{"id":10129,"date":"2025-03-01T14:02:50","date_gmt":"2025-03-01T19:02:50","guid":{"rendered":"https:\/\/dhss.delaware.gov\/dph\/dhan171\/"},"modified":"2025-03-02T00:47:53","modified_gmt":"2025-03-02T05:47:53","slug":"dhan171","status":"publish","type":"page","link":"https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan171\/","title":{"rendered":"php\/alerts\/dhan171 ~  Division of Public Health &#8211; &#8211; Health Alert  &#8211; Delaware Health and Social Services &#8211; State of Delaware"},"content":{"rendered":"<div data-swiftype-index=\"true\">\n\n\n\n  <br>\n\n\n\n  <div class=\"container\" id=\"main_header\"> \n\n    <!-- BEGIN readspeaker div -->\n\n    <div class=\"rs_skip rsbtn rs_preserve\" id=\"readspeaker_button1\">\n\n      <a accesskey=\"L\" class=\"rsbtn_play\" href=\"https:\/\/app-na.readspeaker.com\/cgi-bin\/rsent?customerid=7262&#038;lang=en_us&#038;readid=main_content&#038;url=https:\/\/dhss.delaware.gov\/dph\/php\/alerts\/dhan171.html\" title=\"Listen to this page using ReadSpeaker\">\n\n        <span class=\"rsbtn_left rsimg rspart\"><span class=\"rsbtn_text\"><span>Listen<\/span><\/span><\/span>\n\n        <span class=\"rsbtn_right rsimg rsplay rspart\"><\/span>\n\n      <\/a>\n\n    <\/div>\n\n    <!-- END readspeaker div -->\n\n\n\n    \n\n    <header class=\"pull-left\">\n\n      <h1>Delaware Health Alert Network #<!--[type=EDIT name=\"DHAN Number\"]-->171 <!--[END]--> <\/h1>\n\n      <h2> <!--[type=EDIT name=\"DHAN Date\"]-->March 19, 2009 3:02 pm <!--[END]--> <\/h2>\n\n    <\/header>\n\n  <\/div><br>\n\n \n\n  <div class=\"container\">\n\n    <div class=\"row\">\n\n      <div class=\"col-md-3\" id=\"leftCol\">\n\n        <div class=\"panel-group\" id=\"accordion\">\n\n          <div class=\"panel sectionmenu_panel\">\n\n            <div class=\"panel-heading\">\n\n              <p class=\"panel-title\"><a class=\"agency_nav\" data-parent=\"#accordion\" data-toggle=\"collapse\" href=\"#collapseOne\"><strong><i class=\"fa fa-align-justify fa-fw\"><\/i> Public Health Menu<\/strong><\/a><\/p>\n\n            <\/div>\n\n\n\n            <div class=\"panel-collapse collapse in\" id=\"collapseOne\">\n\n              <div class=\"panel-body\" id=\"clf_nav\">\n\n                  <ul class=\"nav nav-stacked nav-pills-clf\" id=\"agency_sidebar\">\n    <li><a href=\"\/dph\/\"><h2>Home <i class=\"fa fa-home fa-fw\"><\/i><\/h2><\/a><\/li>\n    <li class=\"toplevel\"><a data-parent=\"#agency_sidebar\" data-toggle=\"collapse\" href=\"#HomeMenu\"><h2>About <i class=\"fa fa-caret-right fa-fw\"><\/i><\/h2><\/a>\n      <ul class=\"panel-collapse collapse\" id=\"HomeMenu\">\n        <li><a href=\"\/dph\/about.html\">About DPH<\/a><\/li>\n        <li><a href=\"\/dph\/sections.html\">Sections &#038; 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A nationwide shortage of Hib vaccine began in December 2007 and is ongoing. The\n\n\n  recall of certain lots of the two Hib-containing vaccines produced by Merck &#038; Co., Inc. and cessation of production of both vaccines\n\n\n  has left only one manufacturer of Hib vaccine in the United States (Sanofi Pasteur). The shortage resulted in a recommendation by CDC to\n\n\n  defer the Hib booster (routinely recommended at 12 through 15 months) for children who are NOT at high risk of Hib infection temporarily,\n\n\n  until supplies are restored. This recommendation is still in effect.\n\n\n<\/p>\n\n\n<p>\n\n\n  Temporary deferral of the booster dose at 12 through 15 months of age for non-high risk children may have resulted in increased Hib\n\n\n  carriage and transmission in non-symptomatic children. There is potential to see increases in cases of Hib disease at the local level.\n\n\n  During 2008 in Minnesota, five children aged 5 months through 3 years were reported with invasive Hib disease; one died. Three patients\n\n\n  had received no vaccinations because of parent or guardian deferral or refusal. One child was aged 5 months and had received 2 doses of\n\n\n  Hib PRP-TT vaccine in accordance with the primary series schedule. Another child had received 2 doses of Hib PRP-OMP vaccine, but no\n\n\n  booster dose, per CDC recommendations during the shortage. Subsequent to Hib infection, this child was diagnosed with\n\n\n  hypo-gammaglobulinemia. The five cases in 2008 were the most reported for 1 year from Minnesota since 1992, when 10 cases were reported.