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Am Fam Physician. 2002 Aug 15;66(4):690.

Resumption of Routine DTaP, MMR Immunizations

Supplies of diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine, and measles, mumps, and rubella (MMR) vaccine in the United States have become sufficient to permit the resumption of the routine schedule for DTaP and MMR use as recommended by the Advisory Committee on Immunization Practices (ACIP) and the American Academy of Family Physicians. However, physicians are advised that until mid-September, the supply might not be adequate for the initiation of ambitious recall or special initiative programs. With increases in national inventory, more comprehensive recall programs can be established. Child care and school attendance provisions requiring children to receive a DTaP booster and a second dose of MMR vaccine at age four to six years can be reinstated.

Three DTaP vaccines are distributed in the United States: Tripedia, Infanrix, and Daptacel. The U.S. Food and Drug Administration approved Daptacel in May.

The DTaP vaccine shortage began in 2000, and ACIP recommended that physicians vaccinate infants with the initial three DTaP doses if the physicians did not have sufficient supply of DTaP to vaccinate all children in their practice. ACIP also recommended deferral of the fourth and fifth DTaP doses if supplies were still inadequate. Supplies are now adequate to resume the full five-dose schedule for DTaP vaccine.

A temporary shortage of MMR vaccine in the United States resulted from a voluntary interruption of manufacturing operations by the only manufacturer of the vaccine in the United States. During the shortage, ACIP recommended deferral of the second dose of MMR vaccine at age four to six years if physicians were unable to obtain sufficient amounts of vaccine. The first dose at age 12 to 15 months was not to be delayed because of the severity of measles in young children. Supplies are now adequate to resume the second dose of MMR vaccine.

Physicians should review the vaccination status of their patients and administer DTaP and MMR vaccines, as appropriate. Until mid-September, physicians should order DTaP and MMR vaccine in amounts sufficient for a 30-day supply to ensure current supplies can meet requests. Recall or special initiative programs can be started when the DTaP and MMR vaccine supply improves further but should be deferred during this transition period. However, if children who need these vaccines seek medical care for other reasons, they should be administered vaccine provided no contraindications exist. Vaccine should also be offered to children who need vaccination and whose parents requested vaccination. The Centers for Disease Control and Prevention will continue to monitor the DTaP and MMR vaccine supply and, if necessary, allocate vaccine.

Updates regarding vaccine supply and shortages are available at www.cdc.gov/nip/. The recommended childhood immunization schedule is available at www.aafp.org/x7666.xml.

FDA Approval of Chlamydia and Gonorrhea Tests

The U.S. Food and Drug Administration (FDA) has approved testing for Chlamydia trachomatis and Neisseria gonorrhoeae directly from the ThinPrep Pap Test collection vial using the Cobas Amplicor automated system. Physicians can monitor for cervical lesions, human papillomavirus infection, and chlamydia and gonorrhea using a single test specimen.

C. trachomatis is the most common sexually transmitted bacterial disease in the United States. According to the Centers for Disease Control and Prevention, an estimated 3 million new cases of chlamydia are diagnosed each year. Nearly one half of these cases occur in young women between the ages of 15 and 19, and women 20 to 24 account for an additional 33 percent.



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