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Pediatric Pharmacists Cope With Vaccine Shortages

Kate Traynor

This year’s Recommended Childhood Immunization Schedule (PDF) places special emphasis on tracking and administering missed vaccine doses, an issue that may become increasingly important because most vaccines on the schedule are in short supply.

Rita K. Jew, Pharm.D., clinical coordinator at The Children’s Hospital of Philadelphia, gave her view of vaccine shortages: "It’s very frustrating, especially in this day and age, when you’re trying to encourage immunizations."

Tracy M. Hagemann, Pharm.D., a pediatric pharmacy specialist at the University of Oklahoma Health Sciences Center, said she expects that shortages will make adhering to the new immunization schedule difficult.

"Right now," she said, "the only thing that looks like it’s immediately available is the Haemophilus influenzae b vaccine and polio[virus vaccine]."

Hagemann said that the current shortage of varicella virus and pneumococcal vaccines worries her the most—especially the pneumococcal conjugate vaccine.

"In children who are susceptible to a pneumococcal infection, the results of an infection can be quite serious...such as pneumococcal meningitis," she said. "The biggest population that I worry about is the sickle-cell [anemia] patients," she added. "They are more prone to getting severe infections" caused by Streptococcus pneumoniae.

Jew also lamented the current shortage of Prevnar, Wyeth-Ayerst Laboratories’ seven-valent pneumococcal conjugate vaccine.

When Prevnar came on the market two years ago, "it was great," Jew said. "Everybody started using it to [protect] against strep pneumonia."

But that changed last summer. "All of a sudden, you can’t get any of it," Jew said. "We absolutely ran out."

Hagemann said planning for vaccine shortages has become standard practice at her hospital. "You can’t assume that you’re going to have any of the vaccines at any one time," she said.

"If we get an alert that something is going to be in short supply,...our institution tries to develop a plan of action," Hagemann said. "We’ll try to hold some back so that way, if we have a child who really needs it, we can use it."

Hagemann said that the hepatitis B vaccine is no longer in routine use at the hospital. "We try to keep that for the preemies that are going home, the kids that are at high risk for certain things," she said.

Jew said her hospital has managed to find enough of most vaccines to meet patients’ needs and has not had to restrict usage yet. But she said the hospital’s buyer is "working overtime" to deal with shortages.

"As soon as they hear there is a problem with one vaccine, we just go frantically to find other wholesalers," she said, adding that there is "a universal shortage of drugs, in general."

Hagemann said she is very concerned about keeping track of children who have missed vaccine doses. "What’s scary about this is, unless you keep good records, you might miss some kids," she said. "There might be big, gaping holes in some kids' vaccination schedules."

Although most routine childhood vaccines are given outside of acute care settings, hospitals do their part, too.

"We have a very aggressive program in our hospital to try to make sure that children who come in who are behind [on immunizations] get caught up," Jew said.

Hagemann described a similar program at her hospital. "In any child who’s admitted, we always check to see where they are in their vaccination schedule," she said. "If they’ve missed something, while they’re here, we’ll just go ahead and vaccinate."

But with most vaccines hard to obtain, Hagemann said her hospital has had been unable to administer catch-up doses.

[The above paragraph corrects text posted earlier that could have been misinterpreted.]

For information about current drug and vaccine shortages, visit ASHP’s Drug Product Shortages Management Resource Center. Drug product shortage bulletins are prepared by the University of Utah Drug Information Center and provided by ASHP through the support of Novation LLC.