\n\n\n<\/p>\n\n\n<p>\n\n\n  There is enough Hib-containing vaccine for all U.S. children to receive the primary series. All children should complete the primary\n\n\n  series by 7 months of age; <em>high risk children should continue to receive the full primary series and the booster dose<\/em>.\n\n\n  Completion of the primary series with currently available vaccine products (manufactured by Sanofi Pasteur) requires a total of 3 doses\n\n\n  of Hib-containing vaccine (2, 4, and 6 months). Although there is enough Hib-containing vaccine nationally to support these\n\n\n  recommendations, there may be times when practitioners do not have an adequate supply of vaccine to meet local demand. If Hib vaccine is\n\n\n  not available in the office at the time of a visit, children who are unable to receive one of the primary series doses should be tracked\n\n\n  and recalled to schedule an appointment to receive their dose as soon as vaccine becomes available in the office.\n\n\n<\/p>\n\n\n<p>\n\n\n  In addition, using available Hib-containing vaccines has presented challenges associated with switching from the Merck to Sanofi products\n\n\n  for some providers.\n\n\n<\/p>\n\n\n<p>\n\n\n  There are indications that these challenges have led to lower completion of the primary series. Preliminary information comes from\n\n\n  sentinel immunization information systems (registries) in select states, which have indicated up to 10% lower coverage with the third Hib\n\n\n  dose in the primary series compared to other vaccines (DTaP, PCV7) commonly administered at the same visit. In the scenario of booster\n\n\n  dose deferral, it is even more important that all infants receive the complete primary series.\n\n\n<\/p>\n\n\n<p>\n\n\n  Specifically, some of the challenges in using the currently available Hib-containing vaccines have included provider reluctance to switch\n\n\n  inventory and schedules, misunderstanding regarding what constitutes primary versus booster doses, determining a catch-up schedule in the\n\n\n  setting of the deferred booster, and provider and parent concerns about over vaccination resulting from switching to the Sanofi Pasteur\n\n\n  Hib-containing vaccine. Despite these challenges, health care providers need to ensure that all children are appropriately vaccinated\n\n\n  with the primary series. For example, if Pentacel (DTaP-IPV\/Hib) is the only Hib-containing vaccine available, this combination product\n\n\n  should be used to complete the primary series, even if doing so results in receipt of additional doses of other antigens (e.g., DTaP,\n\n\n  IPV). The Hib-containing vaccine products that are available may not be what providers used previously in their practice; however, the\n\n\n  potential for increased transmission of Hib makes it more important than ever that every child is adequately protected.\n\n\n<\/p>\n\n\n<h4>\n\n\n  Recommendations\n\n\n<\/h4>\n\n\n<p>\n\n\n  The following non-high risk children should be scheduled to receive the primary series of Hib vaccine as outlined below:\n\n\n<\/p>\n\n\n<ul>\n\n\n  <li>If the child is at least 6 weeks but less than 12 months of age and has received zero, one, or two doses of Hib vaccine, schedule\n\n\n  him\/her for the first or next dose(s) immediately with a minimum of four weeks between the doses. These children will need one booster\n\n\n  dose when the Hib vaccine shortage is over.\n\n\n  <\/li>\n\n\n  <li>If the child is between 12 and 14 months of age and has not had any doses of Hib vaccine, schedule appointments for two doses, eight\n\n\n  weeks apart.\n\n\n  <\/li>\n\n\n  <li>If the child is between 12 and 14 months of age and has received Hib vaccine but did not complete the primary series before they\n\n\n  turned 1 year old (i.e., had 1 dose of the Merck product OR 1-2 doses of the Sanofi product), schedule an appointment for 1 additional\n\n\n  dose, a minimum of eight weeks from the last dose.