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June 27, 2001

Vaccine Shortage Affects Normal Distribution in Oregon

Portland, OR (SafetyAlerts) - As a nationwide shortage of tetanus-diphtheria (Td) vaccine continues, the vaccine's sole manufacturer has announced it will no longer ship to private physicians, according to public health officials at the Oregon Department of Human Services.

"The means the vaccine will only be available through hospitals and county health departments," says Mel Kohn, M.D., Oregon State epidemiologist at the Health Division. "It will only be given to people who have tetanus-prone wounds, or those who will be traveling to a country where the risk of diphtheria is high."

The Health Division is notifying health providers throughout Oregon of this change and informing physicians that they will need to write a referral for any high-risk patients that go to a hospital or health department for Td vaccination.

"This is a difficult problem and we need the cooperation of everyone involved," Kohn says. "We must make sure that maximum disease prevention is achieved with the limited vaccine available. We will continue to keep health providers and the public informed of developments."

The vaccine shortage resulted when one of the two manufacturers discontinued production. Aventis Pasteur, the remaining manufacturer, has increased its production to try to meet national needs. More information on the Td vaccine shortage and usage guidelines is available on the Web at:

Tetanus-diphtheria (Td) for foreign travel:
Td should be administered to persons traveling to countries where the risk for diphtheria is high. Travelers to certain countries may be at substantial risk for exposure to toxigenic strains of C. diphtheriae, especially with prolonged travel, extensive contact with children, or exposure to poor hygiene. High-risk countries include the following:

Africa – Algeria, Egypt, and sub-Saharan Africa (Angola, Benin, Burkina Faso, Burundi, Cameroon, Cape Verde, Central African Republic, Chad, Comoros, Congo, Cote d'Ivoire and the Democratic Republic of Congo).

Americas – Brazil, Dominican Republic, Ecuador and Haiti.

Asia/Oceania – Afghanistan, Bangladesh, Cambodia, China, India, Indonesia, Iran, Iraq, Laos, Mongolia, Myanmar, Nepal, Pakistan, Philippines, Syria, Thailand, Turkey, Vietnam and Yemen.

Europe - Albania and all countries of the former Soviet Union (Armenia, Azerbaijan, Belarus, Estonia, Georgia, Kazakhstan, Kyrgyz Republic, Latvia, Lithuania, Moldova, Tajikistan, Turkmenistan, Ukraine and Uzbekistan).1,2,3

1 Immunization Practices Advisory Committee. Diphtheria, tetanus, and pertussis: recommendations for vaccine use and other preventive measures—recommendations of the Immunization Practices Advisory Committee. MMWR 1991;40 (no. RR-10)

2 CDC. Shortage of tetanus and diphtheria toxoids. MMWR 2000;49:1029-30

3 CDC. Deferral of Routine Booster Doses of Tetanus and Diphtheria Toxoids for Adolescents and Adults. MMWR 2001;50:418,427

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