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December 7, 2001

Pneumococcal Conjugate Vaccine Vote

The Advisory Committee on Immunization Practices (ACIP) voted today to temporarily revise recommendations for the pneumococcal conjugate vaccine due to continued shortages of the vaccine that are insufficient to allow full implementation of the 4 dose schedule for infants.
      Pneumococcal conjugate vaccine is highly effective in preventing invasive pneumococcal disease in young children.  Prior to the introduction of PCV-7, pneumococcal infections caused approximately 700 cases of meningitis, 17,000 cases of bacteremia - blood stream infections - and 200 deaths each year in children under age five.  Meningitis is the most severe type of pneumococcal disease.  About five percent of children under 5 years old with pneumococcal meningitis will die of their infections.
      The ACIP had previously revised recommendations for the vaccine on September 14, 2001, for shortages, which at the time were anticipated to be brief.  However, according to manufacturer estimates, about 1.2 million doses of vaccine will be distributed per month through March 2002, less than the 1.5 million doses per month needed, based on current demand.
      The shortage of the vaccine is due to a rapid increase in demand and manufacturing problems that have prevented the manufacturer from producing at full capacity.  The shortage is expected to continue until mid-2002, depending on adherence with the revised recommendations.
      The ACIP is making revised recommendations to limit pneumococcal conjugate vaccine use until supplies are adequate.  Two key principles underlie the revised recommendations.  First, providers should conserve vaccine supply by decreasing the number of doses administered to healthy infants, rather than leaving some children in the group recommended for vaccination completely unprotected.  Second, changes in pneumococcal conjugate vaccine use and ordering should be made by all providers, regardless of the current vaccine supply in their own practice.
      The ACIP revised recommendations are as follows:
 

1) High risk children less than 5 years of age should continue to be vaccinated as recommended by the ACIP in October 2000.

2) Healthy infants and children less than 24 months old should receive a decreased number of pneumococcal conjugate doses based on the age at which vaccination is initiated and the providers estimate of vaccine supply in their practice.  All providers should defer the 4th dose for infants who are vaccinated beginning at less than 6 months of age.  Additional recommendations to decrease vaccine use are included in the specific recommendations adopted by the Committee. (Guidelines will be given when the recommendations are published in CDC's Morbidity and Mortality Weekly Report).

3) Further studies should be done to evaluate the immune response to a pneumococcal polysaccharide vaccine booster dose among children 12-15 months of age.  Polysaccharide vaccine is recommended for children more than 2 years old who are at increased risk of invasive pneumococcal infection.  It is not licensed for use in children less than 2 years old.

4) Providers should maintain a list of children for whom PCV-7 has been deferred so that it can be administered when the supply situation improves.

DTAP Vote

The ACIP voted to continue prior CDC recommendations (published March 16, 2001) for providers who had insufficient quantities of DTaP vaccine due to spot shortages of the vaccine.  The recommendation applies only to providers with insufficient quantities of DTaP vaccine and recommends that they prioritize vaccinating infants with the initial three DTaP doses, and if necessary, to defer the fourth DTaP dose.  The ACIP also added that if deferring the fourth DTaP dose still does not provide enough vaccine to vaccinate infants with three DTaP doses, then the fifth DTaP dose can be deferred.  When adequate DTAP vaccine becomes available, steps should be taken to recall all children who did not receive a DTaP dose for remedial immunization.  Children should be vaccinated in accordance with existing ACIP recommendations to assure immunity to pertussis, diphtheria and tetanus during the elementary school years.
      The vaccine protects against Diphtheria, Tetanus, and Pertussis or whooping cough.  Diphtheria, tetanus, and pertussis are serious diseases caused by bacteria.  Diphtheria and pertussis are spread from person to person.  Tetanus enters the body through cuts or wounds.