A Brief Immunization Update
Jody R. Murph, MD, MS, Children's Hospital of Iowa
Summer 2004

Pneumococcal conjugate vaccine shortage. Vaccine shortages are once again part of the landscape. In February 2004 the Centers for Disease Control (CDC), citing production problems, recommended that the third and fourth doses of the pneumococcal conjugate vaccine (PCV7 or Prevnar) be temporarily suspended for healthy children. Children at increased risk for severe disease should continue to receive all 4 doses. Wyeth, the only US supplier of the vaccine, predicted production and shipping delays that could cause spot shortages or supply problems that could become widespread.

The shortage is expected to last until the end of summer 2004 and possibly beyond. Limiting the number of doses in healthy children is hoped to conserve vaccine supply, to ensure that all children younger than 24 months receive at least 2 doses of vaccine. The CDC estimates that efficacy rates following 2 doses of PCV7 are approximately 86% to 94%. For more information, including a parent fact sheet on the shortage, see the National Immunization Program website.

Flu season is coming; immunize in the fall. It is also time to start planning for the 2004-2005 flu season, which typically runs from about December through April. The CDC recommends that vaccination occur in early fall.

This March, the American Academy of Pediatrics Committee on Infectious Diseases released a policy statement regarding influenzae immunization in children. It recommends yearly immunization for: 

• Healthy young children who will be 6-24 months of age during flu season
• People who will be in close contact with high-risk children (household contact, out-of-home caregivers, health care professionals). This may be particularly important for those caring for infants who cannot be vaccinated because they are less than 6 months old.
• Children older than 6 months who have:
• Asthma
• Chronic pulmonary, cardiac, renal, or metabolic disease
• Hemoglobinopathies
• HIV infection
• Immunosuppression

The role of health care providers cannot be overstated. A 2001 survey of parents found that the most important determinate of flu vaccination in children is the health care provider's recommendation.

Plan ahead. Last year's more severe flu season resulted in a tremendous increase in parental requests for vaccine, and the trend is expected to continue. Consider pre-ordering vaccine to ensure an adequate supply. For younger children or children allergic to preservatives, thimerosol-free Fluzone® (Aventis Pasteur) and Flu-virin® (Evans) vaccines are available.

Because of the need to give two doses of flu vaccine the first time a child younger than 9 years of age is vaccinated, it is important to:

1. Start immunizing as early in the season as possible
2. Use all encounters to offer vaccine
3. Consider offering flu vaccine clinics

Providing immunization clinics at "parent-friendly" hours, such as after work or on Saturday, can encourage more parents to have themselves and their children vaccinated.

Watch for more information on childhood immunization in the fall issue of the EPSDT Care for Kids Newsletter.