HIB Vaccine Shortage Continues – Pentacel Combo Vaccine is an Acceptable Alternative for Now Tuesday, January 13, 2009 With Merck’s PedVaxHIB vaccine still unavailable (and not anticipated to return until mid-2009), the country has been relying solely on Sanofi Pasteur’s ActHIB brand (which happens to be my preferred brand since it is aluminum-free). While most doctors, including myself, have been able to remain stocked with ActHIB (given at 2, 4, and 6 months of age), we aren’t yet able to offer the 4th and final dose of HIB vaccine at 15 months (current recommendations state to skip this last dose until the shortage is over). Some areas of the country may have already run out and are unable to provide any doses of plain HIB. Some doctors have instead begun offering Pentacel (a combo vaccine from Sanofi Pasteur that contains DTaP, Polio, and HIB). The HIB component is identical to ActHIB. The polio and DTaP components vary slightly from the regular plain polio and DTaP vaccines, but not in any way this is significant (read more about this under the Vaccine News Blogs). The amount of aluminum in Pentacel is the same as what is in Sanofi Pasteur’s plain DTaP (330 mcg). I believe that Pentacel is an acceptable alternative during this shortage. Although it does give polio vaccine earlier than where I have it on my Alternative Schedule (which has polio at 9, 12, and 24 months), using Pentacel at 2, 4, and 6 months provides all three vaccines (DTaP, HIB, and Polio) at the usual ages recommended on the regular vaccine schedule. I wouldn’t recommend using Pentacel for all four infant doses of DTaP and HIB (2, 4, 6, and 18 months) because that means an extra Polio dose (only 3 are needed during these first 2 years). Feel free to use Pentacel for any 3 or the 4 doses at 2, 4, 6, or 18 months. How this would look on my Alternative Schedule would be something like this: 2 mo – Pentacel 3 mo – PC, Rota 4 mo – Pentacel 5 mo – PC, Rota 6 mo – Pentacel 7 mo – PC, Rota 6 to 12 mo – flu shot at start of flu season, whenever you can work it in. Then continue on according to my schedule, just without the 9, 12, and 24 mo polio shots. You can also do the opposite – PC, Rota on the even months, and Pentacel on the odd months. If you begin Pentacel, you can switch back to the individual components at any time if the HIB supply returns. Dr. Bob Labels: Vaccine News posted by Dr. Bob Sears @ 2:41 PM   21 Comments: At January 13, 2009 11:06 PM ,  Catherina said... what a sensible schedule - why would you ever want to change that back?   At January 20, 2009 7:00 AM ,  Anonymous said... Dr. Bob, My son is due for his 12 month appointment. We have been following the alternative schedule but have missed his 9 month Polio due to a move and a round of colds. Would it be advisable to get the Pentacel vaccine at his 12 month or is this too early for the HIB and DTaP component that are recommended at 15 and 18 months? Thank you.   At February 2, 2009 2:31 PM ,  Anonymous said... Our pediatricians office began withholding the 3rd and 4th dose of ActHIB because of the shortage. I have been following your alternative schedule but my son who is now 10 months has only received two doses of ActHIB. I assume you would recommend the Pentacel at 12 months which would give him the 3rd dose of HIB, and the 4th and final dose of DTaP, and the 2nd dose of Polio? I'm leary of this option because of the high aluminum content. Any other suggestions? Thanks.   At February 8, 2009 8:10 PM ,  Eilat said... Dr. Bob, Have you seen this? http://www.timesonline.co.uk/tol/life_and_style/health/article5683671.ece I'm curious to hear your thoughts on this new development. Will you be updating the section in your book on the link between MMR and Autism?   At February 11, 2009 1:31 PM ,  Dr. Bob said... Catherina, did you actually can me sensible? Thanks! Anon and Anon - The 4th DTaP is really supposed to be between 15 and 18 months, so I would wait until 15 mo to do the Pentacel. You don't need to worry about the aluminum in Pentacel - it's pretty low. Eilat - Yes, I saw it, and it's concerning. However, Brian Deer is a reporter, reporting what he's found. I'm not inclined to automatically believe him, since he's been plugging away at Wakefield for many years. I'll wait until a medical source tells me that Wakefield faked his data before I believe it.   At February 11, 2009 2:00 PM ,  Angie092172 said... Dr. Bob, First: thank you, thank you for the concise Vaccine Book. I've tried to do my own research and have stumbled upon both too much information and not enough statistical and scientific data to make sense of it all. (Unfortunately, every Ped we've had just point us back to the CDC fact sheets.) I'm only in Chapter 1 but have followed your links in the book to read up thoroughly on the HIB vaccines and their ingredients, etc. I live in Minnesota with two unvaccinated children ages 7 months and 2 years. I won't go into the reasons they're not vaccinated since as I just said, I'm reading your book. I am able to stay at home with them both and am breastfeeding. My question though, concerns the recent HIB "outbreak" in MN. The local news and other sites such as WEBmd and others have reported this story based on the recent report. The MN Dept. of Health is urging parents to get their kids vaccinated and there seems to be a panic. The story is basically covered by the CDC's website here: http://www.cdc.gov/media/mmwrnews/2009/n090129.htm#4 I finally found some actual data regarding the "outbreak" on the CDC website: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e0123a1.htm#tab According to the table, the cases were 3/First Qtr. 2008 & 2/Fourth Qtr. 2008. So my questions for you Dr. Bob are: 1) Is this really an "outbreak", 5 cases in 1 year at separate times? 