http://www.news-press.com/news/today/020612vaccinations.html
By ANDI ATWATER,
aatwater@news-press.com
A nationwide shortage of certain vaccines has Fort Myers doctor Teresa Stevens at odds with her promise to provide well-baby care to all her young patients.
 CAUGHT IN CRUNCH: Devon Bryce, 15 months, is comforted by his mother, Jan Bryce, during an examination by Dr. Teresa Stevens. Pediatricians are dealing with a national shortage of vaccines, many of which might not be relieved until December. (STEPHEN HAYFORD/news-press.com) Click on image to enlarge. |
“This is the first time we’ve had to tell people, we can’t give you everything because it’s back ordered,” said Stevens, a pediatrician with Island Coast Pediatrics.
“We’re telling them we think vaccinations are important, but we don’t have any, but it’s OK, don’t worry — it sends mixed messages to parents.”
For about a year and a half now, manufacturing problems have created a shortage of five of the vaccines that protect against eight infectious diseases, including whooping cough, tetanus and diphtheria.
The shortage has caused states to ration limited supplies, forcing health departments and private doctors to find creative ways to serve their patients while warding off the potential for new outbreaks of old diseases.
In Lee County that has meant deferring certain booster shots and giving extensions that would allow a child to enter preschool or kindergarten without all the required boosters, health officials said.
As parents here begin the back-to-school shuffle, many will find that their 4-year-old or seventh-grader may have to wait for booster inoculations.
“We’re deferring them until Dec. 31,” said Nancy Creveling, immunizations supervisor for the Lee County Health Department. “Once we do get the supply, we will call everyone to come in. We’re hoping to have it by the end of summer.”
Creveling said she’s had to defer 209 children for the DTaP booster, the vaccine against diphtheria, tetanus and pertussis given to children up to 7 years old. She’s also deferred 1,500 seventh-graders for the Td booster for tetanus and diphtheria.
The shortage also includes a relatively new vaccine called Prevnar, which protects against several pneumococcal bacteria strains, a leading cause of ear infections in children.
Health officials here are giving it to all babies, but deferring the third and fourth booster shots.
They’re also short on the chickenpox vaccine, which Lee County health officials say they hope will be caught up by the end of July.
The MMR vaccine for measles, which has been in short supply across the nation, has not been a problem here except for private doctors who are sending patients to the health clinic.
“It makes it very inconvenient for our workers and our patients when we have to send them to the hospitals or the health department to get a vaccine,” said Pauline McVay, office manager for First Care Medical Center in Fort Myers, which sees a number of patients who need tetanus shots.
“It’s cheaper if we can give it rather than have someone go to the emergency room. But if we don’t have it, what can we do?”
It’s not a perfect system, but health officials said it works because it still allows babies their initial shots and adults their emergency tetanus shots in case of cuts.
“The younger kids are boostered for added protection and for the protection of siblings who aren’t fully immunized,” Creveling said. “It’s like herd immunity — everybody around us has been immunized, so hopefully no one will get sick until we’re caught up.”
Health experts say that the risk of epidemics is minimal. But if the shortage isn’t remedied by the end of this year as predicted, some areas might see outbreaks of diseases that doctors haven’t dealt with in up to 30 years.
“We’ve got whole generations of parents now who’ve never seen a child with measles and a lot of new doctors who’ve never seen a child with measles,” said Lynn Carroll, public health adviser for the Centers for Disease Control’s National Immunization Program.
The center maintains tabs on available vaccines and writes recommendations on how to stretch that supply as far as possible.
“We can’t predict what effect this might have,” Carroll said. “It’s only reasonable to believe that if vaccines are in short supply, the disease these vaccines are protecting children against could reoccur.”
Before the measles vaccine was introduced in 1963, the United States saw about 4 million cases per year and about 2,000 deaths from it.
The vaccine resulted in a 99 percent reduction in measles with fewer than 100 cases today — mostly imported, health experts say.
But outbreaks do sometimes occur, said Cody Meissner, chief of pediatric infection services at Tufts New England Medical Centers and a member of the American Academy of Pediatrics.
Meissner remembers a three-year period from 1988 to 1991 when 55,000 cases and 120 deaths occurred.
“People forgot about what a severe disease it is,” he said. “That’s the point now: If a child misses his or her immunization now, it’s absolutely critical that parents bring that child back when the supply shortage is alleviated.”
The shortage began in January 2001 when one of three pharmaceutical manufacturers that made vaccines quit making them.
That left two manufacturers and only one that produced the Td booster.
Stricter FDA guidelines that require manufacturers to make expensive modifications, coupled with high production costs and low profits, have not made vaccine production attractive to pharmaceutical companies.
“It’s a good warning flag to the community that says this is not something that’s guaranteed to you,” Stevens said. “Manufacturers are a business just like anyone else.”
Health officials recommend that parents keep checking with their physicians or the health clinic to determine when a vaccine is available — and then go get it.
“I think we’re hopefully at the beginning of the end of the shortage, and that supplies are going to improve,” Meissner said. “Are we going to see a resurgence of disease? Probably not — people are so well vaccinated right now — but we’ll lose that very quickly if they don’t keep up.”
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.