Some states defer schoolchildren's shots

Vaccine shortages may be ending but are forcing public health authorities to issue waivers for student immunization requirements.

By Susan J. Landers, amednews staff. Sept. 2, 2002.

Washington -- Kids in some states were probably rejoicing at decisions made by several health departments to temporarily waive school vaccine requirements because of lingering shortages of certain vaccines.

But their physicians and health officials were not at all pleased.

What's available, what's not
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"The more kids in the community who are susceptible, the more likely it is that, if a vaccine-preventable disease shows up it will ripple around a community and affect many people," warned Bruce Gellin, MD, MPH, executive director of the National Network for Immunization Information.

Among the requirements waived are those for vaccines that provide protection from some extremely infectious diseases, such as measles and whooping cough. State health officials in Indiana, for example, will allow schools to admit students whose immunizations for measles, mumps and rubella and diphtheria, tetanus and pertussis have not yet been completed.

"Certainly everyone is acutely worried," said Cody Meissner, MD, a member of the American Academy of Pediatricians' Committee on Infectious Diseases. "It is critically important that we maintain high immunization rates."

But the good news is, because there was a high level of immunization before the shortages, there haven't been any disease outbreaks, he said.

Some states are temporarily waiving school vaccination requirements.

And the short duration of the deferrals means those high vaccination rates should soon return. In Indiana, for example, all students must be fully immunized by Jan. 31, 2003. Parents of children who have not had all their shots are required to obtain a form from the school or local health department that includes a written statement and a schedule for the completion of the remaining immunizations. A physician or the local health department must also approve that form.

Indiana is asking each school district to track the children who haven't had all the required immunizations so that, when the vaccine shortage is resolved, the children can be recalled.

Other states are also grappling with the shortages. New Jersey is allowing students to enter school without all their shots but with a physician's note. Texas and a number of other states are allowing students to defer their 10-year tetanus boosters.

The shortages

The deferrals resulted from the extreme shortages of certain vaccines for the past two years. The MMR and DTaP vaccines, high on the list of important vaccines for all children to receive before they begin attending day care programs or school, were in especially short supply.

The DTaP shortage resulted when two manufacturers abruptly halted production in 2000 and the single remaining manufacturer, Aventis Pasteur, was not able to produce sufficient quantities of the complex vaccine quickly enough to meet demands.

The shortage of MMR vaccine is attributed to interruptions in the manufacturing process due to factory modifications and compliance issues raised by the Food and Drug Administration.

MMR and DTaP vaccine shortages have passed, but distribution problems remain.

The shortages led the Centers for Disease Control and Prevention to recommend that physicians administer the scarce doses on a priority basis, to those most in need of immediate protection. For example, the agency suggested that routine Td booster doses to teens and adults be delayed but that travelers to areas where diphtheria is present be vaccinated.

Now that manufacturing shortages have been resolved, the CDC recently announced that the MMR and DTaP vaccines are available in sufficient quantities to allow physicians to recall patients who need catch-up shots.

However, distribution problems remain. The vaccines must find their way to patients, and patients must be fit into crowded physician schedules. The move to earlier openings by many schools in the nation also means a shorter summer break and less time for back-to-school exams.

"Remember that you still have to get the children back to the pediatricians' offices to be vaccinated," noted Dr. Meissner.

ADDITIONAL INFORMATION:

What's available, what's not

Hep B: No shortage.
DTaP: Quantities are sufficient to return to the routine schedule. However, additional vaccine is not available for ambitious recalls or special initiative programs.
Td: No shortage.
Hib: Available from Aventis Pasteur. Orders from Wyeth require up to 60 days to fill and orders from Merck are taking 6 to 8 weeks to fill.
Polio: No shortage.
MMR: Quantities are sufficient to return to the routine schedule. However, additional vaccine is not available for ambitious recalls or special initiative programs.
Varicella: No shortage.
PCV: Shortages will exist at least until the end of this year. Physicians are advised to give priority to high-risk children younger than 5, including those with sickle cell disease and other hemoglobinopathies.
Hep A: No shortage.