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PA Bulletin, Doc. No. 04-1738


Immunization Practices for Children in Child Care Group Settings

[34 Pa.B. 5218]

   In accordance with 28 Pa. Code § 27.77(c) (relating to immunization requirements for children in child care group settings), the Department of Health (Department), Bureau of Communicable Diseases, Division of Immunization, is updating the list of Morbidity and Mortality Weekly Report (MMWR) publications that contain the Advisory Committee on Immunization Practices (ACIP) recommendations that meet the standards in 28 Pa. Code § 27.77(c). Children in child care group settings as defined by 28 Pa. Code § 27.77(c) are required to be immunized in accordance with the recommendations included in the following publications. The Department is providing a summary of the publications for the ease of reference of the public:

   ''Notice to Readers: Limited Supply of Pneumoccocal Conjugate Vaccine: Suspension of Recommendation for Fourth Dose,'' MMWR, February 13, 2004/Vol. 53/No. 5.

   Summary: In December 2003, the Federal Centers for Disease Control and Prevention (CDC) reported that Wyeth Vaccines, the only supplier in the United States of 7-valent pneumoccocal conjugate vaccine (PCV7, marketed as Prevnar®), was experiencing production constraints that could cause delays in shipments and was implementing an allocation plan to ensure the equitable distribution of available vaccine (1). In February 2004, Wyeth Vaccines advised the CDC that production constraints had not been resolved and that supplies will remain limited at least through July 2004. Until full production capacity is resumed, local shortages might occur. Effective immediately, the CDC recommends that health-care providers temporarily suspend routine use of the fourth dose of PCV7 to conserve vaccine and minimize the likelihood of shortages.

   ''Notice to Readers: Updated Recommendations on the Use of Pneumoccocal Conjugate Vaccine: Suspension of Recommendation for Third and Fourth Dose,'' MMWR, March 5, 2004/Vol. 53/No. 8.

   Summary: On February 13, 2004, the CDC recommended that health care providers temporarily suspend routine use of the fourth dose of PCV7 when vaccinating healthy children (1). This action was taken to conserve vaccine and minimize the likelihood of shortages until Wyeth Vaccines, the only supplier in the United States of PCV7, restores sufficient production capacity to meet the National need. Since that recommendation, PCV7 production has been much less than expected because of continuing problems with the PCV7 vial-filling production line. Shipments have been delayed, resulting in spot shortages that might continue beyond summer 2004 and become widespread. Effective immediately, to further conserve vaccine, the CDC recommends that all health care providers temporarily suspend routine administration of both the third and fourth doses to healthy children.

   ''Notice to Readers: Availability of Diphtheria Antitoxin Through an Investigational New Drug Protocol,'' MMWR, May 21, 2004/Vol. 53/No. 19.

   Summary: Effective treatment of respiratory diphtheria includes early administration of an equine diphtheria antitoxin (DAT). Delay in DAT administration can lead to life-threatening respiratory obstruction, myocarditis and other complications. To ensure quick access to DAT, the CDC maintains a stock of DAT for release to physicians in the Untied States.

   ''Prevention and Control of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP),'' MMWR, May 28, 2004/Vol. 53/No. RR-6.

   Summary: The 2004 recommendations include four principal changes or updates:

   1.  The ACIP recommends that healthy children 6 to 23 months of age, and close contacts of children aged 0 to 23 months of age, be vaccinated against influenza (see Target Groups for Vaccination).

   2.  Inactivated vaccine is preferred over live, attenuated influenza vaccine (LAIV) for vaccinating household members, health care workers and others who have close contact with severely immuno-suppressed persons during periods when these persons require care in a protected environment. If a health care worker receives the LAIV, the health care worker should refrain from contact with severely immuno-suppressed patients for 7 days after vaccine receipt. No preference exists for inactivated vaccine use by health care workers or other persons who have close contact with persons with lesser degrees of immuno-suppression (see Live Attenuated Influenza Vaccine Recommendations/Close Contacts of Persons at High Risk for Complications from Influenza).

   3.  Severely immuno-suppressed persons should not administer the LAIV. However, other persons at high risk for influenza complications may administer LAIV (see Personnel Who May Administer LAIV).

   4.  The 2004-2005 trivalent vaccine virus strains are A/Fujian/411/2002 (H3N2)-like, A/New Caledonia/20/99 (H1N1)-like and B/Shanghai/361/2002-like antigens. For the A/Fujian/411/2002 (H3N2)-like antigen, manufacturers may use the antigenically equivalent A/Wyoming/3/2003 [H3N2] virus and for the B/Shanghai/361/2002-like antigen, manufacturers may use the antigenically equivalent B/Jilin/20/2003 virus or B/Jiangsu/10/2003 virus (see Influenza Vaccine Composition).

   Additional information regarding vaccinations can be obtained from the Department's website: Additional information regarding vaccinations can also be obtained from the National Immunization Program of the CDC's website:

   Persons with a disability who require an alternative format of this notice (for example, large print, audiotape or Braille) should contact Alice Gray, Director, Division of Immunization, Department of Health, P. O. Box 90, Harrisburg, PA 17108-0090, (717) 787-5681, for speech and/or hearing impaired persons V/TT: (717) 783-6154 or the Pennsylvania AT&T Relay Service at (800) 654-5984 (TT).


[Pa.B. Doc. No. 04-1738. Filed for public inspection September 17, 2004, 9:00 a.m.]

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