http://bmj.com/cgi/content/full/323/7310/418/a
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Deborah Josefson
The US Centers for Disease Control and Prevention (CDC) has asked doctors to
delay giving children their last injection of the tetanus,
pertussis, and diptheria (DTP) vaccine until they are 4 years
old because of a nationwide shortage of tetanus and diphtheria
toxoids in the United States (MMWR 2001;50:189-90.)
Ordinarily, the fourth injection is given between ages 15 and
18 months. The vaccine is in short supply because the pharmaceutical company
Wyeth Lederle stopped producing tetanus and diphtheria toxoid last
year, leaving Aventis Pasteur as the only US supplier.
The CDC is requesting that all routine tetanus boosters for adults and
adolescents be delayed until April of 2002. Booster injections
are normally given every 10 years.
Tetanus and diptheria toxoid should be reserved for those most at risk.
These include pregnant women who have not been vaccinated with the
toxoid within the previous 10 years; people travelling to
countries where diphtheria is endemic; and those at high risk of
wound infection (such as people with diabetes, those who have been
burned or have frostbite, those with puncture and crush wounds, and
immunocompromised patients); and those with wounds contaminated with
dirt, faeces, soil, or saliva.
Aventis Pasteur has increased production of the toxoids to fill the need,
but the manufacturing process takes at least 11 months. The
company plans to have sufficient vaccine by early 2002 to
supply the national demand.
© BMJ 2001
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