Immunizations:
Another Aspect of Homeland Security
By: Dr.
Stefanie Kelley
July-August 2002
During a recent family dinner I was asked, "What are you doing to protect
yourself and your family against bioterrorism?" I replied that I was
making sure everyone had up to date immunizations and remembered to wash
their hands. We all know hand washing is one of the best ways to prevent
disease but preventing disease by immunization is often overlooked. The
news media's focus on bioterrorism organisms have highlighted a recent and
potentially devastating reality, the lack of available immunizations which
have proven to protect against disease.
Immunizations are primary prevention tools used throughout the lifespan.
They are effective yet under-utilized. Several reasons for the under-utilization
exist. Immunizations are not administered due to cost or a patient's limited
access to resources. Patients often become disinterested in immunizations
or have misunderstandings about the effectiveness and contraindications
of immunizations. Finally, repeated changes in the administration schedule
and, more recently, the lack of supply have affected the complete comprehensive
immunization of children and adults.
There are three vaccines
currently in short supply: 1) tetanus, including diphtheria and tetanus
toxoids and acellular pertussis vaccine (DTaP) and tetanus and diphtheria
toxoids (Td), 2) Prevnar™ , the pneumococcal conjugate vaccine (PCV-7),
and 3) flu vaccine.
The shortage
of DTaP and Td will continue into mid-2002. The shortage began in
2000 when two manufacturers (Wyeth Lederle, Pearl River, New York,
and Baxter Hyland Immuno Vaccines, Baltimore, Maryland) stopped
production of tetanus vaccines. The remaining suppliers for the
United States are Aventis Pasteur (Swiftwater, Pennsylvania) and
GlaxoSmithKline (Philadelphia, Pennsylvania). (CDC. Update on the
supply of tetanus and diphtheria toxoids and of tetanus and diphtheria
toxoids and acellular pertussis vaccine. MMWR 2001;50(51):1159.)
Due to the shortage, the Advisory Committee on Immunization Practices
(ACIP) recommends that providers who do not have enough DTaP give
priority to the first three doses for infants. To ensure an adequate
supply of DTaP to vaccinate infants, providers should defer vaccination
of children aged 15--18 months with the fourth DTaP dose. When the
DTaP shortage ends, providers should recall and administer all missed
doses. For adults needing Td, all routine Td boosters in adolescents
and adults should be delayed until 2002. Td should be administered
for
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persons
traveling to a country where the risk for diphtheria is high |
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persons
requiring tetanus vaccination for prophylaxis in wound management |
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persons
who have received <3 doses of any vaccine containing tetanus
and diphtheria toxoids |
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pregnant
women who have not been vaccinated with Td during the preceding
10 years
(CDC.Deferral of routine booster doses of tetanus and diphtheria
toxoids for adolescents and adults. MMWR 2001; 50(20);418-,
427.)
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2001 deliveries
of Prevnar™, the pneumococcal conjugate vaccine (PCV-7), marketed
by Wyeth Lederle Vaccines, have been delayed due to increased demand
in 2000 resulting in shortages for some providers and health departments.
Although the manufacturer projects shipping sufficient vaccine to
meet needs throughout the remainder of 2001 and has sufficient manufacturing
capacity to meet U.S. demand, health-care providers may continue
to experience temporary shortages as supplies are replenished. The
CDC is recommending, if a shortage exists, providers defer the vaccination
of children older than 2 years except those 2-5 years old who are
at increased risk of pneumococcal disease. (CDC. Notice to Readers:
Decreased Availability of Pneumococcal Conjugate Vaccine. MMWR 2001;
50(36);783-4.)
The short
supply of the flu vaccine is due to a decrease in manufacturers
producing the vaccine. One of the four manufacturers of the flu
vaccine is no longer producing the vaccine. Of the three remaining
licensed manufacturers in the United States, production capabilities
have been added to increase the supply. The remaining flu vaccine
supply was delivered in December 2001. Flu protection is recommended
throughout January and beyond, as long as the supply lasts. Until
production reaches the pre-1999 four-manufacturer level, high-risk
patients are encouraged to receive flu vaccine in October or November.
High-risk patients include:
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persons
65 years old or older |
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people
who live in a nursing home or chronic-care facility |
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adults
and children with chronic health problems |
|
adults
and children with immunosuppression |
|
children
and adolescents between six months and 18 years who are on
long-term aspirin therapy |
|
women
who will be at least three months pregnant during flu season |
Any person working
with someone in the high-risk categories or anyone wanting to prevent
the flu should be immunized between December and February.
The
Advisory Committee on Immunization Practices (ACIP) lists all
the information published by the ACIP and CDC regarding general
recommendations on immunization, impact of vaccines in the United
States, adult immunization schedule, immunization of adolescents,
combination vaccines for childhood immunization, immunization of
health-care workers, vaccination of immunocompromised persons, and
vaccine side effects and contraindications. Another excellent web
resource for immunization information is the
Immunization Action Coalition. The mission of the Immunization
Action Coalition, a 501(c)3 nonprofit organization, is to boost
immunization rates and prevent disease. The Coalition promotes physician,
community, and family awareness of, and responsibility for, appropriate
immunization of all children and adults against all vaccine-preventable
diseases.
We have all
learned that bioterrorism is a real and deadly threat. It is important
to remember that keeping current regarding immunization schedule
changes and vaccine supply is part of the United States' "Homeland
Security".
Stefanie J. Kelley, ND, RN, CS has
been in the nursing field for over 10 years. She has clinical expertise
in general pediatrics and pediatric hematology, oncology, and bone
marrow transplantation. As a family nurse practitioner she has advanced
practice expertise in internal medicine, urban health care, and
general pediatrics. As a faculty member at Texas A&M University
and Case Western Reserve University, she has taught in the undergraduate
and graduate didactic and clinical portions of nursing. Dr. Kelley's
interest in web-based instruction and health care has been a part
of her academic, clinical, and research practice.
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