Vaccine shortage delays shots for many children

http://www.washtimes.com/business/20020117-76890316.htm

Vaccine shortage delays shots for many children
By Kristina Stefanova
THE WASHINGTON TIMES

Medical providers across the country are short on vaccines that protect younger children from diseases, forcing a delay in administering some necessary shots.

     The vaccines, which won't be in full supply before the summer, include those for meningitis, pneumonia, whooping cough and tetanus, the Centers for Disease Control and Prevention said.
     The shortage affects the District's efforts to have all public school students fully inoculated by Jan. 25. The city said it will bar students from attending school if they have not been immunized, but is making an exception for students missing the tetanus booster vaccine, which is given to children at age 10 or 11.
     The shortage stems from two drug makers pulling out of the vaccine market about a year ago. Medical providers are now facing a critical shortage of the vaccines.
     "For the parents, [the shortage] means you take your child for a two-month checkup and can get some vaccines but not all of them," said Dr. Julia McMillan, a pediatrician at Johns Hopkins University School of Medicine. "And you have to come back at some other time and you don't know when."
     The most severe shortage is of Prevnar, a vaccine that protects children from diseases like meningitis. Supplies of tetanus shots are inadequate as well.
     Pediatricians say the tetanus shot is being administered only in cases of emergency, and will be given as routine immunization once the vaccine has been restocked. Their more immediate worry is the shortage of vaccines given to younger children.
     Prevnar, for instance, is supposed to be administered in three doses at 2, 4 and 6 months old, followed by a fourth dose at 12 to 15 months old.
     "The shortages of Prevnar are so great there's been a need to temporarily alter the vaccine's administration recommendations so the fourth dose [is] deferred until a time the supply can be brought up to appropriate standards," Dr. McMillan said.
     At Children's National Medical Center in Washington, pediatricians have altered the schedule similarly so that toddlers receive all but the booster shots. Only children who are at high risk for developing the disease are receiving the full immunization series.
     "The main thing is that you want to get high-risk kids immunized and at least start it on infants because they are the most likely to get sick," said Dr. Jennifer Tender, a pediatrician at Children's. "There are kids who are not adequately immunized and might be at risk for the disease because of the shortage."
     Pediatricians across the nation have been putting pressure on vaccine manufacturers to accelerate production. But that has not helped ease the shortage because the lengthy process of making a vaccine can't be hurried, companies say.
     "There have been sporadic and periodic back orders," said Douglas Petkus, spokesman for Wyett-Ayerst, the maker of Prevnar. "At times, certain physicians' offices have been unable to get the product. But that situation is alleviating itself daily — we're shipping and manufacturing this product 24 hours a day."
     Prevnar became a blockbuster when it reached the market a year ago. Pediatricians flooded the company with orders but, because the vaccine takes six months to make, there is no way to alleviate the shortage immediately, said Mr. Petkus. He would not provide numbers.
     The demand for the vaccine is about 1.5 million doses per month, said Dr. McMillan, who had figures Wyett provided to the American Academy of Pediatrics' Committee on Infectious Diseases. In September, about 700,000 doses were distributed. That number slipped in October but is projected to rise and be adequate by the spring or the summer.
     Wyett used to make two other vaccines that also are now in short supply. One is DTaP, which protects children against diphtheria, tetanus and whooping cough. The other is a booster shot of tetanus, which is recommended to be given to adults every 10 years.
     Wyett stopped making these two after conducting a product portfolio evaluation about a year ago, Mr. Petkus said. The company had to eliminate some products to make room for the new one, Prevnar. Another consideration was two other makers of the DTaP and the tetanus vaccine.
     But one of them, North American Vaccine, was bought by Baxter International Inc. in November 1999, which discontinued production of its DTaP vaccine. This left Aventis Pasteur and GlaxoSmithKline as the only makers of the vaccine.
     The diminished production capacity has led to supplies of the vaccine slowing to a trickle in most state health clinics and doctors' offices.
     "Tetanus is a main problem," Dr. Tender said. "We are not giving it to kids unless they have an injury that would expose them to tetanus, like stepping on a rusty nail or getting a bad cut. For routine immunization, we are holding off on that until the shortage is resolved."
     The tetanus vaccine takes 11 months to produce and "the process can't be accelerated," said Len Lavenda, spokesman for Aventis. "But we're nearing the end of this period for both vaccines," he added, referring to the other vaccine that Aventis makes — DTaP.
     "The shortage of the tetanus vaccine has led to the distribution pattern being only to pediatric offices for infant vaccines and the emergency department. So if you were to go to your internist office for the vaccine, you couldn't get it," Dr. McMillan said. "There's anecdotal evidence of shortages at various pediatricians' offices for almost every vaccine that you can think of."
     "There have been shortages in the past, but often on one vaccine," Dr. Tender said. "It seems today that we're basically short on everything. The one thing there seems to be plenty of is the flu vaccine."
     Many pediatricians, however, say they are seeing less-severe shortages of other vaccines. Among them are chicken pox, measles and hepatitis B.
     • Vaishali Honawar contributed to this report.

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE. THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.