June 11, 2001 -- The U.S. is experiencing a severe, unprecedented shortage of the vaccine that protects against tetanus and diphtheria.
Normally, children get tetanus immunization in a triple shot that also contains diphtheria and acellular pertussis vaccines (DTaP) at ages 2 months, 4 months, 6 months, 12-18 months, and 4-6 years. Adults and adolescents get a tetanus booster vaccine every 10 years.
Last month, however, the CDC announced that all routine tetanus boosters in adolescents and adults should be delayed until 2002.
About 50 to 100 cases of tetanus are reported in the U.S. each year, according to the CDC. Tetanus, also known as lockjaw, is an acute disease caused by a toxin from the bacteria Clostridium tetani, which grows at the site of an injury. The disease is characterized by painful muscular contractions, primarily of the jaw muscles.
Diphtheria is an acute bacterial disease involving primarily the tonsils, windpipe, and nose. It causes inflammation and complications that can lead to airway obstruction.
The shortage of tetanus vaccine is having less of an effect on childhood immunizations than on adult immunizations, says Robert H. Hopkins Jr., MD.
"The situation as it stands right now is that the manufacturer of the DTaP vaccine -- the childhood vaccine -- says they've got adequate supplies to provide for all of the childhood immunizations," says Hopkins, associate professor of internal medicine and pediatrics, University of Arkansas for Medical Sciences.
He says while the CDC is trying to contain the situation to prevent a true shortage, such as what happened with flu shots last fall, there is a potential for shortages of childhood tetanus vaccine in certain areas of the country. If that happens, Hopkins says the fourth dose of the triple vaccine -- normally given at 12-18 months -- should be withheld until supplies are back to normal.
Hopkins says there also is enough adult tetanus vaccine for people requiring tetanus shots in emergencies, people who have not received the minimum number of tetanus and diphtheria shots, people traveling to countries with a high rate of diphtheria or pregnant women who have not had a tetanus shot in the last 10 years. He also serves on the Vaccine Medical Advisory Committee for the Arkansas Department of Health.
Those who are most affected by the shortage are adults requiring a routine booster. Also, kids going off to college in the fall who want to keep their tetanus booster current may be told to wait until next year, according to Hopkins.
The tetanus problem began months ago when Wyeth-Ayerst, one of two manufacturers of the adult tetanus vaccine, announced they would no longer make it due to a "business decision." Since then, the sole remaining manufacturer has been trying to keep up with the demand. But, they are limited by the fact that each batch of vaccine takes 11 months to produce.
"It is a severe shortage in that it clearly changes our practice," says Kathleen Neuzil, MD, MPH, assistant professor of medicine, University of Washington School of Medicine, in Seattle. "What we used to say was that every contact with the healthcare system should be a time to review and update immunization. This shortage is severe enough that ... we don't want to give routine boosters to people, which really is unprecedented in the United States."
Fortunately, the immunity provided by tetanus shots lasts a long time, so waiting another year if you're due for your booster now isn't really a big deal, says Neuzil, a member of the physician advisory board for the American College of Physicians-American Society of Internal Medicine Adult Immunization Initiative and a liaison to the CDC's vaccine committee on immunization practices.
Although doctors are being instructed to keep track of people whose boosters are being delayed, she says if yours is delayed, it's a good idea to remind your physician about it next year, just in case.