Skip Navigation LinksSkip Navigation Links
Centers for Disease Control and Prevention
Safer Healthier People
Blue White
Blue White
bottom curve
CDC Home Search Health Topics A-Z spacer spacer
Blue curve MMWR spacer

Persons using assistive technology might not be able to fully access information in this file. For assistance, please send e-mail to: Type 508 Accommodation and the title of the report in the subject line of e-mail.

Notice to Readers: Limited Supply of Pneumococcal Conjugate Vaccine: Suspension of Recommendation for Fourth Dose

In December 2003, CDC reported that Wyeth Vaccines, the only U.S. supplier of 7-valent pneumococcal 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 advised 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, 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.

PCV7 is a highly effective vaccine. In October 2000, a primary series of three PCV7 injections and one booster was recommended for all children (2). In 2001, the incidence of invasive pneumococcal disease among children aged <2 years was 69% less than during 1998--1999, before the recommendation (3). Preliminary data from CDC's Active Bacterial Core Surveillance program indicate that effectiveness, at least for the short term, is not compromised by delaying administration of the fourth dose. A case-control study comparing the effectiveness of a 3-dose series with a 4-dose series found that 3 doses were 90% effective (95% confidence interval [CI] = 74%--96%) against invasive disease caused by serotypes represented in the vaccine, whereas 4 doses were 96% effective (95% CI = 68%--100%); this difference was not statistically significant.

Because precise allocation of PCV7 is difficult, spot shortages are inevitable when supplies are limited. To ensure that every child can be protected against pneumococcal disease despite the limited supply, and on the basis of the short-term effectiveness of the 3-dose primary series of PCV7 at ages 2, 4, and 6 months, CDC, in consultation with the American Academy of Family Physicians, the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices, recommends that all health-care providers, regardless of the amount of PCV7 in their inventories, help conserve the national PCV7 supply by temporarily discontinuing administration of the fourth dose of PCV7 for healthy children. Health-care providers should continue to administer the fourth dose to children at increased risk for severe disease*. Children whose booster dose is deferred should receive PCV7 on their first visit after supplies are restored. If all health-care providers comply with this temporary recommendation, >1 million doses will be conserved by July 2004, making widespread or prolonged disruptions in vaccination services less likely.

This recommendation reflects CDC's assessment of the existing national PCV7 supply and may be changed if the supply changes. Updated information about vaccine supplies is available from CDC at


  1. CDC. Limited supply of pneumococcal conjugate vaccine. MMWR 2003;52:1234.
  2. CDC. Preventing pneumococcal disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR 2000;49(No. RR-9).
  3. Whitney CG, Farley MM, Hadler J, et al. Decline in invasive pneumococcal disease after the introduction of protein-polysaccharide conjugate vaccine. N Engl J Med 2003;348:1737--46.
  4. CDC. Pneumococcal vaccination for cochlear implant candidates and recipients: updated recommendations of the Advisory Committee on Immunization Practices. MMWR 2003;52:739--40.
  5. American Academy of Pediatrics. Table 3.43. In: Pickering LK, ed. 2003 Red Book: Report of the Committee on Infectious Diseases, 26th ed. Elk Grove Village, Illinois: American Academy of Pediatrics, 2003.

* Includes children with sickle cell disease and other hemoglobinopathies, anatomic asplenia, chronic diseases (e.g., chronic cardiac and pulmonary disease and diabetes), cerebrospinal fluid leak, human immunodeficiency virus infection and other immunocompromising conditions, immunosuppressive chemotherapy or long-term systemic corticosteroid use; children who have undergone solid organ transplantation (2); and children who either have received or will receive cochlear implants (4). All these children have been identified as being at either "high risk" or "presumed high risk" for severe invasive pneumoccocal disease (5).

Use of trade names and commercial sources is for identification only and does not imply endorsement by the U.S. Department of Health and Human Services.

References to non-CDC sites on the Internet are provided as a service to MMWR readers and do not constitute or imply endorsement of these organizations or their programs by CDC or the U.S. Department of Health and Human Services. CDC is not responsible for the content of pages found at these sites. URL addresses listed in MMWR were current as of the date of publication.

Disclaimer   All MMWR HTML versions of articles are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the electronic PDF version and/or the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices.

**Questions or messages regarding errors in formatting should be addressed to

Page converted: 2/12/2004


Safer, Healthier People

Morbidity and Mortality Weekly Report
Centers for Disease Control and Prevention
1600 Clifton Rd, MailStop E-90, Atlanta, GA 30333, U.S.A


Department of Health
and Human Services

This page last reviewed 2/12/2004