School immunization rules revised in wake of vaccine shortages

By Carol Chmelynski

8/13/02 – Children in at least five states–Indiana, Louisiana, Minnesota, Nebraska, and New Jersey–will be heading back to school this fall even though they might not have received their required immunization shots.

That's because state health officials have been forced to relax vaccination requirements due to shortages in vaccines for many common childhood diseases.

The Centers for Disease Control and Prevention announced July 11 that the two-year shortage of two childhood vaccines–one for diphtheria, tetanus, and pertussis, or whooping cough (DTP), and the other for measles, mumps, and rubella (MMR)–is generally over, but parts of the country are still experiencing shortages.

A number of what immunization experts call "unique and unprecedented" factors contributed to the lack of the MMR and DTP vaccines. These include the departure of companies from the vaccine market, manufacturing changes and equipment modification that caused production problems, and insufficient stockpiles.

Regulatory changes also affected the vaccine supply. In 1999, the CDC and the American Academy of Pediatrics recommended removing a mercury-based preservative from all vaccines, which caused several companies to stop production. Pharmaceutical experts say the manufacturing process can take up to a year from start to finish, because of the slow growth rate of the cultures used in the vaccine.

According to CDC officials, no disease outbreaks were reported nationally as a result of the shortages.

The New Jersey Health Department will allow students who aren't immunized to begin school this fall if they present a note from a doctor saying they are still trying to get the vaccine.

"If they can demonstrate a good faith effort, and the physician is working with a family to get a vaccine, we don't want to keep the child out of school," says New Jersey Assistant Health Commissioner James Blumenstock.

In July, Indiana health officials pushed back the fall deadline and now require students to be fully immunized by Jan. 31.

"It's an unfortunate circumstance," says Mary Tiede-Wilhelmus, a spokesperson for the Indiana Department of Education. "We're reassured that [districts] required schools to put forth a method to track students who have not been immunized in order to address their situation later" when the shortage is resolved.

Minnesota waived its tetanus/diphtheria shot for junior high and high school students until next fall.

Louisiana officials have had to suspend the rule for the mandatory DTP vaccine until fall 2003 due to the shortage. "It's been a big problem, and we're hoping it ends sooner than that," says Dr. Martha Whyte, medical director for Region 7 of the Louisiana Office of Public Health.

In Nebraska, if health care providers run out of a vaccine, they can give students a letter stating when new supplies are expected and when the student is scheduled to get his or her shots, says Grey Borden, coordinator of the state's immunization program.

Students can then be provisionally enrolled and continue in school as long as the required immunizations are completed as quickly as possible, Borden says.

According to Nebraska Chief Medical Officer Dr. Richard Raymond, most vaccines required for school entry are readily available. The most acute shortages are for vaccines not required for school admission.

Children are supposed to be given the MMR shot at 12 to 15 months and again at 4 to 6 years. The CDC recommended putting off the second shot while supplies were low.

The DTP vaccine is usually given to children in five doses from ages 4 to 6 years, but CDC suggested postponing the fourth and fifth doses during the shortage. Infants, considered most vulnerable, had continued to receive their initial shots, but not follow-up inoculations.

The U.S. Food and Drug Administration recently approved use of a Canadian DTP vaccine called Daptacel, which is expected to help alleviate the U.S. DTP vaccine shortage by early fall.