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Friday, February 28, 2020  

CDC Recommends Suspension of the Routine use of the Third and Fourth DosesPublished 3/8/2004

All health-care providers should temporarily suspend routine use of both the third and fourth doses of pneumococcal conjugate vaccine (PCV7), the Centers for Disease Control and Prevention (CDC) recommended recently. Children at increased risk of severe disease should continue to receive the full, routine, four-dose series.

CDC took the action in consultation with the American Academy of Family Physicians (AAFP), the American Academy of Pediatrics (AAP), and the Advisory Committee on Immunization Practices (ACIP), to most effectively use the limited, available doses of until the manufacturer can restore full production. Wyeth Vaccines, the sole manufacturer in the United States, markets PCV7 under the trade name Prevnar®.

"CDC is concerned anytime children are not able to receive all the recommended doses of a recommended vaccine," said Dr. Steve Cochi, acting director for the CDC’s National Immunization Program. "Delaying the third and fourth doses of this important vaccine is not ideal; however, it is important to take steps to assure all children receive some protection with at least two doses of vaccines."

CDC had previously recommended that health-care providers temporarily suspend routine use the fourth dose. Since that recommendation was issued, PCV7 production has been much leass than had been expected and shipments have been further delayed, resulting in shortages of vaccine. Widespread shortages may now continue beyond this summer.

"Four doses of PCV7 provide the best protection, but children who have received three doses should also have a very high level of protection," said Dr. Cochi. "Children who have had two doses should also have some protection, but the exact level is unknown."

Children whose third and fourth doses are delayed should receive the missed doses on their first visit to a healthcare provider after supplies return to normal. Healthcare providers should keep track of children who are not able to get all the recommended doses of the vaccine and then contact those patients when they receive adequate supplies of vaccine.

Children with certain health condition, such as sickle cell anemia or immune system disorders, are at increased risk of severe disease and should continue to receive the full, routine, four-dose series.

The vaccine is normally recommended for young children in a four-dose schedule: one dose at 2 month, at 4 months, and at 6 months, and one dose between 12 and 15 months. This recommendation suspends the third and fourth doses usually administered at 6 months and between 12 and 15 months for healthy children. PCV7 is not routinely recommended for children 2 years of age or older.

The vaccine can help prevent serious pneumococcal diseases, such as meningitis and blood infections. Pneumococcal invection can cause serious illness and even dealth. Invasive pneumococcal disease is the leading cause of bacterial meningitis in the United States. Children under two years of age are at the highest risk. Before a vaccine was available, each year pneumococcal infection caused more than 700 cases of meningitis, 13,000 blood infections and about 5 million ear infections.v

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