U.S. nearly out of tetanus vaccine

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US Nearly Out Of Tetantus Vaccine

By Emily Richmond, The Las Vegas Sun



A nationwide shortage of an essential vaccine against tetanus and diphtheria has left Clark County Health District officials onserving supplies and limiting the doses to only the most serious cases. Under normal circumstances, county health officials would have thousands of doses of the Td vaccine, which protects against both tetanus and diphtheria. There are fewer than 400 doses remaining in the stockpile, said Suzann Chesebrough, public health nursing supervisor for the health district. Because Clark County's supply is critically low, only people with wounds are being given the vaccine to protect against tetanus, Chesebrough said. Travelers to high-risk areas for diptheria -- such as Algeria, Egypt, Brazil, Haiti and Vietnam -- will have to find a private doctor with the vaccine on hand, she said. Tetanus is a potentially fatal disease transmitted by bacteria, often through dirty wounds. It can cause seizures and muscle spasms and is often referred to as "lockjaw," because of the tightening of the facial muscles. Diphtheria is a respiratory illness that spreads through the bloodstream and attacks the organs. Although diphtheria cases are rare in the United States, the disease is more common in underdeveloped areas. An outbreak of more than 150,000 cases of the disease in southern Russia and neighboring countries since 1990 was blamed on a lack of vaccinations. The Centers for Disease Control and Prevention in Atlanta first began warning of the potential shortage in December. The leading manufacturer of the vaccine, Aventis Pasteur, fell behind in production after maintenance work at the company's facilities took longer than expected. That, coupled with another pharmaceutical company deciding to stop production, resulted in the shortage, according to the CDC. The CDC has recommended that health officials nationwide use the vaccine only to treat people with wounds and to prepare travelers headed to areas in which there is a high risk of diphtheria. The health district has been using about 170 doses of the vaccine each month for wound care alone, Chesebrough said. "If we added travelers into the equation, we wouldn't last a month," she said. Officials hope to reverse the nationwide shortage early next year. In the meantime, students are not being vaccinated as part of regular school registration. The tetanus vaccine should be followed by a booster shot every 10 years, health officials say. The health district is working to add to its supplies, and the state Health Department is expected to issue an advisory soon about the shortage, Chesebrough said. Dr. Jerald Malone, who practices at the Family Medical Group in Las Vegas, said his office is running low, as well.

For now, physicians are administering the vaccine to those who need it and aren't rationing the supplies, he said. There is no cure for tetanus once a person contracts the disease, Malone said. "Prevention is the only treatment."

-- Swissrose (cellier3@mindspring.com), May 31, 2001


Headline: Notice to Readers: Deferral of Routine Booster Doses of Tetanus and Diphtheria Toxoids for Adolescents and Adults

Source: Morbidity and Mortality Weekly Report [Centers for Disease Control and Prevention], May 25, 2001 / 50(20);418,427

URL: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5020a8.htm

A shortage of tetanus and diphtheria toxoids (Td) and tetanus toxoid (TT) in the United States has resulted because one of two manufacturers discontinued production of tetanus toxoid-containing products (1). Aventis Pasteur (Swiftwater, Pennsylvania) is the only major manufacturer of tetanus and diphtheria toxoids (Td) in the United States. In response to the shortage, Aventis Pasteur has increased production of Td to meet national needs; however, because 11 months are required for vaccine production, the shortage is expected to last for the remainder of 2001.

To assure vaccine availability for priority indications (2), all routine Td boosters in adolescents and adults should be delayed until 2002. Td use should follow existing recommendations for all other indications, which include 1) persons traveling to a country where the risk for diphtheria is high*; 2) persons requiring tetanus vaccination for prophylaxis in wound management; 3) persons who have received <3 doses of any vaccine containing tetanus and diphtheria toxoids; and 4) pregnant women who have not been vaccinated with Td during the preceding 10 years.

CDC recommends that health-care providers, including clinic personnel, record the names of patients whose booster dose is delayed during the shortage. When Td supplies are restored, these patients should be notified to return to their health-care provider for vaccination. According to Aventis Pasteur, sufficient vaccine will be available in early 2002 to supply the national demand.

Health-care providers using Td for wound management should follow recommendations from the Advisory Committee on Immunization Practices for wound management (3). All wound patients should receive Td if they have received <3 tetanus-containing vaccines or if vaccination history is uncertain. These patients also should receive tetanus immune globulin for wounds that are contaminated with dirt, feces, soil or saliva, puncture wounds, and avulsions and wounds resulting from missiles, crushing, burns or frostbite (3). For persons with >3 doses of tetanus toxoid-containing vaccine and severe or contaminated wounds, Td should be given only if >5 years have passed since the last dose of tetanus-containing vaccine. For clean and minor wounds, Td should be given only if the patient has not received a tetanus- containing vaccine during the preceding 10 years. Health-care providers should inquire from patients presenting for wound management about the timing of their last tetanus-containing vaccine to avoid unnecessary vaccination.

Pediatric formulations of diphtheria and tetanus toxoids (DT) and diphtheria and tetanus toxoids and acellular pertussis vaccine (DTaP) should not be used for persons aged >7 years. Although TT might be considered a substitute for Td in wound management when Td is not available, TT is not available for national distribution. Existing stocks of TT are extremely limited and are mainly reserved for production of tetanus immune globulin and other special circumstances.

Health-care providers and institutions requiring Td for priority indications should contact Aventis Pasteur, telephone (800) 822-2463 or (800) VACCINE. Institutions should place orders for their anticipated needs for priority indications only. Limiting quantities of vaccine in each order is necessary to assure the widest possible distribution of available vaccine. For emergency situations (e.g., natural disasters) requiring increased use of Td, Aventis Pasteur can provide vaccine within 24 hours.


1. CDC. Update on the supply of tetanus and diphtheria toxoids and of diphtheria and tetanus toxoids and acellular pertussis vaccine. MMWR 2001;50:189--90.

2. CDC. Shortage of tetanus and diphtheria toxoids. MMWR 2000;49:1029--30.

3. Immunization Practices Advisory Committee. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures---recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR 1991;40(no. RR-10).

*Travelers to certain countries may be at substantial risk for exposure to toxigenic strains of C. diphtheriae, especially with prolonged travel, extensive contact with children, or exposure to poor hygiene. Based on surveillance data and consultation with the World Health Organization, countries at highest risk are: Africa=Algeria, Egypt, and sub-Saharan Africa; Americas=Brazil, Dominican Republic, Ecuador, and Haiti; Asia/Oceania=Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Iran, Iraq, Laos, Mongolia, Myanmar, Nepal, Pakistan, Philippines, Syria, Thailand, Turkey, Vietnam, and Yemen; Europe=Albania and all countries of the former Soviet Union (3).

Disclaimer All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices

-- Andre Weltman, M.D. (aweltman@state.pa.us), June 01, 2001.

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