DTaP vaccines can be used to complete the vaccine series.
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To view the complete text of "Use of Diphtheria Toxoid-Tetanus Toxoid-Acellular Pertussis Vaccine as a Five-Dose
Series: Supplemental Recommendations of the Advisory Committee on Immunization Practices
(ACIP)" online in text (HTML) format, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr4913a1.htm
To obtain a camera-ready copy (PDF format) of the entire supplemental ACIP statement, go to:
http://www.cdc.gov/mmwr/PDF/rr/rr4913.pdf
For copies of the Vaccine Information Statement (VIS) for DTaP in 23 languages, go to:
http://www.immunize.org/vis/#dtap
To find out more about Vaccine Information Statements (VISs) and the federal
requirements for their use, visit: http://www.immunize.org/vis/
For instructions on how to obtain a free electronic subscription to the MMWR,
see the information following story six below.
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(2)
November 17, 2000
CDC PUBLISHES NOTICE ABOUT THE SHORTAGE OF ADULT TETANUS AND DIPHTHERIA TOXOIDS (Td) VACCINE
CDC published a Notice to Readers titled "Shortage of Tetanus and Diphtheria
Toxoids" in the November 17, 2000, issue of MORBIDITY AND MORTALITY WEEKLY REPORT (MMWR).
The text of the notice (without the endnotes) follows:
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SHORTAGE OF TETANUS AND DIPHTHERIA TOXOIDS
A temporary shortage of adult tetanus and diphtheria toxoids (Td) in the United
States has resulted from two coincident situations: 1) a decrease in the number of lots
released by Wyeth Lederle (Pearl River, New York), and 2) a temporary decrease in inventory of vaccine following
routine maintenance activities at the production facilities by Aventis Pasteur (Swiftwater,
Pennsylvania) that lasted longer than anticipated. Approximately one half of
the usual number of Td doses has been distributed this year. Although there have been no decreases in production of
tetanus toxoid (TT), availability is low because of increased use during the Td shortage. On the basis of
information provided by Aventis Pasteur, the Public Health Service expects vaccine
supplies to be restored early in 2001. Until then, Aventis Pasteur will be limiting orders
to assure the widest possible distribution of available doses.
The shortage will only impact persons aged 7 years and older who 1) require tetanus prophylaxis in wound
management, 2) have not completed a primary series (three doses) of vaccine containing Td, or 3) have not been
vaccinated during the preceding 10 years with Td, diphtheria and tetanus toxoids and
acellular pertussis vaccine (DTaP) or diphtheria and tetanus toxoids (DT). This
shortage will not affect vaccination of children aged less than 7 years who require additional doses of a vaccine-containing TT; they should receive
DTaP or pediatric DT, which are not in short supply. Td is preferred to TT because Td provides protection against both tetanus and
diphtheria. However, during this shortage, if Td is not available, TT can be used as an alternative for
persons aged 7 years and older who require immediate boosting with TT (e.g.,
wound management), or who are unlikely to return to a clinic if vaccination is
delayed. If TT is administered, patients and health-care providers must weigh
risks and benefits of subsequent vaccination with Td. Arthus-type reactions may occur among persons who receive
multiple doses of TT, especially within short intervals (less than 10 years). However, if vaccination with Td is
delayed for greater than 10 years following their last Td administration, persons may
be protected inadequately against diphtheria.
Clinics experiencing shortages of Td may need to prioritize their use of available supplies. If administration of Td is
delayed, clinics should implement a call-back system when vaccine is available. Recommendations for use
(highest to lowest priority) of Td are:
- Persons traveling to a country where the risk for
diphtheria is high.
- Persons requiring tetanus vaccination for prophylaxis in
wound management.
- Persons who have received fewer than 3 doses of vaccine
containing Td.
- Pregnant women and persons at occupational risk for
tetanus-prone injuries who have not been vaccinated with Td within the preceding 10
years.
- Adolescents who have not been vaccinated with a vaccine
containing Td within the preceding 10 years.
- Adults who have not been vaccinated with Td within the
preceding 10 years.
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To view the complete text of this notice online, including the references, go to:
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4945a3.htm
For information on how to obtain a free electronic subscription to the MMWR,
see the information following story six below.
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(3)
November 17, 2000
NEW! CDC'S "BEST PRACTICES FOR MASS INFLUENZA VACCINATION CAMPAIGNS" ON IAC'S WEBSITE
IAC has added another new CDC resource to its website. "Best Practices for Mass Influenza Vaccination Campaigns"
is a one-page education piece developed by CDC to help health professionals ensure that people at high risk
and their households are vaccinated against influenza. This resource lists general strategies for conducting a
vaccination campaign as well as specific strategies that can be employed at the vaccination location.
To obtain a copy of this resource, go to: http://www.immunize.org/vis/flupract.pdf
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(4)
November 17, 2000
CDC WEBSITE OFFERS CLINICAL QUESTIONS AND ANSWERS ON INFLUENZA
Still have questions about influenza as the 2000-01 flu season is about to begin? CDC offers an updated online
resource for clinicians titled "Influenza Disease and Complications: Questions and Answers." This set of thirteen
common questions and answers provides information about influenza disease and influenza vaccine to health
professionals and others.
To obtain these questions and answers, go to:
http://www.cdc.gov/nip/Flu/qa-public.htm
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(5)
November 17, 2000
MERCK'S HEPATITIS A VACCINE GETS SUPPLEMENTAL APPROVAL FOR EXTENDED USE
The Food and Drug Administration has approved a supplemental license for Merck's hepatitis A vaccine,
VAQTA. The new approval extends the age range for the pediatric dose of VAQTA an extra year--it is now approved
for use from age 2 through age 18 instead of from age 2 through age 17.
The new approval also extends the timing of the adult formulation booster dose
of VAQTA from six months following the initial dose to an interval of six to
twelve months.
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(6)
November 17, 2000
CDC REPORTS ON PROGRESS TOWARD POLIO ERADICATION IN THE EASTERN MEDITERRANEAN REGION
CDC published an article titled "Progress Toward Poliomyelitis Eradication--Eastern Mediterranean Region,
1999-September 2000" in the November 17, 2000, issue of MMWR.
According to the Editorial Note, progress has been remarkable and by the end
of 2000, poliovirus transmission probably will be interrupted in all but four
Eastern Mediterranean Region countries. The Note states in part: "Improved local level planning and supervision, house-to-house vaccination, community
mobilization, and heightened political commitment have enabled vaccination of
an increasing number of children, especially among hard-to-reach and high-risk populations."
For the complete text of this article, go to: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm4945a2.htm
HOW TO OBTAIN A FREE ELECTRONIC SUBSCRIPTION TO THE MMWR:
To obtain a free electronic subscription to the "Morbidity and Mortality Weekly
Report" (MMWR), visit CDC's MMWR website at: http://www.cdc.gov/mmwr
Select "Free MMWR Subscription" from the menu at the left of the screen. Once
you have submitted the required information, weekly issues of the MMWR and all new ACIP statements (published as
MMWR's "Recommendations and Reports") will arrive automatically by e-mail.
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