2) Why is it so difficult to readily find "real" numbers...ie. When did the child(ren) acquire the illness? How many children who are vaccinated still get the illness? Why is no one required to report the entire story? 3) Where is the outbreak--geographically? When I think of outbreak, I think of everyone wearing surgical masks and not leaving their homes. :) I understand that MN has not had an outbreak in years since the vaccine. 4) What determines an outbreak? 5)Is there a source to get more information when the CDC states we have one so that we (parents) may make informed decisions? I don't doubt this is a serious matter. However, I think the Government tends to react with overwhelming almost "scare tactic" responses sometimes. Also, the Govt. seems to be finally reacting to the news that there's been a HIB vaccine shortage. I just can't trust their timing when it comes to getting answers. Thank you for the sanity and REAL answers. I appreciate your time, Angela Alshouse Wyoming, MN   At February 12, 2009 11:15 AM ,  Anonymous said... Dr. Sears, While this is totally hearsay, in October, I discussed the single dose MMR with my pediatrician. She told me that their Merck rep had recently informed her office that Merck was no longer producing the single shot. According to the Merck rep (as reported by my pediatrician, so we are now getting close to a game of telephone), the CDC requested that Merck stop producing the single dose b/c they felt like it was playing into parents' hysteria about the possible autism link. Merck was complying wiht the CDCs wishes despite the single dose shots being financially beneficial for both Merck and my pediatrician (I have no idea how financially beneficial was determined for either Merck or my pediatrician). I hesitate to post it b/c i have no way of verifying the info, but thought you might like to know. Thanks for your balanced and reasoned approach to all of this. I wish more individuals in this debate were including all the information(or as much as is reasonable), rather than just cherry picking the info that supports their argument.   At February 17, 2009 12:04 PM ,  amummert@vt.edu said... I'm confused -- Here on the website it says: "...Pentacel Combo Vaccine is an Acceptable Alternative for Now" and "the amount of aluminum in Pentacel is the same as what is in Sanofi Pasteur’s plain DTaP (330 mcg)." But on the hardcopy of The Vaccine Book, it says that there are 1500 micrograms of aluminum in the Pentacel combo vaccine (page 41). Which is correct? Than you!   At February 17, 2009 5:22 PM ,  Anonymous said... Ammummert: Throughout The Vaccine Book, Dr. Sears states he will post updates & corrections on this website. You can find the latest here: http://www.askdrsears.com/thevaccinebook/the_vaccine_book_updates.asp hope it helps :) Angie092172   At February 28, 2009 8:39 PM ,  Anonymous said... I would like to know if anyone has heard the following about vaccine-making companies: A woman told my mom today that although vaccination manufacturers say that they never use mercury in their vaccine formulas that they do rinse the vials with mercury before filling them with the vaccines and therefore, they can still use it as a preservative without having to claim that it is present in the vaccination. Is this true?!?   At March 3, 2009 5:49 AM ,  Amy said... I didn't know there were updates which is unfortunate. When going to get the second dose of hib for my baby I was told it wasn't available and was offered Pentacel. I declined and went home to check the book. The book said the aluminum content was a lot higher and after much internal debate I decided to wait and continued with the separate doses of dtap. My baby is now 9 months old, I have done all 3 doses of dtap and one dose of polio and still only one dose of hib. The drs. office never gave info. on what they knew about the shortage and I just assumed short-lived. Now I understand it won't be available until at least mid-year and I'm worried she will contract the virus. If I had known the amount of aluminum was the same in Pentacel as in the separate shots I would have done it back at the time for the 2nd dose. Very frustrating and hoping "herd immunity" will protect her. I know the one dose isn't enough because one or two of the babies in MN that contracted it this winter hadn't completed the series. Please make that information more prominent on the website. I had checked the website, but never saw the updates to the book, only this blog.   