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DTP Vaccine Shortage Continued first three doses of DTP vaccine provide protection against pertussis in 70%-90% of recipients and immunity to diphtheria and tetanus in over 90% of recipients (2-4). The doses given at 18 months and at 4-6 years of age enhance protection through the preschool and early school years, respectively.

Taking all these factors into account, interim postponement of the doses of DTP vaccine given at 18 months and at 4-6 years of age could achieve substantial savings in the rate of DTP vaccine use, while still protecting those at greatest risk of these diseases. To have enough vaccine to provide initial protection to all young infants until larger quantities of DTP vaccine are again available, it will be necessary to begin this approach immediately.

After consultation with members of the Immunization Practices Advisory Committee and the Committee on Infectious Diseases of the American Academy of Pediatrics, the following interim recommendations are made: 1. Effective immediately, all health-care providers should postpone administration of the

DTP vaccine doses usually given at 18 months and 4-6 years of age (fourth and fifth

doses) until greater supplies are available. 2. When adequate DTP vaccine becomes available, steps should be taken to recall all

children under 7 years of age who miss these doses for remedial immunization. If these recommendations are followed by all providers of DTP vaccine throughout this temporary vaccine shortage, immunity in infants will be maintained at the best possible levels. Public health-care providers and professional organizations throughout the United States have been notified and are being urged to follow these recommendations. Reported by U.S. Public Health Service Interagency Group to Monitor Vaccine Development, Production, and Usage. References 1. ACIP. Diphtheria, tetanus, and pertussis guidelines for vaccine prophylaxis and other preventive mea

sures. MMWR 1981;30:392-96, 401-7; 1981;420. 2. CDC. Pertussis – United States, 1982 and 1983. MMWR 1984;33:573-5. 3. Brown GC, Volk VK, Gottshall RY, Kendrick PL, Anderson HD. Responses of infants to DTP-P vaccine

used in nine injection schedules. Public Health Rep 1964;79:585-602. 4. Orenstein WA, Weisfeld JS, Halsey NA. Diphtheria and tetanus toxoids and pertussis vaccine, com

bined. In: Recent advances in immunization: a bibliographic review. Washington, D.C.: Pan American Health Organization, 1983:30-51. (Scientific publication no. 451).

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December 21, 1984 / Vol. 33 / No. 50
697 Toy Safety United States, 1983

RS 699 Temporal Patterns of Motor Vehicle

Related Fatalities Associated with
Young Drinking Drivers – United
States, 1983

702 Measles – Hawaii
711 Influenza Activity – United States
712 Availability of MMWR Supplement Dec
712 Combined Issues of MMWR






Current Trends

The University

of Michigan Public Health


Toy Safety – United States, 1983

The U.S. Consumer Product Safety Commission (CPSC) estimated that, in 1983,594,100 toy-related injuries to children under 15 years of age were treated in U.S. hospital emergency rooms (Table 1); 16 children died (Table 2). Most injuries occurred from impacts with toys (falling on, tripping over, or hit by). Choking from ingestion of small toys or parts of toys was the second most frequently reported incident. Half the deaths involved children who choked on balloons, rode tricycles into pools, or were struck by motor vehicles while riding tricycles.

These incidents often involved children who may have been too young to use the toys, such as balloons, crayons, marbles, small building toy pieces, and stuffed crib toys-as they were intended. Parts of the toys were ingested, or pieces were broken or bitten off and put into the nose, ear, or mouth. Small riding toys and rocking horses were involved in tip-over and falling incidents and sometimes resulted in head/face injuries to children in the 1-year age group. Toys with cords, including play phones that entangled some very young children, kites with metallic twine that contacted power lines and caused electrocution or burns, and electric or battery-powered toys that overheated, melted, and resulted in fires caused other toyrelated injuries in 1983. Editorial Note: CPSC has mandatory safety standards for electric toys, bicycles, pacifiers, and infant rattles, toys with sharp points and edges, lead paint in toys, and small parts in toys. Approximately 150,000 different toys are on the market, and toy manufacturers are responsibile for assuring that products meet these standards. Many manufacturers have extensive testing programs. Although CPSC does some testing to check for compliance and to follow up on consumer complaints, it does not approve or endorse toys for safety.

During 1983, CPSC investigated consumer and trade complaints and reports of injuries and deaths by conducting inspections of toy manufacturers, importers, and distributors and

TABLE 1. Estimated injuries among children under 15 years old treated in hospital emergency rooms United States, 1983

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Toy Safety Continued by collecting samples of suspected unsafe toys. CPSC determines the appropriate corrective action based on the severity of the hazard presented by the subject toy, which may include: correcting the violation in future production, ceasing distribution, recalling from retail stores, and recalling from consumers.

Approximately 39 toys and 11 other children's articles were recalled between October 1, 1983, and September 30, 1984. Several infant rattles were recalled because they presented a choking hazard. Manufacturers are responsible for notifying retailers when a product is recalled and should be removed from shelves; banned or recalled toys are removed from shelves.

The Toy Manufacturers of America (TMA) has a Voluntary Product Standard that establishes safety requirements and tests. This standard is currently being revised to cover additional safety requirements. Manufacturers have extensive testing programs, both to assure compliance with federal and voluntary standards and to conduct actual “play testing" of toys by children.

