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Am Fam Physician. 2004;70(5):985

Update on Pneumococcal Conjugate Vaccine Shortage

The Centers for Disease Control and Prevention (CDC) has recommended that physicians increase the number of doses of pneumococcal conjugate vaccine (PCV7, Prevnar) administered to healthy children from two to three. Production problems earlier this year caused shortages of the vaccine and prompted the CDC to reduce the recommended four doses to two in order to most effectively use the limited available doses.

The CDC, the Advisory Committee on Immunization Practices, the American Academy of Family Physicians, and the American Academy of Pediatrics also recommended that providers continue to administer the full four-dose series of the vaccine to children up to 15 months of age with health conditions such as sickle cell anemia or immune system disorders, who are at increased risk of severe disease. The groups said providers should defer the fourth dose of the vaccine for healthy children until production and supply data convincingly demonstrate supplies of the vaccine are adequate for routine administration of the four-dose series.

The vaccine is normally recommended for young children in a four-dose schedule: one dose each at two, four, and six months of age, and one dose between 12 and 15 months of age. This recommendation reinstates the third dose usually administered at six months for healthy children. PCV7 is not routinely recommended for children older than two years.

The CDC also issued a recommended catch-up schedule for children who missed the third dose. The highest priority for catch-up vaccination is children at high risk for invasive pneumococcal disease. Second priority is vaccination of healthy children younger than 24 months who have not received any doses of pneumococcal conjugate vaccine. The third priority is vaccination of healthy children younger than 12 months of age who have not yet received three doses.

Because of the frequency of physician visits for children during their first 18 months, catch-up vaccination might occur at regularly scheduled visits for most children who receive vaccines from their primary care physician. Physicians who administer vaccinations but do not see children routinely for other reasons should consider a notification process to contact parents of under-vaccinated children.

The catch-up schedule and additional information about the recommendations and PCV7 is available online at

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