Flu vaccine lag may hit those at high risk

Physicians should be aware that expected slowdowns in influenza vaccine production require advance planning to aid weak or elderly patients.

By Stephanie Stapleton, amednews staff. Aug. 14, 2000.

It might still be summer, but public health officials are thinking seriously about flu season -- and there appears to be reason for concern.

Influenza vaccine manufacturers have advised the Centers for Disease Control and Prevention and the Food and Drug Administration to expect potential delays and reductions in the amount of flu vaccine available for the 2000-01 season.

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This news comes just as health plans, clinics and physician offices are planning annual vaccine outreach efforts. Therefore, the two agencies, in conjunction with the federal Advisory Committee on Immunization Practices, have issued recommendations on how to handle this development.

For physicians, the message now is that there should be enough vaccine available to immunize those patients at highest risk of suffering serious complications, such as the elderly and those who are immunosuppressed.

"We want to alert [doctors] to focus on high risk," said Tim Uyeki, MD, MPH, a epidemiologist in the CDC's influenza branch. "There's no change in how one goes about vaccinating these people. It should be routine."

But the CDC and FDA also are advising health professionals planning flu vaccine campaigns to begin factoring in the possibility of delays and shortfalls. "Everyone who is planning a vaccine campaign needs to replan it and postpone it," said William Schaffner, MD, a professor of preventive medicine and infectious diseases at the Vanderbilt University School of Medicine, Nashville. "The replanning process should begin immediately."

Specific plans necessary

Overall, vaccine production takes six to eight months. The influenza vaccine now being made contains the strains designated A/Panama, A/New Caledonia and B/Yamanashi. According to the CDC's Morbidity and Mortality Weekly Report, vaccine manufacturers are reporting lower-than-expected production yields for the A/Panama vaccine component, one of two new strains included in the trivalent inactivated influenza vaccine.

"This is the limiting factor," said Dr. Uyeki. The exact impact -- potential delays of four weeks in receiving vaccine shipments or the possibility of receiving only partial shipments or none at all -- will become clearer by late August or early September. But public health experts say the situation already has raised tough questions about how to maximize protection against the flu in the wake of these difficulties. A series of recommendations were outlined in the CDC's July 14 MMWR.

First, implementation of organized flu vaccination campaigns should be delayed until early to mid-November. CDC experts point out that vaccine provided after mid-November will still be protective during the 2000-01 flu season. "That is something that a lot of physicians probably don't realize," Dr. Uyeki said.

In addition, CDC officials underscore that the vaccination of high-risk patients should proceed routinely during regular health care visits. "Health care workers who have close contact with high-risk patients should also be vaccinated -- that includes physicians," Dr. Uyeki said.

Initially, ACIP had broadened its recommendations this year to include vaccinating all people between the ages of 50 and 64, rather than focusing only on those 65 and older. In the context of a possible shortage, the MMWR report indicated that it again would be appropriate to focus primarily on vaccinating those in the 50-to-64 age group who are at high risk.

"We're not saying at this point, 'Don't vaccinate completely well people,' " Dr. Uyeki said. Physicians should not shy away from routine vaccinations during office visits once the vaccine is available. But it will be especially important that those who are at high risk do not fall through the cracks.

Among the worst-case scenarios public health officials are trying to avoid, Dr. Uyeki said, is that fewer high-risk individuals would be vaccinated. Between 20,000 and 40,000 deaths are attributed to flu and flu-related complications in the United States each year. More than 90% of the deaths occur in people age 65 and older.