Tag: discontinued vaccines

What Are the Changes in the 2018 Immunization Schedules?

As they do every year, the Advisory Committee on Immunization Practices (ACIP) just released an updated immunization schedule.

The 2018 immunization schedule didn't bring any changes for most kids.
The 2018 immunization schedule doesn’t bring any changes for most kids.

And just like in most other recent years, there were few big changes or announcements.

That means that most kids won’t need any extra shots when they go to their next well check up with their pediatrician or to start school.

What Are the Changes in the 2018 Immunization Schedules?

There are some changes though…

  • A third dose of MMR is now recommended for some people during outbreaks of mumps.
  • MenHibrix was removed from the schedule, which was expected, as this combination meningococcal vaccine for high risk kids was discontinued in 2016 because of low demand. Fortunately, this doesn’t mean that any kids will be left unprotected. They can just get one of the other meningococcal vaccines if they need it, with a separate Hib vaccine, just like other infants.
  • Menomune was removed from the schedule, which was expected, as this older meningococcal vaccine was discontinued in 2017, as it was replaced with the newer meningococcal conjugate vaccines (Menactra and Menveo).
  • Shingrix, the new recombinant shingles vaccine is added to the schedule for adults aged 50 or older. They should get 2 doses 2 to 6 months apart, even if they have had shingles in the past or have had the older Zostavax already. And Shingrix becomes the preferred shingles vaccine for those who are at least 60 years old.

The other changes are to the formatting of the schedule and schedule footnotes.

“The schedule footnotes are presented in a new simplified format. The goal was to remove unnecessary text while preserving all pertinent information and maintaining clarity. This was accomplished by a transition from complete sentences to bullets, removal of unnecessary or redundant language, and formatting changes.”

CDC on Changes to This Year’s Schedule

So, unless your child is in a mumps outbreak, the new immunization schedule shouldn’t mean any extra vaccines.

What to Know About the 2018 Immunization Schedule

The 2018 immunization schedule from the CDC, AAP, ACOG, and AAFP incorporates the latest recommendations from the ACIP, including that folks in a mumps outbreak might need a third dose of MMR.

More on the 2018 Immunization Schedule

Typhus vs Typhoid Fever

Typhus and typhoid have both been in the news recently.

  • Texas officials issue alert about typhus threat
  • Typhoid: Two children die‚ 60 ill after drinking from contaminated stream in South Africa

Should you start panicking?

Of course not.

Even before they knew which bacteria actually caused typhus and typhoid fevers, they knew they were different diseases.
Even before they knew which bacteria actually caused typhus and typhoid fevers, they knew they were different diseases.

While neither is usually a threat to most people in developed countries, instead of panicking, get educated and learn how you can prevent these still common infections.

Typhus Fever

Epidemic typhus fever is spread by human body lice (not head lice!) that are infected with the Rickettsia prowazekii bacteria.

Symptoms of typhus fever can include the sudden onset of:

  • fever
  • muscle aches (myalgias)
  • headache
  • chills
  • not feeling well (malaise)
  • cough

Some patients develop a characteristic rash made up of small red spots (macules) that start on the upper trunk. It then spreads to the rest of the body, but spares the face, palms, and soles. The rash can eventually become petechial.

Untreated, the fever may last up to two weeks, followed by a slow recovery of two to three months for all of the other symptoms. Typhus fever can be fatal.

Fortunately, treatment is available – the antibiotic doxycycline.

How do you prevent epidemic typhus fever? You avoid body lice. And avoid flying squirrels, which can be infected with Rickettsia prowazekii bacteria.

Is typhus fever vaccine-preventable? No, although a typhus vaccine was once available, it was discontinued in 1979.

Keep in mind that in addition to epidemic typhus, which is now very rare, typhus can also be spread by fleas (murine typhus) and chiggers (scrub typhus).

Murine or endemic typhus is common in tropical and subtropical climates, where it is spread by rats and fleas. In the United States, it is mainly found in California, Hawaii, and Texas, where it has also been associated with cat fleas found on cats and opossums.

Scrub typhus is associated with chiggers in rural areas of Southeast Asia, Indonesia, China, Japan, India, and northern Australia.

Typhoid Fever

Although typhus and typhoid some very similar, there are some big differences between these two diseases.

What are they?