CPSC and TMA recommend the following guidelines for selecting and using safe toys: 1. Toys should be selected to suit the age, skills, abilities, and interests of the individual

child. There are age recommendations on many toy packages, which sometimes reflect

safety concerns, in addition to aiding in selection of stimulating, educational toys. 2. If supervision is required, “ground rules" for play should be set. 3. Instructions should be clear to parents and, when appropriate, to the child. 4. Toys should be sturdily constructed. Soft toys for young children should be well made,

with eyes, noses, and other small parts tightly secured. 5. For infants and toddlers, small parts that children can put in their mouths and long

strings or cords that can cause strangulation should be avoided. 6. Toys that shoot or propel objects that can injure eyes or become lodged in the throat

should be avoided. 7. Arrows or darts should have soft cork tips, rubber suction cups, or other protective

tips. Tips should be securely attached to their shafts and should be examined periodi

cally to ensure the protective tips remain secured. 8. Electric toys with heating elements are recommended only for children over 8 years of

age and only with adult supervision. 9. The surroundings in which toys will be used should be considered, as should sufficiency

of toy storage and play space, and whether young children will be exposed to toys de

signed for older children. CPSC has a toll-free telephone number ([800) 638-2772) that consumers and others can call to ask questions, request information, or file complaints. Reported by U.S. Consumer Product Safety Commission, Washington, D.C. TABLE 2. Reported fatalities associated with toys and other children's products United States, 1983


No. fatalities

Nature of injury leading to death


Hit by auto (1); rode into pool spa (2)

Small toy (soldier)
Small part (knob on

child's jewelry box)
Building toy piece
Toy whip
Doll-making kit
Unnamed toy
Beach ball
Toy chest (homemade)

1 1 1 1 1 1 1

Hanging from tree
Plastic face over child's mouth
Struck head falling
Drowned while playing
Neck compression

Temporal Patterns of Motor Vehicle-Related Fatalities
Associated with Young Drinking Drivers – United States, 1983

Analysis of data from the Fatal Accident Reporting System (FARS) reveals that there were 37,971 reported fatal motor-vehicle incidents in 1983, resulting in 42,584 fatalities. Alcohol was an important contributing factor in 17,847 (42%) of these deaths. Of the 54,649 drivers involved in these incidents, 16,483 (30%) had positive blood-alcohol concentration test results or were judged by the investigating officers to be alcohol-involved. Thirty-three percent (17,764) of all drivers in fatal motor-vehicle incidents were between the ages of 16 years and 24 years. Thirty-eight percent (6,833) of the drivers from this age group were alcoholinvolved, compared to 26% for all other ages. In 1983, incidents involving young drinking drivers claimed 7,784 lives, of which 3,992 (51%) were the young drivers themselves."

Several studies have indicated that motor-vehicle-associated deaths involving young drinking drivers are not uniformly distributed temporally (2-4). For example, more fatalities occur during nighttime rather than daytime and on weekends rather than weekdays. Analysis of 1983 FARS data for youth-related alcohol-involved fatalities supports and expands these findings. Temporal patterns of fatalities were investigated by quarter, month, day of week and time of day, and holiday period. Examination of the frequency of fatalities by quarter shows that the third quarter (July-September) accounts for the largest proportion of fatalities, followed by the second, fourth, and first quarters (Table 3).

An examination of monthly totals for alcohol-involved young driver-related fatalities reveals a more detailed picture of the quarterly pattern. January has the fewest fatalities for the

"There are several limitations related to these findings. One is that blood-alcohol information is available for fewer than half the drivers reported in the FARS (1); also, these data do not allow consideration of other risk factors, such as miles driven by young drivers, compared with other drivers, or average number of occupants per car, by driver age.

TABLE 3. Motor-vehicle-related fatalities associated with young drinking drivers, by quarter and month United States, 1983

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Motor Vehicle-Related Fatalities - Continued year. From January through May, the frequency of fatalities rises steadily, followed by a slight drop in June. Fatalities peak in July and August, then decline from September through December.

Temporal patterns of fatalities associated with young drinking drivers also vary depending on the day of the week and the time of day of the incident (Figure 1). Approximately 67% of all such deaths occur on Friday, Saturday, or Sunday. Seventy percent of all such deaths occur between 8 p.m. and 4 a.m. When these two factors are considered simultaneously, 48% of all such deaths occur between 8 p.m. and 4 a.m. on the weekend.

The number of persons killed in motor-vehicle incidents involving young drinking drivers for the major holiday periods (5,6), Memorial Day, Independence Day, and Labor Day accounts for 65% of all holiday fatalities (Figure 2). The numbers of fatalities for these holidays were greater than those for similar quarterly nonholiday days of the week and times of day. ! while fewer young drinking driver-related fatalities occurred for the New Year's, Thanksgiving, and Christmas holiday periods. Reported by I Zobeck, PhD, MB Grigson, Alcohol Epidemiologic Data System, CSR, Incorporated, ul Noble, H Malin, MA, Div of Biometry and Epidemiology, National Institute on Alcohol Abuse and Alcoholism, Washington, DC; Epidemiologic Studies Br, Div of Surveillance and Epidemiologic Studies, Epidemiology Program Office, Special Studies Br, Chronic Diseases Div, Center for Environmental Health, CDC. Editorial Note: Many fatal motor-vehicle-related injuries are associated with young drivers, particularly those who are alcohol-involved. Nonetheless, although alcohol use is clearly a risk factor for fatal vehicular injuries among young persons, the increased risk of incurring such injuries when drinking is not limited to young drivers.

The prevention of alcohol-associated motor-vehicle deaths and injuries has been a subject of scientific scrutiny (7). Research indicates that drunk-driving laws can have an effect in reducing fatality rates only when there is sustained public perception of a significant possibili

FIGURE 1. Temporal patterns of fatalities associated with young drinking drivers, by day of week and time of day United States, 1983

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