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By Susan J. Landers, AMNews staff. June 17, 2002. Additional information

Washington -- Over the next few months, supplies of DTP vaccine should return to normal, and physicians will be able to pick up where they left off with patients' immunization schedules.

It is a certainty that children will be the main recipients of the renewed supplies, because adults have apparently managed to avoid their routine diphtheria/tetanus booster -- a practice begun well before the vaccine shortage.

A substantial number of adults in the United States do not have antibody levels that protect them against the two diseases, according to a recent Centers for Disease Control and Prevention study of serologic data on 18,045 people 6 and older.

Only 60% of Americans were protected from diphtheria and 72% were protected against tetanus, according to the study, which was conducted by researchers at the CDC's National Center for Health Statistics.

The study, which was published in the May 7 issue of the Annals of Internal Medicine, reinforces what has been known for several years, namely that most cases of tetanus occur in women older than 60 who had not received even the primary series of DTP shots. Older men are more likely to have protection from immunizations received while in the armed forces or from boosters following on-the-job injuries.

The CDC's Advisory Committee on Immunization Practices recommends that the adult formulation of diphtheria and tetanus toxoids be given every 10 years beginning at 11 or 12. Infants and younger children receive the combined primary series consisting of diphtheria and tetanus toxoids and the acellular pertussis vaccine.

Although diphtheria and tetanus are rare diseases in the United States, strains of the diphtheria bacteria continue to surface, the researchers note. Multiple strains of diphtheria bacteria recorded in 1996 in a Native American community were closely related to strains identified in the same area from 1979 to 1983, suggesting the continuing presence of the bacteria.

Proponents of adult immunization say the study findings should serve as a warning.

"Once the shortage is over, physicians should actively search out those people who are out of date and bring them up to date," said Marty Roper, MD, a medical epidemiologist at the CDC. Dr. Roper was not a researcher on the recent CDC study.

The shortage of tetanus and diphtheria toxoids the past two years is expected to subside by late summer or early fall, said William Schaffner, MD, chairman of Preventive Medicine at Vanderbilt University.

So everyone who has been deferred could, by the end of the summer, find their way back into their doctors' offices to pick up their booster shots, he said. "We are very optimistic about that," said Dr. Schaffner, who is also a member of the Governing Council of the Infectious Diseases Society of America.

To ensure sufficient supplies of the vaccine during the shortage, the vaccine advisory committee had recommended that priorities be set. People traveling to countries where the risk of diphtheria was high or patients who received a wound or burn were given top priority. Adults who had not received a booster in the preceding 10 years fell to the bottom of the list.

Although the need for boosters had long been established by the CDC, adults and their physicians were not heeding that recommendation long before the shortage, according to the study.

"As an adult provider myself, I know we don't provide immunization services to our adult population as assiduously as we do to children," Dr. Schaffner said.

He added that the problem goes well beyond the Td vaccine to include such adult vaccines as those for hepatitis B and pneumococcal disease.

The lack of insurance coverage for adult vaccination is one reason for the difference, he said. But a second reason is that "we have pretty darn good vaccines for adults, but we have absolutely brilliant vaccines for children," he said.

Dr. Schaffner predicted that in the next 10 years adult vaccines will be available for scourges such as HIV. Physicians and patients should be working to perfect the system by delivering the vaccines available, he added.

Dr. Schaffner also likes to paraphrase Voltaire when colleagues cast some aspersions on today's vaccines. "Waiting for perfection is the greatest enemy of the current good," he said.

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