At March 23, 2009 12:55 PM ,  Anonymous said... Further to what one of your anonymous contributors announced above about the CDC putting pressure on Merck to stop producing the mumps vaccine, I am from the UK and have similarly heard that there is likely to be some link between the fact that Merck is the supplier to the UK's NHS (National Health Service) of the MMR vaccine. The NHS is OBSESSED (and I don't use the term lightly) with children having the MMR rather than single doses...   At March 25, 2009 10:46 AM ,  david said... thank you for your helpful articles. Our son had his MMR live vaccine on 3/4/09 but has yet to have any HIB shots as we live in Japan and they just began to recommend them. After reviewing the CDC recommendations we plan to get him HIB as soon as possible, but were suggested to wait until 4 weeks have past between the MMR live and HIB vaccines. We will be visiting the U.S. from 4/3 and would like to get him his HIB shot a week before on 3/27/09 in case of any post-vaccine complpications. But this will make it only 3 weeks since the MMR vaccine. How necessary to observe the 4 week suggestion if consider that we might not be able to get him the HIB vaccine until back in Japan around 4/20/09 if we miss this opportunity? Would you suggest waiting or getting it now at the 3 week point?   At April 8, 2009 3:47 AM ,  Anonymous said... Can you tell me about the tDAP and pregnancy. Is it a good idea to get updated before pregnancy. How long is the vaccine in my body? How long do I have to wait? Is tetanus so rare that it's better to just wait and get the shot only if I need it?   At May 20, 2009 9:27 PM ,  Anonymous said... following up on what amummert@vt.edu wrote above... i'm also confused because the pentacel insert i have from my daughter's pedi states that it contains 1500 mcg of aluminum. Is there another pentacel? if not, please correct your website, so parents are aware of the high level of aluminum! thank you!   At June 9, 2009 1:27 PM ,  KristinL said... I have the book in front of me and on pg 41 it says Pentacel contains "Aluminum phosphate-1500 mcg(which is only 330 mcg of actual aluminum). So it is a form of aluminum but I guess when broken down is only 330 mcg. Hope this helps!   At July 7, 2009 11:22 AM ,  Angela said... Dr Sears, After reading your info on pentacel, "feel free to use pentacel for any 3 of the 4 doses at 2,4,6, or 18 months." we have decided to start at 4months with pentacel. Our son is 2 months old and can start the PC, and rotavirus at 3 months then. My uestion is, after the 6 month shot, how immune will our baby be, since it is a full 12 months since he will gt th 3rd and final dose of this.   At July 7, 2009 2:48 PM ,  Sue said... Dear Dr. Sears, My son is 13 months old, and we have not gotten him any vaccinations thus far. We are now interested in beginning vaccinations. I have read your book, and am wondering what vaccinations to start with, as 13 months is not listed on your Selective Vaccination Schedule. I am very worried about aluminum, and do not want to get MMR. Thanks for any advice!   At July 16, 2009 10:22 AM ,  yogibrenda said... Dr. Sears: My daughter is almost 2 years of age and has not had a HIB vaccine. She has only had 2 DTaP vaccines. I was planning on giving her the Pentacel at 2 years of age which would be her 3rd and final DTaP until her booster at age 4 or 5 and it would give her her 1st Polio and her 1 HIB which would be the only dose of HIB I would plan to give her according to your book after 18 months she only needs one. Is it okay to give her the Pentacel this once and then give her remaining 2 polio vaccines as just IPV??   At October 6, 2009 7:54 PM ,  bluezy said... Dr. Bob, I am a bit confused about the aluminum content data you present in your book in comparison to data I see on a chart from Johns Hopkins Bloomberg School of Public Health website(http://www.vaccinesafety.edu/components-DTaP.htm). You write in your book (pg 41) that Pentacel contains 1500 micrograms of aluminum phosphate, which translates to 330 micrograms of actual aluminum. You also write that Daptacel contains 330 micrograms of aluminum (pg33). The website I mention above shows that Daptacel contains 330 micrograms of aluminum phosphate, not actual aluminum. If this data is true, why doesn't the 330 mg of aluminum phosphate in Daptacel translate to a much smaller amount of actual aluminum (as per your calculation for Pentacel)? Thank you for your time -Alex   At October 7, 2009 2:18 PM ,  bluezy said... RETRACTION OF PREVIOUS COMMENT: It looks like the content on the Johns Hopkins Bloomberg School of Public Health website(http://www.vaccinesafety.edu/components-DTaP.htm) is incorrect regarding Daptacel. The product pamphlet from the manufacturer states 330 micrograms of aluminum (not aluminum phosphate). Although it does use aluminum phosphate as the adjuvant.   Post a Comment << Home   The 12 Childhood Vaccines Vaccine-preventable Diseases Boost Your Child's Immune System FAQs Parents Who Choose not to Vaccinate Current Outbreaks and Epidemics Vaccine Discussion Forum Read Dr. Bob's Online Interviews Updates & Corrections to The Vaccine Book Find a vaccine-friendly doctor near you Alternative Vaccine Schedule American Academy of Pediatrics 2007 Vaccine Schedule Vaccine News Vaccines and Autism Vaccines and their diseases

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