\n\n\n  <\/li>\n\n\n  <li>If the child is at least 15 months of age but less than 5 years of age and has not received any doses of Hib vaccine OR has not\n\n\n  completed the primary series (i.e., had 1 dose of the Merck product OR 1-2 doses of the Sanofi product), schedule an appointment for one\n\n\n  dose.\n\n\n  <\/li>\n\n\n  <li>If the child is 5 years old or older and hasn\u2019t received any Hib vaccine, Hib vaccine is not necessary.\n\n\n  <\/li>\n\n\n<\/ul>\n\n\n<p>\n\n\n  Certain children are at increased risk for Hib disease, including children with asplenia, sickle cell disease, human immunodeficiency\n\n\n  virus infection and certain other immunodeficiency syndromes, and malignant neoplasms. CDC recommends that providers continue to\n\n\n  vaccinate these children with available Hib conjugate vaccines according to the routinely recommended schedules, including the 12 through\n\n\n  15 month booster dose. Providers who serve predominantly American Indian\/Alaska Native (AI\/AN) children living in AI\/AN communities\n\n\n  should continue to stock and use PRP-OMP\u2013 containing Hib vaccines (Merck product) and vaccinate according to the routinely\n\n\n  recommended schedule, which includes the 2-dose primary series (ages 2 and 4 months) and a 12 through 15 month booster dose. This product\n\n\n  is available from the VFC Pediatric Vaccine Stockpile, through their state immunization programs.\n\n\n<\/p>\n\n\n<p>\n\n\n  For more information about Hib disease and vaccination please call the Delaware Immunization Program Hotline at 1-800-282-8672 or the CDC\n\n\n  at 1-800-232-4636\/1-800-CDC-INFO or by email at <a href=\"http:\/\/www.cdc.gov\/vaccines\/about\/contact\/nipinfo_contact_form.htm\">www.cdc.gov\/vaccines\/about\/contact\/nipinfo_contact_form.htm<\/a>.\n\n\n<\/p><!--[END]-->\n\n  \n\n        <div class=\"panel panel-danger\">\n\n          <div class=\"panel-heading\">    \n\n      <h2>Categories of Health Alert messages:<\/h2>\n\n       <\/div>\n\n       <div class=\"panel-body\">\n\n      <ul>\n\n        <li><strong>Health Alert:<\/strong> Conveys the highest level of importance; warrants immediate action or attention.<\/li>\n\n        <li><strong>Health Advisory:<\/strong> Provides important information for a specific incident or situation; may not require immediate action.<\/li>\n\n        <li><strong>Health Update:<\/strong> Provides updated information regarding an incident or situation; unlikely to require immediate action.<\/li>\n\n            <\/ul>\n\n         <div><strong>NOTE: This page is for informational purposes only and dated material (e.g. temporary websites) may not be available.<\/strong><\/div>\n\n          <\/div> \n\n        <\/div><br>  \n\n\n\n      <\/div>\n\n    <\/div>\n\n  <\/div><!-- \/container -->\n\n  <\/div>","protected":false},"excerpt":{"rendered":"<p>Listen Delaware Health Alert Network #171 March 19, 2009 3:02 pm Public Health Menu Home About About DPH Sections &#038; Programs Office Locations Contact Info Calendar Services A-Z Services Air &#038; Water Quality Birth, Death, &#038; Marriage Records Clinics Health Data &#038; Statistics Emergency Preparedness Health &#038; Wellness Healthy Homes Healthy Workplaces Laboratory Restaurant Inspections [&hellip;]<\/p>\n","protected":false},"author":8,"featured_media":0,"parent":9294,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"inline_featured_image":false,"footnotes":""},"class_list":["post-10129","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10129","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/users\/8"}],"replies":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/comments?post=10129"}],"version-history":[{"count":1,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10129\/revisions"}],"predecessor-version":[{"id":11305,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/10129\/revisions\/11305"}],"up":[{"embeddable":true,"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/pages\/9294"}],"wp:attachment":[{"href":"https:\/\/dhss.delaware.gov\/dph\/wp-json\/wp\/v2\/media?parent=10129"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}