Update on pneumococcal conjugate vaccine shortage

Author: Carrie Morantz, Brian Torrey
Date: April 1, 2004

On February 13, 2004, the Centers for Disease Control and Prevention (CDC) recommended that physicians temporarily suspend routine use of the fourth dose of 7-valent pneumococcal conjugate vaccine (PCV7, marketed as Prevnar) when vaccinating healthy children. This action was taken to conserve vaccine and minimize the likelihood of shortages until Wyeth Vaccines, the only U.S. supplier of PCV7, restores sufficient production capacity to meet the national need. Since that recommendation, PCV7 production has been much less than expected because of continuing problems with the PCV7 vial-filling production line. Shipments have been delayed, resulting in spot shortages that might continue beyond summer 2004 and become widespread.

To ensure that every child is protected against pneumococcal disease despite the PCV7 shortage, the CDC, in consultation with the American Academy of Family Physicians, the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices, recommends that all physicians temporarily discontinue administering the third and fourth dose of PCV7 to healthy children. Physicians should continue to administer the routine four-dose series to children at increased risk for severe disease. Unvaccinated, healthy children 12 to 23 months of age should receive a single dose of PCV7. For children older than two years, PCV7 is not recommended routinely.

Limiting healthy children to two doses of PCV7 will conserve vaccine and permit more children to receive at least two doses. More vaccine is expected to become available for distribution in May and June, but availability cannot be guaranteed.

Physicians should maintain lists of children for whom vaccine has been deferred so it can be administered when the supply allows. The highest priority for vaccination among children who have been deferred is children vaccinated with less than two doses who are younger than one year.

Because data on the long-term efficacy of three-dose or two-dose vaccine regimens are limited, physicians should consider the diagnosis of invasive pneumococcal disease in incompletely vaccinated children and are encouraged to report invasive pneumococcal disease after any regimen of pneumococcal conjugate vaccine to the CDC through state health departments. If a pneumococcal isolate is available from a vaccinated child, the CDC will perform serotyping to determine whether the type is included in the vaccine.

Additional information is available online at http://www.cdc.gov/nip/home-hcp.htm and by telephone, 404-639-2215. Updated information about the national PCV7 supply is available from the CDC at http://www.cdc.gov/nip/news/shortages/default.htm.

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