It is expected that all the shortages will be resolved no later than the end of 2002, and some as early as summer 2002. The causes for the shortages, which�vary depending on the vaccine, are:

DTaP
(1) Two manufacturers stopped DTaP production in 2000.
(2) Production has been less efficient since thimerosal was removed from the manufacturing process.
(3) There were distribution problems between private and public sectors.

MMR and Varicella
Interruptions in manufacturing due to factory modifications and FDA compliance

Pneumococcal conjugate�
(1) Demand exceeded manufacturing projections.
(2) Good Manufacturing Practice issues.

Td
One manufacturer stopped producing the vaccine in 2000

Delays in receiving Merck�s hepatitis B vaccine and Merck�s and Wyeth�s Haemophilus influenzae type b vaccine have been reported, but other manufacturers� production and distribution of these vaccines continues without significant delay.� Providers experiencing delays of these vaccines might order from another manufacturer.� If you are unable to get a certain vaccine, the ACIP (Advisory Committee on Immunization Practice) recommends the following:

DTaP
If your office does not have enough DTaP to vaccinate all children with 5 doses, first defer vaccination of children aged 15-18 months with the fourth DTaP dose.� If need be, also defer the fifth dose usually given to children 4 to 6 years of age.� Children traveling to countries where the risk for diphtheria is high should receive the full series.

Td Toxoids
Because of significant shortages in Td, the manufacturer�s policy is to limit Td distribution to central locations (hospitals, emergency centers, and some health departments).� All routine boosters should be deferred.� Td should be given to:

• Persons traveling to a country where the risk for diphtheria is high;
• Persons who have a dirty wound and have not had a tetanus booster in the last five years;
• Persons who have received less than 3 doses of any vaccine containing tetanus and diphtheria toxoids;
• Pregnant women who have not been vaccinated with Td during the preceding 10 years.

Providers who require Td for priority indications should contact Aventis Pasteur (1-800-822-2463), to obtain the vaccine they need.

Pneumococcal Conjugate Vaccine
While recommending that all high risk children less than 5 years of age receive PCV according to the original recommendations, ACIP now has provided a table of recommendations for PCV use among healthy children during moderate to severe shortages.

All health care providers should reduce the number of doses of pneumococcal conjugate used and ordered, regardless of their current supply, so that vaccine is more widely available until supplies are adequate.� Note that pneumococcal polysaccharide vaccine is not licensed or recommended for use in children less than 2 years of age; and it cannot substitute for PCV.

MMR
Those providers who are unable to obtain sufficient amounts of MMR should defer the second MMR dose.

Varicella
ACIP recommends that all providers delay routine administration of varicella vaccine until 18 to 24 months of age.� If a significantly severe shortage persists, a plan for prioritization of individuals at greatest risk is available.

Lists of people who missed a vaccine should be maintained during these shortages.� Mail or telephone recall systems should be used to recall them to complete their series as vaccine becomes available.

What is CDC doing about the situation?��
To address the shortages, CDC is:

• Working through the ACIP to provide flexibility in the vaccination schedules and prioritization options;
• Coordinating vaccine amounts dedicated to the 64 immunization project grantees;
• Evaluating central vaccine depot inventory information reported each month by the projects to better ensure equitable distribution;
• Working with other federal agencies and programs and national committees to study root causes for vaccine shortage and to develop national recommendations for solution.

For more information:�

• For weekly updates and links to vaccine-specific recommendations, visit CDC�s website
• For questions related to changes in child care and school entry requirements necessitated by these supply problems, link to state websites
• VFC and private health care providers should contact their state immunization programs or national organizations.
• General immunization questions can be called in to:
  1-800-232-2522 (English)
  1-800-232-0233 (Spanish)
  1-800-243-7889 (TTY)