This notice from the CDC about shortages with DTaP was sent to someone I
know from the
INSIDE and I wanted to share it with all of you.  She was told Wyeth will be
backing out of these vaccines because all the effort is going to be going to
the big combo vaccines.  Notice how they plan on altering ACIP
recommendations to fit the market demands.

Vaccine Inventory Management in Consideration of DTaP and Td

 On January 29, 2001, Wyeth Lederle (W-L) gave notice in the Health News
 Daily that they had evaluated their product portfolio, production
 capabilities, and recent FDA consent decrees and decided to cease
 producing certain of their vaccine and toxoid lines including: DTaP (brand
 name Acel-Imune), Td (adult), DT (pediatric), and Tetanus.  W-L previously
 sent written notification to a number of health care providers with the
 same message.

 Aventis Pasteur (Av-P) and Glaxo SmithKline (GSK) are now the only two
 manufacturers of DTaP vaccine for the U.S. market. Av-P will continue to
 provide DTaP (brand name Tripedia), Td (adult), DT (pediatric), and
 Tetanus.  However, because of the increased demands for Av-P's products,
 their inventory of DTaP, Td, and Tetanus is low.  Td (adult) and Tetanus
 have been in short supply for at least the past 6 months. With a single
 manufacturer of Td, DT, and TT  for most of the country (some product is
 produced in Massachusetts), it is almost certain the shortage will
 continue for at least 6 to 12 months.

 GSK is also committed to the supply of DTaP vaccine (brand name Infanrix).
 However, their inventory is also low.  We can anticipate that DTaP will be
 in short supply for possibly the next 12 to 18 months.

To best manage inventories the National Immunization Program (NIP)
suggests several steps that may assist grantees and health care providers
to whom you supply vaccine:

1) Notify all providers receiving public purchased vaccine that they must
limit their vaccine/toxoid orders for the affected products to no more
than a 30 day inventory.

2) Limit vaccine inventory in your depot or your contractor's depot to no
more than a 30 to 45 day supply.  This means that your total  dose amounts
of DTaP ordered from both Av-P and GSK should not exceed the 30 to 45 day
threshold.  For Td, and Tetanus ordered from Av-P, inventory should be
kept even lower, whenever possible.  Av-P is very carefully monitoring the
distribution of Td.  Av-P would prefer that facilities submit a weekly
request for small amounts of Td to meet their immediate need rather than
large orders which must be tracked through a number of partial shipments.

 Among other options and considerations, the Advisory Committee on
Immunization Practices (ACIP) will soon be reviewing the immunization
schedule recommendations for possible short term solutions. These
temporary solutions might or might not include vaccine schedule
adjustments, e.g., prioritizing Td shots for wound management versus
routine booster doses.  Another example might be to prioritize product for
key age groups, emphasizing DTaP shots for those needing the 3-dose
primary series versus those in need of booster doses.  ACIP
guidelines/recommendations will quickly be sent to all grantees should
such considerations become policy.

NIP will continue to monitor DTaP vaccine orders placed through our
contracts to better assure equitability among the grantees.  Please
contact Bob Snyder or Gary Coil (404) 639-9222 if you have questions or
comments regarding this advisory.