Immunization Action Coalition and the Hepatitis B Coalition

IAC EXPRESS

Previous issues index

IAC Home page

Issue Number 210            November 17, 2000

CONTENTS OF THIS ISSUE

  1. CDC publishes supplemental ACIP recommendations on use of diphtheria toxoid-tetanus toxoid-acellular pertussis vaccine (DTaP)
  2. CDC publishes notice about the shortage of adult tetanus and diphtheria toxoids (Td) vaccine
  3. New! CDC's "Best Practices for Mass Influenza Vaccination Campaigns" on IAC's website
  4. CDC website offers clinical questions and answers on influenza
  5. Merck's hepatitis A vaccine gets supplemental approval for extended use
  6. CDC reports on progress toward polio eradication in the Eastern Mediterranean Region

----------------------------------------------------------

Back to Top

(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. 

****************

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.

****************

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.
------------------------------------------------------------

Back to Top

(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:

****************

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:

  1. Persons traveling to a country where the risk for diphtheria is high.
  2. Persons requiring tetanus vaccination for prophylaxis in wound management.
  3. Persons who have received fewer than 3 doses of vaccine containing Td.
  4. Pregnant women and persons at occupational risk for tetanus-prone injuries who have not been vaccinated with Td within the preceding 10 years.
  5. Adolescents who have not been vaccinated with a vaccine containing Td within the preceding 10 years.
  6. Adults who have not been vaccinated with Td within the preceding 10 years.

****************

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.
------------------------------------------------------------

Back to Top

(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
------------------------------------------------------------

Back to Top

(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
------------------------------------------------------------

Back to Top

(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.
------------------------------------------------------------

Back to Top

(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. 

 

Immunization Action Coalition1573 Selby AvenueSt. Paul MN 55104
E-mail: admin@immunize.org Web: http://www.immunize.org/
Tel: (651) 647-9009Fax: (651) 647-9131

This page was updated on February 15, 2002