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12/26/2001

ACIP Extends Delay in Pneumococcal Immunization of Healthy Children

Cheryl A. Thompson

As long as the national supply of seven-valent pneumococcal conjugate vaccine (Prevnar, Wyeth Lederle Vaccines) lags behind demand, the Advisory Committee on Immunization Practices (ACIP) wants all health care providers to order and administer fewer doses of the agent, regardless of the status of a provider's own supply, according to recommendations issued in late December.

ACIP requests that health care providers estimate the amount of vaccine available to them, determine whether their shortage is "moderate"—a shortfall of less than 25% of the four-dose immunization schedule for infants—or "severe," and vaccinate healthy children according to the following new instructions:

  • Moderate shortage—For children <6 months old at the time of the first vaccination, administer doses at 2, 4, and 6 months but defer the fourth dose. Children 7–11 months old at the time of first vaccination, administer two doses two months apart and a third dose at age 12–15 months. Children 12–23 months old at first vaccination, administer two doses two months apart.
  • Severe shortage—For children <6 months old at the time of the first vaccination, administer two doses two months apart in the first six months of life and defer the third and fourth doses. Children 7–11 months old at the time of the first vaccination, administer two doses two months apart and defer the third dose. Children 12–23 months old at first vaccination, administer one dose and defer the second.

During the current shortage, which the Centers for Disease Control and Prevention (CDC) expects to last into March 2002, ACIP said it does not want health care providers to administer pneumococcal conjugate vaccine to children who have not received their first dose by the age of 24 months. Health care providers who estimate having less than 50% of the supply needed to complete the four-dose immunization schedule should assess their patients and defer administering doses to the infants at lowest risk of pneumococcal exposure or invasive infection, ACIP advised.

Cases of invasive pneumococcal disease in young infants who received a two- or three-dose series of immunizations should be reported by the health care provider to the state health department, which will share the information with CDC. ACIP noted that not much is known about the long-term efficacy of a two- or three-dose pneumococcal immunization schedule for young infants.

Once the supply of the vaccine improves, ACIP advised, health care providers should administer doses to infants whose third dose had been deferred, with second priority given to infants who had received three doses and are eligible for the fourth dose.

CDC had told health care providers in September that they could administer the vaccine to healthy children 1–2 years old if sufficient doses remained after the high-priority patients received their doses. At the time of that recommendation, the federal agency expected the shortage to last through December 2001, perhaps longer.

ACIP's October 2000 recommendation on administering the vaccine to children at high risk of pneumococcal infection still holds.