U.S. Moves to Manage Remaining Flu Shot Supplies

Two vaccine makers say they're out as demand rises

SATURDAY, Dec. 6, 2003 (HealthDayNews) -- With word that the two makers of flu vaccine have run out of supplies amid heavy demand sparked by an early outbreak of the disease, U.S. health officials are trying to determine whether there is enough vaccine left to immunize people who still want shots.

Doctors are also asking healthy people to skip inoculations in favor of a nasal-spray version of the vaccine, saving the traditional flu shot for children and the elderly, who are more susceptible to the illness.

The spray, called FluMist, is manufactured by MedImmune Vaccines, which made between 4 million and 5 million doses this year. Spokeswoman Jamie Lacey told the Associated Press that the company had sold 400,000 doses as of mid-November, and "there is still a wide supply available."

FluMist, which received U.S. Food and Drug Administration approval earlier this year, is typically recommended for healthy people ages 5 to 49.

"If you're healthy, you have two options: Please take the option that the other folks can't have," said Dr. William Schaffner of the National Foundation for Infectious Diseases.

Federal health officials, meanwhile, report there is flu illness pretty much across the United States, which is a huge leap over this time last year.

Aventis Pasteur and Chiron Corp. said Friday that their flu shot supplies, which totaled more than 80 million doses, are exhausted. And they won't be able to make more before the season ends, they added.

However, the U.S. Centers for Disease Control and Prevention (CDC) said that, in a typical year, between 70 million and 75 million people get a flu shot, and that number has never exceeded 80 million. The agency added that the shortages of vaccine appear to be due to the flu season's jackrabbit start and a late surge in demand, and that it would work to make vaccine available.

According to the CDC, 48 states are currently reporting flu activity; only 21 were reporting activity this time last year. In 2001, about 25 states were reporting activity at this time, according to CDC spokeswoman Christine Pearson.

"In general, this year is more severe than the past three years," Pearson said. "Right now, 13 states are reporting widespread illness and 48 are reporting some flu activity in their area. It's quite widespread, and there are not many corners of the country that are not being affected right now."

Colorado, which has been hit hardest by the bug, has 6,306 confirmed cases of influenza and eight deaths, both higher than this time last year, said Lori Maldonado, a spokeswoman for the Colorado Department of Public Health and Environment.

That news has exacerbated the vaccine shortage, Aventis told the AP.

"Because of the recent outbreak, we've seen an unprecedented surge of vaccine orders late in the season," said Len Lavenda, an Aventis spokesman. "As a result, we have now shipped all our available supplies."

The companies said they cannot make more vaccine this year, because the process takes four months. By that time, the flu season will be over. Nevertheless, both companies said people may still be able to get shots, since suppliers have probably not distributed all they have.

"What we are telling people is there is still vaccine in the pipeline, although we are not sure how much," Lavenda told the AP. "People who want to get a flu shot this year should not wait any longer. They will have to be persistent."

Dr. Michael Decker, vice president for scientific and medical affairs of Aventis, agreed that persistence and fast action would probably pay off for those who still want a flu shot.

"I would suspect a person determined to get a flu shot will find it right now," he told The New York Times. "But it's probably a lot like shopping on Christmas Eve. You better move fast."

The CDC and medical groups have started surveying doctors and health departments to determine if -- and where -- vaccine shortages might be occurring. If there were a serious outbreak of flu in some areas of the country, while other areas had unused vaccine, the CDC would help to redistribute remaining stocks, the Times reported.

The federal government typically doesn't monitor how many doses have been given out or how many remain, the newspaper said.

Health experts said there are signs the flu has begun moving east, after an unusually early start in western states.

Dr. Andrew Campbell, director of pediatric infection control at Mount Sinai School of Medicine in New York City, said he is seeing more cases of flu this year than last.

And Dr. Marc Siegel, a clinical assistant professor of medicine at New York University School of Medicine in New York City, thinks the end of December is going to be peak flu season in New York, about a month earlier than usual.

Whether this signals an all-around bad flu season is unclear, and few will commit to forecasting the future. "You never can predict too accurately," Siegel said.

"It's particularly early this year," Campbell added. "We don't know if it's particularly bad."

Nevertheless, experts concede there are troubling signs.

"It was a bad year down in South America, which is a predictor here," Siegel said.

Also this year, the main strain is influenza A, which is worse than B. "This looks like an A year, and that tends to be more severe disease and more deaths," Siegel said.

Much has been made of the fact that one of the flu strains circulating this year, Fujian, is not included in the current vaccine. The CDC and others, however, believe the vaccine should ward off the infection because it's a closely related virus.

"The strain circulating and the vaccine are not an exact match; however, we do believe that the vaccine will provide some cross-protection," said the CDC's Pearson.

"It's not uncommon for there to be some shortages in a few specific locations," she added. "We're trying to work with states to learn more about their situation."

Aventis, the nation's largest supplier of flu vaccine, had said in a July statement that it started shipping supplies a month ahead of its delivery schedule.

"This year it appears that many more people than in recent years received a flu shot during October and November, and unlike other years, there is high interest in obtaining flu shots into December," Dr. Julie Gerberding, the CDC director, said in a statement released Friday. "CDC is doing everything possible to assess the availability of flu vaccine to identify any locations that have supplies that may be able to be made available to locations that need vaccine. Some states have plans in place to redistribute vaccine supplies should that be needed."

Since most vaccination programs are held in October and November, the agency said it's not unusual for vaccines to be limited around December. "People wishing to be vaccinated may need to be persistent," the CDC statement said.

Experts emphasize that getting vaccinated is still the best protection.

"It does look like a bad flu year, but any year is a bad year," Siegel said. "It's a bad bug. This may be a year where instead of 40,000 deaths we see 60,000 or 70,000. This is always a bad thing."

More information

The American Lung Association has an online flu shot locator while the CDC has all kinds of information on the flu, including how to tell the difference between colds and the flu.

SOURCES: Christine Pearson, spokeswoman, U.S. Centers for Disease Control and Prevention, Atlanta; Marc Siegel, M.D., clinical assistant professor, medicine, New York University School of Medicine, New York City; Andrew Campbell, M.D., assistant professor, pediatric infectious diseases, and director, pediatric infection control, Mount Sinai School of Medicine, New York City; Lori Maldonado, spokeswoman, Colorado Department of Public Health and Environment, Denver; U.S. Centers for Disease Control and Prevention, Aventis Pasteur statements
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