Unlike typhus, typhoid fever is:

  • caused by the Salmonella typhi bacteria
  • spread by ingesting contaminated food and water
  • characteristic by symptoms that include a gradual onset of fever, with stomach aches, headache, loss of appetite, and sometimes a rash.
  • still vaccine preventable – in fact, there are two typhoid vaccine, one oral and the other a shot

Fortunately, typhoid fever can be treated with antibiotics, although it is sometimes multi-drug resistant and some people become chronic carriers, even with treatment (Typhoid Mary).

While adventurous and fun, eating street vendor food is probably a good way to get typhoid fever.
While adventurous and fun, eating street vendor food is probably a good way to get typhoid fever. Photo by Sam Sherratt (CC BY-SA 2.0)

That it can still be treated is a good thing, because unlike epidemic typhus, typhoid fever is still very much around.

The CDC estimates that there are about 5,700 cases of typhoid fever in the United States each year, mostly in travelers that leave the country.

Worldwide, there are about 21 million cases of typhoid fever and 222,000 typhoid-related deaths each year!

In addition to getting vaccinated, if traveling to the developing world, to avoid typhoid, you should avoid risky food and be sure to “Boil it, cook it, peel it, or forget it.”

What to Know About Typhus and Typhoid Fever

Typhus and typhoid fevers are two very different diseases that can both be avoided with good hygiene practices.

More on Typhus and Typhoid Fever

Underreporting of Side Effects to VAERS

Vaccine injuries and side effects should be reported to Vaccine Adverse Event Reporting System (VAERS).

Reporting Side Effects to VAERS

The CDC advises that “all significant adverse events that occur after vaccination of adults and children, even if you are not sure whether the vaccine caused the adverse event.”

Are they?

Unfortunately, no.

Vaccine adverse events can be reported to VAERS online or using a downloadable form.
Vaccine adverse events can be reported to VAERS online or using a downloadable form.


While both doctors and parents can report these side effects, they don’t always get reported.

Underreporting of Side Effects to VAERS

Still, although reports to VAERS are underreported, they are almost certainly not underreported by as much as some folks believe.

Have you heard the claim that only 1% of serious vaccine reactions are reported to VAERS?

That’s not true.

That claim is based on an old study about drug reactions and was not specific to vaccines.

We also know that underreporting is less common for more severe adverse reactions than for those that are more mild. For example, one study found that up to 68% of cases of vaccine-associated poliomyelitis (a table injury) were reported to VAERS, while less than 1% of episodes of rash following the MMR vaccine were reported.

That’s not to say that only severe or serious adverse reactions should be reported.

But since VAERS watches “for unexpected or unusual patterns in adverse event reports,” it still works even if each and every side effect isn’t reported.


Reports to VAERS are underreported.

VAERS still works well though.

Again, that’s because VAERS doesn’t need each and every adverse event to be reported for the system to work and to help it identify vaccines that might not be safe.

“Despite its limitations, VAERS effectively detected a possible problem soon after introduction of RRV-TV in the United States.”

Lynn R. Zanardi, et al on Intussusception Among Recipients of Rotavirus Vaccine: Reports to the Vaccine Adverse Event Reporting System

We saw that with the RotaShield vaccine. After nearly 20 years of research, the first rotavirus vaccine was approved by the FDA on August 31, 1998. About seven months later, in March 1999, the ACIP published their formal recommendations that all infants get RotaShield on a three dose schedule, when they are two, four, and six months old.

By June 11, 1999, VAERS had received 12 reports of intussusception related to the RotaShield vaccine and by July 13, its use was temporarily suspended, as the CDC continued to investigate.

Once the CDC announced the temporary suspension, even more reports of intussusception after RotaShield were made to VAERS. Those extra reports likely mean that intussusception was being underreported initially, but it still triggered the temporary suspension and extra studies that eventually got the manufacturer to withdraw the vaccine.

“VAERS is used to detect possible safety problems – called “signals” – that may be related to vaccination. If a vaccine safety signal is identified through VAERS, scientists may conduct further studies to find out if the signal represents an actual risk.”

CDC on How VAERS is Used

Early signals in VAERS also helped detect a very small increase in the risk of febrile seizures among toddlers who got the 2010-11 flu vaccine combined with either Prevnar or a DTaP vaccine.

Also keep in mind that VAERS isn’t the only system that helps to monitor vaccine safety. We also have the Vaccine Safety Datalink project, the Clinical Immunization Safety Assessment Network, and the Vaccine Analytic Unit.

