As young students gear up for the first day of school next month, local health officials are warning parents the nation’s limited supply of vaccines that prevent some childhood diseases will impact immunization requirements in Louisiana this school year.

For the second year in a row, officials are not requiring parents to get their pre-kindergarten children diphtheria, tetanus and pertussis shots, or DTaP, before they can enter public school.

Supplies of the state-required vaccination, pediatricians and health officials report, are so critically low there is barely enough to treat newborns.

Widespread vaccination shortages are affecting five other immunization areas, including the pneumococcal infection, measles, mumps, rubella and varicella.

The vaccines have been in short supply since 2000 because some drug companies had dropped out of the market and others had slowed production to upgrade their plants or fix manufacturing problems.

"We’re working on parents to set a timeline for when the medication comes in, but the bottom line is those children still need to be in school," said Linda Joseph, who supervises student services for the Terrebonne Parish school system.

Childhood vaccination shortages are affecting Louisiana’s Office of Public Health the same way they are impacting every other health-care agency across the United States, forcing officials to double-count their limited reserves and preserve vaccinations only for the neediest children.

In the case of DTaP, which Louisiana requires at 2 months, 4 months, 6 months, 12-15 months and 4 years old, the neediest children are babies younger than 12 months or children with severe infections, said Ruben Tapia, immunization manager for the state Office of Public Health.

Every other child, he said, must wait for the shot until supplies are more plentiful, a situation some predict won’t happen until fall 2003.

"Every physician and everyone in the health-care field should be concerned," said Mickey Viator, the Region 3 director of the state public health office. "We vaccinate for a reason and that’s because diseases can occur if immunization drops."

Diphtheria is an infectious disease that affects the throat and makes breathing difficult. Pertussis is the clinical term for whooping cough. Tetanus is the result of an infection that affects the muscles and nerves, usually from a contaminated wound.

"Before vaccines, these epidemics were quite severe, killing large percentages of the population," said Viator.

A NEW PROBLEM

Current childhood vaccine shortages are unique and, in the history of immunization, unprecedented.

At a committee on Senate Governmental Affairs meeting last month, a top health official said his immunization office could not find any single reason for the long-standing shortages, which have typically occurred in the past because few manufacturers produced a particular vaccine.

But in this latest round of shortages, economics are not a factor and neither is cost - there are limited supplies of vaccines that range from $7.63 to $45.99 per dose.

"This puts children at risk, and puts a significant burden on providers to keep track of children they weren’t able to immunize," said Walter Orenstein, director of the National Immunization Program for the Centers for Disease Control and Prevention.

Orenstein blames dozens of factors on the shortages, including manufacturers’ production capabilities, regulatory compliance issues, business decisions to stop producing certain vaccines, and decreases in production and vaccine output.

Unexpected business moves to abandon the immunization market also have impacted supplies, especially in the case of tetanus and diphtheria, or Td. Orenstein said when one major producer stopped making the toxoid Td, the other company was unprepared to satisfy all the new clients. In the case of the DTaP vaccine, two of the four manufacturers abruptly pulled the plug on production.

WHO’S AFFECTED?

The impact of the shortage can be felt by nearly everyone involved in the business of caring for children, including health-care providers, school officials and parents.

The shortage has changed routine immunization recommendations for more than a year, prioritizing limited vaccine supplies for the most vulnerable children.

"We only give it from 2 months to one year," said Judy Naquin, a nurse who works at Terrebonne Parish Medical Center’s Kid Med, which handles most immunization shots in the area. "The shortage has been in affect since last year and it looks like it will last another year."

Naquin said about 450 children’s names are on the DTaP waiting list, to be called back into the office when vaccinations are available.

Changing school immunization requirements has been one of the most effective intervention policies to prevent outbreaks of preventable diseases among school-aged children, said Orenstein, whose office has suspended school entry requirements for some vaccines in dozens of states.

A recent survey of state immunization programs that included Louisiana found that 48 percent of states have made changes to their school entry requirements for Td, and about 10 percent have changed school and day-care requirements for DTaP.

‘PLAYING CATCH UP’

"When vaccine supply improves and the rules are reinstated, school staff will have to ensure that children missing required vaccines have received them," said Orenstein.

While vulnerability to disease increases when children are not vaccinated, officials said there has been no evidence of outbreaks related to the shortage.

At the state public health office in New Orleans, which supplies vaccinations to 50 percent of Louisiana children, officials are working on updating a patient database to keep track of students who started school without the proper immunization.

"So when the time comes, we’ll have those names right there and we can begin playing catch-up," said Tapia.

The database, called LINKS, will be expanded this school year to prepare for next fall, when supplies of the DTaP vaccination are expected to increase.

Last week, Tapia said he received a DTaP shipment of only 3,000 doses, barely enough to satisfy the demands of a single parish.

"That doesn’t help us at all," he said.

AN OUNCE OF PREVENTION

To reach all students who need immunizations next year, Tapia’s office also will spend some time next year reviewing children’s medical records from the past three years to determine how many doses of the five-dose DTaP were actually received.

"We have a lot of work cut out for us, but we have to do it and we have to make sure we get every child," he said.

"There’s always the risk of outbreaks. Could it happen in Louisiana? Yes, it could happen." As parents grow frustrated their children can’t get all their vaccinations in one visit and health-care providers are anxious about keeping track of children missing certain vaccines or doses, federal officials have published a list of recommendations to prevent vaccination shortages from further impacting America’s schoolchildren:

n Changing immunization schedules for each affected vaccine.

n Prioritize using supplies for the most vulnerable children.

n Deferring boosters and shots given later in the dosage series.

n Working with state immunization programs and health-care providers to inform parents about changes.

SUPPLY AND DEMAND

But the problem with monitoring vaccinations is that many times the amount available rests solely on the whims of the immunization manufacturer.

To better control the situation, Orenstein said his department is learning to work with this reality and trying to involve more organizations in the process of making immunization demands reflect supplies, bridging the gap between state immunization offices and vaccine manufacturers.

A report with recommendations for preventing future shortages is expected from the National Vaccine Advisory Committee later this summer.

And the U.S. General Accounting Office is expected to release another later this month detailing the factors related to the current vaccine shortages.