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From the Centers for Disease Control and Prevention
August 28, 2002

Resumption of Routine Schedule for Diphtheria and Tetanus Toxoids and Acellular Pertussis Vaccine and for Measles, Mumps, and Rubella Vaccine

JAMA. 2002;288(8):953-954. doi:10.1001/jama.288.8.953-JWR0828-3-1

MMWR. 2002;51:598-599

Supplies of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine and measles, mumps, and rubella (MMR) vaccine in the United States have become sufficient to permit the resumption of the routine schedule for DTaP and MMR use as recommended by the Advisory Committee on Immunization Practices (ACIP).13 However, health-care providers should be advised that, for the next 2 months, supply might not be adequate for the initiation of ambitious recall or special initiative programs. With increases in national inventory, more comprehensive recall programs can be established. Child care and school attendance provisions requiring children to receive a DTaP booster and a second dose of MMR vaccine at age 4-6 years can be reinstituted.

DTaP Vaccine

Three DTaP vaccines are distributed currently in the United States: Tripedia® (Aventis Pasteur, Swiftwater, Pennsylvania), Infanrix™ (GlaxoSmithKline, Philadelphia, Pennsylvania), and DAPTACEL™ (Aventis Pasteur, Toronto, Ontario). The Food and Drug Administration (FDA) approved DAPTACEL™ for use in the United States on May 14, 2002.4

During the DTaP vaccine shortage beginning in 2000,5 ACIP recommended that health-care providers vaccinate infants with the initial 3 DTaP doses, if they did not have sufficient supply of DTaP to vaccinate all children in their practice. ACIP also recommended deferral of the fourth and fifth DTaP doses if supplies were still inadequate.6 Supplies are now adequate to resume the full 5-dose schedule for DTaP vaccine.1,3

MMR Vaccine

A temporary shortage of MMR vaccine in the United States resulted from a voluntary interruption of manufacturing operations of Merck & Co., Inc., the only manufacturer of this vaccine in the United States.7 During the vaccine shortage, ACIP recommended deferral of the second dose of MMR vaccine at age 4-6 years if health-care providers were unable to obtain sufficient amounts of vaccine. The first dose at age 12-15 months was not to be delayed because of the severity of measles in young children.7 Supplies are now adequate to resume the second dose of MMR vaccine.2,3

Vaccine Supply

Health-care providers should review the vaccination status of their patients and administer DTaP and MMR vaccines, as appropriate. For at least the next 2 months, providers should order DTaP and MMR vaccine in amounts sufficient for a ≤30-day supply to ensure that current supplies can meet requests. Recall or special initiative programs can be instituted when DTaP and MMR vaccine supply improves further but should be deferred during this transition period. However, if children who need these vaccines seek medical care for other reasons, they should be administered vaccine provided no contraindications exist. Furthermore, vaccine should be offered to children who need vaccination and whose parents requested vaccination. CDC will continue to monitor DTaP and MMR vaccine supply and, if necessary, allocate vaccine. Updates regarding vaccine supply and shortages can be found at http://www.cdc.gov/nip/.

References
1.
CDC, Pertussis vaccination: use of acellular pertussis vaccine among infants and young children—recommendations of the Advisory Committee on Immunization Practices. MMWR Recomm Rep. 1997;46 ((RR-7)) 1- 25
2.
CDC, Measles, mumps, and rubella—vaccine use and strategies for elimination of measles, rubella, and congenital rubella syndrome and control of mumps: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR. 1998;47 ((No. RR-8))
3.
CDC, Recommended childhood immunization schedule—United States, 2002. MMWR Morb Mortal Wkly Rep. 2002;5131- 3
4.
CDC, Food and Drug Administration approval of a fifth acellular pertussis vaccine for use among infants and young children—United States, 2002. MMWR. 2002;51574
5.
CDC, Update on the supply of tetanus and diphtheria toxoids and of diphtheria and tetanus toxoids and acellular pertussis vaccine. MMWR Morb Mortal Wkly Rep. 2001;50189- 90
6.
CDC, Update: supply of diphtheria and tetanus toxoids and acellular pertussis vaccine. MMWR. 2002;501159
7.
CDC, Shortage of varicella and measles, mumps and rubella vaccines and interim recommendations from the Advisory Committee on Immunization Practices. MMWR Morb Mortal Wkly Rep. 2002;51190- 7
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