By Carol A. Kemper, MD, FACP

Shortage of Meningococcal Vaccine

Source: August 9, 2001, TravelMED@Yorku.CA.

Just as the school year gets underway, some physicians are reporting that Pasteur (Aventis) has restricted orders of meningococcal vaccine (Mennimune) to 3 single doses per month—and has increased the price. Ten-dose vials are available, but some physicians complain that they are unable to use this product quickly enough once it has been reconstituted. Facing increasing demands from parents, college-bound students, and some colleges requiring vaccination, physicians are frustrated at yet another shortage of a key vaccine product.

Just in the past year, physicians throughout the United States and Canada have been faced with escalating costs and/or shortages of flu vaccine (for both 2000-2001 and 2001-2002), diptheria-tetanus, rabies, typhoid fever, and yellow fever vaccines. The mega-mergers of several large pharmaceutical companies have created a situation leading to near monopolization of certain vaccine markets by a handful of manufacturers. "Holes" in productivity are more likely when manufacturing problems occur.

Influenza Vaccine—Delayed Again

Source: ProMED-mail post July 13, 2001; promed@promedmail.org.

Table: Persons Who Should Receive Flu Vaccine First
Persons > 65 years of age
Residents of long-term care facilities
Adults and children with underlying pulmonary or cardiovascular disease
Children and teens receiving long-term aspirin therapy
Persons who require regular medical care or who were hospitalized during the previous year, such as those with renal disease, diabetes, HIV, or other immune suppressive illness
Women who will be in their 2nd or 3rd trimester during flu season
Health care workers

Health care providers should be aware of the anticipated delay in influenza vaccine for 2001/2002. The 3 remaining manufacturers of vaccine are projecting that ~50 million doses will be available sometime in October, which is about twice that available at the same time last year. They hope to have an adequate supply distributed by December. The delay this year is because one of the manufacturers has dropped out of production due to compliance issues with manufacturing last year. As a result, the Advisory Committee on Immunization Practices is recommending that the vaccine arriving in October be reserved for health care workers and persons at highest risk (see Table), and that vaccination of persons at lesser risk be "phased in" over succeeding months. While this approach is laudable, officials should understand that a staggered approach to vaccine administration is impractical and only complicates the job of physicians and clinics trying to respond to the Centers for Disease Control’s stated goal of 100% vaccine compliance. It is difficult to aggressively promote vaccine usage but then deny it to some, even temporarily.


Recommendations for Smallpox Vaccination

Source: MMWR Morb Mortal Wkly Rep. June 22 2001;50:RR-10:1-25.

The events of September 11 heightened concerns of a potential bioterrorist attack. Of the several agents of concern is smallpox (variola) virus, although experts believe that the probability of a deliberate attack using this agent is low. Physicians should be aware that, in the United States, the routine use of smallpox vaccine (vaccinia) in the general public stopped in 1971; vaccination of health care workers stopped in 1976; availability of vaccine to the public and to international travelers ceased in 1982; and the administration of vaccine to military personnel ended in 1990. Therefore, most people in the United States, with the exception of some military personnel, received vaccine more than 25-30 years ago, with the possible loss of protective immunity.

A new smallpox vaccine is currently being developed using cell-culture techniques (Infectious Disease Alert. 2000; 20:24). At present, pre-exposure vaccination is not being recommended except for key military and laboratory personnel involved in this area of viral research. In the event of an outbreak, postexposure vaccine will be made available to persons who are directly exposed to a clinical case or who are likely to be exposed to contaminated medical waste and laundry. If at all possible, persons who received childhood vaccine (or who received vaccine > 3 years ago) should be revaccinated and assigned to direct patient care duties.

In the event of a suspected case, physicians in the United States should immediately contact their local and state health authorities, who will contact the CDC. (Physicians in countries outside the United States are to contact the World Health Organization).