What to Know About Underreporting of Side Effects to VAERS

Even though underreporting of side effects to VAERS is an issue, because VAERS works by looking at early signals and trends, it still works well to identify possible safety problems from vaccines.

More About Underreporting of Side Effects to VAERS

Discontinued Vaccines

The Tripedia DTaP vaccine was discontinued in 2013.

Most people know that the RotaShield rotavirus vaccine was discontinued in 1999 because it was found to be linked to intussusception.

It took eight years for a new rotavirus vaccine to be licensed.

Lymerix, a Lyme disease vaccine was discontinued in 2002. Unfortunately, we still don’t have a new replacement Lyme disease vaccine.

Vaccines That Have Been Discontinued

More commonly, a vaccine gets discontinued with little notice, as there are other options to keep kids vaccinated and protected.

Other vaccines that are no longer made, include:

  • Menomume – an older meningococcal polysaccharide vaccine was discontinued in 2017 in the US as it was replaced with the newer meningococcal conjugate vaccines Menactra and Menveo.
  • MenHibrix – a meningococcal – Hib combination vaccine that was discontinued in the US in 2016 due to low demand
  • Cervarix – an HPV vaccine that was discontinued in the US in 2016 due to low demand
  • Comvax –  a Hib/Hepatitis B combination – discontinued in 2014
  • Tetanus toxoid – discontinued 2013
  • Tripedia – a DTaP vaccine – discontinued 2011
  • TriHIBit – a DTaP/Hib combination
  • JE-VAX – discontinued 2005
  • Attenuvax – measles vaccine
  • Mumpsvax – mumps vaccine
  • Meruvax II – rubella vaccine
  • M-R-Vax – measles and rubella combo
  • M-M-Vax – measles and mumps combo
  • Biavax II – rubella and mumps combo
  • Heptavax-B – the original hepatitis B vaccine
  • HIB-Vax – the original Hib vaccine
  • Plague vaccine
  • Poliovax
  • Dryvax – smallpox vaccine
  • Measles-Smallpox combination vaccine
  • Diptussis – a diphtheria/pertussis combination (1949-55)
  • Quadrigen – a DTP/Polio combination (1959-68)
  • Streptococcus vaccine (1952-88)
  • Serobacterin – a pertussis vaccine (1945-54)
  • Rocky mountain spotted fever vaccine (1942-78)
  • Typhus vaccine (1941-79)
  • smallpox vaccine (1917-1976)

Most of these vaccines were discontinued because they simply became obsolete.

Orig. Title: SPvac806.8a
A smallpox vaccination kit included the diluent, a vial of Dryvax smallpox vaccine, and a bifurcated needle.

The Hib-Vax and Heptavax-B vaccines, for example, both use older technology, so these vaccines were discontinued when newer Hib and hepatitis B vaccines were introduced.

And some vaccines are discontinued  or are phased out when they get an update:

  • MMR -> MMR-II (1978)
  • Prevnar 7 -> Prevnar 13 (2010)
  • Gardasil -> Gardasil 9 (2014)

Still other vaccines, like Tripedia and TriHIBit, seemed to get discontinued as a business decision. Through mergers, Sanofi Pasteur, Ltd. ended up with two DTaP vaccines. They had their own Daptacel, but also had Tripedia, a vaccine they acquired from Pasteur Merieux. They ended up discontinuing Tripedia.

Merck also stopped making Comvax not because of “any  product safety or manufacturing issues,” but rather “as part of its ongoing effort to focus company resources on opportunities that provide the greatest value for customers, patients, and public health…”

Cervarix was discontinued because of low market demand. The competing HPV vaccine, Gardasil, had the much larger market share.

Vaccine Manufacturers and Discontinued Vaccines

And of course, some vaccine manufacturers simply stopped making vaccines.

The Texas Department of Health Resources once had a license to make vaccines, including DTP, diphtheria, DT, pertussis, tetanus, Td, and typhoid vaccines since 1950. They completely exited the vaccine market in 1979.

In the 1970s and 80s, dozens of vaccines were discontinued as Miles Inc., Eli Lilly, Parke Davis, and other companies stopped making vaccines.

While that is often downplayed these days, it is important to realize that we used to have much more competition among vaccine manufacturers. For example, in the early 1970s, the DTP vaccine was made by at least 11 different companies! We now have just two that make DTaP. And in many other cases, like for Prevnar, MMR-II, polio, and the chicken pox vaccine, there is just one manufacturer.

For More Information on Discontinued Vaccines:

Updated on February 7, 2018